Best Practices by Natalie Jambazian, MFT Intern

To Talkspace or Not to Talkspace: Is that the Question?

Since I received great attention following the last article I wrote, I decided to further my investigation on platforms used for telehealth purposes because I believe it merits more in depth exploration. First I will discuss the risks because as clinicians, we must act in the best interest of our clients.

In investigation, I discovered important facts that may be helpful in your decision making process of whether using telehealth, specifically, Talkspace will work for you and your practice. There hasn't been much evidence to prove text messaging or video conferencing alone is a great modality to provide psychotherapy. The Board of Behavioral Science defines telelehealth as, "the use of any online device such as any means that is over the internet, by phone, or electronic means." Platforms such as Talkspace have been highly criticized because the methods of communication used are, via text messaging, voice, or video calls to provide therapy are not the most effective or confidential.

Privacy Policy
I reviewed a link on Talkspace's "terms of use" and under privacy it reads "You affirmatively consent to the fact Talkspace's Clinical Oversight Personnel will, as needed, review your particular "Session Transcripts" or "Rooms" in a de-identified "Safe Harbor" form.

Does that sound like confidentiality, which holds to our commitment to provide confidentiality in the best interest of our clients? This appears to say that any Talkspace employee can access the conversation a clinician has discussed with his or her client? Hmmm.

To learn more about the Talkspace client "terms of use" refer to https://talkspace.com/public/terms and https://www.talkspace.com/public/privacy.

One of my resources mentioned an incident in which a young woman shared about a drunken family member driving her child while under the influence. Under normal circumstances as mandated reporters we are required to report such an incidence. When using Talkspace, a clinician does not readily have access to his or her client's demographic information so in the instance the need to report arises, the clinician would need to obtain client information from a Talkspace representative.

Similarly, Talkspace policy indicates, for a client who reveals he or she has a suicidal ideation, the therapists must encourage the client to call a suicide hotline, 911, or head to the nearest hospital. Here the responsibility appears to fall on the suicidal client and the risks fall on the therapist. I believe these are factors clinicians must consider when contemplating using such a service to determine if the guidelines of these platforms align with the mission or commitment to service of his or her practice. From my last article I did state the benefits of the platform, which seemed to be benefitting clients such as low cost therapy, as well as dealing with anxiety and the stigma attached to therapy.

Research Study
In an interview with CEO of Talkspace Mr. Frank stated, "Talkspace has done a pretty big study around all the major conditions and actually found that our clinical efficacy is indistinguishable from traditional face to face therapies in all of these conditions." However, I haven't found sufficient evidence to support his statement.

Talkspace conducted a study in which, 63 client users were invited by his or her Talkspace therapist to participate in a study in which they would receive services between 3 and 4 months. Following the services, the participants were asked to complete a survey which as how he or she remembered feeling before they started using Talkspace versus how her or she felt at currently. The study measured the impact texting had on the "reduction symptoms, the quality of the relationship individuals built with their therapists, the cost-effectiveness of Talkspace services in comparison to traditional therapy, the ease of accessibility to get therapy, and the satisfaction with Talkspace's services as a whole." The results indicated participants felt better using text therapy than before, the low cost provided better satisfaction compared to the cost of traditional therapy, and the overall feedback about Talkspace in general was, "it was more reliable, affordable, and people get the help they need in the moment." However, I have concerns about the efficacy of the study as the participants were selected by therapists rather than a random selection made to deter the possibility of coaching; thereby tainting the outcome of the research. In addition, the study included only 63 participants over three or four months, which appears to be a limited sample and timeframe to yield the most valid results.

Boundaries of Competency
Apparently the way the service works, the back office employees of Talkspace, assign each client to a therapist. My concern is with such a random process of connection there does not appear to be any consideration for whether that therapist has the necessary skills to work with that particular client. For instance, will they connect a person with an eating disorder with a clinician for whom eating disorders is outside his or he scope of competency; bring me back to my previous point, we are to work with the best interest of our clients at the forefront of our service. Aren't we supposed to meet the standard of care by assessing to see if we have a strong competence in the area in question. I see this principle at work often on Facebook groups where clinicians refer clients out to a colleague because he or she may not have strengths in the areas the client needs help. We do this for the benefit of the client. Some LMFT's specialize in couple's therapy while others specialize in trauma. You can't possibly have enough time to do research or consult when you have a short amount of time to chat with the client via text. Although I learned that representatives from Talkspace do, in fact, ask the clients questions before matching with him or her the therapist. However, I am curious how effective their match methods are. I have yet to use Talkspace myself to determine the effectiveness of their matching process.

So hopefully here you have learned more about the pros and cons of Talkspace of which I imagine there are many, some of which I have not even covered. But even more, I wonder how many us can see the benefits as well as still have questions as to how effective this new-age method of delivering therapeutic services may be. Hmmmm . . . To Talkspace or Not to Talkspace, still remains the question.

References:
http://www.prnewswire.com/news-releases/new-talkspace-study-reveals-effectiveness-of-delivering-therapy-via-text-messaging-300104890.html.
https://talkspace.com/public/terms.
https://www.talkspace.com/public/privacy.

Natalie Jambazian is a Marriage and Family Therapist Registered Intern working in private practice under the supervision of Anita Avedian, LMFT, CAMS IV. Natalie is currently an Anger Management facilitator through Anger Management Essentials and NAMA facilitating groups in Sherman oaks and Glendale. Anger Management 818 accepts both volunteer and court ordered clients, In addition, Natalie works with children, teens, and adults and her specialty includes but not limited to anger management, ADHD, PTSD, divorce, and grief. Natalie has received training in NLP, CBT, Mindfulness, and Trauma Focused Therapy. She is fluent in Armenian as her second dialect and can be reached at 818.334.8786 or via email at www.therapywithNatalie.org, Please visit her website at www.Angermanagement818.com.