Avoiding Liability Bulletin – September 2009

… It is interesting to me that online education has recently gained, and likely will continue to gain, increased acceptance nationwide. Not only are private educational institutions granting degrees earned online, but also, major “brick and mortar” universities are increasingly adding online components to the traditional methods of delivering education. This is of interest to me because it reminds me that in the late nineteen seventies and the nineteen eighties in California, a good number of educational institutions offering masters degrees that qualified for licensing of marriage and family therapists engaged in “distance learning” of one kind or another. These schools were routinely suspected or accused of providing inferior education and were often referred to as “degree mills.” These schools were largely non-accredited, but they were “state approved.”

Yet, my limited research at the time showed that such institutions compared favorably with most of the traditional WASC accredited schools and universities when I looked at the rate and frequency of ethics complaints and licensing board disciplinary actions. Additionally, pass rates on the examinations (written and oral) for licensure were seemingly unaffected by the kind of education received – that is, whether or not it was a correspondence school or another kind of distance learning school, or one with traditional classrooms. Perhaps it depended upon the particular institution, and the ethics and commitment of those involved with delivering education, rather than the manner in which the education was delivered. There were good and bad schools that were WASC accredited, and good and bad schools that were only state approved.

I think there are similarities with respect to providing counseling and therapy online, rather than in the traditional face-to-face manner, with that of the education experience described above. Of course, video cameras and online technology increasingly makes it possible to do therapy online while being face-to-face on the monitors/screens of providers and clients. Arguably, the quality of the therapy or counseling delivered depends more upon the knowledge and skills of the practitioner than upon the method in which the services are delivered. Further, as with the educational experience, the convenience of service delivery, the saved travel time, and the privacy of the experience all add up to –for some- a better experience.

State licensing boards must grapple with emerging questions concerning online masters degree level education, acceptable hours of experience gained online, online supervision, online continuing education, and other related questions. There is no question but that telemedicine is a growing and well-accepted trend in the delivery of healthcare for physical problems, including chronic conditions, and there is no reason why online counseling and psychotherapy should not be similarly utilized and accepted with respect to mental health care. I am aware, however, that there are legitimate questions and concerns that have arisen and that will arise, but feel comfortable that those questions and concerns can ultimately be answered and resolved.

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Richard Leslie

Richard S. Leslie is an attorney and acknowledged expert on the interrelationship between law and the practice of marriage and family therapy and psychotherapy. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT) and has written articles regarding legal and ethical issues for their Family Therapy Magazine. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. While there, he also served as their director of Government Relations and tirelessly advocated for due process and fairness for licensees and applicants.

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