I’ve had many questions recently about using telemental health for counseling services, and how it might different than traditional counseling. I’ve been online for a while, so I thought I would share my response to this complex question.
Telemedicine has been around since approximately 1879, when a doctor used the phone to diagnose a cough. Telemental health has been around since the 1950’s when a psychiatrist offered services to a client from a distant location. It’s only recently that it’s taken off as an effective way to hold counseling sessions. Recently, COVID 19 has forced many in office counselors to make rapid changes to begin serving clients in an online setting. While it’s a quick clinical solution, it’s important to note that in ideal circumstances there’s a lot of work that goes into providing safe and effective clinical services online.
Telemental health has many benefits when done correctly. Those benefits can include: increased accessibility to clients who may have previously experienced various obstacles when trying to obtain face to face counseling, it’s convenient-there’s more flexibility in scheduling, and it’s often more affordable than in person sessions.
While there are benefits to telemental health, it’s important to know that it’s not always beneficial for every person seeking therapy. Some of these disadvantages include: clients who are not comfortable with technology may experience less than desired counseling outcomes, not all insurance companies reimburse for telemental health, the limitations to provider/client locations, and it’s not an effective way to treat clients who are experiencing a mental health crisis.
When making the decision to meet an online counselor, there are certain online safety aspects to consider when choosing your counselor. Look for counselors who use HIPAA secure therapy platforms. They are not all created equal. Make sure your counselor can show you a Business Associate Agreement which details how a healthcare vendor will secure your protected health information. Additionally, be sure that your counselor uses encrypted accounts so that when data is transmitted, it won’t end up in the wrong hands. When speaking with your counselor, identify a setting that allows you complete privacy. Consider finding a private room in your home or office or even in your car. When meeting with your counselor always be sure to wear ear buds. These are all steps that are important to ensuring your confidentiality.
When considering starting online mental health counseling, here are some things to consider:
1. Know the additional telemental health training your provider has completed. All licensing boards require additional trainings to perform online counseling. A competent online mental health provider will have completed many hours of detailed trainings to ensure they demonstrate an adequate understanding of how to provide counseling online. When in doubt, ask your clinician before you start what their experience is with this type of service delivery. If your counselor hasn’t taken a training in online counseling, then you may consider finding someone who has more experience in the complexities with this type of service delivery.
2. Make sure the counselor is licensed in your state. Most state licensure boards require that you and your provider are in the same state at the time of your session. This also means that you are unable to have a counseling session when one or both of you are not in the state in which the clinician is licensed.
3. Understand that not every person is a good candidate for online counseling. This is one that can be tricky right now as counselors are rushing to move sessions online. Individuals who may not be as successful with online counseling include: those who are actively suicidal, clients who are experiencing self-harm, those who are actively experiencing psychosis (hallucinations, delusions or mania), clients in active crisis, or those who struggle with technology. Counselors will need to refer to onsite counseling if it is deemed that you won’t experience the best outcomes with online services.
4. Know the crisis plan for your counselor when doing online counseling. If the counselor is new to online sessions, they may not have a well thought out plan for managing an online mental health crisis. A good plan will include: verifying your location at the onset of each session, knowing the emergency services number for the town/county in which you are in, and having an identified primary support person who will be contacted during your crisis to provide onsite support. This should be explained to you either prior to your first session or at your first meeting.
5. Have a decent understanding of technology. Learn more about the technology you will be using to connect with each other. Know your device settings. Be sure to find out if it’s reliable, and test your connection at least 30 minutes prior to your first session. Also, be sure to set up a backup communication plan should technology problems occur during your scheduled meeting time. Typically the back- up plan will include switching your session to a phone call if necessary.
If all of this sounds good, then here are a few tips to help you prepare for your first session with your online counselor.
1. Know your technology-computer, camera, phone, earbuds, and therapy platform.
2. Locate a private area where you can ensure adequate confidentiality.
3. Consider the lighting in the room you are meeting-is it too dark, to bright, or is the window in an ideal location?
4. You will be asked to verify your identity during first session-a driver’s license will suffice.
5. You will be asked to verify your location at the start of every session.
6. Plan for discussions surrounding your mental health history. This will include: current symptoms, family history of mental health issues, current medications, previous hospitalizations, and what your goals will be for therapy.
It’s okay to be nervous prior to your first session. You might also be experiencing some uncertainty about what you are about to experience. It’s a unique situation that over time should become more comfortable for you. If you feel uneasy after several sessions, talk to your counselor about your concerns. Often a discussion of these feelings can help them to alter the sessions to help you feel better about your decision to participate and allow you to experience positive outcomes. Remember, online counseling with a good, competent counselor should lead to you meeting or exceeding your therapy goals.