Safety planning for teletherapy: What therapists need to know

Just a few years ago, teletherapy was not a service that many therapists offered to their clients. But since the coronavirus pandemic, connecting remotely via teletherapy (using a HIPAA-approved video or phone conferencing platform) has quickly become the norm for many therapists. This shift in the way we deliver care has made mental health support more accessible for many people.  Yet some therapists have concerns over possible safety issues related to remote therapy. Because while safety planning is an important part of the therapeutic process no matter the setting, it becomes even more critical when you aren’t able to meet with a client face-to-face. 

What are safety plans?

Simply put, a safety plan is a set of mutually agreed-upon steps you and your client will take in response to a safety concern. Many therapists talk about basic safety planning as part of their intake process. You might weave this topic into discussions about informed consent, the limits of confidentiality, or your client’s existing resources and coping strategies.  But whether your safety planning process happens at the outset of therapy or in response to an increase in risk, it’s important to clearly communicate the plan to your client and use their input to create it. Keep in mind that safety plans often require updates, depending on your client’s situation.  While many safety plans are designed to be used in response to issues of self-harm or suicidality, they can be used for safety concerns and crisis intervention of all kinds. At a minimum, safety plans should include a list of:

• Triggers: What are the signs that there could be an increase in risk?
• Coping strategies: What are the client’s existing, effective coping strategies? Who can the client rely on for support in difficult situations?
• Provider responses: What steps will the therapist take to keep the client (or someone else) safe? What does the client need to know about the limits of confidentiality in these situations?
• Emergency protocols: Who is on the client’s emergency contact list? What other emergency numbers (crisis hotlines, etc.) or resources might be helpful to include?

Safety plans should include these basic elements but they should always be personalized to your client’s unique strengths and challenges. In taking some time to create a safety plan before something concerning happens, you’ll be better equipped to support your client if a crisis arises.

Best practices for teletherapy safety planning 

The goal of safety planning in a teletherapy context is the same as safety planning in other environments — to keep your client safe.  But this requires some additional steps that aren’t typically required in a traditional setting. When you aren’t face-to-face with your client during a session, clear and proactive communication is vital. So in addition to the basic safety plan elements listed above, you’ll also need to make sure your teletherapy safety plans include:

• Crisis response protocols appropriate for a teletherapy context. During intake, collect your client’s emergency contact information and their exact location during their session. Without this information you won’t be able to direct emergency services to your client should the need arise. Be sure your client understands the importance of letting you know whenever they are accessing their session from a new location.
• A clear plan of action in case your internet connection is weak or interrupted. This might include directions for switching platforms or contacting you by phone if you lose access to your video conferencing platform. It’s also a good idea to check that your client has the numbers for local emergency services in their area. In addition, make time to ensure that your clients are familiar with how to use your teletherapy platform before they begin remote sessions.
• Information on how to ensure confidentiality during remote therapy and a discussion of the benefits and risks of teletherapy. Be transparent about the privacy challenges associated with teletherapy and discuss ways your client can let you know if there’s a person nearby so that you can pause the session. This might mean using the chat feature or simply having a hand signal that means “Let’s pause, someone is listening.” 

Remember, no matter the setting, safety planning should always be a collaborative experience. As you fine-tune your safety planning process for teletherapy, be sure to involve your clients in every step. Let them know they can always ask questions and invite them into the conversation whenever you review and update their plan. Since you won’t be meeting in person, be sure to send your client a digital or hard copy of their plan to review and save for their records. Evidence-based safety plans like the Stanley Brown can help you streamline this process.

What to do when a safety plan doesn’t go according to plan

Just like in-person therapy, sometimes things don’t go according to plan with safety planning in teletherapy. For example, maybe a client doesn’t use the coping strategies you outlined together. There could be a technology glitch you didn’t foresee. Or maybe there’s a safety concern you didn’t take into consideration. Here’s how you can respond to scenarios like these:

• Use your professional judgment. Consult with a peer if needed and take immediate action to reassure your client and address the concern. Your response might range from rescheduling a missed appointment to contacting emergency services. It all depends on your client’s situation.
• Remind your client. As you work to support your client, remind them of their coping strategies, and connect them with whatever resources they might need, communicate with them as you are able and keep them updated on recommended next steps. 
• Adapt. Learn what you can from this experience and update the client’s safety plan accordingly. Be sure to follow up with your client after the incident to ensure their safety and talk about whatever changes might need to be made to their plan for the future.

Final thoughts

Whether you’re running an in-person, hybrid, or fully remote teletherapy practice, safety planning is a critical part of providing quality mental health care. At Rula, we’re here to help therapists simplify this process and make it easier to collaborate with clients in making safety plans that can evolve with their unique needs. And if you have a safety planning concern, our supportive provider community can offer you the consultation you need to help keep your clients safe. Learn more about joining Rula