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Psychotherapy and Texting by Psychologists Marlene M

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Psychotherapy and Texting by Psychologists Marlene M FEATURE Psychotherapy and Texting by Psychologists Marlene M. Maheu, PhD and Laura Groshong, MSW Marlene M. Maheu, PhD Responsibilities of Psychologists ([email protected]) has been an industry leader in telebehavioral health Providing Text Therapy since 1994. With ve textbooks, dozens of Psychologists have a responsibility to be knowledgeable book chapters and journal articles to her about both the promise and peril of using digital tools in their name, as well as having educated more practices. Psychologists who choose to engage in providing than 25,000 clinicians, she has given more text therapy must be willing to consider factors such as the than 400 professional presentations and is following: a master at quickly and accurately answer- ing your questions with clear, actionable, “Text Therapy” as Compared to evidence-based suggestions. Psychotherapy Laura Groshong, MSW ([email protected]) is a licensed Psychotherapy is a collaborative treatment based on the clinical social worker in private practice in relationship between an individual and a psychologist. Seattle, WA. She serves as the Director of Grounded in dialogue, it provides a supportive environment Policy and Practice for the Clinical Social that allows you to talk openly with someone who’s objective, Work Association in Seattle, and is the neutral and nonjudgmental. You and your psychologist will author of Clinical Social Work Practice and work together to identify and change the thought and behav- Regulation: An Overview (2009). ior patterns that are keeping you from feeling your best. (APA, 2012). Psychotherapy (however delivered) is a continuous process t is common to see print ads and television commer- based on an established emotional relationship, an ongoing cials advertising the bene!ts of “text therapy.” Texts dialogue between two people in real time about complex is- are short missives, primarily used for social purposes, sues with deep emotional content. In contrast, texting is by that convey limited information. While much has been its nature short, often with a gap in the timing of communica- written about the negative impact of solo reliance on tions between client and therapist; it is not consistent with a this mode of communication (Turkle, 2012), texting is dialogue based on emotional meaning, as with psychotherapy. Ithe most commonly used method of communication among Such clari!cations are often found in the small print of User Americans younger than 50 (Statistic Brain Research Insti- Agreements offered by many online therapy platforms (plat- tute, 2017). The typical California psychologist has most likely forms and companies are used interchangeably) to emphasize considered text messaging to increase ef!ciencies. to patients that the services provided are not healthcare, or While it is likely that texting can play a useful role in some in this case, psychotherapy. However, the term “text therapy” behavioral health treatment, critics would say that texting’s continues to appear prominently in many text therapy web- role is unclear, that the literature on text messaging for be- sites and ads, potentially creating confusion for those seeking havioral care is weak, and that the little research that does psychotherapy as well as for unwitting therapists. exist is dif!cult to decipher. Critics may also point to the me- ticulous nature of other telehealth ef!cacy research into other Evidence Base for Clinical Care modalities, such as videoconferencing, where sample sizes are The use of texting is void of auditory and visual cues, and large. Godleski and colleagues (2012) had 98,609 subjects, for therefore changes the process of therapy. While the previous example, and there are other credible telebehavioral health statement may seem obvious to most clinicians who have been studies of videoconferencing ef!cacy reported by Luxton and trained to rely heavily on visual and auditory input for com- colleagues (2016). The California 12 Psychologist munication, the differences are not considered relevant by tex- ting proponents who claim that the evidence is in their favor FREE CE CREDIT when it comes to outcomes. The authors know of no studies that measure similarities or differences in therapeutic alliance CPA Members: Read this article and all articles marked CE when the primary means of communication is texting. In fact, with a ✹ on the table of contents to earn 3 CE credits. critics of text-messaging therapy would claim that therapists From www.cpapsych.org select the Free CE option using this modality may actually be dividing their focus with on the Continuing Education menu and follow the multiple patients in the same clinical hour, or treatment epi- directions . sode, thereby diminishing their ability to form a therapeutic alliance. How can this texting process equate to the in-depth, 1-1 focus required by traditional in-person and video-based psychotherapy? to be a key part of psychotherapy, “the frame” can be lost if Psychologists often use a biopsychosocial assessment model the client and therapist communicate at different times; if the prior to rendering a diagnosis. Are digital tools provided by therapist and client communicate with other people during a these platforms that allow for such assessment using stan- treatment episode; and if those episodes span four or !ve days dardized and evidenced-based protocols? Furthermore, ex- per week as they can in texting therapy. isting text-messaging related articles claim positive outcomes Furthermore, critics argue that text-messaging can not only using a variety of employer-related tests, including the PHQ-9 lead to distraction of the therapist, but also the client. Who and GAD-7 (Donker, et al., 2011). These reports, however, fail else is in the room with the client? Who might be in"uencing to mention whether the clinicians have had formal training in any one or more questions or responses? These and other is- such tests, their scoring or interpretation. Critics would also sues deserve further discussion across professional settings. point to the lack of graduate education and professional edu- cation focused on the administration of these tests through a Legal and Regulatory Considerations text-messaging platform (Callan, Maheu & Bucky, 2017). California professionals may question whether texting is Critics point to a similar lack of evidence demonstrating covered by telehealth laws. It may be of interest to note that that text-messaging provides the same exploration of emo- California’s Telehealth Advancement Act of 2011 de!nes tele- tional understanding after the assessment phase. Considered medicine (and telehealth) “to mean the practice of health care EMDR ¨#(#() THERAPY ¨#$§ ¨ 40 CE § *§ *§ ¨. Credits #§ $*+#() THE EMDR INSTITUTE, INC., founded by Dr. Francine Shapiro, offers trainings to licensed mental health professionals and graduate students EMDR Therapy Basic Training in their internship. EMDR therapy is recognized as an evidence-based treatment for trauma-related disorders by WHO, APA, ISTSS, DOD and others. SAN DIEGO Weekend 1 - September 20-22, 2019 EMDR THERAPY: More than 30 randomized studies Weekend 2 - March 20-22, 2020 support the efficacy of EMDR therapy in the treatment of a wide range of clinical complaints, including depression, anxiety, phobias, grief, somatic conditions, addictions and attachment disorder. IRVINE Weekend 1 - January 10-12, 2020 Weekend 2 - May 15-17, 2020 ABOUT THE TRAININGS: These experiential trainings consist of lectures, live and videotaped demonstrations, supervised practice by a highly skilled EMDR Institute trained facilitator, small group SAN FRANCISCO observation and feedback. Weekend 1 - February 7-9, 2020 For information about the history of EMDR therapy, Weekend 2 - May 29-31, 2020 Dr. Francine Shapiro, research, trainings, registration and more, contact us: EMDR.COM 831.761.1040 EMDR Institute, Inc. maintains responsibility for this program and its contents Approved by EMDR International Association (EMDRIA) and adheres to the ethical standards of these boards: APA, NBCC, RN, SW Fall 2019 13 delivery, diagnosis, consultation, treatment, transfer of medi- Additionally, licensed psychologists are responsible for as- cal data, and education using interactive audio, video, or data suring that the texting platform is HIPAA compliant. How is a communications.” (Telehealth Advancement Act of 2011). As clinician to know who might have access to the text messages a type of data communication then, text messaging for any stored on a texting platform? Obtaining a Business Associate health care purpose constitutes the delivery of healthcare via Agreement is essential. telehealth. Another factor is whether or not the platform’s employment Most states require a psychologist delivering care to be li- contract addresses issues such as diagnosis, interjurisdiction- censed in both the state where the psychologist is licensed and al licensing laws and dual relationships? Does the company’s the state where the client is located at the time of the contact promotional material make false claims? Does it help a patient (or in compliance with any temporary practice law). Critics understand the differences between in-person treatment and of online platforms for text messaging services would claim text therapy? Does it explain how they will be referred to in- that they hire licensed practitioners to deliver services in an person therapy when indicated? Does the platform limit the attempt to sidestep the law by using terms that confuse not clinician’s
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