Lessons Learned in Teletherapy:

A Psychologists’ Reflection on Practicing During the COVID-19 Crisis

by Erika J. Vivyan, PhD

The past several weeks have been some of the most rewarding and frustrating in my career as a Licensed Psychologist. Not only am I managing my own anxieties and moral dilemmas related to the COVID-19 pandemic, but I am actively diving into the worries, fears, and collective traumas of my clients. What has been the most challenging and exciting, however, has been diving into full-time Teletherapy work. I have learned many lessons along the way – some through my colleagues, some through my own strokes of genius, and some through trial-and-error. Here’s hoping that these lessons guide other therapists, clients, and parents as we navigate the world of Teletherapy together:

Lesson 1: Plan for technology troubles.

As much as we like to think that our beloved technology will never fail us, it will. The more Teletherapy sessions I have, the more I realize that planning for technology trouble isn’t just a pessimistic afterthought – it’s necessary. Make a backup plan for everything technology-related. For example, when my Wifi starts to waver and my client reports garbled speech or video, I immediately turn on my phone’s hotspot to combat the poor connection. When there are sound or video issues, I check connectivity and restart my computer before calling a client back. In the worst-case situations, I’ve had to rely on my phone for its audio and video capabilities or simply use a voice-only call. All of these strategies can help to maintain a connection with clients despite the inevitable technology woes.

Lesson 2: Set up a late login policy.

Most mental health providers have a policy for when clients don’t show up on time for an in-person session. What I realized in the world of Teletherapy, however, is that the lack of regular schedule and commute sometimes leads to more “I forgot” moments than a typical in-person session would. Be sure to clarify expectations for both providers and clients so that no one gets blindsided. How long should the provider wait after the scheduled session time before attempting to contact the client? When should we consider cancelling or rescheduling the session? What communication methods (secure message, phone, email) should be used? Be clear about whether a no-show or late cancellation will result in a fee, and be sure to note whether these fees are covered by an insurance provider. Clear and consistent policies allow the focus to remain on the therapeutic relationship.

Lesson 3: Involve the entire household.

When planning for Teletherapy sessions, both therapists and clients need to communicate about their goals and expectations for treatment. While this seems blatantly obvious, what many of us don’t realize is that expectations need to be clear for all members of the household – both on and off camera. Do both parents want to participate in sessions? Would a teen prefer to spend time with the therapist privately and have a separate parent-only session? How long should a young child be expected to sit in one place? Any and all of these questions should be considered, answered, and discussed prior to each session. Expectations may change. Goals may change. Family situations may change. Communication must remain consistent.

Hopefully, many mental health professionals, clients, and parents out there have been learning these lessons too. I am excited to continue my Teletherapy sessions into the next phase of our community’s COVID-19 plan, and I know that I will continue to discover ways that I can best serve and collaborate with my clients.