Audio Update: Christine Korol telehealth and online therapy

Quick talk with Dr. Christine Korol about tele-health and online therapy

Can you give me a nutshell overview of taking your practice online? How does it differ from an in-person therapy session?

There are a few things to learn when you’re moving to an online practice. Typically it’s understanding a lot of what tech to use safely and to get comfortable using tech. A lot of therapists are intimidated so a big chunk of what I teach is how to evaluate the safety of a tech, not to be intimidated by a lot of the technical language, and how to do a privacy impact assessment.

After that it’s how to get your patients comfortable doing online therapy, teaching them about keeping their conversations with you private and safe, finding a good location, having secure internet, not using public wi-fi or wi-fi at a coffee shop. And having backup, especially if the person’s not in your community how to reach emergency contacts they might have if you’re concerned about their safety. Knowing where their family doctor is in their community can be a good option.

There are many technical things to think of and then after that the practice of online therapy usually involves a little bit of tweaking – understanding that clients often feel more comfortable in their own homes, so they over-disclose a little bit. So how to contain that, how to keep people engaged. I think most therapists have the experience of doing a crisis call with a client over the phone, so it’s not as hard a transition as they think. It’s a lot of practical training for us just to keep it safe and pick the right tact.

What does it mean that someone might “over-disclose”?

That means that they’re a bit more comfortable so maybe they talk a bit too fast or go too deep a little too soon, whereas they might pace themselves with what they talk about in a face-to-face session. We find that for example in email therapy, people write down more than they would be willing to share otherwise, and then they’ll maybe have some regrets about that or feel uncomfortable about it. Especially with trauma, we want to pace it out with people and slow them down a little bit so some of it is knowing when to pause and say “I want to ask about something else first before we go deeper into that”. Also knowing how to structure the session a bit so people don’t go too fast in therapy.

When you do tele-therapy yourself, what is your tech setup?

I have very high-speed internet so that from my end the connection will be smooth. I make sure my router’s encrypted and that I have an up-to-date router. Routers are actually very important in terms of security. If you have a fairly up to date router and keep it well maintained you should be fine. I have a device that I know is secure and I store no data on my device – I use electronic health records, those are in the cloud, and I make sure I use a video platform that meets privacy standards.

Even little things that people don’t realize, like you have to keep your device safe too – make sure it’s password protected and when you’re not using it treat it like a file. If there’s any data on it lock it in a filing cabinet. It’s practical things – security of the device, security of the platform, knowing where all your data is stored in different locations. And making sure at a simple level people can’t hear you doing your therapy sessions while you’re in the other room.

I presume keeping other people out of your space is paramount while you’re doing online therapy.

Absolutely. I’ve been doing tele-health for many, many years so this was a pretty easy transition for me. Although moving into ALL tele-therapy has been still a bit of a learning curve for me so I’m settling into that this week. This is my second week of all tele-health. At first I was going into my office and doing it from my office at work, even for remote patients, because it was completely secure there. Now that I’m working from home I have a white noise machine that I put out into the living room just outside the door where I’m working so none of my family can hear what I’m doing and I keep the door closed, so it’s very private.

Sort of like one of those red lights outside a studio so you don’t walk in while someone’s recording.

Exactly! Except for therapists it’s a white noise machine.