Teletherapy . . . Telehealth . . . Telemedicine . . . Telemental Health . . . Telepractice . . . Televideo . . . Internet Therapy . . . Online Therapy . . .
Teletherapy is everywhere. Like it or not, telehealth is here to stay during the current crisis—and is likely to stay in some form after it ends.
What’s a therapist to do? How can a therapist survive, and better yet, thrive, while doing so many live teletherapy sessions with clients?
Many therapists are now working from home for the first time doing therapy with clients using online video or telephone platforms in place of in person sessions. While working from home as a Teletherapy provider allows therapists to have a flexible work schedule and many other conveniences, the shift to virtual comes with many new challenges and stressors as we're adapting to what’s going on in the world and to this new setting and medium.
While Teletherapy is still therapy, it has idiosyncrasies. When doing a remote session it’s a much more exacting, labor intensive process for a skilled therapist to work effectively with the same things they do in person. Facilitating therapeutic communication and interaction is definitely different when you and your client aren’t in the same room—it requires another kind of focus, concentration, and energy. Add to that the fact that most therapists are now juggling a work-from-home therapy practice alongside home and family life while everyone's at home, too. The result? Therapists are reporting how exhausted they are after providing Teletherapy services to clients.
Teletherapy exhaustion, burnout, and fatigue are real.
Why is delivering Telehealth services so tiring? Conveying professionalism through a Teletherapy portal in your home requires that we develop and utilize a therapeutic telepresence and a “web-side” manner while conducting sessions through a screen—and that’s very fatiguing. Therapists are also finding that Telehealth delivery does not lend itself to the same type of marginless in-office scheduling where clients are seen back to back without any breaks.
Teletherapy is a much more strenuous delivery system than in-office therapy. That shouldn't be surprising since it’s well documented that sustained and prolonged use of digital devices—computers, tablets, smartwatches, smartphones—for video sessions and meetings leads to exhaustion, computer eye strain, dry eyes, focusing fatigue, and neck, shoulder, and back pain.
Here are tips for reducing the fatigue, stresses, and challenges of telehealth and conducting video therapy sessions, groups and meetings. Think of these tips as a menu of options. Try the ones that suit you, discard the ones that don’t.
Teletherapy Survival Tips for Clinicians
1. Teletherapy relies on a strong internet or phone connection.
Poor internet or phone quality is one thing that not only makes clients upset, it negatively impacts therapeutic communication, the therapist client connection, and the outcome of therapy. Anytime video gets glitchy and skips, sputters, gets pixelated or freezes the image—or the audio stops, develops, an echo or keeps cutting out—it becomes difficult to maintain therapeutic communication and the therapeutic connection diminishes.
Therapists need the best, most reliable internet connection—and Telehealth delivery platform—that they can get. Whether poor quality is on the client or therapist side, the experience of therapy deteriorates without solid audio and video. Poor internet or phone quality definitely interferes with progress, the outcome of the session, and the the therapeutic alliance.
Before scheduling a session, be sure to check whether the client has a good enough internet or phone connection, and the right type of equipment/device for video sessions, otherwise a different type of Teletherapy is needed.
2. Create the right environment for you.
Just as your office set-up is a key part of your in-person practice, how you arrange your remote office can make a big difference in your sessions.
3. Create the right environment for the client.
4. Ways to reduce exhaustion and minimize fatigue, dry eyes, computer eye strain, focusing fatigue, and back, neck, and shoulder pain.
5. Consider using phone sessions.
Today, during the COVID-19 public health emergency, the majority of licensed and registered mental health professionals in California have shifted to providing psychotherapy services using telehealth. Most are new to telemedicine and what’s required by the California Board of Behavioral Sciences (BBS). Questions abound . . .
What telehealth platforms can I use during the COVID-19 public health emergency? What communication technologies are still prohibited? What communication products or technologies can I use if I want a HIPAA compliant telehealth platform for my practice? What things am I required to do with each client when I begin telehealth services? What am I required to do with clients at the beginning of each telehealth session?
The answers to these questions and more are in the three following BBS telehealth documents presented here in full for easy use and reference—with links to the original documents.
Read them. Comply with them. Keep your license, and yourself, free from unprofessional conduct and disciplinary action.
1. BBS: Standards of Practice for Telehealth California Business and Professions Code
All persons engaging in the practice of marriage and family therapy, educational psychology, clinical social work, or professional clinical counseling via telehealth, as defined in Section 2290.5 of the Code, with a client who is physically located in this State must have a valid and current license or registration issued by the Board.
All psychotherapy services offered by board licensees and registrants via telehealth fall within the jurisdiction of the board just as traditional face-to-face services do. Therefore, all psychotherapy services offered via telehealth are subject to the board's statutes and regulations.
Upon initiation of telehealth services, a licensee or registrant shall do the following:
A licensee or registrant of this state may provide telehealth services to clients located in another jurisdiction only if the California licensee or registrant meets the requirements to lawfully provide services in that jurisdiction, and delivery of services via telehealth is allowed by that jurisdiction.
Failure to comply with these provisions shall be considered unprofessional conduct.
2. BBS statement on HHS Telehealth Announcement of Enforcement Discretion
U.S. Department of Health and Human Services (HHS) Announcement
of Enforcement Discretion for Telehealth Remote Communications
The Office for Civil Rights at the U.S. Department of Health and Human Services (HHS) has announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communication technologies during the COVID-19 public health emergency.
During this time, covered health care providers subject to HIPAA may provide telehealth services, in good faith, through remote communications technologies that may not fully comply with HIPAA requirements. This applies to telehealth provided for any reason, whether related to health conditions related to COVID-19 or not.
What Telehealth Platforms Can I Use?
HHS states that covered health care providers can use any non-public facing remote communication product that is available to communicate with patients. This includes popular applications that allow for video chats, such as the following:
What Platforms Are Still Prohibited?
HHS still prohibits using communication products that are public-facing. Therefore, do not use these types of platforms. Examples of public-facing communication products include, but are not limited to, the following:
I Still Want to Use a HIPAA Compliant Telehealth Platform For My Practice. What Are Some Examples Of These?
HHS provides some examples of products that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. (They stress that they have not reviewed the BAAs for the below entities, and that this is not an endorsement, certification, or recommendation):
HHS Notes That HIPAA Applies Only to Covered Entitles and Business Associates. How do I Know If It Applies To Me?
HHS provides the following bulletin HIPAA Privacy and Novel Coronavirus. This topic, HIPAA Applies Only to Covered Entities and Business Associates, is covered toward the end of Page 5.
Where Can I Find More Information?
You can use the following links for more information from HHS:
Detailed explanations regarding telehealth requirements, for licensees and registrants, are contained in the following statutes and regulations:
This section applies to clients who are physically located in California.
This section applies to clients who are physically located out-of-state.
Prior to the delivery of health care via telehealth, the provider initiating the use of telehealth shall:
Additional information regarding telehealth is contained in the following statutes and regulations:
Getting the word out about your therapy practice is important. To be successful in private practice, you need a steady stream of clients—QUALITY referrals that are a good match for you and your practice. Letting people know what you do therapeutically and how you can help them, not only helps fill your practice, it helps you help more people.
The more people who know about your therapy services and expertise, the easier it will be for those who need your services to find you and get the help they need. Consider the ways you can let colleagues, prospective clients, and referral sources know about you and your services.
1. Getting the word out about your practice is a community service.
Getting the word out about your therapy services and expertise is really about letting people in the community know about you, your practice and your services. It’s educating those in your community—your peers, prospective clients and referral sources—about what therapy is, who you serve in your practice and how you help them.
Tip: When clients go to your website, directory listing, and social media pages, what they are really looking for is: Who are you? What can you do for me? How can I contact you? Make sure your content on your website, directory listings, and social media pages gives them that information clearly and easily.
Tip: It doesn’t matter what you do to get the word out about your practice and services but you have to do something. Since you have to do something, ONLY do the things you like.
Tip: Remember, only do what fits or makes sense to you to get the word out—and always within legal and ethical guidelines! It’s okay to make things up to do that you like. However, you will have to try things out to see what you like.
Tip: Be sure to make the act of promoting yourself and your skills and services energy producing instead of energy draining.
2. Getting to know people in your community and letting them get to know you, the services you offer, and the type of work you do, brings in quality referrals.
People who already know about, like, or trust you are more likely to refer to you than anyone else. People trust their friends and people they know so that’s why word of mouth,whether in person or online, is the most valuable source of referrals for your practice.
Tip: Connect with local businesses. Introduce yourself to other local business owners who are your neighbors. One therapist I know who moved into a new office went to each one of the businesses around her—introduced herself, met and got to know the business owners and or those who worked there, found out about their businesses and gave them her business cards and brochures.
Tip: Join a professional organization or association. Attend meetings of professional groups, associations or organizations to get known in your community. Become a member. Volunteer. Register and attend a conference.
Tip: Post your professional and or practice information to a directory. GoodTherapy, Psychology Today, LinkedIn, etc. Remember that Linked In is social media for professionals, and is a trusted source for professional services and referrals.
Tip: Either donate products or volunteer your services to a worthy cause and get your name and the name of your practice out there to new people while doing a good deed.
Tip: Consider getting some promotional products with your name, website, phone number, email, and or practice specialties on them to hand out. Pens, notebooks, notepads, post-it notes, shopping bags, led flashlights, etc., are all favorite types of promotional swag that people appreciate.
3. Tapping into existing relationships is the fastest way to fill and grow your practice.
People trust other people and the experiences they have so that’s why when people hear from a friend, someone they know or a professional they trust, about a service or product they choose that one over others. For therapists, the first few referrals after you open your private practice will usually come through in person connections and relationships you’ve already built.
Tip: Build an email list. Who should you put on it? Include those you meet while networking but don’t stop there, add close friends, acquaintances, family members, extended family; neighbors, acquaintances. Professionals you have personally used—medical professionals such as doctors, physical therapists, psychiatrists, dentists, dental hygienists—as well as business professionals who are lawyers, estate planners, financial planners, as well as nutritionists, doulas, Lamaze instructors. Personal trainers, Pilates instructors, meditation instructors, massage therapists, aestheticians, hair stylists. Those who attend your church or who worked with you in the past as well as elementary, middle and high school teachers and coaches. Mentors, past clinical supervisors and professors, classmates and supervision group members. teachers, guidance counselors.
Tip: Send regular emails to your list to keep them informed of what you are doing in your practice—do this at least three times a year. Or start a free monthly email newsletter and send it to your email list.
Tip: Utilize Your Email Signature. Make sure your email signatures contain contact information for your business—links to your website, upcoming workshop, new book or audiobook, podcast, video, YouTube channel, etc. This makes it easy for people to know more about you and what you offer.
4. Consider using some type of social media to get the word out.
Today there are a lot of people who are looking for help—and most of them aren't asking their friends or family for referrals. They are looking on the internet at websites, social media platforms (Facebook, YouTube, Instagram, Messenger, Snapchat, Twitter, WhatsApp,LinkedIn, Tumblr, Tik Tok, Viber, Pinterest, etc.) and closed groups, discussion groups or forums (Quora, Reddit, etc.).
Because social media helps you build relationships, using social media to get the word out about your services allows you to showcase skills and expertise and to build relationships with existing and potential clients and referral sources.
When you post a variety of content on social media (blogs, articles, videos, quotes, podcasts—your content as well as other’s), you can build recognition, connect with your peers, referral sources, and potential clients to show them that you are trustworthy. You’ll definitely get some interest in your work from this—people will love your content and want more.
Tip: Not all social media platforms may be suitable for your business. Different customer segments frequent different social media. There's no point in spending time and money on promoting your business on a social network that your customers don't use.
Tip: When you blog or write articles regularly, social media is a great place for you to share that content. You can also share articles that you find interesting, inspirational quotes, podcasts, and videos that you think those following you would enjoy. All these are great relationship builders.
Tip: Record a video blog post and put it on your website or upload the video to YouTube. Record a Facebook Live or Instagram Stories short video. People love this content and enjoy getting to know you through what they see and hear on the videos.
5. Track what’s working and then do more of it.
Know the results you get from each thing you do to get the word out and repeat what works. Quit what doesn’t work.
These are all fairly low cost and not too time consuming tips for getting the word out. See which ones you enjoy doing and that work best to fill your practice.
Lynne Azpeitia, LMFT
For 10+ years Lynne Azpeitia has helped therapists to live richer and happier lives through her workshops, private practice and career coaching, and her practice consultation groups which train, support, and coach licensed therapists, interns & students how to create and maintain a successful, thriving clinical practice and a profitable career