Before-Session Factors

In efforts to support productive sessions, all users should ensure proper camera setup and lighting (see Chapter 12), turn off unnecessary computer programs, and pre-test their equipment prior to beginning the clinical work (Simpson et ah, 2016). This testing should include basic image quality when someone is still, and should also involve people moving their hands and body to ensure the movement is smooth on both ends. This pre-session check is also a good time to ensure that the pan, tilt, and zoom features of a PTZ camera work, if available (Myers et ah, 2017). If issues are recognized for any component, this check can allow for parties to problem-solve (e.g., changing video settings, restarting videoconferencing platform, resetting internet) before any important information is discussed. In supplement of basic checks, before beginning, the provider should practice adjusting the videoconferencing platform’s settings and video quality features so that they can seamlessly adjust options as needed during session with minimal interruptions. This practice can reduce the provider’s need to look away from the screen while making needed adjustments (Lozano et ah, 2015; Simpson et ah, 2016). Finally, if allowed through the videoconferencing platform, some have suggested the provider and patient should turn off picture-in-picture (PIP) features. While this feature allows the speaker to see themselves in the window, it has been suggested as being distracting (Lozano et ah, 2015; Simpson et ah, 2016).

During-Session Factors

Once session begins, as further detailed in Chapter 12, the provider should position the video image in a way that will allow one to look at the screen, while capturing their eye gaze in the video camera to simulate direct eye contact (Grayson & Monk, 2003; Simpson et ah, 2016; Shore et ah, 2018). Following this adjustment to ensure telepresence, the provider should conduct their session as they normally would (i.e., similar content and discussion style), with some additional considerations. While some have suggested using hands and nonverbal behaviors (e.g., head nods) in a similar way as would be done in F2F interactions, others have recommended that providers should slightly exaggerate these motions to ensure they are easily viewed on the videoconferencing image (Lozano et ah, 2015). Of note, “slightly exaggerate” means just that, as providers should remain authentic and avoid excessive or overly dramatic mannerisms that could come across as fake or condescending. Further, providers should take care to avoid overly repetitive mannerisms, such as excessive head nodding (Lozano et ah, 2015). As session progresses, the provider should ensure that they are not engaging in distracting behaviors that may be outside of their awareness. Such behaviors may include tapping of pens, clicking of pens, spinning of pens, twisting or playing with one’s hair, rocking or spinning in a chair, repetitive shaking of legs, cracking of knuckles, and reading of documents outside of the computer screen (Simpson et al., 2016). Each can be distracting, while also potentially fostering feelings of disengagement of the provider for the patient.