Articles:  Pandemic spurs interest in walk-and-talk therapy &
Cybersecurity for telehealth in the home office {Below}

Mom and Daughter

Pandemic spurs interest in walk-and-talk therapy

By Kathy Lynn Gray, Associate Editor
January 6, 2021 - Last updated: January 5, 2021

While most psychologists have flocked to online therapy because of COVID-19, a few lucky practitioners have another alternative: walk-and-talk therapy.

Walking with patients while talking with them for clinical sessions isn’t new – at least one New York social worker has been doing it for years. But in a worldwide pandemic where outdoor togetherness is a much safer option than indoors, the practice is being noticed by psychologists who had never considered it before.

“I’ve had a number of therapists call me about it,” said Denice Clark, Ph.D., whose Sole to Soul Therapy practice in Atlanta specializes in walk-and-talk – now with client and therapist wearing masks and walking in a socially distanced manner. “One of the positive things about the pandemic is people are realizing the importance of both physical activity and being outdoors for their well-being.”

Clark, dubbed Dr. Walk and Talk, said the advantages of therapy while walking are many. Some clients feel more comfortable side-by-side rather than facing a therapist. The physical activity boosts mood, and it’s less confrontational and more informal than therapy in an office. And clients tend to take more ownership over their experience because they’re in a neutral space, not one that reflects the therapist’s style, she said.

Social worker Tania Paredes, Ph.D., LCSW, has used walk-and-talk therapy for about ten years in her practice in Miami. She particularly recommends it when treating teenagers and new mothers, as well as clients who have been working from home or have multiple family members at home together during the pandemic.

“It’s great to be able to put a baby in a stroller and move outside for a session,” Paredes said. “People drop their guard a bit and are a little more open. A lot of negative thinking slows down too because you’re thinking about where you’re walking.”

Paredes and Clark had to switch to online therapy at the beginning of the pandemic but have since resumed walk-and-talk.

Clark lost some clients when she temporarily halted walk-and-talk, but her practice picked up again when she resumed it. Old clients returned and new clients showed up.

“Those who work from home are finding their home is not the respite it once was,” she said. And for many, finding a place at home to do an online therapy session in private is nearly impossible.

Before she started her practice in 2015, Clark did extensive research on walk-and-talk therapy and spent hours in the park she intended to use walking the pathways. She figured out which ones were most appropriate for private conversations, which would be better for sunny days and better for cooler days. She wrote up an informed consent document that included special contingencies for the outdoors and did a walk-and-talk therapy session with a therapist who has used the practice for years.

And while Clark doesn’t usually have the problem of cold weather interfering with walking, the Atlanta heat during the summer is a consideration.

“I like to joke, but I’m serious, that there’s no bad weather – just bad clothing,” she said. She plans sessions during hot weather in the morning to avoid the heat. If it’s raining, she’ll put on a raincoat or carry an umbrella.

“I’m up for most everything but thunderstorms and big winds,” Clark said.

“But I always leave the weather decision up to the client.”

Keeping conversations private while walking is another concern, but Clark

said that hasn’t been much of an issue for her.

“When people see you, they just think it’s two friends walking and people come to realize that others really don’t listen to you,” she said. “But I tell clients if they feel that a session is going to be particularly intense, let me know and we’ll go back inside.”

Another consideration is insurance payments. Clark said some insurers won’t pay for walk-and-talk sessions unless they start and end in an office.

Lori Klett Roberto, Ph.D., a clinical psychologist in Sacramento, Calif., has found walk-and-talk therapy useful for some clients who are depressed or shut down.

“Movement can help with that, and there’s the idea that as you’re waking, you’re moving forward,” Roberto said. “It also can be helpful when someone is holding more emotion than they feel they can hold; it may lessen the intensity a bit.”

Ironically, Roberto had to stop walk-and-talk therapy when the pandemic hit; the paths she used became crowded and were too narrow to provide confidentiality for patients. She said she misses the outdoor sessions, which were a welcome alternative to sitting in an office during therapy.

Toronto psychologist Kate F. Hays, Ph.D., began using walk-and-talk therapy in the 1990s, several years after she began running for exercise and realized its impact on her.

“Moving has a positive impact on one’s mental health, and there’s also the way in which walk-and-talk is like driving in a car with a reluctant teenager and having a really wonderful conversation because you’re not looking at one another,” Hays said.

She said she recognized the effectiveness of walking and talking decades ago with a client who wouldn’t talk in an office setting but became much more engaged when they were walking.

Hays discussed the value of walk-and-talk therapy in her 1999 book, Working It Out: Using Exercise in Psychotherapy. While she has retired from seeing patients, she’s still eager to offer advice to psychologists who want to try the therapy modality.

First, she said, ask patients if they’re interested in trying walk-and-talk once, then evaluate how it goes. Encourage patients to wear adequate footwear and clothing, depending on the weather. Before beginning, talk with clients about what to do if either of you encounters someone they know during the session.

Finally, watch out for the “slippery slope” created by the informality of walk and talk.

“It has the potential of the client viewing the relationship as more of a friendship, and the responsibility is on the therapist to stay mindful of that,” she said.

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Online Discussion

Cybersecurity for telehealth in the home office

By Roy Huggins, LPC NCC
January 5, 2021

In March, COVID-19 forced us all to either start operating by telehealth or stop serving clients. The field adjusted quickly and admirably. However, clinicians now need to develop our basic skills – and legal-ethical compliance – around the security of our home-based telehealth offices.

Like any clinical workspace, home offices need to protect the privacy of client information while ensuring that records stay intact. Even for those who do not need to comply with HIPAA legally, its rules can provide a clear professional standard for cybersecurity.

How does HIPAA come in?

In my analysis, these are the HIPAA standards that require special attention when setting up a home-based telehealth office. I have phrased them in more easily accessible language than is used in the actual HIPAA rules.

* Security of Internet connections – “network security.”


* Awareness of current security issues which impact client privacy and safety.
* Clearly defined boundaries around physical workspaces.
* Clearly defined boundaries around access to devices and other equipment which handle client information.

Safety and WiFi

For most people, Internet access means WiFi. While most modern WiFi requires a password, that doesn’t cover the main concern.

When we connect a computer, smartphone, or another electronic gizmo to WiFi, we’re connecting it to a shared virtual space that other people also may be using. If the WiFi isn’t set up right, or a bad guy has compromised it, those other people can use the shared space to infect our devices.

There are two main options for covering this issue:

1. Secure your home WiFi. That means:

a. Setting up your WiFi router in a space which only closely trusted people can physically access.
b. Making sure the firmware is fully updated.
c. Creating two networks: one for the home and one for your practice. Most WiFi routers can create a “guest network,” so use that one for the home.
d. Making sure the security scheme on your practice network uses WPA2 with AES encryption.
e. Setting up all your devices to exclusively connect to this WiFi. When outside the range of your trusted WiFi, only use your smartphone’s cellular data as an Internet connection.

2. Use a VPN on all your devices.

Note that option No. 2 is significantly less complicated than option No. 1. That’s because a VPN service that’s correctly set up will allow you to use pretty much any Internet connection safely.

Current security issues

According to the U.S. Cybersecurity & Infrastructure Security Agency (CISA), the rise

in people working from home has created a substantial rise in “phishing” and similar

scams. These scams are not just efforts to get money out of unwitting victims. They

also are used to plant viruses onto devices, get access to your online systems or

perform other acts of cybercrime.

For example, I have received dozens of text messages from people

pretending to be UPS or FedEx. The messages say I have a package on the way and include a link. Clicking the link would be the first step in falling for their scam.
Falling for a phishing scam can impact not just your finances but also your clients’ privacy. The FCC has valuable information as well as resources for reporting such scams at www.consumer.ftc.gov/articles/how-recognize-and-avoid-phishing-scams.

Clear boundaries

Lastly, it is essential to define clear boundaries in your workplace, primarily if you perform telehealth sessions there. Declare the space off-limits to others in the house and enforce this boundary.

If you can’t make the space off-limits to others 24/7, inform everyone when it is off-limits and when it is not. Make the difference clear to everyone. When the space is in “open mode,” ensure that all documents are locked up and devices are logged out. If you have a device only used for work and small enough to lock in a cabinet or drawer, do so while the space is in “open mode.”

These are not the only cybersecurity guidelines you need to follow. They are, however, a solid start to ensure your home telehealth office meets the same standards as your conventional office.

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Roy Huggins is a professional counselor and founder of Person-Centered Tech (personcenteredtech.com). Roy was a web developer before graduate school and now teaches counseling ethics while leading Person-Centered Tech’s training and consultation program. His email is roy@personcenteredtech.com

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