Laura Groshong, AM, LICSW, the Policy & Practice Director of the Clinical Social Work Association (CSWA), wrote an article entitled, LCSWs and the Use of Texting in Mental Health Treatment, with co-author Margot Aronson, LICSW, CSWA’s Policy & Practice Deputy Director. The article explained the responsibilities of the LCSW providing text therapy. They allowed Telebehavioral Health Institute (TBHI) to obtain a copy of the article and share to the TBHI Blog.
Text Therapy – Start Feeling Better Today with Talkspace Online Therapy. A Convenient and Affordable Solution That Provides Access to Therapy Whenever You Need. 100% Private & Secure. Secure & Confidential. 1 Million Happy Users. 2000+ Licensed Therapists. As Low As $49/Week. (Talkspace Website, https://help.talkspace.com/hc/en-us )
Texts are primarily used for social purposes: short missives conveying limited information. Much has been written about the negative impact of reliance on this mode of communication (Turkle, 2012), but the popularity of texting is obvious, particularly among those under the age of 30 who have texted regularly throughout their lives. Therefore, the increasing use of texting in the context of therapy cannot be ignored.
While there is no definitive research as yet, it appears that texting can play a useful role in some mental health treatment. Certainly for anyone who is most comfortable with texting as the preferred form of communication, this may be where a treatment relationship can best begin.
Responsibilities of the LCSW Providing Text Therapy
Clinical social workers should be knowledgeable both about the promise of digital innovations in treatment, and equally about the potential downside. LCSWs who choose to engage in providing text therapy must be willing to explore ethical complications, perhaps even license violations, in the terms of agreement with client and/or texting platform.
The first issue: is “text therapy” really psychotherapy?
Psychotherapy — also called “talk therapy” or just plain therapy — is a process whereby psychological problems are treated through communication and relationship factors between an individual and a trained mental health professional. Modern psychotherapy is time-limited, focused, and usually occurs once or twice a week for 45-50 minutes per session (Herkov, M., “What is Psychotherapy?”, PsychCentral, October 8, 2018.)
This simple definition of psychotherapy, paired with the quoted Talkspace web advertisement at the top, illustrate the very real differences that exist between psychotherapy and text therapy. Psychotherapy (whether in person or through synchronous videoconferencing) is a continuous process based on an established emotional relationship, an ongoing dialogue between two people in real time about complex issues with deep emotional content.
Texting is by its nature short, often with a gap in the timing of communications between client and therapist; it is not consistent with a dialogue based on emotional meaning, as with psychotherapy. This fact is acknowledged in the Talkspace User Agreement below:
Talkspace User Agreement – This Site Does Not Provide Therapy. It provides Therapeutic conversation with a licensed therapist (Essig, T., “APA Cancels Talkspace Ads Moving Forward”, Forbes Magazine, July 29, 2018.)
It is in the small print of User Agreements that some text therapy platforms (platforms and companies are used interchangeably) emphasize to clients that the services provided are not psychotherapy. Meanwhile, the term “text therapy” continues to appear prominently in the ads, potentially creating confusion for those seeking psychotherapy, and giving an appearance of misleading advertisement.
How, then, do we as LCSWs conceptualize and engage in text therapy? Perhaps “text therapy” might more accurately be called “text assessment” or “text coaching”. Texting might also be the means for starting the therapeutic process, to be converted to an in-person or videoconferencing process if it becomes an ongoing psychotherapy.
Reading any contract with care is essential, and this is most certainly true for contracts offered by text therapy platforms. Does the contract address issues such as diagnosis, HIPAA compliance, state-to-state licensing laws, and dual relationships? Does the company set limitations on helping a client understand the differences between in-person treatment and text therapy, or on recommending in-person therapy when such treatment is indicated? LCSWs who sign on as providers should be aware that our ethics and standards of practice may not be supported by these companies.
This is Part 1 of the 3-part blog series. You can also read Parts 2 and 3 below:
- LCSWs and the Use of Texting in Mental Health Treatment: LCSW Standards of Practice
- LCSWs and the Use of Texting in Mental Health Treatment: Regulatory & Ethical Considerations in Text Therapy
Is Text Therapy Good For Your Practice?
Therapists are finding that clients are increasingly asking for text messaging in therapy. TBHI’s online training event is entitled, “Is Text Therapy For You? Telehealth Legal/Ethical Requirements. Join Dr. Marlene Maheu and Guest Laura Groshong, AM, LICSW on September 5th, Wednesday, at 11 pm – 12 pm, Pacific Standard Time. In the discussion, basic risk management approaches to using text messaging will be reviewed. The popular choice of using text messaging as the basis for clinical care will be examined from the perspective of legal and ethical requirements. This discussion will also clarify considerations for accepting employment from online text therapy companies. The online training will be recorded for your convenience.
Disclaimer: The views and opinions expressed in the article and on this blog post are those of the authors. These do not necessarily reflect the views, opinions, and position of the Telebehavioral Health Institute (TBHI). Any content written by the authors are their opinion and are not intended to malign any organization, company or individuals.