This article has also be published in the Georgia Society for Clinical Social Work Clinical Page Spring 2014 Issue.
Technology has revolutionized most fields in the last few decades. However, much of the mental health field remains unchanged. Administratively, most therapists include at least some emailing or telephone use. Perhaps a phone session with an established client when they are traveling, or an email regarding scheduling. But the available technology today offers so much untapped potential. Technology, like any powerful tool in therapy, is both helpful and ethical if used properly. When the topic of technology comes up in conversation, many therapists understandably become skeptical or uncomfortable. Some therapists immediately label technology outside the boundaries of true psychotherapy. Afterall, so much technology is new and unfamiliar, and we tend to fear what we do not understand. I can recall that most of my graduate professors rarely described the use of phone or email without the standard cautionary tale of a boundary crossing or therapeutic failure. It is certainly true that without proper training or supervision, no one can ethically practice outside their scope of competency. However, the benefit of technology is to great for us to continue ignoring. Clinical social workers are the best candidates in the mental health field to lead the way in the use of technology in psychotherapy, and there are several reasons I would like to encourage you to consider joining me in this endeavor.
First, we should consider using more technology because it helps clients. There is ample research supporting that online, video therapy is as effect as face-to-face*. For some clients, online therapy is even more effective than face-to-face. For example, one of my clients struggled with shame related to entering therapy, despite considering therapy for years. With the prospect of online video therapy, this person reported feeling less shame and more hopeful than she had towards the prospect of in-person therapy. Also being able to request a first session online through my website made the process less daunting. Having read all about my practice on my website, she was much more comfortable by our initial phone conversation. Eventually, this client transitioned towards in-person therapy sessions as the feelings of shame and anxiety lessened.
Second, the use of technology is practical and meets the needs of our clients by reducing real, logistical barriers to treatment. I have learned that busy schedules, physical limitation, transportation, travel, or distance does not change the fact that many of our clients still want therapy each week. Some theories suggest a client is "resistant" to therapy or lacks motivation when they cancel or fail to reschedule a therapy session. However, more often than not, these clients are just dealing with the normal logistical barriers we all face in life. For example, the far majority of my clients kept their appointments during the famous "Snowpocalypse" snow storms this winter by changing their in-person sessions to video sessions, thus avoiding unnecessary cancellations or disruption in treatment. Another example is a couple with a young child and limited support system. They would prefer in-person sessions, but simply cannot make that work most weeks. They are grateful that they can still "see" me for therapy using online video sessions in the evening when their child has fallen asleep.
Furthermore, change is inevitable. All signs point towards technology in our future, regardless of our personal views. We now have a chance to embrace new technology and actively participate in evolving our field. In terms of financial cost-saving and private practice survival, I predict that technology will become essential. Although most technology-assisted therapy such as online video sessions are not yet reimbursable by most payment providers, it is only a matter of time before more insurance companies and EAP systems incorporate new technologies into their preferred practices as the supporting research and demand for it grows. One new online software, "Therapy Appointment," allows therapists to immediately submit electronic billing directly to insurance companies, and also provides online scheduling, electronic records, and a platform for video sessions. A colleague of mine recently compared the billing feature to "Oz...it feels too good to be true, but it's real!" Not everyone will embrace these new technologies, or the requirements if it becomes a standard of care. When healthcare law changed and physicians were required to move towards an electronic medical record system, one of my family friends, an older physician, decided he preferred to simply retire than transition to the new system.
Most importantly, social work values and education place us at an advantage for the use of technology in mental health. We believe in reducing barriers to treatment, and increasing accessibility to treatment. Historically, we have not balked at the idea of entering a client's home when it has been therapeutic, such as with hospice, child welfare, or family preservation work. One of our greatest strengths is our multicultural training, and the online world is yet another culture to appreciate and learn about--not to fear. If we truly value "meeting the client where the client is", what if that means online? From our office to their dorm room, home, or office?
Furthermore, the decision to incorporate technology into a private practice or agency setting is a long process. When I began my private practice, I decided to provide in-person, phone, and video sessions. There are other technology assisted delivery models such as emailing, chat, and avatars, but I felt that phone and video was a better fit for my practice. I knew that I needed to increase my competency in this delivery model in order to be effective and ethical, so I completed the "Distance Credentialed Counselor Training Program" through Ready & Motivated Minds, L.L.C., at Ridgeview Institute. To stay updated, I continue supervision and consultation, education through workshops and professional journals.
One of the primary concerns about technology is privacy. Of important note is that Skype is not secure, nor HIPAA-compliant. Nor are standard cell phones. Ethically, we should all be concerned about client privacy and this is a valid concern when considering new platforms, such as electronic storage of sensitive medical records, or the transmission of video sessions. Understandably, many clinicians are concerned about technology and privacy issues. Traditional in-person sessions or paper storage of records may appear safer. I respectfully disagree. Fires happen. Some offices, even with sound machines, have thin doorframes adjacent to waiting rooms. Someone can more easily stand next to a therapist's door and hear a session than access an encrypted video session. Someone can more easily break into your office using a sledgehammer than they can hack into a HIPAA-compliant, double encrypted web portal to access digital records. How you feel about technology greatly depends on your familiarity with it.
For my private practice, I chose to use a secure, online practice management service, Counsol, which is encrypted and HIPAA-compliant; it safely stores electronic records, and provides a two-way encrypted platform for video sessions. My clients log on to the system with their own username and password to complete initial paperwork and assessments, payment, and scheduling. Nowadays, most of us are already doing this with our insurance companies and general care practitioners by logging onto their websites, scheduling, sending secure messages, and viewing test results. Nearly all of my clients, ranging from age 14 to 70, have easily navigated the system and have very positive feedback. I love it, too, but not just because it helps them. It eliminates the unnecessary telephone exchanges, and all of my clients pay for their sessions immediately online. I use a different software, MyOutcomes, to briefly measure the progress of my clients and collect feedback about our therapeutic relationships. For in-person sessions, I simply hand my client my Ipad at the beginning and end of each session, and this takes about one minute total. The information is invaluable in tracking whether or not I am actually helping my clients, and it also gives us a built-in space to discuss treatment goals and progress. Lastly, I use an encrypted fax machine to securely deliver and receive faxes electronically, so that my clients' information will never be sitting at an unattended fax.
Finally, if you are interested in learning how you can integrate the use of technology into your clinical work, please feel free to contact me for a consultation. As social workers, we are in the prime position to begin using technologies to help our clients, as well as our agencies and private practices. There is ample training for this specialization, and with increased competency, we can practice ethically and lead mental health into the future.
* Helpful Articles Regarding Technology and Mental Health:
ABOUT: Stephanie Cook, LCSW, provides in-person and online counseling services to adults, teens, couples, and families; she specializes in working with young adults and couples on improving themselves and their relationships. Stephanie owns a small private practice, Counseling ATL, LLC, located in Decatur, an intown-suburb of Atlanta, GA, near Emory University. Her blog is dedicated to helping people improve their lives and relationships.