Getting Paid: Guiding New Clients into Teletherapy in Your Telepractice
How to Talk with Potential Clients about Doing Teletherapy in Place of In-Office Sessions

The biggest challenge therapists say they’re facing with telementalhealth, is how to talk with potential clients about doing teletherapy in place of in office sessions.

Since therapists now have telepractices doing video and phone sessions instead of face-to-face sessions in their office, they’ve discovered that having the initial contact—the intake or pre-therapy phone or email interaction—with a potential client is, and needs to be, a little bit different than the interaction a clinician is used to having when orienting a client to beginning in-office therapy sessions.

While clinicians are skilled and practiced in what to say and cover with potential clients during the first contact for in office therapy, now when potential clients call inquiring about therapy, therapists who aren’t doing in-office sessions find their biggest dilemma is what to say to introduce teletherapy video and phone sessions—and how to respond effectively to those potential clients who are resistant or reluctant to schedule an appointment or pay for these sessions.

When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions? What’s the best way to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person in the office? What should a therapist say to a new client to orient and prepare them for video or phone therapy sessions?

As you know, when clients come to therapy they are entering a new world. They are moving from a familiar way of operating to the therapy context where different rules apply. Our job as therapists begins with helping clients enter, become familiar with, and safely navigate the therapeutic context. We are their guide.

For successful therapy, clients need to experience a safe enough environment where they can be free to examine things and share their feelings. For most clinicians and clients this previously occurred in a therapist’s office that had been specifically created to insure a safe, confidential, and supportive environment.

Now that the therapy office is a virtual one with therapist and client in a different location, no longer does the clinician arrange for privacy and provide the Kleenex, bottled water, tea, coffee or snack; decorative pillow to hug, comforting blanket and client chair or couch. Gone, too, is therapist greeting the client in the waiting room and the comfortable small talk on the way to the office. Clients, prospective clients and the general public are familiar with and know what to expect from in-office therapy; teletherapy not so much.

With teletherapy it’s extra important for us to remember that when clients begin therapy and enter the therapeutic milieu via telehealth their experience of changing contexts is much more complex than with in-office therapy sessions. This means that not only are new clients moving from a world where they behave in certain ways to a place where they are expected to think and act differently in the therapeutic setting, with telementalhealth this includes adding another layer to that—a video screen or a phone and the therapist and client being in two locations. That’s quite different from driving to, parking, sitting in the waiting room, and walking into a therapist’s consulting room where therapy occurs and the client is taken care of in person by the therapist.

How can a therapist re-create that experience with teletherapy and convey to clients and prospective clients that it works? For most new and continuing clients this shift to creating and utilizing a virtual space for therapy takes learning and practice under guidance and direction of a competent therapist—and that starts with the very first phone conversation when Teletherapy is presented.

As you read the following information, be sure to remember:

• Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
• You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.

1. When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions?

When doing in-person therapy sessions, during the intake conversation, therapists usually disclose their credentials, review the address and location of the office, frequency of appointments, session length, cost, type of payment accepted, directions to the office, where to park, etc.—and discuss why the client is seeking therapy to make sure it’s within their scope of practice.

When teletherapy is involved, whether or not a client has requested video or phone sessions, it’s up to the therapist to introduce, disclose, and orient the client to not only the usual therapy information but also the video and phone delivery model, treatment methods, and limitations of the telemental health services the therapist provides (Section 2290.5 of the Code). How every therapist does this is different.

Regardless of whether a client requests telementalhealth services, or the therapist is informing the client that therapy will be conducted remotely by video or phone, the opening statement and disclosures are the same. Most therapists begin with a simple general statement like, “During this time of social distancing and stay at home orders I provide therapy through telementalhealth video and phone sessions.” Some also include, “In-office sessions may be resumed at a future date and I will let you know when that becomes an option.”

2. What should a therapist say a new client to prepare new clients for video or phone therapy sessions?

After an opening statement saying why teletherapy sessions are the sole therapeutic format, stating your own version of the following information is helpful and covers required disclosures:

• Teletherapy is similar to in-person therapy and studies show it’s just as effective.
• All the same therapy methods I use for in-person sessions work for video and phone sessions.
• All that’s needed for teletherapy is a place that’s private where you can talk (at home, work, or in your car) and a device—phone, tablet, laptop, desktop, smartwatch—with internet access or a good phone connection for phone sessions.
• To get you started with teletherapy, I can show you how simple and easy it is to do therapy with your computer, tablet or phone—at home or any other location of your choosing.
• I will guide you through the process, just as I would for in-person sessions.
• With video your session is on the secure platform I use as my virtual office. I email you the link, or phone number I use for your session and help you with any issues that come up.
• Even before social distancing and stay-at-home orders, I’ve worked successfully with clients who have chosen phone or video sessions when out of town or not able to come to the office (unusual work schedule, sick child, not feeling well but need a session, etc.).

This is the type of information and guidance that clients and potential clients rely on therapists to provide to guide them into teletherapy that’s safe, confidential and effective.

3. What are the things therapists need to address with potential telementalhealth clients during that first pre-therapy interaction/intake?

Aside from informing the client or prospective client about teletherapy by introducing, disclosing, and orienting the client to the usual therapy information, and the video and phone delivery model, treatment methods, and limitations of the telementalhealth services the therapist provides, the California BBS: Standards of Practice for Telehealth also state that before the delivery of teletherapy the therapist needs to obtain verbal or written consent from the client for those services. In addition, the therapist needs to document in the client notes that informed consent was obtained from the client. This is more specifically stated by the BBS, in Section 5,b.

That’s enough on introducing and talking with clients about doing teletherapy instead of in-office sessions. Next time we’ll focus on how to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person. 

Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative people across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping develop successful careers and thriving practices. To learn more about her services, training or the monthly LA Practice Development Lunch visit www.Gifted-Adults.com and www.LAPracticeDevelopment.com.