Online Education/Online Therapy

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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.


Richard Leslie

"At the Intersection of Law and Psychotherapy" Richard S. Leslie is an attorney who has practiced at the intersection of law and psychotherapy for the past twenty-five years. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT), where he worked with their various state divisions to develop and implement their legislative agendas. He also provided telephone consultation services to AAMFT members regarding legal and ethical issues confronting practitioners of diverse licensure nationwide. Additionally, he wrote articles regarding legal and ethical issues for their Family Therapy Magazine and presented at workshops on a variety of legal issues. 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. He was director of Government Relations for CAMFT, and as such was the architect of CAMFT’s widely regarded and successful legislative agenda. He represented CAMFT before the regulatory board (the Board of Behavioral Sciences) and was a tireless advocate for due process and fairness for licensees and applicants. He was a regular presenter at workshops and was consistently evaluated as CAMFT’s most highly rated presenter. He also sat with the CAMFT Ethics Committee and acted as their advisor on matters pertaining to the enforcement of ethical standards. Richard is an acknowledged expert on matters pertaining to the interrelationship between law and the practice of marriage and family therapy and psychotherapy. For many years, he taught Law and Ethics courses for a number of colleges and universities in their marriage and family therapy degree programs. While at CAMFT, he provided telephone consultation services with thousands of therapists in California and elsewhere for over twenty years. He is highly regarded for his judgment, his expertise, his direct style, and his clarity. Richard has been the driving force for many of the changes and additions to the laws of the State of California that affect MFTs. In 1980, he was primarily responsible for achieving passage of the "Freedom of Choice Law" that required insurance companies to pay for psychotherapy services performed by MFTs. Passage of that law allowed MFTs to earn a living, allowed them to better compete in the marketplace, and strengthened the profession in California by leading to a great increase in the number of licensees and CAMFT membership. Currently, about half of the licensed marriage and family therapists in the country are licensed in California. While at CAMFT, Richard was primarily responsible for, among other things, the successful effort to criminalize sex between a patient and a therapist. He was successful in extending the laws of psychotherapist-patient privilege to MFTs, thereby giving patients the same level of privacy protection as when seeing a psychiatrist or psychologist. He fought tirelessly and successfully for the right of MFTs to refer to themselves as "psychotherapists," to perform psychological testing services, to be appropriately reimbursed by California’s Victims of Crime Program, and to be employed in county mental health agencies throughout California. Richard was admitted to the Bar in New York (1969) and in California (1973). While practicing in New York, he served as a public defender, and later, as an Assistant District Attorney. Shortly after moving to California, he worked for the San Diego County Human Relations Commission as their Law and Justice Officer. While there, he worked successfully to achieve greater racial diversity in the criminal jury selection system and to expose and stop police abuse. For such work with that agency, he was the recipient of the Civil Libertarian of the Year Award by the San Diego Chapter of the American Civil Liberties Union.

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