Texting in Mental Health Treatment: LCSW Standards of Practice

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Laura Groshong, AM, LICSW, the Policy & Practice Director of the Clinical Social Work Association (CSWA), wrote an article entitled, LCSWs and the Use of Texting in Mental Health Treatment, with co-author Margot Aronson, LICSW, CSWA’s Policy & Practice Deputy Director. The article explained the LCSW standards of practice in providing text therapy. They allowed Telebehavioral Health Institute (TBHI) to obtain a copy of the article and share to the TBHI Blog.

LCSW Standards of Practice

The use of ongoing asynchronous texting changes the process of therapy for LCSWs. The therapeutic alliance is significantly different when the primary means of communication is not direct ongoing communication between the client and therapist, as the asynchronous method of communication tends to preclude in depth exploration of emotional understanding. Further, a key part of psychotherapy, the “frame”, is lost if client and therapist text and reply at different times, or if the client is limited – as with some agreements – to making and receiving two texts a day to a therapist five days a week.

LCSWs base their understanding of a client on a biopsychosocial assessment, leading to a diagnosis. ASWB Technological Guidelines (2015) identifies additional factors that may contribute to determining whether a client is suitable for text therapy: age, technological skills, disabilities, language skills, cultural issues, and access to emergency services in the client’s community. How does the platform provide for assessment? Can you ensure that our standards of practice will be upheld by the texting platform?

When more intensive treatment is called for, will the platform respect and support the licensed provider’s clinical judgment? LCSWs know that a client with a psychotic disorder, an autistic spectrum disorder, or an acute episode of depression or anxiety may need in-person communication or hospitalization. Are there contractual provisions for such a situation?

This is Part 1 of the 2-part blog series. You can also read Part 2 below:

Ethics of Texting: Do’s and Don’ts

Explore clinical, legal & ethical requirements for text messaging with clients & patients.

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