Equipment
Use a laptop or desktop that is set up on a stable surface. If you need to use a mobile phone, turn off notifications and place mobile on a stable surface
Strong wifi connection; even better is consider plugging your computer/laptop directly into the modem. Do you have a backup option (4G for example) if your office/home internet goes down?
Software
Security issues vary between countries and regions, so please follow your local ethical guidelines
• Some free HIPAA compliant services in the US are VSee and Doxy.me
• Many electronic health records (EHR) will come with a secure video platform. For example, the one provided by Simple Practice.
• Google’s new version of Hangouts is called Meet and with a G Suite account you will receive additional security features (can be HIPAA compliant) - w/signed BAA
Setup - Creating the therapeutic space
Commit to the same place each session - gives clients consistency;
Provide a safe and private space and assure clients of continuity of confidentiality.
Limit distractions for yourself
Backdrop - Clutter-free environment behind you
Lighting - Well lit, natural light is preferred. Make sure you are not back-lit. Consider purchasing a ring light to ensure you have good lighting no matter what time of day you are working.
Facing the camera/screen front and center and maintaining eye contact possibly more than in in-person scenarios
Transferring What We Do In-Person to Online
Worksheets & Exercises - you can share your screen with a client in lieu of paperwork. Practice this ahead of time so you know how to do it when need be.
Downloads - add downloadable PDFs, audio files and videos to your website for clients to access
Consider using more relaxation, imagery exercises than usual. These transfer well to the online medium.
If you are new to video therapy, take the time to notice and unhook from what your own mind is telling you about this new medium - “it's not as effective”, “I can only do psychoeducation”, “I can't do any experiential exercises”. Still focus on doing ACT not just explaining ACT. It may take both you and the client a bit of time to adjust to the new medium, but follow your values and you`ll get there :) Instead of hugging clients, if you often do that, recommend them that they have a fluffy blanket at hand that they can hug themselves in when in need of soothing. Sounds weird, but it really works!
Marketing & Client Communications
If you`re transitioning with your clients from face to face to sessions via videoconference make sure you take the time to let them know and clarify any questions or misunderstandings that they may have prior to the first online session. It might be helpful to do this over the phone, in a short conversation.
State clearly from the beginning the online platform that you will use (Skype, Zoom, etc), and the method and time of payment.
Make it known on your website, professional social media page that you`re offering video therapy. You may even upload a short video of yourself to explain why you are choosing this method, and why it is important to you to provide your clients with continuity.
If you have an ongoing online advertising campaign, consider adapting it`s settings for the foreseeable future.
Coaching Clients New to Video Therapy
Defining a private space (possibly adding the use of headphones/earbuds to reduce noise). Make sure they do feel safe and that they can speak freely in the chosen space
Advise against - speaking from uncomfortable spaces - like the car.
• having distractions around them - pets, kids, smoking, eating during session, etc.
Advise clients to - use a laptop rather than a mobile phone or a tablet. It is very difficult to focus on a therapy session when talking on a small mobile screen. If they must use a mobile phone, ask them to turn off notifications
• make their space comfortable - cozy,, have tissues, glass of water or cup of tea.
Normalizing possible technical difficulties and coming up with back-up plans
Accepting Payments
Manual Credit Card entry via Square, Strip or Ivy Pay; Paypal, Revolut
Bill pay and ACH options through personal banks
Some platforms let the client agree to store the credit card for continued use
Further Reading & Resources:
Online tools for presenting the ACT matrix and zoom demonstration of their use, courtesy of Benjamin Schoendorff
https://youtu.be/tuLA9QsNEr8
https://contextpsy.box.com/v/onlinematrixtools
Lighting Concepts - article by Zoom
Making Eye Contact Over Video - article by Person Centered Tech
Backhaus, A., Agha., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorpe, N. M. (2012).
Videoconferencing Psychotherapy: A Systematic Review. Psychological Services, 9 (2), 111-131. DOI: 10.1037/a0027924 - https://www.ncbi.nlm.nih.gov/pubmed/22662727
Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. The Australasian Journal of Rural Health, 22, 280-299. https://www.ncbi.nlm.nih.gov/pubmed/25495622