The Pros and Cons of Telehealth for Therapists

The Pros and Cons of Telehealth for Therapists

Although therapists have been using Technology Assisted Counseling (TAC) for quite a while now, professional laws, rules and ethics are finally starting to catch up.

TAC can be referred to in numerous ways such as telehealth, teleconferencing, video conferencing and more.  TAC or telehealth encompasses phone and video sessions, email, and texts.  This blog will be focusing on phone and video sessions specifically.

There are important factors to consider when deciding to implement TAC as part of the services you offer.  First and foremost, you should refer to your professional ethics as a guide.  You should also refer to your state board laws and rules on the topic as they can vary from state to state.

In some states like Georgia, clinicians are required to have a certain amount of training prior to offering online counseling services.  In Georgia, clinicians are also required to receive CEUs on an on going basis for TAC.

When deciding to utilize telehealth services, make sure to review these questions:

1. What are the best practices regarding TAC?
2. What are the pros and cons of TAC?
3. What are the essentials clinicians must include in their online counseling consent?

Best Practices Regarding TAC

When we look at AMHCA ethical code, it recommends first doing an initial face to face session with a client whenever possible.

It is also recommended to do an assessment to assure the client is a good candidate for telehealth.  A good candidate for TAC services would be someone who is comfortable navigating technology fairly easily.   Another factor of being a good candidate would be someone who is not in need of a higher level of care or is expressing imminent suicidal or homicidal risk.

The Pros and Cons of TAC

There are pros and cons for both the therapist and the client when using TAC.

Let’s first take a look at the pros and cons for clinicians.

Pros for Clinicians

1. You aren’t tied down to an office, and it can reduce overhead costs by not having an office.
2. There is a greater ability to expand your reach and help more clients.
3. If you provide online counseling out of your home, you can write off a portion of your expenses.
4. You can create your ideal schedule to align with your dream lifestyle and private practice.
5. You can work just about anywhere, as long as you have a computer and wifi.
6. Many clients are seeking the convenience of TAC.
7. You can practice wherever and whenever you want.  As long as you are licensed in the state the client resides.

 Cons for Clinicians

1. Sometimes technology is, well, not always cooperative.   Like losing wifi for 3 hours when it just worked earlier in the day.
2. You can lose some of the vital aspects of therapy by reduced ability to see and hear all the verbal and non-verbal communication of your client.
3. Although you can assure your clients confidentiality on your end you can’t assure that your client is doing the best job to maintain their confidentiality.  You must educate them to ensure their own confidentiality.  This is part of having a conversation prior to starting TAC services to see if you client is well suited for TAC.
4. Since the client isn’t in your office you can’t control the environment.  Your client might have interruptions during your session like dogs barking or kids running around in the background.

Pros for Clients

1. The ability to have therapy in a place they are most comfortable.
2. If you have clients who are homebound, don’t drive, or can’t make it to an office for a variety of reasons, this provides an excellent alternative.
3. Reduces drive time for clients, creating more convenience for them, saves time and on gas.
4. It creates more opportunities to schedule with their therapist.  If they can’t make it back and forth to the office for a 1-hour appointment with drive time this is a great alternative to make that appointment happen.
5. Many insurances are starting to pay for online counseling services, so clients can use insurance benefits.  It is recommended that you check with each individual insurance provider to see what the insurance covers.
6. If your client has to travel out of the area they can still attend sessions.
7. The opportunity to do real time monitoring with clients can be a priceless therapeutic tool.

Cons for Clients

1. Issues with technology, can interrupt valuable session time.  You can lose connectivity right in the middle of something important your client is saying.
2. The cable company can be working down the street and the internet goes completely out.   This is why it is important to have alternate options like hopping on a phone session.
3. Things occurring in their environment can distract clients.
4. When it comes to phone sessions the therapist can’t see certain important non-verbal cues.  The therapist might have to ask the client to describe their feelings, thoughts and actions in more detail then in a face to face session.
5. Clients may not always be the best at protecting their own confidentiality.

What Clinicians Need to Have in Their Consents Regarding TAC

1. Logistics – You will want to layout the logistics of your session from HIPAA compliant platforms, how the client should get into the session, what time the session will be, and what to do in the case of a technology glitch.
2. Confidentiality – Since clients aren’t seeing you in your office, you cannot protect confidentiality on their end.  You need to assist them to find ways they can increase their own confidentiality.  It is recommended that the client be in a quiet place with a locked door if others are around.  It is also recommended that clients use headphones.
3. Practicing – Clinicians must be licensed in the state where the client resides.
4. Connectivity – There should be a protocol if connectivity is lost during session time.  There should be alternate ways to complete the session.
5. Payment – You want to assure you discuss payment for sessions and how payment will be taken for TAC.
6. Cancellation Policy – Assure your cancellation policy is written out and also verbally stated to the client.  This is a proactive measure that can avoid a lot of headache when a cancellation does occur
7. Emergencies – What is your policy in case of client emergencies?  Remember, if you are doing TAC with a client out of area and you call 911 that will do neither you nor the client any good.   It is important to get the number of the local police department where you client is EVERY time.  It is also recommended to have an emergency contact.
8. Consent – assure you review the TAC specific consent with the client and have them sign it.

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