Teletherapy Hub: A Guide to Virtual Therapy Appointments

Health technology has evolved such that proficient providers can offer greater access to clinical care without compromising the quality of that care. Still, it can be intimidating to navigate this technology as a client. Maybe the concept is new, or you aren’t enthusiastic about tech in general. Or maybe you’re very tech-savvy and wary about keeping our communications private and secure. Either way, it’s normal to feel a bit anxious or wonder how this technology can work for you.

While many therapists were pushed to virtualize by the COVID-19 pandemic in 2020, I’ve been an avid teletherapy practitioner since 2017. I have received training around telehealth-specific ethical and legal issues, safety concerns, privacy protections, HIPAA security compliance, and more. There are extra considerations that are not present in ‘traditional’ office-based sessions. As such, I created this hub to help anyone wishing to self-educate before committing to virtual sessions. To learn exactly how I use telemental health tools in my practice, read on!

What is teletherapy?

Teletherapy can go by many different names — “telehealth,” “telemental health,” “telebehavioral health,” “telemedicine,” and “distance counseling” to name a few. As a licensed mental health counselor, I abide by this definition from the American Counseling Association (September 2020):

“Telebehavioral health, or distance counseling, is the use of a digital platform that provides secure, encrypted, audio-video conferencing to communicate with a client in real time.  This does not include nonsynchronous (not real time) texts, calls, digital chats, emails to and from counselors and their clients.”

In other words, teletherapy can be thought of as just one of many formats or settings in which clients can attend therapy. This really has nothing to do with a therapist’s theoretical orientation or other therapeutic tools that might be used in sessions. In fact, the content of a virtual session is often the same as an office-based session, aside from a few additional considerations related to patient privacy and technology usage that I’ll describe below.

What does teletherapy look like in my practice?

The passage of the Health Insurance Portability and Accountability Act (HIPAA) in 1996 set the standard for best practices by healthcare organizations to safeguard patient data. When these standards are met, healthcare technology is said to be “HIPAA-secure” and healthcare providers “HIPAA-compliant.”

In my practice, I use only HIPAA-secure phone and video platforms that allow for encrypted real-time communications between clients and myself. My internet connection provides for 1Gbps usage speeds to ensure high-quality video calls, comparable to a “5G” cellular signal. All sessions are conducted from my home office to ensure consistent privacy and security on my end.

• Video sessions: Zoom for Healthcare with BAA.
  You will need access to a Zoom account and platform, which you can create, download, and use free of charge on Zoom’s website. Prior to your appointment, you will received a detailed email from me containing my private waiting room information, which is password protected for security. Make sure you have downloaded the platform in advance, and that you sign in using your full name. I’ll invite you from the virtual waiting room into your video call when it’s time for your session. Client names are only visible to me, and clients in the virtual waiting room cannot ‘jump onto’ or interrupt another client’s ongoing video call, thus ensuring all clients’ privacy on the platform. This also means you are free to sign in early to troubleshoot or run pre-call diagnostics as needed.

• Phone sessions: GoogleVoice with BAA.
  No need to download anything, create a new account, or even ‘sign in’ — simply let me know your preferred phone number, and I’ll initiate the phone call when it’s time for your session. My phone system will forward all incoming calls to voicemail so as not to disrupt phone sessions that may be ongoing. You will not be able to reach me directly by dialing my number, but in return you will have my full attention, and your phone session will never be interrupted.

OTHER SECURITY NOTES:

• Many common, popular, or free editions of video platforms are NOT HIPAA-secure. This includes FaceTime, GoogleMeet, Skype, Facebook, and LINE. I am NOT able to use such platforms for video sessions.

• I maintain 3 other HIPAA-secure video platforms as ‘backups’ for Zoom. These are web-based and do not require any download or account creation. In the event that Zoom is inaccessible for an extended period due to technical issues with their platform, I will email further instructions to impacted clients directly. Again, you will NOT need to download anything or create a separate account to use these backup platforms. (You may also request to meet by phone rather than video for any appointment other than your initial intake, if that’s easier.)

• For security reasons I do NOT encourage texting for clinical purposes, and I do NOT respond to text-based messages that contain clinical content. These are not considered teletherapy interactions. Likewise, please default to email for administrative issues, but refrain from sending clinical information or updates; email can be hacked or compromised en route to me without additional encryptions from both of our ends.

• To the best of my knowledge, I have not opted-in to AI technology or data collection on any platform utilized by my practice (including Zoom’s AI Companion), nor do I utilize any AI-assisted technology in any area of practice administration.

Of course, none of these guarantee privacy at the client’s end of the phone or video call. That depends on your environment, the technology you are using, and the security of your devices and connection. Below, I’ll share some more ways you can think about and address those concerns preemptively.

What considerations should clients keep in mind?

SECURING A CONFIDENTIAL SPACE

• Do you have a private space?

  • Can you lock your door? If not, will others respect your privacy and avoid entering your space during appointment times? Is it safe to have a conversation with them about this?

  • Can others outside of your space hear you talking? If so, are you able to create background noise or white noise (such as with a fan, possibly placed right outside your door)? Can you use headphones/earbuds to keep our voices from being overheard?

• If you don’t have a private room to spare, are there any makeshift options available? Some ideas include: walk-in closet, laundry room, basement, attic, or even a car (parked in a private and SAFE spot, of course).

YOUR TECHNICAL SETUP

• Do you have a laptop/desktop with functional webcam and microphone? This is ideal. Bigger screen sizes help increase overall comfort and reduce eye strain during video calls.

• Do you have a tablet/smartphone with functional webcam and microphone? You’ll want to prop up your device in a way that is stable, secure, and comfortable for the duration of your 45-minute appointment.

• Make sure your webcam is as close to eye-level as possible. You may need to rest your device/monitor on other items such as books or boxes. This will allow us to interact in a more organic way.

• Lighting is important — I prefer to see your face when we speak by video! You can help with this by adjusting your seat so you are not back-lit by a window or other light source directly behind you. Soft, ambient lighting is best.

YOUR INTERNET CONNECTIVITY

• Move your device as close to the router as possible when using WiFi.

• Close all programs/apps that are not necessary for your appointment, as these use the same internet connection and can interfere with video/audio quality during your appointment.

• Better yet, do a fresh restart of your device.

• If you’d like even more detailed troubleshooting tips, PersonCenteredTech provides a helpful reference guide here.

STILL HAVE QUESTIONS?

The US Department of Health & Human Services has made some more detailed privacy and security recommendations here.

Additionally, you may request an exploratory 10-minute phone consultation by clicking on the button below!