Online sessions
Online therapy in South Africa: HPCSA telehealth guidelines
Online sessions are now an ordinary part of private practice. The HPCSA telehealth guidelines, published as Booklet 10 of the HPCSA’s ethical guidelines, set out what the regulator expects when you work this way.
This guide summarises the main points and turns them into a practical checklist. Read the booklet itself before you change how you practise.
3 October 2026 · 6 min read
What the guidelines cover
Booklet 10 is titled “General ethical guidelines for good practice in telehealth”. It applies to every practitioner registered with the HPCSA, including psychologists, registered counsellors and psychometrists.
Its starting point is simple: a telehealth consultation must meet the same standard of care as one in person. Working by video doesn’t lower the standard, and you remain fully accountable for your clinical decisions.
The main requirements
| Area | What is expected |
|---|---|
| Registration | You must be registered with the HPCSA and work within your scope of practice |
| Standard of care | The same as for an in-person consultation |
| Informed consent | The client consents to the treatment and, specifically, to the use of telehealth |
| Limits and risks | Explained to the client beforehand |
| Confidentiality | Client information is collected, stored and transmitted securely, in line with POPIA |
| Records | Kept to the same standard as for any other session |
| Suitability | You judge whether telehealth is appropriate for this client and this problem |
Consent for online sessions
Consent is the requirement most often handled badly. Consent to counselling is not the same as consent to counselling by video. The client needs to agree to the technology as well as the treatment, and that agreement should be documented.
The consent wording should cover:
- That sessions will take place by video, and on which platform
- The limits of working online, such as reduced non-verbal cues
- The risk that a connection could fail or be insecure
- What happens if the session is interrupted, and how you will reconnect
- That neither of you will record the session without agreement
- What to do in an emergency, and the client’s location during sessions
- Fees, which should be clear for online sessions as for any other
Our guide to the counselling consent form covers the rest of the form. With an online intake and consent form, this can be signed before the first session without the client coming in.
How to run online therapy sessions in South Africa
A short checklist before each online session:
- 1Confirm where the client is. You need an address if you have to send help.
- 2Confirm they are somewhere private, and that you are too.
- 3Agree on a backup. If the video drops, who phones whom?
- 4Check your own setup: connection, camera, lighting, and a charged device in case of load-shedding.
- 5Keep the emergency contact from the intake form within reach.
- 6Write the note afterwards exactly as you would for an in-person session, and record that the session was online.
Load-shedding and unstable connections are a South African reality. A backup power source and a mobile data fallback are worth having, and the consent form should say what happens to a session that can’t be completed.
Choosing a platform: Google Meet, Zoom and the rest
Practitioners often ask whether they can use Google Meet for therapy sessions in South Africa, or whether Zoom is acceptable. The guidelines don’t name approved products. They put the responsibility on you to protect confidentiality and comply with POPIA.
When you assess a platform, ask:
- Is the connection encrypted?
- Can you control who enters, with a waiting room or a locked meeting?
- Does each session have its own link, or is one link reused?
- Are recordings off by default?
- What does the provider do with data about the call?
- Can the client join easily, without creating an account?
The last point affects attendance. Every extra step between a client and the session is a reason for it to start late. A room that opens from a link in the reminder email, with no download, removes most of them.
When online isn’t suitable
The guidelines leave the judgement with you. Telehealth in South Africa has widened access considerably, particularly outside the cities, but it does not suit every client or every problem.
- A client at high risk, where you can’t respond quickly from a distance
- A client who has no private place to speak
- Young children, for whom video is often a poor fit
- Assessments that require standardised in-person conditions
- A client who simply doesn’t want it
Review the decision as the work goes on. If something changes, raise it, and be ready to move to in-person sessions or to refer.
Billing online sessions
An online psychologist consultation in South Africa is invoiced like any other session, but schemes differ in how they treat it. Some expect a particular code or modifier for a virtual consultation. Check each scheme’s rule before you claim, and make sure the invoice reflects how the session was delivered.
When clients book online, they can choose an online or in-person session at the time, so the right kind of appointment is in your diary from the start.
Common questions
Do I need separate consent for online sessions?
Yes. The client should consent to the use of telehealth specifically, as well as to the treatment. It can be a section of your main consent form, as long as it is clear and documented.
Can I see a client who is in another country?
That raises questions of registration and jurisdiction in the client’s country as well as South Africa, and of whether your indemnity insurance covers it. Take advice before you do.
Does the HPCSA approve particular video platforms?
No. The guidelines set the requirements, such as confidentiality and compliance with POPIA, and leave it to you to choose a platform that meets them.
This is a summary of the HPCSA’s telehealth guidelines as we understood them in October 2026, not a substitute for the booklet. Read Booklet 10 on the HPCSA website and confirm the current version before relying on it.
Sources
In Wholistic
Run online sessions from the same place as your diary.
A built-in video room with a waiting room, and no account or download for the client.
See online sessions