TBHI is delighted to be launching a series of Q&A from our audiences. In this blog, then interspersed with our other news and features, we’ll post a question obtained from one of our Trainees. One such question will be drawn and answered regularly. While we can’t answer each question individually, we will try our very best to respond to all your queries. Send us your questions/enquiry/concerns by dropping an email here.
Online Therapy: If professionals are not trained to lookout for the various concerns that can come up there will be situations that will occur that can put a patient at risk in behavioral health situations. Many times these are subtle issues that practitioners with good intention, may not consider- or even be aware of, when seeing a client virtually.
The reality that I see is that many professionals don’t know what they don’t know about online therapy. Like the authors of the article we critiqued, they haven’t stopped long enough to consider the whole picture. They don’t know the legal/ethical moodles and why their assumptions are incorrect. (Their assumption is that digital service delivery is the same as in-person in most ways, and that’s good enough.)
This fallacy is much akin to ethnocentrism, whereby we may tend to see everyone as sharing our values, beliefs, traditions, but in fact, many cultural and language issues can make us experience the same event in quite different ways. It wasn’t until the voiceless were heard that the government actually imposed sanctions on discrimination, and required multi-cultural diversity training became not only popular. That “ignorance is bliss” stance is now happening with telehealth too. Luckily, we are seeing leadership in national and state associations take a stand, as well as state regulators because they are hearing of the many errors that are occurring, and clients/patients are filing more and more complaints. Many of them have appracohed us for training and consultation – which is a good sign, indeed.
In reality though, it all boils down to money. The fundamental questions create a tension: how much can I make, how much can I keep and how much do I have to pay in training and other required expenses for the privilege of earning my living this way?
Money tension is also at the core of the funding for an interim “educator” role that you mentioned. It of course is a good idea (and actually is required through informed consent) to educate your client/patient ahead of time about possible issues. The ways online therapy can go wrong are much more involved than many professionals imagine. But, who would possibly pay for such visionary education by a third party? If a company builds such a service, where will they get their return on their investment (ROI)? The truth is that clients/patients don’t usually want to pay more for a bit of pre-telebehavioral health education, Insurance companies are not looking for new services to reimburse, and clinicians don’t generally want to give a portion of their income to another party to educate their clients/patients. There are many needs, but payment only flows for the essential. In the United States today, we don’t even have enough payment to cover the essentials.
As you may have concluded, I have been thinking and discussing this topic with my colleagues for more than a decade. And so, I created a webinar to share the ideas with clinicians. If anyone wants to hear an hour recording of a webinar that outlines the client/patient education considerations in detail, we have a very good one available 24/7 at TBHI. It is entitled, 7 Tips for Introducing Telemental Health to Clients / Patients Let me know what you think!