From a practical sense, virtual therapy requires the following things: a computer, an Internet connection, a webcam, a headset or speakers, and a videoconferencing application. To be HIPAA compliant, you need full encryption and data protection as well. But the nuts and bolts of virtual therapy are fairly modest for all of its 22nd Century, Science Fiction aura.
Did you know, though, that the most critical part of virtual therapy has nothing to do with technology? Sounds like a contradiction, yes. Before I explain, let me share an experience: I was once contacted by an individual who was interested in virtual therapy via video conferencing. We lived in different cities, too far apart to see each other regularly for in-office sessions. As part of the discovery process, we talked about his needs, my credentials and experience, and about his support network. In order to work with him, I felt it was necessary that he have additional local support in addition to the individual therapy sessions with me. He reported he experienced severe depression with occasional suicidal thoughts (no reported plan at the time of the interview) and was not under a physician’s care for medicine management. I asked him, “Are you willing to be seen by your physician” His reply was no. “Do you have family who will support you as you begin therapy?” The answer was a negative; he wasn’t willing to reach out to his family. “What about local groups, associates or a capable friend that you can rely on and talk with?” Yet again, the answer was negative.
As a long-time clinician, I have come to depend on the clinical evaluation process that includes identifying the client’s current issues; level of care i.e. is this client appropriate for outpatient individual care, and possible additional therapeutic and personal support systems to support the needs of a recovery process in a safe and ethical manner. This is true whether the client is local or at a distance. In this case, I declined to accept this individual as a client because I didn’t feel like he would have adequate support in place once we started the therapeutic process; it was my recommendation that he arrange to meet with a local practitioner who could provide regular face-to-face support. Each clinician has to evaluate their skills and comfort level when working with a client locally or at a distance.
When you provide therapeutic support via video conferencing, the most important component, as I’ve said, has nothing to do with technology and everything to do with your clinical abilities and embracing your professional ethics and standard of care. I strongly recommend that my clients use local support systems where they reside—family or friends, a therapeutic group or a medical physician. Get releases signed by the client and work with those local support systems to develop a coordinated treatment plan. A support network can make all the difference as you expand your practice to leverage technology in the virtual environment!
– Martha H. Ireland PhD, RN, CS, CEDS