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8 Tips for Online Therapy

8 Tips for Online Therapy

If you have questions about best practices for online therapy as a clinician, a client/patient, or even as a person who is now forced to have teleconference sessions from home, this guide should be helpful to you.

Video conferencing software

  • Since HIPAA has gone out the window, my advice on this is to find a platform (I suggest Google Meet) and one backup (I recommend a phone call if the video fails) to standardize in advance. Why standardize on one? It helps you to feel like you aren’t juggling as much (“Wait, were we meeting on FaceTime, Skype, Zoom, SimplePractice, Theranest or Doxy.me?”). Sure, some switching may be unavoidable, if you can get used to one system, it will go a long way to help you to make this transition more seamless. 
  • Understand there may be some learning curve that comes with learning a new system, but give it time and go to back up systems if needed and again, establish that before your call.
  • You may also need to teach clients about how to use this platform as well. Make sure you both have your camera and microphone enabled. Think about the other issues mentioned below. If there are technical issues with a computer, have them move to their smartphone, have them participate with Google Meet through the call in number, or just have them call you.
  • Look at the training videos for the video software you are using and try it with someone before trying it with a client.

Think about privacy

  • Would it be better to take a phone call while walking?
  • Could you put an Alexa dot by your door and use a “white noise” or “washing machine sounds” skill to add privacy?
  • Could you take a call in your car or closet?
  • Can you use headphones?

WiFi related

  • WiFi can be tricky. If you are a techie at all, use an app to create a WiFi heat map (AndroidiOS) of your home so you can see the strong and weak areas of your home WiFi signals. If you have a lot of competing devices, maybe look at Wirecutter’s Mesh WiFi suggestions. One other note, keep in mind that any walls that have pipes in them will decrease your WiFi signal (laundry room, bathroom, kitchen, etc).
  • If you can directly connect to your modem, you may eliminate your problems.
  • If you don’t direct-connect, go in the same room as your router and set up there or put a signal repeater within range of the base unit to help extend your network.
  • Remember, everything that is on your network and active is all competing at the same time. Most systems function like a bustling four-way stop. With everyone having kids on smartphones, smart outlets, Alexa or Google Home, smart TV’s, tablets, computers, connected alarms, cameras, garage door openers, water heaters, smoke alarms, watches, Kindles, Xbox, etc. Not that all of these are all competing at the exact same time, but you can see how things can back up. Many older wireless routers were designed with the needs of that time. Thus, they aren’t able to handle a bunch of concurrent connections with a large number of devices. It becomes like trying to hear someone in a busy restaurant. If you have a busy network, you might want to think about updating to a newer one that does better with this. Wirecutter has helpful articles on Mesh WiFi systems that might help you.
  • Cable company routers that also have WiFi built-in are frequently old and typically not worth it (plus many of them have an additional monthly cost with no benefit). If you really know nothing about modems and WiFi, it might be worth a call to your cable company to see if you are eligible for an upgrade.

Equipment

  • Battery life – If you do a lot of video calls, you are probably familiar with the basics. You need to make sure you can plug in your devices as video calls will chew up battery life quickly. So, keep that in mind as you set up your new work from home space.
  • Test your microphone and camera before starting to make calls with someone to troubleshoot issues before you have to make calls.
  • Tripods can be helpful if you are using a tablet or smartphone for video. It helps to keep you at eye level if you aren’t using a laptop. If you don’t have a computer or a tripod, books can help accomplish the same goal to get to eye level. *Note, if you are using books with a tablet or smartphone, make sure you aren’t partially covering your microphone as it’s normally on the bottom of the device.
  • Camera quality – You might want to compare how the video looks from different devices as, depending on the age of your computer, the camera quality can vary a good bit. Test in your own home between two devices or with someone and see what you notice.
  • Audio source – I love my AirPods, but I am also keenly aware that they are not the best to use for back to back calls as their battery life is not great for this. AirPods last 1.5 hours, but they do recharge quickly. If you have 50-minute calls and have 15 minutes between sessions, then they can charge to 80% in that time. You might look at alternatives like Bluetooth headphones. They can help to make your calls feel more private and intimate. Also, wired connections are not a bad idea since they do the same thing and help to deal with battery life concerns.
  • Lighting – You don’t want to look like you are taking calls in a dungeon, and this is another one of those things you need to try different things. What you think looks best ordinarily in your home environment may look very dark, or it may be too bright. You are going to want to try different things like closing all your windows and turning on your overhead lights, letting some light in but not all of it, so it doesn’t wash you out. Use a lighting source that helps to focus its light on your face. This might seem ridiculous, but it allows people to feel more connected to you as the production values are better. 

Backgrounds

  • Think about what you want your background to be during calls. It may be that we are stuck unavoidably taking some calls in our closet or car, but look to see what you can do to improve this. Can you find a better place or do anything to improve your environment? I saw one therapist who added lighting and nailed some pictures to the inside of their closet to make it feel/look more comfortable and allowed them to have privacy.

Incall tips

  • When on a video call, it can be helpful to look directly at the camera, so you maintain eye contact. One thing that can help is putting a Post-It note near your camera as a reminder or even have notes for the session there.
  • Have people write things down, or you can even use markers and paper and create illustrations or write down points yourself to help illustrate points.
  • Hand signals might be helpful. Since there can be a delay in audio and video between people talking, and it can result in people talking over one another and points not being communicated. Due to this, notice what helps the flow of conversation. One thing I have found helpful is when someone is talking, and I can raise a finger when I want to slow them down to reframe something. In some ways, there are overlaps between effective video communication and what can happen in group communication. Note that.

Animals & Family

  • Quick story – I love our cat and our dog. That said, they both seem to instantly change their schedule for the day when a video call is initiated. Our cat will suddenly become attentive and want to walk in front of the camera or become strangely loving. Our dog will decide now is the perfect time for a walk or to bark. My guess is it’s something about the audio tones that trigger a change in behavior but just know this and try to plan around it as best you can. This may mean taking your dog on more regular walks and doing some training to wear them out. For cats, you could get/create some unique toys that you break out when in session, or you could wear them out before video calls (this is also a good job for kids). You could also just lock them out of your session area if that’s possible. I know this is even more challenging with kids, and that may mean you just have to be creative with picking a work area, setting communications and plans (when the sign is on the door, you can’t come in), etc. Everyone is struggling with this right now but get creative and reach out to friends for ideas.

Snafus

  • Inevitably this will happen, but being aware of the potential for it can help. If you are screen sharing, make sure of what you have up, so you don’t accidentally show something you don’t intend to personally or professionally (email or otherwise). Similarly, be ready for your meetings to start so you don’t accidentally have it start before you are prepared.
  • Eliminate distractions like text messages popping up, notifications, chats, new email, etc. 

If you have additional thoughts or suggestions, tweet us @justmind to let us know and we will add them. 

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