WE ARE NOW PROVIDING ONLY ONLINE ASSESSMENTS AND THERAPY SERVICES GIVEN COVID-19 (CORONA VIRUS). SESSIONS COULD BE CONDUCTED OVER THE PHONE OR VIA SECURE VIDEO USING ZOOM, VSEE OR OTHER SECURE ELECTRONIC FORMATS.

 

Important Information Regarding The Use of Psychological Services Online 
 
1.    Psychological services being offered online is a fairly new option in the field of mental health care. Relative to standard ‘face-to-face’ therapy, there is less research and theory on things like effectiveness, the client-therapist relationship, and ethical considerations. 
 
Therefore, it is important that anyone considering online psychological services bear in mind the limitations in knowledge, the possibility that it may not be as effective as standard therapy, as well as other potential limitations. However, the research that has been completed to date on online psychological services has been very promising, showing that therapy can be effective – sometimes as effective as face-to-face interventions. 
  
2.    There are various pros and cons to consider when psychological services are completed via the internet. For instance, the client-therapist relationship could be inferior to standard therapy. Also, communication tends to involve both verbal and nonverbal components. Thus, it is possible that both you and your mental health provider may have less than optimal communication via the internet, as opposed to standard therapy. There is also the possibility that problems with the technology (ex: losing the internet signal; power failure) could cause problems during the services.  
 
Alternatively, there are some potential benefits to online services. For instance, clients may feel more comfortable in their own home, more comfortable expressing themselves online, and there is perhaps more flexibility in scheduling appointments. Online therapy is also a nice option for those living in regions where access to services is less than adequate.  
 
I recommend that all clients considering online services spend time weighing the benefits and risks, in order to decide whether it is an appropriate fit for them. This decision should also include alternative options, such as working with another mental health practitioner in your area.   
 
3.    While your clinicians can research the security of a particular online tool (ex: zoom; Vsee), the clinician is not an internet security expert. Also, the internet is constantly evolving and changing in terms of online security and threats to such security. Therefore, clients should bear in mind that there is some loss of control over issues of confidentiality and privacy, in that your clinician cannot guarantee complete security of information exchanged.  
 
However, I (Dr. Eyal Bodenstein) have researched various options for online services, and have found that the programs/companies Zoom and VSee appear to offer excellent security for health information and confidentiality. The following are key features of VSee: 
 
a.    It does not store or record any online sessions (unless it is requested, which I would never do). 
b.    It encrypts the data being streamed during the online session. This means that our online therapy session would be well protected from hackers.  
c.    The company VSee does not have the key to the encrypted data, so they cannot have access to the online session being streamed.  
 
Because VSee appears to be an excellent program for online therapy, I highly recommend using it. Therefore, any client wanting to do online therapy with me would have to sign up for a VSee account, which is free and can be found at However, should you wish to communicate via other electronic means, I am willing to accommodate your needs.
 
4.    Due to the fact that loss of communication could happen at any point during online service (ex: loss of internet connection), it is important to have a plan in place. First, should the connection be lost, the clinician and client should note the time that remains in session. Given that clients are paying for a specific period of therapy time (ex: 50 minutes), it may be possible to make up the lost time at a later date, or to negotiate a change in rate for that session based on the actual amount of therapy time.  
 
Second, ideally the clinician should have a phone number in order to contact that client in case of lost communication. The clinician agrees to phone and speak with the client about how to proceed.  
 
Third, the clinician also requires the address of the client as well as the number of local police and emergency services. As in standard therapy, if the clinician believes there is a risk of harm to the client (ex: suicide) or to another person (ex: violence), the clinician must take steps to prevent such an occurrence. Similarly, if the internet connection with your clinician is lost and the clinician cannot contact the client via phone, the clinician may contact third parties if there is a concern for safety.  
 
5.    As with regular face-to-face therapy, clinicians maintain a regular file on each client in accordance with existing professional standards. These files are kept in a secure location.  
 
6.    Your clinician may suspend, change or terminate online services in the following scenarios: 
 
a.    The client has not honoured payment of previous services.  
b.    The clinician decides that the client’s problems cannot be adequately addressed via online services.  
c.    An unforeseen ethical problem arises. 
 
Any decision made by the clinician will be reviewed with the client.  
 
7.    In accordance with recommendations by the Canadian Psychological Association, I offer to clients from Ontario the contact information of the provincial regulatory body of psychologists and psychological associates – The College of Psychologists of Ontario. Clients wanting more information about the practice of psychology in Ontario can contact this organization at: 
 
Web:  
Tele: (800) 489-8388 
 
References 
 
•    Richards & Vigano (2013). Online counseling: A narrative and critical review of the literature. Journal of Clinical Psychology, 79, 994-1011. 
•    Rochlen et al. (2004). Online therapy: Review of relevant definitions, debates and current empirical support. Journal of Clinical Psychology, 60, 269-283. 
•    Spence et al. (2011). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of Consulting and Clinical Psychology, 79, 629-642.