There have been many studies over the years investigating the efficacy of distance mental health treatment. At iCouch, we group these non in-person treatments under the generic terms online therapy and online counseling. While we can debate semantics, for the sake of clarity, we use those generic terms to refer to any form of behavioral health treatment delivered outside of a face-to-face context. We’ve been trumpeting online therapy effectiveness for years and the research has been rather convincing, however there are also a few problems with distance treatment that we must consider (and mitigate!)

Effectiveness of Online therapy

While practitioners are welcome to their own bias, it’s very important to the mental health profession that science be our guide. The behavioral health field has some problems with a distinct minority of practitioners who eschew science in favor of, let’s just say, an “artistic” approach to treatment. In the context of online counseling effectiveness, one notable 2013 paper concluded, based on a comprehensive review of the literature, that “Telemental health is effective and increases access to care.”

The investigators went on to note that there is a need for more research on specific service models, disorders and socio-economic issues relating to distance therapy modalities.

They suggested that effectiveness should be considered from the perspective of the patient, provider, program, community and society as a whole.

Problems with online counseling

While there are certainly areas for further research and we can’t say “online behavioral health treatment works” any more than we can say “CBT works.” It’s definitely contextual; it depends on the patient, provider and service model. However, the general consensus is that online counseling is effective, but I would add the caveat, assuming it’s delivered ethically and not in a haphazard way.

Some key problems with online therapy:

  • Inadequate technical aptitude
  • Weak procedural policies
  • Provider quality

Inadequate technical aptitude

This doesn’t necessarily refer to a provider or patient that isn’t “good with computers.” It encompasses more than that. For example, what are the data security and HIPAA/HITECH safeguards used by the practitioner? Are they using a videoconferencing or practice management vendor that provides a Business Associates Agreement? How secure is a therapist’s website and practice managment system? Is the practitioner using a consumer system such as Skype to deliver care? (Be sure to read our article about Skype and HIPAA if you haven’t already!) Does the provider practice good password discipline? Is the provider confident with the technology they chose to use?

Reputable mental health videoconferencing and practice management vendors should have a product that’s easy to use and makes it easy for the practitioner to gain technical aptitude within the context of online behavioral health treatment. However, no matter how good a system might be, it’s essential that the practitioner actually practice! Test out your system on friends and relatives. Use the system to connect with your parents, children or siblings. Your skills with the system should be well developed before you subject a patient to a video session! Also, the system should be so simple, that anyone to whom you send a video session invitation shouldn’t have to call you for help. If your friends and family struggle to use the system, so will the client and the quality of treatment will necessarily suffer.

Weak procedural polices

This is easy to remedy. This simply means that you have prepared for various contingencies. If you or your client’s internet connection fails, are you prepared with a telephone number as a backup? Does your informed consent clearly define the parameters of your engagement with the client? What happens in an emergency situation? Do you have emergency contact information for your client?

Provider quality

This is another issue with online counseling, but certainly not unique to online modalities! Licensed providers aren’t the issue. The issue is typically related to unlicensed “practitioners” who attempt to sell their services to unsuspecting consumers. The problem with these pseudo-therapists is that they erode public confidence in the mental health industry. When someone spouts “scientific” sounding jargon to a vulnerable person, it can be quite convincing — and dangerous!

There is actually a course that purports to help people become an “accredited Certified Crystal Healer.” They even have their own clever certification abbreviation “CCH.” Still there are others engaged in Thought Field Therapy and other nonsensical “systems” that dupe people with actual mental health issues into entering “treatment” that’s no more effective than a crystal ball is for predicting the future.

I want to make it clear that these “practitioners” are just as prevalent in person as they are online, but it’s important that reputable behavioral health practitioners disclose both their qualifications and licensure to potential patients. It’s also important that reputable practitioners maintain professional ethics regardless of treatment modality. By raising and maintaining the quality expectations of the general public towards online therapy, we can further expand people’s willingness to seek out care when they might not have done so otherwise.

Published by Brian Dear

Brian is the cofounder and CEO of iCouch, Inc. He has an extensive background in software engineering, inbound marketing and mental health practice management.

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