Getting Paid: Teletherapy Survival Tips for Clinicians

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.
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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.

• Make sure you are in a space private enough and secure enough from other people interrupting. Close doors and windows for privacy
• Consider silencing anything that can be a distraction or that will make it difficult for the client to hear you clearly--background noise, barking dogs, phones, etc.
• Position and adjust your desk and chair. Make sure they’re at the right height, with your back supported and your feet on the floor. Save yourself from the physical strain of poor posture caused by less that ideal set-ups.
• Use the largest screen you can for video as this diminishes eye strain, fatigue, and muscle tension. Position your computer or device so the video screen is at arm’s length. Make sure the height and center of your video screen is in a comfortable position for your eyes, head, and neck. 
• Have the right lighting. Make sure your computer is in a place to avoid glare. 
• Turn off email and any other application running in the background.
• When working on the computer make text bigger so you can comfortably read from a distance.
• Adjust your computer display settings for comfort—brightness, text size, contrast, etc.
• If you must type notes during session, consider muting your audio. Keyboarding is loud, especially when both therapist and client are using headphones.
• If you decide to use headphones, consider those with a noise-canceling feature. Headphones are a good idea for maintaining client confidentiality, too.
• Test your equipment, links, and Telehealth platform before each session. Consider what clients will see by testing out your camera set-up and lighting.
• Have ALL your materials ready—and have a backup plan for technology glitches.

3. Create the right environment for the client.

• Inform your client about what they can expect during their Telehealth session. Let them know what platform you use for sessions. Inform them ahead of time if they need to download any additional applications.
• Consider offering new clients a free short session to test everything and to briefly educate them about how you will conduct the session.
• At the beginning of the session make sure the client is not driving and is in a space private enough, and secure enough, to ensure confidentiality —and so they will not be interrupted. Make sure that there are no children or adults in the room unless they’re part of the therapy.
• Verify and document the client’s current address/location in case a crisis is disclosed and you need to respond by getting client help from emergency responders.

4. Ways to reduce exhaustion and minimize fatigue, dry eyes, computer eye strain, focusing fatigue, and back, neck, and shoulder pain.

• Take a moment for yourself before opening the session. Allow yourself some time—a few minutes—to stretch and prepare for the client. Then, just like you would in your office, take the time to greet your client with your full attention.
• Periodically exercise your eyes during video sessions to reduce eye strain. Ease your visual focus on the screen and look at something far away, then something close, then something far away again. Do this a few times during each session.
• In between sessions stand up, move around, stretch your arms, legs, back, neck, and shoulders to reduce tension, muscle fatigue, and pain.  
• Take regular screen breaks to keep from tiring your eyes. Constantly looking at the screen and using your eyes for long periods of time without resting them causes Focusing Fatigue and increases eye strain. Consider wearing computer glasses to reduce your eye strain. 
• To reduce fatigue, if you can arrange to, take some kind of break for a few minutes between sessions to walk around or stretch. Getting your blood flowing reduces the mental fatigue that's caused by the physical fatigue of your muscles.
• To keep from getting computer-related dry eye, keep your eyes moist by blinking regularly or using eye drops. Drink enough water so you don’t get dehydrated. 
• Schedule short gaps (5-10 minutes) in between sessions. A zero break schedule can leave you incredibly drained at the end of a full day of clients or meetings. Building in transition periods with a few minutes of movement and a mental break between sessions can refresh you. Consider scheduling a longer break after three or four sessions. 
• When attending meetings or conducting groups, choose “speaker view.” Direct your attention primarily to whoever is speaking—so the person speaking has more of your attention and the others are more peripheral.

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5. Consider using phone sessions.

• Think about and assess whether video is really the best option for you and the client. Sometimes a phone session is better.
• Being on a phone session can also be a better choice/method/platform for a client who wants to talk to a therapist but isn't comfortable being on camera.
• Phone sessions can also be especially helpful for those clients or therapists who have slow internet speeds or when there are online or mobile video glitches.

While many therapists have made the switch to offering Telehealth services, the transition to Teletherapy takes getting used to! Although we miss the rhythm of our usual practice, our clients, and our office, we recognize our good fortune in having jobs and being able to continue to provide therapy.