Teletherapy Setup Guide: 5 Tips for Optimizing Your Home Office

If you’re like most therapists, you started offering teletherapy visits out of necessity, working from a hastily assembled home office with whatever you had on hand. Now that virtual therapy is a critical part of your practice, it's worth getting intentional about your setup so that both you and your client can stay focused and fully engaged.

To help you upgrade your teletherapy office, we sourced tips and advice from Matthew Ryan, LCSW, a therapist, group practice owner, and avid video content creator based in New York. To make shopping easier, we also scoured trusted sites like Wirecutter and CNet, to give you (unbiased and unsponsored) leads on well-reviewed gear.

The good news is that the list of factors that truly matter when it comes to a high-quality teletherapy visit is relatively short — and optimizing them doesn’t have to take a lot of time or money. In fact, there are just 5 things that can make a world of difference.

1. Keep your face warmly & evenly lit

It’s always nice to look good, but the real value of quality lighting goes much deeper. "Light is integral for video quality and it’s also a metaphor for transparency, honesty, and safety," says Ryan. "If you're in a dark room or your face is lit from the side — or even if parts of your background are in shadow — your client may have negative associations."

Ryan is a fan of natural light. “Natural light is the kindest and most comforting, so if you can position yourself across from a window, that's often your best bet.” If you are relying on window light, using sheer or light-diffusing shades can help soften harsh sunlight and create gentle, even illumination. “A dimmable light set up behind and above your monitor is a must, as a backup for darker days or evening sessions,” adds Ryan.

Most tech sites recommend a 12-inch ring light as the ideal size and recommend a model that offers different shades of light. Some smaller square lights also get solid reviews.

Highly-rated lights to consider:

• The UBeesize 12'' Selfie Ring Light with 62’’ Tripod Stand for $32 on Amazon
• Sunpak - 12" Bicolor LED Ring Light Kit for 39.99 on Best Buy
• Logitech for Creators Litra Glow Premium LED Steaming Light and Tripod for $49.99 on Amazon

2. Position your camera for optimal eye-contact

To convey to your patient that they have your full attention, it’s important to look directly into the camera. "If you're looking up, down, or sideways at your client, that makes it harder to connect," says Ryan. “If you’re taking notes during a session, you also don’t want to be looking back and forth from one screen to another.”

If you have a laptop or monitor with a built-in camera, that might work fine. A stack of books under your laptop or monitor can raise the camera to eye level. (The downside of raising-up your laptop is that you won’t be able to type, making an external keyboard and mouse necessary.)

A tripod with an external camera positioned at eye-level is another option. Alternatively, you could use an ipad on a tripod.

Whatever you choose, you’ll want to sit far enough back from the camera that your head and upper shoulders fill about a third of the frame. This is the same distance you'd naturally keep in an in-person session.

External webcams that get great reviews:

• Anker PowerConf C200 2K Webcam for $59.99 on Amazon (includes noise-cancelling dual microphones)
• Logitech Brio PRO X 4K Webcam for $169.99 on Amazon
• Logitech C922 Pro Stream Webcam 1080P Camera with Tripod for $99.99 at Office Depot

Connect with new teletherapy clients on Alma. Learn more here.

3. Make sure your voice comes through loud & clear

"Clear sound is critical," Ryan emphasizes. "While clients may be willing to tolerate a slightly grainy video, they won’t get much out of a session if your voice is hard to hear or you’re being drowned out by background noise."

The good news is that you might not need much equipment. "If you're in a quiet room, you may not need a microphone," Ryan notes. And if you have an external webcam, it may come with a good-quality built-in mic. "But if outside noise is often audible, an external microphone will be a huge improvement. Be sure to position it so that you're speaking directly into the microphone."

Budget microphones that deliver quality sound:

• CMTECK USB Computer Microphone G009, Noise-Cancelling Recording Desktop Mic for $15.99 on Amazon
• JOUNIVO USB Microphone for $16.99 on Amazon

Upgrades if you’re making professional recordings:

• HyperX SoloCast – USB Condenser Gaming Microphone for $36.99 on Amazon
• Logitech for Creators Blue Yeti Nano USB Microphone for $79.99 on Amazon

Another tip from Ryan: "If you're typing a lot during sessions, a keyboard with silent keys will be much less distracting for your client." It's these small details that help make a video session feel more like therapy and less like a Zoom meeting.

Options for keyboards with quieter keys:

• HP 230 Wireless Keyboard for $18.99 at Amazon
• Logitech MK295 Wireless Mouse & Keyboard Combo with SilentTouch Technology for $29.99 on Amazon
• Adesso Multi-OS Scissor switch Desktop Keyboard for $39.99 at Best Buy

4. Create an ideal teletherapy office background

Very little research is available on client preferences when it comes to backgrounds, but one study found that two-thirds of people surveyed preferred a traditional health care setting for video visits (vs. a solid color background, or multi-use room like a kitchen). In other words, clients want to see you in what looks like a typical therapy office. Think: calming colors, uncluttered furniture, books, plants, books, soothing art.

If you don’t have a home office, you might be tempted to blur your background, or use a photo background, but these can be off-putting. “The edges of your hair and body can become distorted as you move, which is very distracting,” says Ryan. “A real, physical space around you is much more grounding for the patient,” adds Ryan.

It also gives you an opportunity to include a few personal items. In studies on the mastery of teletherapy, one measure of success is that the clinician and client connect as humans. Another is that the clinician shares personal experiences with their patients. Objects in your environment can be springboards for getting-to-know you conversation.

Color, obviously, is another major consideration. "As we know from color psychology, the color of your surroundings can impact a client’s state of mind," says Ryan. Stark whites can feel cold. Oranges and reds can be overstimulating. Blues, greens, and warm, neutral tones are often cited as the most calming shades. That said, people of different ages and cultures can respond differently to color, and must be taken into consideration.

In the market for some art to hang on your wall? A few recommended themes:

• Tranquil nature scenes set in spring or summer can reduce stress and anxiety while evoking gratitude and mindfulness.
• Abstract art featuring soothing colors and gentle, non-repeating forms can encourage creative interpretation without overwhelming.
• Whimsical art with vibrant colors, animals, and gentle fantasy landscapes can prompt playfulness and wonder in child therapy sessions.

5. Prevent aches & pains to stay fully present

It’s hard to stay attuned to your client's emotional state when you're trying to figure out if your aching back, numb glutes, and sore wrists can survive another hour at your desk. “I used a kitchen chair for far too long before investing in a comfortable office chair," admits Ryan.

Ergonomic office gear comes in all shapes and prices. It’s usually worth starting with a cheaper option to see if that gets results. If you’re ready to upgrade your desk chair, it’s best to head to a Staples, Office Depot, or other furniture store then buy online. Make sure there’s a return policy — it can be hard to know how much you’ll like a chair until you’ve used it for several days.

These ergonomic cushions are worth trying before investing in a new chair:

• Pressure Relief Seat Cushion by Cushion Lab for $69
• 5 Stars United Seat Cushion for $29.95 on Amazon
• Everlasting Comfort Seat Cushion & Back Support for $64.99 on Amazon
• FORTEM Seat Cushion and Lumbar Support for $32.99 on Amazon

Some highly-rated ergonomic keyboards and wrist pads:

• Logitech Wave Keys Bluetooth Keyboard for $59.99 at Target
• HP 960 Ergonomic Wireless Keyboard for $119. 99 on Amazon
• Gorilla Grip Silky Gel Memory Foam Wrist Rest for $12.99 at Amazon
• Enhance Keyboard and Mouse Pad with Wrist Pillow for $44.99 at Office Depot

Other small changes that keep you comfortable and engaged include placing one foot on a box or yoga block under your desk, and occasionally changing the height of your monitor by an inch or so to avoid neck strain. And, finally, don’t forget to get up and stretch between sessions!

For more tips on optimizing your practice, check out Alma’s Provider Resource Hub.