During-Session Factors

Luxton et al. (2014) highlighted that during a session, the audio volume should be loud enough at each end so that everyone can be easily heard, but not so loud that the session can be overheard by others outside of the room. Speaking voice should remain relatively normal in terms of volume and rate; however, one should be mindful of the need to provide frequent pauses to allow for those on the other end of the videoconferencing call to respond. As interrupting can create issues for both the therapeutic alliance and therapeutic outcomes, similar to working with medical interpreters for language differences, the provider should encourage that all members of the session speak in short sentences, and wait a few seconds before speaking again to ensure that the initial speaker is done (e.g., to account for audio lag and if someone is thinking of their next comment; Hadziabdic & Hjelm, 2013; Juckett & Unger, 2014). This notion of waiting before immediately speaking to avoid speaking over each other can be especially important for videoconferencing, as some microphones and software will cut the sound of a second speaker if someone is already speaking, thus resulting in missed information (Simpson et al., 2016). Finally, to avoid disruptions during session, the provider and patient should be careful to avoid any noises that may be amplified by a microphone. Such activities could include typing on a keyboard, rustling papers, or writing on hard surfaces (Simpson et al., 2016).

Post-Session Factors

It is important for the provider to mute their microphone at the end of the session. This can ensure that inadvertent discussion or comments are not captured by the microphone for any unintended audience (Simpson et al., 2016). This is especially important for providers who read documents out loud to themselves, make phone calls, or speak to colleagues between sessions.

Summary Points

. Ensure that the provider and patient avoid clothing that will create distracting noise throughout a session.

. Before the session begins, the provider and patient should explicitly test the audio quality, turn off other programs that may create noise, and silence any phones or other devices.

. During the session, the provider and patient should speak at a normal volume and rate, but consider speaking in shorter sentences, and providing a few extra seconds after sentences to help reduce speaking over each other.

. During the session, the provider and patient should avoid engaging in activities that may be amplified through a microphone. These activities include typing, rustling papers, or writing on hard surfaces.

. When the session is completed, the provider should mute their microphone to ensure no transmission of unintended information.


Hadziabdic, E., & Hjelm, K. (2013). Working with interpreters: Practical advice for use of an interpreter in healthcare. International Journal of Evidence-Based Healthcare, /7(1), 69-76. https://doi.Org/10.l 111/1744-1609.12005.

Juckett, G., & Unger, K. (2014). Appropriate use of medical interpreters. American Family Physician, 90(1), 476 480.

Luxton, D. D., Nelson, E. -L., & Maheu, M. M. (2016). A practitioner’s guide to telemental health: How to conduct legal ethical, and evidence-based telepractice. Washington, DC: American Psychological Association.

Luxton, D. D., Pruitt, L. D., & Osenbach, J. E. (2014). Best practices for remote psychological assessment via telehealth technologies. Professional Psychology: Research and Practice, 45(1), 27-35. https://doi.org/10.1037/a0034547.

Myers, K., Nelson, E. -L.. Rabinowitz, T., Hilty, D., Baker, D., Barnwell. S. S., ... Bernard, J. (2017). American Telemedicine Association practice guidelines for telemental health with children and adolescents. Telemedicine and e-Health, 23(10), 779-804. https://doi.org/10.1089/tmj.2017.0177.

Simpson, S., Richardson, L., & Reid, C. (2016). Therapeutic alliance in videoconferencing psychotherapy. In S. Gross, K. Anthony', L. S. Stretch, & D. M. Nagel (Eds.), Technology in mental health: Applications in practice, supervision, and training (2nd ed., pp. 99-116). Springfield, IL: Charles C. Thomas.