88: Having a Teletherapy Practice: Is it Right For You?

 
 
 

After two years of living in a pandemic, more therapists and allied healthcare private practice owners consider opening a teletherapy practice, pivoting full-time to one, or keeping their online business even after restrictions lift. In this podcast and corresponding post, I'll cover:

  • The effectiveness of teletherapy

  • Who can become a teletherapist

  • Cross-state licensure reciprocity 

  • Questions to ask yourself about whether or not teletherapy makes sense for you.

What is Telehealth Therapy or Teletherapy?

Telehealth therapy is a therapy conducted over the phone or video, where the therapist and the patient are in different physical locations. Teletherapy data collection started in the 1960s. So while teletherapy isn't new, there was a massive jump in demand at the start and throughout the pandemic. I'll use the terms "telehealth therapy" and "teletherapy" interchangeably in this post.  

Effectiveness of Teletherapy

According to David Mohr, Ph.D., in most cases, phone and video-based teletherapy services are just as effective as face-to-face therapy when it comes to 1-on-1 therapy. There was a stigma that certain disorders couldn't be treated via telehealth in the past. However, in a meta-analysis, researchers found that teletherapy was as effective for the disorders of depression, anxiety, PTSD, eating disorders, and substance use. At the time of this podcast and blog post, the data doesn't hold up for the effectiveness of text-based therapy. 

There are, however, some populations you have to be mindful of when providing teletherapy. If you work with people aged 10-19, preliminary research found that this age group tended to do better with shorter session durations and more frequent appointments than adults (Burgoyne and Cohn, 2020). This might look like seeing a teenager client on a Monday and Thursday for 30- or 45-minute sessions instead of the traditional weekly psychotherapy hour. The same 2020 study by Burgoyne and Cohn found for couples and families, or in situations where there are multiple people in a single therapy session, the therapist might have to take a more active role in managing communication flow and be more directive about who has the virtual floor.

Regardless of the population you serve, there are some logistics that I've found helpful in providing teletherapy. Make sure you and your client(s) have a quiet, safe, and private space to do therapy from. For some folks, this could be a bedroom or office; for others, it's a conference room at work or a car safely parked. Invite clients to move around, turn off their video, or eat during the session. I like to have my video "view self" or "self-view" turned off as it feels more authentic to a face-to-face session. When I had my video on, I'd find myself distracted by looking at myself. Investing in a white noise machine for clients and therapists who have shared or thin walls can add another layer of privacy. Nowadays, a white noise app or playlist is easily accessible from a smartphone.

How To Become a Telehealth Therapist

Suppose you are a licensed therapist in your state; congratulations! You are eligible to provide therapy services via telehealth. Getting certified as a therapist means finishing all requirements to become a practicing clinician:

  • Finishing grad school.

  • Completing an internship or practicum.

  • Earning required hours.

  • Sitting for your respective exams.

Like any other business, you need to do to become a teletherapist. You need to get an EIN, open a separate business bank account, have a specialization/niche you work with, have a professional website. When you have an online counseling practice, you need to be marketing yourself online. If you don't have a website, at the bare minimum, get on therapy directories, and get comfortable with online marketing. There are many HIPAA-compliant telehealth platforms you can choose from when it comes to technology. Most professions advise against using FaceTime, Skype, or GoogleMeet for teletherapy services. 

Teletherapy Reciprocity & Salary

Telehealth therapists should earn just as much money as face-to-face therapists in private practice. Notice I said, "in private practice." Telehealth therapists' salaries will be much lower when working for a teletherapy app like Better Health, Talk Space, or similar telehealth therapy platforms because those services take a more significant cut of the therapist's money. I've talked about that in length in episode 64: Private Practice vs. Agency Work vs. Therapy Apps.

Something to consider with an online therapy practice is state reciprocity. Depending on the therapists' licensure, other states may recognize or "reciprocate" a therapist's current license. For example, if you are a psychologist, I'd recommend looking into PsyPact. PsyPact is the Psychology Interjurisdictional Compact (PSYPACT). It's an interstate governing body designed to facilitate the practice of telepsychology across state boundaries. Joining PsyPact allows psychologists to have their license recognized by many others, allowing them greater accessibility to clients. At the time of this podcast, no such compact exists for LPCs, LLPCs, or LMSWs. If you hold one of those licenses, you'll want to google your license, plus the state you are licensed in, plus the state you are interested in getting reciprocity from to learn about the necessary licensing steps needed. As an MSW, I wish there was LMSW reciprocity across state lines, and I imagine other disciplines would want LPC or LLPC state reciprocity.

Should You Have a Virtual Private Practice?

If you are considering having a virtual private practice, there are seven questions you can ask yourself to determine if an online private practice is right for you.

  1. Do you have a quiet and private space in your home? If so, it makes it a bit easier to set up your virtual practice from home. 

  2. Do you need more flexibility in your work? In other words, does commuting somewhere cause an additional undue burden? Having a virtual office gives you more time back in your day since you aren't spending your time commuting to and from a physical therapy office. 

  3. Is keeping overhead low for your practice important for you? If you are starting in private practice or are newly licensed, not having to pay for physical office space could be a great way to test the waters of private practice. It also could be good for you if you want to start your private practice on the side.

  4. Are you comfortable addressing tech hiccups and pivoting as needed? With teletherapy, there will be technical issues. I give all of my clients a 15-minute grace period to connect to Wi-Fi, login, or troubleshoot on their end before I consider them a no-show or same-day cancellation. I find most tech issues can be solved in about 15 minutes and am comfortable with a last-minute pivot to a phone-based session if needed.

  5. Do you have a chronic illness? Do your clients have chronic illnesses, are disabled, or immunocompromised? Having a virtual practice could be easier for you or your clients as it offers more flexibility.

  6. Are you licensed in an area with a high demand for therapists? Or where there is a low number of therapists? You may have greater access to clientele if therapists are in high demand and you have a virtual practice. 

  7. Do you have a unique niche? If you specialize in a particular area, having an online practice might better fit you.

Disadvantages of Teletherapy

There are potential disadvantages of teletherapy as a clinician considering pivoting to online practice. Having a teletherapy practice isn't suitable for everyone. Opening an online counseling practice might not for you if:

  • You see a large population of at-risk clients. You could have higher recidivism rates, no-show rates, or have to be more worried about the physical safety of your clients, making teletherapy too high-risk.

  • You crave the in-person healing and energy work. Even though I love online therapy, I don't mean to downplay the genuine differences that in-person treatment can have. There is a therapeutic benefit to in-person care that you or your clients crave.

  • You live in a space where there isn't a lot of privacy or have access to solid Wi-Fi. If privacy and quick internet access aren't available, having an online practice probably isn't wise.

Online Therapy Practice Help

If you are a teletherapist with a virtual private practice and are struggling with filling your telehealth practice, I'd invite you to join me in my small group coaching program, Grow a Profitable Practice From the Inside Out. I run this program throughout the year, and past participants have shared that it "was more than worth it for the self-growth, business growth, and mindset." Read through the program details and consider applying if you are ready to have loving support and accountability as you sustainably grow your online therapy practice. We'll cover money mindset, fee-setting, adhering to boundaries, niching, writing your website for SEO, and how to practice self-care.

 

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