Clay: Welcome back to the podcast. I am Clay Cockrell. I’ve just returned from the Psychotherapy Networker Symposium in DC and it was amazing. We had a booth there and it was the official launch of the Online Therapy Directory. What is the directory? Well, if you’re familiar with Psychology Today’s Therapist Directory, it’s the same concept. It’s a directory of therapists and counselors who are working online doing telemental healthcare. Somebody anywhere in the world who is looking for a therapist who works online can go to onlinecounselling.com and put in what they are looking for.
Say, they are looking for a female therapist that speaks English, specializes in ADHD, depression, anxiety, or whatever, maybe they have a Muslim background or a Christian background to their practice, all sorts of different filters. They enter that into the filter search and up pops all the therapists who have created profiles with those criteria. I’m hoping it can be a huge resource of connecting people in need with the therapists that can meet those needs. All the therapists listed will have their credentials verified by us so you know you get qualified providers.
If you are a therapist and would like to be listed, it is a small monthly fee. There’s no contract. You don’t have to sign up for a whole year or whatever. We don’t take any percentage of your fee like some of the other sites, which to me seems somewhat complicated. You set your own prices. You choose your own platform. You don’t see your clients through us. This is only a listing directory hopefully to build your practice and bring lots of new clients to you.
The monthly fee is going to start out at $24.95/month, but for listeners of the podcast, we are dropping that price to $19.95/month and you get a free month so you can try it out and see what it’s like. I think it’s pretty affordable and hopefully, it’s going to bring some clients to you. When you go to onlinecounselling.com, you click on “List Your Practice” and you fill out some information and enter in the discount code of “Podcast2016” and the discount will be applied to you and you’ll only be charged $19.95 after your first free month. That’s going to be your price ongoing for as long as you want to be with us.
We’re also going to be a resource to therapists, so you get some value here. On the site, there’s going to be a tab for what we’re calling the Therapist Toolbox. On that page, you’re going to learn about all the HIPAA compliant platforms like VSee.com,
thera-LINK, Regroup, and all the ones that are going to be okay to see your clients on because I think if you’re a listener of the podcast, you know you can’t use Skype or Facetime and be HIPAA compliant, at least not yet.
We’re also going to be tracking issues like doing therapy across state lines. You have up-to-date information about your state and license issues and what the requirements are. We’re also going to have tips on how to build and market your practice. I’m hoping this is going to be really valuable for therapists and for clients as well. Of course, the podcast is going to live there. Speaking of this podcast, let’s talk about today’s guest. During the symposium, almost every counselor who came up to the booth, first they were really excited, “What a great idea!” but then they would say, “What about ……?” Fill in the blank for some scary concern.
What about HIPAA and issues related to Skype? What about doing counseling across state lines? What about liability? What about international clients? What if I just call my practice coaching, can I do online work then?” I answered these questions for three days and it was wonderful to get to know all of you and to learn that across the board, we have some of the same concerns. I thought let’s, once again, go to an expert. Today, we’ve got the expert of all experts, Eric Strom of Strom Consulting.
He is a licensed professional counselor in Washington State and he’s an attorney. He started out in the Navy answering ethical questions with the Navy’s therapists and now he’s doing that in private practice. I love his byline, “Legal Services for Mental Health Professionals. You’ve got questions, he’s got answers.” He’s our amazing guest, a treasure trove of valuable information. Today, we cover it all. Sit back, enjoy. Your questions are finally going to be answered.
Welcome to the Online Counselling Podcast. This is Clay Cockrell, your host, and I am thrilled to welcome our guest today, Eric Strom from the great state of Washington. Is that correct?
Eric: That’s right, Seattle, Washington.
Clay: Alright. How are things out in Seattle today?
Eric: It is beautiful and sunny today. I have mixed feelings about being inside. I almost thought about trying to do this call outside in the yard.
Clay: It’s a little bit of spring fever?
Eric: Totally, totally.
Clay: Yeah, same thing here in New York. The park is coming alive. I love this time of year. So, you are both a licensed professional counselor and you are an attorney. Tell me a little bit about your services because on your website, I think the byline is really cool, “Legal Services for Mental Health Professionals.”
Eric: Yeah.
Clay: Tell us a little bit about you.
Eric: Yeah. My professional practice is kind of that intersection between the law and ethics and the counseling part. I do some clinical work and then my law practice is 100% giving legal and ethical support to other mental health professionals.
Clay: How long have you been doing that?
Eric: That’s a good question. I’ve had my law practice doing this since 2010, so six years. The way I got into this practice though was I was an attorney on active duty in the Navy for eight years. While I was practicing through the Navy, I kind of, just by chance, developed this expertise of working with the mental health professionals because believe it or not, most of the other attorneys didn’t like working with the counselors, social workers, and the psychologists because they just sort of couldn’t communicate. I found that I could, so I started working with the mental health professionals.
When I got out of the Navy and was starting my own law practice, I thought that thing that I did in the Navy with the mental health professionals could call me up and say, “Hey Eric, how does confidentiality work? Does HIPAA apply in this situation?” That kind of thing didn’t exist in the civilian world, so that’s what prompted me to start this law practice that was just services for mental health professionals.
Clay: Wow. What are some of the common issues that you’re dealing with? Is there like a top three, top five kind of things that therapists come to you?
Eric: That’s a great question. Yeah, I would say #1 is documentation. All of the mental health professionals are required to have this pretty elaborate set of documentation and it’s all fairly legally driven and for a lot of professionals, it’s difficult to know how this documentation should work. One of the things I do is help. People just draft all their documents. I would say that’s #1. Number 2 is probably subpoenas. Subpoenas are very technical aspect of law and so there’s this kind of tension between on the one side, if a clinician responds to an invalid subpoena, potentially, they are violating client confidentiality. On the other side, if a clinician does not respond and it is a valid subpoena, then arguably, they are in contempt of court.
Clay: Oh wow.
Eric: That’s a really kind of a scary place and so that’s one of the topics that I often help clinicians with just because it’s so technical. I had a third one and I haven’t mentioned what that was, but those are the big two.
Clay: Those are the big ones, okay.
Eric: Yeah.
Clay: Okay, but you also are in clinical practice yourself currently?
Eric: That’s right.
Clay: Okay. So you’re seeing clients?
Eric: I’m a licensed mental health counselor also and my clinical work is focused on working with combat veterans.
Clay: Okay, alright. Now, more into kind of what this podcast is about with online counseling, tell me a little bit about some of the things that you’ve learned about the process because when we spoke earlier, I found actually that you went through the process of all 50 states a couple of years ago.
Eric: That’s right.
Clay: What did you find out?
Eric: The really interesting thing is and I’ll back it up a little bit and tell you why I even started being interested in this. One time, I was looking at some of those big online counseling sort of corporations, those umbrella companies that sort of advertise to clients and then also advertise to counselors. I was putting together some kind of a CEU at that time. I came across this website and thought, “Wow, this thing looks just huge,” and it basically said, “Any counselors, join us and any clients come and find a counselor.”
I started thinking, like, this is sort of interesting and so I went and read their fine print just because that was the lawyer side of me that said, “Hey, I want to see how they are doing this.” I went and read the terms and conditions and the fine print on the website and one thing stood out to me. I was reading through it, I saw this line in it that said something like, “We believe that counseling occurs in the location of the counselor. In essence, you’re responsible to know the laws in your jurisdiction.” I read that and thought, “That seems strange because that doesn’t actually seem like what my understanding from an attorney’s point of view of how the law works.”
That sort of started me off and I thought, “I want to look into this.” So I started looking state by state and as it turns out, that’s not the case. No state looks at the location of the counselor as the final decision.
Clay: I want to underline that because that’s the common wisdom, right, that if I’m licensed in New York, therapies happening in my office as I sit in New York and I can talk to somebody in Kansas that the therapy is happening right here in my office. You’re saying that’s not the case in any of the 50 states?
Eric: Correct.
Clay: Okay.
Eric: I’ll tell you the reason, In my view, a lot of people have that belief that yeah, if I’m sitting in my office in Seattle and my client is in New York, the counseling is happening in Seattle and Seattle law applies. I think the reason a lot of people believe that is because of things like this company, in essence, are saying that, but why they are saying that is they are saying, “It’s your problem, not ours.” The reality of the situation is there is not one single state that says, “That’s how it happens.”
Not one single state says counseling only occurs where the counselor is. This is what I learned in going state by state by state. Most states, the majority of states will say counseling occurs in the location of the counselor and the location of the client. That’s what most states say. There are some states that don’t have any opinion at all who just haven’t come out with an opinion yet. None of them say it only happens in the location of the counselor.
Clay: Okay.
Eric: New York is an interesting example. New York has a policy that specifically says, “If the client is in New York, the counselor who is providing services to that New York client no matter where they are must be licensed by New York.”
Clay: Okay.
Eric: That’s affirmative. There’s an affirmative rule.
Clay: Very clear, no gray area.
Eric: Very clear, absolutely. What’s interesting, though, is there is some variation. There are a few states that say if you’re licensed in a different jurisdiction, you’re allowed to provide counseling to residents of our state on some temporary basis. For example, it will be something like 30 days out of the year or 90 days out of the year. Louisiana, I think, is one of the states that says, “If you’re licensed in another state, you can provide distance counseling to residents of our state; however, you are required to file with the state and agree to the jurisdiction of the Louisiana regulators.” Maybe it’s Maine, but there are a couple of states that do that. Some states like New York, again, that just say, “Nope, you can’t do it if you’re not licensed by us.” That’s a big deal.
Clay: I found it fascinating. I think it was North Carolina that you were talking about that they said you could do 30 days but they did not say consecutive days.
Eric: Correct.
Clay: So in theory, it could be once a week for 30 weeks.
Eric: That’s right, yeah and a few states that have those temporary rules, yeah. I did the research in all these states and then I presented at the American Counseling Association conference in 2014. I presented the results. One of the challenges, though, is that the laws are sort of influx. They are subject to changing all the time and so doing this review of the 50 states laws sort of needs to be an ongoing process because they could change at any time. One of the things that I often advice people is if you are doing cross jurisdictional, so from state to state online counseling and you have a client in another state, make sure that you know what your state rules are about online counseling. Make sure you know what the client’s state rules are and periodically check back because you need to know when that changes as well.
Clay: Absolutely. It’s so hard to find because I’d begun, like I said, initially looking into this and it’s so hard to find out where to look. I guess go to the actual legislature and look up laws and search for terms like mental health, but where do you find it?
Eric: It is a little challenging and there are a couple different places. One, the first place to start is just to go to the regulator’s website. In Washington, it’s the Department of Health. In New York, is it the Department of Health that regulates counseling?
Clay: No, it’s the Office of Education and Licenses. It’s this long name.
Eric: Right. It’s a different regulator in different states, but you go to the website of the regulators and then often, they will have a link to the laws and regulations that apply. So typically, there are two sets of rules. The laws are the state legislature making laws. The regulations then are the statutes that are enacted by the regulators themselves. In Washington, it’s the Department of Health that sets out those regulations. You look into those two, the statutes and the regulations, and they are typically linked from the regulator’s website, but that’s not always often enough because sometimes, there will be policy statements as well.
For example, the Board of Health or the Board of Professional Counselors will actually publish a policy that’s not a law or a statute of regulation, but will say, “Here’s how we interpret or here’s how we believe this works.” It’s kind of looking at the laws, looking at the policies, and then sometimes, there can be case law. I’m actually not aware of any states where this is ruled by case law, but that’s also possible. It takes quite a bit of research sometimes especially for the states that don’t have a specific policy that are just kind of laid out there.
Clay: Right. You say that there’s really no case law that you’re aware of and there isn’t that I’m aware of. We can make an assumption, at least I’ve not heard of a therapist being called on any of this and gotten into trouble. I see that expression. Have you heard of something like this?
Eric: Well, no. I’m not aware of any therapist but there’s a really interesting case out of California. It happened a few years ago where a physician was part of this online program where a patient could sign up on this website and fill out a form with symptoms. The physician would receive that form, look at the symptoms, issue a prescription. The physician was in Colorado, would send the prescription to Florida. A pharmacy in Florida would fill the prescription and ship the medication back to California.
Clay: Oh my gosh.
Eric: Yeah. This was the plan that was going on. The patient went through this process, got the medication, and then took the medication and I think something like caused a car accident. The victim in the car accident then sued everybody including this physician in Colorado. This was the really interesting part though, is the State of California then brought a legal action against the Colorado physician and it was a criminal action for practicing medicine in California without a license. The physician’s argument was, “I’ve never even set foot in California.” The State of California said, “By issuing a prescription to a patient located in California, you practiced medicine in California without a license.”
Clay: Wow! What happened?
Eric: That was pretty traumatic.
Clay: Did he get convicted?
Eric: He was, yeah. Isn’t that crazy in a way, but then it also makes sense, right?
Clay: Of course.
Eric: In California, they are saying, “We have an interest in regulating the healthcare that is provided to residents of our state regardless of where that provider is sitting when they give that healthcare to residents of our state.”
Clay: Which brings me to something that you said earlier in the call in that these state boards, they are not there as a service or to protect counselors or therapists as far as their primary goal. They are there to protect their citizens, the citizens of Pennsylvania, not necessarily the therapists of Pennsylvania.
Eric: I think that’s exactly right. The dual role of these boards is one to regulate therapists and to protect the patients, the clients, and the general public. I think those are the two primary functions. You’re exactly right.
Clay: Yeah. Do we have any idea what could happen if the therapist gets in trouble for counseling across state lines, in a state they are not licensed?
Eric: Yeah. I’ll start by saying I think that the states are not particularly motivated to try and identify people who are practicing across state lines and crack down on them. They just don’t have the resources and they are not particularly interested in doing that. That probably explains why we see it happen so much and we don’t see the states actually doing anything about it. That being said, I can imagine worst case scenario and that’s putting on my lawyer hat.
Clay: You’ll always be a lawyer. That’s what you do.
Eric: Worst case scenario is that same kind of thing that happened in California, right, where a patient does something horrible, let’s say, kill someone. The surviving family members then sue that clinician and say, “Look, #1, you failed to meet the standard of care by whatever you did or didn’t do clinically. #2, you failed to meet the standard of care because you weren’t even licensed.” That’s where I can see this really being a problem and then the regulators would have an interest in saying, “That’s right. This person was not regulated by us. They were practicing outside of the state, the state system and the state regulation.” That’s where I can see this happening.
Clay: Okay. Good to be aware of that and really, it kind of comes down to like so many things, your ability to be familiar with risk and what is your comfortable level of risk with your own license.
Eric: Yeah. I think that’s exactly right.
Clay: Okay. Alright. Talk to me a little bit about the ethics and what you may be aware of because we’ve got how many licenses? We’ve got NASW for the social workers and APA for the psychologists, ACA for you guys and the counselors. We’ve got the Marriage and Family Therapists, right? We’re up to four and then we go across 50 states for all those four or up to 200 people talking about different – what do you know about this?
Eric: As far as, like, what’s the standard of care?
Clay: What’s the standard as far as going state to state with counseling? What is ACA? Thinking about it, should counselors look at ACA in general or the ACA of Pennsylvania? Are they going to have a separate policy regarding online counseling?
Eric: We are on the growing edge right now of online counseling. I think we have a whole bunch of different places where the standards are being created right now. If just for some context, I often like to go back to a couple of things that I saw on the literature. I was reading one time this article that was published, I think probably in the mid-70s and it was a survey that had been sent out to mental health professionals and asking them about how ethical or unethical they thought different things were. One of the things that really stood out to me that seemed kind of amazing was a majority of the respondents felt that it was unethical for a mental health professional to talk to a client on the phone. Isn’t that interesting?
Clay: Wow. It’s the mid-70s.
Eric: Yeah, like in the mid-70s and I think basically, the concept was pretty across the board, mental health professionals feeling like that communication needs to be in person, one on one where I can see the client or in a letter. Talking on the phone is just unethical, right? Now, can you imagine having a practice where you said, “I do not use the phone.” You’d have no clients, right, if you’d say, “Come to my office or send me a letter.” You’d’ never have a client, but I think it’s really interesting because that kind of demonstrates to us that change in the view on what’s ethical and what’s not.
I think we’re in that place right now with online counseling. It’s going to happen. I mean, using technology to have counseling happen remotely, there’s no way to hold it back. It’s going to happen. The regulation, the standard of care, and the ethics are kind of lagging a little bit behind. What’s really interesting is as the ethics codes for the different organizations are being revised and new editions are coming out, they are more and more addressing sort of giving us guidance for how to do this distance counseling.
The very first ethics code, I’ll tell you, the NASW Ethics Code was last updated in 2008. They do have a use of technology policy guidance as well, but in 2008 in NASW Code, nothing about distance counseling. In 2012, the NBCC Code was released and actually started addressing distance counseling. The 2014 ACA Code came out and had a whole section on social media, electronic communication, and distance counseling. The brand new American Mental Health Counseling Association Ethics Code came out in December 2015 which should have been January because that would have been the 2016 code, but they made it the 2015 code instead.
That newest ethics code, the American Mental Health Counseling Association Code has some wonderful guidance about social media, distance counseling blogging even. It’s just pretty cool.
Clay: Oh wow, yeah.
Eric: We’re starting to see the ethics codes reflect that this is where our profession is going and giving us more and more guidance. The bottom line to me is pretty interesting. What we’re seeing the trend being is that the standard of care and the expectation for online counseling pretty much mirrors what’s expected of us for real life counseling as well. You need to be able to protect confidentiality. You need to be able to adequately conduct a risk assessment. You need to be able to identify who your client is and make sure that that’s really your client.
You have an obligation to make sure that you can communicate with your client, right, so what happens if the internet goes down or their computer doesn’t work, that kind of stuff. All the same things that you would need to do in real life, you have to do in the virtual space. I think that’s pretty neat that that’s the direction we’re going in this regulation of recognizing in a lot of ways, online counseling is just like in-person counseling as far as what you, the counselor, are expected to do.
Clay: You’re kind of answering then my next question. If you were to look into the future of three, five, 10 years, is this going to be the new norm and you’re saying it’s going to happen and the ethics boards are just catching up to it.
Eric: Exactly. That’s exactly right. I think it is going to be the norm.
Clay: Okay. Now, let’s go into the idea of international. State to state, there’s still some foggy area. What if I’ve got my friend in Dubai who wants to have a counselor? There’s no English speaking therapist, but there’s one in Mississippi and he could jump on and connect. What’s Mississippi guy’s problem or does he have one?
Eric: I love that question, Clay. I love this question. My answer to it is, it’s kind of the Wild West. If you’re doing international counseling and I always use this as an example with, say, in Canada. I would kind of treat that as if you were doing counseling across state lines and not for any derogatory reasons against Canada, but the idea being the regulation is so similar to us and the proximity is so close and the populations are so similar that if you were to provide counseling, say, in Ontario without being licensed by Ontario, and I think it’s actually federal, I think, in Canada, without having a federal license to practice.
I could imagine the Canadian regulators complaining to the state board not being a problem. I could see that happening. I would imagine in Canada, I would kind of treat that like it was another state. Internationally though, there is a wild difference between different countries and how they regulate and what they even consider to be healthcare, psychology, or counseling. In many, many countries, there’s no regulation whatsoever, and so my thought is in a lot of the international settings, there’s just no regulation to really be concerned with.
For example, if I had a client in Dubai and I was practicing here in Washington, the Washington regulators don’t mind at all that I provide distance counseling to a client in Dubai. As long as I meet all the other requirements in my license, Washington regulators couldn’t care less that my client is in Dubai. I have no idea what the laws are in Dubai, no clue, but I suspect that it doesn’t make that much difference because if I had an English speaking client that we’d say is temporarily assigned for work to Dubai and I was conducting counseling, and the regulators in Dubai had a problem with it, I don’t think the state of Washington is going to care that much.
Clay: Okay. The laws of the foreign country then would not necessarily apply to you sitting in Washington if there were law.
Eric: It may not. Yeah, #1 if there were laws. Assuming there are, they may not even apply to you and then assuming that they did, it would be difficult for them to actually have any real application to enforce that, but I do think that again, this is the direction we’re going. I wouldn’t be surprised if within our lifetimes, this isn’t the short term, but within our lifetimes, there does start to be some kind of international standards set or international licensure credentialing or something, but right now, it is still the Wild West, kind of everything goes.
Clay: Yeah, which is exciting and I think, I was talking with people at the symposium this last weekend that they had never thought, they were so concerned about that next state over, but they had never thought that somebody in the UK, Australia, or India, they could be expanding their practice, filling those slots, actually helping people in need. There’s a massive need in India alone for licensed, educated therapists.
Eric: Yeah.
Clay: They could be doing that and they are safe. Not just safe, they are doing good work.
Eric: Yeah and like you said, filling a really important need.
Clay: Yeah.
Eric: Especially when you think about something like, say, Americans who are overseas for work, for education, or for whatever reason and expecting them to find counseling and services in other countries, it’s fairly unrealistic.
Clay: Right. What is your comfortable level of talking about HIPAA in regards to platforms and we all know, I think, basically Skype, Facetime, Google Hangouts, we can’t use that for counseling because one cannot be HIPAA compliant and use those platforms.
Eric: Well, yeah. I’ll give you a real general sort of explanation from my point of view with HIPAA. It is kind of interesting. HIPAA gives us a federal rule that’s a bare minimum of client protection that you must ensure. HIPAA is a bare minimum. The states are allowed to set rules that are higher that exceed that HIPAA minimum. In many, many states, the rules apply into mental health counseling already exceed HIPAA. In most places, HIPAA is already met just by meeting the requirements of your state law.
The interesting thing about, say, Skype, Skype is a wonderful example. There’s nothing necessarily illegal about using Skype, but here’s sort of the slightly over simplified analysis. There’s what’s called the conduit of information and the conduit of information under HIPAA is really, in essence, not a disclosure of information but just a way to transmit. For example, the post office is conduit of information. The post office doesn’t have to be HIPAA compliant.
We can assume that when you send a letter to a client that the information inside that envelope is secure and so you don’t have to make sure that the post office complies with HIPAA. The interesting thing with Skype is that originally, it was considered to be a conduit of information. Because of the way the technical way that Skype works, there was an opinion from the HIPAA regulators that said, “No, Skype is not just a conduit of information. Skype is a business associate. You are, in fact, releasing, you’re giving client information to Skype and because of that, they have to sign what’s called a Business Associates Agreement.”
A Business Associates Agreement under HIPAA basically says me as a clinician, the way that HIPAA applies to me, now I’m having you, that person I’m disclosing client information to sign a contract that says you agree to be bound by HIPAA just like me.” Microsoft wouldn’t those for Skype. The disconnect was it was just this technical reason that they wouldn’t sign the Business Associates Agreement. I have heard that Microsoft is developing a Skype version especially for the healthcare setting where they will sign Business Associate Agreements.
Clay: Wow.
Eric: As soon as they will sign it, Skype is fine. That’s the really interesting thing.
Clay: Oh, that is really interesting.
Eric: Yeah. If you’re doing counseling remotely and you’re looking for some kind of a solution, it needs to be either something that is what’s called, again, a conduit of information and that just means that the information flows from you to the client without anyone accessing it in between, no caching, none of that kind of thing. It has to be that or a business associate who signs your Business Associate Agreement. For example, there’s a solution called VSee and that is one that is HIPAA compliant. That’s a platform that we can use. The new Skype when it comes out and they sign Business Associate Agreements, that will be usable too. In these types of areas though, I would plug a resource that I rely on a lot, a website called Person-Centered Tech.
Clay: Oh yes, our friend. Tell us about our friend, Roy.
Eric: Roy Huggins, man, I’m an evangelist for Roy. He is a licensed professional counselor and technology expert in Portland, Oregon, probably the most competent person out there in that space between technology and counseling. He has a website called Person-Centered Tech. He does a blog and sends out a lot of really valuable information. Roy is always spot on. My personal view is if Roy tells you something, you can rely on it. He has an article about which of these online services can you use, which can’t you use, why is Skype a problem with HIPAA compliance. That’s a wonderful resource for anybody who is in this space of using technology and counseling. I would say sign up for Roy’s newsletter. Go to Person-Centered Tech. That’s a ton of really useful information.
Clay: Ton of information. In fact, I don’t know if you’re part of his group, but you can sign up for like $10 a month or something and he has office hours that he’ll just be there and answer your question. He’s like this savant in regard to all this. I think across the country, he had been seen as a leading voice in all of this.
Eric: I’ll tell you again my orientation as an attorney and this is one of the reasons that sometimes people don’t particularly like attorneys. My sort of knee-jerk reaction is always, just if you say, “A” my first thought is, “Okay yeah, but what about B?” No matter what it is. One of the things that always strikes me with Roy is every time I have some communication with him or I see something that he puts out there I think, “Yeah, but… oh yeah. He’s right.” I feel very comfortable with Roy’s expertise.
Clay: Yeah, he’s a fascinating man. Are there some other things that we’ve not covered about online counseling from a legal standpoint that maybe people should be aware of?
Eric: A couple of things. One is simply calling your practice coaching doesn’t necessarily fix the problem. Now interestingly in some jurisdictions, the only thing that is controlled is advertising your services counseling. In some states, if you say, “I’m not providing counseling. This is coaching,” it doesn’t actually matter what you do if you’re not calling it counseling. In other states, it doesn’t matter what you call it. It’s the function that’s regulated. Simply calling it coaching doesn’t necessarily fix the problem of not being licensed in lots of states. One I would recommend against is just saying, “As long as I don’t call it counseling, I’m fine.” That’s one.
The other sort of ethical liability, legal issue that I would really stress is the lethality situation that when you’re doing distance counseling, it’s much harder at times to assess someone’s lethality. That really, I would say, is the biggest thing to make sure as a counselor that you feel very comfortable that you have fully addressed. Sometimes, I have a sense that that’s just not considered as much in distance counseling. It’s the same thing with having a client who is talking to you on the phone. There are certain pieces of that communication that you’re not able to see or experience. That means you need to really put more focus in other parts of the communication.
Clay: [inaudible 38:31]
Eric: Maybe. In some states, that might be okay if all they regulate is the title, calling yourself a counselor, but not every state for sure.
Clay: I want to spend a little bit of time plugging what you do. If people want to know more about you, what services do you provide, how can they get in touch with you?
Eric: Yeah. A couple of things, I do ethics consulting and that’s through my private practice, Strom Consulting, and I have a website, that’s just www.strom-consulting.com. Also, I’m one of the co-founders of Counsel Chat, which is a project that I’m really excited about. In essence what we’re doing is setting up this what we’re calling a knowledge market where we take questions that come into us from the general public about counseling, mental health, and wellness. We take those questions and we put topics out for counselors to respond to.
We have this forum where counselors can respond to topics that are based on information coming from the general public and sort of display how they view counseling, how they practice, what their orientation is, and build this set of information so that when a potential client is looking for a counselor, they can see all of this information about that counselor and how they practice, what their orientation is, and actually start to build that therapeutic alliance before ever even contacting a counselor.
It’s something that we’re really kind of excited about and again, going back to this space, this virtual space is where counseling is going, this is a way to leverage that to do a thing that’s impossible in real life, right? A potential client can’t just sit in on a couple of sessions and say, “Clay, I want to just kind of see how you do marriage and family therapy and so I’m just kind of sit in a corner here and be real quiet and watch.” Of course they can’t do that.
What happens is, it’s kind of a guess of what that therapeutic match is until you set up that first session and then you can start assessing from the client’s point of view, from the clinician point of view, is this really a good match? What we’re creating is this way to really start assessing that match before you ever get into that first session.
Clay: Wow, fascinating and needed to because I look for counselors for family in another state. They obviously can’t see me and it’s hard to go, “Hi, now go to the website.” They kind of look like they know what they are doing, I know this educational program that’s probably good, but you could be referring to a complete nutcase too because in all fields, we’ve got our outliers that aren’t very good and this is a family member or maybe the client that is moving away, to have the ability to hear their voice in such a way, to understand their thinking process would make me feel more comfortable and as a consumer, as a client, I would feel better. That’s fascinating.
Eric: Yeah and imagine this, imagine that you are looking for a referral for a marriage and family therapist in Georgia. You found three different potential MFTs and didn’t really know them. You could go and look at several questions about counseling that they had responded to. Let’s say one, the question was something like, how come my spouse and I fight all the time? for example. One of the counselors had said something like, “Fighting is the sign of a doomed relationship. You should probably just end it.”
Another counselor says, “There’s a bunch of different reasons for conflict in a marriage, but they can be addressed and starting marriage and family therapy really begins with communication and identifying what you both want out of the relationship and try to get on the same page.” You went to the other one and the other one, the third one said something like, “Well, it’s just really important to keep a good attitude and hope for the best.” Now, with that, would you know which therapist you would refer that client to? Totally, right?
Clay: We’re going with #2. Right.
Eric: Isn’t that great and so you’d be able to say, “There’s something I can see about that therapist. That’s the approach that I recognize as being meaningful for this client” that there’s really no way of getting that off of a bio about me, right?
Clay: Right, so Counsel Chat.
Eric: Counselchat.com.
Clay: Alright. Okay, we’re going to put all that in the show notes as well as Strom Consulting and how you can get in touch and Eric, I can’t thank you enough. This is like gold information. I predict this is going to be the #1 downloaded podcast interview that we’ve done because it’s just all the questions that people are asking, so thank you very much for talking with us.
Eric: That’s awesome. Yeah, I was happy to be here. Thanks.