Contemporary Family Therapy

, Volume 36, Issue 1, pp 58–69 | Cite as

Marriage and Family Therapists’ Use and Comfort with Online Communication with Clients

  • Katherine M. Hertlein
  • Markie L. C. Blumer
  • Justin M. Smith
Original Paper


Despite the growth in computer and Internet use, marriage and family therapists’ (MFT) use of such technologies to communicate with clients has received limited attention. The purpose of the current research was to understand the frequency and ways in which MFTs are communicating online with clients and identify their level of comfort with online treatments. We administered a survey to practicing MFTs across the US to identify the frequency with which they used online communications with their clients, and the extent to which they felt comfortable using online communications in various treatment modalities. Implications for research, training, and practice are discussed.


Marriage and family therapy Technology Cyber Practice 



This project was funded by the Alaska Association for Marriage and Family Therapy.


  1. Aguilera, A., & Muñoz, R. F. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42(6), 472–478. doi: 10.1037/a0025499.CrossRefGoogle Scholar
  2. Bacigalupe, G., & Lambe, S. (2011). Virtualizing intimacy: Information communication technologies and transnational families in therapy. Family Process, 50(1), 12–26. doi: 10.1111/j.1545-5300.2010.01343.x.PubMedCrossRefGoogle Scholar
  3. Bauer, S., Okon, E., Meermann, R., & Kordy, H. (2012). Technology-enhanced maintenance of treatment gains in eating disorders: Efficacy of an intervention delivered via text messaging. Journal of Clinical and Consulting Psychology, 80(4), 700–706. doi: 10.1037/a0028030.CrossRefGoogle Scholar
  4. Best, M. L., & Maclay, C. M. (2002). Community internet access in rural areas: Solving the economic sustainability puzzle. In G. Kirkman, J. Sachs, K. Schwab, & P. Corneilus (Eds.), The global information technology report 2001–2002: Readiness for the networked world (pp. 76–89). Oxford: Oxford University Press.Google Scholar
  5. Bischoff, R. J. (2004). Considerations in the use of telecommunications as a primary treatment medium: The application of behavioral telehealth to marriage and family therapy. American Journal of Family Therapy, 32, 173–187. doi: 10.1080/01926180490437376.CrossRefGoogle Scholar
  6. Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: Live therapy vs. self-help via the internet. Behaviour Research and Therapy, 43, 1321–1333. doi: 10.1016/j.brat.2004.10.002.PubMedCrossRefGoogle Scholar
  7. Castaño, P. M., Bynum, J., Andrés, R., Lara, M., & Westhoff, C. (2012). Effect of daily text messages on oral contraceptive continuation. Obstetrics and Gynecology, 119(1), 14–20. doi: 10.1097/AOG.0b013e31823d4167.PubMedCrossRefGoogle Scholar
  8. Ellis, A. R., Konrad, T. R., Thomas, K. C., & Morrissey, J. P. (2009). County-level estimates of mental health professional supply in the United States. Psychiatric Services, 60(10), 1315–1322. doi: 10.1176/ Scholar
  9. Fischer, H. H., Moore, S. L., Ginosar, D., Davidson, A. J., Rice-Peterson, C. M., Durfee, M. J., et al. (2012). Care by cell phone: Text messaging for chronic disease management. American Journal of Managed Care, 18(2), 42–47.Google Scholar
  10. Foreman, K. F., Stockl, K. M., Le, L. B., Fisk, E., Shah, S. M., Lew, H. C., et al. (2012). Impact of a text messaging pilot program on patient medication adherence. Clinical Therapeutics, 34(5), 1084–1091. Retrieved from doi: 10.1016/j.clinthera.2012.04.007.Google Scholar
  11. Grubaugh, A. L., Cain, G. D., Elhai, J. D., Patrick, S. L., & Frueh, C. B. (2008). Attitudes toward medical and mental health care delivered via telehealth applications among rural and urban primary care patients. Journal of Nervous and Mental Disease, 196(2), 166–170. doi: 10.1097/NMD.0b013e318162aa2d.PubMedCrossRefGoogle Scholar
  12. Hailey, D., Roine, R., & Ohinmaa, A. (2008). The effectiveness of telemental health applications: A review. The Canadian Journal of Psychiatry, 53(11), 769–778.Google Scholar
  13. Harwood, T. M., & L’Abate, L. (2009). Self-help in mental health: A critical review. New York: Springer.Google Scholar
  14. Jerome, L. W., & Zaylor, C. (2000). Cyberspace: Creating a therapeutic environment for telehealth applications. Professional Psychology: Research and Practice, 31, 478–483. doi: 10.1037/0735-7028.31.5.478.CrossRefGoogle Scholar
  15. Karhula, T., Kauppila, T., Elonheimo, O., & Brommels, M. (2011). Use of email in communication between the finnish primary healthcare system and general practitioners. Informatics in Primary Care, 19(1), 25–32. doi: 10.1186/1472-6947-5-2.PubMedGoogle Scholar
  16. Mackinnon, A., Griffiths, K., & Christensen, H. (2008). Comparative randomised trial of online cognitive-behavioural therapy and an information website for depression: 12-month outcomes. The British Journal of Psychiatry, 192, 130–134. doi: 10.1192/bjp.bp.106.032078.PubMedCrossRefGoogle Scholar
  17. Menachemi, N., Prickett, C. T., & Brooks, R. G. (2011). The use of physician-patient email: A follow-up examination of adoption and best-practice adherence 2005–2008. Journal of Medical Internet research, 13(1), e23. doi: 10.2196/jmir.1578.
  18. Moore, S. (2011). Text, tweets, and patient portals. Oncology Nursing Forum, 38(4), 393.PubMedCrossRefGoogle Scholar
  19. National Board of Certified Counselors. (2008). The practice of Internet counseling. Greensboro, NC: Center for Credentialing and Education, Inc. Retrieved from
  20. Negretti, M. A., & Wieling, E. (2001). The use of communication technology in private practice: Ethical implications and boundary dilemmas in therapy. Contemporary Family Therapy, 23(3), 275–293.CrossRefGoogle Scholar
  21. Neville, R. G., Marsden, W., McCowan, C., Pagliari, C., Mullen, H., & Fannin, A. (2004). A survey of GP attitudes to and experiences of email consultations. Informatics in Primary Care, 12(4), 201–205.PubMedGoogle Scholar
  22. Nickelson, D. W. (1998). Telehealth and the evolving health care system: Strategic opportunities for professional psychology. Professional Psychology: Research and Practice, 29(6), 527–535. doi: 10.1037/0735-7028.29.6.527.CrossRefGoogle Scholar
  23. Northey, W. F. (2005). Studying marriage and family therapists in the 21st century: Methodological and technological issues. Journal of Marital and Family Therapy, 31(1), 99–105. doi: 10.1111/j.1752-0606.2005.tb01546.x.PubMedCrossRefGoogle Scholar
  24. Papacharissi, Z., & Rubin, A. M. (2000). Predictors of Internet use. Journal of Broadcasting and Electronic Media, 44(2), 175–196.CrossRefGoogle Scholar
  25. Petrie, K. J., Perry, K., Broadbent, E., & Weinman, J. (2012a). A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication. British Journal of Health Psychology, 17(1), 74–84.PubMedCrossRefGoogle Scholar
  26. Petrie, K. J., Perry, K., Broadbent, E., & Weinman, J. (2012b). A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication. British Journal of Health Psychology, 17(1), 74–84. doi: 10.1111/j.2044-8287.2011.02033.x.PubMedCrossRefGoogle Scholar
  27. Reese, C. S., & Stone, S. (2005). Therapeutic alliance in face-to-face versus videoconferenced psychotherapy. Professional Psychology: Research and Practice, 36, 649–653. doi: 10.1037/0735-7028.36.6.649.CrossRefGoogle Scholar
  28. Ritterband, L. M., & Tate, D. F. (2009). The science of internet interventions. Annuals of Behavioral Medicine, 38(1), 1–3. doi: 10.1007/s12160-009-9132-5.CrossRefGoogle Scholar
  29. Robinson, P. H., & Serfaty, M. A. (2001). The use of e-mail in the identification of bulimia nervosa and its treatment. European Eating Disorders Review, 9, 182–193. doi: 10.1002/erv.411.CrossRefGoogle Scholar
  30. Ruskin, P. E., Silver-Aylaian, M., Kling, M. A., Reed, S. A., Bradham, D. D., Hebel, J. R., et al. (2004). Treatments outcomes in depression: Comparison of remote treatment through telepsychiatry to in-person treatment. American Journal of Psychiatry, 161(8), 1471–1476. doi: 10.1176/appi.ajp.161.8.1471.PubMedCrossRefGoogle Scholar
  31. Schopp, L., Johnstone, B., & Merrell, D. (2000). Telehealth and neuropsychological assessment: New opportunities for psychologists. Professional Psychology: Research and Practice, 31(2), 179–183. doi: 10.1037/0735-7028.31.2.179.CrossRefGoogle Scholar
  32. Shapiro, J. R., Bauer, S., Andrews, E., Pisetsky, E., Bulik-Sullivan, B., Hamer, R. M., et al. (2010). Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa. International Journal of Eating Disorders, 43(6), 513–519. doi: 10.1002/eat.20744.PubMedCrossRefGoogle Scholar
  33. Simms, D. C., Gibson, K., & O’Donnell, S. (2011). To use or not to use: Clinicians’ perceptions of telemental health. Canadian Psychology/Psychologie Canadienne, 52(1), 41–51. doi: 10.1037/a0022275.CrossRefGoogle Scholar
  34. Singh, H., Fox, S. A., Petersen, N. J., Shethia, A., & Street Jr, R. L. (2009). Older patients’ enthusiasm to use electronic mail to communicate with their physicians: cross-sectional survey. Journal of Medical Internet Research, 11(2). doi: 10.2196/jmir.1143.
  35. Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behavior therapy for mood and anxiety disorders: A meta-analysis. Psychological Medicine, 37(3), 319–328. doi: 10.1037/0022-006X.74.4.677.Google Scholar
  36. Stockwell, M. S., Kharbanda, E. O., Martinez, R. A., Lara, M., Vawdrey, D., Natarajan, K., et al. (2012). Text4Health: Impact of text message reminder-recalls for pediatric and adolescent immunizations. American Journal of Public Health, 102(2), e15–e21. doi: 10.2105/AJPH.2011.300331.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Tambling, R., Johnson, L., Templeton, G. G., & Melton, M. (2007). Using web-based technology to facilitate client engagement. Contemporary Family Therapy: An International Journal, 29(3), 177–183. doi: 10.1007/s10591-007-9037-z.CrossRefGoogle Scholar
  38. VandenBos, G. R., & Williams, S. (2000). The internet versus the telephone: What is telehealth, anyway? Professional Psychology: Research and Practice, 31(5), 450–492. doi: 10.1037/0735-7028.31.5.490.Google Scholar
  39. Virji, A., Yarnall, K. S. H., Krause, K. M., Pollak, K. I., Scannell, M. A., Gradison, M., et al. (2006). Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication. BMC Medicine, 4, 18–27. doi: 10.1186/1741-7015-4-18.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Watkins, D. C., Smith, L. C., Kerber, K., Kuebler, J., & Himle, J. A. (2011). Email reminders as a self-management tool in depression: a needs assessment to determine patients’ interests and preferences. Journal of Telemedicine and Telecare, 17(7), 378–381. doi: 10.1258/jtt.2011.110105.PubMedCrossRefGoogle Scholar
  41. Wiersma, J. E., Titov, N., VanSchaik, D. J. F., Van Oppen, P., Beekman, A. T. F., Culjpers, P., et al. (2011). Treating chronic symptoms of depression in the virtual clinic: Findings on chronicity of depression in patients treated with internet-based computerized cognitive behavior therapy for depression. Psychotherapy and Psychosomatics. doi: 10.1159/000323167.PubMedGoogle Scholar
  42. Wooton, B. M., Titov, N., Dear, B. F., Spence, J., & Kemp, A. (2011). The acceptability of internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: An internet survey. PLoS ONE, 6(6), e20548. doi: 10.1371/journal.pone.0020548.CrossRefGoogle Scholar
  43. Young, K. S. (2005). An empirical examination of client attitudes towards online counseling. CyberPsychology and Behavior, 8(2), 172–177. doi: 10.1089/cpb.2005.8.172.PubMedCrossRefGoogle Scholar
  44. Yuen, E. K., Goetter, E. M., Herbet, 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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Katherine M. Hertlein
    • 1
  • Markie L. C. Blumer
    • 2
  • Justin M. Smith
    • 3
  1. 1.Marriage and Family Therapy ProgramUniversity of Nevada, Las VegasLas VegasUSA
  2. 2.Marriage and Family Therapy ProgramUniversity of Wisconsin-StoutMenomonieUSA
  3. 3.Rainbow Family and Child TreatmentLas VegasUSA

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