Teletherapy is the Future Norm


Teletherapy will be part of normal practice for psychologists in a decade, predicts leading online therapy educator Marlene Maheu, PhD.

Psychologists must embrace the change or be left behind, warns Sherry Benton, PhD, ABPP, founder of the teletherapy company TAO Connect.

“We in the behavioral world are the last holdouts for technological change in health care,” said Maheu, executive director and founder of the Telebehavioral Health Institute. “Technology is evolving, and I firmly believe we will be connecting with one another in many new ways in the future.” Maheu oversees telebehavioral health training at the institute and has been involved with teletherapy as a clinical psychologist herself since 1994.

Benton, a psychologist and former director of a large university mental health clinic, became convinced a few years ago that adding teletherapy to psychology practices could help millions of people living in areas underserved by mental health specialists. After testing the concept with college students in 2014, she launched TAO Connect to provide teletherapy to college and university counseling centers.

Both Maheu and Benton believe that psychologists who want to provide counseling via video conferencing, email or telephone need to educate themselves first about the practice. Maheu’s institute offers classes, as do the American Psychological Association and other organizations and companies.

“It’s critical to get training,” Benton said. “There are so many things you might not think about.”

That includes having a license to practice in the state where the patient is, having a crisis management plan for online patients, knowing how to keep consultations with a patient private and knowing how to rewrite consent-to-treat forms for patients you may never see in person, she said.

Equally important, Maheu said, is figuring out what population you want to serve online and identifying a way to get paid for your online work. If you work with at-risk youth and want to serve that community online, figure out what agency might pay you for the online work. Or if you want to work online with senior citizens in nursing homes, there are online employers who will hire you to do that, she said.

Similarly, if you are in private practice and want to add online work, health insurance could be your payer, she said. “This is not about reinventing yourself, but doing what you’re already good at with technology,” Maheu said.

Numerous online therapy companies have popped up in recent years, including TalkSpace, BreakThrough, BetterHelp, and iCouch, and many enlist a variety of therapists, including psychologists, to work full or part time as outside contractors.

Each company is different and any psychologist who wants to associate with one should investigate the firm carefully, Benton said. “You want to look at how they work, what your reimbursement rate is, what’s expected of you – basically what’s their deal and does it fit with the way you want to work,” she said.

TalkSpace is one of the largest and mainly provides counseling sessions through texting. BreakThrough and BetterHelp both offer videoconferencing with therapists and BetterHelp also offers messaging, live messaging chats and telephone sessions with therapists.

iCouch, while it offers therapist referrals, concentrates on providing services for therapists who want to practice online. Those include videoconferencing, therapy marketing, scheduling and billing services.

Benton’s company is similar, offering private practitioners a suite of tools they can use for their own online services. They include HIPPA-compliant video conferencing, education modules for patients, administrative tools and secure messaging.

“We just license our materials; we don’t actually hire psychologists,” Benton said. “But our tools allow psychologists to help more patients and to help their income.”

Psychologists can offer patients shorter therapy sessions, such as 20 minutes, and augment that with patient education sessions from TAO, she said. “Even after a psychologist pays for TAO they really can increase their income,” she said.

One of the newest entries into the market is LARKR, a video therapy app that launched in October through the Apple App Store. LARKR links therapists with patients for 50-minute sessions on mobile devices. The site, at, is seeking 10,000 certified mental health therapists to join its ranks, according to its press information.

Plenty of information is available online for psychologists who are considering trying online therapy.

iCouch has several blogs that suggest ways to get started: (Add “online therapy available” to your business cards and website; ask current clients if they’d be interested in trying a session online; try online therapy several times so you become comfortable with the technology).

The APA has a 19-page Guidelines for the Practice of Telepsychology on its website that encourages psychologists to get specific training and includes information about confidentiality, informed consent and interjurisdictional practice.

This article is included in the online continuing education course Therapy Tidbits – March/April 2018. Click here to learn more.

Related Online Continuing Education Courses:

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

Ethics and Social MediaEthics and Social Media is a 2-hour online continuing education (CE) course that examines the use of Social Networking Services (SNS) on both our personal and professional lives. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on SNS like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication? The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2016 | 32 pages | 15 posttest questions

Preventing Medical Errors in Behavioral HealthPreventing Medical Errors in Behavioral Health is a 2-hour online continuing education (CE) course that examines the ways in which clients can be harmed in mental health practice, and the many strategies for anticipating and avoiding such undesirable outcomes. This course is intended to increase clinicians’ awareness of the many types of errors that can occur within mental health practice, how such errors damage clients, and numerous ways they can be prevented. Its emphasis is on areas within mental health practice that carry the potential for “medical” errors. Examples include improper diagnosis; breaches of privacy and confidentiality; mandatory reporting requirements; managing dangerous clients; boundary violations and sexual misconduct; the informed consent process; and clinical and cultural competency. There are major new sections on psychotherapy in the digital age, including the use of social networking systems, the challenges of maintaining and transmitting electronic records, and engaging in the practice of teletherapy. *This course satisfies the medical errors requirement for license renewal of Florida mental health professionals. Course #21-18 | 2018 | 38 pages | 15 posttest questions

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor 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 Alabama State Board of Occupational Therapy; 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 and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Target Audience: PsychologistsCounselorsSocial WorkersMarriage & Family Therapist (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs)School Psychologists, and Teachers

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