Videotaping Therapy

Videotaping is widely acknowledged as a valuable tool to improve the effectiveness of clinical training and supervision across a wide range of psychotherapy models (e.g., Bernard & Goodyear, 2014; Briggie et al., 2016; Ellis, 2010; Friedlander et al., 2011). Notably, this includes psychodynamic supervisors, who previously were among the most cautious regarding videotape (e.g., Abbass et al., 2004; Alpert, 1996; Eubanks-Carter et al., 2015; Haggerty & Hilsenroth, 2011; McCullough, Bhatia, Ulvenes, Berggraf, & Osborn, 2011).  

Haggerty and Hilsenroth (2011) described the benefits of work observation:

"Suppose a loved one has to undergo surgery and you need to choose between two surgeons, one of whom has never been directly observed by an experienced surgeon while performing any surgery. He or she would perform the surgery and return to his or her attending physician and try to recall, sometimes incompletely or inaccurately, the intricate steps of the surgery they just performed. It is hard to imagine that anyone, given a choice, would prefer this over a professional who has been routinely observed in the practice of their craft." (p. 193)

How to Introduce Videotaping to Clients

Here’s how I explain it to my clients: "My strategy for quality-assurance and improvement is to get continual feedback from clinical experts.  Video helps us see opportunities to help you better. I, like everyone, have blind spots and makes mistakes. That is human and happens in any field.  Videotaping is kind of like getting a routine audit. If anyone goes long enough without an audit, problems can develop. Getting video-based feedback on my work helps me identify my blind spots and mistakes, so we can continually improve our work together."

Picking a Video Camera

Economy-model digital video cameras are suitable for recording psychotherapy. They are available for less than $200. Choosing economy model video cameras that have been for sale for more than one year is recommended because newer or premium cameras may record in newer digital formats that may not be compatible with playback devices (such as your computer). For security reasons, therapists should dedicate a specific device exclusively for videotaping psychotherapy. That camera should be used only for that purpose, and kept locked with the psychotherapy notes.

Audio

Most economy-model video cameras have sufficient sound quality for recording psychotherapy. If higher-quality sound is required, choose a video camera with ports for an external microphone.

Video Playback

Videos can be played on a wide range of devices, including computers and modern televisions. VLC Media Player software is recommended for viewing videos on a computer.

Storing Digital Videos

Videos can be stored directly on the video camera or transferred to a computer hard drive. If videos are stored on a computer, therapists should use a strong password for the computer and set the computer to autoencrypt when not in use (see here for more info). One good option is to save videos to an auto-encrypting portable hard drive (e.g., the Apricorn Aegis Padlock). This kind of drive requires a password for access and automatically encrypts itself when it is unplugged from a computer. This helps ensure security even if the portable drive is lost or stolen.

Picture-in-Picture Video

Therapists may wish to see both themselves and the client in the video through “picture-in-picture” video. The simplest method for doing this is to place a large mirror behind the client, in view of the camera, so the therapist’s face appears in the mirror. Picture-in-picture video can also be accomplished by having multiple cameras or webcams feeding into videoprocessing software. This requires some additional cost and technical expertise to set up.

Videotaping on Mobile Devices

Many mobile devices (e.g., smartphones, tablets) have videotaping features. However, it is recommended that therapists avoid or be very careful when using mobile devices to record psychotherapy sessions. This is because mobile devices may pose greater threats to security and confidentiality than other recording methods. Mobile devices are common targets of theft and are easily lost. Additionally, mobile devices often include preinstalled software that automatically sends backups of videos to the internet cloud. Therapists may not realize this backup software is running or may not know how to turn it off. If a mobile device is used to videotape psychotherapy, internet connectivity on that device should be disabled, the device should be used exclusively for that purpose, device encryption should be turned on, and the device should be kept locked with psychotherapy notes. 

Consent

Client consent should be obtained in writing before videotaping. Legal and regulatory issues may apply, depending upon your jurisdiction. More information on this topic, as well as template consent forms, are available at www.zurinstitute.com

Internet Security

For more information on internet security for therapists, see here.

Examples and Additional Resources

Paraverbal communication in therapy.

For detailed case examples of how videotaping can be used in supervision, see Osborn and Bhatia (2015) and Escudero and Friedlander (2015).