How to best present yourself while delivering telehealth

By Catherine Robertson Souter
May 7th, 2020
Thomas Plante, Ph.D., ABPP
Thomas Plante, Ph.D., ABPP, Santa Clara University professor and Stanford University adjunct clinical professor who writes about online ethics and hygiene for

Across the country, as we deal with the fall-out from the COVID-19 pandemic, therapists are turning to video platforms for delivering care. For some, it’s an extension of what they were already doing, but for others this is a whole new world.

“Therapists are quickly shifting their practices online,” said Rachel McCrickard, LMFT, CEO & founder of Motivo, a video platform that provides clinical supervision. “Many have formal training and/or extensive experience in the delivery of telehealth, and many do not.”

By this point, you have probably made the decision whether to do on-line therapy and have done the research on HIPAA-compliance, insurance coding, inter-state laws, and the optimal conferencing platforms.

You may have already begun working with patients or you may have rolled this out more slowly. And the process may be working perfectly by now.

But then, you sit down to talk to a client and wonder, “Yuck, do I really look this bad?”

Of course, it’s not the most important part of a therapy session, the attractiveness (or lack thereof) of the therapist. But, still…

And so, here are some tips on the more superficial part of making the most of your online therapy. After practicing a bit with the platform and then making sure to dress appropriately and comb your hair, you know enough to check the online camera before you start for spinach in your teeth or a stray crumb in the beard.

What else can you do to best present yourself?

When setting up a video conference call, the first thing to look at, and this cannot be overstated, is the angle of the camera lens. Using books, a stand or whatever it takes, place the lens at just about eye level. This way, you avoid unflattering and distorted chin or nose views and it will also bring a level of professionalism to the session. Think about making eye contact by looking at the computer camera as often as possible (all while also watching the client’s reactions).

“You don’t want to get just the bottom of your face because the laptop is too low,” said Thomas Plante, Ph.D., ABPP, a Santa Clara University professor and Stanford University adjunct clinical professor who writes about online ethics and hygiene for “Have it level with your head and about an arm’s length away. The whole idea is to approximate the real experience.”

Next up would be the lighting. Just like with an aging movie star, the right lighting can do wonders. Overhead lighting brings out under-eye bags. Back lighting will put your face in the dark and spot lighting can wash you out completely. The best lighting for conference calls is the same as it would be in-person.

“Look for bulbs that have an info chart on the packaging, and buy those with a color accuracy rating of 90 or higher,” states a Vogue article on how supermodels choose at-home lighting, “and a color temperature of around 2700K for clean, soft, warm light.”

The third piece would be the microphone. Plante recommends using an unobtrusive headset with an external microphone.

“You get a better sound using something close to your mouth,” he said. “Computers sound a little hollow. But maybe not big earphones like a pilot would wear, that could look weird.”

Don’t forget about the appearance of your surroundings; books, personal photos, or a stray kids’ toy on the shelf behind you all become part of the session whether you mean them to or not. And be wary of virtual backgrounds where the tech is not always perfect.

“Fake backgrounds seem unreal and if a person moves too much they almost disappear,” said Plante. “And don’t rock in your chair either – you can make the person watching you nauseous.”

Beyond appearance and sound, McCrickard recommends making sure your sessions are private by reducing interruptions from pets, children or housemates and by silencing phones, watch alarms, and other computer apps. Plus, avoid sitting outside to talk as microphones amplify even the slightest breeze. Let a client know if you plan to type during the session to take notes as those sounds can be distracting or can make it seem you are not paying attention.

While it is important to make sure that you act professionally and eliminate distractions, it may often be the client whose poor net-etiquette can disrupt the session. It’s a good idea, said Plante, to ask them to follow the same simple guidelines.

“It’s helpful to say to a patient that we want you to get the most out of this experience, so here are some tips for things you can control,” he said.

In the end, of course, this is a learning experience for all of us and a little patience can go a long way.

“We are dealing with not only setting ourselves up to do this overnight but also dealing with our own challenges in our own lives,” said Plante.

“Especially for us older types, we are not necessarily techies and all of a sudden the whole world is about tech. So, there’s an element of being reasonably gentle with ourselves and others in the process.”

And forgiving the occasional technical difficulty is part of that process.

Leave a Reply

Your email address will not be published. Required fields are marked *