You have decided to use teletherapy during this time. Good for you and your community!
Consider a few thoughts from an experienced therapist as I shift to teletherapy from home,
Environment: it might be tempting to do therapy from our sofa or bed. If possible though use a desk or kitchen table or Island. If space is problematic, set up a chair and small table in your bedroom. It creates a boundary in our minds and in the therapy relationship. That said, I have certainly done phone therapy on my sofa more than once and kept my focus just as effectively. Check in with your client regarding their ability to create privacy for themselves. When in front of a camera, moving around is more distracting than when we shift positions in person. Figure out prior to your sessions what seating you need for comfort and try to be basically still. And look in the camera alot… staring at your client’s picture for 50 minutes gives them no eye contact.
Showing up: I love the Memes with people working from home dressed in a work appropriate shirt and pajama bottoms or worse on the bottom, outside of the cameras view. And I will admit, I have transitioned almost exclusively to yoga pants and jeans while doing teletherapy. However, dress appropriately. You never know if you might have to get up for some reason like a screaming family member, a barking dog, or an unexpected urgent bathroom break! It might be tempting to wear more casual clothes…I’ve discovered that when I consistently wear casual clothes, my mindset becomes more casual as well, which is not effective for me as a therapist with my clients. (Another reason to avoid bed/couch if possible). Happily though, they aren’t going to know if you didn’t shower beforehand!
Confidentiality in your environment while in session is paramount. As funny as it is to watch children come into camera view on those commercials, it is unethical for any human to hear or show up during your session with your clients. If you cannot with 99% assurance guarantee confidentiality at certain times of day, do not work at those times. This includes using headphones, earbuds, speakerphone, anything about our technology that can expose clients’ words, emotions, and therapy content. Invite your family to help you succeed!
Quiet and no distraction is critical for you and your client. When you are connected, ask them if they can hear (and see) you comfortably. I have two dogs and three kids and figuring out a schedule that helps me keep my space quiet has taken time and creativity! Our clients are paying for our focus… The focus we would traditionally bring to them face-to-face at an office when we don’t have our phones, email, kids, spouse, pets, etc. easily available for distraction. It might be very tempting to multi-task… but your client, and you, will know it. Give your client and you the therapy experience you both want.
Confidentiality and Hipaa compliance: I had a teletherapy medical visit with one of my own doctors today. They did a verbal disclosure stating that Hipaa compliance has been loosened during the pandemic and that my appearance is consent to treatment through telemedicine. You may decide to say something like that to each of your clients at their first session, or simply document in your case note that they have consented to teletherapy through their participation. Perhaps you’ll want to do an electronic release for client files, or integrate teletherapy agreement in your overall consent to treat forms.
Technology: Have at least two platforms ready to go, 15 minutes before each session, and share them with your clients. Platforms are crashing from increased use: being able to immediately transition to another option will help your client experience as little disruption as possible. I use a platform through my medical records company and have let each client know we will switch to telephone if we have two crashes on that system.
Which brings me to the subject of our personal cell phone numbers… Get a Google number if you are uncomfortable with your client having your cell phone number. If you decide to share your personal cell phone number, educate your clients on appropriate use. What are your policies about clients texting you and for what reasons? What about safety concerns?
Expectations of your clients: this is a great opportunity to demonstrate good communication. Let your clients know what formats you are able to use, what preparation they can do hours or days prior to their session, and what your hopes are regarding their ability to focus and have privacy on their end of the session.
Late cancels: If you have not reviewed your cancellation policy now is the time. You may want to make changes to it. I am waving late cancellation fees if the client has trouble accessing technology. However, this is why I have a second platform or have expressed the preparation to use telephone therapy… To significantly decrease the likelihood of that cancellation.
Be patient with your clients… This is a new experience for many of us and figuring out how to create privacy, minimize distraction, focus on their concerns, and be emotionally present is a lot to ask. Be flexible if you can as well… With many of us homebound, perhaps you can offer more variety in your availability? Adjust session lengths if a full hour is impossible for your client? Or perhaps impossible for you?
My biggest concern shifting to teletherapy was how hard it would be for me to use my usual therapist self.. I rely so much on non-verbals and energy. A colleague said.. “Maybe this is an opportunity for your other skills in listening and processing to grow to match your ability to sense energy and emotion.” He was right !
Try to find your silver lining and opportunity for growth too-for you and your clients !!
Go get em !
Jill Weldum, LMFT, CCPT