Back in October I received an email from art therapist Lola Carlile with the article below attached. I followed up with her to ask if her article was submitted for our first PPIO Blog Carnival. Initially, I misunderstood her reply and then it was too late to include her post in the Blog Carnival. Mea culpa! I asked for Lola’s permission to share it with you as a guest post and she graciously agreed.
(If you are interested in writing a guest post, check out the guidelines here.)
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A Guest Post by Art Therapist Lola Carlile
“Now can you explain to me how 
you can do art therapy online?” my bemused and patient friend asked me once again. I had shared that I thought it might be interesting to try to do art therapy using SKYPE. I smiled and simply shrugged my shoulders.
Why not think out of the box? Why not think out of the box? I can’t find a job at 64 and I am over qualified for everything. I am a retired educator and a neophyte therapist. What to do? Start going where the need is . . . . And the need seemed to be individuals who have no money, health insurance, or mobility to get anywhere. Solution? SKYPE with them. And so I began . . . .
The first and obvious problem was how can I watch my client doing art? Simple mechanics like moving the camera on the computer to where my client shows me what she is doing. I watch and comment. She smiles and laughs.
Little does it matter that I have my pajama bottoms on. She laughs and says she is in her bathrobe. The tone is relaxed and she begins drawing. She sighs and looks up and I smile back at her.
What has she drawn? Lots of circles. Busy little circles. And she says she feels too fragmented. We talk about what that looks like. Is it a problem? Would she like to change it? How would that look then?
And she begins drawing conjoined circles and colors them brightly. Her mood visibly lifts and we both smile.
The end of the session begins and I share that we will continue next week – same time – same station. And she thanks me for the wonderful, but very quick, hour.
And when I disconnect, I write my notes and save them to her computer file. What a wonderful way to help someone who would otherwise not receive any treatment.
Will I continue this line of work?
Is it profitable?
Maybe and maybe. But I have just begun and that is all that matters.
I am trying to think out of the box. Now, on to find some more clients . . . .
Many small things need to be worked out – like how can I get PayPal set up for payment? Can I figure out a way to bill insurance?
But the bottom line is that I don’t have the expense of an office and neither do I have to deal with traffic and weather.
This might be a great transition for me . . . .
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About the Author: Lola Carlile in Oregon describes herself as “an educator, writer, art therapist, muse, and lover of life.” She founded Masabi (Mind and Spirit and Body Improvement), an organization that helps underprivileged women, children, and families.
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Lola:
This was an exciting post! I am so proud of how you’ve found what I surely believe is your niche. And what a lovely session to share with us. I have to believe this can work. I know the VA is getting serious about Skype therapy sessions – particularly for those living so far away from the care providers they need. Checking to see if they also have use for art therapists is also a thought. There’s a DOD subcontractor that needs people to work w the kids on bases overseas, and this might be something they consider. I know, DOD, gulp, but the soldiers and families do need help – even from us staunch pacifists.
This is intriguing! Please do keep us in the loop.
From Deb in Ann Arbor
Lola, I love how you are thinking out of the box! However, I am surprised that Skype has been the platform of choice for both you and the Veterans Administration. It is my understanding that Skype is still not HIPAA-compliant. Wondering if either you or Deb have information to the contrary that you can point us to.
And, Deb, thanks so much for suggesting that Lola (and other creative arts therapists) consider providing services via the VA! I so appreciate the idea and even more so appreciate your collaborative spirit!
Tamara, I don’t know whether anybody has found anything different, but I asked Skype’s support whether they were HIPAA compliant, and they specifically said no. Skype is encrypted, but they specifically said that they are not HIPAA compliant and pretty much told me that they do not plan to be (though they may change their mind at some point).
An interesting point of note – I heard something the other day that HIPAA compliance may only apply to people who are in some way accepting funding from insurance companies, but I haven’t actually verified that information. It’s my personal preference that I want to be HIPAA compliant whether or not I have to be.
Lauren, the last I checked, Skype was not HIPAA-compliant but that’s been several months ago. It is my understanding that HIPAA compliance is required for anyone who is transmitting “health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA (the “covered entities”).” This goes far beyond insurance-related practices.
Here’s a link to a decision tree to help you decide if you are a covered entity.
Just to clarify on the VA’s use of telehealth for mental health appointments. The VA uses a private double encryption system and not Skype. Both the clinicians and clients voice and image are encrypted as they are sent back and forth. This has been the only way to ensure confidentiality and to comply with HIPAA.
Thanks, Gidsy! That’s such an important issue for health care professionals. I appreciate you dropping back in to make that clear.
Lola,
What a wonderful idea! I am a Distance Credentialed Counselor, which is a certification that specifically qualifies me to do distance counseling. There’s more about the actual credential here: http://www.cce-global.org/DCC. As of research that I conducted in June of this year, insurance companies do not yet cover counseling services that are delivered from a distance.
I would like to introduce you to the platform that I plan to use for my distance counseling practice: https://counsol.com/site/index/default/. They have a wonderful site that is HIPAA compliant and recommended by the Online Therapy Institute. Their customer service is great. I have a PayPal business account, and people will be able to pay me through the secure website without me actually having any knowledge of credit card information. I’m happy to communicate with you here, but if you have questions that go beyond the scope of what this blog discussion turns into (and believe me, these discussions to become very interesting at times 🙂 ), I can find another way to get my contact information to you.
I’m quite intrigued by your ways of thinking outside the box and getting treatment to those who would not otherwise receive it. Excellent!
Lauren, thank you for sharing this platform. I’m not familiar with it and will definitely look into it. As you begin to use Counsol.com, feel free to let us know your thoughts.
I really respect the Online Therapy Institute because those gals are (like me) mental health professionals first who happen to also offer training and professional development to their colleagues. They know the distance counseling / coaching from the inside out and understand the subtle differences that may apply to mental health professionals (rather than other knowledge brokers).
This was such an interesting post thank you Lola, and Tamara for the guest post. How wonderful to know that a person could receive therapy in whatever way, online. Art therapy – wonderful! I loved the example of the person and her circles. Thank you again.
This brings up a lot of questions about therapy I hadn’t thought about. First, how to do you verify the identity of the “client?” Do you require a form of identification? I know that sounds nitty-gritty, but I have actually had to defend one art therapist who was performing similar work via online format and had this happen– it was a mess and a very interesting situation! I wish I could tell you more, but I cannot share specific details on that one.
I am not certain, but authorities on ethics and the Internet have told me that Skype should not be used for client contact, no matter what, HIPAA or not. Basically, one never knows where a client case will lead and what encryption or security should have been in place. Nevertheless, this is quite an interesting post; I work with military via the DoD, but am not allowed to use this type of format at this time. It will be interesting to see if that changes in the future. Kind regards, Cathy
Hi, Cathy! Thanks so much for dropping in! I’m not the expert on distance therapy but I do know that the questions you are posing definitely have to be considered both from a clinical standpoint and also a risk management standpoint. I would advise anyone interested in pursuing distance therapy to get formal training before pursuing it. It is not the same as face to face therapy.
Having said that, I do know that the US Military is at the forefront of supporting distance therapy. While they are not allowing Skype as a platform, they are stretching the boundaries of traditional therapy to address veterans’ issues. What is it you do for the DoD? Art therapy or something else? And, what platform are you using if you you are already providing distance therapy?
Hi Cathy, I went through a training course in distance counseling and I had a subsequent discussion with the ACA person who answers general legal questions, and the consensus seems to be that I will need to have a copy of some sort of ID/driver’s license to verify age and location (in my case, they need to be 18 years of age or older and living in Pennsylvania). In terms of verifying their identity at each session, if it is a video session, that is relatively obvious. If not, there is usually use of some code word or phrase.
I like what you chose to use for your Gravatar.
Good morning, Lauren! These are excellent tips to tighten your work long distance. Thanks so much for sharing!
That is really quite incredible. With the internet virtually anything is possible these days!
Hi, Sandra! Welcome to Private Practice from the Inside Out! It really is amazing, isn’t it?! And, what is it you do?