and counseling to
a wide range of
has shown that the
in psychotherapy via
is comparable to the
alliance found in in-person treatment.
There is also a
broad literature on
the effectiveness of
treating a wide range
of mental health issues
and concerns. It has
been shown to be
helpful in treating individuals, couples, families and groups for
issues such as anxiety disorders including generalized anxiety
disorder, post-traumatic stress disorder and panic disorder
(e.g., Germain, Marchand, Bouchard, Drouin, & Guay, 2009;
Spence, Holmes, March, & Lipp, 2006; Wims, Titov, Andrews,
& Choi, 2010); depression and grief (e.g., Dominick et al.,
2009; Ruwaard et al., 2008); and addictions (e.g., Mermelstein
& Turner, 2006; Riper et al., 2009); among others. Mental
health clinicians should familiarize themselves with this
extensive and rapidly expanding literature to ensure that
treatments offered have empirical support.
An important aspect of competence requires practitioners
to be able to determine which telemental health services and
treatment modalities may be appropriate for which clients.
Telemental health would be inappropriate, for example,
with clients with serious mental illness, including serious
depression, suicidality and impulse control difficulties, such
as violence and homicidality. Unfortunately, Dr. Vater is
welcoming all prospective clients into her telemental health
practice, regardless of their needs or circumstances. While
some clients may benefit from counseling services offered
via telephone or email, some will need videoconferencing
treatment, others will need in-person treatment and still
others may benefit from a combination of these services.
These decisions should be made after carefully screening each
potential client to determine the seriousness of a diagnosis,
whether or not the client is in crisis, the level of rapport, and
the client’s motivation for therapy. Screening should also
explore whether the client has a support system, whether the
client can find competent clinician services, and whether the
client has access to a secure and private space for participating
in the telemental health services.
The clinician should document the rationale for concluding
that a particular client is suitable for telemental health services.
Ideally, clinicians will also begin with cases that present the
best chance of success from receiving distance services, such as
clients who already have an established and positive treatment
relationship with the clinician or who are temporarily traveling.
Potential clients outside of one’s local area who, after careful
screening, are deemed to be best served by in-person treatment
should be referred to others.
Multicultural competence: Mental health clinicians who
provide services via the Internet may easily find themselves
violating professional expectations for multicultural
competence. For example, since Dr. Vater is accepting clients
from around the world, she will be interacting with people from
different cultural, ethnic and linguistic backgrounds. Failing to
give careful consideration to each client’s individual differences
may result in more harm than good.
When treating clients from around the world, it is not
realistic to expect them to all speak English fluently. Yet, the
ability to communicate effectively is essential for counseling to
be successful. Similarly, clients may come from a wide range of
cultural backgrounds. Even if there are no language barriers,
practitioners should possess the necessary multicultural
competence to ensure sensitivity to clients’ beliefs and practices
so these are not misinterpreted or violated.
Clinical competence and telemental health: It may be
tempting to accept new clients, regardless of their problems,
but of course clinicians should not provide assessments and
treatments via telemental health if they are not competent
to provide them in person. Mental health services must
While Dr. Ino Vater may have over 30
years of clinical experience and may use
certain technologies in her personal life,
her failure to take courses on telemental
health and her use of text-based therapy
as an alternative suggests that her
professional understanding of telemental
health may be limited.