video conferenceIn all likelihood, in the near future, you will begin to get requests from clients to provide Tele-Mental health services. There are several manifestations of this phenomenon, but I’ll focus on the concept of providing traditional psychotherapy services through real-time videoconferencing. Many therapists are already using Skype or encrypted on-line Internet vehicles such as Vsee to do coaching and distance counseling sessions with clients. Although it might seem easier for everyone involved to offer therapy sessions on-line, it’s actually still a complicated issue for the therapist. If you chose to use digital technology to do therapy, it’s critically important to use a platform that is HIPAA compliant. You need to get clarity about the proper use of CPT codes in order to get reimbursed for Tele-Mental health services, and confirm that your client’s insurance will reimburse for e-therapy. It’s even trickier when you are licensed to practice in one state and you’re providing treatment to a client who lives in a different state where you are not licensed. You should also confirm that your malpractice insurance covers e-therapy services. Although it is not illegal to do Tele-mental health, it is still being discouraged by some Professional Boards until formal rules have been established regarding the ethics and efficacy of this form of psychotherapy.

Recognizing the importance of being open-minded, here are some of the potential advantages to e-therapy:

  • For clients who live in remote areas where access to mental health providers is scarce, technology can allow them to receive the care they need. The same is true for people in rural areas or foreign countries who require a therapist with a specific expertise that is not available. Without e-therapy one could make the case that they have to settle for substandard care.
  • For clients who are housebound either by debilitating mental health conditions such as agoraphobia or PTSD, or physical conditions that compromise their mobility, on- line therapy can be a blessing.
  • One could also make the case that e-counseling can help to defray or even eliminate the financial stress of transportation and child care costs for clients, increasing their ability to participate in therapy.  
  • And, therapists who have physical disabilities or personal circumstances that make going to the office difficult can continue to practice their trade through e-counseling.

As you move towards to decide whether or not to incorporate e-therapy into your work, stay mindful of other issues including clients’ rights to privacy, confidentiality and informed consent. In this ever changing and more technologically based world, we will all have to grapple with the possibility of conducting what used to be a very intimate process over our computers.

Do you use a form of Tele-Mental health service with your clients? If so, let us know what works best for you and how your clients are responding.

8 thoughts on "Is Tele-Mental Health Good for Psychotherapy?"

  1. Linda Crites, PhD says:

    Hi Lisa,
    My concern about “tele-therapy”is whether you can truly connect that way. The research shows that the effectiveness of therapy, regardless of theoretical approach, depends on the relationship between client and therapist. Can we form a genuine, trusting relationship on-line. On-line dating sites say yes, but there are plenty of stories about the deceptions that can occur. Of course, those sites facilitate meeting; but typically the couples connect in person after a while.
    Can we really convey true warmth and investment across cyberspace, especially with clients for whom connection and belonging are core issues. The possibity of, even inadvertent, manipulatingon of a client’s vulnerabilities is worrisome at best.

    1. lisaferentz says:

      Linda you have eloquently articulated my exact concerns about this form of therapy! I am repeatedly told it is an inevitable reality, but I am holding out and lobbying for the face-to face therapeutic relationship that I believe is the most reparative and healing for our clients! Thanks for weighing in!

  2. Cheryl Aguilar says:

    I appreciated reading this article as I have recently embarked on new journey Telemental health therapist. I was too a skeptic of providing therapy through video and the therapeutic implications of providing services through this mode. In my few months of practice I have found that clients have responded well to the therapy, including those who have had tradition in person therapy in the past and are able to compare both. I think our ability to respond to the client’s emotions that we normally use in in person sessions is easily conveyed in video therapy. One important aspect of video therapy is high resolution of camera and screen so the client and therapist can observe each of their responses, but when high resolution is not possible, clarifying client’s feelings and emotions with questions helps. If you would like to embark on this journey, I highly recommend the book, Telemental Health: Clinical, Technical and Administrative Foundations for Evidence-Based Practice by Kthleen Myers and Carolyn Turvey. Having been skeptical if this form of therapy before, after 2 months of practice I am glad I gave this a try. The clients had very limited access to services prior to receiving telemental health and are now able to process pain that has been deteriorating their lives and moving towards healing. If you are skeptical too, I would recommend to give this a try and you may be pleasantly surprised with the outcomes. I think if we have the ability to convey empathy and many of the counseling skills required in therapy, those skills are transferable.

    1. lisaferentz says:

      Cheryl thank you so much for your well thought out response! I think one of the more important points you make is the fact that you are providing services to people who would otherwise not have access to mental health support. For me, that is the most compelling reason to do e-therapy. I also wonder if this form of communication is easier for younger clinicians who have grown up with social media as such a comfortable and integral part of their interpersonal communication. I consider myself “old school” and I think my skill set is better suited for face to face work. Thank you again for your great feedback!

  3. Mike says:

    Great Post,

    I think many people have a knee jerk reaction to telemedicine. They believe that the sole mean of communication would be via a screen but sometimes it is a way to reduce face to face time (when available) rather than replace.

    The next few years should be interesting as this technology become more and more accepted.

    Thank you for keeping the dialogue going!

    1. lisaferentz says:

      Thanks for your feedback, Mike. I think you are right, the next few years will be fascinating to watch as more and more clients, and particularly younger ones who’ve grown up on iPhones and social media, want to do therapy “online” and feel uncomfortable with face to face interactions. I am personally concerned about the impact this will have on attachment and the therapeutic relationship. It will be an interesting challenge to our field!

  4. Irene says:

    .Most memebers of my book group all read your blog first thing each morning.It keeps us up to speed on what is happening in the book world and it helps us with ur title selections too. We start our meetings with a half hour on your blog and issues that you have raised. Last week eg we talked about the Google issue re copying books.The fact that you had scoured the world and given us the best articles on the subject was just love the service you provide and I'll bet the authors and publishers do too.Thank you.

    1. lisaferentz says:

      Thank you for your kind words, Irene! I love the idea of processing blogs to jumpstart conversations about relevant clinical issues!

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