How to Become a Teletherapist

In our guide to becoming a teletherapist, we provide the tips you should follow to make your career in virtual therapy a success. Plus, we outline some challenges you may face—and how to best avoid them.

The COVID-19 pandemic changed the way we all interacted with our health care providers; the same applies to clinical therapists who provide online therapy and online counseling. The American Psychological Association (APA) reported that Medicare, Medicaid, and other stakeholders relaxed their rules on telehealth to ease some of the financial challenges of those seeking mental health care.

Clinical psychologist Adam Haim, Ph.D., head of the Treatment and Preventive Intervention Research Branch at the National Institute of Mental Health (NIMH), told the APA that the pandemic hastened the move toward telehealth. “The whole paradigm of sitting in a room with a clinician and receiving an intervention in a 45-minute session has essentially been flipped on its head,” Haim said.

Peer-reviewed studies even revealed that online therapists are indeed effective, which is why there are so many opportunities for clinical therapists who want to work remotely.

Tips for becoming a successful teletherapist

You’ll increase your potential for success as a virtual clinical therapist if you set up your practice with clear goals in mind. While the clinical aspects of therapy remain the same in telehealth, there are special considerations. The American Medical Association (AMA) provides many strategies to set up a successful telehealth practice, so consider these key points when preparing for a career in online therapy.

Check legal and regulatory rules

Make sure you have the proper licenses and permits to begin your practice. If you’re teaming up with an established practice, you may be able to rely on them to verify these credentials. However, it’s always best to confirm that you’re in compliance.

Choose your professional colleagues

Analyze the backgrounds and reputations of your associates as well as their practices. If you choose to open a private teletherapy practice, confirm the associates you choose to work with have the appropriate licensure, education, credentials, and reputation to ensure they're a good fit.

Decide if you need administrative support

Do you want to work with an accountant? An administrative assistant? A medical coding specialist? Consider your needs, potential income, and how paying for these support roles may help grow your practice.

Consider your technological needs

Discuss any technology challenges with your colleagues, and consider working with a consultant to determine your tech needs, including your internet connection and your work setup (computer, webcam, microphone, phone, etc). Then, you can determine which equipment to purchase to meet your potential client volume while staying within budget.

Ensure you protect client confidentiality

Confidentiality is vital for both written documents and any type of telecommunication involving client health information. To protect client confidentiality, it is best practice to develop standard practice protocols and require signed confidentiality agreements with colleagues, employees, and outside vendors. Invest in high-end paper shredders, a locked filing system, and secure teleconnections.

Document your current workflow

The workflow in a practice that relies on face-to-face therapy is different from that of a telehealth practice. Consider how yours may differ so you can adapt your operating procedures. Ask yourself how you’ll work with distractions such as a client’s child interrupting a session. Also, is it possible for you to shorten your sessions and remain effective?

Educate your clients

Set client expectations by talking to them about how your teletherapy sessions will differ from traditional visits. Also, consider investing in written materials that explain these differences.

Design your workspace

Create a functional and positive workspace so you can easily schedule appointments, track time, document notes, and provide seamless communication. Take this time to also fully understand the technology that works best for your clients and the best way to introduce it. For example, if you want to do virtual video chats, choose a reliable platform with an intuitive interface. Whichever tool you pick, make sure your clients know about it beforehand.

Determine how client services are coded and billed

Do you plan to code your medical records and bills? If so, what support do you need to determine their accuracy? Consider how your practice may benefit from electronic code programs and professional coding specialists. You can use them on an as-needed basis or as full-time support.

Challenges to overcome with online therapy

While working remotely as a therapist certainly has its perks, you’ll also face challenges in this role. Here are the biggest issues you may encounter.

Technology barriers

You want to ensure that your clients have high-speed internet and access to a computer to use your services successfully. If they don’t have access to this tech, what other options can you make available?

Failure to set clear expectations for communication, time, dynamics

The switch from traditional therapy to teletherapy involves both significant and small changes in the practice. Discuss the changes with your clients, and take all the time needed to answer questions and receive feedback.

Clearly establish boundaries early on with clients by communicating when and how they may contact you outside of scheduled sessions. Lack of personal and professional boundaries is a major contributor to mental health worker burnout, so this is an essential step to maintain a healthy relationship with clients.

Write out all expectations and post them electronically so clients can access them easily.

Failure to establish payment expectations

Set payment expectations for your clients. If you don’t correctly and promptly bill clients, you may cheat yourself. If clients aren’t aware of expectations, they may become frustrated and seek treatment from another practice. Determine how you want payment cycles to work, document your process, and share this information with your clients.

Lack of formal feedback tools for clients

Give your clients a way to offer honest feedback. Social media surveys and contests that ask for ideas and comments are two positive ways to solicit information and improve your practice.

Failure to formally ask clients to agree to teletherapy

Your sessions with clients will be different, but you want to make sure your clients buy into the process as they may not be familiar with the intricacies of virtual therapy. Provide clients with written information on what they can expect and invite them to ask questions before signing the agreement.

HIPAA missteps that make client information vulnerable

You must follow the rules set forth by the Health Insurance Portability and Accountability Act (HIPAA) to keep all client records secure, according to the U.S. Department of Health and Human Services (HHS). It is also important to recognize the specific ways HIPAA compliance applies to virtual care.

More than simply doing this, however, you want to prove how you do it. Keep written copies of policies that outline how you protect client confidentiality and privacy. One common misstep is to combine medical records with psychotherapy notes. It’s imperative that you limit access to psychotherapy notes except in rare circumstances, such as under court orders.

Take extra steps to safeguard and isolate psychotherapy notes. You can do this by encrypting electronic notes, or by separating everything and locking away your written notes immediately after a session ends.

Client hesitation

Clients are cautious of therapy for many reasons, including fear of judgment and bad experiences with previous therapists. You can overcome these challenges by welcoming your clients, focusing on their needs, and remaining non-judgmental, as noted by GoodTherapy. Taking measures to improve your webside manner will also help clients feel more comfortable.

Interstate licensure missteps

The American Mental Health Counselors Association is a professional association that continues to grapple with licensure portability. Traditionally, clinical therapists and other medical professionals were bound by state laws that limited their practices to clients in their state of licensure. This is problematic when clients travel to other areas, such as when attending college in a different state, and still want to receive treatment.

The Zur Institute suggests several safeguards practitioners may take in this case, including temporary licensure in certain states, to stay within the laws and regulations that govern clinical therapists.

Virtual mental health professionals often obtain multiple state licenses so they can continue providing care for clients outside their state of residence. This can be a tedious process but multi-state licensing can open the door to new opportunities. Here are additional resources on multi-state licensing for mental health providers.

How does Wheel make it easier to be an online therapist?

With a broader acceptance of telehealth and an increase in the sophistication of telecommunications, clinical therapists have many more opportunities to work remotely and provide proper services to their clients. Like any shift in a profession, the move from face-to-face therapy to teletherapy offers its own set of challenges. That’s why setting up a new teletherapy practice or joining an existing one may seem daunting.

With Wheel, you can work with as many—or as few—telehealth companies as you’d like on a flexible schedule that fits your lifestyle.

Plus, you don’t need to worry about juggling staff or administrative tasks like billing. Our support allows you to do what you do best—provide clinical therapy to your clients.

Whatever professional path you choose, telehealth has opened an array of opportunities for you. Join Wheel and provide virtual care on your terms.