Digital Therapy

Online and in-person therapy differ, but both are proven effective and backed by research. The ascent of digital therapies demonstrates a growing trend to provide online psychological services to enhance or replace traditional mental health treatment. Here are a few tips for online therapy providers to have productive and connected sessions.

1. Prep for the online session.

To prepare, make a mental checklist of the things you need to hold a session. This is the perfect time to refill your water bottle or grab your cup of tea or coffee. Gather your notebook and review other record-keeping materials to reference where you are in the treatment plan. And, don’t forget to set your phone on silent or do not disturb if you’re coming back from a break.

2. Check in with your client.

Check in with your client on how they feel about virtual therapy. Sometimes patients prefer virtual therapy, while others may hesitate to switch from their in-person care. Allow your clients to be open and honest about their feelings as you navigate the new experience of virtual therapy with them. Also, think of ways to start a session with clients in a way that feels personal to them.

3. Limit distractions.

With digital therapy, there’s more flexibility to where you are able to host sessions. It’s crucial to find a quiet, confidential location each time. Attempt to mitigate distractions like loud noises by remembering to close windows or use a white noise machine. It is often more difficult for your clients to secure private, secure spaces. To help with this issue, brainstorm places that are accessible to your client.

4. Have a backup plan.

Don’t forget to have a backup plan if there are any technological issues, as sometimes they’re unavoidable. Power outages and wifi connectivity issues may arise, so it’s vital to have additional ways of connecting with your client. Phone calls or FaceTime usually work when the internet is down. If timing allows, it helps to add a few extra minutes to a session to recuperate the time lost with technological problems. 

5. Wind down the session.

Most clients use a majority of the session to open up, settle in, and become more comfortable. The client generally tends to reveal psychologically sensitive information or recent developments toward the end of a session. Learn how to provide gentle reminders regarding timing. It’s helpful for the client to know the session is winding down and allows them to prepare themselves to re-enter their day.

1. Make space to start.

Make space for each client in a way that feels individualized to their treatment plan. With a reserved client, try maintaining a comfortable silence when opening a session and allowing the space for your client to speak up. For an anxious client, a meditative body scan is useful in bringing mindfulness and intent to the beginning of a session. Find a way to touch base at the beginning of every session as strong rituals incentivize clients to participate in their own treatment.

2. Encourage silence.

Silence is not awkward in a therapy session, instead think of it as a powerful tool. As professional listeners, mental health providers need to know how to encourage silence. The most revealing information often comes out in moments of intentional silence. In regular conversation, people tend to speak up during conversational pauses in an attempt to fill the silence. Professional researchers and interviewers also use this technique in ethnographic or social science research studies.

3. Suggest comforting items for a session.

Clients who are new to therapy need additional prompting on what items are helpful to keep around during a session. Traditionally, an office provides tissues for tears or a water cooler for a parched mouth. Suggest that your client keep a box of tissues handy, a drink to refresh their voice, and potentially even a white noise machine to create an ambiance similar to a therapeutic office. Other ways to establish this atmosphere include playing meditative music, lighting a candle, or using a blanket. 

4. Gently wrap up.

In an ideal world, therapy clients would have all the time in the world to reintegrate themselves into their day after a session. Use the last few minutes of a session to cover how your client plans to take care of themselves. It also helps to be somewhat familiar with your client’s schedule and not explore psychologically triggering topics on important or significant days. For example, a client who is a student may need to take an exam following their therapy, and it is appropriate to adjust the intensity of the session.

5. Collaborate on how to create a comfortable environment.

Depending on the client, their access to privacy varies. It seems counterintuitive to hold a therapy session in an environment in which a client cannot speak freely about their environment. For clients with family or roommate issues, spend time with your clients brainstorming where they can create a confidential space. Noise machines are an option in addition to using unconventional spaces like a parked car or the parking lot of a building that offers free wifi. 

With the rise of internet interventions, there are many platforms for psychological care providers to utilize.

• Email & text
• Video chat tools like Google Meet, Zoom, Facetime, or Skype
• Meditation apps like Calm or Headspace
• SimplePractice or TherapyNotes, a HIPAA compliant EHR software 
• Signal, encrypted instant communication

Increasingly, therapists tend to lean toward instant communications as a way of connecting with their clients. Professor Bankman, a Stanford law professor and Associate Director of the Center for m2Health at Palo Alto University, advises therapists “if you’re using email you ought to have a business associate agreement from your email provider” in his lecture on foundations in digital therapy where he covers the legal and ethical considerations of teletherapy. 

If you text your clients, treat your phone with the same level of confidentiality you would with therapy notes and make sure to lock it. Similarly, double-check your video chat links are secure and only available to the client. Upgrading to a business associate agreement helps therapists meet the privacy rules of HIPAA. Additionally, there is available software with built-in encrypted communication ensuring the only people with access to your conversations are you and your client.

Dr. Barr Taylor, Director of the Center for m2Health at Palo Alto University and emeritus professor of psychiatry at Stanford, covers several studies on mental health apps in his lecture on the foundations in digital therapy in conjunction as part of a certificate in digital mental health. He reveals mental health apps are only as valuable as the client’s willingness to engage with them and to “make sure in the therapy session you follow up with their use.”

While clearing obstacles like distance and inaccessibility, online therapy also possesses its limitations.

• Out-of-state providers & insurance issues
• High-risk patients

Generally, insurance covers most Telehealth sessions, but specific clients may face difficulties with covering their treatment. For example, psychological care providers cannot continue to provide care to a current client who plans to move to a state where the therapist does not hold a license.  

Online therapy also limits treatment options of higher-risk patients like those with suicide ideation, eating disorders, substance abuse, or addiction. Dr. Muñoz, a distinguished Palo Alto Professor of Clinical Psychology, reveals the costly consequences of substance abuse on a nation’s productivity and “suggests that perhaps the state and national government should invest in making evidence-based Internet interventions and other digital tools available to everyone in the country who needs them.”

Learn to understand and apply high-risk factors in individual contexts from client to client. Dr. Sommers-Flannigan is a clinical psychologist and professor of counseling at the University of Montana, and Dr. Coker is an associate professor in counseling at Palo Alto University, who together reenact a role play in suicide, risk assessment, and treatment planning via Tele-mental health. Dr. Sommers-Flannigan ​​shares, “big statistical studies are not very predictive of risk and that’s why we have to individualize risk.” 

Now more than ever, clients and mental health providers are both leaning into utilizing digital therapy. Internet interventions like online therapy or mental health apps provide the client with a way to become active and consistent in their treatment.