Integrating Telemental Health Practice Into Counselor Education Training E-Book
Heather C. Robertson
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Counselor educators and instructors need impactful and concise strategies to successfully integrate telemental health (TMH) concepts into an already demanding counseling curriculum. As TMH counseling continues to expand in a post-pandemic era, counselor educators and instructors are charged with the responsibility of training the next generation of professional counselors in ethical and effective TMH counseling.
Utilizing the CACREP general curriculum and specialization standards as a framework, Integrating Telemental Health Practice into Counselor Education Training provides counselor educators, doctoral students, and instructors with creative ideas, as well as concrete strategies, to infuse content on TMH into their existing courses and curriculum. Readers will benefit from suggested TMH content for each CACREP standard, as well as TMH teaching tips and sample lessons from contributing authors. Lessons include variations for in-person and online instruction. This book provides the counselor educator or doctoral student with a foundational knowledge of TMH, who needs ideas and activities to seamlessly infuse TMH concepts into their counseling courses and curricula.
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Preface
References
Acknowledgements
Additional Contributors
How to Use This Book
1 Understanding Telemental Health Practice
Describing TMH
Defining TMH
Prior TMH Knowledge
Conclusion
Suggested Reading
2 Teaching Telemental Health Practice
CACREP Lens
Teaching Framework
Foundational Counseling Curriculum
3 Professional Counseling Orientation and Ethical Practice
Key Concepts
Teaching Techniques
Sample Lesson: Role of Ethics in Telemental Health Delivery
Sample Lesson: Law, Ethics, and Credentialing: Attempting to Make Sense of Guidance When Utilizing Telemental Health as a Clinical Modality
4 Social and Cultural Identities and Experiences
Key Concepts
Teaching Techniques
Sample Lesson: Multicultural Counseling in the Digital World
Sample Lesson: Examining Cultural Counseling Directories and Services
5 Lifespan Development
Key Concepts
Teaching Techniques
Sample Lesson: Observing the Impact of Technology Across the Lifespan
Sample Lesson: Detoxing from Our Digital Lifeline
6 Career Development
Key Concepts
Teaching Techniques
Sample Lesson: Transformational Learning in TMH – Finding a Life Through Career Development
Sample Lesson: Online Career Counseling Approaches to Enhance Career Decision-making
7 Counseling Practice and Relationships
Key Concepts
Teaching Techniques
Sample Lesson: Counseling Skills Practice in Multiple TMH Modalities
Sample Lesson: The Application of Smartphone Apps to Counseling Practice
8 Group Work and Group Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Developing Informed Consent for Online Groups Using ChatGPT
Sample Lesson: Preparing for Online Group Attacks
9 Assessment and Diagnostic Processes
Key Concepts
Teaching Techniques
Sample Lesson: Examining Psychometric Properties of Online Administration
Sample Lesson: Delivering Assessments via TMH: Case Study, Questions, and Discussion
10 Research and Program Evaluation
Key Concepts
Teaching Techniques
Sample Lesson: Integrating AI in Counseling Research: Utilizing ChatGPT for Literature Review and Research Question Development
Sample Lesson: Online Quantitative and Qualitative Research in Counseling
Entry-Level Specialized Practice Area
11 Addictions Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Online Assessment for Addiction Disorders
Sample Lesson: TMH Addictions Counseling: Case Study, Questions, and Discussion
12 Career Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Exploring Values in the Career Decision-Making Process via TMH
Sample Lesson: Asynchronous Career Counseling - Case Study, Questions, and Discussion
13 Clinical Mental Health Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Diagnosis and Treatment Planning via Telemental Health
Sample Lesson: Identifying Symptoms of Antisocial Personality Disorder (APD)
14 Clinical Rehabilitation Counseling
Key Concepts
Teaching Techniques
Sample Lesson: TMH Rehabilitation Counseling - Case Study, Questions, and Discussion
Sample Lesson: TMH Clinical Rehabilitation Counseling - Case Study, Questions, and Discussion
15 College and Student Affairs Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Assessing College Online Delivery Services
Sample Lesson: Examining CAS Standards for Distance Guidance
16 Marriage, Couple, and Family Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Adapting Play Therapy Techniques to TMH
Sample Lesson: Mini-Practice in Applying Play Therapy Techniques Adapted to TMH
17 School Counseling
Key Concepts
Teaching Techniques
Sample Lesson: Tech Awareness & Decision Making
Sample Lesson: Facilitating Online Classroom Guidance Lessons
Other Considerations
18 Professional Practice and Fieldwork
CACREP Curricular Standards
19 Counselor Education and Supervision
CACREP Curriculum Standards
Teaching Techniques
20 The Future of Telemental Health Counseling and Training
TMH Counseling
TMH Training
Conclusion
Appendix A: ACA & NBCC Codes of Ethics on Telemental HealthACA & NBCC Codes of Ethics on Telemental Health
American Counseling Association (ACA) Code of Ethics (2014)
Section H: Distance Counseling, Technology, and Social Media
National Board for Certified Counselors (NBCC) Code of Ethics (2023)
References
Glossary
Index
About the Author
End User License Agreement
List of Tables
Chapter 3
Table 3.1 CACREP Section 3.A (Professional Counseling Orientation and Ethical ...
Table 3.2 ACA Code of Ethics Standards and Suggested TMH Content
Table 3.3 Alignment between NBCC (2023) and ACA (2014) TMH Standards
Chapter 4
Table 4.1 CACREP Section 3.B (Social and Cultural Identities and Experiences) ...
Chapter 5
Table 5.1 CACREP Section 3.C (Lifespan Development) and Suggested TMH Content
Chapter 6
Table 6.1 CACREP Section 3.D (Career Development) and Suggested TMH Content
Chapter 7
Table 7.1 CACREP Standards, Section 3.E (Counseling Practice and Relationships...
Chapter 8
Table 8.1 CACREP Section 3.F (Group Counseling and Group Work) and Suggested T...
Chapter 9
Table 9.1 CACREP Section 3.G (Assessment and Diagnostic Processes) and Suggest...
Chapter 10
Table 10.1 CACREP Section 3.H (Research and Program Evaluation) and Suggested ...
Chapter 11
Table 11.1 CACREP Section 5.A (Addictions Counseling) and Suggested TMH Conten...
Chapter 12
Table 12.1 CACREP Section 5.B (Career Counseling) and Suggested TMH Content
Chapter 13
Table 13.1 CACREP Section 5.C (Clinical Mental Health Counseling) and Suggeste...
Chapter 14
Table 14.1 CACREP Section 5.D (Clinical Rehabilitation Counseling) and Suggest...
Table 14.2 CACREP Section 5.G (Rehabilitation Counseling) and Suggested TMH Co...
Chapter 15
Table 15.1 CACREP Section 5.E (College Counseling and Student Affairs) and Sug...
Chapter 16
Table 15.1 CACREP 2024 Standards 5.F. (Marriage, Couple, and Family Counseling...
Chapter 17
Table 17.1 CACREP Section 5.C, Clinical Mental Health Counseling (CMHC) and Su...
Chapter 19
Table 19.1 CACREP Standard 6.B.1 (Doctoral Counseling) and Suggested TMH Conte...
Table 19.2 CACREP Standard 6.B.2 (Doctoral Supervision) and Suggested TMH Cont...
Table 19.3 CACREP Standard 6.B.3 (Doctoral Teaching) and Suggested TMH Content
Table 19.4 CACREP Standard 6.B.4 (Doctoral Research and Scholarship) and Sugge...
Table 19.5 CACREP Standard 6.B.5 (Doctoral Leadership and Advocacy) and Sugges...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Preface
Acknowledgements
Additional Contributors
Begin Reading
Appendix A ACA & NBCC Codes of Ethics on Telemental Health
References
Glossary
Index
About the Author
Wiley End User License Agreement
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Integrating Telemental Health Practice Into Counselor Education Training
HEATHER C. ROBERTSON
Copyright © 2025 American Counseling Association. All rights reserved.
American Counseling Association2461 Eisenhower Avenue, Suite 300Alexandria, Viriginia 22314
Published in the United States of America
Library of Congress Cataloging-in-Publication Data
Names: Robertson, Heather C., author.
Title: Integrating telemental health practice into counselor education training / Heather C. Robertson.
Description: Alexandria, VA : American Counseling Association, [2025] | Includes bibliographical references and index.
Identifiers: LCCN 2024056565 (print) | LCCN 2024056566 (ebook) | ISBN 9781556204173 (paperback) | ISBN 9781394222872 (epub) | ISBN 9781394222889 (PDF)
Subjects: MESH: Distance Counseling--education | Counselors--education | Mental Health Teletherapy | Mental Health Services
Classification: LCC RA790.8 (print) | LCC RA790.8 (ebook) | NLM WM 18 | DDC 362.2071--dc23/eng/20250130
LC record available at https://lccn.loc.gov/2024056565
LC ebook record available at https://lccn.loc.gov/2024056566
Preface
My motivation to explore teaching telemental health came from an interaction with a student in 2015 while teaching a clinical mental health counseling internship class. The student was discussing her client’s case and, at one point, remarked, “It’s just hard because I see her on the VeeSee.” My response to the student was, “What’s the VeeSee?” panicking internally when the student explained that she was seeing her client via video conferencing software. I asked the student where she learned to counsel clients via videoconferencing and who was supervising her on that technology—because I knew it was not us.
Our program did not train students in what would come to be known as telemental health (TMH) in 2015, but this brief interaction alerted me that we should be. I took it upon myself to get trained. Having completed my master’s degree in 1996 and my doctorate in 2010, I never received TMH training. Even though I remained in clinical practice, the agencies I worked with did not use TMH before COVID-19. I completed the distance credentialed counselor (DCC) training through Renewed Vision Counseling and became my institution’s de facto TMH researcher and instructor. I later transitioned this credential to the Board Certified Telemental Health Provider (BC-TMH). I obtained grants in 2016 and 2018 focused on teaching TMH and my first book contract on the practice of TMH in 2019. Then, unexpectedly, in March of 2020, my prior training and research became of great importance as our students swiftly transitioned to digital delivery.
Digital delivery of counseling services, known as telemental health, is not new. Practices date back to the 1950s when psychiatrists conducted clinical interviews via closed-circuit television. Around 2000, technologies expanded through broadband internet and smartphones, opening digital counseling to a broader audience. Over the past 20+ years, a growing research base has verified its efficacy with multiple populations and clinical foci. In 2020, COVID-19 propelled the profession into widespread use of TMH, yet the training that prepared counselors for that transition is questionable. Some counselors may have transitioned to TMH with no training at all. Training in TMH, even before COVID-19, was problematic. No unified training standards exist for digital counseling delivery. Although there are national certification programs, these programs vary in terms of training content, cost, and length of time.
The training dilemma extends into counselor education programs. During COVID-19, the Council on the Accreditation of Counseling and Related Education Programs (CACREP) and state organizations approved the digital delivery of counseling services for fieldwork experiences. The newest 2024 CACREP standards do not specifically require counselor education programs to train students on TMH but do require training programs to address the “application of technology related to counseling” (CACREP, 2023, Standard 3.E.5) and for “establishing and maintaining counseling relationships across service delivery modalities” (Standard 3.E.7). Despite these directives, faculty may have limited knowledge or experience in the nuances of TMH delivery. There is a significant knowledge gap between those who were trained prior and those who will be trained in the future. Counselor educators training the next generation of counselors in digital delivery may lack knowledge and experience in TMH.
Even counselor educators trained in TMH practice can lack the tools to translate that knowledge into their training. Counseling curricula are already full of required information, and counselor educators and instructors may be unsure how to weave TMH content into their existing programs. Despite the growth, emergence, and increase of digital services, there are no resources on how an educator can provide training on TMH counseling. Various books have been written for practitioners on delivering TMH. Yet, to date, none exists for the educator or instructor charged with teaching TMH practice to counselors-in-training (CITs). This book addresses that shortcoming by providing a resource that counselor educators and instructors can use to train current and future counselors in TMH.
It should be noted that this book assumes that instructors hold a foundational knowledge of TMH practices. The book aims to support instructors in integrating TMH knowledge into their counselor education training programs. Instructors who lack foundational knowledge in TMH are encouraged to receive TMH training, review resources on TMH, or engage in supervised TMH counseling prior to training counselors in TMH practice. Some suggested resources are provided in Chapter 1. The book is divided into four sections to support the integration of TMH concepts into counselor education.
Section 1 includes two chapters that set the stage for using the book within your curriculum. Chapter 1 provides general concepts on TMH and common definitions while also directing readers to additional resources for gaining TMH content knowledge. Instructors lacking knowledge or experience in TMH can start with the resources at the end of the chapter to develop that foundation. Chapter 2 discusses teaching TMH through a CACREP lens and multiple modalities such as on-campus, online synchronous, and online asynchronous. This chapter concludes with an introduction to andragogy, the practice of adult education, which informs the instructional delivery methods suggested.
Section 2 addresses the foundational CACREP curriculum, including Professional Orientation, Social and Cultural Diversity, Lifespan Development, Career Development, Counseling Practice and Relationships, Group Counseling and Group Work, Assessment and Diagnostic Processes, and Research and Program Evaluation. Section 3 addresses CACREP specialization areas, including Addictions, Career, Clinical Mental Health, Clinical Rehabilitation, College and Student Affairs, Marriage/Couple/Family, and School Counseling. In Sections 2 and 3, the format of the chapters includes Key Concepts, Teaching Techniques, and Sample Lessons.
Key concepts address CACREP standards, and two to three additional focus areas are worthy of attention. All CACREP standards within the curricular area are reviewed, and specific suggestions for integrating TMH concepts are included in alignment with each standard. The additional focus areas provide instructors with information or reminders on TMH topics that warrant special attention or emphasis within the counseling curriculum. Teaching Techniques within each chapter outline 10 suggested activities that instructors can utilize to actively integrate TMH into their counseling curriculum. Each chapter in Sections 2 and 3 contains two Sample Lessons on teaching TMH within the foundational or specialization areas. Several professionals across multiple organizations and institutions have contributed, coauthored, edited, and supplemented these lessons to provide the reader with diverse ideas, styles, and mechanisms to teach TMH. The lessons include interactive classroom activities, case studies, and lecture topics that instructors can modify to suit their instruction and student needs.
Section 4 includes additional considerations for integrating TMH content into the counseling curriculum. Chapter 18 addresses Professional Practice and Fieldwork, and Chapter 19 addresses Counselor Education and Supervision. These chapters also address CACREP curricular standards and teaching techniques but do not include sample lessons. Finally, Chapter 20 addresses future trends in TMH counseling and training.
Counselors are no longer just sitting across from their clients and students in physical spaces but meeting their clients and students where they are through digital delivery. Teaching TMH practice to the next generation of counselors can be daunting, particularly for those not trained and experienced in its use or those unsure how to integrate their TMH knowledge into the classroom. Technology is constantly changing, improving, and innovating. As educators and instructors, we commit ourselves to remaining current in the emerging practices of the field. This book intends to support instructors by linking key elements of TMH and CACREP standards directly to the curricular areas in which they teach. I hope to make the prospect of teaching TMH less intimidating and, by doing so, help you avoid the internal panic I experienced back in 2015.
Be well, practice wisely, and thank you for being open to teaching TMH counseling ethically and effectively. Future counselors are counting on our ability to do so.
References
Council on the Accreditation of Counseling and Related Education Programs. (2023).
2024
CACREP standards
.
https://www.cacrep.org/for-programs/
Acknowledgements
Thank you to the American Counseling Association (ACA) for supporting this project. I am particularly grateful to Christine Fruin, Tom Cadorette, and the ACA for their ongoing support, their patience, and their constant advocacy for the counseling profession. Thanks to my colleague, Dr. Michael Jones, for our initial collaborations and for providing my first training in distance counseling back in 2016 through Renewed Visions, which sparked my knowledge and passion for telemental health. I’m also grateful to the many colleagues who contributed lessons to support the book—their input and expertise are valued more than I can express.
The Department of Counselor Education at St. John’s University deserves a special shout-out. My goodness, this dream team of coworkers and colleagues is a group I am so grateful for: Gina, James, Ming, Nouna, Qiana, Bob, Leo, and Zoya—thank you for loving this field and enjoying training our students as much as I do. You are a wonderful group to be surrounded by. Special thanks go to Michelle Schwab, a St. John’s University Clinical Mental Health Counseling student and rising star who dedicated hours of her own time—beyond her graduate assistant position—to help edit and review the book, for which I am incredibly grateful.
The foundation of my soul, my world, and my existence is my family and friends. I get by with a bit of help from my friends (or a lot): my Scituate Sailors, SU Boland crew, and SJU confidants—you know who you are. You sustain me, and I thank you. My mom and my sisters always buoy my mental health, and without them, I would surely sink. Ben, I’m eternally grateful to you. I love you for being the glue that keeps me together, as well as our family. Ryan and Sam, continue to let your spirits soar. Your individual journeys inspire me, and I cherish watching you grow into the kind men that you are. I’m lucky to be your mother.
Additional Contributors
To the many colleagues who contributed lessons to this book, thank you for your contributions. Your ideas and insights will be incredibly valuable to readers.
Kami Ball Tran, MS, LPC-S, RPT-S, NCC
James Bethea, PhD, LMHC, CRC, St. John’s University
Pamelia Brott, PhD, LPC, NCC, ACS
Claudette Brown-Smythe, PhD, LMHC, ACS, NCC, CRC, SUNY Brockport
Gina Cicco, EdD, LMHC, NCC, Certified School Counselor, St. John’s University
Robert Eschenauer, PhD, LMHC, NCC, St. John’s University
Leo Gonzalez, PhD, LMHC, NCC, St. John’s University
John J. S. Harrichand, PhD, LPC-S, LMHC, NCC, ACS, University of Texas at San Antonio
Cameka Hazel, EdD, MHC-LP, New York Institute of Technology
Nouna Jalilzadeh, PhD, LMHC, NCC, St. John’s University
Michael Jones, PhD, LPC-S, NCC, BC-TMH, University of the Cumberlands
Ming-hui Li, EdD, LMHC, LPC, St. John’s University
Tyce Nadrich, PhD, LMHC, NCC, ACS, Mercer University
Joni O’Hagan, MSEd, St. John’s University
Michelle Perepiczka, PhD, LMHC, LPC, RPT-S, ACS, NCC, University of Phoenix
Brittany L. Prioleau, PhD, LCMHC, NCC, Mercer University
Matthew R. Shupp, EdD, NCC, BC-TMH, ACS, LPC, Shippensburg University of Pennsylvania
Jessica L. Sniatecki, PhD, CRC, SUNY Brockport
Qiana Spellman, EdD, Certified School Counselor, St. John’s University
How to Use This Book
1Understanding Telemental Health Practice
To provide effective instruction on telemental health (TMH), counselor educators and instructors must understand the practice of TMH. This chapter broadly introduces TMH and directs the instructor to additional resources to expand their knowledge.
The practice of telemental health, while not new, has been growing rapidly since the onset of the COVID-19 pandemic in 2020. A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that mental health telemedicine services more than tripled between 2015 and 2020 (22.2% to 68.7%), with the most significant increase occurring between 2019 and 2020 (38% to 68.7%). Similarly, telemedicine services for substance use, which had seen little increase between 2015 and 2019, more than doubled between 2019 and 2020 (25.7% to 58.6%; Alvarado, 2021). Consumer awareness of TMH is also growing. In a 2021 survey by the American Psychiatric Association (APA), 60% of respondents indicated that they would use telemedicine for mental health care. Respondents who would use TMH increased from 49% in 2020 to 59% in 2021, with 66% of respondents ages 18–29 responding that they would utilize TMH services (APA, 2021). While the onset of COVID-19 and government-issued “stay-at-home orders” may have driven these increases, the practice of TMH has remained steady since those restrictions have been lifted.
Describing TMH
The delivery of counseling services via the internet or other digital systems has had several titles over the years. While I primarily use “telemental health counseling (TMH),” other terms include cyber counseling, e-therapy, internet-based counseling, distance counseling, and digital delivery of counseling services. In a pre-COVID-19 study of 65 state licensure board websites, 42 different terms were utilized to explain the concept of TMH and counseling services, with 19 being more frequently cited. The terms electronic counseling or electronic therapy were the terms most often used among counseling and social work state licensing boards, whereas, among psychology state licensure boards, telehealth was the most prevalent term used (Ostrowski & Collins, 2016).
Different counseling specializations utilize different terms for TMH. The American Mental Health Counselor Association (AMHCA) uses Technology Supported Counseling and Communications (TSCC) in its 2023 Standards of Practice for Clinical Mental Health Counseling and its 2020 Code of Ethics. The American School Counselors Association (ASCA) refers to virtual/distance school counseling in its 2022 Code of Ethics. The National Career Development Association’s (NCDA) 2015 Code of Ethics discusses providing career services online while also referring to the use of technology and social media. The National Board for Certified Counselors (NBCC) initially offered a policy regarding the provision of distance professional services (NBCC, 2016) and uses the terms telemental health, social media, and technology in its Code of Ethics (NBCC, 2023, p. 12).
Readers may note that the definitions used by some professional organizations do not contain the term telemental health (or TMH) when discussing distance services. One possible reason for not utilizing TMH within certain counseling specializations is that not all counseling professions involve mental health counseling. In fact, mental health counseling might not be included in the scope of practice for some specializations. Examples include career counseling, school counseling, and student affairs counseling. While these individuals may address the clients’ and students’ social and emotional needs, their scope of practice may or may not include mental health. Thus, while I use TMH throughout this book for consistency, I will be certain to note when the term may not be appropriate for some specializations.
National and international public health organizations often utilize terminology such as telehealth or telemedicine. Some organizations consider TMH included within telehealth/telemedicine, while others consider it a separate practice. SAMHSA (n.d.) utilizes “telemental health” in some contexts while using “telemedicine” or “telehealth” in other settings. The National Institute of Mental Health (NIMH, n.d.) refers to these services as “telemental health services” and recognizes that different terms, such as “telepsychology” and “telepsychiatry,” may also be utilized. The Centers for Disease Control and Prevention (CDC, 2020) references “telemedicine” and “telehealth” but uses “telemental health” when specifically addressing mental health content. The World Health Organization (WHO, 2022) references “services via telehealth and telemedicine” and utilizes the term “digital health.” Along with the International Telecommunication Union (ITU), WHO publishes standards for accessibility of telehealth services (WHO-ITU, 2022). Counselor educators and instructors recognize that different terminology for TMH may be used in other contexts.
Defining TMH
Definitions of TMH also vary. One of the earliest groups to define the concept of web counseling was the National Board for Certified Counselors (NBCC), which called it “the practice of professional counseling and information delivery that occurs when client(s) and counselor are in separate or remote locations and utilize electronic means to communicate over the Internet” (NBCC, 1997, p. 3). Professional organizations have created definitions that meet the needs of their profession. For example, when defining Technology Supported Counseling and Communications (TSCC), AMHCA’s broach definition reads:
B.6.a. CMHCs understand that the uses of TSCC in counseling may be considered to fall under the following categories: i.) The use of TSCC as the medium for counseling, also called “telehealth” or “distance counseling,” includes but is not limited to the delivery of counseling by video call (e.g., internet, video chat), by voice (e.g., telephone), by synchronous text (e.g., chat or SMS), or by asynchronous text (e.g., email). ii.) The use of TSCC as an adjunct to counseling (i.e., for arranging, coordinating, or paying for counseling services), including the use of payment processing services that are integrated with TSCC (e.g., PayPal, Stripe, Zelle) for receipt of payment for counseling services. iii.). The use of online “cloud-based” services for the storage of counseling records. iv.) Marketing, educational forums, and other TSCC to include blogs, webpages, chatroom, etc. (AMHCA, 2020, p. 6)
In this AMHCA definition, TSCC includes providing counseling services via technology as well as technological communication, record keeping, and billing accompanying those services.
Federal agencies use other definitions of telehealth and telemedicine. The Health Resources and Services Administration (HRSA) states that “telehealth is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health” (HRSA, 2022, para. 1). Since the provision of telehealth services is often a component of insurance billing and medical payment, many organizations utilize the Medicaid definition of telehealth:
Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. … Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. (Center for Medicaid & Medicare Services, n.d., para. 13-14).
According to the Center for Connected Health Policy (CCHP), a program of the Public Health Institute, there is no single definition of telehealth, and definitions vary by state jurisdictions and settings. Again, counselor educators and instructors recognize that definitions of TMH may vary based on context and setting.
Prior TMH Knowledge
This book is not intended to provide instructors with initial training in TMH practice but to support the implementation of TMH concepts into counselor education and training. As addressed in the preface, this book assumes a baseline knowledge of TMH practice. This book will regularly utilize terms that are well-known in TMH practice settings but may not be familiar to all readers. The glossary at the end of this book is designed to define these terms, which will be denoted in bold as they appear and support the reader as they progress. Supplemental information may be needed to instruct with confidence and competence on issues of TMH. Before turning to this book, instructors who do not already have a baseline knowledge of TMH are encouraged to obtain this knowledge via training, reading, and practice.
Training
Professional development training programs in TMH have existed for many years. The American Counseling Association (ACA), in conjunction with Counseling Outfitters and Ready Minds, published the book Distance Counseling: Expanding the Counselor’s Reach and Impact in 2007, indicating the early acceptance of TMH training within the profession (Malone et al., 2007). The Center for Credentialing and Education offers the Board Certified Telemental Health Provider (BC-TMH) credential (CCE, 2024). Originating as the Distance Counseling Credential (DCC), CCE transitioned to the BC-TMH in 2018. Other training and certificate programs in TMH are offered by well-regarded institutions such as the Zur Institute, PESI, and the American Telemedicine Association (ATA). These training programs vary in length, time, content, and cost (Robertson, 2021). There are free training programs available as well. The U.S. Department of Health and Human Services offers free telehealth training resources for providers (2024). However, there is no standard of TMH training, and no universal criteria have been established for TMH competence. Earlier research has unfortunately demonstrated a sense of confidence among practitioners utilizing TMH despite having limited, unsatisfactory, or no prior training (Baird et al., 2018; Cipoletta & Mocellin, 2018; Perle et al., 2012; Robertson & Lowell, 2021; Simms et al., 2011).
Training is not only recommended but an ethical imperative that is included within the ethical codes of organizations such as the ACA (2014), ASCA (2022), AMHCA (2020), and NCDA (2024), as well as others. For example, the ACA Code of Ethics addresses training in its discussion of counselor competence (Section C.2.a) and new specialty areas of practice (Section C.2.b; ACA, 2014). These codes indicate that counselors only engage in new areas of practice for which they received “education, training, and supervised experience” (ACA, 2014, p. 8). Section H.1.a specifies that “counselors who engage in the use of distance counseling, technology, and/or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work)” (ACA, 2014, p. 16). Similar standards are reflected within other professional organizations’ ethical codes, and counselor educators should review those codes to identify the related provisions within their counseling specialization.
Reading
Counselor educators and instructors (henceforth “instructors”) can pursue training programs, such as the BC-TMH mentioned above, or they may expand their knowledge through professional literature. A common misconception is that TMH is a “new” professional trend. TMH saw tremendous increases during and following the COVID-19 pandemic, yet the use of technology to provide counseling services has been in place for decades (Hornblow, 1986). As such, professional literature on TMH also spans decades.
Professional academic journals in counseling, psychology, social work, and other helping professions are good starting points for examining professional literature. When examining the literature, keep in mind that search terms may vary based on the multitude of titles used to describe and define TMH. More recently, targeted professional journals, such as the Journal of Technology in Counselor Education and Supervision (JTCES), published by the Western Association of Counselor Educators and Supervisors (WACES), focus exclusively on the use of technology in counselor education. Other specialized journals, such as the Journal of Telemedicine and Telecare and Telehealth and Medicine Today, focus on technology in delivering medical and mental health services. Following the onset of COVID-19, several professional journals dedicated special issues to COVID-19 interventions, including TMH.
Professional books on the practice of TMH continue to emerge. While individual research on TMH is useful, some instructors may seek a more comprehensive view of TMH through a book, as opposed to journal articles. While I completed the Distance Certified Counselor training in 2016 and additional training when transitioning to the BC-TMH in 2018, the books listed at the end of this chapter were particularly helpful in expanding my knowledge of TMH. I have also included some newer resources, as well as the book I authored in 2020 on TMH and distance counseling. Instructors are encouraged to seek updated resources and materials to remain current on TMH practice issues.
Practice
Instructors who are practicing counseling can expand their TMH skills by practicing via TMH modalities. As indicated above, counseling professional codes indicate that we gain competence through training and supervised practice. The 2024 Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards include “ongoing counseling practice” (Standard 1.Z.3.c) as a faculty indicator of professional activities, scholarly activities, and service to the profession (CACREP, 2023). Thus, CACREP supports instructor engagement in ongoing counseling practice. Instructors who engage in counseling can seek supervision in TMH practice to expand their skills and comfort in providing TMH training to counselors-in-training (CITs).
Conclusion
Telemental health has become firmly embedded in the practice of professional counseling. Counselor educators and instructors are charged with educating the next generation of professional counselors to utilize TMH ethically and effectively with their clients and students. Instructors must understand the various descriptions and definitions of TMH and recognize that it is not a novel practice. Those without prior training can increase their knowledge in TMH via professional training, reading, and counseling practice.
Suggested Reading
Gilbertson, J. (2020).
Telemental health: The essential guide to providing successful online therapy.
PESI Publishing & Media.
Goss, S., Anthony, K., Stretch, L. S., Nagel, D. M. (2016).
Technology in mental health: Applications in practice, supervision, and training
. Charles C. Thomas.
Lutxon, D. D., Nelson, E., & Maheu, M. M. (2023). A practitioner’s guide to telemental health:
How to conduct legal, ethical, and evidence-based telepractice
(2nd ed.). American Psychological Association.
Malone, J. F., Miller, R. K., & Walz, G. R. (Eds.). (2007).
Distance counseling: Expanding the counselor’s reach and impact.
Counseling Outfitters, LLC.
Matheu, M. M. (2017).
Career paths in telemental health.
Springer.
Myers, K., & Turvey, C. (2012).
Telemental health: Clinical, technical, and administrative foundations for evidence-based practice.
Elsevier.
Robertson, H. C. (2021).
Telemental health and distance counseling: A counselor’s guide to decisions, resources, and practice
. Springer Publishing Company.
2Teaching Telemental Health Practice
Before the pandemic, there was an ongoing debate about how mental health professionals should be trained in telemental health (TMH). Some felt that TMH training should be embedded into foundational graduate curricula. The fields of psychology and psychiatry strongly advocated for TMH training within the curriculum (Alicata et al., 2016; Glover et al., 2013; Hilty et al., 2015; Hoffman & Kane, 2013; Pullen et al., 2013; Sunderji et al., 2014). Others felt TMH training should be a post-training specialization (Anthony, 2015), following face-to-face (F2F) training in counseling. Psychology and psychiatry led early efforts to embed TMH into practice (Colbow, 2013), recognizing that TMH could increase access to much-needed psychological and psychiatric services. Some counselor educators have embraced TMH within master’s level training, including TMH in content areas such as counseling skills (Trepal et al., 2007), group dynamics (Kozlowski & Holmes, 2017), and fieldwork (Haberstroh et al., 2008).
The U.S. Department of Health and Human Services (HHS) announced in March 2020 that it would waive Health Insurance Portability and Accountability Act (HIPAA) violations for practitioners during the pandemic (U.S. Department of Health and Human Services, 2020). This concession was designed to support the TMH continuum of care for those needing mental health and medical services; however, it may have inadvertently diverted practitioners from engaging in formal training. Professional development programs and TMH access continued to grow during the pandemic. PESI offered a free two-day, pre-recorded webinar to educate practitioners on the ethical practice of TMH. The online videoconference company Zoom offered free, unrestricted time when using their platform to support people in staying connected. Clinicians did whatever they could to continue practicing during this time, but TMH training may have been secondary to effectively engaging clients and students in counseling.
In a pre-COVID-19 study, 74 counselor educators were surveyed on how they taught TMH content within their counseling curriculum. Options included: not intentionally infused into their curriculum (26%), based on instructor preference (26%), intentionally infused into their curriculum (15%), offered as stand-alone elective on TMH (5%), and required as stand-alone class on TMH (1%; Robertson & Lowell, 2021). If that same study were administered today, many counselor educators would likely respond that they are trying to intentionally infuse TMH content into their curriculum. This book aims to support instructors in their efforts to infuse TMH content into an already crowded CACREP curriculum.
CACREP Lens
The Council for Accreditation of Counseling and Related Educational Programs (CACREP) exemplifies the profession’s highest standard of counselor education. While other accreditation organizations exist, CACREP’s 40-year history, national and international scope, and recognition from state and federal organizations as the standard for counselor training positions CACREP as a national model for counselor education programs. As such, this book uses a CACREP lens as the framework for providing TMH instructional information in relation to the core curriculum and specialization areas. The hope is that instructors may discover ways to weave TMH content into some of these areas without having to add an additional class in TMH to an already robust curriculum. While the CACREP standards have been included as I discuss each strategy, it may be helpful for the reader to have them available as a reference throughout their reading.
Prior versions of CACREP standards, specifically the 2009 and 2016 standards, do not mention the prospect of providing counseling via technology (CACREP, 2009; 2015), despite the National Board for Certified Counselors (NBCC) publishing Ethical Standards for Web-based Counseling in 1997 (NBCC, 1997). The Center for Credentialing and Education (CCE) began providing Distance Counselor Certification (DCC) in conjunction with Ready Minds in 2004 (Shafer & Clawson, 2007). Despite these long-running developments within the profession, CACREP does not yet require counselor education programs to provide instruction in TMH.
There was no mention of technology, distance counseling, or digital delivery in the 2009 CACREP standards. The word “technology” only began to emerge in the 2016 CACREP standards, specifically, Standards 2.F.1 (Professional Orientation), 2.F.4 (Career Development), and the specialization curriculum standard 5.B.3 (Career Counseling) all mention technology (CACREP, 2015). Concerning career development, “technology” primarily referred to obtaining career information online, as opposed to providing counseling via technology. Beyond these three mentions of technology, no other references to “technology” or “digital delivery” are mentioned in the 2009 and 2016 standards.
The use of “technology” and “digital delivery” is addressed more frequently in the 2024 standards, but CACREP fails to require direct instruction in TMH. Standard 3.D.5 (Professional Orientation) requires that programs provide instruction on the “application of technology related to counseling” and uses the phrase “across service delivery modalities” at least twice (CACREP, 2023, p. 14). CACREP’s directive to provide instruction on counseling across delivery modalities and on the application of technology to counseling signifies that counselor education programs should provide instruction to counselors-in-training (CITs) in both F2F and TMH modalities. While these cues are not explicit, they acknowledge the infusion of technology into the profession and the emergence of multiple counseling modalities. Throughout the book, I specifically cite CACREP standards and strategies to support the instruction of TMH in the core curriculum or specialized content areas.
Teaching Framework
CACREP’s use of the phrase “across service delivery modalities” references the provision of counseling services. Instructors also provide training across delivery modalities. The pandemic changed many higher education institutions. Universities that operated primarily in an on-campus modality implemented significant changes to instructional methods. Many counselor education programs traditionally taught on campus had to quickly pivot to online modalities (Coker et al., 2021). Some state education departments provided concessions for online education and online supervision (e.g., New York Department of Education, 2020).
Programs used different strategies to train counselors, such as technological software, to enhance counseling instruction (Chen et al., 2021). Much of the research from this period focuses on how education programs transitioned to online teaching and the mechanisms used to make that transition. Less research has been focused on how these education programs train students to use technology in TMH practice.
Today, instruction for CITs occurs via multiple modalities, including on-campus classrooms (sometimes called “bricks and mortar” or “on-ground” settings), virtual synchronous classrooms, virtual asynchronous classes, as well as hybrid and residential models that combine these modalities. TMH training for CITs must reflect the technological diversity with which it is delivered in the classroom.
On-Campus Classroom Instruction
Instructors who teach on campus have ample opportunity to teach and assess F2F counseling skills but will need access to additional technologies to adequately train and assess TMH skills. Lectures and didactic instruction can be delivered through traditional classroom methods, yet the practice and modeling of TMH will require supplemental technology. Universities may have access to technologies such as a learning management system (LMS) (e.g., Canvas, Blackboard, Google Classroom) or videoconferencing tools (e.g., WebEx, Teams, Zoom) that may not be available in agencies or smaller professional development training settings. Conversely, training offered through agencies or private practices may utilize turnkey or proprietary software (e.g., Simple Practice, TheraNest) unavailable to academic institutions. CITs will need access to platforms that allow them to learn, view, and demonstrate skills in video conferencing, phone, message, and email counseling. Using secure and encrypted technology, these platforms should allow them to practice their skills with mock clients or peers. The capacity to record, store, save, and transmit secure videos of students’ mock counseling sessions is helpful. Yet, institutions need secure, multifactor authentication devices to store, submit, or send these recordings. Alternatively, instructors can utilize real-time observations via technology or view recorded videos with CITs in a shared location.
Online Synchronous Classroom Instruction
Instructors who teach in online synchronous settings can train and assess students in TMH, specifically in synchronous TMH counseling. Lectures and didactic instruction can be delivered via synchronous instruction methods. Videoconferencing tools used to provide synchronous instruction, such as WebEx, Teams, and/or Zoom, may also be utilized to practice TMH skills, assuming they are secure and encrypted. Often, these tools provide options for video conferencing and chat, two modalities regularly utilized in TMH. In addition, the video component can be turned off to simulate telephone counseling while maintaining a secure connection without having students use personal mobile phones. Video and audio functionality can be turned off/muted to simulate chat-only sessions. Online synchronous instructional formats present a perfect opportunity to discuss and model online counseling skills. Instructors can model TMH skills in real-time during synchronous classes with volunteer students as mock clients. For effect, instructors can advise all other students to mute themselves and turn off their cameras while “pinning” the instructor and volunteer video to the screen, thus simulating the observation of a two-person TMH session. In addition, students can pair off into breakout rooms to conduct mock counseling sessions, where they can practice TMH skills; the instructor can drop in to observe sessions while muted and with their camera off for minimal distraction. While the online synchronous class is not a counseling group, it provides many tools and opportunities to simulate virtual group counseling. As discussed above, the capacity to record, store, save, and transmit secure videos or engage in real-time observation is helpful.
Online Asynchronous Classroom Instruction
Teaching TMH in purely an online asynchronous modality can present some challenges, particularly without the opportunity for real-time observation. For lecture and didactic instruction, instructors can post mock video and audio recordings or chat transcripts of TMH sessions to model ethical and effective TMH practice. To assess students’ TMH skills, video and audio recordings of sessions should be submitted by students in alignment with the security and encryption features discussed above. Since the option for real-time observations or viewing recorded videos in a shared location is not an option in asynchronous settings, the capacity to record, store, save, and transmit secure videos of their counseling sessions is essential. Many online asynchronous programs utilize a residency or hybrid component; in this case, educators can utilize on-campus meetings or online synchronous instruction to provide training in the TMH practice.
Email Counseling
This brings me to the challenge of training students in email counseling, regardless of classroom setting. Email counseling is an asynchronous modality for TMH counseling utilized by some practitioners. In a TMH setting, counselors who use email counseling should utilize secure, encrypted email, using the address for client communication only. When training CITs in email counseling, instructors should use caution when students utilize their school or personal email, which could create a permanent record that can be accessed long after the class ends. Even though instructors often use “mock” clients during training, these mock clients may include peer students who share low-level personal concerns that are nonetheless confidential. Instructors need to utilize the same caution in disposing of these mock email transcripts as they would with actual client records, and all parties should understand that email leaves a digital footprint. An alternative to using actual email would be to use a word processing document to record the written dialogue, simulating back-and-forth email communication. This document would be sent back and forth between mock clients and counselors via a secure platform such as an LMS. Like recordings, the document needs to be appropriately disposed of after the course’s conclusion.
Counselor-in-Training (CIT) Audience
Instructors come from various walks of life and hold different positions within the field. Some instructors hold positions as counselor education faculty at institutions of higher education. These positions include full-time, adjunct, clinical, teaching, tenure-track, and/or tenured faculty. We often think of counselor educators training master’s or doctoral-level students in graduate counseling programs. Faculty may also teach associates, bachelor’s, or continuing education students in courses leading to a different degree, such as a bachelor’s in human services, or certification, such as a credential in addictions or peer counseling. Students in counselor education doctoral programs may be practicing instructors. Other instructors are not affiliated with institutions of higher education but instead work as professional trainers. Individual service agencies or large organizations may employ trainers focused on professional development. Still, other instructors may be practicing clinicians or supervisors charged with training other practitioners. Regardless of the setting or position, instructors (including counselor educators, faculty, trainers, and supervisors) who train counselors may be responsible for TMH training. Instructors often have experience in their area of instruction. Counselor educators have experience as professional counselors and may be required to hold a counseling license or certification to teach. However, depending on the area and setting in which they practiced, they may or may not have experience with TMH. As emphasized in Chapter 1, they need to have a foundational understanding of TMH before training others.
CITs, like instructors, come from various walks of life. This book uses a CACREP lens to create a teaching framework best aligned with master’s training. However, as discussed above, CITs may be students at any educational level or professional counselors receiving additional training and continuing education. Like instructors, CITs may have extensive or limited experience with TMH. Many people desire to become professional counselors because they have benefited from professional counseling. Yet, their own personal counseling experience may not have included TMH either. In March 2020, during the onset of the COVID-19 pandemic, as we transitioned to online instruction and TMH practice, I remember some of my students resisting the transition to TMH. Their thought of seeing clients over a computer screen was not in their vision of counseling and not within their comfort zone. Fast-forward to March 2024, when most of my students who elected to share their own personal counseling experiences indicated that those occurred via TMH. CITs come to training with varying degrees of TMH comfort. Our goal is to meet them where they are and engage them in learning.
Understanding Andragogy
Counselor training typically occurs with adults. Whether providing instruction in a master’s level CACREP program, bachelor’s level instruction, or continuing education certification, the CITs are typically out of high school and often have completed a minimum of a bachelor’s degree. Most would be classified as adults or young adults, yet CITs often include career changers and older adults transitioning to a new career. Unfortunately, many teaching and training approaches utilize pedagogy, the lens of instructing children and adolescents. How is teaching and training adults different from teaching and training children? More specifically, how do we most effectively teach TMH to adult CITs? Since most counselor training programs are graduate programs aimed at adult learners, Malcolm Knowles’s concept of andragogy can be utilized for TMH instruction. Defined as “the art and science of helping adults learn,” andragogy focuses on providing strategies to engage adult learners, as opposed to pedagogy aimed at children and adolescents (Knowles, 1975).
Andragogy embraces the needs of adult learners through four primary principles. The first is that learning should be self-directed. In general, graduate work is often driven by self-directed personal motivation, as opposed to legal mandate or parental pressure. This concept of self-direction is easily adapted to master’s and doctoral-level training programs motivated by the individual’s personal goals. Concerning TMH training, instructors should seek opportunities to provide self-directed learning when possible.
The second component of andragogy suggests that adult learners draw from their experiences when they approach learning, as suggested in my earlier commentary on students’ familiarity and comfort with TMH. Instructors should seek opportunities to engage students’ TMH experience in their learning while also providing practice TMH experiences for them to assess and evaluate. Providing ample practice with TMH during their training expands their lived experience with TMH, even in mock settings, and supports their learning.
The third principle states that adult learning occurs when there is a need for information. With the rapid increase of TMH practice, instructors can help CITs recognize the need to develop ethical and effective practice skills. More often, when CITs approach their fieldwork experiences, they will be challenged to engage in TMH practice. Those who have not had TMH training and practice throughout their education should not be learning these skills for the first time with actual clients and students in their fieldwork. Thus, the need to learn TMH concepts must be addressed before they meet with the public.
Finally, Knowles posits that adult learners prefer immediate learning application (Knowles, 1975). Regarding TMH training, instructors should provide timely opportunities for CITs to practice their acquired TMH skills and opportunities to use TMH in different modalities and settings, such as video, phone, chat, and email. Another component of immediate application is timely feedback. It is essential that CITs receive timely feedback on their TMH learning and have opportunities to correct any deficits and improve their practice.
This book will provide instructors with critical content, case studies, and lessons on the instruction of TMH, referencing adult learning while seeking to infuse andragogical concepts. By doing so, I hope the instruction you provide to CITs will be impactful, relevant, and sustained as they continue from the classroom into their TMH practice.
