agreement with any program or app that will be used in audio-video conference or to chat online. With Skype, for example,
clicking “I accept,” gives the company that owns Skype the right
to all conversations. “The likelihood that Skype will broadcast
your client’s session is tiny, of course, but it’s still a risk to
confidentiality,” he says. This is where technology and legal
issues intersect — and because you the provider are ultimately
responsible for all things related to confidentiality (regardless
of what your client is comfortable with), as well as the security
of your patient’s health information, it’s important to fully
understand the technology you’re using.
Create safety nets
Safety is also a concern when you’re providing services remotely.
For example, what if a client in another
region says she’s suicidal? What if another
one faints or appears to have a heart attack
while speaking with you via video? Who’s
responsible for helping them if they’re on
the other side of the state?
“If the client is in crisis, we have to ask
ourselves, what’s the ethical and legal way
to respond?” says Cindy Juntunen, PhD,
who’s developing a telepsychology seminar
at the University of North Dakota.
“We need to make sure there’s a safety
mechanism in place. Even if you’re 300
Establishing relationships with first
responders in the client’s location is an
important initial step when beginning
a relationship with a potential client
remotely. Having the contact information
of your client’s family and friends at your
fingertips is also important, Juntunen says.
Another option is arranging for your
clients to receive telepsychology services
out of a health-care facility in their area,
such as a local clinic, instead of from their
homes. “That gives you the extra safety
cushion of having medical professionals
right there if anything happens,” Juntunen
says. “There’s also the added bonus of
better ensured privacy for the client.”
It’s also important to determine
whether telepractice is suitable for certain
clients, says Juntunen. Like the Joint
Telepsychology Task Force guidelines,
she recommends that psychologists meet
clients face to face before beginning
remote counseling to get an overall picture
of their mental state. Then you can decide
whether a client would be better served
with in-person sessions or telepsychology.
Some psychological problems and mental health disorders may
be treated exceptionally well with telepsychology. Agoraphobia
and generalized anxiety disorder are good examples, says
Palomares, since telepsychology puts a little extra distance
between the provider and the patient.
He adds that even after you determine that telepsychology is
appropriate and sessions are underway, you’ll need to constantly
evaluate and re-evaluate whether the client is still benefiting from
that type of service. After a while, it may be time to switch to in-person meetings. But in either case, the important point is to be
continuously reappraising the best choice for your client. n
Alice G. Walton, PhD, is a writer in New York City.
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