Incorporating E-Therapy into Practice, Social Worker Perspectives

Access to mental health services locally, nationally, and globally is a challenge. E-therapy is an appealing avenue to offer services to underserved and stigmatized clients. While an interesting new therapy modality, numerous questions and concerns are raised in the literature regarding online therapy services. This study sought to answer the research question, what factors influenced a provider’s decision to provide online therapy? This qualitative study recruited clinical social workers providing E-therapy. Questions were designed to shed light on the development of a therapeutic connection, insurance coverage and reimbursement, technology glitches, and client inappropriateness for E-therapy treatment. Findings for this study highlighted E-therapy offering increased flexibility of services for clients and providers alike. Providers cited lowered costs by using free video services and no brick and mortar overhead. Insurance coverage is extremely limited and typically self-pay. Security was raised as an issue of concern and consent regarding the acknowledgement of current security deficiencies. A therapeutic connection can be established in this format, however providers did agree that severe and persistent mental illness diagnoses are not appropriate for an E-therapy treatment environment. Concerns regarding licensing for E-therapy services to limit service delivery to within a licensed state were raised. The inability to have a high-speed Internet connection is an issue keeping many underserved clients from this therapy format. Implications for practice include provider boundaries, E-therapy training, and technological expertise by providers. Policy considerations include state and national initiatives to increase high-speed Internet access