The doctor will ‘see’ you now. Or text, talk, or chat if you would rather
Before 2020, telehealth therapy had barely infiltrated the profession, covering about 9-11% of all outpatient visits, according to the American Psychological Association (APA.)
Then along came COVID-19 and everything changed. According to the APA, which began annual “pulse” surveys during the pandemic, the number of clinicians using telehealth with at least some patients grew from 33% in 2020 to 50% in 2021 and then to 88% in 2024.
“The most recent APA survey data show that therapists are overwhelmingly using telehealth,” said Marlene Maheu, Ph.D., executive director of the Telehealth Institute, a nonprofit that provides telehealth training and consultation. “Since Covid, people realize that they don’t want to travel for care and they prefer the anonymity of avoiding a mental health waiting room.”
However, while a vast number of therapists may offer telehealth, they may not be doing it correctly. From using unsecured email to non-HIPPAA-compliant software to not providing appropriate consent forms, the errors she has seen in how therapists have adopted telehealth are concerning.
“A majority of therapists using telehealth have not been trained in best practices,” Maheu said referring to legal, ethical, clinical, and technological practices. “A seasoned clinician would never think of offering a service in a new area without training. We are known for offering competency-based, evidence-based services. This is our hallmark and in most states, it is legally required by licensing boards.”
For instance, a clinician needs to understand all laws that apply when working across state borders because they can vary in unexpected ways.
“I show them 20 ways different states may have different laws and audiences are usually dumbfounded,” said Maheu.
A clinician must educate themselves on the best therapeutic practices while using various technologies.
“We need to be looking at clinical, evidence-based literature and understand that we are not compliant without following it,”
said Maheu.
She pointed out that the literature on telehealth has nearly doubled since 2020. “Most therapists I work with are shocked to learn that all this literature is out there.”
On the technical side, it is important to know the ins and outs of the software or hardware and if it complies with HIPPAA laws. Not all versions of Skype, for example, would comply. Regular email does not but could be used in some cases (with informed consent).
It is a serious issue that Maheu feels often gets overlooked, posing a great risk to the therapist.
“HIPAA requires the covered entity, the clinician in our case, to choose tech wisely or they can be brought up on charges,” said Maheu. “Every single piece of software you use needs to have a business associate agreement.”
Double checking everything is key, including anywhere that information leaves your system such as an iCloud backup.
“The Office for Civil Rights makes a free, online tool available that will tell you what you need to do to secure your software,” Maheu added.
Clinicians need to provide an informed consent document that thoroughly addresses telehealth concerns, like if a patient would be required to do an in-person visit periodically or the appropriate way to communicate.
Let a client know you will not reply if they reach out on an un-secured channel, like social media, and how you would handle texts or other chat options.
“It’s not about what clients do, it’s what you do,” said Maheu. “It is jaw-dropping how many clinicians engage people on social media who are identified as their clients.”
In the end, it is about protecting both the client and the clinician by ensuring that all legal, ethical, technological, and clinical requirements are met.
“The number one rule is to do no harm and many clinicians are failing at that,” Maheu said.