Running telehealth and online therapy sessions in South Africa: a practical guide
Offering sessions by video opens your practice to patients who couldn't otherwise fit therapy around work, caring responsibilities or distance — but it adds a handful of things worth deciding deliberately rather than figuring out mid-session for the first time.
Get explicit consent for the remote format
It's good practice to cover telehealth explicitly in your consent process rather than assume it's automatically covered by standard consent to treatment. A short addition, set up once, should note the platform you use, its general limitations (connection issues, the different feel of reading body language on screen), and — importantly — what happens if a session is disrupted or a risk situation arises while you're not in the same room.
Have an emergency plan that doesn't depend on the call staying connected
Before a remote patient's first session, confirm their physical location at the time of the session and have a plan for what you'd do if you needed help reaching them urgently and the call dropped. This is a five-minute conversation to have once per patient, not something to work out live during a crisis.
Choose a platform with health data in mind
A general consumer video app isn't automatically the right choice for clinical sessions just because it's familiar or convenient — check any platform's data processing terms and hosting region before relying on it for special personal information under POPIA. See our full POPIA guide for psychologists for what "appropriate" actually means in practice.
Working across borders: seeing a patient based outside South Africa, or seeing a South African patient while you're travelling, raises real questions about your registration, insurance cover and professional body's rules that are worth confirming case by case, rather than assuming your usual cover extends automatically.
Keep the same note structure, remote or in person
A telehealth session's clinical content is recorded the same way as any other — see our guide to what to include in session notes. The only addition is a line confirming the session was remote and which platform was used, useful context if the file is ever reviewed later.
Booking a remote session shouldn't be harder than booking an in-person one
If online booking is part of how patients reach you, make sure it's clear at the point of booking whether a slot is in person, remote, or either.
Plan for connectivity issues, not just consent
Load-shedding and patchy connectivity are ordinary realities for a South African practice, not exceptional events. Agree with each remote patient, up front, what happens if the call drops mid-session — do you call them back, on which number, and how long do you wait before treating it as a missed session rather than a technical hiccup. Deciding this once, calmly, beats improvising it live while a call is actually failing.
When telehealth genuinely isn't the right fit
Not every patient or every presenting concern is well suited to remote sessions — active risk situations, some couples or family work, and patients without reliable private space to take a call are all worth flagging honestly rather than defaulting to video because it's convenient for your diary. Being willing to say "let's do this one in person" is part of using telehealth responsibly, not a failure of the format.
One system for in-person and remote sessions
Booking, reminders and records that work the same way whichever format a session takes.
Frequently asked questions
Do I need separate informed consent for online sessions?+
It's good practice to cover it explicitly rather than assume standard consent to treatment automatically extends to telehealth. A short, clear addition covering the platform used, its limitations, and the emergency plan if a session is disrupted takes a few minutes to set up once and applies to every remote patient after that.
Can I see patients based anywhere while working online?+
Working across provincial or national borders raises questions about registration, insurance cover and professional body rules that are worth confirming with your insurer and registration body before you commit to it, rather than assuming your usual cover automatically extends.
Is video-calling software like Zoom or WhatsApp video POPIA-compliant for sessions?+
It depends on the specific service, its data processing terms, and how you configure it — a general consumer video app isn't automatically appropriate for special personal information just because it's convenient. Check a platform's own data processing terms and hosting region before relying on it for clinical sessions.
In-person or remote, the same reliable record
Booking, reminders and POPIA-aware notes, whichever format a session takes.
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