Anthony and Stephen Ragusea

Licensed Psychologists

1901 Fogarty Ave.
Suite 5
Key West, FL 33040

I offer video-based psychotherapy as a service for those clients who are either unable to attend or are uncomfortable with attending face-to-face sessions. For legal reasons, where you live makes a big difference about whether I can work with you over video and for how long. Please let me know where you are located so that we can discuss your options. You also must be over 18 years of age. If you are under 18 and seeking treatment, a parent must provide permission. Please read the following important information about this service. If you still wish to pursue video therapy, please continue to the next step.

I am a recognized expert in the field of telehealth and ethics, and have published several articles on the subject. While available research generally suggests video-based therapy is equally effective as face-to-face therapy, more research needs to be done before its effectiveness can be fully understood.

You will need a computer with broadband Internet access, a webcam, and the necessary software. We can discuss software options to determine what would be most convenient and secure for you.

Some people seeking Internet-based therapy wish to remain anonymous. While some services and professionals do permit this, for clinical and liability reasons I do not. Please ask if you have questions about this policy.

Advantages and Disadvantages of Internet Therapy
Internet-based psychotherapy has distinct advantages and disadvantages over face-to-face therapy. Video is very similar to face-to-face interaction in many respects: I can both hear and see you. I can see your body language, and you can see my facial expressions. This helps us to communicate and understand each other in the clearest way possible. However, because we are not in the same room, some people feel a lack of connection with their therapist. This feeling, if it occurs, may go away with time or it may be an interference to the therapeutic relationship, and may require that we discuss referring you to therapist who can see you in person. People who are attracted to Internet therapy are often interested in the convenience of it, and sometimes want to supplement their sessions with emails or chat-room conversations. I find that email and chat can be a valuable supplement to some clients, but they also have their advantages and disadvantages. Chat and email can make it harder to communicate because body cues and voice cues are not present. These cues make it much easier for people to know what a person’s feelings and motivations are. Sarcasm, for example, is often misinterpreted as an insult in text because the humorous intent is typically communicated through tone of voice. However, “chatting” or emailing can also facilitate communication because it tends to be disinhibiting. When you write your feelings down, you are more likely to say exactly how you feel and to say more rather than less. This can be helpful because of the intimate nature of the therapeutic relationship. Another advantage is that “chatting” with your therapist can be more convenient; you don’t have to travel to your therapist’s office, and you can even “pre-compose” your thoughts before the session to save time.

I charge $200 per 50-min session, the same as my face-to-face fee, which can be paid using Paypal, credit card, or by check or money order. If you choose to pay by check or money order, payment must be received prior to service. Understand that most insurance companies do not reimburse for any kind of email, phone, or video-based psychotherapy, but you may wish to check first with your company.

As with face-to-face therapy, I typically schedule sessions once per week, but the frequency of services depends on the individual needs of my clients.

Technical problems do happen. If we schedule a session and either you or I experience technical problems that significantly interfere with the session or if one of us is unable to log on, one or both of us should attempt to contact the other via email or phone to alert the other to the problem. At that time, we can discuss whether troubleshooting or rescheduling is the most appropriate option. I will not charge for sessions cancelled due to technical problems, but you must make a good faith effort to notify me of the problem as soon as you are aware of it. If I log on for a session and you aren’t there, and if I don’t hear from you and can’t reach you via phone or email, I will assume you forgot the session and will not refund your money.

Appropriateness of Video Therapy
Video therapy is not for everybody, and not every problem can or should be worked on via video. If I believe your needs would be best met by face-to-face therapy or another service, I may make such a recommendation.

Client confidentiality is of utmost importance to me, and although I make every reasonable effort to ensure privacy I cannot guarantee full and complete privacy. This is due in part to the fact that emails and video streams can be intercepted while in transit between the client and myself. While it is unlikely that somebody would try to intercept our communications, it cannot be completely prevented. Encryption goes a long way toward preventing unauthorized access to client information, so I encourage the use of software that supports encryption whenever possible.

In traditional, face-to-face therapy, maintaining confidentiality is primarily the responsibility of the therapist. The therapist stores clinical records and provides a room that should be fairly sound-proof, for example. In Internet-based therapy, maintaining confidentiality becomes a more shared responsibility between the therapist and the client. Each must do his or her part to try and ensure that private information does not become public.

The most likely way for confidential information to be read by unauthorized persons is for it to be accessed on the computer of the client or the therapist. When you receive an email, a copy may be saved on your computer. While most programs do not automatically save a log of a chat conversation, some programs can be set up to do so. If you save a copy of your conversation the data remains intact on your hard drive, even if you delete the file, until it is overwritten by other data. If your computer is infected by a virus, the virus may record keystrokes or send copies of your chat to somebody else. If somebody steals your computer or borrows it for awhile, they may see confidential information. I highly recommend that you avoid confidential chat sessions while on your computer at work or on a public computer, as doing so greatly increases the chances of someone else reading what you wrote. Your employer, for example, likely has the legal right to monitor and record any chats you engage in from your company computer.

There are many ways you can help ensure the security of your information. You should regularly use virus-detection software. If you have a firewall on your computer, use it. Avoid using a wireless connection in public (e.g., at a coffee shop or hotel) without encrypting the connection using VPN (Virtual Private Network) software. Intrusion detection software is designed to look for unusual and unauthorized behavior on your computer, possibly indicating someone may have hacked into your files. There are also more simple methods. Don’t save your chats, or delete old chats and emails. If you’re really worried someone’s trying to break into your computer from the “outside,” disconnect your Internet connection whenever you’re not using it.