But, much like the technology, the research is still new—and there is a lot science doesn't yet know. In a systematic review of the research regarding the effectiveness of online counseling published in the Journal of Technology in Human Services, the authors concluded that the overall quality of the studies is poor and stressed the need for further research to support the widespread implementation of this form of mental health service delivery. Even less is known about the effectiveness of text-based therapy, even when it's positioned as “coaching” rather than “counseling.”

According to the American Psychological Association's most recent practice update regarding text-only platforms, “There is no research suggesting that texting alone is an effective modality for psychotherapy.” Additionally, based on five years' worth of health and productivity outcomes data from EAP participants, CuraLinc Healthcare has observed that virtual counseling, while effective, is less impactful than in-person counseling.

Similarly, many mental health experts have noted significant limitations to telebehavioral counseling. The Telehealth Certification Institute, the only organization authorized by the National Board of Certified Counselors to provide the training required for a licensed clinician to become a Board Certified Telemental Health Provider (BC-TMF), cautions clinicians of the following drawbacks of distance counseling:

• The difficulty of completing an accurate risk assessment
• The challenge of intervening during a crisis
• The contraindication of distance counseling for clients with (or at risk for) suicidal thoughts, homicidal thoughts or psychosis
• The difficulty of verifying a client's identity
• The tendency of some clients to present differently online than in person
• The challenge of establishing rapport
• The effect of disinhibition on counselor listening and attending skills with certain clients
• The problem of clients changing therapists too soon, or seeing multiple counselors at a time
• Technical problems or limitations that distract or interfere with the effectiveness of counseling
• The limitations of written language (text, chat or email) that can be easily misinterpreted, especially when asynchronous

The final drawback is particularly concerning, since the design models of many new entrants into the mental health ecosystem are based on communicating through asynchronous chat. Consider the case of a program participant who experiences a mental health crisis such as suicidal thinking. After sending a message to a counselor or coach within the program, the individual may need to wait several hours to receive a response, and even after the message has been received, there may not be an avenue for the counselor or coach to evaluate the client in “real time.”

Fortunately, it's possible to assess whether telebehavioral counseling is an appropriate avenue for care prior to the first session, and, more importantly, to provide guidance and navigation to a more suitable care option, when appropriate. While this is an ongoing challenge for many technology-based behavioral health providers, an employee assistance program (EAP) that offers technology-based access to clinical resources—in addition to providing mental health advocacy and in-person counseling—can ensure that all participants are connected to the right type of care, the first time they use the program.

When an employee or family member reaches out for help with a mental health issue, an EAP with the proper clinical construct will always start with a comprehensive clinical assessment. If the participant is considering counseling by video, phone or live chat, a licensed clinician can first assess the participant for fit—and then provide education regarding the advantages and drawbacks of each option. In this manner, an EAP can ensure that only individuals who are appropriate for telebehavioral counseling—and who understand the potential risks—are referred to these services. Others can be steered to more clinically-appropriate treatment options, such as in-person counseling.

Virtual counseling is a widely accepted form of treatment for common mental health concerns, and is also an important design element of an employee assistance program. With over 123 million Americans living in Mental Health Professional Shortage Areas, providers must make care accessible through a variety of channels. That said, an EAP that offers technology-based counseling as an integrated component of its suite of services expands the footprint of mental health and has the highest likelihood of engaging participants in a manner that is both personally and clinically relevant.

Read more:

• Coming soon: Onsite behavioral health clinics
• Employer-sponsored benefits and the fight to improve mental health
• Recognizing employee barriers to mental health services

David Pawlowski joined CuraLinc Healthcare as the director of clinical operations in 2014 and was promoted to vice president of administration in 2016.  He is a licensed clinical professional counselor (LCPC) in the state of Illinois with 19 years of experience in the mental health field, including over 15 years in employee assistance.  He is also a certified employee assistance professional (CEAP), whose expertise is the in the creation and delivery of advocacy-based employee assistance program (EAP) models. In his role as vice president of administration, he oversees the delivery of all clinical and organizational services for CuraLinc's EAP and integrated behavioral health clients.