The Digital Age continues to facilitate new ways to assist people to meet their mental health needs. Sonoran Counseling is happy to move in step with technological advancements to provide telehealth services. As part of our commitment to your well-being and safety, a few guidelines should be discussed. Please read this carefully.
Variously dubbed telemedicine, teletherapy, e-therapy, or online therapy, “telehealth” is defined as the use of electronic transmission to provide interactive, real-time, mental health services remotely, including consultation, assessment, diagnosis, treatment planning, and psychotherapy with an experienced psychotherapist. This can include both video and audio forms of communication, via the internet or telephone. Telehealth services do not include texting or e-mail.
Telehealth is governed by all the same ethics and laws that cover in-office, in-person, face-to-face psychological service. All other policies and consents in the psychotherapist’s office agreement forms apply to telehealth services. This document is an addendum to, and does not substitute for, our standard in-office services agreements.
Advantages & Disadvantages
The advantage of telehealth is that it can flexibly provide continuity of care when in-person treatment sessions cannot be conducted comfortably or safely in-person. Like a regular in-person therapy session, telehealth allows for both verbal and non-verbal communication through video.
Some research has shown the benefitsof telehealthto be very high, sometimes finding it even more beneficial than “in-person” sessions. More cruciallyperhaps, your momentum in recovery and healing is made more secure by continued telehealth therapy; which could make abig difference when the first task is to stay the course throughparticularly uncertain times.
COVID-19 is a bad illnessthat is close at hand and very dangerous to some, but only ever to those who are “touched by the virus.” We don’t want anyone harmed because they were trying to come in tohave a session. We can’t promise more than our best efforts to keep the office safe, but we can guarantee that no virus will spread through an online session.
The Internet is a powerful force for good when it makes it possible for people to “see” their counselor or psychotherapist. The Internet is uniquely suited to ease the isolation of “physical distance” without paying the often devastating costs of disconnection. The choice it offers instead, motivates emotional connection and doesn’t require actual contact with another person.
Seeking connected growth in solitude. The Internet literally facilitates people helping people at a time when many aretold(wisely we think)to keep distance from each other, or even “self-quarantine.”
Still, telehealth is not a universal substitute, nor the same as, in-person psychological care. Some say that telehealth services cannot provide the same level of comfort and may not seem initially as thoroughor connecting. Misunderstandings can more easily occur. This can impact the professional therapeutic relationship. Like in-person psychotherapy, telehealth services are nota “magic pill” or ticket to eternal wellness.
Telehealth is not suited to all circumstances. Telehealth, in normal circumstances, is only part of psychotherapy. Telehealth services with Sonoran Counseling are provided to previously established patients who continue to have at least intermittent in-person sessions in the office, as recommended.
Note: Initial consultations and the occasional in-person session are typically important sessions held only in the office, however, exceptions are being made as we move through the COVID-19 public health crisis and the CDC recommendations to “socially distance.”
Telehealth requires reasonable comfort with technology.
Telehealth is best for augmenting in-person services when the patient is unable to come in to the physical office location due to temporary limitations. Examples of temporary limitations include medical conditions limiting physical mobility, distance, and scheduling conflicts.
In this office, periodic in-person check-ups may beclinically necessary. Ideally, it is recommended we meet in-person on intermittent occasions, to ensure optimal care. If occasional in-person sessions are recommended and cannot be scheduled, your psychotherapist may discuss referral to another appropriate provider. Exceptions will be made depending on circumstances and clinical necessity.
In extreme circumstances, where services reasonably should not be provided remotely, your psychotherapist may recommend coming in to the office, waiting until you can come into the office, or referring you to a psychotherapist who can provide more optimal care.
Our professional services are being provided under our licenses issued by the state of Arizona. If you live in another state some part of the year, or are visiting another state, please understand that the law is unclear about whether we can extend our licenses to cover the work we may do with you in that state. Unless you explicitly request otherwise, this agreementserves asan agreement between you and Sonoran Counseling to permit the licensing board of the State of Arizona to handle complaints, if or whenever necessary.
Telehealth is not ideal for psychological emergencies. Telehealth services are typically only provided when it is unlikely that a mental health emergency will arise during the session. Overwhelming or potentially dangerous challenges are best addressed with in-person professional support. In the event that in-person sessions are recommended due to symptom severity, the patient is asked to schedule an in-person session as a first option.
Just like in-person services, if an emergency should occur during a telehealth session, the psychotherapist may consider taking steps necessary to ensure your safety or the safety of others. It is important to have a plan for responding to therapeutic emergencies. At a minimum, this involves your agreement to consult the closest emergency care provider to evaluate your condition, should that ever become necessary to protect you or someone else.
Just like with an in-person appointment, telehealth sessions are scheduled in advance by prior arrangement. Scheduling a telehealth appointment involves reserving time specifically for you. Just like in-person appointments, you are responsible for keeping all telehealth appointments.
We make every effort to start and end telehealth sessions on time. In all telehealth sessions, the therapist will initiate the telehealth session, unless other arrangements have been made. A window will remain open around the starting time of your appointment. Similar toan in-person session, if your psychotherapist is unable to reach you, they will attempt again, but will discontinue after several attempts.
Cancellations and unkept appointments are treated like in-person cancellations and unkept appointments. The psychotherapist is not responsible for the patient’s ability to participate in the session, including for reasons of technological limitations.
The laws that protect the confidentiality of your medical information in the office also apply to telehealth sessions, including mandatory and permissive exceptions to confidentiality. The patient and psychotherapist both agree to maintain the same privacy safeguards as during an in-person session. The environment chosen should ideally be free from unexpected or unauthorized intrusions ordisruptions to our communication.
There may be a risk of being overheard by a third party near you if you do not conduct the session in an enclosed private room, with reasonable sound barriers, and with no one else present or observing.
You have the right to opt in or opt out of the methods of telehealth communication at any time, without affecting your right to future care or treatment with Sonoran Counseling.
It is your responsibility to discuss, prior to your telehealth session, which medium you prefer, how you will use it, and any necessary login codes, or other details.
No electronic transmission system is considered completely safe from intrusion. Interception of communication by third parties is technically possible.
Due to the complexities of electronic media and the internet, risks of telehealth include the unlikely possibility of private information being “hacked” or stolen online, including audio and images. Your psychotherapist cannot fully guarantee the security of telehealth sessions. You are responsible for information security on your computer, laptop, tablet, or smartphone.
As a policy, we ask for your agreement to not electronically record telehealth sessions without prior written consent.
While a variety of software programs are available for video conferencing, such as Skype, Facetime, or GoToMeeting, not all are encrypted, or compliant with Federal law to protect the privacy of your health communication. We use software with encryption to maximize your confidentiality.
Telehealth may include telephone sessions. When using the telephone, remember to be in a place you feel comfortable speaking about personal and private matters. If you are using a cellular telephone, remember that not all calls or telephones are absolutely secure and may be compromised by various detection devices. A landline is preferable because it is more secure, more reliable, and may offer clearer audio quality.
The patient is responsible for their own hardware and software, audio and video peripherals, and connectivity and bandwidth considerations.
At the time of the telehealth appointment, it is your responsibility to have your electronic device on, video conferencing software launched, and to be ready to start the session at the time of the scheduled telehealth appointment.
If a video telehealth session is not technically possible after several reasonable attempts, we ask that you be open to having a telephone session for that time.
Telehealth services are professional services and the fee charged at the end of your session isthe same as for in-person sessions. You are invited to keep a credit card on file with us to simplify payment; in which case, a credit card agreement will be providedfor your review and signature.
Sonoran Counseling is not an “in-network” provider and is not contracted withany insurance companiesto provide psychotherapy services. However, many insurance benefit plans includereimbursement for services we providein our capacity as a qualified“out of network” psychotherapy provider.
The details of your specific coverage and any reimbursementbenefitsmay be complex.You are responsible for confirmingany “out of network” provider reimbursement benefits and for knowing in advance what your insurance may or may not cover. You willlikely want to know ifany reimbursementbenefits in your plan are different for telehealth versus in person services.
I have read and understand the information provided above. I have discussed it with my psychotherapist. All of my questions have been answered to my satisfaction. I hereby request and consent to telehealth services as a part of my treatment. I agree to abide by the terms of this agreement.
Technical Instructions for Telehealth Video Conferencing
Below are specific technical instructions for preparing for your initial telehealth session. Please read this carefully. If you have any questions, please contact your therapist in advance of your first telehealth appointment.
You are responsible to provide your own hardware and software, audio and video peripherals, and internet connection.
In our office, we use VSee videoconferencing software. VSee downloaded from www.vsee.com is free and allows secure communication via text, screen share, picture share, and real-time audio/video. It is fully compliant with federal telecommunication security protocols.
VSee runs on any operating system, and any hardware including desktop computer, laptop, tablet, or cellular telephone.
Telehealth videoconferencing can take increased set-up time and requires reasonable comfort with technology. Please test all of your systems and technical capabilities ahead of time.
Before your first session with the therapist, we recommend that you ensure that your software and hardware are working together properly and that you know how to operate them.
Confirm your internet connection and wireless router are fast enough to provide a full signal and won’t be saturated. We recommend you shut down all unnecessary other programs and apps before installation. Go to www.vsee.com and download the free “messenger” software.
Despite VSee being very simple, learn the basic menus, try all the features, test your settings. Click on “Settings,” then “Audio and Camera Setup.” Make sure that your camera and microphone are working.
Provide your therapist with your VSee contact address. Your therapist’s VSee contact address is firstname.lastname@example.org. Enter this e-mail address in the VSee “Contacts” tab.
Before an initial telehealth session, a test call, up to 10 minutes, can be arranged with your therapist to ensure that technology is functioning.
Make sure your video conference session is in a private place, free from distraction or intrusion. A room with a door that closes is best.
Confirm that there is plenty of even light with minimal glare. It is best to avoid strong lighting directly behind you (like a window in daytime) and helpful to have some lighting in front of you, to better illuminate your face.
Aim your camera. Check your camera angle. Check to see that your face can be seen. Avoid positioning your camera too low or too high. Try to fill the screen as much as possible.
To maximize audio quality, freedom from extraneous noise, and privacy, a headset or earbuds may be better than a speaker and microphone.
The most important part of a video conference is not the video––it is the audio. Speak in your normal voice, without shouting.
Avoid “double talk.” Double talk is when both people talk at the same time. Double talk may cause audio feedback and echo. Allow the other person to finish speaking before you speak. Since audio has a very slight delay, you may want to pause briefly for the therapist to respond or to make comments.
Please dress as you would for an in-person appointment.
Just like an in-person appointment, schedule your telehealth session in advance.
10-15 minutes before the appointment time, have your device on, video conferencing software launched, and be ready to start the session at the time of the scheduled telehealth appointment.
Your therapist will initiate the call at the appointment time.
Distortion or Disruption
If the connection is distorted or interrupted by a technical malfunction, we may reconnect and try again. If a video telehealth session is blocked after several reasonable attempts, please be open to having a telephone session for that time.
At other times, technology may malfunction, and you may be uncertain if I received your communication (phone message, email, text message, etc.). I am usually able to respond within 24-hours, however, if you do not hear from me in a timely manner (2 business days maximum), please attempt to contact me again by the same or other means.