Rachel fostered the creation of Motivo in 2017 to create an easier path to licensure for therapists through the responsible use of technology.
Angela McDonald, PhD, is dean of the School of Health Studies and Education and a professor in the Department of Educational Leadership at Saint Joseph’s University in Philadelphia, Pennsylvania. She earned her doctorate in counselor education at the College of William and Mary in 2006. She has been a licensed counselor in North Carolina for 13 years, working in a variety of settings, and she has been published in several journals, including the Journal of Counseling & Development. She is also the past president of the American Association of State Counseling Boards and the past chair of the North Carolina Board of Licensed Professional Counselors. She is a national certified counselor.
Jeffrey Parsons, PhD, is a professor of counseling at Lindsey Wilson College and serves as the director of the Counselor Education and Supervision program. He is a licensed professional clinical counselor in the state of Kentucky. Prior to serving in his current role, Jeff served 7 years as director of program evaluation and technology for the School of Professional Counseling and 3 years as director of teaching and technology effectiveness for the Office of Academic Affairs. He recently completed a term as a board member (including 2 years as chair) for the Council for Accreditation of Counseling and Related Educational Programs.
Harrison Tyner is a social impact entrepreneur, technology innovator, and startup adviser to numerous early-stage tech companies. As founder and chief executive officer of WeCounsel Solutions, Harrison launched the first cloud-based software platform for behavioral health, which has facilitated more than 1 million virtual sessions to date. With expertise in telemedicine, health care, and software as a service, Harrison regularly collaborates with other startup founders to develop innovative solutions that make a positive impact on the community.
Appendix Authors
Kenda Dalrymple, JD, is an attorney and the managing partner of Dalrymple, Shellhorse, Ellis & Diamond, LLP, in Austin, Texas. She earned her undergraduate degree in communications from Baylor University and her Juris Doctor degree from Baylor University Law School. For the past 26 years, she has represented hundreds of professionals before their licensing boards on complaint and license-related cases. She also presents frequently on ethics, risk management, confidentiality of records, Health Insurance Portability and Accountability Act of 1996 and Health Information Technology for Economic and Clinical Health Act regulations, and other matters related to administrative law and mental health. Although she excels at helping professionals when a problem has arisen in their practices, she much prefers to educate and train them to recognize common pitfalls and avoid trouble, if possible. She is past president of the Austin Bar Association’s Administrative Law Section and the Kappa Alpha Theta Austin Alumnae Association and a past course director for the State Board of Texas Advanced Administrative Law Seminar, an annual 2-day continuing legal education seminar. For the past 10 years, she has been a member of the American Psychological Association (APA) Board of Directors’ Standing Hearing Panel, which hears and decides ethics cases brought by the APA.
Amber Hord-Helme, MA, LPCC-S, NCC, has been a licensed counselor for more than 15 years. She has owned her own private group practice in Versailles, Kentucky, for the past 10 years. She is currently a doctoral candidate in the Counselor Education and Supervision program at Lindsey Wilson College in Columbia, Kentucky. She has been an adjunct instructor for Lindsey Wilson College since 2017 and has supervised interns and provisionally licensed postgraduate practitioners since 2012. She is a former secretary of the Kentucky Mental Health Counseling Association and is currently president of the Kentucky Association for Assessment and Research in Counseling. Her current areas of research include counseling for clients with dyslexia, implementing telehealth counseling in private practice, and developing professional counselor identity in early professionals.
Chapter 1
Ethical, Legal, and Risk Management Considerations: Understanding the Landscape of Telebehavioral Health and Supervision
Jennifer Nivin Williamson and Daniel G. Williamson
The ACA Code of Ethics (American Counseling Association [ACA], 2014) declares the following in the introduction to Section H:
Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. (p. 17)
This section on distance counseling, technology, and social media was among major revisions to the ethical standards and identifies technology as a part of the profession. Counselors have an ethical obligation to understand how new technologies might be used to serve clients and to use them responsibly. The introduction to Section H goes on to caution counselors to recognize the concerns with using these technologies, especially in terms of protecting confidentiality, and to recognize the ethical and legal requirements needed to implement these resources appropriately (ACA, 2014). The primary goal of integrating technology into counseling practice is to enhance human interaction (Association for Counselor Education and Supervision Technology Interest Network, 2007). As counselors engage in technology-assisted mental health services, it is imperative that they consider ethical, legal, and risk management standards in an effort to provide competent care to clients. In instances when the process is not clearly outlined, an ethical decision-making model should be used, the law should be explored, and the appropriate stakeholders should be consulted.
Providing some form of mental health services at a distance is not a new concept. Suicide hotlines have been in existence since the 1950s (Centore & Milacci, 2008), and poet Sylvia Plath continued to connect with her Boston-based psychiatrist after she moved to England by exchanging letters in the 1960s. Although Plath’s life ultimately ended in suicide, she described the letters as a lifeline (Alexander, 2018). This illustrates both the risk and benefit of distance counseling.
In 2014, ACA recognized “the evolving nature of the profession with regard to distance counseling, technology, and social media” (p. 17). In 2016, the National Board for Certified Counselors (NBCC) recognized the impact that computers and technology have had on the counseling profession, drafted a policy regarding the provision of distance services, and developed a distance counseling credential. Multiple terms are used to describe counseling activities that partly or completely use the internet, including “online counseling/therapy, technology-assisted counseling, e-therapy, psychotechnology, behavioral telehealth, distance professional services, internet counseling, cybertherapy, and distance counseling” (Wheeler & Bertram, 2019, p. 172). Harris and Birnbaum (2015) touted the possibility of technological advances to reach tens of millions of individuals who are currently underserved.
Legal and regulatory bodies struggle to keep up with the integration of technology into the profession, as do practitioners. VandenBos and Williams (2000) reported that in a survey of American Psychological Association members, 98% affirmed that they had provided counseling services over the phone. Although the use of technology in counseling and supervision has been present for decades, the use of modern technologies remains hotly debated.
During the 2020 Coronavirus (COVID-19) crisis, technology proved to be an opportunity for maintaining continuity of care, providing emergency services, and coping with the global pandemic. Many governing bodies, including state licensure boards and the U.S. Department of Health and Human Services, temporarily relaxed Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations in an effort to allow
