Tele-Supervision: Ethical, Legal, and Clinical Aspects of E-Supervision

By Ofer Zur, Ph.D.


In recognition that TeleMental Health, Online Therapy or E-Therapy (the terms are interchangeable) is increasingly widespread and often a common part of providing psychotherapy in the 21st century, most professional mental health organizations have established guidelines for the ethical, legal and effective use of TeleMental Health and also for the closely related fields of E-Supervision, Tele-Supervision or Online Supervision (these terms are also interchangeable).
Conducting E-Supervision entails much more than simply setting up HIPAA compliant video-conferencing between supervisors and supervisees. An ethical and effective e-supervisor needs to:
  •  be familiar with the special intricacies of confidentiality and privacy that e-therapy and e-supervision entail;
  • discuss and solidify expectations with supervisees about meeting times, settings, and other formalities covering such things as appropriate attire and privacy of the environment;
  • decide on appropriate platforms that are clearly HIPPA-compliant;
  • have his or her own experience conducting e-therapy;
  • understand the special opportunities and difficulties of establishing a solid supervisor-supervisee e-therapy alliance;
  • understand the regulatory requirements of each state in which both the supervisor and supervisee are licensed;
  • discuss and identify whether supervision will be synchronous (essentially live and in the present) or asynchronous (for example, via email) or a hybrid;
  • look for and discuss confusion, apprehension, anxiety and/or unfamiliarity with various online technologies that are relevant for e-supervision and e-therapy;
  • discuss and implement effective feedback and outcome measures;
  • be familiar with the research on e-supervision regarding risks, limitations and effectiveness;
  • follow guidelines and regulations established by your state licensing board and professional association (i.e., APA, CAMFT, ASWB, ACA, NBCC) and be familiar with the guidelines of national telemental health organizations, such as the American Telemedical Association (ATA);
  • prepare a back-up plan in case of technology glitches or failures.
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