We are now able to provide psychotherapy, counseling and psychological testing over the Internet because of recent advances in technology. The efficacy and effectiveness of this possibility has been studied and evaluated for many years. The challenge has been the development of a safe, reliable, real time Video/Audio platform that is properly encrypted, that is HIPAA compliant and that ensures the level of privacy and confidentiality that meets professional ethical standards. Although people have been Skyping, Face Timing and Zooming each other routinely, these forms of communication do not meet these standards.
The Covid-19 pandemic has accelerated the use of this format because of the health risks involved in office visits. Insurance companies have been mandated to respond to this emergency by expanding insurance coverage to include telehealth visits. Some insurance carriers have temporarily waived copayments for such visits during the present health emergency conditions.
The convenience of being able to get help in the comfort of your own home, without the bother of commuting to a therapist’s office, without hassling travel, traffic and parking, is certainly appealing. This is especially true for people with busy schedules, or living at a distance from the psychologist’s office, or people with transportation or babysitting problems.
In my own practice I have been pleased to find that the excellent quality of the video/audio platform, the convenience of conducting sessions at your own home or office as well as the elimination of travel time has been welcomed by most people who previously saw me in my office.
Telephone, E-mail and Text Counseling or Psychotherapy
Of course, there has always been the option of offering consultation by telephone, but restriction to voice only communication has been a big drawback. The obvious disadvantages of communicating verbally only, without the important visual dimension allowing the therapist and patient to see the facial expressions, body language, gestures and movements have made this a limited and inferior option. Telephone communication by a landline might meet the criterion of privacy, but more problematic is the use of cordless phones or cell phones, which certainly can result in accidental or “hacked” interception of communication.
Some therapists have offered professional advice via email, or by text messaging, but this eliminates the nuances of meaning communicated by the sound of one’s voice, limiting communications even further. In addition, email and texting are unencrypted and can be easily intercepted, thereby eliminating the privacy and confidentiality of communication between patient and counselor or therapist. This obviously could make matters worse for the patient and it is an ethical violation for a psychologist to communicate in a way that does not ensure privacy.