Canadian Psychology / Psychologie canadienne © 2014 Canadian Psychological Association

2014, Vol. 55, No. 4, 291–302 0708-5591/14/$12.00 http://dx.doi.org/10.1037/a0038002

Toward Uniform Competency Standards in Telepsychology:

A Proposed Framework for Canadian Psychologists
Gerald R. Johnson
University of Calgary

As Canadian psychologists increasingly incorporate Internet-based technologies into their practice, they
are reminded that telepsychology—the application of technologies for the delivery of distance psycho-
logical services—requires special skills, knowledge, and judgment that extend beyond the core require-
ments of professional practice. However, what constitutes competence in both face-to-face and telepsy-
chology practice is still evolving in Canada. This article explores how the existing framework for
Canadian psychologist competence found in the Mutual Recognition Agreement of the Regulatory Bodies
for Professional Psychologists in Canada (Council of Provincial Associations of Psychologists, 2001/
2004), along with current research and other supporting documents in distance mental health, may serve
as a useful foundation for the development of uniform telepsychology competency standards across
Canada.

Keywords: competence, telepsychology, Canadian psychologists, Mutual Recognition Agreement, pro-

fessional practice

The use of technologies by psychologists to deliver tailored
psychological services and information over distance, also known
as telepsychology, is now seen as a viable alternative to traditional
face-to-face (F2F) therapy, and has generated a growing body of
research (Mallen & Vogel, 2005a) and increasing professional
consideration (Association of Canadian Psychology Regulatory
Organisations [ACPRO], 2011; Joint Task Force for the Develop-
ment of Telepsychology Guidelines for Psychologists [JTF],
2013). Mental health professionals who practice telepsychology
are now combining evidence-based psychological interventions
such as cognitive– behavioural therapy (CBT) with both traditional
distance platforms (e.g., telephony, King, Bambling, Reid, &
Thomas, 2006; videoconferencing, Simms, Gibson, & O’Donnell,
2011) and newer mobile health (mHealth) smart technologies that
can have synchronous (e.g., chat, cell phone), asynchronous (e.g.,
e-mail), social media, and videoconferencing capabilities all
within the same device (JTF, 2013; D. M. Kaplan, Wade, Conteh,
& Martz, 2011; Luxton, McCann, Bush, Mishkind, & Reger, 2011;
Maheu, Pulier, McMenamin, & Posen, 2012). Other emerging
technologies such as cloud computing and virtual reality (VR) are
also now starting to appear in telepsychology interventions
(Maheu et al., 2012) to help clients from diverse cultural back-
grounds (Choi et al., 2012) with a range of presenting issues (e.g.,
obsessive– compulsive disorder, E. Andersson et al., 2012; depres-
sion, G. Andersson & Cuijpers, 2009). Although F2F counselling
still remains the preferred medium of delivery for psychological
Special thanks to Dr. Faye Wiesenberg (University of Calgary, Faculty
of Education) for her expertise, feedback, and kind support in helping me
develop this article.
Correspondence concerning this article should be addressed to Gerald R.
Johnson, Education Tower 114, Graduate Programs in Education, Univer-
sity of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N
1N4. E-mail: johnsogr@ucalgary.ca or geraldao@hotmail.com
services (JTF, 2013; Kraus, 2010a), telepsychology is now seen as
a useful adjunct to F2F therapy (e.g., G. Andersson, 2010; G.
Andersson & Cuijpers, 2009) or as a stand-alone service in its own
right (Richards & Vigano, 2013), especially for clients who may
have difficulty accessing traditional F2F services (Mallen &
Vogel, 2005b) or those who prefer the convenience, privacy,
and anonymity afforded by distance technologies (Leibert,
Archer, Munson, & York, 2006). As both consumers and psychol-
ogists become more familiar with ethical guidelines and more com-
petent using distance technologies (Mallen & Vogel, 2005b; Simms
et al., 2011), and as the standard of efficacy research improves
(Proudfoot et al., 2011), telepsychology is projected to become an
important component of mainstream psychotherapy (Barak, Hen,
Boniel-Nissim, & Shapira, 2008). Perhaps the next significant mile-
stone will be the creation of uniform telepsychology competency
standards and a reliable assessment tool to establish professional
competency in the delivery of telepsychological services (Fang et al.,
2013). At present, there are concerns that, without proper telepsychol-
ogy competency standards, unlicensed mental health providers may
draw clients away in a consumer-driven market in which younger
generations appear to increasingly prefer online communications to
F2F contact (Maheu et al., 2012). Until telepsychology competence
standards are established, the public remains at risk for harmful
treatment from incompetent practitioners who, as Mallen, Vogel,
Rochlen, and Day (2005) have noted, may also misuse or misrepre-
sent psychological materials on the Internet. The purpose of this
article, then, is to set the groundwork for uniform competency stan-
dards in telepsychology by proposing a framework for Canadian
psychologists who wish to add telepsychology to their F2F practice.
Distance Mental Health in Canada
Although traditional forms of telephone counselling and tele-
medicine (i.e., via videoconferencing) have long been used by a
number of mental health professionals to reach clients in remote

291
292 JOHNSON
locations across Canada (Rojubally et al., 2013; Simms et al.,
2011), Internet-based distance interventions are still considered
part of an emerging practice that has varying degrees of profes-
sional regulation and guidance across Canadian provinces and
territories (Martin, Turcotte, Matte, & Shepard, 2013; Rojubally et
al., 2013). Both Canadian nurses and physicians, for example, have
national guidelines about the use of distance technologies to de-
liver telehealth information and services. These guidelines are
nonbinding, however, and do not spell out competency require-
ments (Canadian Nurses Association, 2007; College of Physicians
and Surgeons of British Columbia, 2013; Rojubally et al., 2013).
Similarly, social workers are also provincially regulated, but only
a few jurisdictions have specific guidelines about the use of
distance technologies for the delivery of mental health services,
and those that do, such as Newfoundland and New Brunswick,
have only limited guidance about required competencies for distance
practice (e.g., New Brunswick Association of Social Workers, 2010;
Newfoundland & Labrador Association of Social Workers, 2012).
Counsellors (a collective term used to describe clinical counsel-
lors, counselling therapists, mental health therapists, and psycho-
therapists, depending on the jurisdiction) are, at present, profes-
sionally regulated in only a few provinces. Thus, in most
jurisdictions, Canadian counsellors are without regulated profes-
sional competency standards when engaged in either F2F or dis-
tance practice (Rojubally et al., 2013).
Canadian psychologists may hence be in the best position to
lead the way in the development of uniform competency standards
in telepsychology. The practice of psychology is well-established
in Canada, with professional regulation in nearly all Canadian
jurisdictions (Truscott & Crook, 2004). There is also a growing
consensus that the delivery of telepsychological services needs to
be professionally recognized and regulated in the same manner as
F2F practice (Nicholson, 2011; Rojubally et al., 2013; Sinclair,
2011). At the provincial level, licensing bodies assume either a
default regulatory authority over the professional behaviour of
licensed members, including telepsychology (e.g., College of Psy-
chologists of British Columbia [CPBC], 2009; Ordre des psycho-
logues du Québec [OPQ], 2008), or regulate telepsychology
through explicit guidelines (e.g., College of Alberta Psychologists
[CAP], 2000). However, as with other Canadian health profes-
sions, provincial regulatory authorities do not describe standard
competencies needed for psychologists who engage in telepsychol-
ogy. At the national level, the Canadian Code of Ethics for
Psychologists (hereafter “Code”; Canadian Psychological Associ-
ation [CPA], 2000) acts as an umbrella standard for both F2F and
telepsychological services across a number of jurisdictions (e.g.,
College of Psychologists of Ontario [CPO], 2009; Psychological
Association of Manitoba [PAM], n.d.). Sinclair (2011) recognised,
however, that specific provisions are needed in future versions of
the Code to address the unique ethical and competency require-
ments of technology-mediated distance psychological services. In
another move toward standardization of telepsychology in Canada,
ACPRO introduced the Model Standards for Telepsychology Ser-
vice Delivery (hereafter “Model Standards”) in 2011 (ACPRO,
2011). To date, a number of provincial regulatory bodies have
officially adopted these standards to help guide and regulate psy-
chologists (e.g., CPO, 2011; PAM, 2012). According to ACPRO
(2011), a Canadian psychologist who delivers telepsychological
services would not only be subject to relevant regulations, stan-
dards of practice, and ethical requirements in the Code for F2F
practice, but also would need to be aware of the additional require-
ments and special competencies required for telepsychology prac-
tice. Crucially, however, ACPRO’s Model Standards do not de-
scribe what those competencies should be, presumably leaving this
responsibility to provincial licensing bodies. To gain a clearer
picture, then, about what competencies are required for Canadian
telepsychology, first we must examine what standard competen-
cies are needed by Canadian psychologists engaged in F2F prac-
tice, and then attempt to bridge these two areas of practice.
Psychologist Competence in Canada
The importance of psychologist competence is recognised in
both the Code and provincial regulatory standards. The Code
requires Canadian psychologists to benefit their clients and avoid
causing harm by only performing activities that are within their
professional competence (CPA, 2000, Standards II.6 and II.9). In
the same vein, provincial regulatory standards typically require
psychologists to limit their practice to the area in which they have
the appropriate education, training, and experience, and to main-
tain this competence through ongoing training (e.g., CAP, 2005;
CPBC, 2009; OPQ, 2008). What is specifically considered profes-
sional competence, however, remains elusive, despite recent inter-
est in this topic (e.g., Pope & Vasquez, 2010; Ridley, Mollen, &
Kelly, 2011; Rodolfa et al., 2013). Although there is broad con-
ceptual agreement that Canadian psychologist competence is, at
minimum, comprised of knowledge, skills, and judgment infused
with diligence (Truscott & Crook, 2004), there is also considerable
variability across Canadian provinces with respect to entry require-
ments for the practice of psychology, including titles, scope of
practice, education, and degree requirements (Cohen, 2009), thus
making it difficult to achieve uniform entry-to-practice and pro-
fessional competence standards (CPA, 2011). The Agreement on
Internal Trade (hereafter “AIT”; Internal Trade Secretariat, 2012),
a federal initiative to ensure broad professional mobility across
Canadian jurisdictions, further muddied the waters when it came
into effect in 1995 by emphasising cross-jurisdictional mobility
and simultaneously failing to address the disparities in professional
standards of practice between jurisdictions (Cohen, 2009; Hall &
Lunt, 2005).
The Mutual Recognition Agreement of the Regulatory Bodies
for Professional Psychologists in Canada (hereafter “MRA”;
Council of Provincial Associations of Psychologists [CPAP],
2001/2004) was introduced to harmonize psychology competency
standards across all provinces and territories (with the exception of
Yukon and Nunavut), and to fill in the gaps created by the AIT
(Cohen, 2009). The MRA considers (a) interpersonal relationships,
(b) assessment and evaluation, (c) intervention and consultation,
(d) research, (e) ethics and standards, and, in some cases (f)
supervision, and (g) administration from a practitioner-scholar
perspective (Gauthier, 2002), and, in this sense, mirrors the be-
havioural exemplar competence model of the Association of State
and Provincial Psychology Boards (ASPPB; Hunsley & Barker,
2011). The MRA does not, however, provide guidance about how
to acquire or evaluate professional competencies. Training and
continuing education programs are left up to each provincial
authority (Cohen, 2009; Hunsley & Barker, 2011). Although sub-
sequent amendments to the AIT and regional differences in the
 TOWARD UNIFORM COMPETENCY STANDARDS
application of the MRA may have eroded its practical effect as an
enforceable national standard (Cohen, 2009; R. Morris, personal
communication, August 27, 2014), the MRA does, nonetheless,
provide a useful framework of competencies that a Canadian
psychologist would need for F2F and, by extension, telepsychol-
ogy competence, regardless of jurisdiction of practice (Cohen,
2009; Hall & Lunt, 2005). The current MRA neither spells out
specific competencies required for telepsychology nor describes
how to acquire, measure, verify, and maintain these special com-
petencies. However, a telepsychology training program based on a
MRA-competence framework, supported by existing telepsychol-
ogy agreements (e.g., Model Standards, ACPRO, 2011), nonbind-
ing guidelines (e.g., Guidelines for the Practice of Telepsychology,
JTF, 2013; Ethical Guidelines for Psychologists Providing Psy-
chological Services via Electronic Media, CPA, 2006), and current
evidence-based research, would ensure that Canadian psycholo-
gists, regardless of their jurisdiction of licensure, would be com-
petent to meet the needs of the public (Cohen, 2012) when deliv-
ering telepsychology services.
A Telepsychology Competency Framework for
Canadian Psychologists
Before making the transition from F2F to telepsychology, psy-
chologists should have competence in both F2F and distance
techniques (CPA, 2006; Guidelines II.1 & II.2). A Canadian psy-
chologist wishing to deliver services via the Internet, for example,
would need to have undergone supervised training in online coun-
selling first (Mallen, Vogel, & Rochlen, 2005), in addition to
meeting the F2F psychologist competence requirements outlined
in the MRA. The standard proposed for telepsychology competence
is high, and would necessarily require considerable extra super-
vised training and practice above the F2F entry-to-practice stan-
dards already in place for Canadian psychologists. In each case,
the Canadian psychologist would need to transfer F2F competen-
cies into the telepsychology context, and acquire specialized skills,
knowledge, and judgment in ethics, interpersonal and cultural
competence, assessment, and evidence-based research that are
unique to telepsychology practice (ACPRO, 2011; Nelson, Thao,
& Velasquez, 2011).
It is beyond the scope of this article to provide comprehensive
guidelines for the psychologist who may be considering developing a
telepsychology practice. Instead, the reader is invited to study excel-
lent existing guidelines, such as the ASPPB and the American Psy-
chological Association’s Guidelines for the Practice of Telepsychol-
ogy (JTF, 2013), and the CPA’s Ethical Guidelines for Psychologists
Providing Psychological Services via Electronic Media (CPA, 2006)
for more detailed suggestions. Rather, what follows is a starting point
for identifying the main competencies required for an evidence-based
telepsychology practice in Canada using key sections of the existing
MRA (Interpersonal Relationships, Assessment and Evaluation, Inter-
vention and Consultation, Research, and Ethics; the category Super-
vision will not be included in this analysis; CPAP, 2001/2004) as an
inclusive framework for both professional F2F and telepsychology
competence. The details of this MRA-based framework are sum-
marised in Tables 1, 2, 3, 4, and 5, where they may be later used as
a foundation for the development of a standardized and scalable
telepsychology competency training and assessment program. Be-
cause this proposal is based on existing guidelines and research, it is
293
expected that the competencies identified in this article will necessar-
ily evolve with further discussion, technological developments, and
continued telepsychology research.
Interpersonal Relationships
The goals of telepsychology are the same as those of F2F
counselling: to help reduce crisis-induced stress and increase client
functioning through an effective psychologist– client working al-
liance (WA; Brown, 2012). As with the F2F WA, the quality of the
WA in technology-mediated distance relationships may predict
both increased compliance and the degree of therapeutic success
(E. Andersson et al., 2012). Clients may perceive few differences
when comparing the quality of the WA between F2F and telepsy-
chology interventions such as telephone counselling and videocon-
ferencing (Nelson et al., 2011), but may find the WA less satisfy-
ing in telepsychological interventions that have fewer visual or
auditory cues (e.g., Haberstroh, Parr, Bradley, Morgan-Fleming, &
Gee, 2008; King et al., 2006). To establish and maintain a
technology-mediated WA, the psychologist needs to develop an
online presence or telepresence (Fenichel et al., 2002; Mallen,
Jenkins, Vogel, & Day, 2011). Special competencies in technical
communication are also required when visual or auditory cues may
be diminished or absent in the delivery of telepsychological ser-
vices (Callahan & Inckle, 2012; see Table 1).
Telepresence. Telepresence is the ability of the psychologist
to engage the client with communications that are warm, smooth,
emotionally engaging, supportive, empathic, nonjudgmental, and
reassuring (Barak & Bloch, 2006; Hanley, 2012; Trepal, Haberstroh,
Duffey, & Evans, 2007), and to avoid fractured conversations or
communications that are too brief (Barak & Bloch, 2006). Good
telepresence helps to foster emotional bonding, a strong rapport,
and collaborative goal setting in the online WA (Castonguay,
Constantino, & Holtforth, 2006; Sucala et al., 2012). The psychol-
ogist should also develop the skills, knowledge, and judgment to
present himself professionally and be perceived by the client to
be credible (Haberstroh, 2010), and to know how to achieve
closure with communications (Trepal et al., 2007), give quality
feedback, and provide the appropriate follow-up (Haberstroh,
Duffey, Evans, Gee, & Trepal, 2007; Mallen, Vogel, Rochlen,
& Day, 2005).
Technical communication skills. Especially when visual or
auditory cues are minimal or absent, the psychologist must possess
technical communication skills that enable him to discern the
difference between crisis versus noncrisis situations and to respond
appropriately (Brown, 2012), to avoid misunderstandings (Brown,
2012; Suler, 2010), and to repair communications if they are
disrupted by technical or other failure (Haberstroh et al., 2007;
Ross, 2011). The psychologist is also required to competently use
questioning techniques (Mallen et al., 2011), textual devices (e.g.,
use of emoticons and punctuation; Fang et al., 2013; Mallen,
Vogel, Rochlen, & Day, 2005), netiquette (Suler, 2010), and
pacing (Murphy, MacFadden, & Mitchell, 2008) to establish emo-
tional immediacy, authenticity, empathy, and meaningfulness in
online communications (Fenichel et al., 2002; Mallen, Vogel,
Rochlen, & Day, 2005; Suler, 2010). The psychologist should
understand that when synchronous technologies are used, they
cannot accomplish the same tasks in the same time frame as
telephone or F2F therapy (Williams, Bambling, King, & Abbott,
294 JOHNSON

Table 1
Telepsychology Competencies for Canadian Psychologists: Interpersonal Relationships

Foundational competencies required for the delivery of both face-to-face and telepsychological services (from the Mutual Recognition Agreement):
Knowledge of theories and empirical data on the professional relationship, such as:
• Interpersonal relationships
• Power relationships
• Therapeutic alliance
• Interface with social psychology
• More specific knowledge of the fluctuations of the therapeutic/professional relationships as a function of intervention setting
Knowledge of self, such as:
• Motivation
• Resources
• Values
• Personal biases
• Factors that may influence the professional relationship (e.g., boundary issues)
Knowledge of others, such as:
• Macroenvironment in which the person functions (work, national norms, etc.)
• Microenvironment (personal, family, gender differences)
• Therapeutic alliance
• Interface with social psychology
• More specific knowledge of the fluctuations of the therapeutic/professional relationships as a function of intervention setting
Skills
• Effective communication
• Establishment and maintenance of rapport, trust, and respect
Additional competencies specifically required for telepsychology:
Telepresence
• Empathic, supportive communications with appropriate follow-up
• Distance communications that enhance psychologist professionalism and credibility
• Distance communications that foster a healthy, collaborative, and effective working alliance between psychologist and client and other helping
professionals (e.g., effective use of mobile health technologies in interdisciplinary teams)
Technical communication skills
• Ability to identify and respond appropriately to crisis and noncrisis situations
• Ability to deal with communication breakdown and repair online working alliance
• Use of special textual and online techniques to foster a warm, meaningful working alliance in the absence of visual cues
• Effective time management when using synchronous, online communications during all phases of the helping relationship
Note. Adapted from the “Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada,” by the Council of Provincial
Associations of Psychologists, 2001/2004, Winnipeg, MB. Retrieved from www.cpa.ca/documents/MRA.pdf

2009), and cannot provide the same amount of time for reflection
as asynchronous (i.e., e-mail) technologies (Suler, 2010). Good
time management skills are needed to avoid spending too much
time at the rapport-building stage (Barak & Bloch, 2006; Williams
et al., 2009) at the expense of problem solving (Brown, 2012). This
is particularly important in light of the evidence that many distance
clients do not return for a second session (Chardon, Bagraith, &
King, 2011).
Assessment and Evaluation
Psychologists need to be able to accurately assess client issues
in both F2F and distance environments (ACPRO, 2011). However,
the inherent limitations of technology-mediated therapy can pose
unique challenges in telepsychology assessment and evaluation.
Whereas the accuracy of assessment via videoconferencing may be
comparable with F2F (Glueck, 2011), other technologies with
fewer visual or auditory cues, such as e-mail or chat, may make the
complexity and seriousness of a client’s problem much more
difficult to assess (Haberstroh et al., 2008; Mallen et al., 2011).
Therefore, psychologists must develop special competencies in
both understanding and assessing and evaluating their clients
when using distance technologies (see Table 2).
Client characteristics. Competence in telepsychology re-
quires a comprehensive understanding of the client’s multicultural
identity in the F2F context (ACPRO, 2011; Collins & Arthur,
2010; CPA, 2000; CPAP, 2001/2004) that would include the
client’s mental and medical history, and motivation to seek out
distance therapy, such as convenience, cost savings, and privacy
(Leibert et al., 2006), or having a condition that makes pursuing
F2F therapy difficult (e.g., social anxiety disorder; Yuen et al.,
2013). Other client factors that need to be considered include the
client’s access to technologies (Simms et al., 2011) and the client’s
cultural, personal, and linguistic suitability for telepsychology
interventions (Choi et al., 2012; Prabhakar, 2013). Psychologists
must also exercise special skills, knowledge, and judgment
when their clients are children or youth. For example, children
or youth often prefer online interventions to traditional F2F
therapy (Callahan & Inckle, 2012; Fenichel et al., 2002; Nelson
et al., 2011), but the psychologists may need to make adjustments
to their online communications to suit the preferred communica-
tion patterns of these younger clients (Brown, 2012) and their
parents (Nelson et al., 2011).
Assessment and evaluation using distance technologies.
Telepsychology competence requires a methodical approach to
assessment and evaluation. The psychologist should begin by
choosing, whenever practicable, a F2F intervention over a distance
intervention (JTF, 2013), especially when a F2F therapeutic rela-
tionship may be impaired by telepsychology (Nelson et al., 2011).
 TOWARD UNIFORM COMPETENCY STANDARDS 295

Table 2
Telepsychology Competencies for Canadian Psychologists: Assessment and Evaluation

Foundational competencies required for the delivery of both face-to-face and telepsychological services (from the Mutual Recognition Agreement):
Knowledge
• Assessment methods
• Knowledge of populations served
• Human development
• Diagnosis
Skills
• Formulation of referral question
• Selection of methods
• Information collection and processing
• Psychometric methods
• Formulation of hypotheses and making a diagnosis when appropriate
• Report writing
• Formulation of an action plan
Additional competencies specifically required for telepsychology:
Client characteristics
• Understand the full multicultural identity of the client in both face-to-face and distance contexts, including mental/health history and
motivations for pursuing distance therapy
• Understand the client’s access to distance technologies and the client’s ability and comfort using those technologies
• Have competencies to deal with special populations such as youth and child clients and their parents
Assessment/evaluation using distance technologies
• Have face-to-face and distance protocols for accurately assessing client issues
• Ability to assess the client’s suitability for telepsychology and evaluate how he might be affected by distance interventions
• Have the appropriate face-to-face and distance referral mechanisms in place
• Understand the limits and applications of distance assessment tools and technologies
Note. Adapted from the “Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada,” by the Council of Provincial
Associations of Psychologists, 2001/2004, Winnipeg, MB. Retrieved from www.cpa.ca/documents/MRA.pdf

Before beginning any distance intervention, the psychologist
should conduct a preliminary F2F diagnosis of all client issues and
consider whether the client is suitable for telepsychology or how
the client might be affected by a particular online intervention
(ACPRO, 2011; Carlbring, Andersson, & Kaldo, 2011; JTF,
2013). In any event, the client should be referred to F2F counsel-
ling or other professional source if the case is outside the psychol-
ogist’s competence or technical limitations (ACPRO, 2011; CPA,
2006, Guideline II.10). It is also important that the psychologist
understand the limitations of reliability and validity of assessment
instruments that have been adapted for online use, as well as the
reliability of assessment applications (apps) that have been devel-
oped for mHealth technologies (Luxton et al., 2011). When nec-
essary, the psychologist should preserve the integrity of an assess-
ment instrument by having the appropriate remote assistance or
F2F applications in place (JTF, 2013).
Intervention and Consultation
Psychologists are ethically required to use an evidence-based
approach and have multicultural competence in the use of both
F2F (Collins & Arthur, 2010; CPA, 2000; Ridley et al., 2011) and
technology-mediated distance interventions (ACPRO, 2011; see
Table 2). They must know the full range of technological media
available, the advantages and limitations of technologies, and how
these may converge (Nelson et al., 2011). No matter which tech-
nology or approach is taken, or how a given distance intervention
is tailored, the psychologist is ethically required to maximize client
benefits and minimise client harm by having a clear understanding
of the applications, limitations, efficacy, and impact his plan will
have before engaging the client with any telepsychology interven-
tion (ACPRO, 2011; CPA, 2000).
Selection of distance technologies. Before engaging in tele-
psychology, a psychologist should know the different technologies
available, including the range of traditional (e.g., landline tele-
phone and video; King et al., 2006; Simms et al., 2011), recent
(e.g., asynchronous e-mail and synchronous chat programs; Mallen
& Vogel, 2005b), and emergent (e.g., mHealth, social media, and
VR; D. M. Kaplan et al., 2011; R. M. Kaplan & Stone, 2013;
Maheu et al., 2012; Yuen et al., 2013) platforms. Telepsychologi-
cal competence also requires that psychologists understand the
essential advantages and limitations of each technological ap-
proach. For example, asynchronous text-based technologies (e.g.,
e-mail) are particularly useful because they allow both psycholo-
gists and clients the opportunity to reflect and describe their
feelings with more depth compared with F2F (Brown, 2012; Dunn,
2012; Suler, 2010). However, because of the time delay, the flow
of communication can also be disrupted when using asynchronous
technologies (Suler, 2010). Synchronous communications on the
other hand, including Skype or short message service (SMS), may
achieve better real-time flow conducive for immediate communi-
cation and behavioural monitoring (R. M. Kaplan & Stone, 2013),
but may not allow for reflection, deeper expression, or consider-
ation of serious issues as with other forms of counselling (Dunn,
2012; Haberstroh et al., 2007; Suler, 2010). Psychologists need to
understand that when visual cues are diminished or absent, as in
the case in which a video camera is not available, there are
advantages, such as increased focus, disinhibition, and honest
self-disclosure (Barak, 2007; Murphy et al., 2008; Suler, 2010),
and disadvantages, such as overdisclosure and an increased inci-
dence of cross-cultural miscommunication (Richards & Vigano,
2013; Skinner & Latchford, 2010). Psychologists need to be aware
that some clients may be uncomfortable undergoing therapy with-
296 JOHNSON

Table 3
Telepsychology Competencies for Canadian Psychologists: Intervention & Consultation

Foundational competencies required for the delivery of both face-to-face and telepsychological services (from the Mutual Recognition Agreement):
Knowledge
• Learning of an array of varied interventions with individuals and systems
• A respect for the positive aspects of all major approaches, which should reflect an openness to varied viewpoints and methods
• Awareness of when to make appropriate referrals and consult
• Awareness of context and diversity
• Knowledge of interventions that promote health and wellness
Skills
• Establish and maintain professional relationships with clients from all populations
• Establish and maintain appropriate interdisciplinary relationships with colleagues
• Gather information about the nature and severity of the problems and formulate hypotheses about the factors that are contributing to the
problem through qualitative and quantitative means
• Select appropriate intervention methods
• Analyze the information, develop a conceptual framework, and communicate this to the client
Additional competencies specifically required for telepsychology:
The selection of distance technologies
• Understand the range of both traditional and emerging technologies available and be able to evaluate their comparative advantages and
drawbacks for specific cases
• Understand the client’s suitability and comfort with both potential technologies and the chosen technology
• Document the rationale for choosing the appropriate technology for a specific client
General technical skills
• Have a good understanding of technical issues that may arise and have appropriate risk management protocols in place
• Be thoroughly competent with any technology or system of technologies that are chosen
Tailoring interventions
• Tailor interventions appropriate to the individual client characteristics
• Have a thorough understanding and facility with both face-to-face and distance interventions adapted for telepsychology
• Have a thorough understanding of both face-to-face and telepsychological versions of cognitive-behavioural therapy, their applications and
limitations
Note. Adapted from the “Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada,” by the Council of Provincial
Associations of Psychologists, 2001/2004, Winnipeg, MB. Retrieved from www.cpa.ca/documents/MRA.pdf

out visual cues and may prefer F2F counselling (Leibert et al., larly in remote locations, may not have easy access to distance
2006) or VR (Yuen et al., 2013), whereas others may be uncom- technologies (Simms et al., 2011). Despite these technical limita-
fortable using a particular technology or mode of treatment (e.g., tions and potential drawbacks, Rummell and Joyce (2010) sug-
videoconferencing, as in Backhaus et al., 2012). Clients, particu- gested that “online counselling is not an area to be feared” (p. 494);

Table 4
Telepsychology Competencies for Canadian Psychologists: Research

Foundational competencies required for the delivery of both face-to-face and telepsychological services (from the Mutual Recognition Agreement):
Knowledge
Basic knowledge of research methods and of the applications of scientific research, including:
• Applied statistics and measurement theory
• The logic of different models of scientific research (from laboratory experimentation to quasi-experimental and field research)
• Qualitative research methods (including observation and interviewing), etc., particularly with respect to the nature of reliability and validity in
the gathering and interpretation of qualitative data
Skills
• Critical reasoning skills
• Applications of various research approaches to social systems
• Ability to write professional reports
Additional competencies specifically required for telepsychology:
Efficacy research
• Have knowledge of the current efficacy research results across a range of telepsychology interventions showing how different delivery
platforms compare with each other and with face-to-face practice
• Understand the limitations and contexts of individual studies and their suitability for transfer to practice
• Know the potential costs–benefits of telepsychology and limitations of interventions that provide limited or no psychologist guidance
• Understand the limitations of studies about specific populations who may be underresearched (e.g., children)
Future of telepsychology research
• Have knowledge of the areas of telepsychology and related or intersecting fields (e.g., mobile health, virtual reality, and cloud computing) that
are emerging and require further research
• Know how to conduct robust randomized-controlled studies and how to transfer controlled research back into community practice
• Use feedback from community practice to inform further controlled research
Note. Adapted from the “Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada,” by the Council of Provincial
Associations of Psychologists, 2001/2004, Winnipeg, MB. Retrieved from www.cpa.ca/documents/MRA.pdf
 TOWARD UNIFORM COMPETENCY STANDARDS 297

Table 5
Telepsychology Competencies for Canadian Psychologists: Ethics & Standards

Foundational competencies required for the delivery of both face-to-face and telepsychological services (from the Mutual Recognition Agreement):
Knowledge
• Ethical principles
• Standards of professional conduct
• Responsibilities to clients, society, the profession, and colleagues
• Awareness of potentially conflicting principles
• Standards for psychological tests and measurements
• Standards for conducting psychological research
• Jurisprudence and local knowledge
Skills
• Ethical decision-making process
• Proactive identification of potential ethical dilemmas
• Resolution of ethical dilemmas
Additional competencies specifically required for telepsychology:
• Understand and accommodate the technical and ethical challenges associated with client privacy and confidentiality in telepsychology
• Understand the application and limitations of various codes and guidelines that are specific to telepsychology practice or those that may be
nonspecific but may have an umbrella application to telepsychology (e.g., the Canadian Code of Ethics for Psychologists)
• Plan and employ emergency and risk management issues and systems
• Have detailed knowledge about the scope and limitations of jurisdiction of practice, client protocols, insurance, and potential legal issues that
may arise from interjurisdictional practice
• Seek and acquire ongoing telepsychology training to meet and maintain demonstrated competence standards in telepsychology practice
Note. Adapted from the “Mutual Recognition Agreement of the Regulatory Bodies for Professional Psychologists in Canada,” by the Council of Provincial
Associations of Psychologists, 2001/2004, Winnipeg, MB. Retrieved from www.cpa.ca/documents/MRA.pdf

rather, psychologists need to be able assess their clients’ prefer-
ences and to document and explain the rationale behind their
choice of technology (JTF, 2013).
General technical skills. Canadian psychologists have an eth-
ical duty to be technically competent with their chosen distance
technology (ACPRO, 2011, Standard 8). To fulfill this require-
ment, psychologists would need additional supervised training and
certification with specific technologies and systems (Schwartz &
Lonborg, 2011; Shaw & Shaw, 2006). As Nicholson (2011) noted,
Responsible caring does not require psychologists to become experts
in the use of technology. They should, however, become informed
consumers, understand and appreciate the potential for harm and
benefit in the use of the technology, and balance the risk and benefits
to those we serve. (p. 221)
The competent psychologist must have a good understanding of
technical issues, including the security of data storage, record
keeping and disposal, confidentiality in communications (e.g.,
when making agreements with the client on how to handle e-mail
correspondence), and the security of transmission (JTF, 2013).
Competence requires that the psychologist should be “familiar
with the tools of the trade” (Zack, 2010, p. 83) in order to skillfully
anticipate and deal with technical issues when they inevitably
arise.
Tailoring interventions. A competent approach to telepsy-
chology requires that interventions are tailored to the particular
needs of a client using an appropriate technology paired with a
suitable evidence-based treatment approach (Maheu et al., 2012;
Nelson et al., 2011; Richards & Vigano, 2013). An extraverted
client, for example, with a less serious issue, may prefer a
microphone-based chat (Tsan & Day, 2007), whereas a younger
client with a more serious issue may prefer telephone counselling
(Callahan & Inckle, 2012) or e-mail, if more reflection is required
(Dunn, 2012). Videoconferencing or VR may be appropriate if a
client has specific problem such as obsessive-compulsive disorder
that may otherwise preclude or constrain a F2F intervention (Yuen
et al., 2013), whereas mHealth technologies may be better if
particular behavioural treatment objectives need to be met (e.g., for
weight loss and smoking cessation, R. M. Kaplan & Stone, 2013),
or if a multidisciplinary team approach to strategic health man-
agement is indicated (Castelnuovo et al., 2014). A mixed method-
ology may be preferred if there is a group of clients with similar
problems and characteristics (e.g., elderly clients with generalised
anxiety disorder who started with a F2F assessment, followed by
e-mail and telephone support, an online forum, homework, and
then F2F follow-up, as in Zou et al., 2012). In particular, psychol-
ogists need to become competent in the use of CBT, as most
telepsychology interventions, regardless of the technology used,
are based on CBT adapted for the Internet (iCBT; Barak et al.,
2008; Chardon et al., 2011). ICBT interventions are typically favoured
because of their cost-effectiveness (Hedman et al., 2011), ease of tailor-
ing, and manualization (G. Andersson, 2010; Hadjistavropoulos et al.,
2011).
Research
Research to date suggests that telepsychology interventions may
have similar or, in certain cases, better therapeutic benefits than
F2F therapy (e.g., Barak et al., 2008; Kraus, 2010b) across differ-
ent client conditions (Yuen, Goetter, Herbert, & Forman, 2012).
Other studies have suggested that telepsychology can be very
cost-effective by requiring minimal or no psychologist involve-
ment (Newman, Szkodny, Llera, & Przeworski, 2011), although
therapist involvement is still generally preferred (G. Andersson &
Cuijpers, 2009; Mallen & Vogel, 2005b).
However, psychologists should also be aware that although the
results of efficacy research to date appear to be positive, there are
still questions about the underlying mechanisms and efficacy of
telepsychology (Caspar & Berger, 2005). There has been variabil-
ity noted in results not only across different telepsychological
298 JOHNSON
interventions but also within specific delivery platforms being
researched (e.g., videoconferencing research reviewed by
Backhaus et al., 2012). There are also concerns about the
quality and robustness of telepsychology research (Proudfoot et
al., 2011) and the real-world application of efficacy research to
community practice (Carlbring et al., 2011). Until robust
randomized-controlled studies are conducted, any conclusions
about the efficacy of specific telepsychology interventions
should remain tentative (e.g., E. Andersson et al., 2012), espe-
cially with populations that are currently underresearched (e.g.,
children, Slone, Reese, & McClellan, 2012) and with emerging
technological applications in mHealth (R. M. Kaplan & Stone,
2013).
This lack of strong randomized and controlled telepsychology
research provides psychologists with the opportunity to conduct
their own well-designed studies on topics such as the underlying
mechanics of how telepsychological interventions work for indi-
vidual clients (Caspar & Berger, 2005) and how online gains
transfer back to the offline environment (Mallen, Vogel, Rochlen,
& Day, 2005). Other topical areas would include how to select the
best intervention for a tailored program (Richards & Vigano,
2013), what the moderators of effective treatment outcomes are
across different online technologies (Carlbring et al., 2011; Mallen
& Vogel, 2005b; Murphy et al., 2008; Yuen et al., 2012), the
potential and reliability of mHealth applications (R. M. Kaplan &
Stone, 2013), how children and youth respond to different tele-
psychological interventions (Nelson et al., 2011), and the role of
religion, spiritual ethics, gender, and cultural diversity in telepsy-
chology (Prabhakar, 2013). Future studies of cost-effectiveness
will also need to investigate the optimal psychologist– client con-
tact time (G. Andersson & Cuijpers, 2009; Newman et al., 2011);
the limitations of online assessment, monitoring, and control of
information (Mallen, Vogel, & Rochlen, 2005); and how to bridge
the gap between research efficacy and real-world effectiveness in
the field (Carlbring et al., 2011; Hadjistavropoulos et al., 2011).
Telepsychology competencies for current and future research and
consultation are summarised in Table 4.
Ethics and Standards
As described earlier in this article, the CPA Code is a well-
conceived umbrella document that can provide ethical standards
for both F2F and technology-based distance practices of Canadian
psychologists (Dever Fitzgerald, Hunter, Hadjistavropoulos, &
Koocher, 2010; Nicholson, 2011). Psychologists practicing tele-
psychology would, at minimum, be subject to the Code’s four
ethical principles (respect for the dignity of persons and peoples,
competent caring for the well-being of persons, integrity, and
professional and scientific responsibilities to society; CPA, 2000)
or similar ethical standards set out by the provincial licensing
body. However, telepsychology requires special competencies in
privacy and confidentiality, cross-jurisdictional practice, and
emergency risk management that go beyond the foundational
ethics of the Code or provincial authority (ACPRO, 2011). More-
over, specialized graduate training, mentoring, and continuing
education programs will become increasingly crucial to the devel-
opment and maintenance of telepsychology competence and ethi-
cal standards of professional practice (Mallen & Vogel, 2005b; see
Table 5).
Privacy and confidentiality. Maintaining the privacy and
confidentiality of clients are key ethical requirements for Canadian
psychologists in both F2F (CPA, 2000) and telepsychology
(ACPRO, 2011). Psychologists delivering telepsychological ser-
vices need to understand, however, that the ease of communica-
tion, self-disclosure, and sharing of personal information using
advanced technologies and social media can also increase the
incidence of inadvertent ethical breaches and privacy issues (D. M.
Kaplan et al., 2011). Thus, a key requirement of telepsychology
competence is psychologist expertise with distance technologies to
the extent that they can protect their clients from ethical violations
(ACPRO, 2011; CPA, 2006, Guidelines I.4 and I.5) by safely
collecting and securing client data (Murphy et al., 2008), and
having the proper technological risk management and prevention
systems in place (JTF, 2013; Zack, 2010). Obtaining informed
consent from adult and child clients and their families (Nelson et
al., 2011), indicating that they have understood the limitations and
risks of a telepsychological intervention (Schwartz & Lonborg,
2011), is a critical part of ethical telepsychology practice.
Emergency and risk management. Psychologists have the
ethical duty to minimise the risk of harm when employing a new
intervention or technique and to “take care to discern the potential
harm and benefits involved, to predict the likelihood of their
occurrence, and to proceed only if the potential benefits outweigh
the potential harms” (CPA 2000, Principle II: Values Statement).
This is especially true when they are using technologies to deliver
distance services (ACPRO, 2011). Psychologists may have an
even higher duty of care to reduce the risk of harm than they would
in a F2F context (Harris & Younggren, 2011; Truscott & Crook,
2004). Thus, although some researchers have suggested that clients
with depression or suicidal tendencies may benefit from telepsy-
chology (Barak, 2007; Fenichel et al., 2002), others have recom-
mended that clients with serious mental disorders or facing crisis
situations should be referred to the appropriate F2F care in the
client’s jurisdiction (Murphy et al., 2008). At the very least,
psychologists need to have a comprehensive F2F referral plan
made available to all distance clients in case of emergency
(ACPRO, 2011; CPA, 2006, Guidelines II.6 & II.7; JTF, 2013;
Kraus, 2010b), even for state-of-the-art mHealth smartphone tech-
nologies (Luxton et al., 2011). Protocols for dealing with technical
failure (CPA, 2006, Guideline II.9), psychologist unavailability
(CPA, 2006, Guideline II.8), and difficulty accessing qualified F2F
in the client’s jurisdiction (Harris & Younggren, 2011) would also
need to be in place.
Jurisdiction of practice. Psychologists practicing telepsy-
chology must be aware that interjurisdictional practice continues to
occupy an ethical and legal grey area. There is still no consensus
about the regulation of national or international telepsychology
practice (Harris & Younggren, 2011; Murphy et al., 2008;
Rummell & Joyce, 2010). At minimum, psychologists need to be
informed about the laws, regulations, and positions of the licensing
boards of their client’s jurisdiction (ACPRO, 2011; Shaw & Shaw,
2006) in order to determine whether they are legally entitled to
provide telepsychological services across jurisdictions (D. M.
Kaplan et al., 2011; Rojubally et al., 2013). Because of the risks of
legal action from both their own jurisdiction of licensure and the
client’s jurisdiction of residence, psychologists are required to
have the appropriate liability insurance prior to engaging in tele-
psychology practice (ACPRO, 2011; Dever Fitzgerald et al., 2010;
 TOWARD UNIFORM COMPETENCY STANDARDS
Harris & Younggren, 2011; Murphy et al., 2008). Understanding
the informed consent protocols in a client’s jurisdiction (JTF,
2013) is another critical part of ethical competence in telepsychol-
ogy. Psychologists need to inform their clients about relevant
ethical regulations and limitations of jurisdictional responsibility
(Kraus, 2010a), as well as recourse mechanisms available to the
client in the client’s jurisdiction (ACPRO, 2011; Murphy et al.,
2008).
Competency training and standards. Perhaps the most im-
portant aspect of telepsychology competence lies in the quality and
availability of graduate-level training and continuing education
programs (JTF, 2013), given that psychologists require consider-
able experience and supervised practice to develop their telepsy-
chology skills and techniques (Murphy et al., 2008). Unfortu-
nately, the speed of technological advancement especially in the
area of mHealth smart technologies continues to outstrip the ability
of professional organisations to respond in kind (Maheu et al.,
2012; Perle & Nierenberg, 2013). As a result, there is little stan-
dardization of practice, training remains largely informal, and the
credentials of telepsychology practitioners continue to vary widely
(Richards & Vigano, 2013). Maheu et al. (2012) and Kraus
(2010b) have envisioned that standardized graduate-level training
will soon be an integral part of psychologist continuing education,
licensure, and competent evidence-based practice, but that this will
require clear guidance and endorsement from professional associ-
ations. Once the next generation of psychologists becomes trained
in telepsychology according to a standard practice model (e.g.,
Fang et al., 2013), and becomes comfortable in using emergent
mHealth smart technologies (Perle & Nierenberg, 2013), they will
lead the way forward with better research in real-world settings
and more refinements to telepsychology competency education
(McKay et al., 2013). Given the current trend toward interjuris-
dictional mobility with agreements such as the AIT on the one
hand, and the movement toward the standardization of psycholo-
gist competence on the other (Cohen, 2009), national guidelines
combined with flexible licensure agreements that allow psychol-
ogists to provide services that go beyond national boundaries are
now being recommended (e.g., Harris & Younggren, 2011;
Rojubally et al., 2013). Despite the difficulty in achieving uniform
F2F competence standards and the more difficult task of realising
an internationally recognised standard of telepsychology compe-
tence (Hall & Lunt, 2005), “the development of a telepsychology
credential required by psychology boards for interjurisdictional
practice is a probable outcome” (JTF, 2013, p. 799).
Conclusion
As Canadian psychologists continue to add telepsychology to
professional practice, they need to be acutely aware that they have
an ethical responsibility to develop special competence in the
delivery of distance therapy that extends beyond the general re-
quirements needed for professional F2F practice. The existing
MRA can act as a ready-made competence framework to identify
and begin to standardize the additional skills, knowledge, and
judgment needed for professional telepsychological practice in
Canada, while providing a platform that is both flexible and
scalable enough to accommodate the recent rapid expansion in
newer mHealth and VR technologies. Once a telepsychological
competence standard is established, appropriate training and edu-
299
cation programs and special credentials can then be developed,
thus paving the way for international recognition and professional
mobility in the field of telepsychology.
Résumé
Tandis que les psychologues canadiens augmentent leur utilisation
de technologies offertes par Internet dans leur pratique, ils pren-
nent conscience que la télépsychologie — le recours à des tech-
nologies pour la prestation de services de psychologie à distance
— requiert des compétences particulières, des connaissances et un
jugement qui dépassent les exigences de base de la pratique
professionnelle. Toutefois, la définition de ce que constitue une
compétence, à la fois pour les séances en personne et de télépsy-
chologie, est en pleine évolution au pays. Le présent article exam-
ine en quoi le cadre actuel de compétences du psychologue cana-
dien, tel que défini dans l’Accord de reconnaissance mutuelle des
organismes réglementaires pour les psychologues professionnels
au Canada (Conseil des sociétés provinciales de psychologues,
2001, 2004), ainsi que dans la recherche actuelle et divers docu-
ments connexes sur les soins de santé mentale à distance, peuvent
servir de fondements à l’établissement de normes de compétence
uniformes en télépsychologie pour l’ensemble du Canada.
Mots-clés : compétences, télépsychologie, psychologues canadiens,
accord de reconnaissance mutuelle, pratique professionnelle.
References
Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti,
T., & Rück, C. (2012). Internet-based cognitive behaviour therapy for
obsessive-compulsive disorder: A randomized controlled trial. Psycho-
logical Medicine, 42, 2193–2203. doi:10.1017/S0033291712000244
Andersson, G. (2010). The promise and pitfalls of the internet for cognitive
behavioral therapy. BMC Medicine, 8, 82. Retrieved from http://www
.biomedcentral.com/1741-7015/8/82
Andersson, G., & Cuijpers, P. (2009). Treatments for adult depression: A
meta-analysis. Cognitive Behaviour Therapy, 38, 196 –205. doi:10.1080/
16506070903318960
Association of Canadian Psychology Regulatory Organisations. (2011).
Model standards for telepsychology service delivery. Toronto, ON: Author.
Retrieved from http://www.cpmb.ca/documents/Telepsychology
.Standards.4June2011.pdf
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., . . .
Rice-Thorp, N. M. (2012). Videoconferencing psychotherapy: A sys-
tematic review. Psychological Services, 9, 111–131. doi:10.1037/
a0027924
Barak, A. (2007). Emotional support and suicide prevention through the
internet: A field project report. Computers in Human Behavior, 23,
971–984. doi:10.1016/j.chb.2005.08.001
Barak, A., & Bloch, N. (2006). Factors related to perceived helpfulness in
supporting highly distressed individuals through an online support chat.
CyberPsychology & Behavior, 9, 60 – 68. doi:10.1089/cpb.2006.9.60
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008). A compre-
hensive review and a meta-analysis of the effectiveness of internet-based
psychotherapeutic interventions. Journal of Technology in Human Ser-
vices, 26, 109 –160. doi:10.1080/15228830802094429
Brown, G. (2012). The working alliance in online counselling for crisis
intervention and youth (Master’s thesis). Retrieved from ProQuest Dis-
sertations and Theses database. (UMI No. MR93718)
Callahan, A., & Inckle, K. (2012). Cybertherapy or psychobabble? A
mixed methods study of online emotional support. British Journal of
300
Guidance & Counselling, 40, 261–278. doi:10.1080/03069885.2012
.681768
Canadian Nurses Association. (2007, November). Position statement. Tele-
health: The role of the nurse. Ottawa, ON: Author. Retrieved from
http://cna-aiic.ca/~/media/cna/page-content/pdf-en/ps89_telehealth_e
.pdf
Canadian Psychological Association. (2000). Canadian code of ethics for
psychologists (3rd ed.). Ottawa, ON: Author. Retrieved from http://
www.cpa.ca/cpasite/userfiles/Documents/Canadian%20Code%20of
%20Ethics%20for%20Psycho.pdf
Canadian Psychological Association. (2006). Ethical guidelines for psy-
chologists providing psychological services via electronic media. Re-
trieved from http://www.cpa.ca/aboutcpa/committees/ethics/
psychserviceselectronically/
Canadian Psychological Association. (2011). Canadian Psychological As-
sociation (CPA) position on the entry to practice for professional psy-
chology in Canada. Ottawa, ON: Author. Retrieved from http://www
.cpa.ca/docs/file/Practice/EntryPracticeProfPsychologyCanada2012.pdf
Carlbring, P., Andersson, G., & Kaldo, V. (2011). State-of-the-art treat-
ment via the internet: An optimistic vision of the future. Cognitive
Behaviour Therapy, 40, 79 – 81. doi:10.1080/16506073.2011.575591
Caspar, F., & Berger, T. (2005). The future is bright: How can we optimize
online counseling, and how can we know whether we have done so? The
Counseling Psychologist, 33, 900 –909. doi:10.1177/0011000005280183
Castelnuovo, G., Manzoni, G. M., Pietrabissa, G., Corti, S., Guisti, E. M.,
Molinari, E., & Simpson, S. (2014). Obesity and outpatient rehabilitation
using mobile technologies: The potential mHealth approach. Frontiers
in Psychology, 5, 559. doi:10.3389/fpsyg.2014.00559
Castonguay, L. G., Constantino, M. J., & Holtforth, M. G. (2006). The
working alliance: Where are we and where should we go? Psychother-
apy (Chicago, Ill.), 43, 271–279. doi:10.1037/0033-3204.43.3.271
Chardon, L., Bagraith, K. S., & King, R. J. (2011). Counseling activity in
single-session online counseling with adolescents: An adherence study.
Psychotherapy Research, 21, 583–592. doi:10.1080/10503307.2011
.592550
Choi, I., Zou, J., Titov, N., Dear, B. F., Li, S., Johnston, L., . . . Hunt, C.
(2012). Culturally attuned internet treatment for depression amongst
Chinese-Australians: A randomized controlled trial. Journal of Affective
Disorders, 136, 459 – 468. doi:10.1016/j.jad.2011.11.003
Cohen, K. R. (2009). Canada’s agreement on internal trade (AIT): Some
things to think about for the practice and mobility of psychology and
other health practitioners. Psynopsis, 31, 1–2. Retrieved from http://
www.cpa.ca/cpasite/userfiles/Documents/PsynopsisFall09Final(1).pdf
Cohen, K. R. (2012, July). The multiple accountabilities of competencies:
Preparing psychologists to do what, when and for whom. Presented at
the International Congress of Psychology, Cape Town South Africa.
Retrieved from http://www.cpa.ca/docs/file/Practice/ICP2012final.pdf
College of Alberta Psychologists. (2000). Providing psychological services
on the internet. The CAP Monitor, 9. Edmonton, AB: Author. Retrieved
from http://www.cap.ab.ca/pdfs/internetservices.pdf
College of Alberta Psychologists. (2005). Standards of practice. Edmon-
ton, AB: Author. Retrieved from http://www.cap.ab.ca/pdfs/
HPAStandardsofPractice.pdf
College of Physicians and Surgeons of British Columbia. (2013, November
13). Professional standards and guidelines: Telemedicine of ethics for
psychologists (3rd ed.). Victoria, BC: Author. Retrieved from https://
www.cpsbc.ca/files/pdf/PSG-Telemedicine.pdf
College of Psychologists of British Columbia. (2009). Code of conduct: Sched-
ule F of the bylaws of the College of Psychologists of B.C. Vancouver,
BC: Author. Retrieved from http://www.collegeofpsychologists.bc.ca/
docs/10.CPBCCodeofConduct.pdf
College of Psychologists of Ontario. (2009). By-law 16: Codes of ethics
and practice for members. Toronto, ON: Author. Retrieved from http://
www.cpo.on.ca/WorkArea/showcontent.aspx?id⫽2432
JOHNSON
College of Psychologists of Ontario. (2011). Model standards for telepsy-
chology service: An advisory for psychological practice. Toronto, ON:
Author. Retrieved from http://www.cpo.on.ca/WorkArea/showcontent
.aspx?id⫽3092&LangType⫽1033
Collins, S., & Arthur, N. (2010). Culture-infused counselling: A frame-
work for multicultural competence. In N. Arthur & S. Collins (Eds.),
Culture-infused counselling (2nd ed., pp. 45– 65). Calgary, AB: Coun-
selling Concepts.
Council of Provincial Associations of Psychologists. (2001/2004). Mutual
recognition agreement of the regulatory bodies for professional psychol-
ogists in Canada. Winnipeg, MB: Author. Retrieved from www.cpa.ca/
documents/MRA.pdf
Dever Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher,
G. P. (2010). Ethical and legal considerations for internet-based psycho-
therapy. Cognitive Behaviour Therapy, 39, 173–187. doi:10.1080/
16506071003636046
Dunn, K. (2012). A qualitative investigation into the online counselling
relationship: To meet or not to meet, that is the question. Counselling &
Psychotherapy Research, 12, 316 –326. doi:10.1080/14733145.2012
.669772
Fang, L., Bogo, M., Mishna, F., Murphy, L., Gibson, M. F., Griffiths,
V., & Regehr, G. (2013). Development and initial evaluation of the
Cyber-Counselling Objective Structured Clinical Examination
(COSCE). Research on Social Work Practice, 23, 81–94. doi:
10.1177/1049731512459966
Fenichel, M., Suler, J., Barak, A., Zelvin, E., Jones, G., Munro, K., . . .
Walker-Schmucker, W. (2002). Myths and realities of online clinical
work. CyberPsychology & Behavior, 5, 481– 497. doi:10.1089/
109493102761022904
Gauthier, J. G. (2002). Facilitating mobility for psychologists through a
competency-based approach for regulation and accreditation: The Ca-
nadian experiment. European Psychologist, 7, 203–212. doi:10.1027//
1016-9040.7.3.203
Glueck, D. A. (2011). Telepsychiatry in private practice. Child and Ado-
lescent Psychiatric Clinics of North America, 20, 1–11. doi:10.1016/j
.chc.2010.08.006
Haberstroh, S. (2010). College counselors’ use of informal language on-
line: Student perceptions of expertness, trustworthiness, and attractive-
ness. Cyberpsychology, Behavior and Social Networking, 13, 455– 459.
doi:10.1089/cyber.2009.0280
Haberstroh, S., Duffey, T., Evans, M., Gee, R., & Trepal, H. (2007). The
experience of online counseling. Journal of Mental Health Counseling,
29, 269 –282. Retrieved from http://amhca.metapress.com/link
.asp?id⫽j344651261w357v2
Haberstroh, S., Parr, G., Bradley, L., Morgan-Fleming, B., & Gee, R. (2008).
Facilitating online counseling: Perspectives from counselors in training.
Journal of Counseling & Development, 86, 460 – 470. doi:10.1002/j.1556-
6678.2008.tb00534.x
Hadjistavropoulos, H. D., Thompson, M., Ivanov, M., Drost, C., Butz,
C. J., Klein, B., & Austin, D. W. (2011). Considerations in the devel-
opment of a therapist-assisted internet cognitive behavior therapy ser-
vice. Professional Psychology: Research and Practice, 42, 463– 471.
doi:10.1037/a0026176
Hall, J. E., & Lunt, I. (2005). Global mobility for psychologists: The role
of psychology organizations in the United States, Canada, Europe, and
other regions. American Psychologist, 60, 712–726. doi:10.1037/0003-
066X.60.7.712
Hanley, T. (2012). Understanding the online therapeutic alliance through
the eyes of adolescent service users. Counselling & Psychotherapy
Research, 12, 35– 43. doi:10.1080/14733145.2011.560273
Harris, E., & Younggren, J. N. (2011). Risk management in the digital
world. Professional Psychology: Research and Practice, 42, 412– 418.
doi:10.1037/a0025139
 TOWARD UNIFORM COMPETENCY STANDARDS
Hedman, E., Andersson, E., Ljòtsson, B., Andersson, G., Rück, C., &
Lindefors, N. (2011). Cost-effectiveness of internet-based cognitive
behavior therapy vs. cognitive behavioral group therapy for social anx-
iety disorder: Results from a randomized controlled trial. Behaviour
Research and Therapy, 49, 729 –736. doi:10.1016/j.brat.2011.07.009
Hunsley, J., & Barker, K. K. (2011). Training for competency in profes-
sional psychology: A Canadian perspective. Australian Psychologist, 46,
142–145. doi:10.1111/j.1742-9544.2011.00027.x
Internal Trade Secretariat. (2012, May). Agreement on internal trade:
Consolidated version. Winnipeg, MB: Author. Retrieved from http://
www.ait-aci.ca/en/ait/ait_en.pdf
Joint Task Force for the Development of Telepsychology Guidelines for
Psychologists. (2013). Guidelines for the practice of telepsychology.
American Psychologist, 68, 791– 800. doi:10.1037/a0035001
Kaplan, D. M., Wade, M. E., Conteh, J. A., & Martz, E. T. (2011). Legal
and ethical issues surrounding the use of social media in counseling.
Counseling and Human Development, 43, 2–10. Retrieved from http://
go.galegroup.com/ps/i.do?id⫽GALE%7CA275311436&v⫽2.1&
u⫽nysl_me_tci&it⫽r&p⫽AONE&sw⫽w
Kaplan, R. M., & Stone, A. A. (2013). Mobile technologies for health
promotion and disease prevention. Annual Review of Psychology, 64,
471– 498. doi:10.1146/annurev-psych-113011-143736
King, R., Bambling, M., Reid, W., & Thomas, I. (2006). Telephone and
online counselling for young people: A naturalistic comparison of ses-
sion outcome, session impact and therapeutic alliance. Counselling &
Psychotherapy Research, 6, 175–181. doi:10.1080/14733140600874084
Kraus, R. (2010a). Ethical issues in online counseling. In R. Kraus, G.
Stricker, & C. Speyer (Eds.), Online counseling: A handbook for mental
health professionals (2nd ed., pp. 85–106). St. Louis, MO: Academic
Press.
Kraus, R. (2010b). Online counseling: Does it work? Research findings to
date. In R. Kraus, G. Stricker, & C. Speyer (Eds.), Online counseling: A
handbook for mental health professionals (2nd ed., pp. 55– 63). St.
Louis, MO: Academic Press.
Leibert, T., Archer, J., Munson, J., & York, G. (2006). An exploratory
study of client perceptions of internet counseling and the therapeutic
alliance. Journal of Mental Health Counseling, 28, 69 – 83. Retrieved
from http://amhca.metapress.com/link.asp?id⫽f0h37djrw89nv6vb
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger,
G. M. (2011). mHealth for mental health: Integrating smartphone tech-
nology in behavioral healthcare. Professional Psychology: Research and
Practice, 42, 505–512. doi:10.1037/a0024485
Maheu, M. M., Pulier, M. L., McMenamin, J. P., & Posen, L. (2012).
Future of telepsychology, telehealth, and various technologies in psy-
chological research and practice. Professional Psychology: Research
and Practice, 43, 613– 621. doi:10.1037/a0029458
Mallen, M. J., Jenkins, I. M., Vogel, D. L., & Day, S. X. (2011). Online
counselling: An initial examination of the process in a synchronous chat
environment. Counselling & Psychotherapy Research, 11, 220 –227.
doi:10.1080/14733145.2010.486865
Mallen, M. J., & Vogel, D. L. (2005a). Introduction to the major contri-
bution: Counseling Psychology and online counseling. The Counseling
Psychologist, 33, 761–775. doi:10.1177/0011000005278623
Mallen, M. J., & Vogel, D. L. (2005b). Online counseling: A need for
discovery. The Counseling Psychologist, 33, 910 –921. doi:10.1177/
0011000005280182
Mallen, M. J., Vogel, D. L., & Rochlen, A. B. (2005). The practical aspects of
online counseling: Ethics, training, technology, and competency. The Coun-
seling Psychologist, 33, 776 – 818. doi:10.1177/0011000005278625
Mallen, M. J., Vogel, D. L., Rochlen, A. B., & Day, S. X. (2005). Online
counseling: Reviewing the literature from a counseling psychology
framework. The Counseling Psychologist, 33, 819 – 871. doi:10.1177/
0011000005278624
301
Martin, L., Turcotte, M., Matte, L., & Shepard, B. (2013). The counselling
and psychotherapy profession in Canada: Regulatory processes and
current status. British Journal of Guidance & Counselling, 41, 46 –57.
doi:10.1080/03069885.2012.750271
McKay, J. C., Vasquez, A. R., Chipp, C. L., Ford, T. J., Robinson, R. V.,
Sharma, D. K. B., . . . Allen, J. (2013). Divided by miles, connected by
purpose: Telepsychology technology in a graduate training program.
Training and Education in Professional Psychology, 7, 166 –173. doi:
10.1037/a0033568
Murphy, L., MacFadden, R., & Mitchell, D. (2008). Cybercounseling
online: The development of a university-based training program for
e-mail counseling. Journal of Technology in Human Services, 26, 447–
469. doi:10.1080/15228830802102081
Nelson, E. L., Thao, N. B., & Velasquez, S. E. (2011). Telepsychology:
Research and practice overview. Child and Adolescent Psychiatric Clin-
ics of North America, 20, 67–79. doi:10.1016/j.chc.2010.08.005
New Brunswick Association of Social Workers. (2010, June 5). Standards
for use of technology in social work practice. Fredericton, NB: Author.
Retrieved from http://www.nbasw-atsnb.ca/download/standards/
Standards%20for%20the%20use%20of%20technology_ENG.pdf
Newfoundland & Labrador Association of Social Workers. (2012).
Standards for technology use in social work practice. St John’s, NL:
Author. Retrieved from http://www.nlasw.ca/pdf/Standards_For_
Technology_Use_In_Social_Work_Practice.pdf
Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011). A
review of technology-assisted self-help and minimal contact therapies
for anxiety and depression: Is human contact necessary for therapeutic
efficacy? Clinical Psychology Review, 31, 89 –103. doi:10.1016/j.cpr
.2010.09.008
Nicholson, I. R. (2011). New technology, old issues: Demonstrating the
relevance of the Canadian Code of Ethics for Psychologists to the
ever-sharper cutting edge of technology. Canadian Psychology, 52,
215–224. doi:10.1037/a0024548
Ordre des psychologues du Québec. (2008). Explanatory guide to the
Code of Ethics of the psychologists of Quebec. Ville Mont Royal, PQ:
Author. Retrieved from http://www.ordrepsy.qc.ca/sn_uploads/
0GuideExplicatif_Web_ANG.pdf
Perle, J. G., & Nierenberg, B. (2013). How psychological telehealth can
alleviate society’s mental health burden: A literature review. Journal of
Technology in Human Services, 31, 22– 41. doi:10.1080/15228835.2012
.760332
Pope, K. S., & Vasquez, M. J. T. (2010). Ethics in psychotherapy and
counseling: A practical guide (4th ed.). Hoboken, NJ: Wiley.
Prabhakar, E. (2013). E-therapy: Ethical considerations of a changing
healthcare communication environment. Pastoral Psychology, 62, 211–
218. doi:10.1007/s11089-012-0434-3
Proudfoot, J., Klein, B., Barak, A., Carlbring, P., Cuijpers, P., Lange, A.,
. . . Andersson, G. (2011). Establishing guidelines for executing and
reporting internet intervention research. Cognitive Behaviour Therapy,
40, 82–97. doi:10.1080/16506073.2011.573807
Psychological Association of Manitoba. (2012, August 1). News and an-
nouncements. Retrieved from http://www.cpmb.ca/
Psychological Association of Manitoba. (n.d.). Members of the public:
Canadian Code of Ethics. Retrieved from http://www.cpmb.ca/
CanadianCode.php?c⫽0
Richards, D., & Vigano, N. (2013). Online counseling: A narrative and
critical review of the literature. Journal of Clinical Psychology, 69,
994 –1011. doi:10.1002/jclp.21974
Ridley, C. R., Mollen, D., & Kelly, S. M. (2011). Beyond microskills:
Toward a model of counseling competence. The Counseling Psycholo-
gist, 39, 825– 864. doi:10.1177/0011000010378440
Rodolfa, E., Greenberg, S., Hunsley, J., Smith-Zoeller, M., Cox, D.,
Sammons, M., . . . Spivak, H. (2013). A competency model for the
302 JOHNSON
practice of psychology. Training and Education in Professional Psy-
chology, 7, 71– 83. doi:10.1037/a0032415
Rojubally, A., Stephen, J., Fergus, K., Sellick, S., McLeod, D., Speca, M.,
. . . Turner, J. (2013). Professional positions on online psychosocial care
in Canada: A review of current policy statements. Canadian Journal of
Community Mental Health, 32, 69 – 87. doi:10.7870/cjcmh-2013-027
Ross, W. (2011). Ethical issues involved in online counseling. Journal of
Psychological Issues in Organizational Culture, 2, 54 – 66. doi:10.1002/
jpoc.20047
Rummell, C. M., & Joyce, N. R. (2010). “So wat do u want to wrk on
2day?”: The ethical implications of online counseling. Ethics & Behav-
ior, 20, 482– 496. doi:10.1080/10508422.2010.521450
Schwartz, T. J., & Lonborg, S. D. (2011). Security management in tele-
psychology. Professional Psychology: Research and Practice, 42, 419 –
425. doi:10.1037/a0026102
Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in online
counseling: Assessing current practices with an ethical intent checklist.
Journal of Counseling & Development, 84, 41–53. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/j.1556-6678.2006.tb00378.x/
abstract. doi:10.1002/j.1556-6678.2006.tb00378.x
Simms, D., Gibson, K., & O’Donnell, S. (2011). To use or not to use:
Clinicians’ perceptions of telemental health. Canadian Psychology, 52,
41–51. doi:10.1037/a0022275
Sinclair, C. (2011). The evolution of the Canadian code of ethics for
psychologists over the years (1986 –2011). Canadian Psychology, 52,
152–161. doi:10.1037/a0024471
Skinner, A. E. G., & Latchford, G. (2010). International and multicultural
issues. In R. Kraus, G. Stricker, & C. Speyer (Eds.), Online counseling:
A handbook for mental health professionals (2nd ed., pp. 257–269). St.
Louis, MO: Academic Press.
Slone, N. C., Reese, R. J., & McClellan, M. J. (2012). Telepsychology
outcome research with children and adolescents: A review of the liter-
ature. Psychological Services, 9, 272–292. doi:10.1037/a0027607
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman,
E. H., & Montgomery, G. H. (2012). The therapeutic relationship in
e-therapy for mental health: A systematic review. Journal of Medical
Internet Research, 14, e110. doi:10.2196/jmir.2084
Suler, J. (2010). The psychology of text relationships. In R. Kraus, G.
Stricker, & C. Speyer (Eds.), Online counseling: A handbook for mental
health professionals (2nd ed., pp. 21–53). St. Louis, MO: Academic
Press.
Trepal, H., Haberstroh, S., Duffey, T., & Evans, M. (2007). Considerations
and strategies for teaching online counseling skills: Establishing rela-
tionships in cyberspace. Counselor Education and Supervision, 46,
266 –279. doi:10.1002/j.1556-6978.2007.tb00031.x
Truscott, D., & Crook, K. H. (2004). Ethics for the practice of psychology
in Canada. Edmonton, AB: University of Alberta Press.
Tsan, J. Y., & Day, S. X. (2007). Personality and gender as predictors of
online counseling use. Journal of Technology in Human Services, 25,
39 –55. doi:10.1300/J017v25n03_03
Williams, R., Bambling, M., King, R., & Abbott, Q. (2009). In-session
processes in online counselling with young people: An exploratory ap-
proach. Counselling & Psychotherapy Research, 9, 93–100. doi:10.1080/
14733140802490606
Yuen, E. K., Goetter, E. M., Herbert, J. D., & Forman, E. M. (2012).
Challenges and opportunities in internet-mediated telemental health.
Professional Psychology: Research and Practice, 43, 1– 8. doi:10.1037/
a0025524
Yuen, E. K., Herbert, J. D., Forman, E. M., Goetter, E. M., Comer, R., &
Bradley, J.-C. (2013). Treatment of social anxiety disorder using online
virtual environments in Second Life. Behavior Therapy, 44, 51– 61.
doi:10.1016/j.beth.2012.06.001
Zack, J. S. (2010). The technology of online counseling. In R. Kraus, G.
Stricker, & C. Speyer (Eds.), Online counseling: A handbook for mental
health professionals (2nd ed., pp. 67– 84). St. Louis, MO: Academic
Press.
Zou, J. B., Dear, B. F., Titov, N., Lorian, C. N., Johnston, L., Spence, J.,
. . . Sachdev, P. (2012). Brief internet-delivered cognitive behavioral
therapy for anxiety in older adults: A feasibility trial. Journal of Anxiety
Disorders, 26, 650 – 655. doi:10.1016/j.janxdis.2012.04.002
Received May 22, 2014
Revision received August 13, 2014
Accepted August 15, 2014 䡲