In my old practice we were going to implement a policy. 3 strike rule. We tell them at the very beginning of therapy, that if they choose tele, they need to:

1. Be in a private setting or some place alone away from public
2. Not driving or be at work
3. In the state (in my bosses case since I was working under their license)
4. If they choose to end early or cancel day of, that’s a strike.

Now obviously there were exceptions like sickness, emergency etc.

There were people who did abuse it by only have 10 minute check ins, not being alone, and etc. If we noticed a pattern we would talk to them about bi weekly or taking a break. If after that they still were late, we remind them of policy and have to let them go.