Although telemedicine is often thought of as including Internet chat, e-mail or telephone conversations, I generally intend it to mean a meeting using video conferencing. Most of the parameters of a psychotherapy meeting remain the same. I will ask you to fill out an additional telemedicine consent form.
The major advantages are that you can use my services without living close by, that you save on travel time to and from my office and that in some ways you have greater privacy.
This is a fairly new idea. That will mean that there may be new or increased risks for you. Here are some areas you should think about:
The most predictable issues would be around poor quality of the connection, or becoming disconnected altogether. In such instances, the frustration is compounded if you are having an important conversation with your therapist!
The likely remedy would be that we could continue for the rest of the session by telephone. I have a toll free number, 888-792-2858, that would be available for that.
Because of sound quality, we may also elect at some points to have a phone conversation at the same time as the video conversation. By eliminating the audio that comes over the internet, we can improve the quality of the communication.
I have found several services that will provide encrypted video conferencing. I think this is critical for privacy. The video conferencing that I will provide will be HIPAA compliant. Although there are always risks to your confidentiality, not coming to my office in person is probably a net improvement in your privacy.
Availability for Emergencies
Video conferencing is not reliable enough yet to count on being able to "meet" with me in an emergency. This is actually a constraint of ordinary face-to-face meetings too, but the technology of video conferencing may make it seem like I will be able to be more available. We should be agreed that if we anticipate needing to meet on an emergency basis frequently, that this is not a good modality.
In the event of an emergency, your best choice is usually the mental health crisis phone line in your city. Frequently you can find this number in the first few pages of your phone book under "Emergency Crisis Phone Lines."
If you anticipate needing to call a crisis hotline, you may want to write down those numbers now somewhere where you will be able to find them when you are upset. I do not have these numbers on my recorded message on my answering machine when you call me.
"You Mean I'll be on a Camera?"
Many people don't know this, but when you come to my office, I will be looking right at you. Although I don't generally take note of these things, I can see what you are wearing, if you've put on makeup, whether you've had a bad haircut, everything! It's not any different than a camera.
Seriously, many people have qualms about being seen over the internet with a camera. However, you'll find that you get used to it very quickly, and it is not as scary as you think.
Don't let camera shyness be an obstacle to trying this.
There are now two services that we can use for video conferencing: Skype, or iChat
You should have a healthy broadband connection to make this work. I suggest that 384kbps is a minimum. That would be basic DSL or Cable service. Dial up Internet access is not sufficient. Reasonably good lighting on your end is also helpful.
I am reluctant to do merely voice chat for psychotherapy and I am unwilling to consider pure text as a mode for psychotherapy. Much too much is "lost in translation" for this to be a worthwhile exercise.
It is entirely doubtful that you can submit this for your own insurance, but you can check with them. The regular CPT code would have a "GT" modifier appended. You can ask your insurer if they will honor this. Insurance reimbursement is likely to grow in the future.
All fees remain the same as with face-to-face meetings.
Licensing law restricts the practice of telemedicine to those who live and contact me from within the state of California. I am looking into licensing in other states in the future, but as yet, that is not available.
To see the perspective of California Board of Behavioral Sciences, (who regulate MFTs), on online therapy modalities, see the BBS site.
We should be aware that video conferencing may not work out and that we will have to consider alternatives, including referral to another provider whom you can see face-to-face.
All other policies remain the same, despite the different modality of how we actually interact.
Contact me if you think you would like to explore this further.
Scheduling | Fees | Cancellations | Insurance | E-Mail | Emergencies | Privacy Practices | Consent
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