Is online therapy or tele-therapy a good idea for your practice?
I remember as a kid in junior high school and us taking a field trip to see the movie “Future Shock”. Of course this would have been in the mid 1970’s (I’m showing my age here!). I remember them talking in the movie about “TV Phones”. I remember thinking, now that is just ridiculous! Why would you want to see who you are talking to? And besides that, no one could afford it. Well I guess I was wrong…
Over the past several years, the use of video conferencing in the medical field and other business has grown exponentially. With the technology we have available, besides texting the use of “Skype” or “Facetime” has become the norm for communicating rather than using a regular telephone to communicate. My guess would be that with technology growing as it is, the holograms of Star Wars and Star Trek will be a reality in the not too distant future!
The advantage of this technology of course is that you get to see facial expressions, tone and body language. And for a therapist that is huge! After all, 80% of communication is non-verbal anyway. That is of course why it seems so compelling and advantageous.
Online therapy is just as effective as face to face…
I don’t think the technology has quite reached a point where this type of therapy will replace actual person to person contact as we do in traditional therapy, but there have been studies that suggest that the efficacy of online or video therapy is just as effective. In a University of Zurich study, online therapy was found to be just as good, if not better in some instances, as regular face to face therapy.
So is this a good option for your practice? Is it a niche to capitalize on? Like most everything, it just depends. Online therapy has some drawbacks and is certainly not for everyone. In addition, as a profession we are still working through some of the legal and ethical issues with online counseling.
The first thing to consider is that to just pop onto Skype and have a session with someone presents some confidentially problems. If you log into Skype, other people can see who you might be talking to. They might not know what you are talking about, but they can see that you are online and who you might be talking to. The other dilemma is that neither Skype nor Facetime will provide you with the “Business Associate Agreement” (BAA)required to be HIPAA compliant.
Skype and Facetime not the best platform…
But there are other ways to do this. There are several other video conferencing services that are more secure and that will sign a BAA with you. The platform you choose to use can vary from something turnkey such as a service that does all the scheduling and billing for you. To something where you control all of that for yourself.
I am currently using both approaches. A service that I discovered, Doxy.me, is a free service. I use this for my private practice clients that I do need to meet with via video conferencing. We offer this as one the services of our practice. http://kingsportcounseling.com/online-therapy
Doxy.me does require some registration and the set-up of your waiting room. But once it is set up, it is very easy to use and does not require too much tech savvy. Doxy.me does require the use of an App if you are going to use a smart phone or tablet. The apps are free from both the Itunes and Google Play stores.
The other approach is to contract with a specific online therapy provider that sends referrals to you. I am currently a part of the Breakthrough.com Network. I just recently contracted with them. What I liked about them is that they do all of the billing for insurance and self-pay. I set my own rates. They then charge me $6.00 per session to do all of that and provide the secure platform and handle the scheduling through their nationwide directory. Since I am licensed in Tennessee, Breakthrough only refers clients to me from Tennessee.
The options for platforms and to join networks seems to be limitless! I found this article and page by Behavioral Health Innovations Comparisons that seems to do a great job at comparing all that is available out there: https://www.telementalhealthcomparisons.com/private-practice
Legal considerations…
The legal considerations for Online or Tele-Therapy are vague at best. For the most part, and in most all states, they would only allow you to see clients that are also within your state when you are online with them. But there are some other legal dilemmas that are not so clear.
So here is a hypothetical situation: I am licensed in Tennessee. If I were to have an online session with a person in North Carolina who is meeting with me from their home in North Carolina and me in Tennessee, am I breaking North Carolina laws? Am I breaking Tennessee laws?
The problem of course is how can anyone or any state entity enforce this? After all, therapy is confidential. Where and how a therapist meets with their client is not going to necessarily be checked up on by State Boards unless there is a complaint filed. The other thing that is vague is would I be practicing my state or the other state? Again it is vague at best.
The other argument is that there are specific Federal Laws in place that prevent states from limiting Interstate Commerce. In other words, if I am providing a service within my state and I am licensed to do so by my state, the state cannot stop me from selling my services in another state. The particular reference for this would be The Sherman Antitrust Act, which was enacted to prevent monopolies says this:
“Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.”
Needless to say, all of this seems to be unclear and legally untested at this point. Most Counseling Associations, (ACA, AAMFT, APA, NASW, etc.) are allowing online or virtual therapy but indicate that clinicians must abide by state and local laws. Again vague at best.
As far as insurance coverage of online or virtual therapy, many insurance companies are starting to pay for this at the regular contracted rates. I would just check with that carrier to see if that is allowed.
So here are some tips for doing online therapy:
- Make sure you are using a secure HIPAA compliant platform to have sessions. Skype and Facetime are NOT a good option.
- Have specific disclosure and consent for treatment forms geared to online therapy that address some of the risks involved for the client. Such as: non-secure internet connections on their end and people being able to listen in on their sessions from their location.
- Check with your state to see what, if any, individual laws are in place around tele-health and tele=therapy. Here are a couple of resources that might be a good starting place: americantelemed.org and http://cchpca.org/state-laws-and-reimbursement-policies.
- Look at joining some of the online therapy professional organizations: http://www.adca-online.org/ or http://ismho.org/
- Be familiar with your own ethical codes for the professional organizations you are a member of.
- Finally, do what is in the best interest of the client.
L. Gordon Brewer, Jr., MEd., LMFT