Digital Private Practice: The Clinicians Perspective

BACKGROUND & PURPOSE

Up to 70 percent of incoming social work students describe themselves as interested in pursuing a career in clinical psychotherapeutic direct practice. This notion, coupled with the rapid expansion of Direct to Consumer Telemental platforms (DTCT) suggests that in order to pursue a private counseling practice, social workers will become conversant in pursuing new clients in digital spaces. Since 2012, private for-profit companies, operating predominantly as technology startups whose product is therapy, rather than as therapists using a technology channel for service delivery, have sprung up to exploit the lack of comprehensive coverage for mental health services. These digital platforms enable clinicians to deliver mental health treatment by phone, video conferencing, email and sms/text message.

METHOD

An interpretive phenomenological approach was used to gather and analyze data from 30 social work clinicians. Participants were recruited from major telemental health platforms such as 3 Cups of Tea, TalkSpace and Better Help. All of those in our sample are currently engaged with delivering psychotherapy on third party platforms at the time of their interview. A focus group member checking process was utilized to verify the author’s interpretation of the major themes in the corpus of interviews.

RESULTS

Two central themes emerged as a result of these transcripts: the affordances for clients and practitioners of the DTCT model and a spirit of pioneering and entrepreneurship across the clinical practitioners. Affordances, described in the literature as opportunities for action that objects, events, or places in the environment provide for users, is not a regular part of the social work vernacular, but in analyzing the interview data, it is clear that clinicians see the opportunities and challenges afforded by third party platforms. They discuss the anonymity of virtual practice both as a benefit which speeds disclosure and embraces populations averse to treatment (the socially anxious, batterers, philanderers, and pedophiles to name a few), and as a liability. Practitioners engaged as providers of mental health services on platforms identify themselves as pioneers—and they articulate ideas about entrepreneurship, innovation, and client access as well as an impatience with professional support structures that have been slow to evolve. Most describe a completely new counseling economy, with rigid expectations of productivity and response time, demanding compensation models and shifting business models, most of which discard professional autonomy.

CONCLUSION

Direct to Consumer Telemental Health (DCTH) services have expanded dramatically in the last decade. Distance delivery of psychotherapy is not new. Indeed the history of delivering remote health services is over 100 years old. However, the expansion of private third-party providers, who operate as profit making bodies, fundamentally alters the relationship between therapist and client. Telemental Health will continue to alter the marketplace for mental health services, as nonprofits add these forms of access to their menu of services, and for-profit players devise models to maximize earnings, for the 70 percent of social work graduates wishing to enter private practice, we would do well to equip them with the knowledge and skills to practice in digital spaces.