Telepsychology Take Two

As referred to in my prior post, this post will be more for counselors and psychologists who are considering doing telepsychology or telemental health. It seems as though this post is definitely in order after some of the responses to my prior post. I admit that I was also very skeptical of how the therapeutic process would work in an online format so I would like to take some space here to answer some questions about doing therapy online.

The very first thing an interested therapist should do is check state laws and licensure codes. In Virginia, for example, licensed clinical psychologists can only practice synchronously (in real-time). Other mental health professionals may be able to do more informal types of therapy, but I am unaware of research on how effective that form of therapy is alone. Some research has been conducted on text messaging therapy as an adjunctive treatment with mixed results (Aguilera, Bruehlman-Senecal, Demasi, & Avila, 2017). In contrast, there is good evidence that most evidence-based therapies, especially cognitive behavioral therapy (CBT), can be delivered via video with the same results as in-person (Nelson & Duncan, 2015; Gross et al., 2013). In other states, the licensure codes and laws will differ significantly, so make sure to check your state’s rules before doing anything else.

After you have determined whether this would be a legal and allowable practice in your state, it is necessary to obtain training to ensure competence. Some graduate programs are now providing the necessary training to become competent (McCord et al., 2013) as there is a recognition that this will be a popular method of delivery in the future. There are many different venues to complete training and, as I have not evaluated them, I will not recommend one here. I do however believe that these trainings should cover HIPPA and other privacy concerns, technology issues specific to the therapy relationship, and ethical issues. A great place to start if you have concerns about the ethical issues of using telepsychology is the American Psychological Association’s Guidelines for Telepsychology document (2010). This document alone will not give you adequate training but is a good jumping-off point.

Finally, you must decide your level of comfort. As I stated in the previous post, the therapist’s comfort level really affects whether or not a good therapeutic alliance will be formed online (Frueh et al. 2007). A good training program will also allow you to feel more comfortable and competent with using technology (Nelson & Duncan, 2015) and excellent book chapters have been written to address this issue (Glueck, 2013). Practice will also increase your comfort level and it may be beneficial to check in with your client frequently to determine whether this format continues to work for them. One approach that has been beneficial to me has been to meet with my clients face-to-face for an intake and then move therapy to a video/online format. At intervals, it may even be beneficial to reconnect face-to-face for a session to re-evaluate the appropriateness of the approach.

Again telepsychology or online therapy will not be for everyone, just as CBT or family therapy is not for every practitioner or client. It can, however, offer significant benefit to individuals in rural areas or those who have mobility or other issues that would prevent them from receiving care otherwise. It is my hope that more qualified mental health professionals will become trained in this format so we can reach those who need assistance but may have trouble obtaining it. As mental health care providers, we should consider every option that will expand access to care.