ACA Blog

Sep 13, 2013

To Build a Counseling App or Should Clients be Allowed to Record Therapy Sessions?

For years people had said to me, “You should build an app.”

I’d reply, “No thank you! The world doesn’t need another useless app.” Apple has almost a million apps in their store, many not worth the bandwidth they’re downloaded on. I should know; I’ve bought and deleted most of them.

I didn’t want to create something that would just add to the clutter. I also didn’t want the headache! Many things can go wrong when building an app; developers quit mid-project, costs spin out of control, and often the final product is non-intuitive and buggy. In fact, almost everyone I know who has commissioned an app has a horror story to tell.

Don’t Do Lists

Last fall I started getting some ideas for a counseling app. I tried to shake them. I shared the ideas with my closest ‘dream killers’, and I literally added “build an app” to my “Don’t Do List” (DDL).

A DDL is a list of items—traditionally business related—that one commits not to do so that that he or she can focus energy on more important things. I can’t remember who told me to create a DDL, but it was terrible advice. It’s like saying to yourself “This is really tempting, but it’s a bad idea. Let’s write it down so I can remember to think about it again.“ To date, I’ve done everything I’ve put on my DDL (most recently this included buying http://credentialing.com).

Like my dad used to say, “You think about getting a tattoo long enough and eventually the conversation changes from ‘should I get a tattoo’ to ‘where should I get a tattoo?’” And so, five months after adding “iPhone app” to my DDL I was transferring a deposit to a developer.

Building “Therapy Buddy”

The app I built is called “Therapy Buddy” and it’s designed it to help clients get the most out of their counseling sessions. It has 5 features:

1) Record your therapy appointments

2) Write a “Helpful Takeaway” for each session

3) Create a homework assignment task list

4) Set an alert reminder for your next appointment

5) Create a list of “Things to Bring Up” at your next session

It’s a simple app. In fact, some of its features already exist in one way or another. For example, an appointment could be made in iCalendar (#4), and there are other to-do-lists that provide something similar to features #3 and #5 (feature #2 is most unique, and provides the user the option to share takeaways on FB/Twitter). In part, the value of the app is that it gives users a centralized place to store info for the purpose of counseling, and it provides increased security as each feature is password protected and all user data is stored securely within the one app.

Recording an Appointment

Before the app went into production, I asked for feedback from friends and colleagues. A friend who would always forget what he wanted to talk to his counselor about recommended feature #5. Also, there were a lot of good feature suggestions that didn’t make the cut, such as a daily mood log and a “med reminder” feature that would remind users to take their meds.

Then too, one counselor raised his eyebrows at feature #1. “What about confidentiality and HIPAA?”

“Confidentiality is the client’s privilege,” I said. “HIPAA really isn’t an issue here.”

He lowered his voice and said, “I’m not sure I like the liability of being recorded.”

Until that moment, I’d never thought of clients recording sessions as a liability. Many of my clients record our sessions and use the recordings to track their progress over time. Also, I know two providers who used to tape sessions on cassette and then give the cassettes to their clients as a gift at the end of each appointment—they stopped this when cassettes became obsolete and never found a suitable alternative. Secure appointment recording was my favorite feature! However, I realized that if one clinician had concerns others might also and I wanted to see if there was a legitimate proven benefit for it, or reason for pause.

First, I asked a lawyer-colleague to help me to search for an instance where a client used recorded appointments to litigate against his/her therapist. In our (very limited) search we found nothing.[i] Next, I looked for research studies investigating the practice of recording therapy appointments. I found several.

For example, a study from the Institute of Psychiatry at King’s College (London) evaluated the attitudes and effects of clients recording therapy sessions. Of the 31 participants who completed the study, 90% reported listening to the recordings between sessions and the majority discussed those recordings with their therapists. Despite early apprehension by therapists, most patients and therapists developed positive attitudes toward the practice of recording sessions and cited benefits including “improving memory for sessions.”[ii]

Second, a meta-analysis with 1615 patients investigated the clinical efficacy of several procedures including recording sessions. Researchers found that reviewing recorded sessions contributed to positive outcome differences that emerged with time.[iii]

Thirdly, and more anecdotally, therapist Karen Duncan, author of Healing from the Trauma of Childhood Sexual Abuse, writes, “Taping sessions can help women review what they discuss and what they learn about themselves. Listening to session tapes at least once or twice a week will help a women stay focused on her recovery and provide her ongoing support during the time between appointments [and]…help a woman identify how negative beliefs distort her thinking.”[iv]

Finishing the App

In the end, we decided the benefits were clear and we kept Feature #1. The app is finished! It cost thousands, and many hours working with developers to make the app bug free and even fun to use (It will be in Apple’s App Store by the time this is printed. Woohoo!) Still, like many new ventures tried, I question if this project was worth the effort. I don’t expect to make my money back in sales (actually, the app is FREE!), but I am hoping the app will help to build my company’s brand. And I suspect my work isn’t really done—I’ll need to find someway to get the word out so that potential users might find it in the sea of other apps. And if someone does download it, I can only hope he or she will like it, use it, and that it will help. 


[i] The search was done in part using WestLawNext Legal Research System and in no way should be considered a comprehensive legal search.
[ii] Shepherd L, Salkovskis PM, Morris M. (2009). Recording Therapy Sessions: An Evaluation of Patient and Therapist Reported Behaviours, Attitudes and Preferences. Institute of Psychiatry, King's College London, and South London and Maudsley NHS Trust, UK.
[iii] Town, J. M., Diener, M., Abbas, A., Leichsenring, F., (2012). A Meta-Analysis of Psychodynamic Psychotherapy Outcomes: Evaluating the Effects of Research-Specific Procedures. Psychotherapy. Vol. 49, No. 3, 276 –290.
[iv] Duncan, K. A. (2004). Healing From The Trauma Of Childhood Sexual Abuse: The Journey For Women. Greenwood Publishing Group
________________________________________________________________________
Anthony Centore is a Counselor, is Private Practice Consultant for the ACA, and helps counseling practices across the US thrive. For more information on private practice and insurance panels go to http://thriveworks.com

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  1. 1 David 26 Mar
    I'm close to finishing my Masters in Counseling, but I'm already determined to offer recordings of sessions to my clients as part of my service. To kick it up a notch (and with their consent), I'm planning to video record the sessions and offer them on a thumbdrive with sophisticated encryption so that the clients' sessions are protected. My ultimate concern is the clients' well-being, and I imagine some harm may come to them if their sessions were obtained by a third party without their consent. With that in mind, did you weave in any sort of protections for the recordings of your app?

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