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Depression and Telepsychology

How Telemedicine Can Work with Your Depressive Disorder

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Telepsychology has many names, like Telemental Health, Teletherapy, Telepractice, Distance Therapy - and falls under the practice that's called Telemedicine.

As with anything new, such names can be confusing. But suffice it to say that these terms are all talking about the same thing: conducting psychotherapy within a virtual space between two places with a therapist and a patient.

For children, adults and seniors who cannot travel to a therapist's office, live in a rural area or want to access a specialist who is not nearby, Telepsychology offers great access to mental health care. This service is growing by leaps and bounds, but it does have its limitations.

The big takeaway is that Telepsychology is recommended for mental health illnesses with mild or moderate symptoms. So when it comes to depression, using Telepsychology is best when you are not experiencing severe symptoms of depression.

Tips for Telepsychology

There are 4 things to address before beginning Telepsychology.

1) Computer Access: You will need a computer, desktop, laptop or tablet to do Telepsychology. Also required is that your computer device has a camera and microphone so that you can hear and see your therapist when doing Telepsychology.

2) Insurance. Telepsychology is covered by both Medicare and Medicaid, and at present, 31 states and the District of Columbia require that private insurers cover Telehealth services the same as they cover in-person services. To find out if your insurance company covers Telepsychology services, contact the benefits department.

3) State Boundaries. The general rule is the state in which you live is the only state you can access Telepsychology. If you live in New York, this means you cannot work with a therapist via Telepsychology in California or New Jersey, for example. It must be a therapist in New York. This is due to licensing, malpractice and state jurisdiction policies.

4) Service Platforms. After you find a therapist to work with who has a license in your state to do Telepsychology, the next thing is to be sure that he or she is using software or services that are HIPAA compliant. Skype and Facetime, while seemingly convenient and free, are NOT HIPPA compliant for Telepsychology. It's vital to protect your privacy, so be sure to read up on why this HIPPA compliant software is a must-have when doing Telepsychology.

Other Things To Know

Set up: For comfort purposes, if you're using a laptop or tablet to do Telepsychology, consider placing it on several books (or something that raises it off the desk or table) so you don't have to look or bend downward during sessions. This will prevent you from having neck pain or other body aches as you do this form of therapy. Your desktop computer will already be at eye level, so this shouldn't be an issue.

Backup Phone Access: Make sure you and your therapist have an alternative phone contact number to use as a back up if your computer connection gets lost or other technical problems arise. Often, your session may cut off due to WIFI or the audio or visual doesn't synch well and you have to reboot. Sometimes I call my patient to keep the session going, while the computer connection tries to re-establish the connection.

Session Fatigue: Be aware that Telepsychology can leave you feeling tired after a session. It's hard on your sense of sight and hearing. Your eye gaze is placed on the video screen in order to "see" your therapist, which actually offsets your focus. This happens for your therapist too. So when you see the image of your therapist, or she sees you, you are never really looking at each other. What you see is an image of the other looking at the screen. As such, you miss important visual cues and other textures that come with in-person sessions. There's also a difference in the kind of non-verbal cues and communications that occur. Sometimes it's hard to detect them, or background noise from the Telepsychology session becomes distracting. As mentioned, another limitation is audio can be delayed, or the video connection can get disrupted or lost - so thoughts and feelings have to be repeated.

"I missed that, can you say that again."

"I didn't hear you. What did you say?"

It's also hard on your body because you need to remain in a somewhat fixed position for the duration of the session so you remain "on-screen." With in-person sessions, I can cross or uncross my legs, kick up my feet, or shift in my chair. I can't readily do these kinds of things with Telepsychology.

So, I've learned that when I do Telepsychology sessions, I need to schedule a nice long break afterwards. You will likely feel tired after a Telepsychology session too. So, know that this fatigue is expected and normal.

Fit: Is Telepsychology working to address your depressive symptoms? If it is, you'll continue working with your therapist, but if there are concerns that Telepsychology isn't fully managing your depression, in-person therapy with another clinician may be recommended.


Telepsychology is an exciting technology that offers people who cannot travel for psychotherapy enormous possibilities. If you live with depression and have limitations that prevent you from accessing care in-person, Telepsychology is a meaningful treatment to consider.

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