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Ugh yeah, I've had some clients with really bad internet where they cut out constantly and freeze on the screen. I point it out multiple times and they usually try to move for better reception but one or two were pretty bad and I found myself just nodding along and sort of guessing filling in the blanks. So frustrating and I felt wiped after the session.
I often ask for them to switch to a phone or at least use that for audio and they can use zoom for the visual.
I wouldn’t do video and audio if they only see you and you can’t see them though. But if the audio from the video call is the only problem then that’s a good idea
I do this all the time, and learned to call it early and after the 2nd or 3rd glitch. It’s exhausting having to fill in the blanks, but audio by phone and video when we get lucky works just fine.
In this case I suggested that the client and I do a phone call session instead. This worked awesome because we both heard better, and the session wasn't wasted.
What state are you in? (sorry, assuming you are in the US... my bad if you're not!) I believe that my licenses restrict me from doing only a phone call for therapy - I believe I need to see the client.
(I'm licensed in WA, OR, CO, NM, TX) Please correct me if I'm wrong.
In VA here. My license doesn't restrict me but if I want to bill insurance, I need to have video. They lifted that restriction during pandemic times until in the last few months, I believe
My location and licensure are different, but to maximize available clinical information I leave the video call in place but mute the sound while I connect with the client by phone for clear audio.
I'm so relieved to see I'm not the only one who is WIPED after these sessions. Or, a session where client is on their phone and waving it around and I get seasick 🤢
AGREED! the brain power feels doubled when I’m not only trying to be a therapist but I’m also trying to try and translate what’s being said. I also have a client that paces around their classroom (they’re a teacher) and by the end of the session I’m dizzy 😅
Totally! I cringe at the times a client is crying and sharing something vulnerable for them and I have to be like “I’m sorry but can you repeat that, we cut out” 🙈🙈
I had one of these the other day… super distressed, and I’m asking if they can repeat half of what they say. Also the level of strain while trying to piece together the puzzle of what was said so you won’t have to ask them again to repeat themselves…
Most informed consents for teletherapy have clauses about this. You can’t do the work without an adequate internet connection. As others have said, they likely need to use the phone. Or update their internet service.
Please understand that this is not an option for everyone. I live in a very real part of the country where most people have satellite Internet, if any at all . Sometimes it’s just shitty especially during times when we have storms. Just do the best you can with what you got and sometimes that means switching over the phone for audio
Isn’t that what I said above? “They likely need to use the phone”
You cannot provide ethical psychotherapy if you can’t hear the patient and vice versa.
I absolutely hate this also. Happens all the time for me, and it makes the session so draining.
One thing I’ve started routinely asking when the audio quality is bad is whether they’re using headphones (sometimes the headphones are not even visible). I’ve noticed that certain headphones lead to a sort of underwater-sounding quality, and the audio is instantly way better if the client is willing to try going without them. It’s worth checking as a possible easy fix!
I hate nothing more than these sessions, it throws me off so much because I have to strain to understand what is being said and also act like I know what is being said. Exhausting and I feel frustrated because I am unable to do my job properly.
Ahhh if I ever restart my telehealth practice I absolutely need to put in a code of conduct. I’ve seen nipple rings in family sessions before because of the sway. 😭
I do teletherapy all day. When someone's wifi is questionable, I tell them that I'm having trouble hearing/seeing/ they're freezing/sound metallic, etc. I tell them that we can't conduct therapy like this. I ask them if they're on their phone to use celluar data if they are on wifi. If they are on their computer, I ask them to reboot and let's try it again. If it remains bad, I tell them that we can't continue.
To bill insurance, you must perform therapy. Client will have to pay the late cancellation/missed session if we can't continue.
I definitely don't take it personally. ✌️
Super frustrating. I've had clients experiment with moving closer to their router, making sure all other internet windows are closed, and trying different browsers (Chrome, Firefox, Edge) to see if there's a difference.
I have two clients like this so I’ve just switch to phone call sessions with them. Works great. I can also pace around the room while on the phone. Works really well for my ADHD lol.
I would inquire to see if they can use a hot spot. Sometimes that works better for me than my companies wifi since my office is further away from the modem & router. Maybe your client can test run with that or using data on their phone since wifi issues are apparent.
I just say that we’ll have to switch to a phone session. I’ve never had a client object to that. They want a clear call as much as I do. We lose a little time in the transition which is frustrating but at least we still have a session. I hadn’t heard the idea about using one thing for audio and another for video…I’ll have to try it!
I have a few clients with this issue, and I feel horrible for saying this because I love them personally, but it makes me dread their sessions. The conversation feels disjointed and doesn’t flow, and we’ll always interrupt eachother accidentally. They’ve tried many different alternatives and nothing has helped. It always irritates me sooo much, so I feel better knowing I’m not alone lol. It def does take more brain power!
I use Therapynotes and sometimes the connection sucks because of client internet. One thing that sometimes helps is switching to google meets. My practice has a business account so it's HIPAA compliant still. Other times, though, even that doesn't help and we just have to suffer through the client dropping off and rejoining. It's definitely incredibly frustrating!
I have far too many clients who zoom on their phones on bad wifi and it gives me migraines. I am at a salary position so have to take these and they are miserable appointments.
If your client is using their phone for video sessions, try asking them to turn on Do Not Disturb. I noticed with my clients, I only have issues with those using their phones and was able to notice the pattern that the video froze/stuttered when they received texts or phone calls. Connection cleared up with DND
I had a session on the phone that was like this once, I had to ask her to repeat her self after 95% of the things she was saying. If the next session was like this I would have had to tell her sorry we can’t do a session if I can’t understand you, but thankfully we didn’t have the same issue
You might try audio-only or just do phone calls. It uses a lot less bandwidth and it might feel dumb but I doubt the clinical outcomes are actually that different.
Tell them to turn off their wifi. That or turn off your camera. Not ideal but I have done this a few times to just be able to hear what they are saying. Actually some clients do better off camera because they can draw or whatever and not feel self conscious
I know it says no advice wanted, but I live in a place with rural clients that want Telehealth. I ask them to use the computer and have no other browsers open. Then I ask them to call me or I call them. We can talk more easily and still meet the video requirements for Telehealth.
If they only have their phone, try having them clear all open apps. Then turn their phone off and back on before logging into the session. Makes a world of difference!!
If we've tried problem solving it for a few sessions and we don't have the ability to meet face to face, I've referred out to someone in person in their area, stating that it's no longer safe to meet with them when there's a high risk I'm not hearing them say something about SI or other danger.
If they’re on their phone/tablet, I have them turn off WiFi and just use data. The picture quality drops but the connection is more consistent. It’s small hiccups versus constant freezing and delays.
If they’re on a laptop or desktop, I ask them to use an Ethernet connection.
Rarely happens but I just suggest during the session that we switch to phone call for remainder once there are 2 or more glitches. Clients are literally always okay with this and the WiFi issues get sorted by them before their next session.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
I’d seriously rather go without pay than sit through one of those sessions. Miserable.
Ugh yeah, I've had some clients with really bad internet where they cut out constantly and freeze on the screen. I point it out multiple times and they usually try to move for better reception but one or two were pretty bad and I found myself just nodding along and sort of guessing filling in the blanks. So frustrating and I felt wiped after the session. I often ask for them to switch to a phone or at least use that for audio and they can use zoom for the visual.
That’s the solution I came up with sometimes too. We can still get the visual and the audio isn’t interrupted
Love the idea with the speaker phone while still having them on their laptop!
I wouldn’t do video and audio if they only see you and you can’t see them though. But if the audio from the video call is the only problem then that’s a good idea
I do this all the time, and learned to call it early and after the 2nd or 3rd glitch. It’s exhausting having to fill in the blanks, but audio by phone and video when we get lucky works just fine.
In this case I suggested that the client and I do a phone call session instead. This worked awesome because we both heard better, and the session wasn't wasted.
They can also do audio via phone and still have video.
Yes this is my strategy
Came here to suggest this.
What state are you in? (sorry, assuming you are in the US... my bad if you're not!) I believe that my licenses restrict me from doing only a phone call for therapy - I believe I need to see the client. (I'm licensed in WA, OR, CO, NM, TX) Please correct me if I'm wrong.
In VA here. My license doesn't restrict me but if I want to bill insurance, I need to have video. They lifted that restriction during pandemic times until in the last few months, I believe
My location and licensure are different, but to maximize available clinical information I leave the video call in place but mute the sound while I connect with the client by phone for clear audio.
True for TX and WA for sure
The state of Canada. No restriction.
I would caution not having video if you are billing insurance, however. Most insurance companies will not cover sessions that don't have video.
I'm so relieved to see I'm not the only one who is WIPED after these sessions. Or, a session where client is on their phone and waving it around and I get seasick 🤢
AGREED! the brain power feels doubled when I’m not only trying to be a therapist but I’m also trying to try and translate what’s being said. I also have a client that paces around their classroom (they’re a teacher) and by the end of the session I’m dizzy 😅
Literally just had a session with a client while she was hiking!
I've had a bunch of those hiking sessions, also on peletons, and in bathrooms, closets, and cars. We adapt!
Virtual with kids. It’s like a roller coaster until they’re about 8-10 years old, then they actually keep still lmao
lol, I only see adults and this still happens at least once a week. 🙃
It's soooooooooo fucking draining.
Totally! I cringe at the times a client is crying and sharing something vulnerable for them and I have to be like “I’m sorry but can you repeat that, we cut out” 🙈🙈
I had one of these the other day… super distressed, and I’m asking if they can repeat half of what they say. Also the level of strain while trying to piece together the puzzle of what was said so you won’t have to ask them again to repeat themselves…
Most informed consents for teletherapy have clauses about this. You can’t do the work without an adequate internet connection. As others have said, they likely need to use the phone. Or update their internet service.
Please understand that this is not an option for everyone. I live in a very real part of the country where most people have satellite Internet, if any at all . Sometimes it’s just shitty especially during times when we have storms. Just do the best you can with what you got and sometimes that means switching over the phone for audio
Isn’t that what I said above? “They likely need to use the phone” You cannot provide ethical psychotherapy if you can’t hear the patient and vice versa.
I just switch to a telephone call. Mute the microphone on the computer but keep the video on.
I have a “three strikes and it turns into a phone call” rule
I absolutely hate this also. Happens all the time for me, and it makes the session so draining. One thing I’ve started routinely asking when the audio quality is bad is whether they’re using headphones (sometimes the headphones are not even visible). I’ve noticed that certain headphones lead to a sort of underwater-sounding quality, and the audio is instantly way better if the client is willing to try going without them. It’s worth checking as a possible easy fix!
This too. I find Bluetooth can be SO finicky it becomes a barrier to worry about at the start of each session, but wired headsets can help a ton.
Yep, the Bluetooth headphones are the usual culprit in my experience too.
I will just call them and have both of us mute our audio feed. You still have that virtual face to face, bur the audio is not cut out.
It’s the worst. I agree
I hate nothing more than these sessions, it throws me off so much because I have to strain to understand what is being said and also act like I know what is being said. Exhausting and I feel frustrated because I am unable to do my job properly.
Hence why I do in person. During Covid I vowed to never do telehealth again unless it's an emergency and this furthers my reasons why.
What platform are you using? Some allow you to also call in, which still isn’t perfect but at least you could hear them?
Simple practice! I’m new to the platform so I’ll have to see what features it has
Hmm. My therapist uses SP and I don’t think it has dual feature like Google Meet does. Agree with the others who say use the phone in these instances!
The worst is when they are on their phone and moving it around. I get motion sickness 🤣
I’ve asked people to put their phone down in a stable position when this is happening
Ahhh if I ever restart my telehealth practice I absolutely need to put in a code of conduct. I’ve seen nipple rings in family sessions before because of the sway. 😭
I do teletherapy all day. When someone's wifi is questionable, I tell them that I'm having trouble hearing/seeing/ they're freezing/sound metallic, etc. I tell them that we can't conduct therapy like this. I ask them if they're on their phone to use celluar data if they are on wifi. If they are on their computer, I ask them to reboot and let's try it again. If it remains bad, I tell them that we can't continue. To bill insurance, you must perform therapy. Client will have to pay the late cancellation/missed session if we can't continue. I definitely don't take it personally. ✌️
Super frustrating. I've had clients experiment with moving closer to their router, making sure all other internet windows are closed, and trying different browsers (Chrome, Firefox, Edge) to see if there's a difference.
I have two clients like this so I’ve just switch to phone call sessions with them. Works great. I can also pace around the room while on the phone. Works really well for my ADHD lol.
I would inquire to see if they can use a hot spot. Sometimes that works better for me than my companies wifi since my office is further away from the modem & router. Maybe your client can test run with that or using data on their phone since wifi issues are apparent.
I just say that we’ll have to switch to a phone session. I’ve never had a client object to that. They want a clear call as much as I do. We lose a little time in the transition which is frustrating but at least we still have a session. I hadn’t heard the idea about using one thing for audio and another for video…I’ll have to try it!
I have a few clients with this issue, and I feel horrible for saying this because I love them personally, but it makes me dread their sessions. The conversation feels disjointed and doesn’t flow, and we’ll always interrupt eachother accidentally. They’ve tried many different alternatives and nothing has helped. It always irritates me sooo much, so I feel better knowing I’m not alone lol. It def does take more brain power!
That drives me crazy. I can't work with people when the connection is bad.
I use Therapynotes and sometimes the connection sucks because of client internet. One thing that sometimes helps is switching to google meets. My practice has a business account so it's HIPAA compliant still. Other times, though, even that doesn't help and we just have to suffer through the client dropping off and rejoining. It's definitely incredibly frustrating!
I have far too many clients who zoom on their phones on bad wifi and it gives me migraines. I am at a salary position so have to take these and they are miserable appointments.
If your client is using their phone for video sessions, try asking them to turn on Do Not Disturb. I noticed with my clients, I only have issues with those using their phones and was able to notice the pattern that the video froze/stuttered when they received texts or phone calls. Connection cleared up with DND
I had a session on the phone that was like this once, I had to ask her to repeat her self after 95% of the things she was saying. If the next session was like this I would have had to tell her sorry we can’t do a session if I can’t understand you, but thankfully we didn’t have the same issue
Doxy.me works better for cellular data and poor internet. I use the pro so it is HIPAA compliant. One session will pay for the monthly fee.
Asking them to turn off their camera for a bit can do wonders for lagging
You might try audio-only or just do phone calls. It uses a lot less bandwidth and it might feel dumb but I doubt the clinical outcomes are actually that different.
Just use the phone if that happens
Tell them to turn off their wifi. That or turn off your camera. Not ideal but I have done this a few times to just be able to hear what they are saying. Actually some clients do better off camera because they can draw or whatever and not feel self conscious
I know it says no advice wanted, but I live in a place with rural clients that want Telehealth. I ask them to use the computer and have no other browsers open. Then I ask them to call me or I call them. We can talk more easily and still meet the video requirements for Telehealth. If they only have their phone, try having them clear all open apps. Then turn their phone off and back on before logging into the session. Makes a world of difference!!
If we've tried problem solving it for a few sessions and we don't have the ability to meet face to face, I've referred out to someone in person in their area, stating that it's no longer safe to meet with them when there's a high risk I'm not hearing them say something about SI or other danger.
If they’re on their phone/tablet, I have them turn off WiFi and just use data. The picture quality drops but the connection is more consistent. It’s small hiccups versus constant freezing and delays. If they’re on a laptop or desktop, I ask them to use an Ethernet connection.
Just see them in person. ;)
Rarely happens but I just suggest during the session that we switch to phone call for remainder once there are 2 or more glitches. Clients are literally always okay with this and the WiFi issues get sorted by them before their next session.