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Shainnaupdatedpic Apr 30, 2020

Counseling in the time of COVID-19: Tips to help clinicians transition to telemental health (part 1)

Within the last decade, telemental health has been utilized to meet client needs by improving convenience and accessibility to quality care.  Also known as telebehavioral health, distance counseling, or virtual counseling, this serve generally utilizes a digital platform to provide synchronous “secure, encrypted, audio-video conferencing” to provide services to clients. Historically, this service has been used to fill the gap in case for individuals who could not leave their home, worked unconventional hours, or lived in remote areas. Studies have shown that well-designed remote services can enhance satisfaction, improve access and outcomes, be utilized for a variety of populations and disorders & be just as effective as in-person therapy. As a result of COVID-19, many providers have swiftly transitioned to offering online therapy in order to help individuals continue to foster their mental well-being while abiding by social distancing guidelines and flattening the curve. While these sessions can provide benefits to care, utilizing an online platform for counseling does come with unique considerations, especially in the current climate in which many are transitioning quickly to remote services.

If you are beginning to offer virtual counseling at this time, I hope that these learned lessons can help to help you ease your transition. In this first article of a 3-part series I will share a few things that may be helpful to consider before your offering telemental health sessions.

Review ethical standards, legal guidelines, and relevant training

Many counselors were not trained in best practice methods for providing online counseling; however, it is our ethical mandate to be aware and informed about these standards, especially when we are implementing virtual sessions into our practice.

Be sure to familiarize yourself with legal and ethical policies as they pertain to distance counseling such as (1) protecting confidentiality, (2) updating the informed consent, and (3) following state and federal guidelines. In the time of COVID many states have adjusted their policies to allow for continued services. However, be mindful that abiding by strong ethical standards can help you to best help your clients during this time. For example, while many HIPAA regulations have been adjusted, it does not mean that you should not still seek to utilize a platform that still supports standard HIIPA guidelines if possible.

To learn more about state guidelines during COVID use this helpful list compiled by the American Counseling Association.

To learn more about ethical considerations during COVID check out ACA’s free continuing education opportunity for April.

Curate Your Virtual Office

Before you begin to offer telemental health sessions, be sure to prepare your virtual office. Perhaps some things may carry over, but your essentials may differ a bit. You still need to secure a quiet, confidential space, however, now you may also need to assure that you have a sufficient high-speed connection, a dependable device to connect to the internet, a secure videoconferencing platform, a high-resolution camera, and potentially a microphone and headphones as well.

It’s helpful to do a test run before your session. This will help you to situate yourself in a way that parallels counseling as much as possible. It will also help you to improve your familiarity with the process and enhance your ease and will consequently you’re your clients feel more comfortable in session as well. In a traditional session, there may be protocol for handling concerns such as hitting traffic on the way to session; for virtual therapy, you may need to learn methods for troubleshooting connection concerns and clarifying these methods for your clients. This is particularly important in this current moment due to the high-saturation as a result of the increase of individuals working from home due to guidelines for COVID-19.

The virtual counseling environment is just as important as an in-person session. If you are unable to utilize your usual office space, try to utilize a similar process to the one you used to create that comfortable space. Create an environment that you enjoy, after all you’ll be there quite a bit! For me, being near a window and having flowers nearby makes quite a difference.

Before COVID I offered sessions in my office space, however, I have transitioned to my home office and I’ll show you a little trick that I found works for me. It was easy to recognize that placing the camera a few feet back at a secure a camera angle that is near eye level helped to mimic the sense of space we use in a traditional counseling session. I used to try to utilize the size of my large monitor by maximizing the screen. However, I noticed that since the camera was at the top of the monitor and this ratio caused me to look down to make some semblance of eye contact. See an example of the previous setup in the image below.