When first starting telepsychology, I wasn’t sure what to expect. Is the process of informed consent the same? Should I write my notes differently? Will I still be able to form genuine connections with my patients? How would I manage a crisis? Because this was unfamiliar territory for me I honestly questioned if it was even worth exploring. Spoiler alert: It was worth it.
I started by educating myself. I examined current research on telehealth and telepsychology. I talked to colleagues who had been practicing with these technologies. I met patients who shared their firsthand accounts of video-based care. Practically all reviews were positive.
Next I started working on logistics. I familiarized myself with APA’s Guidelines for the Practice of Telepsychology. I obtained a webcam and did a few test calls with peers. I downloaded sample forms such as Informed Consent for Telepsychology from the Document Library of The Trust. I reviewed some basic netiquette and I scheduled my first patient.
So, what are the main ways I have acclimated to telepsychology?
Communicating the nature, risks and benefits and expected outcomes of mental health services to patients is part of psychologists’ standard practice of care. In a digital environment some additional elements to consider include:
- Limits of telepsychology across state lines (i.e. only -providing services to patients in states where the psychologist is licensed)
- Technical glitches (i.e. what to do when technology does not work properly)
- Confidentiality (i.e. associated risk of electronic communications and steps to mitigate risk)
- Communication (i.e. expectations regarding preferred method of contact such as phone, email, secure messaging, etc.)
- Emergency response plan (i.e. how to handle a crisis when the patient and provider are in different locations)
Outlining these and other important elements at the outset of therapy clarifies expectations and helps protect both the patient and the psychologist.
In addition to my standard practice of documentation, in every telepsychology note I add:
- The patient’s physical address/location
- Whether anyone else is present in the environment (i.e. spouse in another room, etc).
- Name and phone number of local police department based on patient’s location (in case of emergency)
Connection with Patients
I tend to look at the camera when I talk and look at the patient (i.e. screen) when they talk. This is a personal preference but can contribute to a better sense of connection. I also ensure that I have a clean, neutral background that doesn’t feel distracting. Related to this, I also make sure the environment I am working in is quiet and private. This is clearly not the time to set up at a local coffee shop or have your kids running around the house. Just because you aren’t in an office doesn’t mean the rules regarding professionalism change.
According to a 2014 publication in The Australian Journal of Rural Health, research on therapeutic alliance has actually showed some advantage in telepsychology with regard to patient’s feeling more comfortable engaging from the environment of their choosing (i.e. home, etc) versus coming into a clinic or office. There is even evidence to support improved performance by psychologists who receive constant live feedback from self-view. Just because telepsychology may be less familiar doesn’t mean it’s less effective. In fact, telepsychology has already enhanced care in many ways.
When it comes to managing a crisis, there are many variables to consider. A common crisis scenario that often comes to mind is suicidal ideation and/or intent. When we determine that a patient is in imminent danger and should be hospitalized, how is that handled when you and the patient are in separate locations? This is when having the name and phone number of the local police department based on patient’s location is critical. Remember that calling 911 would not suffice because 911 will connect to the psychologist’s location, not the patients. Similarly, if a patient has a medical emergency during a live appointment, knowing where to call for emergency response is critical. Having these conversations at the beginning of treatment and accurately documenting the patient’s location every session can decrease uncertainty and increase proper intervention when the need arises.
Today telepsychology feels second-nature to me. It took a bit of acclimating initially, but now I can’t imagine the profession without it. I increasingly find that patients actually prefer telepsychology when given the option of in-person care versus video interface. By expanding access to treatment and producing a comfortable therapeutic environment, I am excited about this option for service delivery and feel fortunate to utilize technology in this vital way.