Question by Dr. Betty Scott Noble

I have a female client I have seen for several years (abusive marriage then divorce and a very recent re-marriage). She has moved with her new husband about two hours away and does all her work by computer, so she doesn’t come to Atlanta anymore. She asked if I could do “phone therapy” with her. I am guessing probably every other week (at the most) and once a month (at the least). She doesn’t use insurance. I would prefer that she just come down to Atlanta once a month, but she has two kids and a full time job, so it’s not so easy to do. I am guessing this “phone therapy” wouldn’t be for much longer, maybe just two to three times, but I’m not sure. Thanks for your input on this matter.

Response by Dr. Barnett

Hi Betty. Good questions. There are a few relevant issues. If this is just for a few sessions to tide her over until she can find a new psychologist in her local area or to help her with the transition to her new situation, and thus is time-limited, it is much more appropriate. If this is to be the primary form of treatment over an extended period of time it raises several concerns. Can telephone contacts replace in-person psychotherapy? A lot of that depends on the client’s treatment issues and needs. For some clients this may actually appropriately meet their clinical needs. For others it may prove insufficient. Doing a careful assessment is important and documenting all options considered and relevant factors, pros and cons, the rationale of your decision, and the actual decision. Then, you will want to be sure to fully address these issues in the informed consent process (an ongoing process where you address any significant changes to the treatment contract). It is also important to familiarize yourself with resources in the clients local area so you can access them or refer her to them should she experience an emergency. Since she’s two hours away and not 12 hours away for example, this may be less pressing an issue, but still important to address proactively. Also, since the client is still in the same state you don’t need to consider licensure issues; you’re not providing services across state lines. That could be problematic. But, even with that, two phone calls when a client is on vacation or on a business trip is very different than providing ongoing treatment via telephone (telehealth/e-therapy) across state lines.

I suggest discussing with the client her needs and her reasons for wanting this type of continued contact with you. If a call once or twice per month for a couple of months is all that is needed it should be less an issue than if this is ongoing treatment. But, any agreement struck with your client should also include what will happen if her treatment needs change. Initial agreements that sound reasonable at times need to change due to changing circumstances for the client. If she needs more intensive treatment will you provide her weekly telephone sessions for an extended period of time or will the agreement stipulate that she will then accept one of the referrals for in-person treatment in her local area that you provide to her?

These are some issues to consider. As always with ethical dilemmas there is no one right answer, but rather, several issues, factors, and options to consider. Also, closely monitoring the situation and having needed agreements in place are all important. I hope this is of help.

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Jeffrey E. Barnett, Psy.D., ABPP

Jeffrey E. Barnett, Psy.D., ABPP is a Professor in the Department of Psychology at Loyola University Maryland and a licensed psychologist who is board certified by the American Board of Professional Psychology in Clinical Psychology and in Clinical Child and Adolescent Psychology. Additionally, he is a Distinguished Practitioner in Psychology of the National Academies of Practice. Among his many professional activities, Dr. Barnett is a past chair of the ethics committees of the American Psychological Association, the American Board of Professional Psychology, and the Maryland Psychological Association. He previously served on the Maryland Board of Examiners of Psychologists and has been a consultant to licensing boards across a range of health professions. His numerous publications and presentations focus on ethics, legal, and professional practice issues in psychology. Dr. Barnett is a recipient of the APA’s outstanding ethics educator award.