Tele-Therapy with CloserCouples

Help to get you started, by Suzanne Pratt

Suzanne Pratt I wrote this to welcome you to Tele-Therapy! I want you to know that it is with a great deal of deliberation that I’ve decided to offer this format because there are certain features which make it worth the learning curve. I’d like to acquaint you with the particulars of how I approach teletherapy and answer questions many of my clients have when considering this format.

 

 

 
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What is tele-therapy?
Teletherapy is defined as any type of communication with a client via a third-party platform where counseling is provided virtually, without being in person or face-to-face.

What platform service do you use?
When it becomes necessary to switch from personal to virtual therapy, I am testing a platform called VSee for my clients. I chose it primarily because it is HIPAA compliant, and privacy and confidentiality are the cornerstone of any good therapeutic alliance. I also like it for my users because even though I must be at a desktop, my clients can join from anywhere by smartphone. Once we are established clients, I will send you an invitation to join. Please let me know how your feel about the experience with the software because it’s for you!

Why not use the applications I already have?
Many people ask whether they can use Skype or FaceTime. While these may be relatively secure it isn’t possible for me to obtain a Business Associates Agreement with those entities. A BAA guarantees that my communication with you is encrypted and secure, and VSee offers this. Zoom does have a HIPAA compliant version, but it is designed for large working groups and is therefore quite expensive for a solo practitioner like me.

Why should I download the software if we’re going to meet in person?
Even if we are scheduled for an in-person therapy, please consider downloading the VSee Clinic app on your smartphone or type this URL into your browser https://suzanne-pratt.vsee.me/u/clinic so that we can be in touch easily if it becomes suddenly necessary. You will need a code for my virtual waiting room; once you are an established client, I will give this to you.

Should I create an alias for my account?
No, please make obvious your identity when we meet by using your real name and email address in your teletherapy (VSee) registration. Your information will be encrypted into the software and secure there. And I will need to look you up with the name I know you by.

How do I overcome technical problems?
Please register and log in before our first virtual meeting, so I might help you if you have any problems. We can test that your microphone, speakers, and video are all working. I have an upgraded version and can get help for us immediately if necessary. It takes a few seconds after you log into the waiting room for us to show up on each other’s screens. That’s normal. If it seems to be taking an inordinate amount of time, feel free to text, email, or call me so that we can troubleshoot together.

What else should I keep in mind?
Please be sure to EXIT out of any programs that steal bandwidth prior to our sessions. QUIT (don’t just minimize) Skype, Carbonite, Google drive back up, or any other cloud backup service. Please ensure that no one in your home is streaming video or playing graphic heavy online video games as this will decrease our internet connection. Technical issues are rare and usually very easy to solve. Turning things off and back on again typically fixes most issues. If for some reason we are unable to connect with the VSee platform, please call me immediately at (801) 484-8838 and we will resume the session by telephone.

Tips for Online Therapy
  • If others will be nearby while you are in therapy, ensure that you have adequate privacy prior to session. Psychotherapy is serious work. You do not want to be interrupted.

  • Turn off notifications on your computer and phone once we are connected.

  • Bring tissues.

  • Research says that the connection between therapist and client is the primary determinant of therapeutic change. I want to make sure that we connect well over video so in our first session, I’ll share some tricks to make sure that we can look at each other, rather than the camera, when we talk. If it looks off to you, please let me know. Eye contact matters.

Why would I want to do therapy this way?
Teletherapy sessions have some advantages over in-person psychotherapy. Once we become accustomed to this way of working, it is possible that we’ll hardly notice an appreciable difference in the therapy. As AI improves, the immersive experience of being together will make it feel more and more as if we are together in the same room.
  • Convenience (no commute, saves time)

  • Comfort (of home, in your familiar surroundings)

  • Continuity (we may keep meeting even if I am away from the office/out of state)

  • Less expensive (no transportation, parking or babysitter costs)

  • Safer (e.g. medical isolation/quarantine conditions/accessibility issues)

  • Simpler Scheduling (busy couples can meet me and all three of us can be in different physical places)

  • Some clients share that they feel more able to share “deep” things because it is online rather than in person.

Why would I not want to do therapy this way?
Teletherapy is not for everyone. Let’s not meet this way if you have:
  • Poor internet connection
  • No private space to meet
  • Unsafe home life
For some there is simply a higher degree of comfort with meeting in person, so we may decide to postpone our work until we can return to in-person sessions. Please notify me about any concerns you might have.

Can tele-therapy be adapted for couple’s work?
Most couples work can be adapted to a teletherapy format. I may need to ask you to be especially receptive and collaborative as we adapt our work to this model. Just as happens in the office, my interventions are only as useful as your willingness to implement them. I may modify, or even pause our work until we can return to an in-person format if I feel I cannot help you tele-therapeutically.

Can we do teletherapy if I’m suddenly experiencing a crisis?
No. I do not provide 24-hour crisis services. If a life-threatening crisis should occur, contact a crisis hotline, call 911, or go to a hospital emergency room. As an individual provider who is not in a group practice, I am generally in a therapy session during working hours and am unavailable outside of working hours. If it is likely that you may need crisis support, let’s discuss this so that I can be sure you have the level of care you need. You deserve support that matches your needs.

I live outside of Utah. Can we work across state lines?
Online therapy allows me to provide services to a broader geographic range of clients than in-person services. I can provide services to clients in states where I am licensed. I am licensed in Utah and South Carolina and serve clients in both states. I’m unable to provide therapy to clients in states in which I am not licensed. I anticipate licensure soon in other states as well.

Can I participate from my office or car?
Yes, so long as your location is safe and private. Should you enter a medical or psychological emergency, I need to know your actual physical location so that I am able to get help to you. Please share the actual physical address (street number/address/city and zip code) or drop me a pin from your cell phone if you’re somewhere different from your usual address. Should you need physical or emotional assistance (e.g. approaching a psychological emergency but not at the threshold of needing to be hospitalized or feeling dizzy but not in need of an ambulance), I would like to be able to contact someone to assist you. There is a place on our agreement where you can provide this to me.

Where will you be during the session, Suzanne?
Tele-therapy will be conducted from my office. If I am traveling the call will be from a private conference room or similar location where I have a secure channel of communication between our devices. I will not provide teletherapy with you from a coffee shop or public place.

What are the most confidential ways we can communicate, besides in person?
I have the following HIPAA-compliant accounts:
  • GSuite email (pratt@closercouples.com)
  • HushMail (pratt@counselingsecure.com
  • VSee Clinic (https://suzanne-pratt.vsee.me/u/clinic with room code GYIE4)
  • Signal https://signal.org/ I’m at (801) 484-8838.
  • Square (payments/invoicing)
I have Business Associates Agreements with all of these to ensure that they keep your information kept private. If you do not also use these secure/encrypted programs on your side of the communication, the communications may not be secure. Some clients appreciate the convenience of having links or confirmations exchanged over text or email, being able to receive and pay invoices on other platforms, & so on. If you initiate such communication through a less secure platform, you are opting in according to the HIPAA Omnibus Rule. Security laws state that clients have the freedom to request or opt in to less secure means of communication if they are aware of the risks, comfortable with them, and find it clinically helpful to do so.

While I regularly check in on the security of all of our ways of communicating, swift advances in technology preclude my ability to be certain of our security. Just as I cannot guarantee a physical office space isn’t broken into, I also cannot guarantee the absolute security of our work online.

Please ensure that you, too, are doing your utmost to protect your privacy by considering who has access to your email, text messages, and so on before choosing online therapy. For example, I would discourage you from using your work email for our communications. Another way to protect your privacy is to be sure to fully exit all online counseling sessions and emails before leaving your computer.

As a therapist who has been a proponent for a long time of only doing therapy in person, this transition has been very deliberate and, I’ll admit, emotional! However, in terms of “least harm,” it makes sense that we have a way to stay in touch if meeting in person isn’t feasible. Please reach out with any questions you may have. We are learning how to do this together!