Family Therapy Video Calls: How To

Following is part 1 in a 3 part series about using video calls in family therapy:

Robert Zemeckis painted a picture of 2015 in Back to the Future 2, with flying cars, hoverboards, automated houses and video calls.  While I’m still waiting to ride a hoverboard, the technology of video calling is readily available for our use.  As a therapist at New Haven Residential Treatment Center, I use video calls so parents can both hear and see their daughters. By using this multi-sensory approach, parents feel more connected to their daughter which is critical for their family therapy work.  Instead of having family members crouching around the computer, I decided this could be a great chance to get more creative and simulate a face-to-face session.  This series of blog posts is an introduction to using video chat in a session and how to go beyond just talking into the webcam.  Let’s start with the basics.

  1. Do you have the right equipment?

Yes, you already have a computer.  Do you have a webcam, a microphone and speakers set up?  Do you have the right software?  Is your Internet fast enough?

For software, I’ve used Skype, Google+, iChat, and Logitech.  Google+ is the most interesting to me, because of the ease of more than 2-way conversation.  Skype offers group calls, but they charge you for it.  And now Google+ video is available on mobile devices as well.  But, remember, you get what you pay for.

For Internet speeds, this is the table that Skype uses to help their customers have accurate bandwidth.

Call type Minimum download
/ upload speed
Recommended download
/ upload speed
Calling 30kbps / 30kbps 100kbps / 100kbps
Video calling /
Screen sharing
128kbps / 128kbps 300kbps / 300kbps
Video calling
400kbps / 400kbps 500kbps / 500kbps
Video calling
1.2Mbps / 1.2Mbps 1.5Mbps / 1.5Mbps
Group video calling
(3 people)
512kbps / 128kbps 2Mbps / 512kbps
Group video calling
(5 people)
2Mbps / 128kbps 4Mbps / 512kbps
Group video calling
(7+ people)
4Mbps / 128kbps 8Mbps / 512kbps

And remember, wireless connections are slower than a hard line.  So, if you only have wireless for your computer, be prepared for lower quality picture and audio.

  1. Do you have the tech know-how?

Keeping up with the fast paced technology world is fun for some people and a burden for others.  And for some, it is almost impossible.  Where are you in that spectrum?  Not only do you need to know how to operate your own system and be able to troubleshoot it when it goes down, you may need to walk your clients through basics such as creating a login name or brainstorming when the sound isn’t working.  In one particular therapy session, the family was having difficulties connecting to their Internet resulting in a frozen images and repeated dropped calls.  With a little detective work, they found their cat sleeping on their wireless router.  Cat moved, problem resolved.

  1. Do you understand how to maintain HIPAA privacy laws?

If you are using video software at work, such as Skype, and you also use it at home for your personal life, did you think to keep your clients’ names private?  Having their Skype information on your family account won’t keep your spouse or kids from seeing their names.  What about Google+ and that stream they put up telling everyone that you are having a hangout? Recording laws apply to the Internet too.  You can’t record the video feed without written permission from your clients.

  1. Do you know all the ethical concerns and considerations regarding online therapy?

What are the licensing guidelines in your state?  Can you do it across state lines?  What are the ethical rules of your professional organization?  What are the limitations to video chat for therapy?  This is a gray area for many state licensing boards, but it’s quickly getting rules and laws affixed.  Stay informed.

Here are some resources for further thought and exploration:

The New York Times recently wrote an article about video calls in therapy.  Here is PsychCentral’s review of the Times’ piece.  This is a list of guidelines for assessing whether or not a client is suitable for online therapy. The follow-up articles are interesting, too.  There is a lot of information on the Internet about all these topics and more, although not a lot of research and data.

In part 2 of this series, we will talk about some ideas on how to make the sessions more interactive than just everyone staring into the webcam.  Stay tuned……