What is Video-Therapy / Video-Psychology?
Video-therapy or video-psychology is the use of video streamed over the internet to provide psychological counselling. Video-therapy falls under the umbrella of TeleHealth. Video therapy allows the therapist and client to see each other. This is important as it allows the counsellor to see the client’s non-verbal signals. Psychological counselling is hard, and many people have an instinct, or have learned the hard way, to hide their feelings. So they will say that they are “ok” when they are not. Video-therapy allows the clinician to see the client’s non-verbals. This is important as it can help the therapist to know when they need to push a bit to help shift the client in the therapeutic process, or when it might be better to move into a more supportive and “holding” approach while the client struggles with an emotion or thought.
Along with the clinician seeing the client’s non-verbals, the client can see the clinician. This is important because then the client knows the therapist is focused entirely on them. Having that 1:1 or, in couples therapy the 1:2 focus is incredibly powerful. For clients who feel ‘unseen’ or ‘unvalued’, just the awareness that someone is truly looking at them and listening to them can be incredibly affirming. For clients who are more anxious at ‘being seen’ because their life experience has taught them that being noticed means that they could be harmed, video-therapy provides a means to receive treatment without triggering the fear response that the person seeing them is close enough to harm them. Video-therapy allows people who struggle anxiety around interpersonal safety to address this anxiety in a more gradual way than what would be required during an in-person 1:1 session.
IS VIDEO-THERAPY SAFE? CONFIDENTIAL?
A variety of services can be used to provide video-therapy or video-psychology. Services developed to provide TeleHealth meet strict standards as outlined in the Health Information Act of Alberta (HIA) or what is also known as the Health Insurance Portability and Accountability Act in the United States (HIPPA). While these acts detail many requirements around the collection and management of health information, a key section concerns the security of client data. This could include clinical notes, test results, diagnostic reports and so on. HIA also speaks to how information can be transmitted. For video communication or video-therapy, HIA requires that the video be encrypted to a certain standard, and that there is no ‘back door’ that the manufacturer, government or other agency could use to ‘listen’ or ‘watch in’ with or without the client knowledge. Baseline and some paid versions of Skype, FaceTime, WeChat, GoogleChat and most other video services do not meet this standard. While some terms of service for these video chat systems will tell you that they do not guarantee privacy, other companies just avoid disclosing their low security approach.
HIA compliant video-therapy services are explicitly designed to maintain client confidentiality. This is important, in the same way that knowing no-one in the waiting room can overhear you talking in your therapists office is important. Most people would not feel comfortable thinking that a Microsoft employee could, on a whim, tap into your therapy session, listen and record it (which is possible and legal if you use Skype, and part of the Terms of Service that have to be agreed to in order to use the service) and then share that information with others if they chose.
While therapists may ask to record therapy sessions for a variety of reasons (i.e. for later review, as part of a training/supervision process for the therapist, as a therapeutic tool for the client to see how they interact or ‘come across’…), HIA compliant video-therapy sessions are designed to ensure the client knows if the session is being recorded. Non-HIA complaint video systems may include a recording feature (video or audio) that the client is never aware of, or never knows if it has been turned on. Storage, usage, and ways to destroy video or audio recordings of video-therapy sessions is closely regulated in HIA/HIPPA. And, of course, as part of informed consent, the therapist always fully informs the client of the purpose of the recording, how the recording would be used, stored, and if/when and how it will be destroyed.
If you decide to use video-therapy or video-psychology services, it is always a good idea to ask what service is being used, and if it is HIA compliant. If the therapist will not tell you, or does not know, that may be a warning flag about commitment to confidentiality. All HIA/HIPPA compliant video-therapy services make a point of detailing this feature on their main webpage as it is a source of pride for the software developer, while adding considerable value to their product. Some examples of HIA compliant services are: Doxy.me, Zoom, SimplePractice, and others.
You may notice your therapist looking away from you during the session to take notes. This is standard practice in counselling. The notes allow the therapist to track goals, challenges, progress, and outcomes. Clinicians often review notes between sessions to ensure they are on track with the client and not missing important elements that need to be revisited. Video-therapy / video-psychology notes are treated the same way as in session notes. They must be stored according to HIA/HIPPA standards. And, as always, therapists cannot discus the events of a video-therapy session with others without the client’s consent.
HOW DOES VIDEO-THERAPY / VIDEO-PSYCHOLOGY WORK?
Video-therapy or video-psychology is similar in many ways to in-person counselling. You can see and hear the therapist in real time, and the therapist can see and hear you. Many of the same therapy techniques can be used in video-therapy. How effective they are depends on many factors (i.e. clinician training and skill, client-clinician fit, client engagement/desire for change…) that would be the same for an in-person session. Some therapy approaches are not safe to use via video-therapy such as hypnosis. Hypnosis deliberately puts the client in an altered state, and if the client were to dissociate or flashback into trauma scenario, not having the therapist in the room could make it very difficult to bring the client back into current reality. Other therapy approaches are less effective or harder to implement via video-therapy for technological reasons (i.e. trying to fit a couple who doesn’t want to sit next to each other in a couples counselling session into the camera viewfinder for the therapist to see both of them) or for therapeutic reasons (i.e. the screen can make emotionally connecting and being emotionally present with the client harder for the clinician). Good video-therapists are skilled and experienced in online therapy, and are better equipped to help clients overcome these challenges. If though, you or your therapist ever feel the format is not working for treatment, or is inappropriate, it is always important to discuss this to identify alternate treatment solutions.
A typical video-therapy session will begin with the therapist sending a text or email link to the client. Clicking on this link allows the client to log into a virtual waiting room. When the therapy appointment is to begin, the therapist will invite the client into a virtual therapy room, where the client and therapist can see each other.
Just as in an in-person session, in the first video-therapy session the therapist will go through Informed Consent. Once that is completed most therapists will move into asking the client why they came for counselling, gather a history, and develop a treatment plan with the client. Through these steps the work of therapy begins. At the end of session (or for some clinicians at the beginning) the client and clinician will address payment and rebooking options.