Is it Beneficial, Ethical or Practical to use Skype for Sport Psychology Consultations?

One of the top Google searches related to finding sport psychologist provision is “sport psychologist near me” (Google Ads, UK, Keyword Planner Search, February 2019) however not every athlete, coach or parent is within a commutable distance to their nearest sport psychologist. This is one of many contributing factors that are leading more and more consultations to take place over videoconferencing technologies such as Skype, Facetime or other VOIP (voice over internet protocol) platforms. And with mass media publications such as the New York Times dedicating articles to this trend under titles such as “When Your Therapist Is Only a Click Away”, one might expect more and more non-athletes and athletes to consider this method for accessing psychological services.

How is it defined?

Teletherapy, or telepsychology, be it by email, webcam, text message or smartphone, has existed in one form or another for more than 20 years (Novotney, 2017). The proposed benefits of these methods of accessing psychological therapies include the convenience of scheduling an appointment and talking with a therapist from the privacy of one’s own home (Hanrahan & Andersen, 2010), as well as accessing particular services from rural or remote geographies, or for elite athletes away in other parts of the country or abroad training and competing (Cotterill & Symes, 2014). For ease of discussion, all references to sport psychology provision via Skype, Facetime or other VOIP services will henceforth be referred to as ‘videoconferencing’. The wider category of ‘teletherapy’ includes other technologies such as email and text message.

What is the evidence behind it?

The first long term study investigating teletherapy took place in 1996 and lasted over a decade. Researchers in Amsterdam examined the effects of online cognitive behavioural therapy (CBT) for a variety of mental health disorders, conducting 9 controlled trials with 840 participants (Ruwaard, Lange, Schrieken & Emmelkamp, 2011). These studies suggested that online CBT is a viable and effective alternative to face-to-face treatment. In a more recent APA article reviewing the literature around teletherapy by Novotney (2017), it was noted that studies indicate “telemental health is equivalent to face-to-face care in various settings and an acceptable alternative” (p.48). It is worth noting that a majority of the studies (which can be accessed herefrom the Telemental Health Institute) only used videoconferencing as the teletherapy variable. Despite the growing evidence base from clinical psychology, there has yet to be any studies that have attempted to assess the effectiveness of online delivery within the sport psychology domain.

What are the ethical considerations?

In the third edition of the British Psychological Society’s (BPS) practice guidelines, there is a section dedicated to the considerations around delivering psychological support through videoconferencing. These include:

• Ensure that the network which is used is as secure as reasonably possible, and, as far as is feasible, assures privacy to their clients.
• Utilise ‘fit for purpose’ VOIP systems (such as Skype) opposed to public networks, such as social media sites (such as Facebook).
• Ensure that any media used to communicate personal data is secure.

In a recent article entitled ‘Sport Psychology in a Virtual World’, Cottrell, McMillen and Harris (2018) also added the following key recommendations and notes:

• Ensure one understands the technology to be incorporated in the consultation, as well as the ability to utilise that technology effectively as a part of service provision.
• For some athletes, technology serves as a significant contextual factor in their experiences (e.g. eSports athletes).
• Ensure steps are taken to protect the confidentiality of online or technology-based sessions. This information can be successfully addressed during the informed consent process.
• Remain aware of any additional persons who might be out-of-sight of the video camera or in close proximity of the athlete(s).

What are the practical considerations?

An article in the Sport & Exercise Psychology Reviewby Cotterill and Symes (2014) note a number of practical considerations to be aware of when using videoconferencing with athletes. These include:

• This service provision relies on having a good internet connection and when the connection is slow it can make for a disjoined conversation, and a frustrating experience for the client.
• Time differences (if a client is in another country) must also be considered, as this can make for some unorthodox consulting hours.
• While many clients are likely to own a laptop, they might not always have this device on them when needed, therefore a phone conversation may take precedent.

Bringing it all together

With technology and smartphones becoming more ingrained in modern society, such devices and videoconferencing may become more prevalent in all types of service provision, including psychology and sport psychology services. Whilst there is a growing evidence base for clinical psychology provision through teletherapy and videoconferencing, there isn’t currently a similar evidence base in the sport psychology domain. Practitioners should also heed the advice of the BPS (or the applicable local accrediting body) when considering ethical issues such as security, privacy and confidentiality. Furthermore, the sport psychologist must be aware of practical considerations such as internet speed, videoconferencing quality, and the time zone of the athlete. If sport psychology practitioners are utilising these technologies with their clients, they might do well to consider the following advice from Watson, Schinke and Sampson (2015) in their book chapter ‘Ethical issues affecting the use of teletherapy in sport and exercise psychology’. That is, to consider the client’s needs, interests and circumstances, juxtaposed with the ability of both client and practitioner to communicate effectively using the technology in question.