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Telesupervision in Psychotherapy and Counseling: Ethical, Legal, Technological, and Clinical Considerations

Course materials are available as articles and audio.

Fulfills requirement: Supervision

Telesupervision (also known as distance supervision, online supervision, e-supervision, and remote supervision) refers to the use of telecommunications technology to provide supervision and training. In our post-pandemic era, many supervisors and supervisees have recognized the benefits of telesupervision and consider it to be not only a viable alternative to traditional face-to-face supervision but also a complementary approach that can enhance training and professional development. Although there are many similarities in the standards for telesupervision and traditional in-person supervision, there are also several noteworthy additional considerations that mental health professionals must understand before incorporating telesupervision into their clinical practice.

This advanced introductory/intermediate course is designed to equip practitioners with the knowledge and skills necessary for effective telesupervision. It is comprised of three articles, available in written and audio formats. These articles review the relevant issues in ethics, professional standards, state and federal law, technology, and clinical work and emphasize the need to keep abreast of the latest information in this highly evolving field.

The first section of the course provides an overview of the history, modalities, benefits, and challenges of telesupervision and compares telesupervision with traditional in-person supervision. First, the course defines telesupervision and places it within the broader historical context of telemental health services. Next, the common modalities of telesupervision are introduced. After describing the benefits of telesupervision, the course identifies specific challenges of telesupervision and how each one can be addressed. The section concludes with a review of studies that compare telesupervision with traditional in-person supervision.

The second section explores the ethical and legal issues that mental health professionals must consider when conducting telesupervision. First, general topics in ethics include competence, confidentiality and privacy concerns, informed consent, dual relationships, and boundaries. Specific ethics codes and professional guidelines are presented for psychologists, counselors, marriage and family therapists, and social workers. Next, relevant state board regulations and federal laws and guidelines are described, using the State of California as an example. The section concludes with factors to consider when reconciling discrepancies in telesupervision guidelines and laws.

The third section discusses technological considerations and practical clinical skills needed for effective telesupervision. Technological considerations include choosing the right platform, gathering reliable technical infrastructure, maximizing device security, obtaining digital literacy and support, and making appropriate choices related to the environmental setting. Practical clinical skills for effective telesupervision are emphasized in the remainder of the course. These skills include communicating effectively, building rapport and trust, establishing a telesupervision agreement, structuring sessions, managing distractions and disengagement, addressing disinhibition, and fostering supervisee development and competence. Ways in which to improve cultural competence and accessibility are addressed as well. The section concludes with future directions in telesupervision, including artificial intelligence, machine learning, and virtual and augmented reality.

Educational Objectives

This course will teach the participant to

  • Explain the benefits and challenges of telesupervision and how these challenges can be addressed.
  • Describe basic ethical and legal considerations for telesupervison, such as competence, confidentiality and privacy, informed consent, and boundaries and dual relationships.
  • Discuss the common technological and clinical concerns related to telesupervision.

Syllabus

Overview of Telesupervision: History, Modalities, Benefits, and Challenges

  • What is telesupervision, and how has it evolved over time?
  • What are the common modalities of telesupervision?
  • What are the similarities and differences between telesupervision and traditional supervision?
  • What are the benefits of telesupervision?
  • What are the challenges of telesupervision, and how can each challenge be addressed?
  • How does telesupervision compare with traditional in-person supervision?

Ethical and Legal Considerations for Telesupervision

  • Ethical and professional considerations
    • General ethical considerations (nonmaleficence, competence, confidentiality and privacy, informed consent, and boundaries and dual relationships)
    • Specific professions’ ethics codes and guidelines
      • American Psychological Association (APA) Code of Ethics, Guidelines for Clinical Supervision in Health Service Psychology, and Guidelines for the Practice of Telepsychology
      • American Counseling Association (ACA) Code of Ethics
      • American Association of Marriage and Family Therapy (AAMFT) Code of Ethics
      • National Association of Social Workers (NASW) Code of Ethics and Technology in Social Work Practice
    • National Professional Regulatory Boards
      • Association of State and Provincial Psychology Boards (ASPPB) Supervision Guidelines
      • National Board for Certified Counselors (NBCC) Code of Ethics and Policy Regarding the Provision of Distance Professional Services
    • State Regulatory Boards, with California’s Board of Behavioral Sciences (BBS) as an example
  • Legal considerations
    • Federal laws
      • Health Insurance Portability and Accountability Act (HIPAA)
      • Health Information Technology for Economic and Clinical Health Act (HITECH)
    • State laws, with California’s Standards for Practice of Telehealth as an example
  • Reconciling discrepancies among telesupervision guidelines and laws

Technological and Clinical Considerations and Future Directions in Telesupervision

  • Technological considerations
    • Platform selection
    • Technical infrastructure
    • Device security
    • Digital literacy and support
    • Environmental considerations (e.g., lighting, acoustics, setting)
  • Clinical considerations with technology
    • Communicating effectively
    • Building rapport and trust
    • Establishing a written supervision agreement
    • Structuring sessions
    • Managing distractions and disengagement
    • Addressing disinhibition
    • Fostering supervisee development and competence
    • Providing culturally-competent supervision
    • Enhancing accessibility
  • Future directions for telesupervision
    • Artificial intelligence and machine learning
    • Virtual and augmented reality