Telepsychology

Transcript

RyanA psychologist starts a video session at seven in the evening. Her client, who usually logs in from home, is smiling and squinting into the sun. She says, guess where I am? At my sister's place. Three states away.

SoheeAnd the psychologist's first thought shouldn't be, how nice. It should be, wait, where exactly are you, and am I allowed to treat you there? Welcome to EPPP Prep, the podcast. I'm Sohee.

RyanI'm Ryan. Today is telepsychology and technology-assisted services, two blueprint spots, with a side of comparative efficacy.

SoheeFirst, a definition. An article by Drum and Littleton calls telepsychology an umbrella term for using telecommunication technologies to provide psychological services. Telephone, email, text, videoconferencing, mobile applications, and web-based programs.

RyanAnd a review by McCord and colleagues in the Journal of Clinical Psychology quotes the American Psychological Association's definition from 2013: the provision of psychological services using telecommunication technologies.

SoheeThat 2013 date matters. That's when APA adopted the Guidelines for the Practice of Telepsychology. McCord's review says they were developed by a joint task force of the APA, the APA Insurance Trust, and the Association of State and Provincial Psychology Boards.

RyanThe guidelines are divided into eight parts. And one important feature: they're aspirational, not prescriptive. The review notes that could be a weakness, but also gives flexibility as practice evolves.

SoheeSo guidelines aren't the same as the Ethics Code. Guidelines recommend. The Code's Ethical Standards, in its own words, set forth enforceable rules for conduct as psychologists, and they apply to telepsychology too.

RyanAnd the Code speaks directly to this. Standard 4.02 on discussing the limits of confidentiality says psychologists who offer services, products, or information via electronic transmission inform clients of the risks to privacy and limits of confidentiality.

SoheeMcCord and colleagues reviewed five sets of telepsychology guidelines, from the APA, the Australian Psychological Society, the Ontario Psychological Association, the New Zealand Psychologists Board, and the Ohio Psychological Association. They consolidated them into nine practice domains. Let's walk through the ones most likely to show up in a vignette.

RyanVerification of identity and location. Psychologists should be able to verify the client's identity, and let clients verify the psychologist's identity and credentials. Over phone or internet, make sure you're speaking with the intended person. Pre-arranged security questions can help.

SoheeJurisdiction and licensure. This is our hook. The review says you must ensure services are only provided within legal geographic borders in which you are fully licensed. So client location must be verified, even when the client may be out of state or out of the country.

RyanAnd the review adds mandatory reporting. You need to know the relevant local laws about who must report and what.

SoheePause and think. Back to our client at her sister's house three states away. What should the psychologist do?

RyanConfirm her location, and determine whether the psychologist can legally provide services there before proceeding. If not, pause the clinical work and plan accordingly, while making sure she knows how to get help locally if needed. The tempting wrong answer is continue as usual because the psychologist is licensed where she sits. The review says the client's location must be verified for exactly this reason.

SoheeInformed consent. The review says the special consideration for telepractice is informing clients of the possible risks, benefits, and alternatives to telepsychology, in language a lay person understands. And setting expectations about attendance, communication policies, and boundaries.

RyanPrivacy and confidentiality. Psychologists should create policies for security issues, including encryption, transmission, storage, and disposal, and follow federal rules such as the federal health privacy law, HIPAA, and the Health Information Technology for Economic and Clinical Health Act. When necessary, they consult technology experts.

SoheeEmergency planning. Providers should have protocols for emergencies, know local resources, and be able to connect clients to local emergency or in-person services. The review also recommends an emergency contact on file.

RyanAnd safety planning with at-risk clients, making sure they get a copy promptly. Being clear about the provider's limits, like time of day and distance, and making sure the client knows local twenty-four-hour resources. The review says to have that discussion early in treatment.

SoheePause and think. Midway through a video session, a client says she has been thinking about ending her life, and then the connection drops. What should already be in place?

RyanAn emergency plan set up at the start: her verified location, an emergency contact on file, knowledge of local emergency resources, and a backup plan in case the equipment fails. The tempting wrong answer is wait to see if she logs back in. The guidelines ask for planning before the crisis, not during it.

SoheeBefore any of that, there's a threshold question: is telepsychology right for this client? The review says the basics of quality care still apply, since telepsychology isn't fundamentally different from in-person care in many ways. But client appropriateness has to be assessed, and ethical practice includes alternative referral plans so people can receive care elsewhere if needed.

RyanSo appropriateness comes first. And once care is underway, testing needs its own caution.

SoheeThe review notes many traditional psychological assessments are designed for in-person administration only. If technology is used for assessment, psychologists should know the limitations and standardization procedures, because some tests may not be appropriate for online administration.

RyanAnd boundaries. Drum and Littleton point out that boundary issues in telepsychology are likely to present in novel ways, and that clients and clinicians may not have a clear expectation of what boundaries look like in non-traditional settings.

SoheeNow technology without a live therapist. The National Institute of Mental Health, NIMH, lists advantages of mental health apps: convenience, anonymity, a first step into care, lower cost, outreach to remote areas, around-the-clock support, and consistency.

RyanAnd the concerns: effectiveness, whether it works for everyone it's meant to help, privacy, guidance, regulation, and overselling. NIMH says there is very little industry regulation and very little information on app effectiveness.

SoheeAnd it says most apps don't have peer-reviewed research to support their claims, and there are no national standards for evaluating them.

RyanBut a helpful line for comparative questions. NIMH says that if you can't find research on a particular app, check whether it's based on a tested treatment. For example, research has shown internet-based cognitive behavior therapy is as effective as conventional CBT for disorders including depression, anxiety, social anxiety disorder, and panic disorder.

SoheeNow the big efficacy question. Is video therapy as good as being in the room?

RyanA 2026 meta-analysis by Meyer-Keirath and colleagues in the Journal of Medical Internet Research used strict criteria. Randomized trials, adults, synchronous video therapy versus face-to-face, with a minimum treatment dose. Twelve trials met criteria.

SoheeAcross forty-one effect sizes, they found no significant differences in symptom reduction between video and face-to-face therapy. Hedges g of negative 0.09.

RyanAnd the qualifiers. Heterogeneity between studies was substantial. The evidence base was limited, mostly Western settings, mostly post-traumatic stress disorder, and mostly cognitive behavioral treatments. And few non-inferiority trials reduced the certainty of the evidence.

SoheeTheir conclusion: the results support offering video therapy as a pragmatic option to extend access to care. And they call for adequately powered non-inferiority trials across diverse diagnoses and cultures.

RyanSo the exam-safe phrasing: in this meta-analysis, video and in-person therapy showed no significant difference in symptom reduction, with limited certainty. Not video is proven equal for everyone.

SoheeAnd one note on supervision, since it's coming in our final episode. A paper on training clinicians in competency-based supervision cites Inman and colleagues, who found supervisees rated online supervision as effective as face-to-face supervision.

RyanNIMH also reminds us why all this matters. The telephone, the internet, and mobile devices create opportunities for accessible treatment, including where mental health professionals may not be physically available.

SoheeRecap. Telepsychology: providing psychological services through telecommunication technologies. APA's 2013 guidelines have eight parts and are aspirational.

RyanEthics Code Standard 4.02: if you provide services electronically, inform clients of the risks to privacy and the limits of confidentiality.

SoheeCore domains: verify identity and location; practice only where you're licensed for the client's location; telehealth-specific informed consent; security through encryption and safe storage and disposal; emergency and safety plans in place early; care with assessment validity; and attention to boundaries.

RyanApps: real advantages, little regulation, most without peer-reviewed support. Internet CBT has been shown as effective as conventional CBT for several disorders. Video versus face-to-face showed no significant difference, with limited certainty.

SoheeAnd for you, studying: online practice and video study groups count. The evidence says learning and healing can both happen through a screen. Make the setting work for you.

RyanThanks for listening to EPPP Prep.

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