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 where we explore how the field of psychotherapy is changing due to the practice of leading our clients online and using other technology tools. My name is Clay Cockrell and Happy New Year! Not sure when you will be listening to this but we have just entered 2017. Makes a guy feel kind of old. I don’t know about you but I’m thrilled at getting a new start. A lot of folks talk about 2016 being a difficult year, shall we say? I have to say for me it really has been a year of growth. We launched this podcast just over a year ago and now we have almost 12,000 downloads. We launched the Online Therapy directory and I have therapists listed there from all over the world and I’ve had really amazing privilege of meeting talented counselors from all over as they share their story of bringing their practices to the online therapy world. My whole goal in starting this podcast was let’s learn together from our mistakes from our challenges from our wins, and I think that we’ve made some wonderful headway in that direction. Yes, 2016 was hard but 2017 is going to be amazing. Building on the foundations that we’ve laid.
If you haven’t had a chance to check out the Online Therapy directory, please head on over there. It’s www.onlinetherapy.com. It is a directory of certified and licensed therapists from all over the world with the express goal of building your practice online with all sorts of tools and tips and community support. We are certainly growing. We are now on Google’s first page for most of our search terms like online counseling, online counselor, find online counselor. We are number one on the first page for the term online therapy directory. Pretty good for less than a year being live. We are getting ready to make some major announcements about the directory so stay tuned.
One of them I can tell you now is that we are starting a blog. If you are a listed therapist, you can submit a blog article on anything about your practice, how online therapy can address depression, how it can be helpful with relationships or anxiety, whatever topic you would like to write on. It will of course shine a spotlight on your practice and hopefully bring you some more clients but it will also help the directory as a whole as we get more and more youthful content for our visitors. We’ve learned from many website designers and developers. It’s all about good content and the whole goal the directory is to shine lights on people who are doing amazing work. Let me know if you would like to participate.
On to today’s interview. A few weeks ago I got to speak with Donijka Monk who is the co-founder of the Irish Online Counselling and Psychotherapy Service. Today I get to talk with her partner and co-founder Mary McHugh. Mary is a qualified psychotherapist with over 18 years experience in the counseling field. She’s accredited with the Irish Association of Humanistic and Integrative Psychotherapy and the Irish Counselling and Psychotherapy Association and is currently in studies addressing mindfulness. She was a wonderful person to get to know and I’m so inspired by both of these women who saw a need and then decided to create a service to address it. They now have a successful group psychotherapy practice 100% online by the way with seven counselors in the group. She was very gracious to talk with us and I hope you enjoy our talk. Here is Mary McHugh.
Clay: Hello and welcome to the Online Counseling Podcast. I am thrilled to have our guest today. Some of you may remember—I think it was a couple of weeks ago—we had one of the co-founders of the Irish Online Counselling and Psychotherapy service talk about her journey and starting an online group practice for counseling and psychotherapy in Ireland. We had wonderful comments about her and just a fascinating story. So we’ve asked the other co-founder Mary McHugh to come on and talk about her story. Mary, thank you so much for coming on the podcast.
Mary McHugh: Thank you.
Clay: How are things in Ireland today? How’s the weather?
Mary: The weather is we’ve had a beautiful Christmas. The weather is really nice. Plenty sunshine so it’s been really, really nice.
Clay: Very good. I see the sun behind you. It’s kind of a cloudy day here in New York. Once again I apologize to all our listeners that you’re going to hear sirens and the little whistle across the street from the doorman. It’s just the sounds of Manhattan but hopefully you’ve gotten used to it. Mary, tell us about your journey to psychotherapy to being a therapist and then how did that morph into an online counseling service.
Mary: If I look back, I suppose I would have came from quite a lot of life experience I suppose. I began foundation in counseling studies, oh gosh, maybe about 20 years ago because I feel interest in I suppose helping people. That was my key initially but. I suppose really I’ve seen that my journey has been about helping myself, and so indirectly through helping people, I’ve really seen that it was myself that needed a lot of help along the way. I started a foundation course and I had been doing voluntary work with the ISPCC which is the Irish Society for the Prevention of Cruelty to Children and crisis pregnancy as well. I have done a bit of and voluntary work there but didn’t feel that I had the experience necessary to really be with somebody in crisis. I went on then to do my training. I’ve done of four year training and in Castlebar with Dr. Jim O’Donohue and Cherry Fray Masterson. From there then I suppose I have moved into private practice and it has been evolving since. I have no idea of where I’m heading to because it’s forever evolving.
Clay: That’s fascinating that you kind of started out with a service. So many people I think are drawn to our field looking for self-healing, but it seems to be a certain type of us that is entrepreneurial and so I’m going to start a private practice. What was the draw for you in doing that?
Mary: I suppose at the back of my head I would be very business minded at the back of my head. I’m quite creative in my ideas. My mind works quite a lot and around business, but I suppose in needing to get an income from what I love, I had to start in the private practice. In Ireland I suppose it’s more difficult to become employed by agencies. Private practice for a lot of us is the way to go.
Clay: Really? Is there a lot of private practice in Ireland?
Mary: The majority of psychotherapy is private practice.
Clay: Wow, okay.
Mary: It’s changing but it’s slow, changing but it’s slow. From there, it is I suppose a very slowly building up your practice and I suppose over the years my practice thankfully is a very busy practice and that has came I’m not sure but maybe word of mouth and through different referral systems. It has came about this way. I suppose them the online side of my business came about really through again voluntary work initially.
Clay: Where was that?
Mary: It was volunteering on a Facebook page and I just happened to see it. It was at the very beginnings. I suppose I was that the first psychotherapist to go on as a volunteer and it wasn’t really in a psychotherapy capacity. It was just as a I suppose as a listener or as an aide to somebody who needed to vent, who needed to talk. From there I suppose it just really opened up the real need for I suppose for the service for the online service because there were people that were needing professional help but weren’t for whatever reason able to access it through the normal channels.
Clay: What were some of the reasons that they were unable to access traditional face-to-face psychotherapy?
Mary: I suppose I have one memory of a guy that came on the Facebook page, and his anxiety was so high and he was unable to make a phone call to make an appointment to GP which is the doctor. His anxiety was that high. He needed to get to the doctor but he was unable. He was typing to me about his anxiety. I remember typing with him as he made his journey to the GP. Yes. So walking him by the hand to where he needed to be. We hadn’t seen. We were waiting for referrals to come through either the doctor or self-referral, but actually for some people they can’t even pick up the telephone. It was seeing that instant messaging is actually necessary for some people as a stepping stone.
Clay: As a stepping stone, absolutely. What was the reaction by your colleagues, I guess the industry at large so using a new tool? I think across the world the people I’m talking to there’s some resistance from some. They want to make sure it’s safe.
Mary: Yeah. For me there was huge resistance. I absolutely and initially said there is no way. I remember there was one specific lady who I actually worked with for quite a number of years and she wanted me to do psychotherapy with her. She had quite a lot of issues going on in her life and she wasn’t from Ireland. She was from another country. On all levels it wasn’t okay I felt for me to do it for me to be her therapist and I was very anti-Internet or online therapy at that time. But I received a message from her and she say that she had been to a psychiatrist and her psychiatrist had wanted her to have the electric shock treatment as the next course of action. I thought to myself look we have nothing to lose here. Why not I take a risk with this lady?
We began to work one hour a week through typing to start with and we worked then from there very slowly. It was very boundaried. Our work was very boundaried. From there to telephone, and from there to her seeing my face but her talking without me seeing her face and then us both seeing each other.
Clay: Wow, to go through the different levels of connection as she got comfortable using all the different steps of technology. How cool is that? As she warms up to the process.
Mary: It was amazing. I couldn’t tell you the amount of medication she was on and she was highly medicated. She was stuck in her bedroom and her husband’s done everything around the house. There was no income coming in from her. She now today a full-time job. She is on no medication. She moved on to a face-to-face therapist which is actually our goal that they don’t stay with us if that’s the issue that they do move on to face-to-face therapy. It really worked out for her and I suppose it showed to me the real need for it.
Clay: Absolutely and I have to say your story reflects so many of the people that I talked to, therapists around the world, who say that it’s really client driven. It’s someone in pain who wants to do this work in a certain way to use these tools of technology to connect and for us to get comfortable and figure out the how behind it, how to do it ethically and legally and boundaried. So many other therapists have said, “How could I with my skills and my training see someone in pain, see someone that I am trained to help and say no because it didn’t come in a certain package, it didn’t come in the traditional come in my office and talk to me? I just couldn’t. I can’t do that. This is a new tool. I have to get uncomfortable and learn about it.” It sounds like that’s what happened with you.
Mary: Exactly. We worked for quite a long time and for me to do it I could not charge her. I would not charge her because I didn’t feel and I didn’t know enough about it. It was a risk I was taking with her and we both agreed that. We held a very strong boundary there around that. But I suppose the end product of it all was that it was so necessary in her life. She is living now. She really is living for life.
Clay: Wow that’s beautiful. At this service is where you met Donijka?
Mary: No. Donijka and myself put trained together. As that Facebook page was beginning to grow, it really quickly. I contacted Donijka asking would she like I suppose come on to give us a hand because it was growing beyond growing which also showed us this real need or people were really needing support but they were also needing those boundaries. Donijka then came on with me and. That page is still running today. But myself and Donijka and over the last few years we decided then just to go out on our own. We are rolling it very, very slowly. We’re very tentative because we are very mindful that that we do it properly and ethically and safely.
Clay: I just want to go back because I think that you cut out there for just a second. It’s five or six years that you have grown the Irish Online Counselling and Psychotherapy Service and that you’ve been doing this slowly, correct?
Mary: Very slowly.
Clay: Before we get to that, tell me about the cultural acceptance of mental health care of counseling in Ireland. Is receiving care becoming more normalized or accepted in Ireland?
Mary: Absolutely, yes yes. I suppose I do a lot of work with teenagers and I see they are so far ahead of us as we’re kind of looking after their mental health. I suppose my age group and would have quite a stigma around mental health issues. I suppose with the internet people are seeing gosh they have the same problems as me, so it is becoming more normal to talk about depression, anxiety, emotional issues, anger issues. It’s becoming more and more acceptable.
Clay: In the industry there, is online counseling becoming more acceptance accepted in your field with your colleagues?
Mary: It’s beginning to. It’s been very slow. I suppose because people aren’t very up to speed even with internet itself, and so it is like oh my gosh and I’m not going near any of that. We would get a lot of “That can’t work” or I suppose there is a lot of pushback against it. But it’s changing. I can really see it changing and people are becoming more open to the possibility.
Clay: I would imagine that because the two of you have been doing this the longest it seems that you would be seen as a leader in the field. Do people come to you and say, “Hey, I like what you’re doing. Can you teach me or do you give seminars?”
Mary: We have. Just last year we’ve done a training and but that was our first training. Now we’ve gotten a lot of students from universities that are doing maybe their dissertations or theses, and they will interview us. There is interest. We are being contacted through that. As I said to you before, we’ve been very tentative. We’ve taken it very slowly because we want to do it right and what is right but we want to do it as best we can so that that the client is as best we can take and care of in this because this is new and innovative. I suppose we’re all treading and through and uncharted waters. I suppose the slowness of our doing this and so we’re only beginning to open ourselves out. Because of our work and because of clients that we’ve worked with, it has given us more of a confidence now to be able to say yes it works, we know it works. Whereas before it was like oh my God, if we’re challenged, what do we say, what do back us up? We feel now yes we can back it up. This does work.
Clay: What are some of the things that maybe you’ve learned because you’ve gone slow? Were there things that say, “We’re going to try this and no that’s not going to work. Let’s pivot and go in a different direction.” What are some of the things that you’ve learned in this tentative process?
Mary: I have to say and it’s amazing because this is where I’m doing my study at the minute is I’m doing my master’s in mindfulness at the minute and the whole process is around mindfulness, being here right now in the present moment with what’s going on, so really being with the client where they’re at in that moment. That’s the process we follow. There’s not really a trial and error. We’re staying with. We’re being where we are than running towards any goals. We haven’t been running towards any goals. We’re just in the process.
Clay: I was talking with or maybe I was listening to a podcast that Joe Sanok here in the US was giving. He interviewed someone about growing a private practice with a group like a group, a group private practice, other therapists working for him. His take, Joe’s, was that he would hire a person and then would not hire another person until that person is pretty full. Now we’ve got a waiting list. Now the next person we can support can come on board. Kind of the business in, you have a total of seven counselors at this Irish Online Counselling and Psychotherapy Service which is fascinating to me and they’re all 100% online, the work they do through you. What was the process for you on the business end of growing and bringing people on board?
Mary: Very scary. I suppose myself and Donijka we would consider this project as our baby and it’s like “Oh my gosh, we’re opening it up.” But we’ve had to. We’ve had to open it up and in that we’ve been so lucky to get the group of people that are working with us. It’s that similar mindset, that wanting to be there and be on the service and whatever the capacity is. This is this is where it’s working. What we did was we had and a training going back last year, and out of the training then we I suppose took on and some people from that training. It has thankfully worked out really well. But we are again tentative as in we’ve taken them on so it’s not that we’re just taking one on. We have five therapists and it’s working and it’s going. But we’re going to take our time whether it’s another six months before we look again, but we will be looking again to expand it that little bit more and more because it’s needed. We have clients coming through and we have really not put ourselves out there. I know we come up on Google you know quite high in whenever you call that thing, the ratings. We come up high there. Really we haven’t yet but ourselves out there as in advertising or anything like that and yet it’s coming through.
Clay: Well obviously the need is there that you’re supporting seven people in your group practice and growing.
Mary: And growing. As you know yourself, the world is quite technological. This is where our young people are going and we need to be prepared for them so that they have support. It is about growing now because it is going to come in like a tsunami and the generation that’s coming is very different to the generation that has gone by.
Clay: Absolutely. Talk about the pros and cons of a group practice. Are there any cons that come to mind or difficulty and challenges?
Mary: Any cons, I suppose for me I’m quite anxious so when emails come in I’m anxious. That side, the technical side of things I wouldn’t be so great on you know I feel I’m a good therapist but I’m not so good on the technical side of things. That would cause some anxiety for me. Cons as yet there aren’t too many. We’re lucky. We haven’t had a lot of teething. Donijka is excellent I have to say. She’s managing a bit more than I am at the minute because I suppose I’m in the study. I suppose if you were to talk to her again about it, she’d probably say, “Well Mary moved the arc.”
Clay: That’s what a great team is is you find someone that has a different skill set than you and you lean on each other.
Mary: We work very well together.
Clay: I can tell. Yeah absolutely. You use the word boundary a lot in our conversations. Tell me a little bit about some of the boundaries that you found to be necessary in this type of work. What do you mean by that?
Mary: The boundaries I suppose and if I can go back to that Facebook page that was set, and it became so evident that we as human beings we crave boundaries, and within that boundary it gives us that sense of freedom then we know how our line is so to speak. I suppose in bringing that into the online work is that we hold exactly the same boundaries that we hold in our private practice. Our one hour and session is a one-hour session beginning at a certain time, ending at a certain time. Payment has to be at a certain time beforehand. That gives the client safety that they can trust us. We would be very clear on our boundaries lovingly of course but that they’re there and that they’re there for them and for us. We were also important in us.
Clay: I would imagine I’ve seen in my own practice when someone would come either face-to-face or online especially someone who is young or has not been in therapy before, there’s a lot of education on what this is. This is this is not friendship. We’re not to see each other outside. We’re here to work and there’s a lot of education that we have to give either face-to-face or online, but those boundaries are really important for all of us.
Mary: Yes. I like that that there’s no contact between sessions except in exceptional circumstances. All of that, the same that we would have an in the private practice. Absolutely.
Clay: Now you’re working with people all over the world, right?
Mary: Yes.
Clay: How do you manage some of the cultural differences? I’ve had clients in the Middle East and Asia. Go ahead.
Mary: Really, we’re working worldwide but I see our audience or our clients are mostly Irish-based because we have suppose I don’t know whether you know that but Ireland has a high immigration. So we’re all over the words.
Clay: I can trace my beginnings on my family all the way back to Ireland. It’s like they start there and then they go all over the world. It’s interesting. Primarily Irish people but just in different locations.
Mary: Primarily, yeah. I think Donijka has had two. We have had clients because they work in whatever companies that they actually move from continent and actually we’ve been consistent. We’ve been the consistent therapists while they’ve been doing the moving which has been really I suppose great for them and stabling for them as having that consistent person as they’re going along in their life with whatever it is that’s going on for them at the time.
Clay: Absolutely, absolutely. Donijka talked about it. It’s like talking with someone from home, somebody that knows my people, knows my culture and I can connect with.
Mary: It’s amazing in that and you can really feel that. You can really feel sort of it’s nearly like that motherly or that love that’s there motherly or that they’re able to just let go into it.
Clay: Absolutely. That brings up an interesting point. Here in the US, and I guess worldwide, but particularly here in the US we’re very concerned about regulations and licensure for the area that we’re doing counseling in. I get questions every day from listeners who say, “I just got contacted from someone in Nigeria or Australia or wherever. Is it okay for me to do counseling with someone like that?” The US is kind of where our own little quirky place and we’ve got a lot of regulations particularly from state to state, but internationally I’ve not found a lot of regulations that prevent us from doing work outside the United States. Have you done some research on that? Are there things which you’re aware of?
Mary: We’re actually the same. The only problem we have is with the US. We’re very similar to yourselves. We have worldwide insurance except for the US but there is talk of that being opened up. I suppose what’s happening is the internet is going so fast as opposed to getting legal stuff around. They’re behind the internet so to speak. They’re running trying to figure out what do we need to do here. Hopefully that they will figure that out.
Clay: But you’ve come across a country that said no there are some regulations. you need to be licensed here in Dubai or wherever.
Mary: No. Just the US.
Clay: Just the US. Interesting. You did mention worldwide insurance. Can you tell me the name of your insurance company that insures you worldwide?
Mary: Balens in the UK.
Clay: Spell that one more time.
Mary: Balens. Balens UK.
Clay: Alright. I’m going to call Balens UK and see if maybe they’ll come on the podcast and talk about that because we really have been looking for insurance companies that are going to cover therapists internationally. That would be a great resource.
Mary: There also is O’Brien I think, O’Brien and Finlay. But I need to get back on to them again because they had spoken to me a couple of weeks ago about being able to offer worldwide inclusive of US. Yes but I’m not so sure. Maybe they got it wrong because I think we’d be very happy if that happens but I’m not sure.
Clay: That would be difficult just because the people that I’m talking to would say that someone licensed in the UK or Ireland or outside the US that would do counseling with someone in one of the states, let’s just pick Florida, that person would be violating Florida law . I don’t think the Florida authorities are going to extradite you to come stand trial in Florida. But we want to be ethical. You don’t know. You don’t want to be the example but we want to be ethical and we want to be following all guidelines that are out there.
Mary: Absolutely and that again is the boundaries. We are as fearing to the boundaries that are there as well.
Clay: We’ve covered a lot of things. Anything that comes to mind as like I want to mention this. Maybe something you’ve learned or tips that you might give to therapists who are thinking.
Mary: I suppose just to say to anybody who’s considering doing online counseling, and what I have found is that that you can be as close in doing online counseling as you can be in face-to-face. While the face-to-face is the ideal for some, it’s not the ideal and that they are may be more able to be open at a level in the online that they wouldn’t be in the face-to-face. It gives them maybe a little bit more courage sometimes to have that sort of just veil between until they’re able to lift that veil and then go because the ideal is face to face, but culturally that can hinder people. If they’re disabled and can’t leave the house, there’s lots of reasons where they can’t. That’s why online is absolutely so great, But also if it is around anxiety and you issues like that, then it is getting the stepping, you are the stepping stone for them to get the strength to get their legs going and get them out and get them into the public and living again.
Clay: Absolutely, absolutely. One of the things that they said over and over in my graduate school training was you meet the client where they are. This is just a tool in order to do that.
Mary: That’s funny because our motto on our online counseling “Wherever you are we are.”
Clay: Yes.
Mary: That is the truth because what I suppose what right am I to say you’re to be at a certain place? We have no right as human beings. Each one of us are struggling just to be where we are so. Why put what we think is normal and somebody else that they should be sitting in an office talking to somebody else just because I can? That doesn’t mean everybody can.
Clay: Absolutely. Mary, you have been fascinating. Thank you so much coming on and sharing your story. I want everyone listening that if you want to learn more, the Irish Online Counselling and Psychotherapy service can be found at counsellingonline.ie For all my US listeners I will remind them that outside the US they spell counseling with two L’s. It’s counsellingonline.ie. Mary, again, thank you for coming on the show.
Mary: Thank you very much, Clay. Thank you.