Advantages of E-Therapy

Course excerpt from E-Therapy: Ethics & Best Practices

E-therapy benefitsE-therapy (a.k.a. distance therapy, telepsychology, telemental health, remote therapy, etc.) refers to the delivery of mental health services in which electronic equipment and therapeutic communication converge online. Typically the online services include emails, discussion lists, chats, or audiovisual conferencing. This kind of therapy is proliferating rapidly, and its applications have the potential to advance the field of mental health in a multitude of ways.

Research suggests that e-therapy may have similar or, in some cases, even better therapeutic benefits than face-to-face (F2F) therapy. Studies have also suggested that e-therapy for certain purposes can be very cost-effective because it can require minimal or no therapist involvement. However, (good news for all of us?) therapist involvement is still generally preferred.

In their article on home-based telemental health (HBTMH), Pruitt and Luxton (2014) state that “one of the principle benefits of HBTMH is its potential to improve treatment attendance and satisfaction, which can lead to more positive treatment outcomes. The benefits of reduced travel, less time off work, shorter appointment wait-times, and greater personal control are frequently cited as advantages of telehealth-based care over in-person care.”

Patients with Limited Mobility

The main advantage of e-therapy is that it can reach people who might not otherwise seek therapy, such as disabled people or those who live in remote areas; it also reduces the contact time between therapist and patient.

A Sense of Anonymity

It has been observed that online interactions can differ from in-person encounters in that the former imparts a sense of disconnect or anonymity. This phenomenon has been referred to as the “online disinhibition effect.” This is essentially the observation that while online, some people self-disclose or act out more frequently or intensely than they would in person. A positive aspect of this effect – in the context of remote online therapy – is that some individuals may be inclined to disclose information they might not be disposed to share in a traditional therapy session.

Bypassing the Stigma

According to Luxton et al. (2012), “Home-based TMH is a viable solution to provide improved access to quality mental healthcare for those unable or unwilling to seek traditional care because of mobility, geography, or concerns about stigma.”

Even in current times, when it is fairly commonplace for individuals to seek psychotherapy for life’s issues, there is still some residual stigma associated with psychotherapy – at least in the minds of some individuals. Particularly in small communities or certain occupational spheres like the armed services and police departments, it is not unusual for everyone to know everyone else’s business. This concern may play a role in the decision of some not to avail themselves of therapeutic resources, even when they are in need and even when such resources are otherwise available and affordable.

Where therapy offices and waiting rooms are visible to others, concerns about privacy can be a significant issue. In rural areas or small towns, or even in some areas of larger cities, it is not uncommon for patients to encounter people they know in clinical waiting rooms. Patients who forgo seeking treatment due to such privacy concerns may be willing to participate in care if it is provided in a private place such as their own home.

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E-Therapy: Ethics & Best PracticesE-Therapy: Ethics & Best Practices is a 3-hour online continuing education (CE) course that examines the advantages, risks, technical issues, legalities and ethics of providing therapy online. E-therapy can be used to address age-old problems, such as how to reach out to those who might not otherwise avail themselves of psychotherapy services even though they are in acute need. At the same time, it is clear that many providers have embraced the new technologies without a firm grasp on the new and serious vulnerabilities that are introduced when their patients’ personal health information goes online. Included in this course are sections on video therapy, email, text messaging, smart phone use, social media, cloud storage, Skype, and other telecommunications services. This course is focused upon the ethical principles that are called into play with the use of e-therapy. Among them the most obvious concern is for privacy and confidentiality. Yet these are not the only ethical principles that will be challenged by the increasing use of e-therapy. The others include interjurisdictional issues (crossing state lines), informed consent, competence and scope of practice, boundaries and multiple relationships, and record keeping. In addition to outlining potential ethical problems and HIPAA challenges, this course includes recommended resources and sets of specific guidelines and best practices that have been established and published by various professional organizations. Course #30-87 | 2016 | 52 pages | 20 posttest questions

This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

About the Author:

Leo Christie, PhD, LMFT, is a Florida-licensed Marriage and Family Therapist with a doctorate in Marriage and Family Therapy from Florida State University. Past President of the Florida Council on Family Relations, Dr. Christie is currently CEO of Professional Development Resources, a nonprofit corporation whose mission is to deliver continuing education credit courses to healthcare professionals throughout the United States. He has more than 20 years’ experience in private practice with a specialty in child behavior disorders and as an instructor for over 500 live continuing education seminars for healthcare professionals.

CE Information:

Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).


Growing your Practice with Technology

By Marlene M. Maheu, PhD, from Ethics & Risk Management: Expert Tips VII

Vague Standards, Guidelines, Laws Create Telepsychology Risks

As a psychologist who’s been researching/writing/practicing/consulting/training online for years, I’m often asked, “Where can psychologists get guidance and training for practicing online?”

Vague Standards, Guidelines, Laws Create Telepsychology RisksJust as frequently, I encounter well-intentioned, ethical colleagues who blithely undertake an online practice without considering their legal and ethical obligations or competencies. In hopes of helping readers avoid many potential landmines, I’ll outline how current guidelines, ethical standards and state regulations can be used to help you avoid trouble and reap long-term benefits of growing your practice with technology.

Professional Guidelines

A joint task force of representatives of the American Psychological Association, the American Psychological Association Insurance Trust and the Association of State and Provincial Psychology Boards has developed telepsychology guidelines.

Guidelines developed by other professional associations can be of benefit to psychologists, but state regulations and guidelines of licensure also must be taken into consideration.

Despite the proliferation of health care technology in the last two decades, including the Internet, many professional associations have struggled to allocate the needed resources to develop clear and timely practice standards or guidelines. Even when they have been clear, many fail to address the current range of technology used in behavioral practice.

Vague Standards, Guidelines, Laws Create Telepsychology RisksFor instance, they might refer to telecommunication technologies for direct care, but neglect the rapid expansion of services delivered as psycho-educational products online, text messaging, virtual reality, robotics, mobile health (mhealth) such as “apps” used with smart devices and other areas.

Some associations are making significant progress; others have barely begun. A number of psychologists are attempting to form a new APA division to address the growing areas that need to be expanded in the definition of psychology and grow the association with vibrant new ideas and enthusiasm.

See the many areas of focus addressed by the proposed Society for Technology and Psychology ( and consider how they are changing traditional in-person care. (Support this movement by signing the petition for inclusion in the APA.)

Even though technology may be outstripping the abilities of professional associations to “keep up,” associations have a responsibility to “catch up.” While many countries are far ahead of the U.S.-based professional associations in both the timeliness and scope of their standards, guidelines or statements of best practice, the following are available online for the psychologist looking for immediate guidance:

For a regularly updated list of currently published standards, guidelines and best practices in behavioral telehealth and telemental health, see Telemental Health Standards, Guidelines and Statements:

Keep Up On State Laws, Regulations

Despite the best research on recommended standards for the use of technology in psychology, practitioners must also carefully consider the strictures of state licensing regulations.

Licenses are awarded by states and therefore their scopes of practice are defined by the specific states(s) of licensure. Federal laws exempt military and federal government practitioners but otherwise state licensing laws define professional work. From one state to another, laws and regulations can differ substantially, be contradictory or outdated in terms of application to online practice. A number of states are working on updating regulations but they are moving forward in a hodgepodge and piecemeal manner rather than a unified plan. Potential penalties for violating licensing laws include fines, community service, public humiliation or suspension of licensure. In some states, certain laws can be considered “criminal offenses” and lead to the forfeiture of malpractice benefits. Examples include insurance fraud or treating a client in a state where the psychologist is not licensed.

Many psychologists fail to understand that being licensed in one state does not grant them the right to practice in another state or the repercussions of making such uninformed decisions. For example, Vermont and Utah carry $5,000 fines for practicing in their states without a license. Disengaging from treatment with remote clients after learning of such regulatory laws can also create thorny clinical dilemmas.

Role of Professional Associations

In addition to other benefits, professional associations can try to intervene to influence state law. They also typically develop and publish ethical standards and guidelines that not only require that a practitioner adhere to state and federal law but the association’s own rules. Ethical standards are the most stringent and are mandatory. They outline appropriate behavior and set the bar for membership.

For professional associations and practitioners alike, keeping abreast of technological demands is important because an existing set of standards, whether outdated or current, creates a standard of due care.

This Standard in Turn Helps Define Malpractice

Similarly, if professionals do not adhere to standards accepted by their national association, they may be responsible for malpractice in tort. Therefore, it is incumbent upon the elected and staff leaders of professional associations to allocate the needed resources to develop adequate standards and guidelines to protect practitioners in a timely manner. The penalty for failing to adhere to a set of standards is most often censorship or removal from the association.

Guidelines, on the other hand, are aspirational and therefore not required. They usually involve a distillation of the relevant literature and provide guidance in the form of suggestions. But, in many states aspirational guidelines by psychological association are incorporated by reference into licensing regulations and have a long history of being used by prosecutors to establish negligence on the part of practitioners.

Professionals, then, may want to be mindful of and carefully document any departure from both standards and guidelines issued by professional associations. If they don’t agree with standards or guidelines as promulgated by any professional association, they can work within the association to change them or leave the association.

The Challenge

Practitioners attempting to operate innovative technology-based programs within the bounds of vague or outdated ethical standards and guidelines are at risk of being at a distinct disadvantage before an equally vague or outdated licensing board or jury. Unclear standards, guidelines and regulatory law leave the innovative practitioner with many opportunities but not enough direction. Formal professional training is warranted to help forward-thinking psychologists access the strong evidence base that reflects reliable approaches to risk management.

Ethics and Risk Management: Expert Tips VII is a 3-hour online continuing education (CE/CEU) course that addresses a variety of ethics and risk management topics in psychotherapy practice in the form of 22 archived articles from The National Psychologist and is intended for psychotherapists of all specialties.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.