Video Therapy at Couples In Step

Video conferencing began in the 1960’s but developed slowly. The first decade of the 2000’s saw video conferencing come into the mainstream. The world of internet video conferencing has evolved light years beyond the 1960’s.

Here’s how Irene , the founder of Couples In Step has integrated (and continues to integrate) video therapy into professional work with couples.

First forays into on line video

I  first started using online video conferencing in 2004. It was called “skype-ing” back then and I “skyped” to communicate with family when I was living in the Philippines.

Professionally I recall using Skype for the first time with a client couple around 2008. Despite the poor video quality and rampant dropped calls of that era, client couples continued to jump at the opportunity when I occasionally presented a video therapy call as an option.

Clients best interest considered

I network internationally with couple therapists. Around 2012 I began to notice that some innovative therapists, particularly in the USA, were using video therapy in their practices. VSee was an early innovator  in telemedicine and so I switched from Skype to VSee and did the occasional video therapy call with couples.  These early telemedicine providers such as VSee were focused on meeting American health privacy laws, not Canadian laws. But Canadian therapists had no Canadian option.

In Canada psychotherapists, along with medicine in general, has lagged behind other countries when it comes to offering services via telemedicine. 

Because I was aware that the available video therapy options didn’t take into account Canadian health care laws, I only offered it to couples upon occasion when I thought a couple could benefit.

Around  2016 Canadian entrepreneurs  began developing video platforms for virtual therapy.

Psychotherapy practice and the internet

Couples In Step was an early adapter of  integrating internet services into its practice structure. In 2015 two Canadian start ups, Jane and OWL, began to offer secure web-based practice management systems to Canadian psychotherapists. This made for ease in the storage and management of client records under Canadian Health Privacy laws. I, as founder of Couples In Step signed up with Owl early in 2015.

Unfortunately these two maverick Canadian based practice management on-line based services, Jane and OWL, were a bit behind the times by not adding in video between 2017-2019. Other emerging Canadian platforms, NousTalk and OnCall Health did take Canadian Health Security laws into consideration as they developed their platforms.

In 2019, I, along with other psychotherapists asked OWL to develop secure video conferencing capability. OWL did begin to work on that capability and was hoping to have this as a live offering in late 2019/early 2020. In early 2020, that date changed to June or July 2020.

In my work with web developers over the years I have observed that working with website developers is a little like working with home renovators: “Add 2-6 months to the target finish date to arrive at the actual finish date.”

Video therapy & COVID-19

In Canada COVID-19 realities hit in mid-March 2020. Sheltering-in-place and isolation recommendations came from every direction. For public safety reasons and in keeping with the goal of flattening the COVID-19 curve I made the decision on March 16 to move all Couples In Step psychotherapy sessions on line.

Given my occasional use of video therapy over the course of many years this wasn’t a difficult transition and I have been able to help my clients transition to the world of on-line therapy.

I also wrote a few frantic emails to OWL pleading with them to add video as soon as possible. OWL responded by promising to move their beta video option to go live by end April or May, 2020.

Over the past few weeks I have explored the feasibility of moving all of Couples In Step confidential client information from OWL to a Canadian on-line practice management software company both compliant with Canadian health information storage laws and video capability. However the cost of tech and admin support, mental focus required, and the amount of time that it would take to make such a move at this time is not possible.

Main issue with Canadian vs American video platforms

As the internet has evolved the general public has become more and more aware of how on-line activity could become available to untrustworthy data collection entities. The word data breach is not a foreign concept anymore.

The ultimate issue for mental health providers such as Couples in Step are questions such as:

• Where is my client’s data, such as the dates of video sessions, the emails of the parties involved and such, stored?
• How will I know if there has been a data breech when it comes to my client’s personal health information (PHI)?
• What do I do if there is a data breech?

The US and Canada have different privacy laws when it comes to breeches of privacy. In so far as I can tell Canadian Privacy laws related to on-line issues are more in line with European General Data Protection Regulations and are stricter. So for example in Canada all breaches of Personal Health Information (PHI) need to be shared with the Privacy Commissioner and the company whose data has been breached. In the US the requirement to share a data breach only applies when a company has information about many hundreds of people have been affected.

On March 20 the Office of the Privacy Commissioner of Canada put out an announcement to help organizations understand their privacy-related obligations during the COVID-19 outbreak. Here’s a quote from that announcement:

All organizations must continue to operate with lawful authority and exercise good judgment. Government institutions will need to apply the principles of necessity and proportionality, whether in applying existing measures or in deciding on new actions to address the current crisis.

The Couples In Step therapists, Irene and Lori are registered in two Ontario colleges: the Ontario College of Social Workers and Social Services Workers and the College of Registered Psychotherapists of Ontario. COVID-19 is posing unprecedented ethical challenges to these colleges as well and the input given by these professional bodies with respect to privacy has been confusing and unclear. All of us, therapists, clients, professional organizations etc are confused and unclear about the impact of COVID-19.

April, 2020: video therapy at Couples In Step

I’ve been pleased over the years with how OWL has carefully and deliberately added features to it’s system that takes into account the Canadian legalities pertaining to mental health infrastructure. Given that all businesses, including Couples In Step, are under significant stress during this COVID-19 time, Couples In Step will remain with OWL and sign on to the online video feature as soon as it becomes available in OWL. (Update: As of mid May, 2020 OWL’s online video feature went live. It’s working well!)

In the meantime I started noticing problems with the VSee video quality as I was meeting with couples. There was more freezing. Video was fuzzy.

There are possible reasons:

• Perhaps the vast increase in numbers who needed to jump into online work was affecting VSee video quality
• Perhaps the amount of users in my particular neighbourhood who were watching Netflix was far more than it was a few weeks ago.
• Perhaps the time of day I was online was making a difference–evening sessions were not as high quality as morning sessions.

I don’t know.

In any event I explored other platforms, some free, some not free: Doxy.me, Adracare, Virtual Care. There are many to choose from.

I did, for now, switch from Vsee to Zoom as my primary video platform, as Zoom, despite the recent press related to zoombombing still appears to be a good choice at this time. Zoom has written about how it’s platform addresses Canada privacy laws.

Stay tuned! Things are evolving rapidly.