clinical and therapeutic competences specific to the online setting. The therapist would require knowledge of ethical approaches and guidelines, as well as specific legal requirements and policies. 2. In general, therapeutic skills for in-person contact do not automatically translate into online therapeutic skills. Communication Issues 1. Among negative issues, one of the most widely discussed is the absence of non-verbal cues in the therapeutic interaction, especially when using text-based media but also when using telephone or videoconferencing, which may lead to misunderstandings and miscommunication. 2. If a therapist were to miss some important item of clinical information, the whole diagnostic process and psychological assessment could be impaired. 3. The use of e-mail in this context can undermine the conversation in terms of time lag and lack of spontaneity, and it may prove difficult to express empathy, warmth, and feelings. Research Gaps Some authors claim there is insufficient research to support online psychotherapy or that there are too many knowledge gaps, especially regarding effectiveness, efficacy, and long- term outcomes compared to in-person treatment. Emergency Issues 1. Questions arise as to whether an emergency or crisis involving threat or harm to self or others can be detected and addressed where patient and therapist are at different locations. Ethical issues regarding emergency or crisis situations include verification of patient identity and location, technological difficulties, and cross border practice jurisdiction. Discussion Ten brief descriptions of arguments for and against were presented here, but the study included many more that should be reviewed in the complete study results. Some concepts were argued as both benefits and risks depending upon the provider’s perspective on the issue. There are extensive standards and guidelines included for reference in this course, and numerous research exists for further study. The counselor will need to weigh the risks and benefits based on their competency to use technology, facility preparedness, organizational support, compatibility with counseling style, effectiveness, and reliability in addition to client suitability and other indicators relevant to their specific practice or specialty. The most important indicators involve whether technology assisted counseling will be beneficial to the client based on their needs, preferences, values, desired outcomes, and any risks to their care. This is the perfect scenario to apply a decision-making model to evaluate the client, environment, setting, and media platforms to determine the suitability of technology before adopting these methods of practice. The following are some questions to answer that might help clarify the decision on technology -assisted practice: ● Which clients might benefit the most from a technology approach and why? Which clients would not be suitable for technology-assisted counseling methods and why?
Technological Competence 1. A therapist’s lack of technological competence, patient/ client and therapist awareness of their respective skills are important issues in this context, as discomfort or fear of using technology is common. Legal Issues 1. Unresolved jurisdiction and few or no specific laws governing licensing, certification, training, education, informed consent, and cross-border practice are problematic issues for online psychotherapy. Practicing Across Borders 1. Many issues arise in relation to online psychotherapy conducted across state or national borders, including legislative, licensing, and cultural differences. 2. It may be unclear whether the therapy take place at the client’s or the therapist’s location, raising such questions on which jurisdiction is responsible when a problem arises, or which regulates professional practice in the event of a violation. Therapeutic Relationship Issues 1. Many authors have questioned whether an effective therapeutic alliance can be developed solely through technology and whether the benefits of the therapeutic relationship might disappear or diminish in online psychotherapy. 2. Other issues raised in this include absence of non-verbal cues and lack of intimacy. Patient Characteristics 1. Online psychotherapy may not be suitable for all clients, clinical conditions, psychiatric disorders, and problems; it may sometimes be contraindicated, especially in the case of severe mental disorder, or for clients who are highly dysfunctional and/or pose a threat to themselves or others. 2. A patient’s inability, diminished competence, or discomfort when using technology might be a barrier. ● Would technology-assisted practice be effective as a stand-alone methodology for some clients, and what criteria would be important when making that decision? ● What clients might benefit most from traditional methods or when might a flexible approach using both traditional and technological methods be indicated? As technology-based counseling is rapidly expanding and becoming more preferred by some clients, the counselor will need to decide whether to include these methods in practice. It is their responsibility to ensure they can implement technology programs while maintaining the highest quality of professional practice. This involves following state and federal legal and ethical regulations and practice within the framework of professional values, principles, and standards. A review of responses on the use of technology-assisted counseling showed almost equal numbers of provider acceptance and rejection of the method. The information from the study presents many points for consideration when a counselor is deciding whether to adopt telemental health methods. The arguments on both sides include responses that correlate with Texas legal regulations and association codes for ethical practice to ensure confidentiality and informed consent, avoid fraudulent or misleading statements, and maintain appropriate boundaries with clients.
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Book Code: PCTX1325
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