Interview with Rubén Tovar: professional intrusiveness in online therapy

Psychologist Rubén Tovar talks to us about the phenomenon of professional intrusion and how to avoid it.

The field of psychotherapy can give rise to ambiguities when deciding which psychologist to go to. Therefore, labor intrusion in this field is a very present reality that must be taken into account.

How to detect cases of intrusion and choose professionals fully trained to practice psychological therapy? Psychologist Rubén Tovar gives us the keys to this..

Interview to Rubén Tovar: how to identify the labor intrusiveness in psychotherapy

Rubén Tovar Bordón is a psychologist specialized in online therapy, and directs the health center of psychological assistance terapiaencasa.es. In this interview he talks to us about the criteria to follow when choosing a psychologist from the point of view of the person seeking professional help.

Do you think that the field of applied psychology is especially prone to labor intrusion?

Yes, without a doubt. Already in the past, before online therapy became widespread, there was labor intrusiveness.

This intrusiveness comes from within and from outside the profession. Let me explain. In the past, I am talking about the last 10 years, above all, there were many psychologists who, without having the specific training or authorization to practice as mental health professionals, performed different types of therapies, even having 'pirate' centers without licenses or any kind of guarantees, and some of them were not even registered. This is a situation that I have been denouncing since 2009.

But more shocking was the case of different profiles of professionals who, without having psychological or psychiatric training, applied or carried out psychological therapies. Sometimes these therapies were copied from the most commonly used techniques or orientations in psychology. In other cases, they were directly therapies of dubious efficacy or even misleading.

Moreover, this intrusiveness is aggravated because clients rely heavily on the experience of what someone else told them that went well; without asking for formal references or to see if the professional is accredited.

In Spain, if you are a psychologist and want to practice as such, you are required to be a PIR (Clinical Psychologist) and PGS (Health Psychologist). In addition, you must be licensed, have liability insurance and have a registered health center.

On the other hand, there is a legal vacuum in the therapeutic field that is exploited by other professionals, who use the word 'therapy' and even use terms such as 'psychology', to which absolutely nothing is required.

And from what you have been seeing... are there people with no training in psychology who advertise themselves as online psychotherapists, taking advantage of the fact that they do not need to invest in premises?

Nowadays, in the online part it is becoming an increasingly serious problem. Sometimes, many do not have the proper training, or have training but are not qualified to practice (because you can have training but NOT be able to practice as a psychotherapist).

On other occasions, we find many websites that advertise quality psychology services, etc., and not even the profiles of the professionals who provide the therapies appear. That is to say, we do not know if it is a psychologist, psychiatrist, educator or social worker.

On many occasions we have received patients who had used these services, which were advertised as 'online psychologists' or 'online psychology center', even promising 'brief and effective therapies'. When we investigate a little, we see that it is almost impossible to access the professional profile of the therapists, at most they say that they have a 'degree in psychology'. And that they are not very transparent if clients ask them for credentials.

At this point, I do not want to be misunderstood: I am totally in favor of multidisciplinary interventions and I believe that very good interventions can be carried out legally. Intrusionism feeds, more and more, on the lack of knowledge and the lack of protection of the patient, who often takes for good something that he/she does not know if it is good.

Websites that advertise this type of services should clearly state the professional profile of their psychologists, or otherwise the training of their professionals, and indicate that they are authorized health centers. In addition, even if they do not perform physical intervention, all their professionals must have their registration number visible and be registered in their liability insurance. Everything else, apart from being an informality, in reality what it hides is a blatant intrusiveness.

Surely many people believe that psychotherapy is basically a chat, something similar to a dialogue you might have with a friend. Do you think that the fact that we tend to associate video calls with a more informal context than a face-to-face meeting with the psychologist is one of the factors that favors intrusiveness?

I think they are different things, but I do think that intrusiveness favors the negative opinion that therapy is just talking.

Psychological therapy is not just talking. Therapy is and should be a regulated and programmed scientific process, where the patient's difficulties, context and all areas of the patient are evaluated. A type of intervention is always established following the guidelines or models that are currently validated. In addition, the sessions are prepared beforehand, therapeutic objectives are sought, personal goals are established with the patient, etc.

Therefore, the problem of intrusion is not only a question of misguidance or the use of theoretical aspects of dubious effectiveness, but also of professionals who really lack basic or specialized training and base their intervention on that, simply chatting and letting the patient unburden his or her feelings. For this reason, the context of video calls, or whether a physical center is more formal or informal, is a matter that depends entirely on the professionals.

I have been in centers that, without judging whether they are better or worse, have a more or less neat aesthetic, or a more or less informal presentation; I have even been in psychology centers more similar to a general practitioner's office.

All of them, whatever their presentation or appearance, seem fine to me; because these aspects are really just a vision of how the therapeutic process is carried out, but as long as it is carried out by professionals who comply with professional ethics and legality, it should not be perceived as a problem.

The same applies to online therapy. Videocalls usually, especially in my case and that of my colleagues at terapiaencasa.es, we establish protocols of how should be the environment from which we serve our patients, as well as the interaction with them. In our case, we want to give an image of what we are: a serious, safe and professional service.

We must never forget that, even though we are on a video call, we are still a healthcare center.

From the patients' point of view, what are the main implications of this intrusiveness?

Intrusiveness leads to misdiagnosis, ineffective therapies and a bad image of the profession.

In the best of cases, the patient will only suffer a small frustration, but it is very likely that he or she will not try again. At worst it will precipitate a serious patient to become destabilized and may harm themselves or their environment; or even chronic certain problems that could have been resolved by a qualified professional.

What advice would you give to someone who is looking for online therapy services but has no experience selecting professionals?

I really like this question. The first thing is not to get carried away by pretty words: free, years of experience, top quality, etc. You have to look at concrete data.

Does the website have any reference to a professional association or indicate a health center number? If not, ask for it by e-mail, if not, be suspicious.

Does the professional association number of your professionals appear? It is mandatory to provide psychological therapy.

Is the training visible or transparent, where they studied their career or what masters or postgraduate degrees do they have?

Are they clinical or health psychologists, psychiatrists, educators, coaches with regulated training... because even if one does not look for a psychologist, other professionals should give us some guarantees. Look for the professional in the corresponding college.

The center follows the rules of data protection, it may seem silly, but no one would want their data to appear anywhere next to their therapeutic report.

Finally, always look for real external references that indicate if they are really good professionals. Internet reviews are not enough, because there are many shameless people who make them up.

For example, do they have a published book, have they appeared in any public media, do they work in other centers or entities, do they have positive references in serious portals, etc.?

And regarding the regulation of the profession, what aspects do you think are necessary, taking into account that online therapy is becoming more and more popular?

I think it is essential that the professional associations dedicate themselves to actively pursue all these intrusive frauds, which will only lead to our profession being undervalued in the long run. I also believe that other entities could do better.

Some platforms do ask for the membership number (which is great because others totally ignore it).

But, there are also many that, knowing the environment and knowing the obligations, do not ask the professionals who advertise any accreditation about their qualification to practice as clinical/health psychologists.

Lastly, there are some magazines and advertising portals that advertise professionals without checking whether they really claim to be what they are. It does not cost anything to ask for a membership number or a title that qualifies you.