Online therapy During Covid 19 - A quick guide

IACAT Members who choose to work remotely during Covid-19 must have received temporary training. 

It is recommended that if members wish to continue to offer online therapy after the crisis has passed 80 hours is the minimum standard of training required. (ACTO)

IACAT does not endorse any specific providers of online courses. 

For members who may wish to consider seeing clients via telephone or online, we ask that you follow our code of ethics and read our NEW policy document on guidance and criteria for online creative arts therapy/Supervision. This document can be accessed here  Online Therapy Policy IACAT ( This documnet may be updated as crisis continues).

These guidelines address the main competences identified by ACTO - The certifying body for Online therapy in UK acto-org.uk

We would like to thank Roweena Keaveny for making a short information video for this section which can be viewed here - Offline To Online .

Members can avail of two fully comprehensive contract/consent forms for online work. One for Adults and one for Children & Adolescents. They have been developed by the Sligo Art Psychotherapy Centre and can be used as a base for your own contract/consent forms - IACAT are very grateful to the team at Sligo Art Psychotherapy Centre for sharing this extensive work with our members. SAPC Online therapy consent form for adultsSAPC Online therapy consent form for children and adolescents

Questions to ask yourself

1. Do you have a stable internet connection/phone signal at home? Is it password protected and secure? See video above for advice. 

2. Do you have a private and confidential space to work from without interruption? Your client's space may change due to circumstance.

3. Have you researched the benefits and risks of online/phone therapy and completed at minimum a full days training in how to deliver online/phone therapy?

4. Are you in a position to re-contract for online/phone therapy with your client or caregiver who provided inital consent? This may need to be done verbally. Is your client still under the care of this caregiver? Consider who's home/accommodation the client may now be living in and if it is safe for them to receive therapy there. 

5. Is your accrediting body (for example IACAT) allowing its members to provide online/phone therapy?

6. Have you contacted your insurance provider and secured a correspondence to confirm you are covered for online/phone work. They may say you are automatically insured to do online/telephone therapy if the secure platforms listed by your professional body were recognised and endorsed by them and as long as you are compliant with your bodie’s online guidelines for working online.

7. Have you discussed moving to online/phone therapy with your supervisor and have they received training in how to support you in this work?

8. Can you provide a backup plan if the service goes down? How is this communicated? By text? Email? Include contractual boundaries around clients having access to your phone number and email and expectation of response from you so they do not feel rejected. 

9. Have you assessed each clients suitability to this way of working? Consider fantasies which may occur as some clients who assess porn online/phone will now have you, their therapist, available in the same medium. 

10. Can you provide their session at the same time as their face to face? Be flexible as they may not be able to continue with the same hours now. 

11. Acknowledge you will not be able to work exactly as you normally do face to face, how will you prepare for this?

12. Is it possible to offer 40/50 min sessions now? Consider a 'dosage' approach building up to your regular amount of time or splitting sessions over two days.

13. If working with children who are living across a number of homes/accommodation can you inform/involve adults in all homes/accommodation of requirements and therapy boundaries? 

14. Have you had an opportunity to practice with peers? 

15. How will you monitor risk indicators when visual cues may not be possible (phone or out of camera view)? 

16. Have you evaluated the risk when ending online therapy and have adequate knowledge of further resources that support to your clients. 

17. If this is not a suitable way to reconnect with your clients consider sending a personalised card to reassure them that you are keeping them in mind until you both can meet face to face. This can be sent through an organisation if you do not have clients address/email. 

Questions to ask your clients and parents/caregivers 

1. Do they have access to an internet connection/phone signal at home?  Are they comfortable using these? 

2. Do they have a private space to safely work from without interruption? Working with young people you will now need parents/caregivers to hold boundaries for you around this. How do you negotiate this? 

3. Where are they now living?  Is it safe for them to receive therapy there or would it put them at risk. 

4. Do they have access to arts therapy materials : is it possible to 'make do' with objects from their environment and consider areas of transference if these objects can not be stored away after. How will parents cope with 'messy' play and clean up/storage of materials created. 

5. Have any new issues arisen since the previous contract? Consider bereavement, domestic violence, abuse etc. 

Choosing A Platform to Connect 

1. Does it adhere to GDPR, HIPAA standards for data protection and privacy? Recommended platforms are Zoom, Thera-Link, VSee, Whereby.

2. WhatsApp, Facetime, Facebook, Skype are not seen as secure platforms due to data shared with third parties. HOWEVER, under current conditions your client may not be able to work any other way. If one of these platforms need to be used it should be discussed with your supervisor and notes taken as to why this was agreed between the parties as a platform to use. 

The Session

1. Check your video and audio ahead of session, especially what is in your background view.  Switch off listening devices for example : Siri, Alexa etc.

2. Both therapist and client should dress appropriately and groom as you would for a face to face session. 

3. Be honest with client if this is new for you too. Talk about this as being a web playspace or web therapy room (whatever you usually call your face to face space) so clients can pick up on this difference. 

4. Tell your clients you are in your web playspace today and you are wondering where they are today? Who is home with them? What room they are in? This gives you a sense of who is in the house/accommodation and what type of environment they are in. 

5. Review the contract in light of online/phone delivery. Discuss safeguarding (same rules apply), limits of confidentiality working online, backup plan if technology fails and/or safety plan, time length of sessions if this has changed. 

6. If working with young people, parents may now need to be involved at the beginning and ending of sessions to set up and close down. Consider using this, if possible, as an opportunity to encourage attachment and modeling. 

7. If working with young people, clients with suicidal ideation or vulnerable adults be aware of what you can see in the room for health and safety. They may be happy to give you a 'tour' of the space for you to consider this in more detail ie what objects are out of your view? Have a safety plan in place with parent/caregiver/supporting adult i.e. their phone number to call in case an incident. 

8. Also consider allowing them control over what they allow you to see in the camera, "Only show me what you want me to see". Some clients may be embarrassed by their current living conditions. 

9. Discuss the implications of being in camera view and off camera view. 

10. Discuss how technology can encourage disinhibition/fantasies for both client/therapist and ways to monitor and communicate this together. 

11. Continue to clarify and confirm the meaning of your clients words as the session progresses, ask them to repeat what they have said if you miss words due to lag or a bad connection. 

12. Be prepared to be introduced to aspects of your client's life that you would not normally be, ie siblings/pets coming into the room. Young children might want to introduce you to their toys/books. 

13. Consider creating a ritual around changing their space into a therapy space. This could be simply getting them to lay out a blanket on the floor, something to mark a change in the room or creating a therapy den with the blanket and chairs. Play with putting this away/back at the end of session to mark the transition back to the room. 

14. For every online session with young people schedule a feedback session with parents if possible, let the young person know you are doing this and contract with them what they are comfortable with you discussing. 

15. If parents get triggered by something, as they may now be at the start and end of sessions, agree you can text/phone them about what might be going on for them and offer a de-brief. 

Payment

1. Online sessions should be paid ahead of time i.e. the day before.

2. A secure online payment system such as Bank Transfer, Stripe, Paypal or Revolut should be used to receive online payments from clients. Refunds can also be given using these systems. 

Stripe and Paypal are online payment systems and are PCI compliant for the processing, transmission, or storage of card data. Both take a fee for each transaction. Stripe deposits the payment into your chosen bank account directly and Paypal holds payment in your Paypal account. Revolut is free online banking where you can make instant payments once both users have a Revolut card. Many Irish banks have means and methods to provide safe payment online, please check with your bank to see how they can help you accept payment online.  IACAT does not endorse any specific providers of these online payment gateways. 

3. Some clients may not want to pay online. In this case you may have to negotiate a cheque or postal order. 

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Please note that fees for April 2020- March 2021 have been reduced for professional members from €110 to €80 to assist members with recovery of practice due to Covid19.

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