Jane's Blog Tips, News, and Thoughts from the Jane Team

Online vs. In-Person Therapy: Finding a Balance

July 04, 2024

A woman in an office looks at a desktop computer and smiles. She wears a long-sleeved green shirt and has a long necklace on. Her brown hair is tied back into a ponytail. There are illustrated elements of a speech bubble coming from the computer screen and little green stars around the woman.

By Rachel Burns

Talia Singer juggles her hybrid mental health practice in the busy urban center of Toronto. As a mental health nurse, psychotherapist, instructor, and mother, her weekly schedule flips between anything from clinical supervision to client sessions, plus parenting.

Like many mental health clinicians pre-pandemic, Talia was initially reluctant to take her practice online. With the pandemic’s pressing needs, however, she quickly discovered the benefits.

“I did a full swing over to balancing online and in-person, noticing the wonderful flexibility it can give you as the practitioner. And as the client, increased accessibility,” she says. “That being said, I could talk about all of the lovely pitfalls of online therapy, because there are significant ones. But, in general, I think that it’s opened up this healthcare service to many more people than it had before.”

Having previously researched online therapy as part of her PhD thesis at Walden University, Talia has developed best practices for creating a seamless, safe, and secure experience for clients — whether online or offline.

Therapist Talia Singer smiles for the camera. She wears a black blazer and black shirt with a gold pendant necklace. Her brown hair is curled and sits at her shoulders. There is a green backdrop behind her, and to her left, the block quote reads: "If we're too accessible, that leads to practitioner burnout, and it leads to misses."

Cultivating a consistent therapeutic environment

While a practitioner can’t control their client’s space, they can help set the tone for the session. For Talia, creating a safe and consistent environment for clients means setting clear expectations for how therapy will look. That includes always meeting patients in her office, displaying the same background behind her.

She uses one office setting for both in-person and online visits to create a sense of continuity and familiarity. “I always tell my clients who are new to therapy: Just so you know, I’m in a private, secure space. No one is in the room with me and you will always see this background behind me. I’ll never meet you in another room.”

When choosing to create a dedicated office space at home, Talia stresses the importance of confidentiality. “Some people use a white noise machine to ensure additional privacy if they’re living with people. I have a set of doors in between my office and home.” This predictability creates a sense of trust, which helps build a solid sense of attachment when clients picture her as a practitioner.

Asking clients to adjust their tech setup

In therapy, it can be difficult when people have poor lighting, opt out of sharing their camera, or have more than one screen. “If [a client has] a split screen, they might be looking in a different direction than I am.”

When Talia’s patients have less-than-ideal setups, she asks them to shift things around. “I’ll tell my clients, can you shut the blinds behind you? Do you have lights [you can turn on]?”

What if someone becomes distracted during the session by texts or other notifications? Talia makes it all part of the experience. She mentions things like, ‘Oh, you seem very distracted today.’ Or, ‘you seem to be pulled in two separate directions’ to raise awareness without judgment. “There’s usually a way to say it to bring attention to it where it just becomes a part of the dynamic.”

Setting your practice up for success

To structure a hybrid practice, Talia stresses taking the time to set yourself up for success with your technology and having backup plans should anything fail.

“You should have consistency of internet strength. Get yourself the best router or modem and make sure that any failure, as much as possible, is never on your end. Have a backup pre-planned. I always tell my clients, ‘if for whatever reason the internet fails, I will call you on the phone.’”

In terms of privacy, it’s also prudent to let folks know the limitations of online confidentiality.

“It’s good to have an addition to your confidentiality spiel to say you’re on a HIPAA-compliant platform, but that doesn’t mean someone couldn’t possibly hack into this conversation. If you’re worried about that, we should not continue online.”

A therapist appears on a laptop screen. He smiles and wears a red plaid shirt. His black hair is short and we see a bit of his office behind him over the shoulder of the client, whose image is blurred.

Addressing the pitfalls of online accessibility

While technology can increase reach, sometimes it can make therapists too accessible. What if a client texts you 24-7? “The boundaries that were in place prior to using video and chat still make sense, and are almost even more important now. I personally don’t give out my cell phone number; I have an office number,” Talia comments.

Talia also sets clear expectations for when she is available. “When I meet someone for the first time, I say ‘I am reachable Monday through Friday during business hours.’” She reminds clients that she’s not an emergency service to avoid any false expectations.

This, in turn, creates greater client safety. “If we’re too accessible, that leads to practitioner burnout, and it leads to misses. If my patients know Talia’s never available at midnight, they won’t expect me to read the email until Monday morning.

“This also only applies to me, people practise in a myriad of ways. Some practitioners do work on weekends. Some work almost on an emergency basis. But that’s not me. You just have to know what you do and put it on paper, basically.”

Finding a work-life balance

In balancing home and work life, the realities are similar to many home office workers, with parenting needs or other tasks popping up throughout the day.

“I always have 15 minutes in between appointments, whether I’m online or in person. [In person] I will usually set up the room with art supplies – I’m an art therapist – or I would make myself a cup of tea, or go to the washroom.

“When I’m home online in those 15 minutes, I take care of my kids. I make them lunch. I ask who needs a ride later to wherever. It’s harder to keep it separate.”

In asking how she makes space for herself, she celebrates the online waiting room found in Jane or in other video applications like Zoom. “It’s fantastic because I can get myself fully prepared before I let the person in. That being said – how do I take care of myself online? With great difficulty,” she laughs.

Location matters: providing care beyond your own borders

When providing therapy online, jurisdiction and limits of professional insurance are important factors. “I’m covered for North America. Therapists I know have coverage for the globe; it’s important to keep that in mind,” she says. “Whether you can see folks who are on vacation internationally is also something to check first with your professional insurance contract.”

And what about working yourself, as a therapist, while traveling? You could, potentially. Though… Talia isn’t interested. The last boundary for herself is knowing when to take a break.

“Like no,” she says to the idea of working while on a trip.

“I’m on vacation.”

An infographic against a green backdrop with an icon of a person on a laptop screen with a speech bubble. The checklist title is "Managing a hybrid therapy practice: Go-to-checklist". The first checkbox reads: "Clear expectations: Inform clients about the therapy setup and what they can expect." The second checkbox reads: "Confidentiality measures: Ensure privacy with soundproofing measures like white noise machines or multiple doors." The third checkbox reads: "No distractions: Address any distractions during sessions to keep the focus on therapy." The fourth checkbox reads: "Reliable internet: Invest in a strong internet connection and a good router or modem." The fifth checkbox reads: "Backup plans: Have a backup method, such as phone calls, in case of internet failure." The sixth checkbox reads: "Privacy and confidentiality: Inform clients about the limitations of online confidentiality despite using HIPAA-compliant platforms." The seventh checkbox reads: "Boundaries: Set clear boundaries for availability to prevent burnout and maintain professionalism." The eighth checkbox reads: "Office vs. personal contact: Use an office number instead of a personal cell phone to maintain professional boundaries." The ninth checkbox reads: "Emergency protocols: Make it clear that you are not an emergency service and outline what clients should do in emergencies." The tenth checkbox reads: "Break time: Schedule 15-minute breaks between appointments to manage personal tasks or self-care." The eleventh checkbox reads: "Online waiting room: Utilize features like online waiting rooms to prepare before each session." The twelfth checkbox reads: "Insurance and jurisdiction: Check your professional insurance coverage and jurisdiction limits, especially when dealing with international clients."

Looking for more tips to help your practice? 🤔

We’ve got your back. For tons of expert advice on all things clinic life, check out Front Desk magazine. You can even sign up for print issues, delivered right to your clinic!

The cover of Front Desk magazine against a yellow background with the text: "Subscribe today for your FREE magazine"

Blog Posts