Starting private practice psychotherapy in the no-contact era

November 7, 2020 10:13 AM

Historically I've gotten some good answers to therapy-related questions (on the practitioner end) here, so here's another, mostly about starting to do some private practice while Zoom is the only option.

I'm figuring out the details of starting to do some private practice, not as a total career move--just a few clients on the side to ease back into that kind of work and see if it might be a career move. I hate to start re-learning how to do this within the frustrating parameters of covid and not face to face in an office, but it's time to give it a go.

I have a lot of questions but the one I'm stuck on now is that the two places I've started a profile to put myself out there, inevitable Psychology Today and Open Path Collective, there are required fields that are physical locations. I obviously don't have an office and am not going to. As you might imagine, I'm reluctant to put my home address, and I'm doubtful about whether putting my day job office address on there is kosher.

I assume most, hopefully all therapists are somewhat in this position now but I also assume most started practice before All This and the profile form has not caught up. Any ideas? Thanks in advance!

Bonus question if that's allowed: what insurance do people use?

posted by less of course to Human Relations (13 answers total)

Would it make more sense for you to join an established practice group? That seems like it would solve a lot of your problems at once.
posted by mskyle at 11:17 AM on November 7, 2020

What about using some sort of virtual office service?
posted by mollymayhem at 12:48 PM on November 7, 2020

You can get a PO Box.

I use the free state insurance for people with low incomes.
posted by aniola at 1:26 PM on November 7, 2020 [1 favorite]

I use Ohio Medicaid. My therapist gives the option of virtual or in person appointments.
posted by kathrynm at 1:28 PM on November 7, 2020 [1 favorite]

Maybe the OP could clarify whether they're talking about what kind of insurance to *accept* or, like, business/malpractice insurance?
posted by mskyle at 1:30 PM on November 7, 2020

Response by poster: Oh yes. Sorry. Malpractice insurance. I am not on any insurance panels at the moment. Sorry for the vague wording.
posted by less of course at 2:27 PM on November 7, 2020

If you're going to do business, you should have a PO Box for all your business mail, for privacy/security purposes. Lots of mailbox places offer open-and-scan or forwarding services if you're not big on the mailbox-checking errands.
posted by Lyn Never at 3:18 PM on November 7, 2020 [1 favorite]

Best answer: Some insurance companies don't play well with virtual addresses and PO boxes, just FYI. I have affiliation with a particular business in the jurisdiction where I practice and asked to list that as my address.

American Professional and HPSO are two malpractice insurance companies I've seen that were amenable to covering virtual practice since before COVID.

Speaking of Zoom, G Suite is much cheaper than the version of Zoom that is HIPAA compliant and includes videoconferencing. The paid form of G suite can be set up to be HIPAA compliant and can function as an EHR if you don't need a lot of bells and whistles.
posted by crunchy potato at 3:22 PM on November 7, 2020 [4 favorites]

Just to offer my perspective as a patient, I have seen two different therapists during the pandemic (my long-time therapist, plus a temporary therapist I saw for a limited number of sessions), and both actually still offer the option of in-person sessions, as well as Zoom. For patients who see them in person, both therapists use social distancing measures (patient's chair is > 6 feet from the therapist) and I know they both disinfect surfaces between patients. While I am only doing Zoom with my long-time therapist, the second therapist I saw actually asked if I would be willing to meet in person for at least our first session, rather than via Zoom (since we hadn't met before), and we wound up continuing to meet in person. I called them prior to one session worried that perhaps I had been exposed to COVID and should not come in, and they decided they would be okay with both of us wearing masks for that session (which we did - it did not significantly affect the quality of the session for me).

All of which is to say, it's not strictly true that therapy sessions are only happening over Zoom right now. Two people sharing a room for 45 minutes can be acceptably low-risk if proper precautions are taken (distancing, cleaning surfaces, ventilation, wearing masks). I would urge you to reconsider not having any kind of physical meeting space available, even if you mostly do Zoom - beyond the importance of a face-to-face first meeting, some people don't have access to a safe private space for video sessions, especially if there's a domestic situation at home. In my case I have a housemate, so I do my Zoom therapy sessions from my bedroom with a rolled-up towel under the door, and he has confirmed the soundproofing isn't perfect.

But even if you decide you are not comfortable offering an in-person option right now, eventually we are going to return to something closer to our normal routines, at which time your patients would likely want and expect the option to meet in person, so you might want to make sure now that you actually know what your future in-person option is going to be.
posted by Dixon Ticonderoga at 9:58 PM on November 7, 2020 [1 favorite]

I switched to remote-only. Before this I worked at home, so my home address is on everything and it doesn't bother me. I don't have any P.O. box and see no need.

I wouldn't in a million years see patients in person now (read about aerosol transmission: 6 feet away indoors, even with masks, is an arbitrary distance that's now disputed to be adequate by experts in this field -- and 45-50 minutes is a LONG exposure.). I'm in NYC and have gone through living in the #1 Covid hotspot in the world. Not taking any chances (I'm also 70 years old, so). As for having a place to see patients "afterward," if your practice exists then, you can rent an office part-time. I wouldn't worry about it now.

Most patients can find someplace to do their remote therapy; I have people who go to a park, if necessary. You'll never be able to serve everyone, even without a pandemic.

I use American Professional Agency for malpractice insurance (mentioned by another poster above).

One thing: this probably won't come up, but don't see patients even remotely who live outside of the state in which you're licensed (if you care about following laws, that is).
posted by DMelanogaster at 6:11 AM on November 8, 2020 [1 favorite]

I have been providing remote therapy only (“teletherapy”) since March. My clients and I have adjusted well to this modality and I plan to continue this for the foreseeable future. Although I own the building my “real” office is in and therefore do not have a problem with mailing address, I have colleagues who have made arrangements with physical practices to “rent” a mailing presence even though they do not have a physical office there. They can then use this affiliation for a mailing address for both insurance claims and listing sites. In those that I know who are doing this, they are at least considering actually renting office space from these practices at a later date but are not doing so for the duration of the pandemic. I have used American Professional Insurance for many many years with no problems (fortunately i have never had to make a claim). In terms of teletherapy platforms, Zoom is not HIPPA compliant. I have been very happy with the free version of Doxy.Me which is HIPAA compliant and will provide you with a Business Associate Agreement (required under HIPAA rules). I have heard that the new platform that comes free with your Psychology Today therapist directory listing is very good, HIPAA compliant, and provides a BAA.
posted by Lylo at 7:21 AM on November 8, 2020 [2 favorites]

I don't know anything about the HIPPA/compliance/security side of things, but as a patient I really hate when my providers use platforms with subpar video/audio quality. It's hard to have a conversation when it's pixelated/jumpy/laggy/etc. IMHO Zoom has the best quality out of all the major ones I've used, and is way better than Google Meet (or whatever they're calling it these days).
posted by radioamy at 12:06 PM on November 8, 2020

The reason that many therapists (and other providers) are not using HIPAA compliant platforms right now is that the federal government has basically said it wants to encourage providers to see patients electronically during the public health emergency, so it's not going to audit for HIPAA compliance on video platforms right now. So you might have more flexibility right now than you usually would, but don't assume that's an indefinite situation. (But also don't limit yourself too much right now if doing so would be prohibitive.)
posted by lapis at 9:53 PM on November 11, 2020