Telehealth Best Practices for Therapists

Telehealth has fundamentally changed how mental health care is delivered. What started as an emergency response during the pandemic has evolved into a preferred modality for millions of clients and therapists alike. But here's the thing: providing exceptional therapy through a screen requires more than just logging into a video call. It demands intentional adaptations to your clinical approach, technical setup, and client engagement strategies.

Whether you're new to telehealth or looking to refine your virtual practice, this guide covers everything you need to deliver care that matches - and sometimes exceeds - the quality of in-person sessions.

Creating Your Professional Telehealth Environment

Your virtual therapy space communicates as much to clients as your physical office would. A thoughtfully designed setup builds trust before you even say hello.

Visual Environment Essentials

Position your camera at eye level to create natural eye contact. Avoid looking down at a laptop screen, which can feel disconnecting for clients. A simple laptop stand or stack of books can make a significant difference.

Technical Requirements Checklist

Technical difficulties can derail therapeutic momentum. Investing in reliable equipment and testing your setup regularly prevents frustrating interruptions during sensitive conversations.

HIPAA Compliance and Security Requirements

Using the wrong video platform can expose you to significant liability. Consumer apps like FaceTime, Skype, and standard Zoom are not HIPAA-compliant and should never be used for therapy sessions.

Essential Security Practices

Beyond choosing the right platform, you need consistent security habits. Clients trust you with their most vulnerable moments, and that trust extends to how you protect their data.

Always verify your client's identity at the start of each session, especially if they're joining from an unfamiliar location or device. Establish a protocol for confirming they're in a private space where they can speak freely.

Consider what's visible on your screen when sharing. A stray notification or visible client name on another tab can create privacy breaches. Close all unnecessary applications and browser tabs before sessions begin.

Adapting Your Clinical Approach for Virtual Sessions

The therapeutic relationship can absolutely thrive through a screen, but it requires intentional adaptations. Some interventions translate naturally to telehealth while others need creative modifications.

Building Rapport Virtually

The first few minutes of a telehealth session set the tone. Arrive early, greet clients warmly, and take a moment to check in about their environment and comfort level. A simple "How are you feeling about meeting this way today?" can surface concerns that might otherwise go unaddressed.

Eye contact works differently on video. Looking at your camera lens - not your client's image on screen - creates the perception of direct eye contact. This feels unnatural at first but becomes second nature with practice.

Be more verbally expressive than you might be in person. Non-verbal cues are harder to read on video, so use verbal acknowledgments, reflections, and check-ins more frequently to maintain connection.

Interventions That Work Well Virtually

Cognitive behavioral therapy, dialectical behavior therapy, and other structured approaches translate exceptionally well to telehealth. Screen sharing allows you to work through worksheets collaboratively in real time.

Mindfulness and relaxation exercises can be even more effective virtually because clients are already in their home environment where they'll practice these skills.

Psychoeducation benefits from the ability to share resources, videos, and visual aids directly on screen during sessions.

Working with Special Populations

Telehealth expands access for many underserved populations, but each group comes with specific considerations.

Children and Adolescents

Young clients often adapt to telehealth quickly since video communication feels natural to digital natives. Use interactive features like virtual whiteboards, screen-shared games, and drawing tools to maintain engagement.

Establish clear boundaries about who else might be in the room or able to hear the session. For adolescents, discuss confidentiality around shared devices and browser history.

Older Adults

Provide detailed technical instructions in advance, ideally with screenshots or a brief video tutorial. Schedule a test call before the first clinical session to troubleshoot any issues.

Be patient with technology learning curves. Some older clients may benefit from involving a trusted family member in the initial setup while maintaining privacy during actual sessions.

Clients in Rural Areas

Limited bandwidth is common in rural settings. Have a phone backup plan and consider whether audio-only sessions might be more reliable than video for some clients. The therapeutic relationship can absolutely develop through voice alone.

Managing Crises in Virtual Sessions

Crisis protocols require adaptation for telehealth. You cannot physically be present if a client is in danger, making preparation and clear protocols essential.

Measuring Outcomes and Continuous Improvement

Research consistently shows that telehealth can achieve equivalent outcomes to in-person therapy for many conditions. But "can" only becomes "does" when you actively monitor and improve your virtual practice.

Frequently Asked Questions