You have questions:
Why are we even talking about video therapy?
What is online video therapy?
Does online video therapy work?
What are the risks of video therapy?
Who can benefit from online video therapy?
What do I need to know to get the most out of it?
So - let’s get to it:
1/ Why Are We Talking About Video Therapy?
At the time of first posting this (April 2020), I am working from home due to COVID-19 restrictions. This pandemic has caused sudden dramatic changes in my daily routine, who I spend my time with (or who I CAN’T see), and what I worry about during a typical day. Of course, what is now a “normal” day is not even close to life before COVID-19. It has been so long – it takes me a minute or two to remember what the inside of a Tim Hortons looks like. Now, with school classrooms shut down indefinitely, I find myself being required to come up with reasons for my early teen children why we can’t stay up all night and sleep all day.
Of course, in my profession, working in the area of mental health, I am aware that these changes are creating significant emotional problems. News reports are just beginning to describe some of the emotional strain being felt around the country and in many homes. Some of the common and the more serious problems include:
Mental anxiety and sleeplessness related to job, housing, and food insecurity.
Panic attacks and worry about being able to control yourself and your reactions.
Frontline workers paranoid about infection and risking the lives of family members at home.
Loneliness due to separation/isolation, being unable to give a hug or be hugged by a loved one.
Lack of structure or accountability leading to depression and problems related to food/diet, lack of exercise, and alcohol/substance use problems.
Being confined to a home in an abusive relationship.
And for some, grief with the loss of a loved one.
The worry of being unable to find toilet paper in the supermarket doesn’t go anywhere near the emotional fallout related to these issues.
As this pandemic hit, with resulting stay at home restrictions, everyone has been compelled to find new ways of connecting. Many of us have been forced to learn how to connect with Skype, Google Meets, Zoom, and other platforms. The current pandemic has not removed the need for psychotherapy. As you can see, it has increased our need for it. Due to the surge of people interested in connecting with a therapist by remote means, psychotherapists and psychologists have had to quickly retool their practices to offer online video therapy. And it seems that current technology is ready to serve when the practical reality of social distancing policies has compelled us to find new ways to engage in meaningful therapy.
Of course, you have more questions. Let’s get to them.
2/ What is Online Video Therapy?
Simply put, online video therapy uses an internet connection to connect with your therapist. Video therapy is also referred to as teletherapy, virtual therapy, e-counselling, and online therapy.
Video therapy permits you to do the following:
You connect face-to-face, so you see and talk to your therapist, live in a virtual therapy session.
You connect remotely from the convenience of your home or office using your computer/laptop camera and audio.
At the time of your scheduled appointment, you login online and your session with your therapist begins. Similar to traditional therapy, sessions are usually one hour long (note therapist speak: a 50-minute therapy session, leaving 10 minutes for notetaking between sessions).
There are alternate modes of video therapy:
The discussion in this post is about live therapy, face to face, albeit by means of technology, with a therapist licensed/registered to practice locally (your province or state).
There are other modes of therapy offered through technology. These are readily found in online searches. Perhaps that is how you found this post. Some of these options are offered by large providers centred perhaps in Canada but also in the United States.
The services may involve a fixed monthly fee for access to a therapist. Access may include a combination of text messaging (referred to as “asynchronous” communication), phone, and/or video interaction (the latter two referred to as “synchronous” communication) set at a prescribed limit depending on the service plan. The qualifications and certification of the actual therapist (or supervisee) contracted to communicate with you varies from service to service and the therapist may or may not be licensed/registered in your province.
In most jurisdictions, psychotherapy and psychological services are carefully regulated for consumer protection (your province or state), it would seem prudent to seek a therapist licensed to practice locally. This provides added protection to you as a consumer and perhaps even a bonus if the therapist has a local office practice where you can meet for in-person therapy when convenient, for example, when there are no socially distancing polices in place.
The video therapy discussed in this post refers to individual direct therapy provided in real time by a registered psychotherapist or psychologist licensed to practice in the jurisdiction where you reside (your province or state).
Interested in a technical definition? Video therapy is more broadly defined as a telehealth service. Telehealth involves the use of electronic communications to enable clinicians to connect with individuals using live interactive video and audio communications. This includes the practice of psychotherapy and psychological services delivery, diagnosis, consultation, treatment, referral to resources, education, and the transfer of medical and clinical data.
3/ Does Online Video Therapy Work?
Psychotherapy a transformational process that occurs in the context of a therapeutic relationship (a “connection”) between the client and the therapist. Humans are social beings. We all desire at least to some degree to be with, connect, and interact with other human beings. There is something special about being in the same room, the same space with another person to see the qualitative aspects of their presentation. This includes not only considering the content/meaning of speech, but also seeing facial expression, reading body language, and hearing changes in voice/speech. This unique shared space is the workspace where psychotherapy occurs. Some may argue that online video therapy degrades the quality of the psychotherapeutic process. Physical separation reduces the connection. Clients are not as engaged. However, it can be readily argued that online video therapy uses technology to reduce the physical distance, so that it is still possible to see facial expressions, read body language, and hear changes in voice/speech.
So again, the question – Does Online Video Therapy Work? Or better yet, how does online video therapy compare with traditional in-person therapy? This is not an academic review of the effectiveness of telepsychology interventions, although this is available. You simply want to know – Does It Work? I highlight three points to answer the question:
Compared to in-person psychotherapy, in popular use since the 1950s, video therapy is relatively new. However, the high-quality reliable studies completed thus far demonstrate that online video therapy is as effective as face-to-face in-person psychotherapy.
The research to date shows its effectiveness for a range of issues, i.e., helping with anxiety, depression, and PTSD.
Based on these findings, setting aside any personal preference you may have, psychotherapists, psychologists, and their clients can be assured that video therapy is as helpful as traditional in-person therapy.
So – yes it works!
4/ What are the Risks of Video Therapy?
The risks of online video therapy can be distilled into two categories. It should be noted that this responds to the question of risks about the use of this technology. This is not specifically about risks of psychotherapy. That is perhaps a separate discussion for a later post. These are essentially the two most prominent risks video therapy:
Technical Failures: Remote electronic communication is not 100 percent reliable due to a risk of technical failure. For example, poor internet connection, mechanical breakdown, and/or software malfunction may result in difficulty establishing communication, disrupt smooth/clear transmission of audio and video, and prematurely end your call.
Security/Privacy Violations: In modern technologically and ethically-informed psychotherapy practice, a) video and audio transmission is encrypted, b) content is not recorded and stored, and c) all reasonable steps are taken to minimize the risk of unauthorized third-party intrusions. However, the security and confidentiality of electronic communications cannot be guaranteed. With this risk noted, the videotherapy platform used by your therapist should comply with Canadian legislation, including the Personal Health Information Protection Act (PHIPA) and the Personal Information Protection and Electronic Documents Act (PIPEDA). (In the USA HIPAA and other Federal/State privacy laws would apply.)
5/ Who Can Benefit From Online Video Therapy?
As discussed above, there is something special about being in the same room with another person to see the qualitative aspects of their presentation. This is the unique workspace where psychotherapy occurs. However, there are circumstances when this in-person connection is not possible. Fortunately, given that this is an effective approach, we can opt for online video therapy with confidence. With this in mind, the following people can benefit from online video therapy:
Those required to keep a social distance due to the coronavirus (COVID-19). At the time of creating this post (April 2020), this includes everyone in Ontario with few exceptions.
Full-time employees/busy working professionals having difficulty creating time in their day to attend in-person.
Those residing in remote/rural areas without good therapeutic options.
Clients in large cities with long commute times and costly transit/parking fees.
People with conflicting work hours or those at home with children can schedule appointments outside of traditional office hours (for example, early morning, evenings, or weekends).
Some may be waiting for the current social distancing policy to end before seeking help for their emotional struggles. Given access to this technology and what we know about its effectiveness – why not try it?
6/ What Do I Need to Know to Get the Most Out of Online Video Therapy?
You should be aware of or take the following steps to get the most out of online video therapy:
Test in advance that you have high speed internet access and a computer, tablet, laptop, or smartphone with a working video camera, microphone, and speakers. This is relatively straightforward as most of us have access to such a device.
Headphones are recommended to improve audio quality, minimize distractions, and reduce risks of eavesdropping.
You should be located in a quiet, private space that is free of distractions, when participating in sessions. The confidential nature of the session should be considered in the context potentially thin walls, location of session, or family members/roommates passing by.
Your therapist will begin your session by confirming a backup plan, that is, continuing the session via telephone, in the event that internet-based video/audio services are interrupted.
As an important part of standard practice, you will be asked to confirm your identity by showing some form of photo ID.
Video Therapy session fees are the same as they would be for in-person sessions. Fees/insurance coverage questions are discussed at intake or in the first session. Payment is typically made with credit card or via etransfer at the end of each session. Check with your insurance provider to confirm that video therapy services are covered.
In an emergency or crisis, such as risk of suicide or harm to someone else, remote video therapy is not a suitable approach. In an emergency, you should immediately call 911 or seek help from a hospital or crisis-oriented health care facility in your area.
Tell Me - Did I Answer Your Questions?
I have attempted to answer the common questions related to online video therapy. If you are in Ontario, Canda, I invite you to connect with a therapist at our clinic, Advance Health, using live online secure video (videotherapy). If new to you - TRY IT!
If you have a reaction to the discussion above – I will be curious to read your comments below.
Dr. Ralph Lubbers, Psychologist
Disclaimer: The content of this post should not be considered professional mental health, medical, technical, or legal advice. You should consult with your mental healthcare provider or other professional for specific questions concerning you personally.