Teletherapy: The Do’s, Dont’s, & Navigating Gray Areas

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26 Mar

Teletherapy: The Do’s, Dont’s, & Navigating Gray Areas


Technology is rapidly changing among behavioral healthcare providers nationwide. Providers and patients love the freedom that teletherapy provides, from scheduling flexibility to a decreased number of missed appointments.

Teletherapy is defined as “…the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

It's important to keep risk management front of mind when navigating this new landscape. The question becomes, is teletherapy legal and what is the risk associated with providing services to a patient you’ve never had a face-to-face interaction with?

The Do’s

Check with your State

It’s critical to know the ruling from your state’s licensing board and if they have issued any policies regarding teletherapy. A number of states have such rulings in place. If you’re practicing across state lines, it’s important to call the state licensing board where your patient resides, in addition to the state you practice in. Treatment is considered to take place where your client resides, not in the state in which you practice.

Apply general ethical standards

Standard ethical principals apply to teletherapy, the same as face-to-face sessions. The same standard of care should be provided to your client. Standard ethical principals include informed consent, competence to practice, confidentiality, and alignment on how client terminations, interruption of service, and payment arrangements are handled.

Keep your malpractice insurance up to date

Teletherapy or telecounseling is “technically” covered under your mental health insurance. You can provide advice to a patient virtually, as long as the state in which you hold your license allows it. What exactly is covered? Claims that are brought about in the US court system, claims brought against you internationally are not covered.

The Dont’s

Don’t use a non-HIPAA compliant platform

The medium in which you choose to provide teletherapy services is important. It may be tempting to utilize the ease and convenience of FaceTime or Skype, but these mediums are not HIPAA compliant. Ensure the platform you are using is HIPAA compliant in order to ensure patient privacy and reduce your risk.

The Gray Area

Secure (SSL) Connection

Use a platform that has an SSL connection. It means you’re using a site with a Secure Sockets Layer (SSL) which provides a secure channel for communication between devices.

Where to conduct sessions

Patient privacy is key when considering where to conduct your teletherapy sessions. Avoid public places as it opens up the possibility of others potentially overhearing the conversation. We recommend a private office, conference room, or a quiet spot in your own home. If you choose to conduct sessions in your own home, it’s important to choose a clean area with a neutral backdrop and avoid inappropriate areas like your bed.