Sarah L. Hancock, Kimberly S. Stark, and David S. Kreiner

Sara L. Hancock, BS
University of Central Missouri
Shancock@ucmo.edu

Kimberly S. Stark, PhD
University of Central Missouri
stark@ucmo.edu

David S. Kreiner, PhD
University of Central Missouri
kreiner@ucmo.edu

Many new technologies have contributed to the expanded use of the Internet, including the introduction of mental health services known as telepsychology (Clough & Casey, 2015, Maheu, Pulier, MeMenamin, & Posen, 2012). Telepsychology has expanded rapidly since its inception (Maheu et al., 2012), presumably because of its potential benefits. However, Telepsychology also presents unique challenges and risks for both clients and providers.  This article outlines the pros and cons of telepsychology and offers recommendations for both potential clients and service providers.

Many of the potential advantages of telepsychology revolve around convenience for clients and providers.  For example, clients who suffer from chronic illnesses, mobility limitations, or who live in remote locations might prefer the convenience of telepsychology to face-to-face psychotherapy (Rochlen, Zack, & Speyer, 2004). Likewise, individuals who travel or relocate frequently (e.g., military personnel), might benefit from being able to continue a therapeutic relationship via telepsychology (e.g., Rochlen et al., 2004). Also, telepsychology might appeal to those who would otherwise be unwilling to seek more traditional psychotherapy (Rochlen et al., 2004).

Some of the challenges and risks associated with telepsychology include obtaining informed consent and guaranteeing clients’ confidentiality; further, managing crises becomes more complicated because of communication through the Internet (Rochlen et al., 2004). Concerns regarding interjurisdictional practice are exacerbated when providing services online (Harris & Youngren, 2011). Additional concerns arise regarding verifying clients’ identities to ensure that one is not unknowingly providing services to a minor (Rochlen et al., 2004). Telepsychology may be inappropriate for certain individuals such as those displaying psychotic features (Rochlen et al., 2004). Despite such challenges, potential clients do not seem to be deterred, with demand for telepsychology services outnumbering the supply of professionals prepared to offer such services (Maheu et al., 2012). Maheu et al. (2012) noted this supply-demand imbalance is worrisome; it places clients at risk of seeking services from ill-trained providers who may be aggressively marketing their services online.

Professional guidelines exist for clinicians who wish to offer telepsychological services. In 2013, the American Psychological Association (APA) published The Guidelines for the Practice of Telepsychology to facilitate the professional development of psychologists offering telepsychology services. The American Counseling Association ([ACA], 2014) published Ethical Standards for Internet Online Counseling, and the International Society for Mental Health Online [ISHMO, 2000] published Suggested Principles for the Online Provision of Mental Health Services.  However, extant research suggests that many providers do not adhere  to these guidelines (Hancock, Stark, Kreiner, Walker & Cordiero, 2016; Heinlen, Welfel, Richmond, & O’Donnell, 2003; Shaw & Shaw, 2006). These findings are disconcerting, as there is variability in the quality of the content included in telepsychology websites and many potential clients might also be unable to discriminate between qualified and unqualified providers (Maheu et al., 2012).

Given the need for high quality service delivery, providers should carefully review telepsychology professional guidelines (e.g., see ACA, 2014; APA, 2013; ISHMO, 2000), the APA’s Ethical Principles of Psychologists and Code of Conduct (APA, 2010), and other sources. Harris and Youngren (2011) addressed issues related to interjurisdictional practice and reviewed risk management and ethical principles that might be helpful in determining whether to offer telepsychological services in a given situation. Drum and Littleton (2014) provided recommendations for maintaining therapeutic boundaries in telepsychology relationships. Clough and Casey (2015) described trends and possibilities within the field of telepsychology (e.g., use of sensor technology to monitor health indices and behaviors) and called for innovative research designs to address the gap between client demand for such services and evidence regarding their effectiveness. Recently, Riper and Cuijpers (2016) summarized research related to telepsychology and discussed its limitations and future directions. The APA and the APA Trust also offer continuing education sessions on the practice of telepsychology (see http://thetrust.bizvision.com/product/ondemandpracticeintheageoftelepsychology(13931).

Those seeking telepsychology services should know they have the right to certain information before committing to any form of psychological service (APA, 2010; APA, 2013). Clients have the right to know how their privacy (identity and information they provide over the Internet) will be protected and to know the limits to confidentiality (APA, 2013). Clients have a right to be informed of the advantages and disadvantages of telepsychology as compared to face-to-face psychotherapy (APA, 2013). Other issues to be addressed prior to establishing a therapeutic relationship or “as early as is feasible in the therapeutic relationship” (APA, 2010, p. 1072) include, but are not limited to, the fee arrangement, what to do in the event of a crisis or technological failure, the fact that telepsychology might not be appropriate for everyone, and the service provider’s credentials (see APA, 2010 and APA, 2013).

In sum, telepsychology presents numerous benefits and unique challenges.  Practicing psychologists should educate themselves in this growing area of practice.  Likewise, potential clients should become informed about the issues raised here prior to engaging in telepsychological services.

(Editors Note: The article is based on a Division 46 Poster of Excellence presented at the 2016 APA Convention, Denver, Co.  The authors received a Division 46 Presidential Citation for Outstanding Undergraduate Poster in Media Psychology and Technology.)

References

Hancock, S. L., Stark, K., Kreiner, D., Walker, T., & Cordiero, A. (2016, Aug.). Website adherence to APA guidelines for the practice of telepsychology. Poster presented at the Annual Convention of the American Psychological Association, Denver, CO.