Clay: Hello and welcome to the Online Counselling Podcast. I’m Clay Cockrell and it’s a gorgeous day here in New York. It’s amazing. We’ve had what I call “stupid weather” for three weeks. It rained nasty. Sandy, my wife, has been about to lose it. We both hate cold, damp weather, but spring is finally here and you’re going to hear that in my voice today. I’m pretty excited.
Just to let everybody know, the Online Therapy Directory, I’m getting a lot of questions. We “launched” about a month ago at the symposium and had all sorts of glitches but we are just about ready to relaunch, all clean and happy. I keep telling people, “I’m a therapist, not a website designer and this is a hugely complicated site with all the different filters and state to state issues,” but my web guy, Aaron over at Legendary Lion is just about finished and we will let you know when we are up and ready to start connecting you with clients that are looking for you.
Today, I get to speak with one of the leaders in our field in terms of combining technology and counseling. When I first started talking about exploring the subject of online therapy, Joe Sanok, many of you know, I talk about Joe a lot. Joe is a consultant and works with therapists to grow their practices and practice of the practice came up. Joe said, “You have to talk to Rob Reinhardt.”
As with anything, I just sent him an email. I’m thinking, “I don’t know if this guy’s ever going to really get back to me. He’s pretty big,” and he jumped right on it. Got right back to me, we talked. I think it was six months ago. I think he was the first person I spoke with, “Okay, I got this idea,” and he was incredibly kind, answered all my questions, very supportive. He even looked at my marital counseling site and had all sorts of comments, some of them about all of the things I was doing wrong, which I really needed to know, but gave me all sorts of questions that I needed to be asking other folks about this topic.
After the call, I said, “Hey, if I ever do a podcast, would you be willing to be interviewed?” He said, “Sure, just let me know when you’re ready.” Today, we finally connected. Now, Rob is incredibly knowledgeable about all things tech and he has this spirit of “don’t be afraid, be informed.” There are many things you need to be set up online in regards to email, practice management, online counseling, but once you get educated and put it in place, it’s really quite easy.
Like me, he is a champion for online counseling when done correctly. Every day, I talk to therapists who want to begin doing online counseling but are super hesitant because they are afraid. They don’t want to get in trouble. They don’t know where to start. They don’t even know where to begin. They don’t know what they don’t know, so they don’t do anything and I’m always saying, there is a world out there that is desperate for what you bring to the table, whether it’s working with adolescents, trauma victims, or like one of our first podcast guests, Dr. Judith Zur, I think she was episode 2 or 3, she worked with survivors of torture due to war.
There’s massive need out there, people looking for you and they may not live in your town, but you can connect with them online with online counseling. Many therapists are struggling to make ends meet because their practices are very small or they live in a small town. They just can fill up their appointment calendars. This is a way to benefit your practice and reach the clients that are really in need of you. Rob helps you do this and in the podcast, we get a bit technical, hang in there, especially in the beginning.
We talked quite a bit about practice management software, which he’s an expert on, but eventually, we start going into depth about what people need to know about online counseling including Skype, HIPAA, ethics, state licensure portability. We really tried to cover many of the issues that he has a knack and expert in, and I think you’re going to find it very helpful. It’s a little longer than normal, but there’s just so much to cover and I know that we just, you know, tip of the iceberg.
Check out the show notes. There are all sorts of links in there for him and all that he brings to the table. Share us on Facebook, Twitter, any other social media you can think of. Let me know what you think. Send us questions. Enough from me, here’s Rob.
Hello and welcome. I’m very excited to have today Rob Reinhardt of Tame Your Practice on the Online Counselling Podcast. Rob, thank you very much for coming on board.
Rob: Yeah, Clay, I appreciate you having me.
Clay: Rob, you are a leader in the industry on electronics, on how technology is incorporated into a private practice. You are the founder of Tame Your Practice. Tell me a little bit about Tame Your Practice, how you got there. Bring us up to speed on you.
Rob: Sure. In a prior life, before I was a counselor, a licensed professional counselor, I had a long history and career in business and technology from doing software development and other things, but my bachelor’s degree was in Psychology. I always knew someday I wanted to be in private practice, so in the early 2000s, I went back to school, did that whole thing, did my little powers, got licensed, started to get into private practice, and along the way, I noticed that a lot of people in our field don’t have a strong technology and business background. They certainly don’t teach us that in the graduate program.
Clay: Right.
Rob: And then it was about 2011, 2012, my practice was growing. I was looking for more software. I had been using a homegrown database to do everything because I could do that. Because of the new restrictions that were coming with HIPAA, I wanted to kind of pass off some of that responsibility to somebody else. I started looking at these cloud-based practice management systems and being the thorough person that I am, I’ve started investigating all of them and I ended up looking through all of them because there is no Facebook or Amazon of cloud-based practice management systems.
There’s no one place that’s got everything you want or all the features you’re looking for, so I ended up looking at all of them, and that combined with knowing that other people in my field don’t have a lot of that technical expertise made me realize, maybe I should put this out there for people since I’ve done all this research and evaluated all of these systems, and I can look at it not only through the counselor’s lens but also through the technical expert lens and give people a balanced view of, “Hey, how can this help you in your practice and how can it also help you do things like comply with HIPAA?”
I put those reviews up and Tame Your Practice was born. That ends up being, how most people find out about me is those reviews that turned into a service where I help people actually identify which of those platforms is going to be the best for their practice and that has grown to other services from there.
Clay: Yeah. You were saying in an email the other day that you’re really known for these reviews of all the different practice management tools that are out there, but you also take people by the step and go, “Okay, you’re this size. This is what you’re dealing with. You really fit with this guy over here,” right?
Rob: Right, exactly. There’s a couple of ways I do it because people have different preferences. One of them is called a Feature Match Report where I actually have people fill out a form that says, “Hey, this is what my practice is like. These are the features we want and what their priorities are.” The reason this works for so many people, some people will say, “I really want that client pool where people can complete their intake paper work. I want to get totally paperless, so I need that.”
Other people will say, “I don’t really care about the client pool. I’m more focused on making sure I can do good notes and file insurance claims.” I take that list of prioritization that people have for that features and that helps me identify for them which of the cloud-based practice management systems I think will fit them best.
Clay: Are there more and more coming online or is there essentially these guys have a corner on the market, they are the leaders and it is pretty stable?
Rob: There is certainly a couple that have a larger market share than others, but nobody has cornered the market and there are still new ones coming on board. I’ve got a couple of new ones in my cue, in fact, that aren’t quite on my reviews yet because I like to be thorough and take my time before I put a review up. I’ve even had companies say, “Hey, we know all about your reviews. We’re not ready yet. We want to get a few more features in there before you put us up there against these other guys because we know we’re not going to fair well, but we want you to know that we’re there. Keep us on your radar and we’ll let you know when we’re ready.” It’s still very much a growing market.
Clay: How long does it take you to review?
Rob: That’s a great question. I’ve never sat down and said, “Exactly how many hours does it take?” My process is pretty much like most people would do going in and most of these have a free trial, so you can go in and create a trial account and start to go through the work flow. How do add a client? How do you add an appointment on the schedule? How do you do the notes? Through that process, I will begin to compile some questions and then I’ll usually meet with the vendor, have them do a demo, let them know, “Hey, I’m pretty technically savvy. I’ve already looked at your system, so you can dive right in and I want ask some questions and details, make sure I didn’t miss anything.”
After I go through that with them and have a demo and have a better understanding of some of the things that maybe I missed or wasn’t sure about, I’ll go back through and spend a little more time and evaluate some more. If I had to guesstimate, I’d say I spend somewhere between 8 and 12 hours to do an initial evaluation. I would revisit them because again, these systems are constantly growing and adding features. I revisit them every few months to say, “Hey, what’s changed?” That’s a shorter time span to take care of that because I already know most of the system.
Clay: Right. Are there particular things that you are looking for? Obviously, HIPAA compliance, speed, I mean, just kind of your top things that you would get somebody a higher rating in the management?
Rob: Sure. I’m really looking for everything because I have such a diverse clientele that I help, everything from a solo clinician who is working part time because they have a day job to a large group practice with 20 clinicians and four offices and trying to manage all that. I’m really looking for a lot of different things, but big picture wise, certainly the HIPAA compliance. Most of these have that covered. There are some things that they pretty much have to have covered to market to our therapists and counselors, and so forth, but I certainly go in and verify, “Hey, do you have a Business Associate Agreement in place and what does it look like?”
I’m really focused on the usability and work flow. A lot of these applications are starting to get to a point where the main functionality, the primary things that most people are looking for are very similar and so a lot of times, the decision will come down to work flow and usability. Am I going to be able to use this on my tablet? Am I going to be able to go through my work flow and do my notes quickly as opposed to it being more of a clunky interface and taking more time to do things? That’s a pretty big thing that I look for. Certainly, I keep my own database of which features does this one have, so I will compare and contrast.
Clay: Do you notice a theme with people that are coming to you today and what they are looking for? I guess it’s independent on whether it is that part time person versus the massive group multi-location practice, but are there things that people are generally looking for in common?
Rob: The one common note on most of them is that usability factor. Now, I do have people who come in and say, “You know what, I don’t care if it’s a little clunky as long as it has all the features that I want,” and that’s one of the reasons my service is so valuable because when people are looking at these 18 different applications, it will take them hours and hours and house to figure all that out, but most people lean toward, “Hey, I want this to be very usable. I want to save time. The whole reason I’m doing this is to make things efficient and save time.”
From there, it really varies because again, I may be working one day with a private pay practice. I don’t do any insurance. Their needs are going to be very different from a practice who does 90% insurance because the insurance practice is going to want that insurance claim process to be smooth and clean. They are going to want things like integrated ERAs which is where the payment from the insurance company comes into back into the system and gets applied to the client record. That’s a huge time saver. An insurance practice is going to be really into that. A private paid practice is going to say, “We could care less about that feature.”
Clay: I was just at the Psychotherapy Networker Symposium in DC and we had a little vendor booth there. You could see in the eyes of these therapists, they kind of have this common exhausted, overwhelmed look. I think it wasn’t just being at the symposium, but a lot of the therapists are talking about they are just overwhelmed with all the work outside the counseling.
Rob: Right.
Clay: And I love the name, it’s Tame Your Practice. It’s getting some kind of control over all that other aspects so that people can focus on the work.
Rob: I’m glad you get that, Clay, because I don’t talk about the name that much and I probably haven’t done the greatest job at branding it and sending that message, but that is what it’s all about is how you tame these parts of the practice that take up so much of our time. That’s something you hear from people whether they go into agency work or what have you. We all are in this because we want to help people on, like that common theme among people, I don’t want to spend so much time dealing with insurance and doing my paper work. That’s what Tame Your Practice is all about. How do you tame that piece of your practice so you have more time with your clients and even for yourself.
Clay: Yeah. When I think of you, I think of the old – it’s not a pot lock, it’s a cooker and the commercial was set it and forget it.
Rob: Yeah.
Clay: You put the meat in and the carrots, and then you set it and you forget it. I get a sense that you put a system in place and then people don’t have to worry about that anymore.
Rob: Yeah. It’s probably not that simple.
Clay: It would be nice.
Rob: It’s as much as you can because the progress notes aren’t going to do themselves, but certainly as much that you can automate as possible, and insurance is certainly to that point where you can automate so much of it. People in our realm are also often very cost conscious. Again, this goes back to that business mentality that we don’t get in graduate school and helping people understand return on investment and understanding that yeah, the system is going to cost you $60 or $70 a month, but if you use the appointment reminders, you’re going to probably save just at least one late cancelation a month, and that alone is going to pay for the system. Helping them understand not just, “Hey, what are the features you want but how are these features going to work for you? How are they are going to improve your practice and your bottom line?”
Clay: Tell me a little bit about the other things that you bring to the table because it’s not just the cloud-based practice management. It’s helping people with marketing and business structure and all of that aspect of the business end of it. Tell me a little bit about how you are helping clinicians build their practices.
Rob: Sure. I think it’s somewhere on my website. It’s the inner geek in me comes out where I say one consultant to tame it all and Lord of the Rings fan will catch the reference, but again, because I’ve got the clinical background, I’ve been in the practice, but I also have the business and technical background, I’ve ended up helping people with just about every aspect of their practice. I’ve helped people start a practice from the ground up. I’ve helped people expand their practice.
People often get to a point where they say, “Okay, I’m full. What do I do with all these calls that keep coming in?” I’ve helped those people decide. “Okay, how do I expand to a group practice?” There are three or four different models for doing that. Which one is going to work best for me? Does this change the type of business structure I have?” Currently, I’m a sole proprietor. Do I need to be an LLC? Do I need to be an S Corp?” I’ve helped practices just implement one piece of technology that will greatly improve the efficiency of their practice.
You mentioned marketing. Primarily, I help people think about and conceive and create concepts of how they are going to do their marketing, especially with things like social media and blogs, and integrating those things into the marketing strategy, but primarily, that ends up being connected to these other things I’m helping them with like the big picture, how to get your practice to the point you want it to be especially using technology
Clay: So now, are you working on an hourly basis? Do you have programs that people kind of go through with you? How do people work with you?
Rob: Yeah. I don’t really do the program thing because I like to tailor things to the individual practice. There are some common themes with people in creating their practice. I want to help people and I want to grow into a group practice, but from there, the details can really vary quite a bit, so I really like to tailor it to what they are doing. I mostly work on an hourly basis. Now, if somebody has some very specific they want to do, I will do a project basis quote. We’ve done some websites for people, for example and that’s usually a project.
“Hey, this is what you want.” We’ve detailed what the project looks like and what the end result is, and here’s what it’s going to cost and how much time it’s going to take. For the most part with the consultations, I offer 20-minute and 1-hour consultations. The 20 minutes are great for people, “Hey, I’ve already got this practice running. I’ve just a couple of questions about how do I use this technology and still comply with HIPAA? Should I use QuickBooks online or should I use regular QuickBooks?” Just questions that can really be handled in 20 minutes and let them walk away knowing they got a great value for their money.
Clay: Wow, that’s a great option, just a 20-minute let’s crank this thing out.
Rob: Yeah. I call that Instant Consultation Gratification.
Clay: I like that.
Rob: Instead of going to 14 of your colleagues whether that’s live or on Facebook and getting 12 different answers that may not apply to your practice because they might not know your practice in detail. I’d like to get in there and say, “Okay, let me know about some details, what you’re really trying to accomplish and let’s hammer out a good solution for you.”
Clay: Nice. It’s the Online Counselling Podcast so let’s switch a little bit and talk about counseling using web-based platforms. When we were setting up this podcast, I sent over to you a comment, a quote that I had heard. We all know that you’re not supposed to be using Skype. Skype is not compliant with HIPAA, but this quote, I was talking with someone and they said, “Yeah, but if you’re not taking insurance, then HIPAA doesn’t really apply to you. You could use Skype.” You said that you might have a comment about that.
Rob: Yeah. There are a couple of issues with Skype. There are two things to examine in here. One is, if I’m not a covered entity according to HIPAA, does it matter whether I use Skype and the other being, well, okay, how secure is Skype? I’ll touch mostly on the HIPAA end of things and maybe I’ll give you some pointers to where to look at more information about the other side.
Technically, that quote is correct. In order to be responsible for abiding by the HIPAA law, it’s a federal law. You have to be considered a covered entity and a covered entity is someone who engages in a covered transaction according to HIPAA. In our realm, really, the primary covered transaction is the filing an electronic insurance claim whether you do that, whether your building agent does that. Technically, if you’re not filing any electronic insurance claim, let’s say you’re a private paid practice then technically, you’re not a covered entity. Technically, you can’t be held to follow the HIPAA law.
There’s some gauche in there. The big one being this, HIPAA is more and more being accepted as a standard of care, as best practices. For example, let’s say you’re running this private paid practice and you’re thinking, “Okay, I don’t have to worry about this HIPAA thing because I don’t file any insurance claims.” You store some notes in some Microsoft Word documents on your laptop and you do some other things electronically.
At some point, you lose your laptop or something happens, maybe a client notices that you’re leaving some electronics out where other people can see them. A complaint gets registered. Maybe one of your clients decides that you’re not keeping things securely or there was some sort of breach and they complain to your licensure board. Your licensure board is going to get involved. “We need to make sure you’re keeping these things securely.”
How are they going to measure that? What standard are they going to look at? What standard is your licensure board? They are probably not technical experts. Some states, Texas in particular, have some things written into their state law about privacy, but most of them, aren’t going to be experts. They are going to say, “Okay, how can we determine if this person is doing everything they should do to protect client data?” Well, HIPAA is probably where they are going to look.
That has become the standard of care, the best practices. People are going to say, “Well, HIPAA has got this down. They’ve been doing this for 20+ years. They know what people should be doing. Let’s use that as a measuring stick.” That doesn’t mean they might say, “Oh, you better be doing everything you absolutely should according to HIPAA,” but that’s probably where they are going to look for that guidance. There are certainly some reasons to consider following HIPAA even if you’re not technically a covered entity.
I mentioned Texas, their privacy laws, in many cases, are even more stringent than HIPAA. If you’re listening from Texas, you already have an impetus to be taking care of business there and more and more other states are getting into that. Another impetus is if you’re a licensed professional counselor and a member of the ACA or even if you’re not a member of the ACA, the American Counseling Association Code of Ethics was revised in 2014 and they included an entire section on technology. One of the things they say in there is you should be using things like encryption and you should be following the laws that provide guidance on how to do things securely.
They don’t mention HIPAA specifically, but they use a lot of the language of HIPAA like encryption and using reasonable measures to protect data and following the relevant laws that have to do with security. They are kind of pointing to, “Okay, you probably need to be doing this HIPAA stuff because that’s the measuring stick.” Even if you’re not technically a covered entity, there are a lot of reasons to consider going ahead and following HIPAA.
Clay: Okay. Every time I talk to you, I learn something new. This is the fascinating thing about online counseling. I’ve been looking at this from every angle and every time I think, okay, here’s the rule of thumb, here’s the black and white, there’s more shades of gray in there, but it comes back to just a kind of C.Y.A., making sure you’re doing it correctly. Skype is generally not the way to go, correct?
Rob: I know you’ve talked with Roy Huggins, a colleague of mine, and I don’t know if you’ve aired that broadcast or it just got mentioned. He’s got a great article on his site, personcenteredtech.com, where he talks about more of the details of why Skype is a concern even if you’re not a covered entity. The primary reason it’s a concern if you are a covered entity is Skype is by Microsoft and they are not going to sign a Business Associate Agreement with you. We’re talking about the free version of Skype. There’s now a paid version of Skype where I think they will, but it’s cost prohibitive compared to a lot of the other options that are out there for you.
They are not going to sign a Business Associate Agreement, which is something that’s required of any covered entity that sharing protected health information with a third party vendor. That could be your billing agent. That could be your cloud-based practice management system. That could be your video telehealth provider, but then when you get beyond “Okay, but I’m not a covered entity,” there are some security issues with Skype and again, I’ll defer to Roy’s article because he has done a lot of research on this. I believe they don’t do some of the really important things for security like audit trails and they keep certain things in a database like the chat records and things like that that make it a security concern.
Clay: What I found and Roy mentioned this when we talked was that outside of all of the encryption issues, the HIPAA issues, all of that, there are other platforms out there that just do this matter. They are tailored for therapists and that therapeutic relationship. They make sure that the video is going to be buffered at a certain level and if somebody is having a hard time with their internet, you’re not going to have the pixilation that some people experience with Skype. There are just affordable other options out there.
Rob: Yeah, exactly. Why you even take the risk when there are these other free and affordable options out there that are doing everything they can to have a secure connection and a quality connection even in low bandwidth situations?
Clay: In your evaluation of the different tools out there, have you looked into the different platforms? I know Jay Ostrowski has a great comparison chart. Have you looked and compared the different VSee, WeCounsel, and etc.?
Rob: I’ve done some brief comparisons, but I’m glad you mentioned Jay because Jay is out there so I’m not going to bother. I’ve got my hands full looking at all the cloud-based practice management systems and there’s no point in me digging into all these different systems because Jay has already covered it. That would be kind of like somebody else coming along and saying, “Well, I’m going to spend hours and hours and hours reviewing all these practice management systems. I’ve already got it covered. It’s freely posted on my web. You’re welcome to just look here.”
In my brief evaluation though, I use VSee primarily because I’ve been using VSee for several years. I’ve been doing the telehealth thing for quite a while now, not primarily, I use it more as an adjunct. It’s great for if I have a client who has a child that’s home sick. The parents are perfectly fine. They are my client. They will still want to come to their session, but they need to be caring for their child. Well, we can do a session while they are still at home. I’ve had people, traffic can be pretty bad in the Raleigh Durham area here. I’ve had people say, “I’m stuck at work. The traffic is really bad.” We can do the session as long as they can be in a secure location.
Since I’ve been using VSee for so long, at the time I started using VSee, it was one of the few free or inexpensive HIPAA compliant solutions. Now, there are some others out there I’ve heard a lot of positive things about doxy.me though I haven’t tried it myself.
Clay: Yeah, I’ve heard good things about them.
Rob: And then there are the combined platforms where they provide not just the video service but also some practice management things, scheduling and so forth. I haven’t really dug into those because there’s just too many of them at this point.
Clay: Yeah. As somebody who is doing telehealth, it sounds like maybe you’ve been doing it for some time, what are some things that people need to be concerned about outside of the actual connection on the web platform, anything like some top things that maybe come to mind for you?
Rob: Oh yeah and I talk about this a lot. I do some presentations where I do a nice chunk on telehealth. A big one right now is licensure portability. You have the issue where you really shouldn’t be practicing across state lines unless you’re licensed in both states and that’s a pretty lengthy conversation and it gets complicated. I had a person recently here in North Carolina and they said, “I’ve got this client. They are going to visit New York State for three weeks. They want to continue our weekly sessions while they are up there.” So we’re looking at telehealth. Well, I contacted the New York State Board and said, “I want to make sure there are no issues with this,” and the New York State Board actually told them, “No, you cannot practice up here unless you’re licensed up here.”
There are times where this whole licensure and portability thing is getting in the way of client care. Now, I’m not an attorney. I encouraged this person to talk to an attorney because I’m not buying the New York thing. I’m guessing that the person on the New York end misunderstood. I don’t see how the New York Board can enforce that law to protect somebody that’s not even a New York State resident. This is supposedly somebody that is just visiting for three weeks, but there’s all that information out there and misinformation, and it gets convoluted. Certainly a big thing to keep an eye on and certainly a reason to advocate for licensure portability is to be able to practice telehealth.
Clay: Absolutely. Eric Strom, we did a podcast with him a few weeks ago and he did this 50-state review. A review of all the 50 states and what their laws were. By the time he finished it, I think this was 2013, by time he finished it, it was already outdated.
Rob: Yes.
Clay: It’s changing from moment to moment and it gets so complicated. It took him a year to do it and he only looked at licensed professional counselors, not the NASW or psychologists, just counselors. It was a tremendous amount of work that didn’t really solve anything.
Rob: Was he looking at portability or was he looking at licensure with regard to telehealth reimbursement?
Clay: He was looking at portability and the reimbursement and what that state’s law said about telehealth in general, I guess.
Rob: Yeah, I mean, there’s websites that keep that up to date and that’s got to be a full time job because thankfully, things are going in the right direction. When there are changes, it tends to be, “Oh, we’re now requiring insurance companies to reimburse for telehealth.” I know that some states as far as the licensure portability, some states have reciprocity and a lot of them, most of them, in fact, don’t and that’s just a huge issue I hope can be addressed soon.
Clay: Yeah.
Rob: We mentioned kind of insurance reimbursement. I know that’s the other thing you want to be aware of if you’re practicing telehealth. In my state, our private insurance companies are required to reimburse for telehealth services. In a lot of states, they still aren’t. My state is just now starting to come around to it. They are trying to push some legislation through. Some of the insurance companies are paying for it even though there isn’t a law requiring it yet, so we’re headed in the right direction. I know there are some states that are still well behind us even.
Clay: Yeah.
Rob: And then there are a lot of ethical considerations in providing telehealth, a big one being, do you know what you’re doing, everything from the technology side. Do you know how to use this technology? Do you know how to coach your clients through using the technology that you’re using? Do you know how to handle and have a plan for technical glitches? What do you do if your internet is down and you’re supposed to have an appointment?
Then there’s the nontechnical things like how do you handle a situation where a client maybe suicidal or self harming. Do you have a plan in place to handle crisis? Are you confirming this person’s identity? How do you know they are who they say they are? What are you going to do if they say, “You know what, I’m just going to end it all” and they disconnect. What do you do in that situation? There are a lot of things that you need to make sure you understand about using telehealth and engaging in telehealth as well as how you handle certain situations.
Clay: Have you looked at the Distance Counseling Credential which doesn’t really solve a lot of the state to state issues, but it does touch on some of the ethical. Have you looked at some of the training programs for that?
Rob: I have and certainly, the DCC is a great thing to get especially if you’re just starting out. You’re not very tech savvy. You haven’t done a lot of reading and studying on what are the ethical implications and technical implications of doing telehealth. The DCC, you can get it through several different educational venues but it certainly will provide you that understanding. I’ve never followed through with getting the DCC because I think I’m covered.
I’ve been doing telehealth since before the DCC existed and I’m educating other people about what are all the concerns. I feel like I’m covered ethically, our ethics require, but you know what you’re doing when you’re providing services, and I feel like I’ve got that covered. I think I’ve got a virtual DCC after my name, but for those who don’t have the experience and the technical background that I do, I think the DCC is a valuable thing to consider.
Clay: You’re looking at things from the technical aspect and the things that could go wrong, and the difficulties, but are you an advocate for telehealth, for connecting with clients online?
Rob: Absolutely. I said it’s been invaluable in my practice to allow clients to continue to have their sessions even if they can’t come to the office. I’ve had adolescents that I’ve worked with who graduate and go off to college and want to continue to work with me. Again, that becomes an issue if they go out of state, but certainly if they stay at a college within the state, I can continue to work with them because of telehealth. It allows you to maintain that relationship rather than them having to go off and start over with somebody new. There are an amazing number of benefits that can come from telehealth and I think it’s incredibly important and I think it’s great that we have the capability of doing it.
Clay: Yeah, I think that that’s kind of the impetus for the podcast and what I’m doing is that to be an advocate for this but an advocate of doing it correctly, ethically, making sure you’re compliant with all your regulations. If you follow all the directions and do it well, this can be a wonderful tool. But with everything, you just have to be educated about it.
Rob: Yeah. I point out all the things that can go wrong, but we’re supposed to be doing that in all areas of our practice. It’s not about the fear factor. One of my presentations about technology is actually called Conquering the Fear Factor and Roy and I are both pretty big on not using fear tactics to get people to do things with technology. We don’t want you to buy this product because we’ve scared you into buying it. We want to make sure people understand all the things that can go wrong to take the fear out of it because most fear is based on lack of understanding. We want to get that information out there so that fear is removed so we can then be focused on making good decisions for ourselves and our clients.
Clay: Tell me a little bit about your clients because in addition to Tame Your Practice, you run a multi-therapist group practice and you have clients of your own. Tell me a little bit about that.
Rob: Yeah, I don’t want to say never because that’s just silly, but I see myself continuing to see clients well into the future. I see less now. The consulting part of my business has certainly grown and I’m busy with other projects as well, but I really love doing the clinical work and I feel like it really keeps me in touch with the clinical work and helps me continue to better stay in touch with my consulting clients because I continue to understand the environment that they are in and what they are dealing with.
Where I use to see probably an average of 18-20 clients a week, now I maybe see 10-12, which is great because it lets me really hone in on, like a lot of people in our field, you get to a point where you’re, “Hey, I’ve got a full load. I can really start to establish a niche, really focus on the clients that I enjoy working with and have real expertise and experience in working with the challenges that they are dealing with. That has made that easier for me to do that and really focus on working with couples and people dealing with anxiety. I do a lot of work with people, adolescents and adults on the autism spectrum, high functioning, what we used to call Asperger’s when we’re not supposed to call that anymore.
Clay: Okay. Right. What I find so great about you is that in consulting all the therapists, you’ve been there. You’ve been there as a single practitioner trying to put up your own practice then growing it to a group practice and then maintaining that group practice and beginning to pull back and focus on a different area. You’ve gone through all the steps yourself and you’ve got that knowledge to help others go in that direction if they want to get it to that size.
Rob: Right. Well, and just to throw another wrinkle in there, when I was doing my practicum and internship and first starting out in my private practice, I was actually a part of a group that I didn’t know and that was a traditional format practice where everybody is paid a split based on the revenue that they bring in. There was that and then I went solo, and then grew into a group which is more of a collaborative group. Each person in our current group is their own independent business entity and pays a membership, which covers their use of the office and some shared marketing expenses and so forth. I’ve not only got individual line group experience but I’ve got experience in multiple formats of…
Clay: The different business models that are out there for doing that. Yeah. I want to touch on Describe Cards because this is really interesting. Tell me about that.
Rob: Yeah that always throws people. I’ve got a bit of, I teach people a little bit about marketing and branding, and I’ve created my own branding challenge for myself because I’ve spent the last five years branding myself as the tech guy, Tame Your Practice, I know about EHR, practice management, HIPAA, and software, and then I come out with this deck of cards that’s a clinical tool that has nothing to do with technology. I kind of reinvent myself or clone myself, virtually clone myself because I’ve got these two branding avenues that I’m going down.
Describe is a deck of cards that I created during this whole time that we’ve been talking about. I started developing it when I first was in private practice. It’s a deck of cards. Each card has an adjective on it as well as some related questions, and over the course of the eight years I developed it, I had created over a dozen activities you can do with individuals, couples, families, and groups. Sometimes, it’s as simple as drawing out a random card and processing one of the questions on the card and other times, there are actual structured activities that people do.
One of the things for example I’ll do with a brand new client, an individual client anyway. This can be pretty much any age, 8 and up. They got to be able to read, have some understanding of language, but I’ll have them pick four, five important people in their life and make a stack of five adjectives for each of those people. I may even have them include themselves. Then, I have them process with me. “Okay, well, what five adjectives did you pick for your husband?” “Oh well, I picked caring because he’s a very generous and caring person, and he’s always doing things for me, but I also picked bitter because he’s still very angry. He was divorced and he’s still bitter about his divorce,” and so forth. I start to get some immediate valuable feedback from people.
Clay: Wow. This is something that’s available on your website and people can purchase this and incorporate it into their practices, right?
Rob: Exactly. There’s some links to it from Tame Your Practice but it has its own website called describecards.com. It’s also available on the Amazon. If you’re like me and you love Amazon Prime, they have got me wrapped around their little finger with Amazon Prime. You can get it two days. This is a total side note, but in the area that we live in, we’re in a smaller town outside, well, we’re still in the triangle area proper, but we’re kind of on the perimeter. We don’t get like, Google is starting to lay down fiber in the area and we’re going to get it last. Amazon is doing, I can’t remember what they are calling it, the same day delivery where you can get stuff in like two hours. They are doing it in a big area and we’re outside that area, so it’s like, “Oh, we’re so close.”
Clay: Yeah, I talk to my folks back in Kentucky and I feel your pain.
Rob: Right, but in a way, that’s probably bad to be. On the flipside, I’m like, “You know, that’s okay. I don’t need to be sucked into that instant gratification consumerism thing.”
Clay: Yeah. I’m in the middle of Manhattan and when I go and stay someplace else, it’s just this most frustrating – I feel like a child. I want it now and why can’t I have it now?
Rob: Right. “What do you mean I have to drive somewhere to get my coffee? I don’t understand.”
Clay: Yeah. It’s good for me to leave New York sometimes because we are just spoiled children.
Rob: Yeah, well just going anywhere from anywhere is great for perspective. I don’t think I’d have some of the perspective that I have if I hadn’t been able to get out of this country here and there and see other parts of the world and other parts of this country, but just to reiterate, there’s also some videos and the full instructions for Describe are on the describecards.com website. You can actually download the instructions, look at it and see. “Do these look like activities I’d use with my clients?” The reason I put them up there so people can check them out but also because it’s a growing being. It was originally published in October of last year and I’ve already added three more activities to it. You can join the mailing list and I would make sure people know when I’ve added new activities. I’ve talked with people who have bought it and made up their own activities.
Clay: Oh, okay. Yeah, it’s a growing thing.
Rob: You’re right.
Clay: It just kind of hits home for you. For me, when I start looking at HIPAA, is my email complaint, where are my records, how am I going to do online counseling, it is frightening and fearful, and that’s one of the reasons that I wanted to bring you on this because you have the spirit of, “Don’t be afraid, be informed. You can do this. It’s possible, just here are some things that you need to know.” That’s one of the reasons I want you to talk today. I’m going to put all of these links on here. If you want to talk with Rob, it’s tameyourpractice.com. It’s going to be in the show notes, the Describe Cards, all of the stuff that we talked about today. Rob, is there anything else you wanted to add because, I mean, there’s just a chockfull of information here.
Rob: Let me bring your point home about, and I know we talked about this earlier, but I really want to bring the point home about not operating out of fear. You really want to take your time with this stuff and when you feel overwhelmed, I know so many of us have had the same conversation with our clients. When you feel overwhelmed and you feel like you might be acting out, if you step back and do some research, do some reading, understand more. Get more knowledge to reduce that fear and break it down into chunks.
I talk with a lot of people who come to one of my presentations or read some of my articles and I’m like, “Oh my gosh. I’ve got to do this with my email and this with my website and this with my practice management system. It seems like so much.” You don’t have to get it all done today. Prioritize, break it down into chunks, decide what you’re going to do this month and what you’re going to do next month, and just take it one thing at a time.
Clay: Yeah, it’s doable. One step at a time.
Rob: Yeah and it’s not that complicated. Once you get some of the knowledge in place, it really doesn’t have to be complicated.
Clay: Right. Alright, Rob, thank you so much. We’re going to put all these links on the show notes and thanks again for coming on the podcast.
Rob: Yeah. I appreciate you having me, Clay.