By Ofer Zur, Ph.D.
Table Of Contents
Video conferencing, or what is often called Interactive Audio-Visual Technology (IAVT), is one of the most popular forms of communication in the 21st century. For those who may have utilized the telephone, email, and text messaging to communicate with clients across distances, IAVT appears to be a great advance. It allows participants in video conferencing to observe the subtle and sometimes not so subtle visual cues and body language that can be important in assuring accurate and effective communication between people. It is important to note that these visual cues are not the only cues in human interaction. Voice intonations, pauses, verbalization, and an intuitive sense of a person may be equally important, in general, or even more important to some people in certain situations or settings.
There is now a wide array of IAVT software options made to be not only HIPAA-secure, but also to provide the video, audio, and connection reliability that professionals need when performing telemental health services. Consumer products like Skype do not provide that quality.
To find the best option for you, we recommend going to Telemental Health Therapy Comparisons. For those who are moving into telemental health incrementally and prefer a free option, see this article on free and legally-ethically viable options.
The use of IAVT in telehealth and TeleMental Health (E-Counseling, Tele-Psychology) has proliferated similarly to the way it has become popular in the general public. IAVT in Tele-Psychology has been increasingly used for assessment, prevention and treatment of mental disorders, as well as for supervision and consultations. Many studies have supported the obvious, that the ability to establish and maintain the therapeutic alliance in mental health treatment provided via IAVT is comparable to in-person treatment. Young people, or those who have been called “Digital Natives,” have extensive experience and equal liking, not only for texting but also for video-conferencing type technologies. Obviously, their positive experience and attitudes towards video-conferencing technologies translate readily to using it in TeleMental Health or E-counseling.
When it comes to TeleMental Health, E-Counseling, or Tele-Psychology, IAVT offers tremendous advantages for working with those who are in remote areas with limited access to in-person services; those who are home-bound (e.g., those with agoraphobia or a physical disability); those in the LGBT community, who are reluctant to discuss their concerns with local psychotherapists or counselors; those in jails and prisons, where mobility of prisoners and access to care are surmountable problems; and those who need professional services outside usual business hours. Indeed, for some individuals in-person treatment may not be a possibility due to personal, physical, psychological, financial, or cultural issues, and IAVT may be a viable treatment option for them. Additionally, IAVT may prove especially helpful for communicating with in-person treatment clients between treatment sessions (such as in emergency situations and crises) as well as when a client may be away from the local area for a period of time, such as in the case of a business trip or vacation. For those clients who want to, or need to, continue regular contact with their psychotherapist, these technologies may provide the means to do so effectively. Then there are people who simply prefer the distance and control of the setting that is provided by video technologies in comparison to in-person meetings.
From the therapists’ point of view, video-conferencing enables them to work from home or anywhere else where they have a computer, laptop, smartphone, tablet and Internet Access. This is not only cheaper but also allows much more freedom and flexibility.
As with any technology, there are a number of concerns that have been associated with the use of IAVT in Telehealth and TeleMental Health. These issues include:
Confidentiality: Using video-conferencing as part of TeleMental Health, obviously raises a number of concerns around confidentiality. When psychotherapists, counselors and mental health providers use IAVT for treatment, prevention and assessment of mental disorders, concerns with privacy and confidentiality and related issues of encryption, access, storage, etc. are of high importance.
Crossing State Lines and Licensing Issues: Using video-conferencing technologies make it very easy to connect and communicate with people from all over the world. When providing telehealth services, psychotherapists and counselors must make an attempt to verify the location and residence of their clients, which is not always easy to do. When practicing across state lines, the mental health practitioners must find out the requirements of the applicable licensing boards in the jurisdictions where the client is and where the clinician resides and is licensed. Mental health professionals who provide services across state lines must also be familiar with all relevant laws and regulations in the state where the client is receiving the mental health services. Examples include laws relevant to reporting the suspicion of child abuse or neglect, similar laws regarding either the elderly or vulnerable adults, and laws relevant to dangerousness or threats to harm self or others. More information on crossing state lines considerations
HIPAA: As discussed in this article, it is important that clinicians ensure that an IAVT program they use is HIPAA-secure.
Informed Consent: Clinicians and administrators of telemental health services must realize that informed consent is a process; it is not merely a written document for the client to sign. It is essential that mental health professionals, who utilize IAVT to provide professional services to clients, employ an informed consent process to ensure that the client fully understands the risk and benefits of the services, how the use of IAVT may alter these services in comparison to in-person services, the options and alternatives available to the client, the relative risks and benefits of each type of treatment to include confidentiality issues, what to do if a technology failure occurs during an IAVT session, procedures for emergencies and crises, fees and financial arrangements, termination of professional services, and other relevant issues as outlined in each profession’s ethics code and licensing laws and regulations. The informed consent process may involve discussions, conversations and a written document to be signed. It should be addressed with clients at the outset of the professional relationship.
Competence and Scope of Practice: Psychotherapists must be competent in the use of the various technologies they use, including IAVT, and need to remain current on trends in the regulations of online services to include technological innovations, changing legal requirements, and ethical and legal issues. To achieve competence clinicians can use a variety of means, such as formal education, consultation, supervision, informal education, experience, and other methods. It is important to understand that in order for clinicians to achieve a reasonable level of competence or for telemental health to fall within their scope of practice, they do not need to take formal classes or show certificates of course completion. They can also teach themselves via reading, watching videos, and hands on experience.
Record Keeping: Keeping records of video-conferencing interactions between clients and clinicians is somewhat similar to any other form of client-therapist interactions. Basically, therapists may use standard forms that are sometimes provided by the telehealth platform or use more traditional clinical note taking. Obviously, recording video conferencing is technically much easier than recording face-to-face live therapy sessions. However, therapists who choose to record sessions must obtain client consent via conversation and consent form. Therapists must explain and disclose to clients the risks and benefit of such recording. Obviously, one of the biggest risks of recording therapy sessions is the unauthorized (and authorized) access by third parties. Therapists should have some clinical rationale suggesting or requesting such recording of video-conferencing sessions and weigh the potential clinical benefits against the risk to privacy and other risks.