When I first heard the words “online therapy,” I immediately thought of Lisa Kudrow’s character in the Showtime series Web Therapy. In the series, Kudrow plays Dr. Fiona Wallice, who starts an online therapy practice via Skype. She believes three minutes of therapy via webcam is better than 50 minutes of people “rambling on about dreams and feelings” in an office setting. It’s a comedy, mind you, and part of what makes it so funny is that it’s so, so wrong.
Today, online therapy—which falls under the so-called “telehealth” umbrella and is sometimes referred to as distance therapy—is exploding, and it’s very different from the way it’s portrayed on television.
There are pros and cons for both clinicians and people seeking help. From a therapist’s perspective, depending on your age and technical know-how, the idea of having a therapy session online might be daunting or perhaps even unthinkable. As a therapist in the 40-and-over crowd, I found it a bit intimidating in the beginning. After all, it requires a working knowledge of technology as well as an innovative spirit open to thinking outside the box.
As for the people I work with in therapy, those under age 30 seem to have no problem jumping online for a session. Of course, access to a computer and internet connection in a private setting is essential, and not everyone can make this happen.
For people who experience agoraphobia, travel often for work, have a chronic illness, or live in areas where pursuing therapy in person is impossible, online counseling can be a solution. As a therapist who works mainly with families affected by autism spectrum issues, I’ve found it is an easy way for people to get the help they need while they stay close by for whomever is watching their children. In fact, a recent study by Michigan State University found that parents of children with autism who conducted therapist-guided behavior and social interventions online experienced better results than those who conducted the interventions without a therapist’s help via video conferencing.
What to Ask a Therapist Before Starting Online Counseling
Many people don’t know what to look for in a therapist in general, and the online component adds a few more things the be aware of.
Skype is not an appropriate platform for therapy as it does not allow the therapist to be compliant with the Health Insurance Portability and Accountability Act (HIPAA).
1. What platform do they use?
Skype is not an appropriate platform for therapy as it does not allow the therapist to be compliant with the Health Insurance Portability and Accountability Act (HIPAA). Several other online platforms do allow for compliance and are just as convenient. If an online therapy platform is HIPAA compliant, it should say so on its website or promotional materials. It may not seem like a big deal, but your health information, including what you talk about in therapy sessions, is confidential. While it’s the therapist’s job to ensure it stays that way, some may not be aware that Skype is not a secure option.
2. What should you do in case of emergency?
Online therapy may not be the best form of treatment for people experiencing certain mental health conditions or emotional states requiring crisis intervention. Be sure to discuss what type of treatment is best for you and your particular diagnosis or treatment goals. Your therapist will need an emergency contact for you as well as knowledge of where your nearest hospital is; this information is typically gathered as part of any intake.
3. How can you reconnect if the connection is poor or dropped?
I once was in the middle of a session when the connection failed. It happens. If you don’t have a plan, you’ll both be trying to call/reconnect, and this can take time away from your session. My plan is that I will call the person back—either by reconnecting the call online or by telephone. It’s a real bummer when you’re in the middle of pouring your heart out to your therapist only to have the connection cut and then have to switch gears into problem-solving mode.
Considerations for Therapists
- Where is the therapy considered to take place when online? In the U.S., psychotherapists are licensed by state. Since this method of therapy delivery is relatively new, some states have enacted (or are actively enacting) laws and rules regarding who can practice it, while others have done nothing. Why is this important? Online therapy is considered to happen where the person in therapy is when the session takes place. When I learned this, it was a game-changer. When I began looking up different states to find out where I could “see” people online, it became so daunting I simply decided to mainly see people in my state of Florida. On some occasions I’ve seen people who went off to college, but I made sure to check the telehealth laws in that state.
- Beware of companies that promise “anonymous online therapy” but don’t protect the person in therapy or the clinician. There are a few companies out there that promise effective online therapy via email, text, or video chat, and even let you stay “anonymous,” but have no training or protection for the therapist or the person in therapy. I signed up with one early in my career and quickly realized the administrators could not answer basic questions about who I could see and who I could not, what needed to be done in case of emergency, and more. I was told it was up to me to understand the laws under which I practiced and they could not be held liable. I could not in good conscience work with such a company, and urge caution for both therapists and people who might try these services.
Whether you’re considering online treatment or you’re a clinician exploring the possibility, do your homework. There are some great places to find therapists who do online therapy, as well as resources for therapists to receive further training in this area.
Ingersoll, B, & Henion, A. (2016, May 24). Can Telehealth Fill Gap in Autism Services? MSU Today. Retrieved from http://msutoday.msu.edu/news/2016/can-telehealth-fill-gap-in-autism-services/?utm_campaign=media-pitch
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