from PSYCHOGRAM: Fall 2009 – Volume 34 Number 4
Virginia Psychological Association
TELEPSYCHOLOGY: TO PHONE OR NOT TO PHONE
By Amber Lea Walser, Meghan McLain, & Kalika Kelkar*
Telepsychology, a recent development in clinical psychology practice, refers to the use of telecommunications and information technology to provide psychological services. It includes the use of the telephone, audio-video, email, and chat rooms to provide psychotherapy, assessment, consultation, diagnostics, education,and supervision (Nickelson, 1998). As with any emerging psychological practice, there is limited research and few studies with rigorous controls examining the effectiveness of this phenomenon. Additionally, current empirically supported interventions and assessment instruments have generally not been validated for use through these electronic mediums. Although it is being practiced with increasing frequency, telepsychology is such a new practice that explicit APA guidelines for its implementation have not yet been developed.
Studies by Aronson, Heckman et al., and Sandgren and McCaul (as cited in Koocher, 2007) have shown that telepsychology can be beneficial for clients. Other research by Wood, Miller and Hargrove (as cited in Miller, 2006) indicates that this technology can be used for supervision as well. However, a study by Reese, Conoley and Brossart (2006) demonstrated that while 53% of participants reported improvements after telephone therapy, it was not as effective as face-to-face therapy for those who felt “very poorly.” It must be noted that the therapy in this study was provided free of cost, which may have confounded the findings, thus limiting the generalizability to “traditional” telepsychology which requires payment.
The telepsychology trend raises a number of ethical issues that need to be considered and researched before it is extensively implemented or recommended. Though no statistics exist, telepsychology appears to be growing in popularity as even private practitioners are entering offering these services across state lines. A primary concern is the effect of the inclusion of technological devices on the therapeutic relationship. Research indicates that positive outcome in therapy is consistently related to therapeutic alliance and cohesion between client and therapist (Lambert, 2004). Similarly, one could argue that therapeutic effectiveness is often contingent upon creating a confidential, appropriate, reliable and safe environment in which therapy can occur (Langs, 1979). A long-distance, electronic interaction decreases the therapists’ control over the settings and the clients. Interpersonal dynamics, rapport and client concentration may be adversely affected and the less ersonal therapist-client interaction may risk diluting the benefits of the therapeutic alliance. Furthermore, certain therapy modalities which rely upon physical interaction (e.g., play therapy), nonverbal cues (e.g., interpersonal therapy), or therapy dependent on the interactions of multiple individuals (e.g., family and group therapy) may be difficult to conduct via electronic means.
Other serious repercussions could arise with respect to confidentiality and test security. Electronic communications can never be assumed to be completely secure from prying ears and eyes. Both client and therapist privacy must be considered. For example, a client could tape sessions without the therapist’s consent and then disseminate information to the public. Some clinicians already conduct assessments via web based or emailed material (Koocher, 2007), which raises other potential pitfalls. Behavioral observations and honest test responses will be tricky to assess. It would be difficult to ensure that tests are not copied, and copyrights are not infringed.
Competency guidelines for telepsychology services have not been established. How does one become appropriately trained to deliver therapeutic services over the phone, email or in chat rooms? There is greater potential for therapist misrepresentation. For instance, how can one be sure that the therapist is who they claim to be during telepsychology sessions? Conducting teletherapy over state lines may pose a special challenge as rules and guidelines for telepsychological methods already vary from state to state (Koocher, 2007).
Even though telepsychology may, at first glance, seem to have significant disadvantages, it does have potential benefits when used appropriately. Telepsychology improves access to care by minimizing time and travel expenses, and easing other significant barriers to treatment, such as the unavailability of providers in remote geographical locations. This type of therapy may be particularly suited for those interventions that are more structured or less interpersonally demanding. Some research has shown that children may be more engaged by the technical aspects of telepsychology, such as participating in video conferences (Rabasca, 2000).
Telepsychology is a new frontier in the field and it would be myopic to dismiss it entirely. Despite differing viewpoints on the subject, it would still be a better option than not providing services to those in need when no other recourse is available. Further research must be conducted to determine optimal methods of delivering treatment as well as the efficacy and effectiveness of this new mode of therapy.
Koocher, G. P. (2007). Twenty-first century ethical challenges for psychology. American Psychologist, July-August, 375-384.
Lambert, M. J. (2004). Handbook of psychotherapy and behavior change. New York:John Wiley & Sons.
Langs, R. (1979). The therapeutic environment. New York: Jason Aronson.
Miller, T. W. (2006). Telehealth issues in consulting psychology practice. ConsultingPsychology Journal: Practice and Research, 58, 82-91.
Nickelson, D. (1998). Behavioral telehealth: Emerging practice, research, and policy opportunities. Behavioral Sciences and the Law, 14, 443-457.
Rabasca, L. (2000). Taking telehealth to the next step. Monitor on Psychology. Retrieved June 15, 2009 from http://www.apa.org/monitor/apr00/telehealth.html .
Reese, R. J., Conoley, C. W., & Brossart, D. F. (2002). Effectiveness of telephone counseling
*The PSYCHOGRAM is the newsletter of the Virginia Academy of Clinical Psychology (VACP). The authors are graduate students within the Virginia Consortium Program in Clinical Psychology (VCPCP), and the first author, Amber Walser, is the Student Representative to the VACP Executive Council and Assistant Editor of the PSYCHOGRAM. Reprinted with Consent.