Text therapy: New platforms spark questions

Several companies have developed Web-based platforms designed to connect prospective therapy clients with a professional via text messaging. However, many questions arise for consumers and psychologists as these companies promote this new way of engaging in therapy. Here are several considerations for psychologists and the public.

Several companies have developed Web-based platforms designed to connect prospective therapy clients with a professional via text messaging — generally referred to as “text therapy.” However, many questions arise for consumers and psychologists as these companies promote this new way of engaging in therapy.

APA does not have an official position on text therapy as a standalone modality of treatment. Psychologists and the public should consider several factors when thinking about whether this is an appropriate approach to care.

At this point, there is no research suggesting that texting alone is an effective modality for psychotherapy. Several studies and meta-analyses have found support for the use of a variety of technologies for delivering psychological services. For instance, the presentation of sequenced Web-based modules targeting a specific problem and involving periodic contact with a therapist can be helpful in reducing mild to moderate depression or anxiety. Yet we are not aware of studies specifically examining texting alone.

Research also supports using text messaging as an adjunct to an ongoing professional relationship to reinforce desired behaviors — for example, texting to prompt regular exercise or to make a social connection. So, texting itself could be very useful, although the research is still emerging on the best use of such technology.

Additionally, APA’s Guidelines for the Practice of Telepsychology recommend that, when possible, psychologists meet new patients for a face-to-face meeting before delivering services via technology to determine whether a particular technology is appropriate for the particular patient and his or her presenting concerns. The text therapy platforms generally are solely text-based and therefore do not allow for an initial face-to-face meeting. At this point, specific procedures for determining appropriateness in the absence of a face-to-face meeting are not available.

Psychologists will also want to consider security and safety issues when providing therapy via text. Before engaging in a text-based relationship, psychologists should ensure that they have procedures in place to protect the security of all information exchanged via text. Considerations should include whether the technology is compliant with both the Privacy and Security Rules of the Health Insurance Portability and Accountability Act (HIPAA) and the platform’s ability to verify the patient’s identity. Further, communication via text may not be synchronous; for example, there is a delay in when a message is sent versus when it is read. A psychologist’s response time therefore may be delayed, making it crucial for him or her to have processes in place in the event of a clinical emergency.

Potential consumers of text-based therapy are often eager to participate as texting could reduce barriers to care. For those who are “digital natives,” texting is an everyday form of communication.

However, consumers need to understand just what they will get with many of these web-based platforms. Before signing up, potential consumers should carefully read the terms and conditions for the product and fully understand the potential limitations of the platform.

Consumers should know the level of training and experience of potential therapists as well as whether those therapists are licensed. Licensure protects potential consumers and ensures that providers meet the minimum level of education and training in their discipline. It also ensures that consumers have recourse if problems in treatment emerge. Consumers need to know that providers must be licensed in the jurisdiction where the consumer is located, and making that determination may be harder to do online.

Finally, psychologists and the public need to be aware that text therapy is not currently reimbursable by government or private sector payers.

These are just a few of the considerations for both psychologists and potential consumers to consider when confronted with using new technology for delivering care.