As Covid-19 continues to hold the world in its grasp, and we as a whole are doing everything to close in on a “new normal,” it becomes apparent that some industries are incapable of working remotely. Fortunately, much of the mental health field is able to provide services remotely, thanks to telephone and video calling technology, often called telehealth or teletherapy. But most of us did not get training in how to make the switch from working in-person to working remotely.

The Japanese concept of kaizen is applicable when it comes to providing mental health services remotely. Kaizen encompasses a concept that all aspects of the organization, including all employees from the top down, are subject to continual improvements.

Every process, every technique, every action should be continually reviewed and assessed for improvements. Providing teletherapy is a perfect situation in which to apply kaizen, because there are ways to keep getting better.

The following list may include items that seem obvious to some.  But if you can learn even just one new thing to incorporate into your telehealth practice, then it is a noteworthy improvement. It is also a step toward embracing kaizen – and helping your clients.

Oscar Wilde eloquently wrote, “To expect the unexpected shows a thoroughly modern intellect,” and embracing telehealth is an exercise in preparing for the unknown.

Here are some additional aspects of telehealth where we can continually improve.

Verbal Consent is Good. Written Consent is Better.

One thing to make sure of, especially the first time you are conducting a remote session, is to get verbal authorization from your client to conduct telephone and telehealth mental health sessions. Document appointment times and affirmation of consent from each patient.

However, meeting remotely does not relinquish you of appropriate professional responsibilities. To that end, consider how you will gather additional documentation you still need, including written consent to treatment and release of information forms that will allow you to communicate with other providers.

Be Mindful When Working Remotely

If you are at home, consider ways to improve in the following areas:

Create a Peaceful Space

Make sure you have no plans to have anything installed or worked on in your home during work hours. The middle of your session is not a good time to have a plumber in the house.

Do your best to minimize interruptions due to scheduled deliveries. Having to get up and sign for deliveries or even just answer the door makes focusing difficult.

Who is staying in your home? Relatives, friends, small children? Make sure all family members are aware that you are having a remote mental health session. If you have a lock on your door, make sure you use it. No one but you is responsible for ensuring quality service to your clients, so avoid a small child barging into the room, or a relative wandering in half-dressed.

Stay Professional

Dress as though you are meeting your client face to face. We have all seen the video where the individual stands up and shows that they are wearing pajama bottoms, or worse, boxers. Plan for having to get up and the camera still being on, and keep in mind that the camera has a wider angle than you may think.

Maintain privacy by having headphones you can speak into, or a noise canceling device setup for your room. Your relatives may be completely okay with listening in on your work calls, but your client may not want your relatives to hear about their private mental health issues. This addresses an issue of privacy which also has implications of potential legal issues if your client feels as though what they were telling you could be heard by others.

If you are in the office:

If you are practicing telehealth from the office, you may still want to consider how the sound travels throughout your office space. Not all office buildings are built the same, and some have very thin walls. Consider a noise cancelling machine even in settings that may seem to provide privacy. Communication privacy is not only visual, but also auditory.

Proceed With Caution Outside the Home or Office

If you are working away from home without access to an office setting, things can be very tricky. Please consult with your licensing board to know whether you can provide remote mental health services via telephone or video chat if you are not at home or in an office setting.

Coffee shops and public spaces are not appropriate spaces for a mental health professional to provide services to clients. It creates an opportunity for a breach in confidentiality, which many supervisors and ethics boards consider unacceptable.

If you must conduct a session and you cannot be at home or in the office setting, consider sitting inside your car. Common sense dictates having your windows rolled up and possibly your air conditioning or heat on. You may lack a quality internet connection, and the quality of the session may be decreased by using your phone rather than a computer and webcam.

Plan Ahead for Tech Trouble

It is not enough just to have a backup plan in case you do not have internet service. You must also communicate the plan to your client before you decide to move to plan B. If you and your client have agreed on a phone conversation if the video call fails, then that will work.

But if you have unilaterally decided that a telephone call will have to suffice as a backup, the client may not be on board. Communicate with your client about backup plans you have in mind; they are your client and deserve proper communication.

Know what kind of telephone that your client is using. If you and your client both have iPhones, this may give you an additional backup plan that many others will not have, as you can use FaceTime to have a video chat with them.

Know Your Video Options

While FaceTime is not HIPPA compliant, a Covid-19 emergency provision from the U.S. Department of Health and Human Services has essentially allowed for use of certain non-HIPPA compliant videoconference services, including the free Zoom service, without risk of penalty. Check with your supervisor first.

Allow clients a buffer period for connecting and logging into the video chat system. Your clients may not be as tech savvy as you, or you may not be as tech savvy as you think. Allow them several minutes to get into and log into the system.

If you are planning on a session, consider allowing time for your next client. Back to back sessions may be okay, as long as you take into account that your client may not log in exactly at the very moment your appointment is set for and then the few minutes it takes for them to log into the video chat room.

Do not rely on one company to conduct your video chat with your client. If one service glitches, have another backup service ready to go. For instance, and VSee also offer free HIPAA compliant telehealth services.

Avoid Last Minute Stressors

When you email a video link to your client, have them confirm they received the link in advance of the meeting, so there are no complications at the appointment time.

Have the link for the video chat session handy. The client may email, text or call telling you that they lost the it.

Have your client’s telephone number handy, either stored in your phone or somewhere you can readily access, in case you need to reach them or the video cuts out.

Put yourself in the right mindset. You are the one providing mental health services, so you need to be the grounded one for your client. Give yourself ample time to set up your computer, your setting, your room, and make sure you communicate with everyone in your home (or even office) that you are in a therapy session.

Work on breathing techniques to help you focus before the session. Do you have a pen and paper to take notes? Do you have a bottle of water in case your throat gets dry? As silly as it may seem, go to the restroom before your session. There is nothing worse than having to ask for a potty break in the middle of a session or being distracted the entire time.

Do not try any technology for the first time during a telehealth session. If you have never used a certain pair of headphones, do not try them out while you are doing therapy. If you have never used a certain platform, be it Zoom,, or another company, try them first with someone who is not a client.  There are many other ways to try things out before you have a telehealth session, but your clients are not the ones you should be trying things out on.

Refresh your memory about your client, their name, age, location, symptoms and behaviors before the session begins. It is not their responsibility to provide you reminders about every previous session they have had with you or to replace your client file with providing you information. Know your client and who you are talking to before you begin.

Interested in more articles about the unique challenges and opportunities of teletherapy? Check out Telesupervision: How Remote Supervision Can Help by Beata Klarowska, M.S. CCC-SLP.

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