What is teletherapy?

You may have already heard quite a bit about teletherapy through references to other terms, such as: "telehealth," "telepsychology," "telemental health," "telebehavioral health"... the list goes on!

In a nutshell, teletherapy is the virtual provision of therapy services using digital communication technology, such as mobile devices or videoconferencing software. It allows the provider and client to work together without needing to be in the same physical location. The content discussed during a teletherapy session is generally the same as an in-person, office-based session. While the method for how care is delivered looks different, mental health providers are still expected to uphold the same standards of care that are required when providing in-person psychological services. Research has shown that teletherapy can be just as effective as in-person therapy. At the same time, there are special considerations for teletherapy related to technology usage and privacy and security, which are discussed further below.

Is teletherapy private and secure?

Let's start with a quick intro to the Health Insurance Portability and Accountability Act (HIPAA): Passed in 1996, HIPAA is a federal law that established national standards for the safekeeping of sensitive patient health information. Information such as demographic details, medical histories, mental health diagnoses, treatment plans, and insurance data are considered protected health information (PHI) under HIPAA. Healthcare providers are considered "HIPAA-compliant" and healthcare technology is "HIPAA-secure" when these standards are met.

I use only HIPAA-secure technology in my virtual practice and regularly pursue education and trainings to ensure that I am using this technology in a HIPAA-compliant way and staying up-to-date with any new developments. I conduct all of my sessions from my home office and always aim to keep quiet, private, and secure surroundings during live video and phone calls.

As a client, the actions that you take on your end can have an impact on privacy and security too. To help promote a more positive experience with virtual sessions, I have listed below some considerations for you to keep in mind.

As a client, what should I consider in preparation for a teletherapy session?

Do you have a private, secure space?

• Situate yourself in a room or space where other people are not present and cannot overhear the conversation. If there is a door to this room or space, close and lock it. If this is not possible, without necessarily disclosing that you are in therapy (unless you feel comfortable doing so), you may also try communicating to others that privacy is needed so they avoid interrupting you or entering your space during your appointment time.

• Use earbuds or headphones and/or background noise (e.g., electric fan, white noise machine) to minimize the chances of others overhearing the conversation. Try to minimize other background noise that could be distracting, such as turning off the television or closing a window to block out loud traffic.

• If you choose to attend a virtual session from your car, please make sure that you are parked in a private, safe spot. I do not conduct sessions while clients are actively driving for your own safety.

How's your technical setup?

• You will need at least one of the following devices: desktop computer; laptop; tablet; or smartphone. Whichever device you choose, check to see that it has a functional webcam and microphone.

• I recommend using a desktop or laptop for comfort and ease. Try to get your webcam as close to eye-level as possible; this can help us interact more naturally and help reduce eye and muscle strain. If you prefer using your smartphone or tablet, consider propping up your device in a way that is comfortable and stable for the duration of your 45-minute appointment.

• Consider the lighting during your video call. Try seating yourself in a way so you are not backlit by a bright light directly behind you. This will help me see your face more clearly!

How's your internet connection?

• You can check the speed and performance of your internet connection using FAST.com. Contact your internet service provider if you're not getting the speeds that you're paying for or are experiencing issues maintaining a fast, reliable connection.

• Limit the number of devices connected to your WiFi. Close all browser tabs/programs/apps on your device that are not necessary for your appointment. These running in the background may interfere with video/audio quality since they are drawing from the same internet connection and your device's limited processing power.

• Try connecting your device directly to your router with an Ethernet cable if possible. If not, try moving your device as close to the router as possible when using WiFi.

• Secure your router by updating the software and adjusting the security settings. If you are unfamiliar with how to do this, a simple internet search will yield many helpful how-to articles.

• If you are using a smartphone or cellular-enabled tablet, you may experience better performance using your WiFi rather than cellular data. Using WiFi will also help prevent you from exceeding the limit of your data plan.

Can I attend my teletherapy session from anywhere?

Not quite. As a Massachusetts-licensed psychologist, I must follow the policies and guidelines of the Massachusetts Board of Psychologists, which state that "the practice of psychology occurs where the patient/client who is receiving the services is physically located at the time of service." This means that if you are my client and you are going to have a session with me, you must be physically located in the state of Massachusetts.

As rapidly as health technology has evolved over the recent years and made care more easily accessible and convenient, our federal and state laws are evolving on a different timeline. There is exciting work being done to close the gap between these two fields and one day (hopefully in the near future!), they may align more closely with one another.

If you are an existing client and have plans to travel temporarily out-of-state in the near future and are worried about how this might interrupt our work in therapy together, please let me know in advance. Each state has its own psychology licensing board with its respective policies and regulations regarding the practice of psychology across state lines. With advanced notice, I may be able to look into the other state's policies or inquire with their psychology licensing board regarding what is permitted in their jurisdiction.