With forethought and attention to several key issues, telepsychology innovations can be integrated into one’s practice ethically, legally, and competently

Jeffrey E. Barnett, PsyD, ABPP
Jbarnett@loyola.edu
Loyola University Maryland

Psychologists regularly integrate various forms of technology into their practices, for both administrative and clinical purposes.  Administrative uses of technology assist psychologists to a more efficient and effective practice.  They allow for more convenient communication between psychologists and their clients, e.g., using telephones to schedule appointments, fax machines to send documents quickly, and e-mailing and text messaging to schedule or change appointment times. Various technologies may also be integrated into clinical practice to augment or supplement in-person treatment and as the sole means of providing clients with clinical services.

A common occurrence is to have a client in traditional in-person treatment unavailable to meet in-person due to business travel, vacation, illness or injury, or adverse weather.  Rather than miss out on needed treatment the psychologist and client can choose to “meet” using a number of technologies so treatment is not interrupted. Examples include conducting treatment sessions via telephone, e-mail, or video conferencing.  One may also integrate such technologies to enhance the quality of ongoing in-person treatment by using various apps or online resources (see for example Mood 24/7 at www.mood247.com) and having clients use e-mail or text messaging to share the results of homework assignments for review and feedback by their psychologist in a timely manner.

Psychologists may also consider, either due to their desire or the request of clients, to use such technologies as the sole means of providing treatment.  Much has been written about the potential benefits and limitations of the use of e-mail to provide clinical services (e.g., Mallen, Jenkins, Vogel, & Day, 2011; Mallen, Vogel, & Rochlen, 2005).  Of particular note is the asynchronous nature of e-mail communications and the absence of verbal and visual cues.  Great strides have been made in recent years in videoconferencing quality. Videoconferencing might be the only way of accessing needed treatment for those clients who would not otherwise have access to needed treatment services due to living in a remote area or one with limited professional resources; who are homebound due to physical limitations, lack of transportation or child care, and even diagnosis (e.g. agoraphobia); and, who may be embarrassed by their conditions (Backhaus, 2012).

Key Issues for Ethical, Legal, and Competent Telepsychology Practice

Regardless of the medium used, the motivations for utilizing it, and how it is applied, each psychologist should consider several important issues prior to integrating available technologies into clinical practice. This list is not intended to be all-inclusive, but will hopefully help psychologists considering providing telepsychology services. It should be noted that using social media is not addressed in this brief article, as that will require its own separate discussion.

• Know the literature relevant to telepsychology to include relative benefits and risks of each medium for various clients, their presenting problems, and their treatment needs, as well as evidence for the effectiveness of new technologies and treatment modalities.
• Be sure to follow all applicable standards in the APA Ethics Code regardless of the medium being used (http://www.apa.org/ethics).
• Thoughtfully consider all available guidelines relevant to practicing telepsychology. New APA guidelines for telepsychology were approved August, 2013 (see Division 46 website).
• Carefully assess and then ensure that the medium selected is appropriate for the client’s treatment needs and circumstances since not all forms of telepsychology are equally appropriate for every client.
• Attend to culture, language, and other individual differences that may impact effective communication through various technologies.
• Be sure to possess the needed clinical and technological competence to provide telepsychology services including familiarity and skill in using the necessary software and hardware in addition to the competencies that would be needed to effectively work with that client in person.
• Know the licensure laws in both the jurisdiction where the services are being offered and the jurisdiction where the services are being received. Do not assume that a license from one jurisdiction will be sufficient to practice legally in another. (Visit the ASPPB website for more information at www.asppb.org)
• Know relevant laws in each jurisdiction where clients receive your services. This can include mandatory reporting requirements of suspected child or elder abuse or neglect, and the duty to warn or protect laws.
• Utilize a comprehensive informed consent procedure that fully addresses the issues typically addressed in in-person treatment as well as those specifically relevant to the provision of telepsychology (e.g., how lapses in technology and emergency situations will be handled).
• Take special precautions to ensure the confidentiality of all telepsychology communications and use HIPAA-compliant software.
• When providing services to clients outside of one’s local geographic area, know the resources (e.g., emergency care) in that area and make advance contact with them to help ensure timely access to them should they be needed.
• Prepare and plan for technology limitations and failures. Address this in the informed consent process and specifically agree upon the procedure to be followed if a technology failure occurs during a treatment session (e.g., having the client immediately call the psychologist at an agreed upon telephone number to complete the session over the telephone).

References

Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, B.,  … Thorp, S. R. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9(2), 111-131.

Mallen, M. J., Vogel, D. L., & Rochlen, A. B. (2005). The practical aspects of online counseling: Ethics, training, technological, and competencies. The Counseling Psychologist, 33, 776-818.

Mallen, M. J., Jenkins, I. M., Vogel, D. L., & Day, S. X. (2011). Online counselling: An initial examination of the process in a synchronous chat environment. Counselling & Psychotherapy Research, 11(3), 220-227.