Thinking about teletherapy?

A friend recently received marketing info from a particular video conferencing company, and was thinking through the pros and cons of offering video based therapy in her psychotherapy practice.  She asked me for a few quick thoughts about teletherapy, and I thought I’d share with you what I came up with.  It’s definitely not a comprehensive assessment… just a few of the highlights to consider, but worth a read if you’re thinking about teletherapy yourself.

Regarding HIPAA compliance and video therapy–
  • Don’t use Skype.  There are HIPAA compliant video conferencing systems, but Skype specifically isn’t one.
  • A service that you use to do teletherapy must, at a minimum, must sign a BAA with you.
  • Beyond the BAA–the video conferencing service must meet HIPAA-specific privacy, security, training and documentation standards.
There are a lot of other considerations for those who want to offer this service–legal, technical, and clinical considerations.
    Clinically–Video conferencing can be great for some clients (i.e. clients with mobility challenges, clients in isolated locations without a specialist in their needed area nearby, or situations where one family member can’t be physically present) but the video medium changes both the connection and relationship.  The clinician will have to develop skill  & awareness in this area.  One minor example: what angle do you have the camera set up at–above/below your head may send a nonverbal that you don’t mean to send, etc.
    Legally–among many many other considerations: most states have laws requiring that therapists providing services to residents of that state (or in some cases, even temporary visitors) be licensed in the state.   Teletherapy across states lines brings a hornets’ nest of legal issues.  (*)
     Technically–need to have fast and reliable internet connection, and so will your clients.  Therapist and client both need to have hardware that is able to support the system and video streaming, etc.  The therapist may need to have enough technical skill to be able to trouble-shoot with clients when THEY have tech problems.
     I think it’s also worth mentioning that there are some lovely business perks for therapists who can make video therapy work.  You can market your specialty practice to a far larger area than your immediate geographic area, for one.  But if you are considering it, make sure you consult with experts that can guide you through some of the potentially sticky legal and technical issues, it’s worth it to protect yourself, your practice, and your clients.
 (*) In Texas, it’s worth mentioning that the LPC board is currently considering proposed rules that would require a face-to-face visit prior to beginning remote services.