You know that moment: your client is opening up about a deeply important issue. You slowly lean towards the camera and soften your voice. After a brief, important pause, you start to speak… and realize that the client’s face has been stuck in the same position for the past several seconds. Your video software has frozen up again!

Many therapists doing telemental health report having this and much worse experiences. Maybe the audio cuts in and out. Maybe the video will get so choppy that it’s useless. Maybe the problems are only occasional, but the intermittent interruption makes you afraid to start any delicate counseling interventions for fear you’ll lose the client in the middle.

Different programs and platforms manage these problems in different ways. But they all have one thing in common: the Internet. In order for the video to do its job at 100%, we need an Internet connection on both sides of the call that has plenty of bandwidth and lacks interruptions.

The Internet: Not a Series of Tubes, But Kinda Like That

The Internet is like a giant Rube-Goldberg machine made out of copper wires, fiber optic cable, radio signals, microwaves, cans connected by string, and whatever else we could cobble together to connect the whole world into a giant, open network. In other words, there are lots of places where a data flow bottleneck could pop in and make your call freeze up.

During an individual online therapy session, there are two sides to the Internet connection: therapist and client. All troubleshooting items need to be addressed by both therapist and client. If only you do these things, your whole effort is likely to be mooted.

For these examples, lets think of Internet connections as “pipes” that carry data “water.”

Consider these points about the Internet “pipes” in your home or office, and that of your client:

• Your telemental health software may not be the only program using the Internet pipes during your session. Even if you or your client have a pretty big Internet pipe, another piece of software may hog the whole thing for several seconds at a go. While it’s hogging the pipe, your therapy software could be completely or partly stymied while it waits in line for pipe space.
• Your WiFi can be a bottleneck. The majority of us use WiFi for everything. That means that our connection starts off with a pipe made out of radio signals (the WiFi signal.) That WiFi pipe then hooks up to the pipe that our Internet Service Provider (ISP) runs into our home or office. That ISP pipe could be cable Internet, DSL, microwave, cellular, cans and string — a big variety of things. Even if your Internet service is really fancy and high bandwidth, though, a clog in the WiFi pipe will bottleneck the whole thing.

Consider this point about the video software that both you and your client are using:

• It’s running live and in real time! Your video software is racing hard to make sure that what you see and hear is actually happening almost exactly at the moment you see and hear it. Online therapy software makers know that a delay between therapist and client is terrible for therapy, and the software is trying it’s best to eliminate that delay.

Almost everything we use the Internet for on the day-to-day is “asynchronous.” Most of it is not affected by Internet pipe blockage in the same way that video calling software is interrupted.

When you watch Netflix, for example, the software is constantly loading up the next minute or so of the movie. That way, if there’s something clogging your Internet pipes (or the pipes momentarily disappear!), you still have a good minute of movie sitting on your computer ready to be watched. That’s usually plenty of time for the pipes to clear (or reappear), and you don’t notice anything wrong.

With online video software, even a split-second interruption in the Internet flow could show up as choppy video or audio. Longer interruptions make for frozen video and lost audio.

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What Do We Do About It?

My theory: the pipes are being clogged by this guy’s beard hair

Here’s a pre-session checklist for you and for your clients, too! Remember, any interruption on the client’s side is just as bad as on your side.

1. Quit out of all other non-therapy programs before the session. Some important examples of programs to quit are:
   • Skype. This is a big offender. Even when you’re not making a call with it, Skype may be using your Internet connection for its own needs. Make sure you’ve quit Skype — not just closed its window.
   • Dropbox, Google Drive, and other file synchronization/sharing services. These use the Internet in the background all the time. It’s part of their job.
   • Cloud backup software. These programs are usually pretty mindful about not clogging your Internet pipe, but it’s probably best to shut them down for the duration of sessions. Remember to start them back up when you’re done, though!
   • Close web browser tabs or windows that you don’t need. Remember that many websites and web applications do a lot of Internet back-and-forth while you have them open.
   • Anything else you can find that’s open!
2. Either connect your computer to the WiFi router with a cable, or move very close to the WiFi router. You know that little icon on your computer that tells you how many bars you have for your WiFi connection? That’s telling you how big the WiFi pipe is, and whether it’s watertight or leaky. Your computer can work with leaky Internet pipes — it’s smart like that. The problem is that your video software is trying its darndest to keep your call going in real time. A WiFi pipe that keeps leaking, or that is really narrow, will make its job much harder. So either move close to the router so the signal is stronger, or connect to it with a cable.
3. Make sure your antivirus program and system software updates aren’t scheduled to run during the session. This isn’t so much a “just before the session” point as an overall planning point. Most online therapy veterans have a story of sessions getting totally borked by antivirus software suddenly hogging all the Internet and processor speed. Some also have stories of allowing a system update to run during a session, and instantly regretting it when their computer automatically restarts!

Remember: both you and the client need to do these things!

What Is Out Of Our Control?

You can’t change the weather. You can’t change when everyone in your neighborhood starts downloading Game of Thrones episodes simultaneously. You can’t change accidents that damage communications equipment down the street from you.

Sometimes you have to accept that these things happen and that’s part of the online therapy world. You can reduce the risks of these incidents by doing things like:

• Avoid cable Internet. Cable Internet is shared by everyone in your neighborhood. That’s why it slows down when everyone is watching Netflix or doing videoconference meetings. The problem is that cable Internet may be the only high-speed service in your area. Or it may be faster than other available options even during peak usage times. In that case, it’s out of your control and you need to accept it.
• Have backup connections. I own a little WiFi hotspot gizmo that uses the same 4G LTE cellular service that my phone uses. It’s quite fast when the signal is strong. It works as a backup for my main Internet service. If the 4G LTE signal is weak or the weather is bad, though, even the backup can fail.

Remember that the issues raised in this article are a big part of why all professional guidelines urge telemental health pros to have multiple backup methods of contact for clients. They also urge therapists to ensure that clients know about these contact methods right from intake, and that they be listed on your website for clients to find when they need them.

None of these troubleshooting tips are perfect solutions. You may try them and find that nothing about your connection problems change. Whenever you troubleshoot anything, however, it’s highly valuable to rule out the basics first. Best of luck with your online therapy journey!