The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts ...

Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

Background
The field of Internet-supported therapeutic interventions has suffered from a lack of clarity and consistency. The absence of professional leadership and of accepted governing approaches, terminology, professional standards, and methodologies has caused this field to be diffused and unstructured. Numerous terms have been used to label and describe the activities conducted over the Internet for mental and physical health purposes: web-based therapy, e-therapy, cybertherapy, eHealth, e-Interventions, computer-mediated interventions, and online therapy (or counseling), among others.

Defining Internet-Supported Therapeutic Interventions

Background Several studies have shown that telephone-administered cognitive-behavioral therapy (T-CBT) is superior to forms of no treatment controls. No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors. Objective To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects. Design Randomized controlled trial including 12-month follow-up. Setting Telephone administration of psychotherapy with patients in their homes. Participants Participants had depression and functional impairments due to multiple sclerosis. Interventions A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy. Main Outcome Measures Hamilton Depression Rating Scale score, Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder, Beck Depression Inventory score, and Positive Affect scale score of the Positive and Negative Affect Scale. Results Of the 127 participants randomized, 7 (5.5%) dropped out of treatment. There were significant improvement during treatment on all outcome measures ( P P  = .02), Hamilton Depression Rating Scale score ( P  = .02), and Positive Affect Scale score ( P  = .008), but not for the Beck Depression Inventory score ( P  = .29). Treatment gains were maintained during 12-month follow-up; however, differences across treatments were no longer evident ( P  > .16 for all). Conclusions Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment. The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect. Attrition was low.

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Telephone-administered psychotherapy for depression.

Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14-0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50-1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23-10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy.

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The Effect of Telephone-Administered Psychotherapy on Symptoms of Depression and Attrition: A Meta-Analysis

Objective
This article aimed to critically review the literature on online counseling.

Method
Database and hand-searches were made using search terms and eligibility criteria, yielding a total of 123 studies.

Results
The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability, and clients’ and therapists’ attitudes and experiences of online counseling are reviewed.

Conclusion
A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters. A need remains for stronger empirical evidence to establish efficacy and effectiveness and to understand better the unique mediating and facilitative variables.

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Online Counseling: A Narrative and Critical Review of the Literature

In the last two decades, new communication technologies have dramatically changed the world in which mental health professionals and their patients live. Developments such as e-mail, online chat groups, Web pages, search engines, and electronic databases are directly or indirectly affecting most people's routines and expectations. Other developments are poised to do so in the near future. Already, for example, patients are acquiring both good and bad advice and information on the Web; many expect to be able to reach their therapists by e-mail. And already there is pressure from third party payers for providers to submit claims electronically. These technological breakthroughs have the potential to make mental health care more widely available and accessible, affordable, acceptable to patients, and adaptable to special needs. But many mental health professionals, as well as those who train them, are skeptical about integrating the new capabilities into their services and question the ethical and legal appropriateness of doing so. Those unfamiliar with the technologies tend to be particularly doubtful. How much e-mail contact with patients should I encourage or permit, and for what purposes? Why should I set up a Web site and how do I do so and what should I put on it? Should I refer patients to chat groups or Web-based discussion forums? Could video-conferencing be a helpful tool in some cases and what is involved? How do I avoid trouble if I dare to experiment with innovations? And last but not least, will the results of my experimentation be cost-effective? In this wide-ranging and practical handbook, five experts, each with a different vantage point and training, systematically guide readers through the new practice arenas already made possible by current information technologies--ranging from Internet-wired offices to wearable computers--and point to those on the horizon. Throughout, the authors clearly define terminology for the beginner and illuminate their points with rich, clinical vignettes and first-person accounts of the experience of pioneering practitioners. The book includes: *an extensive overview of legal and regulatory issues, such as those raised by the Health Insurance Portability and Accountability Act (HIPAA); *concrete technical, ethical and managerial suggestions summarized in a seven-step Online Consultation Risk Management model; and *"How to" resource lists and sample documents of use to beginners and experienced professionals alike. For better or worse, no mental health professional today can avoid confronting the issues presented by the new technologies. The Mental Health Professional and the New Technologies: A Handbook for Practice Today will enormously simplify the job of thinking through the issues and making clinically, ethically, and legally prudent decisions. Contents: Preface. Introduction to Technology in Mental and Behavioral Health. Technicalities. A Professional Online Presence. Professional Web Site Considerations. Audio & Videoconferencing. Computer-Aided Assessment. Computer-Aided Psychotherapy. Electronic Practice Management and the Computer-Based Patient Record. Legal, Regulatory and Reimbursement Issues. Standards of Practice. Online Consultation: Training. Online Consultation: Referrals, Client Education, and Consent. Online Consultation: Delivering Clinical Care. The Near Future. The Distant Future. Epilogue: A Checklist of Immediate Steps. Appendices: Comparative Studies of Psycho-Technologies in Mental Health. Sample Listserv Guidelines. Draft International Convention for Telemedicine and Telehealth. Patient Consent Form.

Nancy E. Brown-Connolly

Papers

The Mental Health Professional and the New Technologies: A Handbook for Practice Today