Growing Your Practice With Technology
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?”
Content
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?”
Just as frequently, I encounter wellintentioned, 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.
For 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
(http://stp-apa.net) 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:
American Counseling Association’s Code of Ethics
(counseling.org/resources/codeofethics/TP/home/ct2.aspx)
American Telemedicine Association’s Evidence-Based Practice for Telemental Health
(americantelemed.org/practice/standards)
Practice Guidelines: Video-conferencing-Based Telemental Health
(umtrc.org/resources/technology/practice-guidelines-for-videoconferencing-based-telementalhealth/?back=Resources)
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:
http://telehealth.org/ethical-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, SpeechLanguage 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.
Original: 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?”
Just as frequently, I encounter wellintentioned, 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.
For 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
(http://stp-apa.net) 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:
American Counseling Association’s Code of Ethics
(counseling.org/resources/codeofethics/TP/home/ct2.aspx)
American Telemedicine Association’s Evidence-Based Practice for Telemental Health
(americantelemed.org/practice/standards)
Practice Guidelines: Video-conferencing-Based Telemental Health
(umtrc.org/resources/technology/practice-guidelines-for-videoconferencing-based-telementalhealth/?back=Resources)
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:
http://telehealth.org/ethical-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, SpeechLanguage 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.
Original: Growing Your Practice with Technology
