Some of you who are thinking about delivering therapy online are wondering what might be the best way to get started. Some practitioners opt to deliver services straight from their own websites tapping into platforms such as Skype and Hushmail. Skype offers encrypted voice, web and chat services. Hushmail offers encrypted email and chat. Skype and Hushmail are but two examples of available services. Now many companies are offering encrypted communication platforms. Currently I use Skype and Hushmail because these services are free and user friendly for clients.
Others may opt to join an “E-Clinic” which is an easy way to describe a platform or portal that allows providers of services and potential clients to conduct therapy. There are some nuances across the E-Clinic menus but in a nutshell, it is a one-stop shop for the client and therapist. I have previously joined E-Clinics in the past and I am still listed on a few. It might be interesting to note that I have been listed for several (a decade in some cases) years on some e-clinic sites and I rarely if ever receive an inquiry from a potential client. I’ll get back to that in a minute. E-Clinics are convenient and easy. Some E-Clinics offer appointment setting, billing capability, credit card processing and an extensive listing. Conceivably, one could create a listing on such a site and use the listing as a website. Some E-Clinics offer customized or “branded” services so that you can integrate the platform into a custom website of your own. And most E-Clinics conduct some variation of credentialing so that license and certification numbers as well as malpractice insurance information is verified.
So it sounds hassle-free. So, why not? Well, there are a few reasons why not. One is cost. Some of these sites charge monthly fees. That’s great but if you also have a website of your own then you might be paying twice, so to speak. Remember I said previously that I rarely if ever receive client inquiries from these sites so just because they have a glossy “store front” and offer a suite of products to the therapist, it does not mean that the site is marketed well. If you want to know, do an internet search using keywords like online therapy, online counseling, online counselling, or etherapy. What comes up? Is the E-Clinic listed on the first page of results? That is but one way to find out how “popular” the service is. The other way is to check press or media tabs on the websites. Has anyone interviewed the company? Is there any information about advertising campaigns, past, present or future? Remember, you can create a listing anywhere on the World Wide Web. That does not mean people can find you. In the case of E-Clinics, make sure your money is working for you.
Another concern is security. Is the site encrypted? Is the information held on the company’s server? I often joke that we need to be careful about setting up our services using encrypted platforms that are hosted on Joe’s server located in Joe’s garage somewhere in an urban neighborhood across the country or the world. But seriously, the security and encryption of the site should meet very high standards. Does the E-Clinic serve via contract, any major government or insurance entities? That is one reasonable and simple way to know if the E-Clinic has “clout” so to speak. But even so, do your own security tests. Take the E-Clinic for a spin. Use their web, messaging or chat services with a colleague. When you are logged on, send the URL (which should begin with https://) via your regular email or chat (yahoo or gmail for instance). Can the person on the other end open the the URL? If so, the site is not secure. Why is this important? If you do this same test with sites like Amazon, Ebay or your bank once you have logged in, the other person will not be able to see your information and will most likely be sent to a login page for that site. The same process should occur for E-Clinic sites.
If you think you have found an E-Clinic you want to use, be sure to check out their Terms of Use, Privacy Policy and other Terms and Conditions. You should be concerned with what you are agreeing to as the provider of services and what the consumer agrees to as the recipient of services. Does it match your legal and ethical responsibilities? Do you have the ability to upload your own informed consent documents to your clients? And if you take client referrals from these sites using their platform, what intake information do you receive? Does the site conduct any screening? Is the site set up to provide crisis intervention? If the site clearly states that online therapy is not for people in crisis, then consider whether you want to make yourself available immediately. Many of the E-Clinic sites offer instant sessions as a way to lure consumers into using the site. Some would say these E-Clinics are offering a viable service to people who are in immediate need. So I ask, is the immediate need a crisis or just needing to have a personal issue addressed right away, representing the immediacy of our culture? Be careful not to compromise standards of care. For instance, if you make yourself available immediately, what client information do you have on hand during this initial contact? Is the client allowed to remain anonymous? If so, what happens if the client is genuinely in crisis? I recommend that if you are going to utilize the option of immediate availability that you use this option as an initial consultation- and treat that time much like you would if a client called on the phone inquiring about services. Why? Well, consider your ethical responsibility to properly screen your client and to know the identity of your client. If you are providing crisis intervention then the site should clearly state that services are for people in crisis with the proper terms and conditions in place. Counseling and psychotherapy services that occur within a contracted relationship are very different than crisis intervention services.
Remember that E-Clinics cater to many disciplines so be sure that you can follow your legal and ethical codes and that you remain within your scope of practice. If you live in a geographic area that does not regulate your profession and you have no real code of ethics to fall back on for reference, then consider using best practice standards set forth by the Online Therapy Institute’s Ethical Frameworks for Mental Health Practitioners and Career and School Guidance.
Hoping this has been a helpful post~ perhaps this will generate a healthy discussion of the topic.
DeeAnna
