It is a regrettable truth that many clients face barriers to accessing effective therapeutic treatment.
Individuals living in remote areas with limited or no transportation and those isolated due to mobility issues are just two examples of clients who may find it challenging to access the professional support they need.
The use of technology in the provision of therapeutic services and the continuing development of new technologies offer opportunities for practitioners to implement affordable, feasible support options and improve client access to therapy across geographical distances.
Video therapy is one such support option. Incorporating video-conferencing software with professional therapeutic services, video therapy can assist practitioners in traversing the vast distances that often separate them from clients in need.
The following article will examine the advantages and disadvantages of video therapy, best practice guidelines, and some technical considerations required to apply video therapy to your work with clients successfully.
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What is Video Therapy?
Online therapy, also known as telehealth, e-counseling, teletherapy, e-therapy, and cyber-counseling, is a relatively new concept in which a therapist or counselor provides psychological advice and support via the internet.
The National Board of Certified Counselors (NBCC, 2001, p.1) describes online therapy as “the practice of professional counseling and information delivery that occurs when client(s) and counselor are in separate or remote locations and utilize electronic means to communicate over the internet.”
Video therapy is one such approach that utilizes video conferencing technology to provide therapeutic interventions and mental health services across large distances in real-time.
Who is Video Therapy For?
Video therapy can be beneficial to a wide range of clients, including those living in remote locations, the elderly, military personnel, prison populations, and individuals who are housebound due to physical or psychological reasons (Simpson & Morrow, 2010).
It is, however, essential to note that video therapy is not suitable for every client; thus, potential clients should be carefully screened, and only those who will benefit from the service should be considered (Suler, 2001).
While video therapy can be particularly beneficial for low-risk clients in outpatient settings, it may not be appropriate for clients who have severe psychiatric disorders.
According to Stofle (2001), video therapy is best suited to clients with a desire for personal growth and fulfillment, anxiety disorders, including agoraphobia and social phobias; as well as body image, shame, or guilt issues.
Clients exhibiting suicidal ideation thought disorders, and borderline personality disorder are not likely to benefit from video therapy (Stofle, 2001).
9 Benefits of Video Therapy
1. A frequently cited benefit of online therapy is convenience and increased access for both clients and therapists. In terms of accessibility to treatment, the use of digital technology to facilitate therapy removes travel and inconvenience barriers and provides opportunities to improve access to mental health care services for clients living in remote and rural areas (APA, 2013).
Furthermore, by employing the use of video therapy, clients can overcome subjective accessibility issues – be they physical or psychological – relating to therapy while it also offers a range of other benefits relative to traditional in-person therapeutic interventions.
2. Video therapy also has some clear advantages over in-person for clients from developing nations. Low-income countries are disproportionately affected by the burden of mental disorders, mostly because of fragmented and underdeveloped health-care systems and few available mental health specialists or treatment opportunities (Becker & Kleinan, 2013).
Few individuals living with mental disorders around the globe have access to mental health care, yet many have internet access (Naslund et al., 2017). This and the growing use and affordability of smartphones and tablets presents new opportunities to reach, support, and treat individuals living with mental disorders.
3. Video conferencing technology can be employed with multiple clients to convene individuals with similar problems spread over a large geographic area (CSAT, 2015).
4. With tech-enabled, remote video therapy on the rise, clients are also able to leverage the advantages of a more extensive selection of therapists. This can be particularly beneficial for clients looking for a counselor with specific experience, or with particular language or cultural knowledge (Speyer & Zack, 2003).
5. The degree of separation provided by video therapy – in contrast to in-person – has been shown to mitigate feelings of intimidation or loss of personal control that may be more prevalent in traditional therapy settings (Rees & Stone, 2005).
6. Yuen, Goetter, Herbert, & Forman (2013) found that adults suffering from general social anxiety disorder (SAD) – a condition which due to its inherent characteristics makes sufferers less likely to seek out help – reported significant improvements in social anxiety, depression, quality of life, and experiential avoidance over 12 weekly sessions of video-facilitated CBT.
7. In terms of individual engagement, a study conducted by Morneau Shepell (2013) found a lower percentage of withdrawals and no shows for video therapy (16%) than in-person settings (28%). This supported previous research by Day & Schneider (2002), which found participation in counseling sessions increases when clients are offered a distance treatment such as video therapy as an alternative or an adjunct to in-person therapy.
8. Increased engagement in video therapy may, in part, stem from a reduction in the social stigma of receiving traditional counseling by normalizing mental health care – particularly for generations adept and comfortable interacting via technology (Slavich, 2003).
Al-Krenawi, Graham, & Fakher-Aldin (2003) found that the stigma-free medium of distance counseling may be a culturally appropriate modality of providing services to clients who conventionally underutilize other forms of professional mental health intervention.
9. Video therapy has similar outcomes in regards to client session attendance, subjective ratings of session helpfulness, pre- and post-counseling self-assessments, and rates of goal completion.
According to Germain et al. (2010), CBT delivered via video-conferencing is as effective as traditional in-person CBT with no significant differences in outcomes. Further, Richardson et al. (2009) found that clients receiving video therapy reported similar levels of satisfaction to individuals accessing in-person therapy.
Are There Any Disadvantages to Video Therapy?
While video therapy has myriad potential benefits, it is not without challenges. Several possible pitfalls may reduce the effectiveness of video therapy; it is therefore vital that practitioners actively work to avoid these issues.
1. Clients require a quiet and safe place for video calls
As the practitioner, you must establish that your clients can create a safe and secure space for video calls by checking that they are in a private location where sessions will be confidential and free from auditory distractions such as intrusive background noise.
2. Video therapy may not be suitable for high-risk clients
Video therapy is commonly used with clients presenting symptoms that are not of a high-risk nature; therefore, clients who need extensive support between sessions are not likely to be good candidates for video therapy. In cases involving high-risk clients, video therapy may be introduced as a supplementary service after in-person sessions have established a good therapeutic alliance.
3. Clients must have adequate computer skills
Client’s computer skills, knowledge, platform, and internet access may all affect the effectiveness of video therapy (Suler, 2001). The ability to benefit from video therapy is partly determined by the client’s computer skills and knowledge, particularly if the process involves installing and learning how to use new software.
4. Challenges to the therapeutic alliance
A positive therapeutic alliance is an important aspect of any therapeutic process. Video therapy may restrict the range of non-verbal communication and hinder the development of rapport; this can potentially delay a client’s progress and, consequently, the outcome of therapy.
According to Manchanda & McLaren (1998), certain characteristics of the therapist may facilitate the application of video therapy, for instance, warmth, empathy, and genuineness.
5. Missing non-verbal cues
It can be challenging to read non-verbal cues over a video call, and the environment in which clients conduct video calls may not be conducive to positive therapeutic outcomes. According to Manchanda & McLaren (1998), it is imperative that practitioners utilizing interactive video technology pay close attention to non-verbal cues that may be obscured or missed.
Practitioners must hone their ability to infer a client’s emotional state from their tone of voice, pace, inflection, and use of silence, and to check the accuracy of these inferences through reflective comments.
8 Guidelines for Applying Video Therapy
Practitioners must understand the rules, regulations, and guidelines for the application of video therapy and other forms of remote therapy.
While the flexible nature of these services can be beneficial to both clients and facilitators, practitioners must ensure their work with clients complies with the legal and ethical obligations of their jurisdiction.
With the advancement of digital technologies and the increased number of therapists using technology in their practices, the APA (2013) recommends adherence to the following protocols.
1. Expand Your Professional Competence
Practitioners have an ethical obligation to deliver services that fall within the boundaries of their experience and training. As per guidance from the World Health Organization (2019), practitioners require adequate training if they are to successfully transition to this new way of working and need to understand and utilize technology with ease.
To ensure best practice, facilitators must develop the necessary knowledge and skills by pursuing additional educational experiences and relevant training – including becoming familiar with video conferencing software, apps, and other technologies that can support client/practitioner video interaction.
2. Ensure Standards of Care Are Met
The use of digital technologies in the delivery of psychological services is still a relatively new concept with its own set of ethical and professional standards of care and practice. Practitioners should make every effort to ensure that these standards are met throughout the video therapy services they provide.
3. Obtain Informed Consent
Practitioners should obtain and document informed consent that specifically addresses the unique concerns and issues associated with the digital services they provide. This document can be used to ensure clients understand the risks of technological breakdown, the boundaries on the use of such technologies, security and confidentiality issues, how their information will be stored, and to establish boundaries.
4. Ensure Confidentiality of Client Data and Information
Practitioners who provide video therapy services should ensure that client information is secure, protected, and remains confidential following the relevant data protection regulations, i.e., GDPR.
5. Ensure Security and Transmission of Client Data and Information
Client data should be protected from unintended access or disclosure. Practitioners must identify and implement appropriate safeguards for privacy and security of confidential information.
6. Ensure Appropriate Disposal of Client Data and Information
Practitioners who provide video therapy services should make sustained efforts to dispose of client data and information in a manner that offers safe and appropriate protection from unauthorized access.
7. Ensure Appropriate Testing and Assessment
Unique issues may arise with assessments designed for face-to-face implementation. Practitioners must not assume that the administration and interpretation of traditional tests and assessments via video therapy will be identical to the same test delivered in-person.
8. Comply with Jurisdictional Regulations
Practitioners are encouraged to be familiar with – and comply with – all jurisdictional laws and regulations when providing digital therapy services to clients. Many states do not permit therapists to practice across jurisdictional and international borders; it is, therefore, important to be aware of what is accepted and legal practice in your jurisdiction.
5 Technical Considerations for Applying Video Therapy
Technology is not perfect, and the risk of technical challenges is very real when introducing a digital approach like video therapy. There are, however, some actions that can be taken to ensure that video therapy sessions run as professionally and smoothly as possible.
Ensure you have a reliable, high-speed internet connection. In anticipation of fluctuating bandwidth speeds, choose software that can run on very low bandwidth if possible.
You will require a dependable, well-maintained laptop, desktop, or mobile device (see mobile therapy) – a backup mode of communication is also recommended if your primary device crashes.
Test all audio and video equipment before therapy sessions; this will troubleshoot any potential problems such as inadequate audio quality.
Confidentiality is the cornerstone of ethical and effective therapy; thus practitioners should understand the potential threats to privacy when using technology. Technology has the potential to keep client records more secure than conventional systems; however, without awareness of Internet protocols and utilization of encryption solutions, online therapists may inadvertently increase the risk of divulging sensitive information (Grohol, 1999).
Consider how you can protect client privacy: Will client conversations be saved in any way? If so, how will you secure the files? Are your sessions encrypted? Do you have appropriate firewall and antivirus protection?
A Take-Home Message
While video therapy may not be suitable for all practitioners, clients, or interventions, the continued advances in digital technology present myriad prospects for underrepresented clients to access appropriate and professional treatment options.
By expanding your practice to the online realm, you have the opportunity to provide high-quality, convenient, and affordable therapy across vast geographical distances to clients who need it most.
Would you consider introducing video therapy to your practice? Do you already utilize video therapy in your work with clients? Tell us about your experiences in the comments below.
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- American Psychological Association. (2013). Guidelines for the Practice of Telepsychology. Retrieved from: https://www.apaservices.org/practice/ce/guidelines/telepsychology-guidelines.pdf
- Becker, A.E., & Kleinman, A. (2013). Mental health and the global agenda. New England Journal of Medicine 369, 66–73.
- Ben-Zeev, D., Brenner, C.J., Begale, M., Duffecy, J., Mohr, D.C., & Mueser, K.T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin. Lebanon, NH: Dartmouth Psychiatric Research Center.
- CSAT: Center for Substance Abuse Treatment (US). (2015). Using Technology-Based Therapeutic Tools in Behavioral Health Services. Treatment Improvement Protocol. Rockville (US): Substance Abuse and Mental Health Services Administration. Retrieved from: https://store.samhsa.gov/system/files/sma15-4924.pdf
- Day, X., & Schneider, P. L. (2002). Psychotherapy using distance technology: A comparison of face-to-face, video, and audio treatment. Journal of Counseling Psychology, 49, 499–503.
- Germain, V., Marchand, A., Bouchard, S., Drouin, M., & Guay, S. (2009). Effectiveness of cognitive behavioural therapy administered by videoconference for posttraumatic stress disorder. Cognitive Behaviour Therapy, 38, 42–53.
- Grohol, J. (1999). Best practices in e-therapy: Confidentiality and privacy. Retrieved from http://psychcentral.com/best/best2.htm
- Manchanda, M. & McLaren, P. (1998). Cognitive behaviour therapy via interactive video. Journal of Telemedicine and Telecare, 4, 53-55.
- Morneau Shepell (2013). The effectiveness of video counselling for efap support: video counselling compares well to in-person counselling. Retrieved from: https://www.morneaushepell.com/sites/default/files/assets/pages/622-efap-tools-and-resources/effectiveness-video-counselling.pdf
- Naslund, J. A., Aschbrenner, K. A., Araya, R., Marsch, L. A., Unützer, J., Patel, V., & Bartels, S. J. (2017). Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The lancet. Psychiatry, 4, 486–500.
- N.B.C.C. (2001). National Board For Certified Counselors: Policy Regarding The Provision Of Distance Professional Services. Retrieved from: https://www.nbcc.org/Assets/Ethics/NBCCPolicyRegardingPracticeofDistanceCounselingBoard.pdf
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- Slavich, S. (2003). The status of online mental health services. Wichita State University. Wichita.
- Speyer, C. & Zack, J. (2003). Online counselling: Beyond the pros and cons. Psychologica Magazine, 23, 11-14.
- Stofle, G.S. (2001). Choosing An Online Therapist. Harrisburg, PA: White Hat Communications.
- Suler, J.S. (2001). Assessing a person’s suitability for online therapy: The ISMHO Clinical Case Study Group. Cyberpsychology & Behavior, 4, 675-679.
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- Yuen, E.K., Goetter, E.M. Herbert, J.D., & Forman, E.M. (2012). Challenges and Opportunities in Internet-Mediated Telemental Health. Professional Psychology: Research and Practice, 43, 1– 8.
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What our readers think
Great online therapy tips, Thanks for sharing.
This is an excellent article! Thank you for your knowledge and your ability to deliver professionally and userfriendly if you will. I will use this article as a template in my 21 year private practice (25 years in the Mental Health industry). I have used video counseling in the past and found it effective for me and for the clients I served. I am grateful I can type at least 60wpm which allows me to type my thoughts at the speed I am thinking and allowing for my messages to flow in coherency and value (for me,
incorporating the written word with video counseling does not slow down the
therapeutic relationship process). My well written messages bring value to self and to those I proudly and caringly serve. Thank you for helping me to better understand the value of the therapist/client relationship when using video counseling. Finally, it has been my deepest honor to serve those in need while striving to educate and empower which produces hope, a much needed feeling that helps clients to bravely continue on in their self-journey.
Dr. Monée N. Merriweather
(PsyD, LPC, NCC)
I am the founder chairperson of an NGO in India offering free Emotional Counselling support .
With the corona virus challenge, we are looking at video counselling for our NGO.
Could you suggest any video conferencing medium that you would consider suitable by US laws.
Secondly, if we are not saving any of the counselling sessions, would security still be as big an issue?
Any other suggestions that you can share with us including the draft consent form.
Thank you for your interest. Actually, we have a partner site that has extensive guides on the procurement of video conferencing solutions for your purposes. You can have a look here: https://blendedcare.com/video-therapy/
Hope it helps!
Excellent article, quite thorough. Thank you. It would be nice to include an example of the Informed Consent form, as it obviously must be adapted for TeleHealth. Can you point us to one? Or can you please attach a generic one we can adapt?
I was thinking the same thing. Great minds think alike!