Welcome to the Online Counselling Podcast. Exploring the practice of counseling through technology. Here’s your host, Clay Cockrell.
Clay Cockrell: Hello and welcome to the Online Counselling Podcast. Thank you for joining us. As you know, this is the podcast where we explore the world of online counseling looking into the subject from the perspective of therapists who have taken their practice to this level and also speaking to leaders in the field. It’s a fascinating thing to watch an industry go through growing pains and change on such a fundamental level.
I want to touch on something that happened just this weekend. Forbes.com has just published an article by Todd Essig on Talk Space which is a site for online therapy. Now, I’ve looked at Talk Space in the past and was somewhat disturbed by their business model. It seems they contract with therapists to do counseling with their members through their portal. So therapists work for Talk Space and Talk Space goes out and markets to find clients for them and then therapists meet and have the session on Talk Space platform. Hope you follow that. Anyway, the article is about how Talk Space administrators apparently violated client confidentiality by sending a mass email to I think eighteen clients about an internal dispute with one of their therapists and they did not blind copy. They showed all of the clients’ emails in the address box. Now, this is an evolving story. There is more to it and seems like there’s some other unethical behavior happening here. It’s just very concerning.
I’m bringing this up because a few people have contacted me to see if something like that would or could ever happen with our directory. Now, many of the listeners know that the Online Counselling Podcast is connected to the Online Therapy directory where we list therapists’ profiles. The answer is really big and really loud NO. That’s not how we are designed. Really looking at Talk Space and better help and breakthrough and plus guidance. There are several sites out there that are very similar. But when I was developing the directory I was very concerned about how these businesses were structured and intentionally did something different. Many of these sites just like Talk Space they hire or contract with therapists to work for them and use their tools and then the therapist and the client actually meet on their site. Sometimes the client doesn’t even get to choose their therapist. I was shocked they go through an incredibly intrusive and detailed questionnaire answering a lot of intimate questions and then are matched with the therapist the site thinks will help them the most. That seemed like a lot of risk for the counselor and that they we’re giving up a lot of control of their own practice.
So, I developed Online Therapy directory as just a directory. Therapists, just like with Psychology Today, they pay up small monthly fee to list their practice and their specialties. And then when clients find them, they send and encrypted email to them from our site and we don’t hold on to the emails or store them or even really see them. And then the therapist and the client connect through the therapist on email surface, not ours. And then the therapist uses whatever encrypted platform they feel best. They have total control. They can use Doxy me, VC, We Counsel, whatever they want. We’re no longer involved. The connection is made and then the therapist is responsible for keeping confidentiality and choosing whatever encrypted platform they want. So, no. What happened to Talk Space cannot happen with Onlinecounselling.com and we designed it that way.
But I would love to hear from folks out there on their thoughts about this article and I’m going to reach out to Todd Essig to see if he would like to come on the podcast and talk about it. So, there you go. Developing story.
Now, also would like to remind folks about Jo Muirhead’s master class conference in San Francisco. As I mentioned last week, Jo is an exceptionally talented private practice consultant that helped hundreds of not thousands really of therapists turn their okay practices to thriving practices. She’s a ball of energy and she will be landing in San Francisco in October. The weekend set for October 14th and 15th and listeners to the Online Counselling Podcast have a special offer. If you sign up before August 30th then use the code THANKS CLAY, all caps, not only will you get registered for this, it really sounds like a—I wish I could go. It’s a mastermind event to develop your practice. So you get registered but you also get three months of coaching with Jo. That’s free three months. So, check out Jo Muirhead.com/SanFran2016 and use the code THANKS CLAY. A little shoutout from Jo? Okay.
So on to today’s guest. I would preface this to say this may be the worst podcast recording I’ve ever done. But this may be one of the best podcast as far as information goes. So, one the reasons why I tell folks not to use Skype is because it’s just not good. It cuts out and sometimes there’s an echo and things you don’t want to happen in a therapy session or a podcast interview. So, Skype was how we recorded this. I apologize upfront. Mike, my sound editor is going to be working overtime on this one. But I know he’s not a miracle worker. So it is what it is. As I say to a lot of people if you’re hoping for perfection in what you do, you are going to be disappointed. So, along those lines, here we go. If you can get past the few little echoes and other sound issues, there is a ton of great information because this week I got to speak to Stephanie Cook in Atlanta.
Many of you might know that Georgia was the first and it may be the only state that mandates therapists to get online training before doing online counseling with anyone living in Georgia. It’s not enough to be licensed in Georgia, you also have to have this specific training. Well, Stephanie was one of the first to explore this and she’s actually a trainer on the subject. So, we’re going directly to the source and getting information on counseling online in Georgia. It’s fascinating to talk with her about her journey from resistance to the idea of online counseling to actually being an advocate and a trainer. Again, lots of good information here and I really do apologize for the sound quality. I do think it gets better if you’re patient. Thanks.
Clay: Hello and welcome to the Online Counselling Podcast. I’m thrilled that we have as a guest today, Stephanie Cook from Atlanta, Georgia. Her website is counselingatl.com. Stephanie, thank you so much for joining us.
Stephanie Cook: Thank you, Clay. Thank you for having me.
Clay: Certainly. I’ve really been looking forward to this because I am fascinated by your approach. Tell us a little bit about your journey to counseling and then how that morphed into an online practice for you.
Stephanie: Well, absolutely. I have been in private practice for about three years now. Before that, I worked at Emory University and their student counseling center and their employee assistance program. I did a post MSW fellowship there that was part of my training. Before that, I worked at a psychiatric hospital here in Atlanta called Ridgeview Institute, worked mainly with teens and their families. And then before that, I did my masters in clinical social work and had an assistantship and studied move visual interviewing with problems substance abuse and the effectiveness of that. Before that, I worked a nonprofit for a couple of years called Youth Villages.
Clay: Okay.
Stephanie: Loved that job working with children, with behavioral and emotional problems and their families and helping families to stay together especially when there is risk for entering or re-entering foster care or the juvenile justice programs. There’s a lot of parent psychoeducation and advocacy. I managed a mentoring program for children and foster care during that time as well.
Clay: Wow! Wow!
Stephanie: And, I know. I’m just, I’m totally…
Clay: You got a lot of history.
Stephanie: I’m going back through my history. I hope this isn’t too much Stephanie’s writing roles.
Clay: No no no. This is good. And that’s what I love about and so glad to have a fellow social worker on the podcast. I’ve been talking to so many psychologists and counselors and I love ’em but it’s nice to have that circles because we such a diverse background when then we finally get to private practice which. Anyway, I loved that.
Stephanie: Thank you.
Clay: So what brought you with all of this experience? What made you think “Okay I’m going to go in to private practice”?
Stephanie: Well, the fellowship that I did was specifically meant to prepare clinical social workers for private practice. And so, I really felt like I kind of like Charlie in the chocolate factory I felt like I’ve gotten the golden ticket for Clinical training because as much as I didn’t like it sometimes, I had about five hours of clinical supervision every week. I videotaped my sessions and I did groups therapy and couples therapy and individual. It was a really great training but it was just something that I’d always considered. But probably like a lot of other clinical social workers I wanted to have that as an option but I also love social justice and policy and a lot you know just a lot of other topics that are near and dear to my heart that I was thankful to get in my MSW training.
So I decided on private practice because when I was at Ridgeview at the psychiatric hospital I really felt like that was great work but it was such crisis management and stabilization that I really wanted to be able to work with clients when they were on the other side and when they had reached stabilization and when they knew kind of they wanted to do some deeper logger term work. When I got a little bit of couples therapy experienced while I was at Emory, that really peaked my interest. and like a lot of people, you’re more of a general practitioner at first and you get really good experience and training and sometimes you’re just really surprised by the types of clients and client issues that interests you and I just kept gravitating towards couples work and Id always loved families work and think you know my training and systems theory really helped with that. But right now, I’m pursuing the Gottman method certification. And so that’s kind of grown organically. But once I went in to private practice, I really did start out more of a general practitioner seeing you know of course lots of young adults since I had been at Emory and seeing lots of grad students and undergraduates. But I really started seeing more and more couples and that’s just how it grew.
Clay: Seems like we’ve got an echo on the line. Podcast listeners, so sorry about that. You get to listen to the background on New York and you also get to have Clay having an echo at the beginning of each sentence. So, sorry about that. Hopefully that can get fixed in posts. As they say in the movie business “will fix that in post.” So, what percentage do you think is couples’ counseling and individual counseling in your practice?
Stephanie: Right now about 50 to 60 percent I would say. A little probably more than half of my clients are couples. So, yeah it’s gone up and up over the last three years.
Clay: Here’s another reason why we shouldn’t use Skype is because that echoes just going to drive everybody nuts. I’m sorry everyone. But okay. So, we’ll just try to pretend like this didn’t happen. That’ll be my last comment on that. In coming then to online work, how did you make that leap? I love talking to you first about their fear level, their concern level and then how they got passed that to just jumped in to the deep end?
Stephanie: Great question. I’ve been doing a lot of trainings for clinicians here in Georgia. We have a new telemental health rule and I can definitely talk to you about that a little bit
Clay: Oh yeah, I’m really excited about it because Georgia’s freakin’ a lot of people out.
Stephanie: I know. It’s like I feel like Chicken Little or I’ve been I felt like Chicken Little for a long time like it’s coming it’s coming but it’s here, Clay. I will tell you about that later. But I think in one of your podcasts I think I recall that you maybe had a similar experience where initially it was not something that was even on your radar. For me, I had a much more traditional training. Again, most of my supervisors in the past have been psychodynamically oriented and more traditional and person focused. I didn’t have any training whatsoever in my undergraduate or graduate programs or even in my fellowship on online therapy. I had a very strong bias I would say against any and all phone therapy, video therapy. That’s one [0:15:24.1 distorted audio] that I started out as the biggest skeptic and the reason I even began to consider it in private practice was that one of my clients had followed me in to private practice from Emory and was going to be travelling for a bit. When they asked me would I be able to do a video session or a phone session, I just reacted very quickly and said absolutely not. And then they challenged me and taught me a lot like a lot of our clients do I think and said why not. I had to step back and pause and think and of course I brought it to my supervision group and I had some time to reflect out and why what is my bias here. Is this founded in anything other than my own experience and training? Is there any research here that indicates this is a lesser form of therapy that it wouldn’t be helpful? I think I previously thought of it as Lisa Kudrow. Have you seen the Showtime show Web Therapy?
Clay: Yes absolutely. That’s giving us all a bad name, I think.
Stephanie: I mean it’s comical, it’s amazing, it’s hilarious but that was my perception of the online therapist wakadoo, someone without any training, without any clinical basis that they just want to make money and that they have no certification or licensure and that they are wanting to take advantage of the technology. So what happened was I said I will consider it but I need to get some more training. I told this client basically not in these words but that they will be my guinea pig. My first case just like when I was at Emory I had my first couple that I ever saw. You know and you have to give them full disclosure and informed consent that I don’t have experience with this. But if we do our due diligence and we’re ethical about it and thoughtful, we can get the training in a supervision to become competent.
Clay: Right.
Stephanie: So that’s what I said. I got my initial training through Ready Minds and the distance credential counseling program. That was wonderful. I did that in person. I think it was at the time I don’t know what it is now but it was a two-day training. I did a lot of other bibliotherapy and reading. And then later I took the Zur Institute training online. But I’ve been a veracious consumer of anything online therapy related. So that’s why I was really excited to hear about your podcast too. Because there is a need and that you’re filling with this podcast.
Clay: I think so. I think that from what I am hearing from listeners is there is that fear and questioning and hopefully we’re answering that. So this is the first time we had someone on the podcast that has talked about specific programs that they’ve taken for a training for online counseling and you mentioned Ready Minds and Zur Institute. So, break those down. Tell me a little bit about those training programs.
Stephanie: Okay. I’ve found out about the programs through some colleagues. You’re part of another organization that I am part of the Georgia Society for Clinical Social Work. Since I didn’t even know if programs existed and I think I googled. I googled for awhile but then I got frustrated and sometimes you can when you’re just searching for something not even knowing if there’s anything out there. I asked around on the list for the Georgia Society and someone brought back to me and you know I’ve heard of this program called ready minds that they have a distance prudential counseling program that you can do in person or online and they just happened to have an in person training in that year and coming through Atlanta and I think it was… I can’t remember her name but she had previously lived in Georgia. I think she’s out in New Jersey. Nagle I think her last name.
Clay: This is probably Deanna Nagle.
Stephanie: Yes, Deanna Nagle. Yes she was fabulous. But she did the training and it was only two days and there was lots of materials she provided and lots of other additional readings that she recommended and so that was the beginning of training for me. It was so helpful. It just gave so much history and research and a framework that it really helped me to feel like I had at least the basic competence to provide online therapy because I’m a little bit more on the anxious type. And so I feel like if there’s a course for it, I would probably take it. Whether or not I actually needed that, but I don’t know. It made me feel more competent and confident to be able to provide this to my first client. So I did that and it really, really helped. It reassured me and it’s what sparked my interest in this and it really started breaking down some of the bias that I had against it. As I started reading I also took the Zur Institute online training which I thought was also great and I’ve never done an online training program before. So that felt good in a different way. I could go with my pace. I do tend to still prefer the in person trainings just because I think I have a touch of ADD sometimes. It’ll take me two months rather than two days to finish something.
Clay: Yeah but I’m a huge fan of the Zur Institute. Anytime I have any kind of question and I go there and they’ve got a wealth of knowledge. I think Roy Huggins has written for them in the past and if you’re listening now it’s Zur Institute, Zurinstitute.com and they just got all sorts of really cool stuffs.
Stephanie: Yes, yes and I think that you’re just interested in it an even if it’s not something you want to provide, just the I think specially on the Zur institute the articles about googling your clients whether or not to do it. The topics are so interesting that I think even if you’re just interested in the ethics of it which I am, I think it’s just fascinating. So that’s a great resource. And then I just read several other books on the topic that Deanna had recommended. There was some fear here in Georgia about the potential for regulation which like we said has now happened. Someone asked me at the Georgia Society for Clinical Social Work since they knew that I was one of the only people providing online therapy around here to give a two hour continuing education lecture on it. At that point I have been practicing about a year, a year and a half in my private practice and have been doing online therapy since the beginning, first with just one client and then with several others. It was really fun to develop just a two hour educational program and to teach my colleagues about just the basic of this and what this is you know yada yada yada.
Clay: So you’ve gone from someone who is reluctant to do online counseling to I’m going to begin online counseling and now you’re training other people in how to do online counseling. What a journey.
Stephanie: I know I know it’s so surreal sometimes because I did probably about 20 prep trainings in the fall and that what was when I was also in my 3rd trimester of pregnancy and because everyone wanted to get their continuing education credits now that they’re mandated on this topic, and because I was one of the only people again around who had done any sort of training on it, they then asked me to do a six hour training. So then I moved from creating a two hour training to creating a six hour training and then I’m in a room full of hundred clinicians and it felt like the TV show This Is Your Life or something like how did this happen. I can still remember that first training that I did for two hours when everyone have their arms crossed in the room. No one, no one felt at least in the beginning I think I suade some people by the end of the two hours, but most people were exactly where I was in terms of their feelings about it. Like “Come on, Stephanie, this isn’t real therapy. You lose the magic.” They were so much resistance to the idea.
Clay: Really?
Stephanie: Yes yes.
Clay: Okay.
Stephanie: I think it’s changing dramatically even in the last 30 years.
Clay: Yep. That’s the sense I am getting. It’s just becoming accepted that the field is going in that direction. But of course obviously I’m going to be biased.
Stephanie: Me too.
Clay: Okay. So, Georgia. Let’s talk about this because I’ve heard bits and pieces. Now I get to talk with somebody who actually knows and does training on this. What happened to Georgia as far as regulation? What is the regulation? What’s going on?
Stephanie: Okay. Well, awhile back and this was the warning cry from Georgia composite board. But there was an email that was sent out a long time ago saying, of course I’m paraphrasing, “Hey guys, new clinicians that we regulate. We are thinking about implementing some regulations related to the use of technology. We’re going to have a town hall meeting. Why don’t you come and let your opinions be heard. We think that there’s a need. It’s not been regulated. It’s starting to be regulated in other states. We’re interested in what you have to say.” I don’t know about your board but that’s pretty uncommon.
Clay: Yeah?
Stephanie: Now I’m kicking myself because I didn’t go. I probably had a dinner date or something. You know. I mean this is one thing that I’ve said in my trainings to most of the Georgia commission is like if you don’t like rules and regulations, you got to be engaged.
Clay: Right.
Stephanie: And so, so much of the resistance and I think frustration that I would hear from so many of the people participating in the training was why do we have to do this. But there was a warning. There was a warning and it’s my understanding that there have been enough cases of questionable ethics or questionable use of technology that has gone before the board that in technology is just dramatically changing mental health that they did made a decision to take action to define what telemental health is so that there’s a consistent definition at least here and to require a minimum level of education for clinicians here.
Clay: Let me just let the echo pass. What is the regulation there in Georgia? How many hours? Is it something you have to re-opt every year? What is the law saying?
Stephanie: The law is now saying that for anyone who practices telemental health and that is very very loosely defined like if you provide services using phone, fax, video, smart phone and they go into very specific details about that but it is broadly defined, then you are required if you have a license as a masters level clinicians. This is not for psychologists. Just for the masters level clinicians because that’s our composite board combines LPCs, LMFTs, LCSWs. Then you’re required to have six hours of continuing education credit for every two years that we have our renewing cycle. It’s part of the 35 required hours here in Georgia. Also on top of that, if you are a supervisor, you have to get an additional three hours.
Clay: This is just only for masters level? You’re saying a PhD psychologist does not have to comply with this?
Stephanie: Their composite board does not currently require it. So, right now it is just our composite board as far as I’m aware. Please if anyone out there listening has heard otherwise, please correct me. But for our composite board for masters level mental health clinicians here in Georgia, six hours are required for every two year renewal cycle.
Clay: Wow!
Stephanie: Just on the topic of telemental health.
Clay: Okay. So, I think this is the only state that says that if you’re going to practice in Georgia, that’s not enough. You have to get additional training in telemental health every two years. Wow. Okay. Alright. So that’s good to know. That’s good to know. Tell us, tell me about your experience online. What do you think your percentage of practice is is online and what’s it like for you as a clinician?
Stephanie: Well, I would say very small percentage of my clients see me online. Probably like ten percent, I would say. And it’s always been part of my like since seeing that first client and getting training, I added it as part of my I would say suite of services. So I deliver therapy, and this is part of what I say in my website, in person or online. Learn all together since relationship are the primary concern people come to me with. This is what I think really helped my private practice and this is what I encourage other therapists to consider for their own is that even though it is not sizable part of my practice, people today especially the millennials and the 20s and 30s somethings that are mainly see who have grown up with technology, they really appreciate being able to schedule online, being able to do their billing, to secure message me and then to have that option, even they don’t use it very often. So many of them are professionals. They’re travelling. Sometimes we have this snowpocalypse. It was a snow storm maybe it was two years ago. It was really hard for anyone to get out there because we just don’t have that much of that here in Georgia. I would say because I would offer online, I saw almost all of my clients even though most of them see me in person. So it just allows I think a level of flexibility. But most people even if it’s not their preference sometimes but they appreciate it.
Clay: Yeah and I’m hearing that a lot from clinicians that this is addendum. This is just something else that they offer to their face to face clients for when their travelling or they’ve got some pockets of time during Wednesday afternoons that they might begin seeing some people online. So they’re starting very slow. It’s nice to hear that that’s kind of how you have done it as well and that your clients are appreciating that level of service.
Stephanie: Yeah.
Clay: What platform do you use to work online?
Stephanie: I just have Counsol. C-O-U-N-S-O-L. That was when I did my initial research three years ago, when I was considering which platform. I definitely wanted electronic health record. I knew I didn’t want paper. Just for my own sake and my clients’ sake to help with organization. I knew I wanted that and then I also knew the client who challenged me and that I got my education, I decided I want to have all in one service and they provide video as well. So, I have everything in that one platform and I don’t know if they’ve changed it or not. But I’ve never worked for insurance companies. That’s I am always been on private pay, and at the time it was one of the best platforms for video electronic health records if you’re going to do private pay. I heard mixed reviews about other once like some really help streamline with say the insurance paper work process. But since that wasn’t something that I was considering, this was the one that met my needs.
Clay: Have been pleased with it?
Stephanie: Yeah! Yeah I have. I will say that some of my colleagues who have used it have criticized the what’s it called? The user interface that they didn’t like that as much. It didn’t feel it as an intuitive to get around. But I really liked how I could add all my forms. I don’t know if you know much about the Gottman method but there’s a million forms.
Clay: Right.
Stephanie: So at the time, they now have the relationship check up online that you can get you can pay them to score it for you. But there are like 50 assessments that I already have each in my couples. Even if their just form page you should really quick, I had to go in there manually and enter each one. And but it was nice once I completed it because then as soon as they were logged in as a new client and I have them in as a couple, all of these assessments would be ready for them to take and then it would automatically drop it into their file.
Clay: Now, I think I am remembering this correctly that you have integrated this into your site at counselingatl.com. So it looks like it’s just another page. It’s not like they’re going to download something or go to counsol.com. It looks like they’re just staying on your website. Right?
Stephanie: Yes. That was important to me. I really like tech I mean as much as I was resistant to the idea of online therapy. I’ve always loved technology. And so that was something early on especially since I went from working full time in Emory to hanging a shingle and saying “Okay I’m a full time private practice and I have one client.” So I have a lot on my hands to be fair. And so, there’s a steep winding curve with setting your website and then setting up your platform for video and for electronic health records. But when I found out was… I used Square Space to build my website. And I found a way that you could I think inject code to where it looked like it was the same page. And so, there’s a way, I’m sure with Wix and all the other ways you could go the website that there’s a similar way you could do it. But there’s a way to make it look like it’s the same page.
Clay: Yeah. It looks really clean and like you’re staying on your site and it’s just very professional. One of the questions I want to ask you, liability insurance. What do you find out about that that surprised you? How do you handle that?
Stephanie: Well, I am married to a lawyer. He is so helpful because I am very much a big picture kind of person, he is very much about the details. So he made sure he said, you know “What about your video, online video?” and I’m like “Oh yeah good question! I should probably make sure that I’m covered if anything happens.”Wwhat I did because I get my insurance through the National Association Social Workers, NASW. They have a preferred insurance company. I called them, and when I was going to first start doing online, I called them and I said “This is what I’ve wanting to do. Is there anything extra that I need to buy so that I am covered?” And at the time they said “No, you’re fine. As long as you’re practicing within current ethical and legal standards, you’re covered.” And when I went to renew the following year, they had just introduced an additional add-on for technology. I don’t want to be cynical, like I’m really am like mainly an optimist. But sometimes you think it’s about money. If you can make a little extra money you to charge people for things, I think that’s what’s also happening because eventually we’re all using technology to some extent Whether or not people are providing online therapy and HIPAA and all this other laws are trying to keep up with all the changing technology. I do think that for insurance purposes they’re starting to just add on another way to make a little money saying this is an additional coverage.
Clay: But certainly affordable.
Stephanie: Yeah very. I mean I think I have a lot of friends that are psychologists and I think that social workers I think we pay like the least honestly in terms of our insurance coverage. I’m very thankful for that.
Clay: Okay. So this is very helpful. We’ve been able to talk about liability insurance platforms, trainings, specific regulations in Georgia and about your unique practice which I think is great. Just as we come in to this, is there anything that you want to maybe a tip to someone who’s considering this or a valuable lesson that you are going online with your practice?
Stephanie: I would say that, you know keeping an open mind. If you have bias like I did in the beginning, really just trying to look at that a little bit more closely, and if you need more education, just get more education or if you need more supervision around on something you don’t feel as confident about, you know need to get it or to get consultation and just stay open minded. Just as you would for what your passions are clinically and who your ideal client is and to not be rigid about where you currently are and to just keep that open playing a possibility for where your career could take you.
Clay: That’s excellent. Be open, be informed, and jump. So, thank you, Stephanie Cook for joining us. Again, her website is counselingatl.com. She’s in Atlanta, Georgia. We’ll have all those links in the show notes. Thanks for joining us, Stephanie.
Stephanie: Thank you, Clay. I appreciate it.