Luísa Soares

doi:10.19080/OAJELS.2024.02.555589

Review Article

Technology as an Imperative Tool in Education of Clinical and Health Psychology

Luísa Soares

University of Madeira, Portugal

Submission: September 09, 2024; Published: October 09, 2024

*Corresponding author: Luísa Soares, University of Madeira, Portugal Open Access

How to cite this article: Luísa S. Technology as an Imperative Tool in Education of Clinical and Health Psychology. Open Access J Educ & Lang Stud. 2024; 2(3): 555589. DOI:10.19080/OAJELS.2024.02.555589.

Abstract

Look at technology not as an inconvenient tool but as must have for clinical psychologist is the discussion we present in this work. We attend research findings about the topic and add our reflections so that we can proceed to an era where technology will be side by side with human being, but the human and genuine aspect, which is a unique therapeutic relationship is the drive of psychological help.

Keywords: Technology; Clinical and health psychology; Therapeutic relationship; Telepsychology; Traditional psychological care

Health Psychology

The work of Health Psychologists is characterized as broad and diverse, extending to all contexts and health behaviors [1]. The intervention of these professionals are based on prevention, promotion and remediation, with the essential goal of improving the health and quality of life of the population, as well as improve the quality of the health system [1]. Carvalho et al. [1] state that the skills of Health Psychologists are a fundamental support for the individual, social and economic realities of the contexts of health, there is much scientific evidence of the effectiveness, cost-benefit and positive effects of action.

Currently, society faces enormous challenges, such as rapid aging population, the increased prevalence of chronic diseases, the growing difficulty of health services in responding to population needs, the prevalence of Information and Communication Technologies (ICT), among others [2]. The technological revolution that we are experiencing in today’s world has opened up possibilities in several domains, with relevant involvement in professional intervention and for one’s own structure of professions [1]. According to Carvalho et al. [1], the intensity and speed of the changes that are being discovered with digitalization, provide individuals with access to various products and services, including the area of Health and Psychology. In this way, the emergence of numerous instruments digital technologies and the possibility of providing Psychology services mediated by ICT, cooperate to change the panorama of healthcare psychological provision, on a path that will intensify in the coming years [1].

Looking into the Challenges of the Clinical and Health Psychologist

The growth of new forms of communication in society has promoted the development of online psychological care [3], causing changes and challenges in the professional himself, specifically in the clinical psychologist. Literature names online psychological care as “telepsychology” [4]. In line with Pozo [5] and Livingstone [6], clinical psychologists must adopt proper measures, considering their new reality. It appears crucial that professionals can identify, choose, interpret, resemble, study and summarize information, in person and online, using new technologies [5,6]. Other capabilities that should be developed: Welcoming, listening, understanding, and empathy [7], resulting in new Challenges in the online context.

The therapeutic setting has been the target of several innovations over time, portraying growing doubts about psychological practice [8]. The novelty of technology allowed the replacement of face-to-face service for online service, not initially revealing itself as something satisfactory for many psychologists, mainly due to losing physical contact with the client [8]. The issue of time is relevant in the online modality, and Costa et al. [9] argue that an online consultation may take longer than a face-to-face consultation; however, the psychologist compensates for this time before by recording the session, which allows the elimination of biases during analysis.

Pinto [10] highlights other challenges faced by clinical psychologists in psychotherapy online, namely, the difficulty in understanding what the client is saying, due to his vocal intonation and the difficulty in interpreting silences. According to Cosenza et al. [4], the psychologist will have more difficulties in visual function, as it is characterized as applicable for diagnosis or treatment judgments. Online service is accompanied by multiple issues, mainly about constructing the therapeutic relationship [3]. However, some studies reveal beneficial results [11-13]. According to Pinto [10], the difficulty and lack of knowledge in handling technological equipment is contextualized as a challenge to a therapeutic relationship. The author adds that professionals’ disbelief regarding online relationship is recurrent, as they do not consider it possible to work with emotions and feelings towards technological equipment. Pieta and Gomes [12] presents advantages for the psychologist, as clients convey their problems more easily online, making it easier for professionals to understand.

In traditional Clinical Psychology, a fundamental aspect is active listening by the psychologist and it continues with the use of technology, challenging it to pay greater attention to the client speech and style of writing [13]. Technological expansion allows professionals and clients to carry out the treatment in synchronous and asynchronous ways [14]. Accordingly, with the synchronous form, the therapeutic relationship only takes place during the online period and is in force in the case of a real-time session [14]. On the other hand, the asynchronous form offers greater freedom to those involved, as they do not need to do their tasks simultaneously [14]. Suler [15] states that, given this last modality, the psychologist can analyze the written reports the client transmits more calmly. Machado et al. [16] concluded that the online service of psychology, synchronous and asynchronous, is a positive format, which leads the psychologist to establish different communication settings and varied clinical positions, i.e., different ways of solving the client’s problem.

In agreement with Magdaleno [17], the primary challenge of the clinical psychologist, consists of creating a new form of expression, which is based on a favorable environment for both the patient and the client, also creating a new therapeutic setting to be adapted to the new conditions of contemporary society. Therefore, it is also important to highlight the fact that the psychologist provides care online, does not invalidate face-to-face psychotherapy [18]. In accordance with Ulkovski et al. [3], the client, when attending online psychological care, can be the beginning of face-to-face service, which is satisfactory for many psychologists. Given the challenges that clinical psychologists face, the importance of innovation is highlighted, self-confidence and learning so that they learn new methods of work, ensuring successful care, whether online or in person [19].

The Psychological Intervention in this New Era

We increasingly live in a society based on the production and exchange of information, therefore, this advancement in tools expanded the possibilities of working at home and in contact with the outside world [20]. Even though some technologies are recent, it is worth noting that professionals have used some forms of “telehealth” for many years. The telephone is a known resource used in healthcare for information exchange and emergency consultations. Email and Video conferencing is finding its place in health services, including the professional practice of Psychology. Like any technology, “telehealth” should not be considered good or bad, being used for various purposes (Milholland, 2000, cited in Ribeiro, [20] ). Ribeiro [20] states that technology is an option for health, classifying itself as more available, diversified, convenient and cheaper, based on the provision of quality, namely, the exchange of information with other professionals and consultation health centers and specialized services. In particular, videoconferencing generates opportunities for consultations, assessment, diagnosis, supervision, follow-up, and home care, which can also prove challenging, given the ethical issues.

Despite doubts about the risks and ethical concerns regarding psychotherapy, Internet-based activities, such as reference sites, information services and online self-help forums, are commonly used, representing an alternative to the provision of traditional services which, according to the results in the literature on programs using technological innovations, has had a great effect for the subjects who attended the treatment [20]. There are some technical difficulties and challenges when using a cell phone (whichend up being transversal), such as the lack of visual contact, as it can affect the timing of interventions, the physical impairment of the patient (for example, handling the telephone), problems may arise in the environment (noise, little privacy). However, it is a widely available, low-cost tool that is easy to incorporate into daily practice, whether for emergency care, follow-up, additional clinic consultations, or clarifying doubts [20].

Therefore, psychologists who provide services mediated by ICT must ensure they have the necessary technical, ethical and legal skills through training [1]. Faced with the challenges of conducting Psychological Assessment through ICT, Psychologists must recognize the need to adapt the conditions of administering the instruments in order to preserve the psychometric properties – reliability and validity. For example, ensure that the client responds or fills out the instrument, that he has not previously accessed the results and that there is no interference from third parties. Psychologists must be aware of other distractions are not present in face-to-face contact and adopt measures to prevent their impact on the assessment results. They should use, whenever possible, instruments that are validated for online application, ensuring that valid results are obtained. Clinical judgment should not be based solely on the results of a single formal instrument but on a set of formal and informal assessment tools [1].

There are several problems associated with administering psychological tests on the Internet, [21]. One is to ensure that the test version has reliability and validity. One cannot be sure that a specific online test produces the same results as one under paper-and-pencil conditions [21]. Several studies suggest that online tests produce different results than those administered under standard conditions [21]. The advantages and disadvantages of computer-based methods must always be considered in light of the circumstances, considering the objectives of the assessment and the nature and extent of the data to be gathered [21]. Another aspect is the editors’ reluctance to expose successful and well-researched tests. It was established to the dangers of low web security. In this way, the fact that Psychologic assessment relies substantially on traditional instruments without major innovations is justified, given that using technologies in this process still presents several dilemmas that require a resolution [22].

When developing digital intervention tools, which psychologists are increasingly adopting, these include applications for smartphones and tablets, websites and virtual reality. When developing or participating in such tasks, one must be aware of the impact of digital tools on the health of their potential users. The psychologist must consider whether these products meet the needs and desires of the population and people with mental health problems [1]. Psychological intervention tools must be built based on knowledge of psychological sciences and present sufficient evidence of effectiveness obtained through quality scientific studies. These tools should only be made available to the community if they present evidence of effectiveness or are contingent on a commitment [1].

Ethical Challenges of Clinical and Health Psychology

As Guareschi [23] defines, ethics is a way of relating, interacting, and dealing with others. Clinical Psychology requires a therapeutic relationship, so a basic principle is ethics [24]. Ethics should always be the “compass” for Psychology professionals. The Code of Ethics of the Order of Portuguese Psychologists - consolidated version, 2021 - advocates five general principles that guide and inspire psychologists in their conduct: respect for the dignity and rights of the person, competence, responsibility; integrity; and the principle of beneficence and non-maleficence [25]. The interest in the use of ICT in Clinical Psychology is increasing and, therefore, due to the adoption of new technologies, new ethical challenges arise. The clinical psychologist faces an increased responsibility in anticipating and managing ethical issues: he needs help guaranteeing and maintaining secrecy and confidentiality and providing effective and safe treatment to the client [20]. In this regard, Bush (2002), cited in Ribeiro, [20] and Siegmund et al. [26] present some measures to assist and guarantee confidentiality, such as including informed consent in the virtual format of the service so that the person is aware of the methodology used and all risks; encrypt private messages; use encrypted services to store data and, finally, use firewalls to protect confidential information. According to Koocher and College [27], in the face of technological and social changes, it is necessary to rethink the ethical forms of Psychology. Two other challenges associated with these changes emerge. The first consists of virtual services, that is, “telepsychology.” Another is having to analyze ethical obligations towards individuals and society. As we face new ethical challenges, it is essential to know where personal and professional responsibilities lie [27].

It should be noted that the Universal Declaration of Ethical Principles for Psychologists (International Union of Psychological Science - IUPsyS, 2014, cit. in Siegmund et al., [26], establishes that Psychology professionals and researchers must regulate themselves by respecting the dignity of the population, competent care of the well-being, integrity and, finally, professional, and scientific responsibilities towards society. Considering this, The British Psychological Society [26] explains that the principles mentioned must safeguard both the professional and the client of Psychology services and that the greater the risk present in the service, the more ethical care must be taken.

In the face of the pandemic, psychological clinical services provided through ICT, became an asset, as it allowed their continuity and expansion. However, it was necessary to reinforce ethical issues to protect the clinical psychologist, the client and the other parties involved [28]. In short, it is essential to know that ethics demarcates and guides the practice and action of clinical psychologists [24]. In the online context, ethical care must be taken to promote human health and well-being, despite the numerous advantages, the Internet continues to be a dangerous place subject to many frauds [27]. Technology, despite being accompanied by multiple challenges and difficulties, it is equally a prodigious tool for online psychological care, being essential to explore skills [29]. Reavley and Jorm [30] portray the importance of using the Internet for clinical psychologists and clients and their families to be informed about their problems and mental health.

The literature points out that individuals with specific mental disorders, specifically mood disorders, anxiety disorders and stress disorders, reveal their preference for online psychological care, as they present more difficulties in mentioning their problems and conditions in a face-to-face clinical context [31,32]. The studies by Bouchard et al. [33] and Spek et al. [34] show positive responses to patients with anxiety, depression and phobias who resorted to online methods. For individuals with special physical needs, Hopps et al. [35] presented pleasant results in the application of Cognitive Behavioral Therapy Focal, via the Internet, whose objective was to reduce the loneliness of those involved. Other studies are in line with the above [36-38]; however, new disorders are added: panic disorder, posttraumatic stress disorder and eating disorders. When it comes to specific problems, such as perfectionism, suffering due to infertility and procrastination, online psychotherapy is beneficial and with favorable results [39-41]. In the face of physical illnesses, online psychological care has proven to be equally effective, particularly with patients with chronic pain, sleep disorders [42], irritable bowel syndrome [43], diabetes, and cancer [44].

In the same line of thought, it is essential to highlight that clients with social anxiety are more likely to establish deep connections in care psychological online compared to face-to-face [45,46]. In this way, clients who participate in online sessions demonstrate more excellent practice, going straight to the point they want to address [47]. It can be justified by the fact that they are not physically present [48]. According to Reynolds et al. [46], clients are more accessible as they feel safe. The authors perpetuate that more profound questions are declared to the psychologist. They confide their problems sooner than in a face-to-face session [46]. Many individuals feel less exposed when providing online service, preferring this route compared to the traditional one, seeking help only if they are sure that they will not be identified, such as in situations related to alcohol abuse or substance abuse [26].

According to Fortim and Cosentino [11], clients are directed to online psychology due to several factors, including unfortunate life experiences, sexual problems, death of family members, and mental disorders, thus demonstrating the benefits of technology. According to Suler [14] and Partala [49], online therapy is beneficial for the most shy, introverted, insecure individuals, that is, those who are most ashamed of verbalize difficulties, emotions and feelings. Jerome et al. [50] indicate that several populations that lack health care are favored by technology, particularly rural populations, individuals who are in isolation or who are busy (they do not have availability and time for face-to-face therapy) and, finally, populations that are most in need, that is, those that do not have a high socioeconomic level.

In addition, populations that prefer anonymity tend to use online therapy [51]. In line with scientific evidence, other aspects are contextualized as motivators for individuals to undertake online psychotherapy: motor difficulties, being pregnant or with newborn children and, equally, not having the possibility of leaving the child with a caregiver during a face-to-face consultation, too much work, having a contagious disease, being an emigrant and preferring care in their mother tongue and, consequently, culture [52-55]. It is also worth highlighting that one of the main advantages of the use of technology focuses on price reduction, compared to in-person service [56]. The correct use of technology by clinical psychologists is compelling, bearing in mind that it is an innovative therapeutic tool, producing well-being capable of providing different ways of reducing clients’ loneliness, fear and anguish in crises [57].

Conclusion

Psychology is contextualized as a diverse and comprehensive area with multiple Specificities. However, the main objective, regardless of the context of action, is the population’s well-being. Referring to Clinical and Health Psychology, the psychologist has several functions in this aspect, highlighting the promotion and prevention of mental health [1]. In a world in constant technological evolution, Psychology proves to be essential. The clinic follows all these advances to achieve the global health objective. ICT is characterized as a beneficial tool for Humanity. Therefore, it also privileges the area of Clinical Psychology [1]. It is intended to demonstrate two possible dimensions, the advantages and the disadvantages of technology, for the psychologist himself and his area of work. Clinical psychologists face several challenges in their online practice. We chose to highlight the difficulty they experience in building the therapeutic relationship, given the loss of physical contact [8], as well as the obstacles they face when the client’s facial and verbal expressions are not understandable [4]. A challenge for the clinical psychologist as a person may be equivalent to a technical/intervention challenge; that is, the technical/intervention challenges of Clinical Psychology will vary depending on the practitioner’s professional and personal capabilities and skills. Following this line of reasoning, the intervention challenges of Psychology involve the cell phone, which is generalized to other technologies, presenting a set of advantages and disadvantages, highlighting their easy accessibility in an emergency context and, on the other hand, being a distraction factor in online psychological care [20].

Ethics is the keyword of psychological practice and, consequently, of the relationship therapist-client; therefore, “telepsychology” urgently encompasses a set of principles that must be respected and fulfilled in every detail. The question of confidentiality, as we know, is crucial in traditional psychological care l, not being seen differently in online psychological care [27]. ICT has countless advantages, specifically for Clinical Psychology, allowing us to reflect on several clinical cases in which technology proved to be an added value. According to Stritzke et al. [58], the psychology online service makes it possible to understand a set of interpersonal preferences, being an increasingly frequent choice of clients that seek help. Exploring this topic is challenging but enlightened us about technological privileges during an online consultation: accessibility, flexibility, own rhythm when handling equipment, promotion technological self-efficacy, greater privacy and anonymity, cultural adaptability, and respective online translation and the low-cost [56,59,60]. That is why we should look at technology as an essential tool in the future of Psychology.