A Telepsychology Casebook is a book published in 2018 by the American Psychological Association (APA) “…to help psychologists understand how standards of practice apply to telepsychology and to offer ways in which psychologists may think about ethical decision-making regarding their movement into telepsychology.”  It is edited and written primarily by former members of the APA Telepsychology Task Force represented by the APA, the APA Insurance Trust (now The Trust), and the Association of State and Provincial Psychology Boards who jointly developed the APA telepsychology guidelines adopted by the APA in 2013. Telepsychology is broadly defined as the provision of psychological services using telecommunications. 

The eight telepsychology guidelines discussed in the book include: competence of the psychologists, standards of care in delivery of telepsychology services, informed consent, confidentiality of data and information, disposal of data, information and technologies, testing and assessment, and interjurisdictional practice.

Each of the guidelines are given a separate chapter that follows a similar format: a guideline, a rationale for the guideline, a brief discussion of the guideline, and multiple case examples or scenarios showing how to interpret and use the guideline in different settings and circumstances. Key points are listed at the end of each chapter that highlight important takeaways to consider. A helpful copy of the telepsychology guidelines is also included as an appendix. 

Although earlier telepsychology guidelines had been developed by psychologists in Australia, United Kingdom and Ohio prior to those of the APA, this publication takes the APA guidelines an important step further by demonstrating how they are applied in practice. This book is useful in identifying that to practice telepsychology ethically (i.e. compliant with the APA code of ethics), psychologists need to be prepared by not only knowing how to do in-person services but also how to apply the same ethical standards when providing services using telecommunications.  A key guideline relevant to this issue is the first guideline, competence of the psychologist.  Since many practicing psychologists have not had education, training or

supervision in telepsychology practice, it is critical that to develop competency in telepsychology, they should obtain sufficient training before delivering telepsychology services.  Hopefully, in the future such education and training will be incorporated in graduate psychology curriculums and newly licensed psychologists will have the knowledge and skills to practice telepsychology.  Until then, most psychologists and psychologists in training will need to develop their own personal telepsychology educational and training plans.

This is not a “how to” book.  Psychologists are provided a good framework and numerous examples to consider when developing or practicing telepsychology.  Questions about the uses of specific technologies (e.g. teleconferencing, social media, email, texting) in specific circumstances (e.g. type of service, type of presenting problems) will at times require further education, consultation and maintaining awareness of what are evolving best practices. 

This book is not only for psychologists who are already practicing or plan to practice telepsychology but can also be helpful for psychologists who may not believe that they are practicing telepsychology.   Many psychologists whether they know it or not have been practicing telepsychology for years.  Communicating with clients via landline or cell phones is a form of telepsychology and commonly is used by psychologists who may be primarily doing in-person services.  

Reading this book is a good first step in sensitizing psychologists to the numerous issues that need to be considered when practicing telepsychology.  It presents a clear framework outlining what psychologists need to know and do to ethically practice telepsychology and can be used to plan and obtain the needed education, training and experience.

*Reprinted with permission from the March/April 2019 issue of The National Psychologist

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A recent publication* describing a study of 82,501 pre-installed software programs (apps) on 1,742 Android smartphones found that many apps secretly collected user data that was transmitted to the app developers. This included such things as user contacts, emails, telephone metadata, geolocation information, and other user statistics.  

*the article, An Analysis of Pre-Installed Android Software,  can be accessed at https://www.ftc.gov/system/files/documents/public_comments/2018/08/ftc-2018-0052-d-0036-154998.pdf

Child Anxiety as a Mediator of the Relationship between Caregiver Anxiety and Child Somatization in Youth with Functional Abdominal Pain Disorders

By: Sarah Love, Psy.M. 

Functional abdominal pain disorders (FAPD) are common pediatric pain conditions that often present with co-occurring anxiety. When youth with FAPD also present with comorbid anxiety, they may experience more adverse outcomes such as increased pain, disability, and somatization (Mahrer, Montaño, & Gold, 2012). Parents of children with abdominal pain often report higher levels of anxiety than parents of children without abdominal pain disorders (Hodges, Kline, Barbero, & Woodruff, 1985; Walker & Greene, 2013). It remains unknown how parent and child anxiety cumulatively influence outcomes in youth with FAPD. The study sought to examine the role of caregiver distress (e.g., stress, anxiety, depression) and child anxiety in relation to child pain-related outcomes (e.g., pain level, functional disability, and somatization). It was hypothesized that higher levels of child anxiety and caregiver distress would be related to poor child outcomes (e.g., pain, somatization, and functional disability). It was also hypothesized that child anxiety would mediate the relationship between caregiver distress and pain-related outcomes in youth. Participants included 96 children and their caregivers presenting to gastroenterology clinics at Cincinnati Children’s Hospital Medical Center as a part of a larger study (Natoshia Cunningham, Ph.D., PI). Youth completed the Screen for Child Anxiety Related Disorders (SCARED; Birmaher et al., 1997),the Functional Disability Inventory (FDI; Walker & Greene, 1991),the Visual Analog Scale (VAS; McGrath et al., 1998) and the Child Somatization Inventory (CSI; Walker et al., 2008). Caregivers completed the Depression Anxiety Stress Scale (DASS; Henry, & Crawford, 2005).

Correlations were conducted to examine relationships between caregiver distress (e.g., stress, anxiety, and depression), child anxiety, and child pain-related outcomes (e.g., pain, somatization, and functional disability). Pearson correlations revealed that both caregiver anxiety (r = .22, p < .05) and child anxiety (r = .26, p < .05) were positively associated with child somatization. It was also found that caregiver anxiety and child anxiety were significantly correlated with one another (r = .25, p < .05). Child anxiety, but not caregiver anxiety, was significantly correlated with child functional disability (r = .23, p < .05). The other caregiver variables (caregiver stress and depression) were not associated with the child outcome variables.

Based on the correlation findings, a mediation model was tested to explore if child anxiety mediated the association between caregiver anxiety and child somatization.  When both child and caregiver anxiety were included in a model, the effect of caregiver anxiety became non-significant (b = .642, p = .14), while the effect of child anxiety remained significant (b = .224, p = .04). Additional testing suggested that child anxiety is trending as a mediator of the relationship between caregiver anxiety and child somatization in youth with FAPD (Sobel Test = 1.54, SE = .14, p = .06). Therefore, assessment and intervention focused on reducing child anxiety may be particularly beneficial to improve somatization in youth with FAPD. Future research would benefit from assessing if psychological interventions targeting pain and anxiety in youth also simultaneously reduce somatization in this population.

The Ohio Board of Psychology is periodically informed about confusion or misunderstandings regarding rules. One misunderstanding is the belief that if a psychologist, as a client, discloses an apparent serious violation of the Board’s law or rules within a professional psychological relationship, the treating psychologist must violate confidentiality and report the violation to the Board. The frequently referenced but periodically misunderstood rule is OAC 4732-17-01:

(K) Aiding illegal practice:

(4) Reporting of violations to board. A license holder who has substantial reason to believe that another license holder or psychological or school psychological supervisee has committed an apparent violation of the statutes or rules of the board that has substantially harmed or is likely to substantially harm a person or organization shall so inform the board in writing; however, when the information regarding such violation is obtained in a professional relationship with a client, the license holder shall report it only with the written permission of the client. Under such circumstances the license holder shall advise the client of the name, address, and telephone number of the state board of psychology and of the client’s right to file a complaint. The license holder shall make reasonable efforts to guide and/or facilitate the client in the complaint process as needed or requested by the client. Nothing in this rule shall relieve a license holder from the duty to file any report required by applicable statutes. This rule requires license holders to report apparent misconduct to the Board, and a release is always required if the information is obtained in a professional relationship. Otherwise, reporting to the Board would be a violation of the client’s right to hold and assert the privilege. There should be no confusion that this does not change when the client is another psychologist. Notwithstanding mandatory reporting laws (e.g., duty to warn, protecting children from abuse and neglect) psychologists shall not violate the confidentiality of their clients. It is therefore a misconception when psychologists believe that they do not have the exact same right to confidentiality and privacy as any other person. The importance is magnified when services are sought from another psychologist and presenting problems relate to professional practice issues or possible impairment. Drug and alcohol abuse, impaired judgment, and boundary violations should be—and are—safe topics about which psychologists should seek consultation and interventions without worrying about the Board being notified.

It is possible that the misconception is rooted in a misunderstanding about the context in which apparent violations are learned. The first sentence of the rule seems absolute (“shall so inform the board in writing”) although it is qualified with the second part of the sentence, “however, when the information regarding such violation is obtained in a professional relationship with a client, the license holder shall report it only with the written permission of the client.”

Help-seeking can be difficult enough under optimal conditions, and nothing should ever prevent a psychologist from receiving confidential psychological services or other healthcare services under the same conditions afforded to anyone else. To the degree that there is any chilling effect in the community of psychologists rooted in misunderstandings, our hope is that this clarification will be reassuring to psychologists as both service providers and as prospective service recipients.

*Ohio Board of Psychology, November 8, 2018

Sandra (Sandy) L. Shullman, PhD, a Columbus, Ohio consulting psychologist internationally known in leadership assessment and development, has been elected 2020 president of the American Psychological Association. Dr. Shullman is a partner in the Columbus, Ohio, office of the Executive Development Group, and manages large, long-term global organizational client engagements, focusing on executive education and coaching, strategic leadership development and organizational diversity initiatives. She has served two terms on the APA Board of Directors and seven years on the board of the American Psychological Foundation. She chaired the APA Good Governance Project, designed to align the organization with strategy and values, promoting transparency, engagement, inclusion and nimbleness at APA. She is a past president of the Ohio Psychological Association. Her distinguished record of organizational leadership spans higher education, research, health care and consulting. Dr. Shullman holds a bachelor’s degree in mathematics from Dickinson College, a master’s in education from Harvard University and a PhD in counseling psychology from The Ohio State University.

*Editor’s Note(s):  Excerpted from an American Psychological Association news release