What therapist doesn’t dream of having their “office” be a cabana chair on a beach in the Caribbean, having productive therapy sessions in between bites of fresh fish, ceviche washed down with some kind of drink featuring an umbrella? For many of you, especially those digging themselves out of the latest blizzard, you might as well be dreaming of a private jet. However, you can certainly add online counseling to your existing office-based practice and with it gain more flexibility (and clients!)

Teletherapy, telepsychiatry, video therapy are more than just trends invented by some tech-addicted Millennials. They are proven, research-supported modes of therapy that can provide you with the opportunity to expand your practice and even reduce missed appointments.

Is online therapy effective?

There are volumes of papers covering the effectiveness of online therapy so we won’t discuss it here, however, please check out our post explaining what online counseling is if you are interested in further reading (as well as over a dozen research citations). The short answer is yes. Online therapy is effective. It certainly isn’t the right mode of therapy for every client, but for many clients research suggests that it is at least as effective as traditional in-person sessions.

Step 1: Use a HIPAA compliant video platform

This step is the most important part of adding online video therapy to your practice. The key requirement is that whichever platform you choose that it be HIPAA compliant and provide a Business Associates Agreement (BAA) upon request. The importance of this can’t be overstated. Once your chosen platform provides that agreement, you’re protected in terms of HIPAA compliance. A Business Associates Agreement certifies that the service that you are using guarantees compliance with the law and has security practices and policies in place to ensure that your client privacy is protected.

Skype is not HIPAA compliant!

This means that Skype therapy is out of the question. Skype is not HIPAA compliant for a variety of technical reasons, however, the key point is that Microsoft (the owner of Skype) will not sign a Business Associates Agreement covering Skype. Microsoft is telling therapists that they can not guarantee the privacy and security of client data within the requirements of the law. No BAA, no compliance. The fact that Skype is “encrypted” is irrelevant. If you want a deeper discussion about Skype, please read our post on the topic. Essentially, “consumer” oriented video tools such as Google Hangouts, Skype and Facetime are not considered suitable for HIPAA compliant video conferencing.

However, not being able to use Skype doesn’t mean that secure video therapy is out of reach. There are several providers that offer video solutions or varying quality, price and ease-of-use. Click here if you are interested in downloading a free comparison chart to help you understand the options and costs of secure video platforms.

Step 2: Offer video counseling to a subset of your clients

While many clients are great candidates for video therapy, it’s best to roll out your video availability gradually. This will give you the opportunity to get more comfortable with online therapy and using the tools. You choose the pace! One easy way to start integrating video with your existing clients is to offer a video option when a client will have trouble making it to an appointment or if a client is going to be out of town for their normal appointment day. You could also offer to alternating sessions with video and in person. Once you are confident with that mode of therapy, you can consider offering it to all of your clients, when clinically feasible. Additionally, you could offer services to new clients exclusively online. This can be a nice supplement to your existing practice and allow you to add available appointment times outside of your normal business hours.

Step 3: Practice

It doesn’t seem like there would be much to practice for video therapy. After all, there aren’t many differences between online and in person therapy right? While your therapy process might be the same, there are a few things to remember.

  • You should be comfortable with your tools. With a friend, practice joining and ending a session.
  • Ensure good lighting. You want to look your best!
  • Use a headset or headphones with a microphone. The headphones that come with the iPhone are perfect.
  • Don’t look at yourself! By constantly glancing down to see yourself, it appears to the client that you aren’t looking at them. You wouldn’t check a mirror during an in-person session, would you? Practice making eye contact by looking either at the camera directly when you are speaking or at least at the top part of the video window. You absolutely should be in full-screen mode.

Step 4: Get feedback

Asking your clients about how they felt the session went is fairly common, but it’s even more important with a video session. Listen to their opinions about the session quality. How did they feel the session compared to their in-person sessions? If they are an online-only client, you still want to get feedback because it can help you improve your video technique. Keep records of this feedback so you can start to compare clients over time. This will likely provide you with great positive reinforcement that your clients are loving the new online medium.

With the proliferation of online therapy sites, for many practitioners, it might feel like they’re either an “online” therapist or an “in person” therapist. The reality is that you can be as online as you want while continuing to practice in a traditional office setting. You can gradually roll out video counseling to your existing clients as an option or you could simply have video as a backup for those clients who might not be able to make an in-person session.

Published by Brian Dear

Brian is the cofounder and CEO of iCouch, Inc. He has an extensive background in software engineering, inbound marketing and mental health practice management.

Join the Conversation


  1. Hi Brian! I’m looking in to my Masters of Counseling Psychology and interested in making this more accessible to people at an affordable cost nationally. Are you aware of any way that this can be done given that licensing is regional? What would be your recommendation on trying to counsel as I have a nomadic lifestyle and like experiencing new places frequently? Would this be a blocker in starting an online counseling practice?

    1. We are not offering legal advice, so you will have to make your own decisions based on your situation.

      However, the article linked below is a very interesting take on cross-state practice. It’s a controversial article in some circles — mostly because there is an entrenched desire to maintain the status quo. The idea of expanding mental health care to those who need it is apparently quite threatening to some interests! Our opinion is that we should be knocking down barriers to care rather than maintaining what essentially amounts to a cartel of state boards that have apparently never heard of the Sherman Act or Goldfarb v. Virginia State Bar (or Quill Corp. v. North Dakota or numerous other Supreme Court cases.)

      We never advise anyone to break the law, but we are also passionate advocates for enabling practitioners to provide care to those who need it. Our job is to provide you with the best tools to elevate your therapy practice, how you use them is ultimately up to you.


  2. Question: What are the potential problems with working both as a coach and as a psychotherapist? How does one avoid unwittingly getting into hot water doing both?
    I mean to say that coaching enjoys so many freedoms disallowed by the BBS for therapists. An example would be giving a financial incentive for coaching referrals. What other sorts of briar patches should a psychotherapist avoid if also acting as a coach? Any suggestions?

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