A practical guide for psychologists looking to start or improve their online therapy practice. Technical requirements, legal framework in Portugal, best practices, and essential tools.

Online Therapy: A Complete Guide for Psychologists

Online therapy has evolved from an occasional alternative into an essential component of modern clinical practice. In Portugal, the demand for remote psychology consultations has grown exponentially since 2020, and the data suggests this trend is here to stay. For professionals who want to offer this service with quality, security, and effectiveness, this guide covers everything you need to know.

Why Offer Online Therapy?

Before addressing the how, it is important to understand the why. Online therapy is not simply a digital version of in-person sessions — it is a modality with its own distinct advantages.

Greater Accessibility

Patients in rural areas or with reduced mobility can access quality care.
Eliminates barriers related to transportation, parking, and commuting.
Enables serving Portuguese nationals abroad or in regions with insufficient professionals.
Facilitates access for patients with social phobias or agoraphobia.

Flexibility for Both Parties

Allows more efficient schedule management.
Reduces the time gap between in-person and online sessions.
Makes sessions possible at times that would be impractical in person.
Facilitates therapeutic continuity during holidays or travel.

Scientific Evidence

Research has demonstrated that, for many conditions, online therapy is as effective as in-person therapy:

Anxiety and depressive disorders: equivalent results across multiple studies.
Cognitive-behavioral therapy: particularly well adapted to the online format.
Therapeutic alliance: studies show it develops comparably to in-person sessions.

Legal Framework in Portugal

The practice of online therapy in Portugal is subject to specific regulations that every professional should be aware of.

Regulation by the Portuguese Order of Psychologists

The OPP (Ordem dos Psicologos Portugueses) recognizes teleconsultation as a legitimate practice provided certain requirements are met:

The professional must be registered with the Order and have their status in good standing.
Platforms that ensure confidentiality and data security must be used.
Informed consent must include specifics related to the online modality.
There must be the ability to refer to in-person services when necessary.

GDPR and Data Protection

Teleconsultation involves the processing of particularly sensitive health data:

Data must be processed and stored on servers within the European Union.
A Data Protection Impact Assessment (DPIA) must be carried out.
Consent for data processing must be explicit and documented.
Encryption of data in transit and at rest is mandatory.

To learn more about data protection obligations in mental health, see our article on GDPR and mental health in Portugal.

Invoicing and Receipts

Online consultations follow the same tax rules as in-person ones:

Issuing an invoice-receipt is mandatory.
Can be included in the e-fatura system with the corresponding activity code.
Patients can deduct them on their IRS (income tax) as a health expense.

Integrated invoicing management can automate this process, ensuring tax compliance with no additional effort.

Technical Requirements

The quality of the online therapy experience depends significantly on the technical infrastructure. Here are the essential requirements.

Minimum Hardware

Computer: Modern processor (last 5 years), minimum 8 GB of RAM.
Webcam: HD (720p) minimum; Full HD (1080p) recommended for better reading of facial expressions.
Microphone: Dedicated microphone or headset with noise cancellation. Built-in laptop microphones are generally insufficient.
Lighting: Adequate front-facing light (ring light or desk lamp). Avoid backlighting (windows behind you).

Internet Connection

Minimum speed: 10 Mbps download and 5 Mbps upload.
Recommended: 25 Mbps download and 10 Mbps upload.
Wired connection: Always preferable to Wi-Fi for greater stability.
Backup plan: Have an alternative (mobile hotspot) for connectivity emergencies.

Physical Space

Private room with closed door and no interruptions.
Neutral, professional background (plain wall, bookshelf).
Adequate soundproofing.
Controlled and consistent lighting.

Choosing the Right Platform

Not all video call platforms are suitable for therapy. The ideal tool must meet specific security, privacy, and functionality criteria.

Mandatory Security Criteria

End-to-end encryption: Session data must not be accessible to third parties, including the platform provider.
GDPR compliance: EU-based servers, Data Processing Agreement (DPA) available.
No recording by default: Recording should be an explicit option, not the default behavior.
Secure authentication: Access protected by password or unique per-session link.

Functional Criteria

Stable video and audio quality.
Ease of use for the patient (no need to install software).
Screen sharing capability for therapeutic materials.
Virtual waiting room to manage patient entry.
Integration with schedule management and clinical notes systems.

Mena.ai's integrated video call was designed specifically for psychotherapy sessions, with end-to-end encryption, clinical-grade video quality, and full integration with schedule management and clinical notes.

What to Avoid

Generic platforms without GDPR compliance (e.g., free versions of corporate videoconferencing tools).
Applications that store data outside the EU without adequate safeguards.
Tools without end-to-end encryption.
Platforms that use session data for advertising purposes or AI training without consent.

Best Practices for Online Sessions

The effectiveness of online therapy depends as much on clinical competence as on technical and relational execution.

Before the Session

Test the technology: Check camera, microphone, and connection 10 minutes beforehand.
Prepare the space: Ensure privacy, lighting, and an appropriate background.
Send reminders: An automatic reminder with the session link reduces no-shows.
Have a backup plan: Agree in advance on what to do if the connection fails (phone call, reschedule).

During the Session

Eye contact: Look at the camera (not the screen) when speaking. This simulates eye contact.
Enhanced verbal language: Compensate for the partial loss of non-verbal cues with more verbal feedback ("I understand," "Go on").
Intentional pauses: Digital latency can create overlaps. Leave more space between interventions.
Managing silences: Therapeutic silences can feel more uncomfortable online. Validate them verbally when appropriate.
Attention to framing: Keep your face visible and centered. Avoid sudden movements.

After the Session

Immediate clinical notes: Document while the session is still fresh in your memory.
End the session properly: Ensure the video call is fully terminated before speaking with others.
Record technical incidents: If there were issues, document them and their impact on the session.

AI-assisted clinical notes can transform this process, automatically generating a structured draft that the therapist only needs to review and approve.

Informed Consent for Online Therapy

Informed consent for online therapy must include additional elements compared to consent for in-person therapy.

Specific Elements to Include

Description of the platform used and its security measures.
Specific risks of the online modality (e.g., technical failures, privacy in the patient's space).
Procedures in case of clinical emergency (patient's local emergency contacts).
Session recording policy, if applicable.
Limitations of online therapy and criteria for in-person referral.
Patient's responsibility for ensuring a private space on their end.

The patient portal allows you to manage digital informed consent securely and traceably, with electronic signature and version tracking.

For more information on digital consent, see our article on digital informed consent.

Special Situations

Therapy with Children and Adolescents

Requires consent from legal guardians.
The platform must allow the presence of a third party when necessary.
Consider shorter sessions for younger age groups.
Use visual and interactive resources to maintain engagement.

Online Couples Therapy

Ensure both partners have adequate equipment and space.
Set clear rules about participation (camera on, shared or separate spaces).
Be prepared to manage conflicts remotely.

Patients in Crisis

Always keep the patient's emergency contact and geographic location up to date.
Know the local emergency resources (112 emergency line, SNS 24 health line, SOS Voz Amiga helpline).
Define a crisis protocol for online sessions in advance.
Assess on a case-by-case basis whether online therapy is the appropriate modality.

Hybrid Model (In-Person + Online)

Many professionals successfully adopt a mixed model.
In-person sessions can be reserved for key moments (initial assessment, sessions of greater emotional intensity).
Managing a smart schedule facilitates switching between modalities.

Measuring the Effectiveness of Online Therapy

Monitoring therapeutic outcomes is essential to ensure that the online modality is being effective for each patient.

Assessment Instruments

PHQ-9: To monitor depressive symptoms.
GAD-7: To assess anxiety levels.
OQ-45: For a more comprehensive assessment of functioning.
Therapeutic alliance questionnaires: To evaluate the quality of the online relationship.

Integrated outcomes tracking allows you to apply these instruments systematically and visualize progress over time.

Indicators to Monitor

Adherence rate (no-shows and cancellations).
Qualitative patient feedback about the online experience.
Score progression on standardized instruments.
Satisfaction with the modality.

Frequently Asked Questions

Is online therapy recognized by the Portuguese Order of Psychologists?

Yes. The Ordem dos Psicologos Portugueses recognizes teleconsultation as a legitimate practice, provided it meets the requirements for security, confidentiality, and informed consent. The professional must be registered and have their professional license in good standing.

Do I need a specific professional liability insurance?

It is advisable to check with your insurer whether your policy covers online practice. Many insurers already include this modality, but it is worth confirming and, if necessary, extending the coverage.

Can I see patients in other countries?

This depends on the regulations of the country where the patient is located. Some countries require local licensing. For Portuguese patients abroad, the situation is generally simpler, but should be verified on a case-by-case basis.

What is the minimum age for patients in online therapy?

There is no formal minimum age, but it is generally accepted that children under 7-8 years old benefit more from in-person therapy. For adolescents, online therapy works well but requires consent from legal guardians.

What if the patient lacks technological skills?

Offer a technical test session before the first consultation. Send simple, visual instructions on how to access the platform. Consider maintaining the in-person option for those who genuinely cannot adapt to the online format.

How to handle technical failures during the session?

Agree on a protocol in advance: if the connection drops, who reconnects? How long to wait? When to switch to phone? Having these rules defined reduces frustration and the impact on the therapeutic session.

Conclusion

Online therapy is an established reality that offers significant opportunities for professionals and patients alike. With adequate technical preparation, compliance with the legal framework, and the adoption of clinical best practices, it is possible to offer a service of quality equivalent to in-person therapy.

Investing in specialized tools makes a difference: a platform designed for clinical practice, such as Mena.ai, integrates secure video calls, schedule management, AI-assisted clinical notes, and a patient portal — all in one place, allowing you to focus on what truly matters: the therapeutic relationship.

Online therapy does not replace in-person therapy — it complements it. And for many patients, it is the difference between having access to mental health care or not.