When I began treating people over 25 years ago, never in my wildest dreams did I think the process of therapy would evolve as it has. I firmly believe the relationship/process between person in therapy and therapist is the most important element of therapy. In reflection of this belief, I’ve always made a conscious decision to create a safe place, both environmentally and emotionally, within my office to facilitate the closeness, trust, and vulnerability that leads to the cultivation of creativity, change, and growth.
Within the last 10 years, life’s circumstances have led me to move four times. With each move came a painful goodbye process to those I had been working with, developing the therapy relationship with new people in a new place, and then, unfortunately, the goodbye process again.
Several years ago, I began exploring the possibility of continuing to work with the people I was treating—virtually. As I explored this possibility, I discovered it was in fact a trend in the industry, one growing faster than I had imagined.
I had many questions, primarily around ethics and privacy concerns. But I did my research and learned how I could ensure these concerns were dealt with legally and ethically for the states in which I am licensed to practice therapy.
What to Consider When Considering ‘Virtual Therapy’
Video therapy, also known as online or distance therapy, has become a viable alternative for anyone with a computer, tablet, or iPhone. Just as physicians began to do with patients in the medical community, more and more therapists now practice distance therapy, treating people seeking help in areas where mental health professionals are scarce. With increased availability and ease of use, the internet now may be a go-to method of receiving therapy for a person who travels with work, has a schedule that makes it difficult or impossible to visit an actual office, and/or may be fearful of facing a therapist in person.
Here are some common questions people may ask when beginning the search for a therapist who provides distance counseling.
1. Where do I start?
At risk of sounding too obvious, I say, “Online, of course.” You can begin your search for a distance counselor at GoodTherapy.org. Many therapists who list with GoodTherapy.org offer distance therapy, and this will be noted in the therapist’s profile, along with types of therapy practiced and their specific approach to treatment. You can also look into websites specifically created to help people find online behavioral health care. A simple Google search will yield many options (and you may wish to compare ratings and customer feedback before settling on any one service or provider). Any of these sites will display therapist profiles and information about their therapy orientation and modalities offered, fees, and time availability.
In terms of confidentiality and privacy, it is important to look at practitioners who use encrypted video software. You may need to download the software they are using. This is typically an easy step, but it is an important one. Skype and FaceTime may seem like obvious, easy choices for video software, but they may not meet the HIPAA standards of privacy in your state and may not meet you or your therapist’s privacy and confidentiality standards.
State licensing boards also require therapists to have a license for the state in which you reside, so you might wish to check this as well. If you are using insurance, it’s a good idea to first check with your provider to make sure they cover video therapy. I’ve seen a wide range of fee structures, mainly based on geographic areas and the experience and expertise of the practitioner.
2. Can I still have a ‘total’ therapy experience?
Yes and no. The experience can be as fulfilling as sitting in an office, but it will be a different experience. To make the process positive, you might wish to approach it the same way as if you were about to visit the therapist in an office. Make sure you have a private space and that you will be not be interrupted while in the video session. Turn off your phone, television, and music. Make sure pets and children are safe in another room. Consider other things that might distract you during an office visit, and clear these from the space you’ll be using for your appointment. The therapist you will be working with should be doing the same.
Because you can only see what’s in the camera frame, just as the therapist can only see what’s in your frame, there is a measure of trust and professionalism that is necessary.
3. Privacy and housekeeping concerns
Your therapist may initially need to verify your identity in order to address imposter concerns. They might ask to see some form of photo identification. You must also give consent for treatment and may need to complete other forms to complete, based on your provider’s requirements and laws of the state(s) in which both of you reside.
As a seasoned mental health care provider, I was skeptical of video therapy at first. Now that I have engaged in the process for several years, I’ve had a change of heart.
Most practitioners will also begin with a conversation about what to do in case of a technical failure and discuss alternative modes of communication. They may outline a procedure for contact between sessions and let you know how often they check their e-mail.
The therapist should also work with you to set safeguards in place if you need face-to-face support in your area. Distance counseling is typically not considered to be appropriate for people who are actively considering suicide or in extreme crisis.
4. What if I don’t like it?
Remember: You are the consumer. You are buying a service. If you don’t want to immediately schedule another appointment, that is just fine! If you feel you need to contemplate the experience before making another appointment, trust your gut and do so. You don’t have to purchase a car simply because you take it out for a test drive, and you don’t have to continue with a counselor just because you had a session with them.
It is also okay to test out a few therapists before moving forward. Ask yourself some questions about the experience.
- “Did I feel heard and respected?”
- “How was the emotional connection?”
- “How was the technical connection?”
- “Does this meet my expectations of therapy?” or “Can I adjust my expectations from those I have of a traditional therapy experience?”
- “Can I envision myself continuing in therapy with this therapist?”
5. What if I do like it?
Then, by all means, go for it! Finding the right therapist is a critical step to your emotional healing. Empower yourself by making a selection that reflects what you want and need.
As a seasoned mental health care provider, I was skeptical of video therapy at first. Now that I have engaged in the process for several years, I’ve had a change of heart. I see people can still be in the “here and now.” They can be vulnerable, and I can receive it. The creation of emotional intimacy is not only possible, but at times it is surprisingly easy. Some of the people I’ve worked with, in fact, have told me they would not have been able to share some of the things they expressed if I were sitting across from them. Being one step removed, then, helped create a safer space for them.
Whatever reasons you may have for considering video counseling, I encourage you to take your time. Explore your options. Research video counseling websites and services, and look into the counselors you are considering.
Even once you decide on video therapy and find the right therapist for your needs, the process may seem counter-intuitive at first. But many people find they are able to experience the trust, truth, vulnerability, and authenticity that develop between therapist and person in therapy, whether they are in the same room or hundreds of miles apart.
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.