These therapists may not have obtained the needed training to understand the difference between consumer grade videoconferencing systems meant for grandmothers and their grandchildren to connect on a Sunday, versus professional grade equipment meant for serious business and/or mental health care. In fact, there are three categories of videoconferencing equipment:

• consumer grade
• health grade
• military grade

The Problems with Consumer Grade Videoconferencing

If you have enjoyed the many conveniences of video contact with your therapist, but not been thrilled with the repeated quality of consumer grade, "free" videoconferencing platforms, you're not alone. Skype and Google talk are notorious for having the image degrade, also known as "tiling" where the image of the other person disintegrates (pixelates)  in front of your very eyes, or the image freezes and you end up looking at a still photo.

At the same time, a person's voice might start sounding robotic and eventually just drop out entirely. In fact the entire connection to drop out at any given time, whether you are in the middle of anxiously revealing the biggest secret of your life, or simply talking about the weather. The unpredictability of the connection belies lots of other problems having to do with these systems using an unsecured network.

Microsoft's Solution

Hope is around the corner. Microsoft, the new owner of Skype, has now issued a programmer's"toolkit" which will allow programmers to build more security and functionality into Skype. it gives programmers the tools they need to further develop Skype using the .NET software framework that works primarily on Microsoft Windows and provide important services such as security.

We can expect that will speed seeing many improvements over the current system. Once Microsoft gets behind an initiative, they made it happen! On many other fronts, we can see Microsoft's dedication to health care innovation, so we can expect no less in their further development of Skype.

What else is available today?

In case you're wondering what we can expect, whether it comes from Skype or other types of videoconferencing systems that are ramping up for healthcare, let me give you a peek. Even today, many of the more advanced systems offer features that are designed to facilitate the type of contact needed for mental health. For example, they may include a whiteboard, which allows you and your therapist to share screen and draw pictures, diagrams or other types of images that may help you express something more than is allowed by only words. Some of the more advanced systems allow you to share your desktop, videos that you may have on your desktop, or websites during the videoconferenced session — all without freezing the screen, or dropping the call. you can expect that if the call is dropped, there is an automatic button to click to resume the call without fussing around.

Many paid platforms have a live information technology professional available in case there's a problem. However, these more robust systems rarely drop calls, primarily because they're built with healthcare in mind.

Why don't professionals use these systems in the first place?

The sad truth is that some professionals have not gotten the professional training they need to know the difference between videoconferencing systems, and which might be most appropriate for professional healthcare. If your therapist is encouraging you to connect with them with any of the bare-bones, free but unreliable and unsecured systems, you may ask them to attend our next webinar on March 27, 2012, or purchase a continuing education unit ($27) and listen to it at their leisure.

Details of this webinar can be found here.

Meanwhile, please leave your thoughts below. I'd love to hear of your experience, whether it is with Skype or a health grade quality videoconferencing system used by your professional.

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Nearly half (46%) of American adults are smartphone owners as of February 2012, an increase of 11 percentage points over the 35% of Americans who owned a smartphone last May. Two in five adults (41%) own a cell phone that is not a smartphone, meaning that smartphone owners are now more prevalent within the overall population than owners of more basic mobile phones.

Nearly every major demographic group—men and women, younger and middle-aged adults, urban and rural residents, the wealthy and the less well-off—experienced a notable uptick in smartphone penetration over the last year. Overall adoption levels are at 60% or more within several cohorts, such as college graduates, 18-35 year olds and those with an annual household income of $75,000 or more.

What do APPS mean for you?

By using any one of thousands of currently available smartphone or other smart devices, it is likely that many basic functions of self-help already allow you to identify, track and change on your own, without seeking the help of a trained professional. You can for example, realize that you have a problem with anger, and look for smart phone or tablet PC applications or "apps" to work on it from the privacy of your own home. You can carry the device with you and track how your anger levels fluctuates throughout the day, with one person or another, in one place or another. Well-designed apps for anger management might help you access decades of science-based information to make better decisions about how and when you are better off saying something, keeping quiet, or going out for vigorous exercise to burn off your pent-up frustrations.

What do APPS mean for your therapist?

For professionals, the movement known as mHealth (mobile health) means a revolution in how they work. It means that professionals will need to re-train to learn more specialized skills, such as how to deliver therapy online, how to email or text you, and a host of other issues related to our rapid movement into an age of digitization and automation of everything from brushing our teeth to communicating with our loved ones. If your therapist hasn't yet been trained to work with you online, you may want to direct them to my professional training blog to better understand the wide variety of issues they may want to learn.

Apps will never replace the primary functions of well-trained therapists, but they can serve as very useful self-help tools and aids to your therapy. If you haven't yet looked at which ones might be useful for you, have a peek at this blog post and think about how you might help yourself with any one of these iPhone apps for consumers.

What do you think?

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Online therapy and online counseling fall under the specialty area of "telehealth." As more and more states re-write their laws to catch up with the rapid proliferation of technology, the more they are including provisions for consumer protection that require counselors, therapists, and other medical professionals to have specialized knowledge of how to work online. Two thirds (2/3) of the 50 U.S. states require that a professional have an in-person meeting with a consumer before rendering service through the Internet.

Before you sign up for clinical services from anyone who offers services online, whether or not you feel an emergency is about to occur, check out your own state website for the following information:

1. Is the therapist licensed in your state? (If not find another  professional if you can. The primary reason for licensing of professionals is consumer protection. If a professional offers to treat you online, go to your own state website and look up their license number. For example, if you live in California, go to the California website for the type of professional you seek: counselor or social worker; psychologist; psychiatrist.

2. Has the therapist completed a course of study to learn how to work online? Does their profile explicitly state that they have been trained in the form of treatment they offer you?

3. What else does your state website say about the laws your professional should be following? Do they have a statement for you to read as a consumer of online therapy, online counseling, or telehealth, telemedicine or online prescribing? Read whichever page applies to you and make sure you understand how your professional is operating within these regulations before you proceed.

Waiting until you are in the midst of a crisis is not a good self-care plan. Just as you would expect offline, you'll want to be sure your therapist knows how they are legally required to help you in your darkest hour, if that ever occurs.

That's my opinion. What do you think?

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Solution#1: How to File a Licensing Complaint

Consumer protection laws for health care of all kinds are developed by each state in the U.S. They are typically enforced by the state within which you reside. So if you live in Idaho and have a complaint against an Idaho clinician, you go to the Idaho state licensing board for that clinician.

Simply ask the state board governing the license held by your treating professional for the proper procedure. It will generally involve anywhere from 1-3 pages of paperwork and is relatively straightforward to complete.

Filing Complaints Out of State or Country
If you live outside Idaho, your options are more limited in that other states may or may not be willing to intercede on your behalf. Cross-state enforcement of the law, no matter how egregious the offense is very, very lax. In other words, don't hold your breath… You might still file a complaint with both your own state and the state of licensure of the clinician, but it will most likely to a few years for the licensing boards to work together to create new laws to protect consumers over state borders.

Currently, you are most likely to be treated like a "hot potato" with neither state wanting to bear the expense of handling your case for you. Working with someone out of your country of residence in effect, gives you no recourse at all if something goes wrong — unless you have millions of dollars and ample free time with which to pursue a legal case internationally.

Solution #2: File an Ethics Complaint
You also have recourse now by going to the professional association of the clinician who served you, and filing an ethics complaint if you thing your treating professional didn't act ethically. For example, psychiatrists generally belong to the American Psychiatric Association, and are therefore subject to ethical review upon consumer complaint. Other professionals in mental health might include psychologists who belong to the American Psychological Association; social workers who most often will belong to the National Association of Social Workers; and counselors who might belong to the American Counseling Association. Your own state might have their local association for each of these groups, and so might the city where you reside. You also might contact the state and local groups where the professional claims to be licensed if different from your own.

Your clinician may also belong to one or more specialty associations, each of which will have an ethics code they may have violated. Depending on your circumstance, you may want to file a complaint with as many groups as possible, both in your geographic location and that of the clinician.

Solution #3 Prevention is About Understanding Your Rights

Look Before You Leap: Check License Status
The obvious antidote to maximizing your protections is to study a professional's online profile very carefully prior to engaging their care, verifying their state of licensure, and making sure they are licensed in the state where you reside. That's where your rights as a consumer will be maximally protected. Also be sure to go to the state board's website where they claim to be registered, and make sure their license is in good standing.

No Verifiable License?
If a professionals' licensure isn't in good standing, or claim to be licensed but don't provide their license number for you to verify on the website where they are soliciting your business, be leery. It the law in most states for professionals to have licensure and carry the number for their license on all advertisements or promotions (including online profiles.)

What if a Professional Doesn't Claim to be Licensed?
Here again, it is helpful to remember that licensure is about consumer protection. If you choose to work with a professional who is unlicensed, you are choosing to work with someone who hasn't subjected themselves to an objective government body to prove that they have "minimal competence" as professional. They may not have chosen an area of specialty that has set minimal standards and had them codified for your protection.  Coaches presently fall in that category.  In that case, you may or may not be getting a competent professional. You may then have little or no recourse with a problem.

Consumer Lobbying
If you live in the U.S., you also have the right to lobby for change. This is where you as a consumer can lobby to your state legislators to help us make the needed changes to state licensing laws now – and not wait for innocent consumers to be caught in the middle. Send your state governor and other elected official a note asking them to improve "licensure portability."  You also can sign this petition to change the current circumstance by going here: FixLicensure.org which is a petition sponsored by the American Telemedicine Association. This organization is at the forefront of changing licensing law in the U.S.

As a mental health consumer, you have many, many legal and ethical rights. Consider them carefully before you bare your soul to someone online. What are your thoughts?

Dr. Marlene

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

1. Is it ok for me to ask my therapist to text me rather than call and leave messages? or have a Skype session with me online? or let me send them an email describing how I feel about a certain topic?

2. If my therapist agrees to work with me using some technology, what does that mean about their professionalism?

3. If my therapist doesn't agree, what does that mean about their professionalism?

4. What else should I know about using technology for psychotherapy or counseling?

5. Should my therapist get special training to do online therapy or online counseling with me?

You can expect that I have strong opinions, since I've been doing research, writing and lecturing on this topic for the past 17 years. You don't need to agree with me, but you might find what I have to say thought-provoking. I invite you to comment and discuss the issues with me, as many therapists do every day. I founded an Institute designed to help professionals learn how to work remotely, using a variety of technologies.

Regardless of my background with this topic, I sincerely look forward to learning from you. I hope you share your views with me.

What are your thoughts?

Dr. Marlene

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Here's how:

1. Your therapist needs to get secure technology. SKYPE is not yet secure, but if they pay a little money, they can get what's known as "HIPAA-compliant technology." If they have any questions about doing that, ask them to get the audio recording available at the bottom of this page about the risks associated with SKYPE.

2. They need to get approved to practice where you live. That's pretty easy. All they need to do is contact the licensing board for the discipline they practice "Psychology, psychiatry, counseling, social work) and ask permission. Most states and countries will grant it, but it has to be approved on a case-by-case basis. This is for YOUR protection, so don't short change yourself. Make sure they get it. I'm offering a webinar on this topic this coming Monday, July 11, for free. They can download it and listen to it later if they can't make the live call.

3. They need to get trained to meet ethical requirement for proficiency and competence in new areas of practice. Using technology is a big new area of practice. If they want training, it is available at the TeleMental Health Institute, which is the Institute I founded with colleagues.

Your insurance company may not like it, but in 11 states, the law says they need to pay for remote care. Ask them before you ask your therapist, just to be sure.

Gotta love technology!

What do you think?

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

It's easy. Check out their license.

1. First of all, make sure she  has a professional license. States require licensure of all professionals so as to protect your rights as a consumer. Bus drivers, undertakers, beauticians, and plumbers need to be licensed. Surely you want someone who is responsible for helping you with your emotional well being, or that of your loved one, to be licensed after proving their skills to an objective state licensing board.Besides, if they mess up, you'll want to be able to call someone, and that would be their licensing board.

2. Find out how much training they've had for doing online therapy or counseling. If they sidestep the question and try to dazzle you with the 10 years of experience they've had workign online or by telephone, be leery. Alcoholics have lots of experience with alcohol, but by state law, they need to prove they have had training in alcoholism treatment before they can deliver alcohol counseling. So you want someone who has had formal classroom training.

3. Go to your state board for their profession, and make sure they are either licensed in your state or registered with your state. If they are not, they most likely are practicing in your state without a license – which is probably a crime. Do you want to work with a lawbreaker? (If they are especially naive, they may not even know or remember that they need a license to work with you, wherever you are, online or offline. Call your state board and get the facts if you are in doubt.

Please post your questions or comments below!

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Fraud

When mis-billed, such practice is technically known as insurance fraud, and a serious crime for which your therapist will be held responsible.

Of course, nothing will happen if you don't get caught, much like speeding in your automobile. However, if you are complicit in fraud, and something goes wrong, you may be held responsible to some degree if you knew of the fraud. Make sure you know how your sessions are being billed to your insurance company, and double check to see if your therapist knows what they are doing both technically and with proper billing practices for the professional services they offer you.

Therapists can get a billing guide funded by the federal U.S. government by using the form in the upper right corner of this website: TeleMental Health Institute to get our newsletter. A free gift we give to professionals subscribing to the newsletter is an ebook called, "Telemedicine Reimbursement Handbook" and also available through CTEC.

What Else Can You Do?

Check with your insurance company. Just call them anonymously and ask if they pay for the specific type of technology your therapist is using, be it email, chat, video, telephone or anything else.

TIP:  if your insurance hasn't traditionally paid for telephone based services, they most likely won't pay for Skype or other non-HIPAA-compliant video services online, either.

The next step for you of course, is to send you insurance company a letter and voice your strong objection to their rejection of services that make access to mental health more possible for you. In fact, 12 states mandate paymentby insurance companies for telehealth. They just seem to be dragging their feet. Consumer complaints will make all the difference

Please post your questions or comments below!

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

.

Help comes in all shapes and sizes, as do people and their challenges. Similarly, online therapy, online counseling and web therapy are being practiced in many research-based and viable forms by responsible practitioners. The scientific literature supporting "telemental health" and "behavioral telehealth" is over 50 years old, and shows that benefits  often parallel in-person therapy.

Bad News

However, online therapy, online counseling, web therapy, Internet therapy and even Skype therapy are also being offered in random, unmeasured and undisciplined ways, from anonymous chat room sessions for $3.99 a minute to Skype sessions. (Anybody online can claim to be a therapist without actually being one — even your next-door neighbor using a false name.)

Worst yet, many therapists have jumped online without any training whatsoever, and now are offering "professional" services through email, chat rooms, text messaging and videoconferencing — without so much as an undergraduate course in what can go wrong, or how to make sure you are safe. That's like allowing them to drive without a driver's ed course or exam, and just hoping they won't hit anything.They might do just fine, until there's a problem with the road, or traffic, or in an emergency.

The professional mental health associations are working hard to help develop guidelines for therapists wanting to use technology, but they move slowly and simply are not there yet in many ways. Their second step will be professional training.  To see 5 questions Dr. Maheu recommends you ask your online professional, click here.

That's my opinion. What do you think?

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.

Having "psych" issues when in the military can quickly lead to being treated as unreliable on the battle field, and other forms of stigmatization. Many military personnel choose to never speak of their internal struggles, thereby rendering themselves more unreliable than if they sought help when they needed it. After all, witnessing the horrors of war is unnatural, and pretending it's business as usual is unnatural. Such deviations from human nature can lead to unpredictable performance and put an entire platoon at risk – but the machismo of the military won't allow such natural reactions to be fully voiced and de-briefed over time.

War veterans then, are often comfortable and at home with gaming-like environments such as Secondlife, and don't feel as threatened by them as they would if they had to go visit a "shrink." Virtual worlds are offering these people a new way of interacting with their medical and mental health practitioners in order to get the help they need as a viable member of their platoon.

And avatar-based therapy isn't just for war veterans. It is useful for anyone who needs relaxation, stress management, anxiety reduction, depression relief and many other types of useful self-help information. It's our job to deliver services in whichever format the consumer will use.

Stay tuned — virtual worlds have a lot to offer, and their therapeutic uses have only just begun to be realized.

That's my opinion. What do you think?

~

Marlene M. Maheu, Ph.D. is the Founder and Editor-in-Chief of the SelfhelpMagazine since 1994. She is also the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling or online therapy. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.