Innovative Methods

The Regulation of Technology-Assisted Distance Counseling and Supervision in the United States: An Analysis of Current Extent, Trends, and Implications
Charles R. McAdams III & Kristi Lee Wyatt
Counseling licensure boards report emerging needs to regulate technologyassisted distance counseling and supervision. An analysis of published regulations and telephone interviews with board administrators nationwide suggests that boards agree generally on 7 aspects of technology-assisted distance practice that need to be regulated. Nevertheless, boards are disparate and often polarized in their views regarding the extent and type of regulation needed for each aspect. Current trends may have important implications for counselor education, supervision, and practice.

Recent advances in electronic telecommunications technology have begun to change the face of professional counseling practice and supervision (Abney & Maddux, 2004; Heinlen, Welfel, Richmond, & Rak, 2003). Activities that once required counselors and clients or supervisors and supervisees to be in the same physical location can now be conducted from remote locations through electronic audiovisual media. Applications of electronic telecommunication in counseling and supervision practice seem to be increasing, as evidenced by a proliferation of new terms to describe them. These terms include (but are not limited to) psycho-technology (Maheu, 2003), telehealth (Barnett & Scheetz, 2003), e-therapy (Castelnuovo, Gaggioli, Mantovani, & Riva, 2003), and e-supervision (Dudding & Justice, 2004). For clarity in the following discussion, technology-assisted distance counseling (TADC) and technology-assisted distance supervision (TADS) are the respective terms applied to the use of electronic telecommunications technology in providing counseling and supervision services to consumers who are not in the same location. Collectively, such services are referred to as technology-assisted distance practice (TADP).

TADC
Layne and Hohenshil (2005) have emphasized that TADC can extend counseling services to individuals in rural and hard-to-reach areas who may otherwise be unable to access such services. Similarly, TADC
Charles R. McAdams III and Kristi Lee Wyatt, Department of Counselor Education, College of William & Mary. Correspondence concerning this article should be addressed to Charles R. McAdams III, Department of Counselor Education, School of Education, College of William & Mary, PO Box 8795, Williamsburg, VA 23187 (e-mail: crmcad@wm.edu).
2010 by the American Counseling Association. All rights reserved. Counselor Education & Supervision March 2010 Volume 49 179

can make counseling services available to those who are physically or psychologically unable to leave their homes or travel (Ragusea & VandeCreek, 2003). Clients who are wary of being stigmatized as mentally ill may be more likely to access mental health services when they know that those services can be provided in the privacy of their own homes through TADC (Rees & Stone, 2005). Nevertheless, along with the assets of TADC are some potential liabilities. The therapeutic alliance between counselor and client has been considered central to the therapeutic process (Rees & Stone, 2005), yet questions remain as to whether an adequate therapeutic alliance can be established when the counselor and client are not in the same physical space (Chester & Glass, 2006). Critics contend that communication through electronic media may limit counselor access to the clients full range of nonverbal cuescues that have been considered to be an essential source of information in traditional therapeutic models (Alleman, 2002). Additionally, these critics contend that the loss of nonverbal information may increase the likelihood of inaccurate diagnosis and treatment that, in turn, will increase risks for serious mental health crises requiring more direct and intensive counselor intervention than distance counselors may be able to provide (Abney & Maddux, 2004; Alleman, 2002). Threats to the condentiality of electronically transmitted client information remain another area of concern, especially in the case of small counseling practices where access to the most secure (and costly) encryption systems may be unfeasible. Technology experts warn that even encryption-protected telecommunications systems remain highly vulnerable to intrusion and that cybertheft has reached epidemic proportions (Andert & Burleson, 2005). Consequently, the potential benets of increased access to counseling through TADC must be weighed carefully against the potential risks for unauthorized access to condential counseling subject matter.

TADS
Watson (2003) has suggested that TADS could revolutionize counselor supervision by making it more accessible and convenient. Counselors who serve rural communities often have limited access to regular supervision and must expend considerable time and incur considerable travel costs to receive it (Kanz, 2001). TADS could alleviate the problems of both supervision cost and accessibility for rural counselors by affording them electronic access to qualied supervisors in almost any location and by eliminating travel restrictions. TADS could also benet counselors needing immediate supervision or consultation in crisis situations, where waiting for a supervisor to travel to the crisis location would not be practical or in the best interest of the client. Through TADS, counselors could have access to real-time supervision from experts in specic clinical issues, regardless of where those experts might reside. As with TADC, however, TADS is not without liabilities. Vaccaro and Lambie (2007) discussed problematic aspects of TADS, citing foremost its restriction of nonverbal cues and the consequent risk of misrepresented communications between a supervisor and
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supervisee. Threats to the condentiality of sensitive information are a concern in the provision of TADS, as are issues of legal responsibility for services provided across state lines or otherwise different legal jurisdictions (Kanz, 2001). The inability of distance supervisors to physically assist their supervisees in a crisis response is considered by some critics to be unacceptable, and as with TADC, the practice of TADS challenges traditional beliefs about the importance of immediate physical proximity between participants in a clinical relationship. Clinical supervisors have ultimate responsibility for the welfare of clients served by their supervisees (American Counseling Association [ACA], 2005; National Board for Certied Counselors [NBCC], 2005). As such, the degree to which the potential liabilities of TADS pose a direct or indirect threat to client welfare warrants thorough examination.

Purpose of the Study

Despite ongoing philosophical debates about the legitimacy of TADP, there is evidence to suggest that it is inexorably tied to the future of the counseling profession. Wells (2008) reported that a majority of Americans are now likely to consult online resources before pursuing ofine resources when seeking solutions to health problems. Accordingly, online counseling resources have burgeoned, with Google Internet searches for the keywords online counseling and online clinical supervision yielding millions of results (Wyatt & McAdams, 2009). The Journal of Technology in Counseling began publication in 1999 as a scholarly journal devoted entirely to the provision of timely and topical information about the convergence of technology and the counseling eld (Jencius & Baltimore, 1999, para. 1). In 2007, the American Distance Counseling Association (ADCA) was formed as an independent professional organization to promote safety and condence in counseling treatment on the Internet and through phone services (ADCA, n.d., para.1). Finally, both ACA (2005) and NBCC (2005) have published ethical guidelines for TADC practice. In response to these developments, some states have independently enacted regulations specic to the governance of TADP; however, the establishment of consistent regulation nationwide has been recommended to ensure that technological innovations in mental health practice do not surpass the capability of independent regulations to both safeguard public interests and minimize legal and ethical risks to TADP providers (Alleman, 2002). As a rst step in developing its own well-informed and consistent response to the emergence of TADP, one state counseling board (on which the rst author is a sitting member) endorsed the current investigation into the extent and nature of TADP regulations that are in place and proposed in other states across the nation. Specically, the study sought to identify the states in which TADP was formally being regulated, the specic aspects of TADP that were being regulated, and the degree to which existing TADP regulations were distinct from regulations for traditional counseling practices. It also sought to assess current trends in thinking among policy makers that will shape TADP regulation in the future.
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Method
Participants and Procedure Using contact information obtained from ACA (n.d.), we began the investigation by examining the ofcial websites of all state boards of counseling in the United States for existing and proposed regulations pertaining to TADP. State boards of counseling were dened as the state government agencies responsible for the licensure and certication of counselors throughout the United States (American Association of State Counseling Boards, n.d.). Currently, there is one board for each of 49 states and the District of Columbia governing practice in mental health counseling, marriage and family counseling, school counseling, rehabilitation counseling, and/or substance abuse counseling specialty areas. (Note. Californias Licensed Professional Clinical Counselor Act [2009] was enacted after the current study was conducted.) As an exploratory activity, the website search parameters were broadly dened, such that states having any legal statutes governing the use of electronic technology to conduct distance counseling or counseling supervision were designated to be states in which TADP is being regulated, regardless of the extensiveness of the statutes or the particular specialty area to which they applied. All existing and proposed TADP regulations found on the websites were copied and included as data for subsequent analysis. It was anticipated that the website information would not always be current, would sometimes be unclear and require further interpretation, would exclude regulations under discussion or undergoing legislative approval, and would offer limited insight into boards general views regarding the legitimacy and future of TADP. Consequently, we conducted follow-up interviews, via telephone, with state board representatives to verify the accuracy and comprehensiveness of website information. Because the boards varied widely in size and conguration, it was not possible to identify agency representatives to interview on the basis of a particular job title. Alternatively, we requested to speak with the board representative who would be most likely to have broad knowledge of his or her boards regulations as well as an awareness of relevant board initiatives under consideration but not yet enacted. This request produced a nal participant group of 46 representatives, one from each of 46 boards (92%), and included 19 executive directors and 27 individuals bearing a variety of titles related to board administration (e.g., board administrator, administrative assistant to the executive director or board). Four boards did not respond to our request for an interview. A semistructured protocol was used in the telephone interviews. Accordingly, we asked participants to respond to a set of four standard questions but invited them to offer any additional information they believed to be relevant. After ensuring that the participants understood the purpose of the study and their rights as voluntary participants, we informed them that a preliminary search of their website had been conducted and briefed them on our current understanding of their respective boards existing and proposed regulation of TADP. For TADC
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and TADS separately, we then asked them (a) to describe additional regulations (if any) that were not currently displayed on the website, (b) to describe new regulations (if any) that had been approved by the board but that had not yet been enacted into law, (c) to describe new regulations (if any) that were currently under consideration by the board, and (d) to elaborate generally on the boards expressed views regarding the legitimacy of TADP and the degree to which it has or will become a priority for board consideration. Interviews were typically 15 to 20 minutes in duration, and participant responses were recorded in notes taken during the interview. Analysis We analyzed data from the website search and follow-up interviews collectively using descriptive (quantitative) and exploratory conceptual content (qualitative) analysis methodologies. Descriptive analysis involved assigning participants boards to one of ve groups: (a) those with formal regulations in effect, (b) those with regulations not yet in effect but in some stage of formal development, (c) those with regulations under discussion but not yet in the formal development stage, (d) those prohibiting TADP altogether, and (e) those for whom issues of TADP had not been discussed. This process produced a statistical prole of the extent to which TADP is currently being regulated across the country. Exploratory conceptual analysis involved three levels of data coding as described by Hahn (2008). The rst level involved open coding (Hahn, 2008, p. 6), wherein we reviewed the website and interview data for words and phrases that distinctly related to TADP and labeled them according to their expressed meaning or emphasis. At the second or focused coding (Hahn, 2008, p. 7) level, we sorted data having the same or closely related labels into groups and labeled each group according to the shared meaning or focus of the data within it. At the third or axial level (Hahn, 2008, p. 7), we reviewed the focus of the data within the groups and rened group labels as necessary to clearly reect their distinctive thematic content. To set aside personal judgments in this process, we each maintained a reexive journal that documented our own reections during the interviews. After our personal perspectives were thus bracketed, we searched for themes in the participants responses. This analysis produced a conceptual prole of current thematic trends in TADP regulation and gave insight into participants prevailing views about TADP and anticipated future trends.

Results
Extent of Regulation The current extent of TADP regulation is summarized in Table 1. From the table, it can be seen that less than a third of the participants states had existing regulations in place for TADC, and only 13% had regulations in place for TADS. Even smaller percentages of states fell into the category of having TADC and TADS regulations not yet in effect but in formal stages of development or legal ratication. A considerably greater percentage of participants reported that TADC and TADS were
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TABLE 1 Current Extent of Technology-Assisted Distance Counseling (TADC) and Technology-Assisted Distance Supervision (TADS) Regulation (N = 46)
TADC Extent of Regulation Regulations were in place Regulations were under development Regulations were under discussion TADC and TADS were prohibited as illegitimate activities TADC and TADS had not arisen as issues No. of States 14 5 15 10 2 % 30 11 33 22 4 6 4 14 19 3 TADS No. of States % 13 9 30 41 7

topics under discussion by their boards but not yet to the point of proposed regulation. The majority of remaining participants reported that TADC and TADS regulation had been discussed by their boards and were subsequently prohibited as illegitimate activities. Only 2 participants reported that TADC had not yet arisen as a problem or issue of board discussion; 3 reported the same for TADS. Trends in Regulation Conceptual analysis of published regulations and telephone interviews with board administrators nationwide found that boards agreed generally on seven aspects of TADP that need to be regulated. Nevertheless, boards were widely disparate and often polarized in their views regarding the specic extent and type of regulation needed for each aspect. Current trends were dened as those views that were incorporated or supported by a majority of participating boards. They are presented in Table 2. The level of regulation refers to the degree to which boards considered TADP as being in need of regulation independent of regulation already

TABLE 2 Current Trends in Regulation of Technology-Assisted Distance Practice (TADP)

Aspect of TADP Regulation Level of regulation Limits of authorization Legal accountability Specialized training Informed consent Standards of practice Reimbursement Current Trend Toward regulating TADP as a specialty area with skills that are distinct from traditional counseling and supervision Toward limiting TADP to special circumstances or conditions Toward requiring licensure in all states where TADP is practiced Toward requiring specialized preservice training for TADP Toward citing additional TADP risks in existing (rather than independent) informed consent documentation Toward incorporating American Counseling Association (2005) and National Board for Certied Counselors (2005) ethical standards for TADP as state standards Toward ensuring comparable reimbursement for TADP and traditional practices

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enacted for traditional counseling and supervision. Approximately 20% favored minimal levels of independent regulation, viewing TADP as merely another context for counseling and supervisory activity that should be subject to existing rules and laws. The remaining majority favored greater levels of independent regulation, viewing TADC and TADS to be specialty areas that are clearly distinct from traditional counseling and supervision practices, respectively. The most stringent level of regulation was reported by a single board, in which TADC and TADS each required specialized certication with independent standards for preparation and practice. Limits of authorization describe the degree to which boards permitting TADP believed that it should be limited to special circumstances or conditions. Limits ranged from unconditional authorization in which TADP was considered to be acceptable under all circumstances appropriate for traditional practices to conditional authorization in which it was restricted according to specied criteria or contingencies. A majority of boards (60%) supported conditional authorization, restricting TADC to situations in which distance or other hardships would prevent service delivery through traditional means (e.g., geographical isolation, physical inability to travel, unavailability of qualied providers of needed clinical service) and TADS to a limited percentage of total supervision requirements. Suggested limits ranged from 10% to 50%. The issue of legal accountability for the conduct of TADP was reported to be a major concern for all boards. Concern centered on the difculty in determining and enforcing legal accountability for TADP involving constituents from multiple legal jurisdictions (e.g., counselors or supervisors in one state conducting TADP with clients or supervisees, respectively, in another state). For some boards, the complexity of the issue was reported as the primary reason for their decision to summarily prohibit TADP. In states where TADP was permitted, current and proposed regulations ranged from a broad requirement to meet legal requirements of any jurisdiction in which an electronic presence is maintained (40%) to more specic standards requiring licensure in each state where TADC is practiced (60%). No existing regulations specic to legal accountability for TADS were found. All interview participants voiced pessimism about their boards capacity to effectively monitor services delivered via electronic means and detect rule violations, especially when the services were delivered across state lines. It was their general conclusion that the effective regulation of TADP will require an unprecedented level of collaboration among states regulatory and law enforcement agencies. Despite its being a common topic of board discussions, few boards had formally addressed the issue of specialized training as a prerequisite for TADP. Specically, only one had enacted a formal requirement for preservice training specic to TADC practice; it required advance board approval of all such training without specifying minimal standards for its content and method of delivery. No formal requirements were found pertaining to specialized training in TADS. Views on the issue of training tended to generally coincide with views on the level of TADP regulation determined to be necessary. Boards viewing
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TADC and TADS as specialized skills tended to favor requirements for specialized training, whereas those viewing them only as specialized contexts maintained that existing training requirements ensured sufcient preparation. There seemed to be general agreement that obtaining consumers informed consent specic and prior to the delivery of TADP services is a necessity. The topic was addressed in the regulations of most states that had TADP regulations and was of reported concern for all representatives. Even boards favoring a minimal level of independent regulation for TADP emphasized the need for practitioners to ensure that consumers served through TADP are intellectually, physically, and emotionally able and willing to use computer applications and that they understand the purpose and operation of those applications. Some boards favoring greater levels of regulation also favored more formal written assurances that consumers are aware of the specic risks associated with TADP, such as electronic breeches of condentiality, the potential for service disruptions because of power outages or technical failure, and the increased likelihood for community service involvement in clinical crisis response at remote locations. Nevertheless, boards favoring more regulation were among the minority in this study, with only two boards requiring consumers to complete a separate informed consent form for TADC prior to engaging in it. Counselor adherence to ethical standards of practice in the delivery of TADC service was of concern to every board that had authorized it, and all boards cited the current ACA (2005) and NBCC (2005) standards specic to TADC as their criteria for evaluating ethicality. Attention to standards of practice in current regulations ranged from the inclusion of a general requirement that counselors comply with the ACA and NBCC standards (60%) to the explicit requirement that those practicing TADC submit a formal, detailed plan that delineates how the standards will be met (5%). A parallel need for standards of practice in TADS emerged frequently as a topic during interviews; however, no formal standards of practice specic to the ethical delivery of TADS were found in existing regulations. Ensuring the establishment of appropriate reimbursement practices for TADP was reported as a topic of discussion by the majority of respondents from boards that had enacted or considered regulation. Nevertheless, the development of formal regulations pertaining to TADP fees for service had occurred in only a small minority (5%) of states and only for TADC. The lack of consensus among both researchers and practitioners regarding the comparability of TADP and traditional, in-person counseling and supervision was cited as a primary concern. Participants in the interviews emphasized that consensus on fees for TADP was impossible when board members themselves varied widely in their views regarding its legitimacy and, thus, its reimbursement value. Difculties in standardizing fees across widely varied geographical contexts were also reported to be a major challenge. As a likely result, the few regulations that have been enacted require independent board approval of each TADC providers reimbursement rate. Under those regulations, reimbursement rates for TADC are to
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be comparable with those for in-person services, with appropriate adjustments anticipated to account for costs of telecommunication and the elimination of travel expenses. Prevailing Views It was in their responses to the nal interview topic (general board views about the legitimacy of TADP and its future development) that participants reected the greatest level of board consensus, regardless of their boards current level of regulation. First, the majority of respondents agreed that interest in TADP is likely to increase dramatically in the coming years, given that strides in electronic technology further improve capabilities to enable real-time audio and visual interaction between people in different geographical locations. Even those boards that currently prohibit TADP seem to agree that requests for it are not likely to diminish in the future and that all states will eventually have to deal with the issue of TADP regulation. Several participants reported that their boards current regulations prohibiting TADP were only intended as stopgap measures to protect public interests until a better informed response to the issue was possible. Others reported that the issues had been presented for discussion on one or more occasions, only to be tabled when it became apparent that there was no hope of reaching consensus at that time about how to address them. They attributed their difculties to the fact that proposing regulation for TADP results in a clash between equally viable philosophical and practical interests in the profession. For proponents, TADP achieves the desirable goal noted previously of making clinical services more available and affordable to remote geographical locations; for critics, it violates the traditional notion of what being present with a counseling client or supervisee minimally requires. In this study, there was only one view with which all participants agreed unquestionablythat TADP is an extremely complex issue for which no singular or standardized regulation may ever be completely appropriate.

Discussion and Implications

The ndings of this study conrmed that TADP is considered a pressing issue among the majority of mental health boards in the United States, with only 5 participants reporting that their boards had not found the need to discuss or act on issues related to its practice. Whereas TADC has received greater emphasis than TADS in existing regulations, TADS is a common area of concern and has been prohibited altogether in more states than has TADC. From the results of the study, it was not possible to designate either TADC or TADS practice as the most pressing concern; rather, ensuring the ethical and responsible delivery of both TADC and TADS seems to generally be of balanced concern to regulatory boards across the nation. Boards in favor of TADP regulation seem to generally agree on the particular aspects that are most ethically and legally challenging. Their views on how to best respond to the challenges, however, tend to be polarized between those who view TADP as requiring new, distinct skills
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and those who view it as simply another context in which traditional counseling and supervision skills are now being applied. Although resolving the disparity in these views will be necessary for consistent regulation, the task may be difcult, in that it will require resolution to a long-standing philosophical debate regarding the necessity of having immediate physical proximity between a counselor and client or supervisor and supervisee (Alleman, 2002; Rees & Stone, 2005). This debate notwithstanding, the current results revealed a preference among most boards for limiting the use of TADP to a percentage of overall services or to only those clients with restrictions from receiving traditional services. They, thus, gave evidence of a current national trend toward the designation of TADC and TADS as practices having substantive differences from traditional counseling and supervision, respectively. The trend has important implications for the future of counselor education and counseling practice. Counselor Education As noted previously, demands for TADP are expected to increase dramatically as real-time visual and auditory interaction between counselors and clients in different locations become increasingly accessible through advanced electronic technology. Consequently, counselor education programs must begin to consider the inclusion of material in their courses and curricula that prepare students to effectively apply approved telecommunications technology in counseling service delivery. At the entry level (masters degree), introductory courses to the counseling profession and professional counselor role should routinely inform students about TADP as an option that may be available to them. Student counselors should be well informed of the potential opportunities TADP affords them as well as the risks associated with engaging in TADP given the current absence of clear ethical and legal guidelines. Perhaps most important, students must be made aware of the need for ongoing vigilance for changes in understanding TADP and for regulation that could expand or restrict the present scope of what is considered acceptable practice. Experiences through which students can examine the current trends in TADP along with their associated ethical and legal liabilities should be integrated into all courses relating to ethics and professional counselor identity. Activities in these courses could also include having students explore and report the existing standards for TADP in the specic states where they intend to reside. Basic counseling techniques classes are a potentially appropriate venue for introducing student counselors to the range of distance counseling methodologies available; advanced techniques classes as well as practicum and internship could afford them the opportunity to practice those technologies in a supervised laboratory setting. Given its recent evolution and limited application, TADP may be no more familiar to many experienced doctoral students than it is to beginning masters students. As a result, doctoral programs in counseling should be prepared to provide doctoral students with introductory learning experiences in TADP that are similar to those
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described for the entry level. Such experiences might be provided in doctoral seminars in counselor education, whereby students would be informed of current methods and trends in TADP and then tasked with the critical examination of those methods and trends in the current professional literature. Seminars in counselor supervision could similarly promote doctoral students understanding and critical evaluation of TADS and, possibly, afford them an opportunity to practice it as student supervisors in laboratory experiences with masters students in their practicums or internships. As teaching assistants in masters-level courses that address TADP, doctoral students could acquire knowledge about both its practice and instruction through participation in course delivery with knowledgeable counselor education faculty members. Finally, doctoral students could be encouraged to both acquire and advance knowledge about TADP through their dissertation research. Counseling Practice and Supervision The initial stages in the development of any new clinical paradigm typically involve high levels of experimentation because practitioners within a new paradigm are not restricted by policies for best practice that necessarily emerge and restrict experimentation at later stages. TADP in its present form is no exception, with practitioners in some states being nearly unconstrained by formal regulation in the TADP methods they choose to use. In the absence of standardized guidelines for practice, it becomes the responsibility of all professional counselors and supervisors experimenting with the application of unregulated TADP to perform several necessary tasks to safeguard the welfare of those they serve. First, they must understand and assess the potential risks of TADP for each consumer and context in which it is applied. Diminished capabilities to ensure condentiality, observe nonverbal cues, and provide effective crisis management were named in this study as just some of the potential and variable risks that are inherent with any application of TADP. In the absence of guiding standards for risk management, the responsibility lies squarely with the individual practitioner to determine the specic nature and level of risks associated with each proposed TADP application and to carefully balance them against anticipated benets. Fulllment of this ethical responsibility to consumers requires that counselors and supervisors maintain a working understanding of current practices and emergent ethical and legal concerns in TADPa requirement that can only be met through ongoing attentiveness to current professional and research literature as well as to regulatory actions in their jurisdiction of practice. Maintaining an ongoing pursuit of knowledge and understanding about TADP is, thus, a second recommended task for those who are currently engaged in it. The third task for current TADP practitioners is to inform others in the profession as they encounter new innovations or unanticipated liabilities. The establishment of optimal best practice guidelines for TADP will rely on decision makers having an accurate understanding of what best practice in TADP actually entails. Through such means
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as professional publication, presentation at professional conferences, and participation on regulatory boards, current TADP practitioners can positively shape the future of such practice by ensuring that decisions regarding the regulation of TADP is fully and accurately informed.

Limitations and Recommendations

The findings of this study are subject to several primary limitations. The first is related to the lack of a consistent working definition of TADP. In the absence of a standardized definition, we defined TADP broadly in this exploratory study to maximize its inclusion of potentially relevant data. By applying such a broad definition, however, we could not answer questions about the specific nature and scope of technological applications in use. A second limitation is related to our inability to acquire a standardized research sample. Current state boards of counseling varied too widely in their organizational structures to accurately identify a sample of representatives with comparable responsibilities or job titles. As a result, our reported data were subject to potential bias resulting from variability in the participants positions and associated levels of access to information within the organization. Time sensitivity of the findings is a third limitation of this study. New TADP legislation that is being pursued in a number of states as well as ongoing technological advances will likely have altered or amended the findings by the time they are published and available to readers. The findings reflect the standing of TADP regulation in the United States as it was reported in mid- to late 2008. That standing may have changed in 2010. Despite these limitations, this study provides an early extemporaneous forum for counselors to explore and consider the uncharted territory of technology in the delivery of clinical practices. It also highlights the need for further research and the specific direction that such research should take. In general, research to advance electronic telecommunications capabilities has outpaced research in the social sciences to determine the utility of new capabilities for use in clinical settings (Alleman, 2002). Outcome studies are needed to demonstrate (or discount) the utility of various telecommunications technologies in counseling and to bring the profession together from its currently polarized positions on the TADP issue. Process studies are needed to help counselors better understand the ways that consumers of professional counseling services are being affected by specific technological applications and to shape the development of future applications. The primary responsibility and resources for research in counseling lie with counselor educators. The degree to which the future of TADP in the counseling profession is shaped by careful process and outcome research may depend on the degree to which counselor educators are willing to embrace the issue by designating it as a primary research priority.

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A Need for Collaboration

TADP stands to make professional counseling and supervision services more accessible and affordable and more in tune with changing trends in the way people are generally communicating and interacting in an electronic world. At the same time, it challenges the well-established conceptual foundations of traditional counseling and supervisory relationships and poses potential risks to clients and supervisees that were not previously at issue under traditional forms of clinical service delivery. At present, capabilities for applying technology in counseling and supervision clearly exceed understanding of its implications and, thus, the ability of counselors to ensure that its impact on consumers will be positive. A collaborative effort that promotes the sharing of experiences, ideas, and concerns among counseling practitioners, supervisors, educators, and lawmakers is needed to close this gap and establish fair and accurate guidelines for best practice in TADP.

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Heinlen, K. T., Welfel, E. R., Richmond, E. N., & Rak, C. F. (2003). The scope of webcounseling: A survey of services and compliance with NBCC standards for the ethical practice of webcounseling. Journal of Counseling & Development, 81, 6169. Jencius, M., & Baltimore, M. L. (1999). Welcome to a new vision for scholarly publication in counseling. Journal of Technology in Counseling, 1. Retrieved from http://jtc.colstate.edu/welcome.htm Kanz, J. E. (2001). Clinical-supervision.com: Issues in the provision of online supervision. Professional Psychology: Research and Practice, 32, 415420. doi:10.1037/0735-7028.32.4.415 Layne, C. M., & Hohenshil, T. H. (2005). High tech counseling: Revisited. Journal of Counseling & Development, 83, 222226. Licensed Professional Clinical Counselor Act, Cal. Bus. & Prof. Code 4999 (West, 2009), available at http://www.leginfo.ca.gov/index.html Maheu, M. M. (2003). The Online Clinical Practice Management Model. Psychotherapy: Theory, Research, Practice, Training, 40, 2032. doi:10.1037/00333204.40.1-2.20 National Board for Certied Counselors. (2005). Code of ethics. Retrieved from http://www.nbcc.org/AssetManagerFiles/ethics/nbcc-codeofethics.pdf Ragusea, A. S., & VandeCreek, L. (2003). Suggestions for the ethical practice of online psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40, 94102. doi:10.1037/0033-3204.40.1-2.94 Rees, C. S., & Stone, S. (2005). Therapeutic alliance in face-to-face versus videoconferenced psychotherapy. Professional Psychology: Research and Practice, 36, 649653. doi:10.1037/0735-7028.36.6.649 Vaccaro, N., & Lambie, G. W. (2007). Computer-based counselor-in-training supervision: Ethical and practical implications for counselor educators and supervisors. Counselor Education and Supervision, 47, 4657. Watson, J. C. (2003). Computer-based supervision: Implementing computer technology into the delivery of counseling supervision. Journal of Technology in Counseling, 3. Retrieved from http://jtc.colstate.edu/vol3_1/ Watson/Watson.htm Wells, A. T. (2008). A portrait of early Internet adopters: Why people rst went onlineAnd why they stayed. Retrieved from Pew Internet & American Life Project website: www.pewinternet.org/~/media//Files/Reports/2008/ PIP_Early_Adopters.pdf.pdf Wyatt, K. L., & McAdams, C. R. (2009). [The prevalence of technology-assisted distance practice in America]. Unpublished raw data.

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