In a therapist’s physical office, efforts are made to protect the privacy of the client: files are locked and inaccessible, windows are obscured, and soundproofing is put in place to prevent eavesdropping.
With the recent shift to the use of telebehavioral health, many clients have identified significant issues with ensuring the same level of privacy that they have come to expect from the face-to-face clinical environment. These are serious issues that the therapist must address to maintain client privacy.
The therapist is responsible for ensuring that their own end of the interaction is secure: that whatever building and room they are using for the therapy session is free from eavesdropping, that they will not be interrupted during the session, and that they have adequate access to the technology they will be using for the session. The telehealth platform being used should be HIPAA-compliant and end-to-end encrypted (to better understand the meaning of this, you can visit https://wickr.com/end-to-end-encryption-vs-client-to-server-encryption/) with recording options turned off in order to maintain privacy. When the therapist engages in telehealth, there is an aspect of the client’s privacy that the therapist can no longer exercise control over: the client’s environment.
While some individuals live alone, most do not, and for those who do not, finding privacy can be a challenge. Sometimes the issue is simply logistical: small children can be disruptive and demanding, or a roommate might be live-streaming a video game at the same time as your appointment - and their participants could inadvertently overhear your conversation. More pertinently, the nature of psychotherapy can involve discussion of upsetting topics - upsetting not just to the client themselves, but to other individuals in their lives. Family, friends, bosses, coworkers, and the like can be subjects of conversation during a therapy session, so what can a client do to ensure that they can speak freely to their therapist without the potential for consequences in their relationships with others around them?
Sit in your car. The car doesn’t have to be running, and you don’t necessarily have to leave your house or driveway. You can sit in the car and keep the doors locked from the inside, leave the engine turned off, and log in or dial in to your therapy session. It is inadvisable to drive during a therapy session, so even if you leave your house, please find a place to park before joining your therapy session.
Take a walk. Earbuds with a microphone paired with a smartphone would be needed for this method of joining your therapy session, and it is possible that nearby strangers might overhear your conversation. Your privacy isn’t absolute in a public place, but typically you will be left alone with decent personal space if you are actively walking a trail or sidewalk. Most of those who could overhear snippets of your conversation will not know that you are talking to a therapist, they are more likely to suspect you are simply on a video chat with a friend or family member.
Coordinate your appointment schedule with your family so that they can be gone from the house during your therapy session. Loved ones who are supportive of your therapy might be willing to give you the space you need by taking children for a bike ride or other activity away from the house, if you ask them and explain the need.
Use a white noise generator. These can obscure the sound of your voice traveling through your house. Place the white noise generator immediately outside the door of whatever room you are using. If you do not have a white noise generator, you can sit in your bathroom with the shower running. *Note: Hot water will cause steam, so if running the water for an hour is ecologically sound where you live, use cold water.*
Ask your therapist about alternative appointment days and times. If your normal appointment time worked great for in-person therapy but will not work as well for telehealth, see if they might be willing to meet at a day and time that works better, such as early in the morning before the rest of your household is awake, or later in the evening after your children are asleep.
There are a host of other concerns that could affect whether telebehavioral health is right for you. Your access to technology and having adequate bandwidth for your video/audio connection alongside what other technology might be running for others in your household are also important concerns. If you have any of those concerns, please contact your therapist and discuss how they can help address those concerns.