Psychological Teleconsultation: Best Practices

Email:info@psycare.it
WhatsApp: +39 375 703 9065

The psychological teleconsultation It’s now part of the professional practice of Italian psychologists. However, before conducting an online psychological consultation, it’s important to consider some simple but essential precautions to ensure a correct and effective professional outcome. We’ve compiled a brief handbook with inside the good practices and we hope it can be a valid help to those approaching this new way of doing therapy for the first time.

Below we will provide some indications on how to conduct a psychological teleconsultation. During the process, it will also be important to educate patients on the various steps, guiding them and explaining some key technical aspects, thus sharing what are considered best practices for online therapy.

The indications we will provide comply with the Guidelines for remote psychological services issued by the CNOP (National Council of the Order of Psychologists), which, “although not binding, aim to provide guidance for competently carrying out one’s professional activity through the use of remote communication technologies.”

REFERENCE INDEX

Some important checks to carry out before a psychological teleconsultation

Compared to a face-to-face session, the practice of psychological teleconsultation It can be significantly more demanding in terms of attention span. However, this concentration effort, which the therapist carries out independently but in collaboration with the patient online, is very fruitful from the perspective of general clinical understanding and metacognitive analysis of the relationship. To achieve a correct and effective professional result, in addition to referring to good practices For online therapy, it’s first necessary to choose the right software; preferably one specifically designed for this profession.

In this regard, the second point of the guidelines issued by the CNOP refers to the“Adequacy” and reads as follows:

"It is the responsibility of every psychologist, before starting an online intervention, to evaluate the appropriateness of that tool—that is, the website or platform used by the professional providing the service—based on the characteristics of the intervention and the subjects involved."

To fully meet this need it was specially designed and created a software for psychologists and psychotherapists which allows for online patient management, providing integrated services with high quality standards on a single platform. The software we are referring to is PsyCare and allows for innovative, safe, and simple management of meetings between therapists and patients.

To maximize performance, it is appropriate and useful to make some preliminary checks in reference to the new elements which will come into play:

technical features, devices and connection
environmental and setting characteristics
privacy and confidentiality
ethics and legal aspects

TECHNICAL FEATURES, DEVICES AND CONNECTION

Devices

In a psychological teleconsultation It is an important added value (for both the therapist and the patient) to be able to carry out therapy online from any device, depending on one’s needs.
The software of PsyCare It was developed to be accessible from all devices with a microphone and webcam (computers, tablets, and cell phones). Registration on the platform occurs directly in your browser; there’s no need to download or install anything.

Browser

It is recommended to always use the most up-to-date versions of browsers (Chrome, Firefox, Edge, Safari, etc.) and not to block their updates. It is among the good practices Make sure you have enabled the camera and microphone functions and consent to their use by clicking “Allow.” You can always check your browser settings and reset them at any time, directly from the device you are using..
PsyCare works with all modern, up-to-date browsers, except Internet Explorer 11 and below.

Connection

It’s best to use a moderately fast and stable Wi-Fi connection, whether fixed or mobile. As an alternative to Wi-Fi, it’s best to have a smartphone plan that allows you to create a hotspot with your phone and generate a Wi-Fi network that can also be used to connect your laptop or tablet to the Internet.
It’s a good idea to check your connection before starting the video call. If for any reason the connection drops during the video consultation, don’t worry! Both you and the patient can recover and reconnect. With PsyCare, the link remains valid and active for the entire duration of the session.

Screen size and resolution

For this reason, one chooses what best meets one’s needs and the requirements of the moment.
Remember that, as far as sizes are concerned, they range from 11-inch ultrabooks to 17-inch notebooks and desktop monitors.
And along with the viewing area, resolution should also be considered. Current devices offer a variety of high-quality resolutions, allowing for optimal viewing even on small devices.

Camera position

The camera is the cornerstone of the psychological teleconsultationIt could be dirty and, if not integrated into the device, it tends to move. Performing these two preliminary checks is the first step to starting an online session.
Make sure you have enabled its use in your device settings.
If you’re using a cell phone, it’s best to use a stand or ensure your phone is positioned steadily. This will improve the fluidity of the conversation, allow for a better view, and ultimately, a better experience. It’s also good practice to ask the other person if they can see your image correctly.

Headphones and microphone

Headphones are a great way to enhance audio clarity and improve concentration. Even external devices like small portable speakers can provide excellent results; it’s always a good idea to consider whether the space allows for sufficient privacy.
Regarding the microphone, make sure you’ve enabled it in your device settings. During sessions, it’s a good idea to check the microphone’s position and operation, and ask the other person if they can hear you well.

Drums

It may seem trivial, but it’s definitely a good habit to remember to check your device’s battery level in good time and make sure you can charge it. For cell phones, portable charging devices are useful, easy to find and low on effort (both in terms of cost and maintenance), and are well suited to addressing this inconvenience.

ENVIRONMENTAL CHARACTERISTICS AND SETTING

THElighting

It’s a good idea to ensure good lighting in the therapy environment; good vision helps with online therapy. Asking the patient to ensure good lighting can also really help improve the management of the online session.

Setting

Setting is another crucial aspect of any psychological therapy. It is essential that the patient be alone and in a quiet, private space (or, depending on the therapy, with a couple, family, or group). Observing patients in their homes or settings outside the office can also provide valuable information about their living conditions and other social determinants of health, which can aid in assessment and diagnosis. Psychologists are encouraged to carefully evaluate the remote environment in which services will be provided to determine any impact it may have on the effectiveness, privacy, and/or safety of the proposed telepsychology intervention. This assessment of the remote environment may include a discussion of the patient’s situation at home or within an organizational context, the availability of staff or technical or emergency support, risk of distractions, potential breaches of privacy, or any other impediments that may impact the effective delivery of telepsychology services.

Context

To further protect privacy, it may be helpful to determine whether the patient is alone in the location where the online session is taking place. It’s also important to understand (for security reasons) whether they have a close family or friends network or live alone, etc.

Equipment and spaces

In some particular cases, for some specific techniques such as, for example, psycho-physical experiences or relaxation and mindfulness, it may be useful to ensure that the patient has the necessary spaces or equipment to correctly carry out the procedures or exercises.

Waiting room

If possible, before starting an online session, it would be a good idea for the therapist to have the opportunity to check the connection quality (both his and his patient’s) and prepare everything necessary before actually starting the online session.
PsyCare provides this feature.

PRIVACY AND CONFIDENTIALITY

Privacy

A psychological teleconsultation should always be done in a private setting. It is a good idea to make sure ~~you~~ that the patient feels at ease. Article 11 of the Code of Ethics also emphasizes:

"The psychologist is strictly bound by professional secrecy. Therefore, he or she does not disclose news, facts, or information learned by virtue of his or her professional relationship, nor does he or she provide information about professional services performed or planned."

It’s important, therefore, to understand that safeguarding patient data doesn’t mean owning it; therefore, while you can process it, you can’t dispose of it at will, but only by virtue of—and within the limits of—a mandate you’ve received.

GDPR

The fifth point of the guidelines issued by the CNOP refers to the “Confidentiality” :

Psychologists must take all precautions (e.g., IT security measures) to protect and maintain the confidentiality of their clients' data and information. They must also inform their clients of the precautions taken, including the potential increased privacy risks inherent in the different technologies used, as well as the limitations that each method poses to confidentiality. Psychologists who use electronic technologies for remote communication are required to use hardware and software systems that provide efficient data protection.

Here we would like to remind you that PsyCare is the first platform in Italy for psychologists and psychotherapists to fully comply with data privacy and confidentiality requirements, being GDPR and HIPAA compliant, particularly for health data and telemedicine.

Regarding Confidentiality, Article 17 of the Code of Ethics also recalls that:

"The confidentiality of communications must also be protected through the safekeeping and control of notes, memos, writings, or recordings of any kind and in any form, relating to the professional relationship. The psychologist who collaborates in the establishment and use of documentation systems works to ensure the protection of the interested parties."

It is therefore advisable to reiterate and clarify the fundamental confidentiality of your profession, both when providing services and when we are required to retain and archive our users’ data. In this regard, it may also be useful to refer to the 11 recommendations by Cert-PA of AgID (Agency for Digital Italy), drawn up to help public employees safely use personal PCs, tablets, and smartphones when working from home. These recommendations also apply to private professionals providing online services, listed below:

 1. Prioritize following the policies and recommendations issued by your Administration.
 2. Use operating systems for which support is currently guaranteed.
 3. Keep your operating system up to date with security updates.
 4. Make sure your operating system's security software (firewall, antivirus, etc.) is enabled and kept up-to-date.
 5. Ensure that access to the operating system is protected by a strong password and in any case compliant with the password policies issued by your Administration.
 6. Do not install software from unofficial sources/repositories.
 7. Block access to the system and/or configure automatic lock mode when you leave your workstation.
 8. Do not click on links or attachments in suspicious emails.
 9. Use access to adequately protected Wi-Fi connections.
 10. Connect to mobile devices (pen drives, external hard drives, etc.) whose origin you know (new, previously used, or provided by your Administration).
 11. Always log out of the services/portals used after you have finished your work-social session.

ETHICS AND LEGAL ASPECTS

It’s essential for professionals to learn about the various options for managing online practices, as well as their risks. Greater awareness of the tools currently in use helps avoid potential harm to patients or ethical conflicts.

What situations cannot be handled online?
An online therapy program may not be suitable if:

the patient is a minor and cannot have proven consent from both parents;
the patient is currently in a particularly emergency situation;
the patient requires significant psychiatric care;
the patient has thoughts related to the possibility of harming himself or other people;
the patient needs to undergo therapy by order of a court;
the patient has psychological difficulties that could affect the performance of online sessions (delusions; reported psychotic disorders; threats to things or people, etc.);
the patient reports significant social or family problems, such as violence, serious substance abuse, etc.

If the patient falls into these categories, for emergencies, the patient is advised to call 112 (from European countries) or contact local services. A valid alternative is to provide specific contact information or contact provincial or municipal health agencies (for example, mental health agencies, anti-violence centers, anti-stalking centers, shelters, law enforcement agencies, social services, and social assistance agencies), chosen, of course, based on the patient’s information. Do not rule out the possibility of referring the patient to another psychologist, psychotherapist, or psychiatrist in person, or to a social/healthcare facility. Furthermore, it is essential, from the first contact, to know whether the patient is currently taking psychotropic medications, whether they are being treated by other professionals, and to obtain information regarding any experiences (past or present) with other therapists.

Jurisdictional and/or international boundaries

The fourth point of the guidelines issued by the CNOP refers to the “Legal Aspects” :

“Psychologists shall be aware of and comply with all laws and regulations when providing online services to clients crosses jurisdictional and/or international boundaries, including determining whether online psychological intervention is permitted in that jurisdiction or whether restrictions apply.”

If a psychologist provides services from one jurisdiction to a patient located in another, the laws and regulations may differ between the two jurisdictions. The guidelines therefore encourage psychologists to be aware of and comply with all relevant laws and regulations when providing psychological services across their jurisdictional and international borders. As part of emergency planning, psychologists are encouraged to familiarize themselves with the laws and regulations of the patient’s jurisdiction, their differences from those in the psychologist’s jurisdiction, and to document all their emergency planning efforts.

Informed consent

When psychological services are provided online, it is good practice to explicitly state this in the informed consent. It is important to obtain two types of consent: informed consent for medical treatment and informed consent for the processing of the patient’s personal data. Psychologists make a reasonable effort to provide a complete and clear description of the telepsychology services they provide and seek to obtain and document informed consent when providing professional services online. They also strive to develop, share, and explain procedures to their patients regarding how they will interact with them using the specific telecommunications technologies involved.

Payment

To allow patients to deduct healthcare expenses, following the introduction of the traceability requirement in the 2020 Budget Law, payments for remote services must be traceable and can be made by the client via bank transfer, credit card (which can also be used to transfer funds directly to the practitioner’s account through online banking), PayPal, or other online payment systems (such as Satispay, Apple Pay, and Google Pay). These payment systems ensure traceability and therefore, if the service provided is healthcare-related, allow the client to deduct the expense. As with other services, the practitioner, in compliance with tax regulations, will be required to issue a healthcare invoice/receipt according to the methods established by their tax regime. The healthcare invoice/receipt must be issued no later than the date of collection of the service and must be sent to the client.

READY TO START

Prepare in advance

Remember to keep all the materials you think you might need during the consultation handy. It is always important (as per good practices) Maintain a section dedicated to patients and your clinical work, where you can keep a copy or a record of your invoices, have templates of any professional contracts you may use, and keep paper tests, clinical reports, projects, a diary, a notebook, documents or files to share, and anything else you like. Therefore, conduct the consultation in a casual manner, similar to an in-person meeting.

Conducting a psychological teleconsultation may seem complex at first, but with a little attention and patient cooperation, you’ll be surprised by its simplicity and, above all, the results. This has been reported by professionals who had to use teleconsultations to continue providing care to their patients during the Covid-19 emergency, and beyond. If you encounter any difficulties during a session, remember to share any observations or recommendations with the patient for the next meeting.

Good work!