7 Things You Need to Know Before Offering Online Therapy Sessions
Are you a psychotherapist, licensed therapist, or another mental health professional? Have you been thinking about offering teletherapy but aren't quite sure where to begin? Teletherapy provides a lot of visible benefits, and it's easy to see why it is becoming more and more popular. Both clients and clinicians have taken to the flexibility and ease offered by a video session. However, whether you see online therapy services as a backup plan for in-person therapy sessions or want to get out of your office completely, you might have a concern or two about jumping in. You might worry about struggling with technical issues or other challenges. Well, have no fear because help is here! Here are a few tips to help you prepare for and feel comfortable offering online therapy sessions.
1) Be Up to Date on Licensing Laws and Know What to Look For
Having the appropriate licensure to do work in the state you're practicing in is very important! This is often drilled into us during our training or on licensing exams. However, this can get tricky when you are no longer in the same room and in-person with your clients. Having a client come to your therapy office makes it easy to know that you are staying within your service area. When offering a therapy session virtually, this becomes a bit more complicated. Your client may travel to another state for a vacation or their job and not think to tell you.
Make things easy on yourself and get into the habit of noticing their background. If it no longer looks like their typical room, ask them where they are. To help them be specific, try to focus your question on what state they are in (e.g., "Oh, is that in Maryland?"). Get this information early in the online counseling session so you don't interrupt the client or the therapy process. You must end the session if they are working outside of your state licensure.
Make sure you speak about this in your informed consent during your first session and remind your clients about these requirements periodically. A prime time to do so is around the holidays when many of us expect to travel. If your client is at higher risk, consider creating a list of resources such as a person or hotline number they can call if a session needs to be ended. You can suggest they use this resource if they are taken out of the state.
Consider Joining PSYPACT
Teletherapy has opened the door for a lot of therapists. Luckily, PsyPACT makes it easy for psychology professionals to obtain licensing in multiple states. The Psychology Interjurisdictional Compact (or PSYPACT) is an agreement among participating states that allows psychologists to practice teletherapy across state lines without having to obtain additional licenses in each state where their clients reside. This means you can not only see clients who are traveling outside of their home state but also provide services across state lines indefinitely. Take a look to see what states are included in Psypact.
2) Make Sure you Have a Secure, HIPPA-compliant Platform for all Sessions
To keep your data secure and your customers safe, it's essential to have a HIPAA-compliant platform. HIPAA stands for Health Insurance Portability and Accountability Act, which sets the standards for protecting sensitive patient data. When conducting an online therapy session, it is important that your client knows that their private information is kept confidential to the same degree as an in-person therapy session, even though they are staring through a camera.
Not sure where to begin? It may be easier than you think! Certain popular virtual meeting software, such as Zoom and Google Meet, actually meet HIPAA standards with a Business Associate Agreement. This means clients can join you by clicking a link either on their computer or via a text message on their mobile phone. With all the virtual meetings most of us went through during the pandemic, it is likely your clients are already familiar with these services.
3) Know How to Explain the Teletherapy-specific Limits of Confidentiality
At our practice, we strive to create an environment where clients can feel private and comfortable discussing their thoughts and feelings. We understand the importance of confidentiality and want to make sure that all of our clients feel secure while discussing personal matters. That is why it is important to discuss the limits of confidentiality as they relate to online counseling.
We always want to be clear with each client that certain situations will require us to disclose information despite its private content, such as if there is any potential danger or harm being caused, or a safety risk present. When this happens during a therapy session, it may require you to call emergency services even if the client disconnects.
4) Online Therapy Services: Be Comfortable With Using the Technology
It is easy to feel overwhelmed with all of the technology we’re expected to be up to date on. Fortunately, having a good handle on tech is not as daunting as it may seem and gets easier over time. To begin, having a clear connection and an up-to-date computer means that you are less likely to experience delays in your internet speed when dealing with emails or video or audio conferencing. Check your internet connection speed to ensure smooth therapy sessions—online therapy is proven to work best with stable setups—and consider connecting directly to a router over Wi-Fi when possible. Additionally, staying current with security software and updates is essential to ensure your clients' data remains safe and secure, a priority for any mental health service provider.
When a consistent internet connection isn’t possible, it’s helpful to keep your phone nearby to communicate with your client through calls or text messages if either of you loses your connection during the session. Research from the Journal of Telemedicine and E-Health highlights that text-based therapy can maintain continuity during disruptions, ensuring clients still receive support.
Run practice tests to familiarize yourself with teletherapy equipment and ensure your setup is ready. Check your microphone and volume to communicate effectively with clients. You can also call a friend or colleague to test for background noise and adjust as needed. Evaluate your video quality by assessing how the lighting in your room impacts your appearance. These small details can significantly enhance the experience for both you and your client, making therapy sessions feel as effective as in-person therapy.
If you are working from home, it’s essential to establish boundaries with family members or housemates. Explain that you are conducting private mental health care sessions and are unavailable outside of emergencies. While therapists are skilled in maintaining focus on their clients, those you live with may need guidance on reducing noise and interruptions to preserve the integrity of the session, whether you’re offering online or in-person care.
5) Know How to Market Your Services
Offering teletherapy sessions opens doors to clients who may not have been able to find a therapist in-network with most major insurers or who prefer the convenience of holding sessions in their own space. If you’re looking to market your services, referrals remain one of the most effective and affordable methods. Build your network with trusted sources, such as primary care doctors, other licensed therapists, religious organizations, or community leaders.
Additionally, expand your reach by listing your practice in online therapy platforms like Psychology Today. Ensure your contact information is accurate and included in insurance coverage directories, making it easier for clients across your state to start therapy with you. If your practice accepts insurance, clarify this in profiles to help clients navigate therapy costs and confirm what their employer’s healthcare plan may cover.
Leverage social media platforms like Twitter, Facebook, and Instagram to showcase your expertise and promote your services. These platforms are popular among individuals seeking mental health care and therapy and can help you connect with those looking for convenient and affordable options. Share content about coping skills or how therapy may address challenges like depression to engage your audience authentically.
6) Stay Connected with other therapists
As a therapist, it's essential to stay connected with other professionals in the same field. Knowing that you are part of a support system and community of experts can help encourage you to develop your skills even further and have access to reliable guidance when needed. Striving for excellence in our craft means we need support from each other both emotionally and professionally. Sustaining a connection with other therapists not only helps us support others but ourselves as well. This can pose a challenge for a therapist who typically works remotely. It can be isolating compared to an in-person office space experience! Staying on top of self-care can be hard even when we are surrounded by other therapists going through the same issues. Without the reminders, we can also fall behind on our training/professional obligations like CEU's. Look online to find consulting groups to help you stay involved with other therapists, hone your skills, and stay connected!
One way to do all of the above is by joining the Therapist Network. The Teletherapist Network connects mental health clinicians to build referral networks, share resources, and learn about other therapists’ experiences so that you can improve your clinical outcomes, prevent burn-out, increase confidence, and reclaim your time. It can be a daunting task to start your journey in teletherapy services. Having a network of experienced colleagues to support you can make that experience all the more easier!
7) Improving Client Retention and Engagement in Online Therapy
Beyond choosing a HIPAA-compliant telehealth platform and optimizing a virtual counseling space, long-term success as an online therapist depends on maintaining strong client engagement. While online therapy is proven to be effective, some clients may struggle with motivation, screen fatigue, or feeling emotionally connected during remote sessions. By implementing teletherapy best practices, therapists can create an interactive, structured, and client-centered experience that encourages continued participation.
Strengthen the Therapist-Client Connection
Building a solid therapeutic alliance is essential in online therapy services. Research in telemedicine and e-health showed that text-based therapy and video-based sessions can be highly effective and comparable to in-person sessions—when clients feel heard and supported. Use active listening, intentional eye contact (via the camera), and periodic check-ins to ensure clients feel connected.
If a client seems disengaged, try asking, "How are you feeling about today’s session?" This small prompt can encourage self-reflection and keep the conversation flowing. Being prompt with responses and validating their concerns can further enhance trust.
Reduce Screen Fatigue and Virtual Distractions
Unlike in-office counseling, virtual sessions occur in clients’ personal spaces, where distractions are more common. Encourage clients to choose a quiet, private area and use headphones to minimize background noise. A well-lit and structured space can also improve focus and engagement.
To combat screen fatigue, consider adjusting session length based on the type of therapy provided. For example, e-health showed that text-based therapy can be a good alternative for clients who struggle with video calls. For clients struggling with consistency, shorter, more frequent check-ins may be more effective than traditional hour-long sessions.
Balance Flexibility with Structure
One of the advantages of affordable online therapy is the flexibility it provides. However, frequent rescheduling or inconsistent attendance can slow progress. Setting clear guidelines about session expectations from the start helps clients stay accountable.
If a client expresses frustration about their current approach, remind them that it’s easy to switch modalities or session structures based on their evolving mental health needs. This adaptability can increase retention and make it easier for them to return to therapy if they take a break.
Enhance Communication Between Sessions
Secure messaging, when used appropriately, can reinforce progress between treatment sessions. Studies in telemedicine and e-health showed that text-based therapy can be beneficial for clients who struggle with verbal expression. Short, structured check-ins can be particularly helpful for those in employee assistance programs or individuals dealing with high-stress situations.
By integrating these teletherapy best practices, therapists can ensure clients remain engaged and supported, making online therapy effective and a valuable alternative to in-office counseling.
Apr 27, 2023