Hello and welcome to the Online Counseling Podcast, I’m your host, and I hope your 2018 is getting off to a great start. I’m really excited about this year, as I think we’ve come to a pivotal time when things are changing rapidly for our industry and online therapy is really gonna take off this year. I’m excited to learn with all of you about some of these changes and some of the growth patterns that we’re seeing in the field.
CC: Now, for today’s interview, I think you’re gonna love this. I’ve been hearing about this company for the past year or more, and several of the directory members use them, and they universally have incredibly positive things to say about them. They are called iTherapy, and you can look them up at itherapy.com, that’s the letter I the word therapy.com. For our interview today we get to talk to the co-founder Forrest Pulley and their chief technical officer, Nicholas Fuller. Now, before today’s interview I really thought I understood what they were all about, but I had no idea of all the different things they bring to the table. Yes, they are a HIPAA compliant platform for online video therapy, and yes, they offer ways to accept payment and EHR services, but they are so much more than that.
CC: First, they pride themselves on their customer support, really is what sets them apart, but they are really positioning themselves as the leader in the industry for online therapists, kind of a one-stop-shop. They’re offering business coaching, marketing guidance, license guidance. The list goes on and on, and I don’t wanna take away from the actual interview, so I won’t list everything. But I will say that my impression of them is that their heart is really in the right place, and they want to be the best at what they do, and they’ve spent a lot of time listening to us, us as in therapists who are doing this, and learning what our needs are. I’m impressed with them. I hope you are too. Oh, and I will say that unfortunately we had a few recording problems that created an echo, and I’m hoping that our sound editor can reduce those, but if not just please be patient, if it’s not as clear as some of our previous interviews, because the information is really incredibly valuable. I hope you can overlook those little glitches. So without further ado, here is our in-depth interview with iTherapy.
CC: Thank you so much for being part of the Online Counseling Podcast. I am really, really excited about today’s interview. I’ve heard so much about iTherapy over the last couple of years, and have been meaning to reach out to them and learn more. There’s a lot of people talking about all that they have to offer for telemental health and online therapists. And today we get to talk to the founder Forrest Pulley. Pulley, is that right Forrest?
Forrest Pulley: Correct.
CC: Okay, good. And you’ve also brought along with you, Nicholas Fuller. Nicholas, what function and role do you play with iTherapy?
Nicholas Fuller: Hi, just real quick thank you Clay for having us on. We’re really happy to be here and excited to answer questions you have. I am the chief technical officer, I’m a minority partner with iTherapy. I handle kind of a lot of the online outreach and that sort of thing, and also the person responsible for managing the website and the different technical elements.
CC: Excellent. So we have got the experts to be able to talk about iTherapy. I’m really pleased that both of you were able to come on. And I guess Forrest my first question is to you, can you tell me a little bit about the history of iTherapy, and why you decided to create this service?
FP: Sure. Well, it actually started… And we have one other business partner also. And she happens to be my wife, Carol Pulley. Carol is a psychologist, and she was practicing and setting up her practice, she was talking about… It was kind of when online counseling was first getting started and you first started to hear about it. And we lived in a fairly remote area, and so she was talking about better ways just for her clients to see her and for her to get to her clients. And I have a business background, I’m not a clinician, and so all of my background has been in business, working at a variety of things. And so we were talking and she said, “You know, it really just needs to be a better way to: A, Deliver services to clients. And B, For it to be easy for a clinician to run their practice.” And so we kind of put our heads together and we came up with the concept of iTherapy to do those two things. To deliver an online counseling platform that’s easy to use for both the client and the clinician, but also at the same time, provide a variety of services that would allow a clinician to be able to run their business simply. And to give them the opportunity to do what they do best, and enjoy doing more and that is helping their clients.
CC: Wow! So I love looking at things through a businessman’s eye, and obviously, you looked at this and said, “There might be an opportunity here to create something.” How long has iTherapy been up and running?
FP: Well, a little over four years, and we started out just by offering online counseling. And then from there as we worked with our providers, they started asking more questions about additional services, and we started adding additional services and started looking at what it did take to actually manage your practice. And so we’ve been doing that. And then from the technical aspect, as Nick mentioned, he came on board a little over a year ago. And so we feel very good about the fact that we provide different perspectives on how to do this, from a clinical standpoint, with Carol, from a technical standpoint with Nick, and then from me from the business standpoint.
CC: I see. And I know there’s a whole suite of bells and whistles, and things that you offer. And before we get to that, I imagine there was a learning curve for you, not being in the clinical mental health world, of what the needs were, so how did you come about understanding what we as clinicians were looking for?
FP: Well, that’s a great question.
NF: Boy was there a learning curve.
FP: It helps to be living with your business partner.
FP: Who we have said, Yes, who is a clinician and understanding her perspective. But at the same time, it was a tremendous learning curve, because as I found out going along, many clinicians, is again, love what they do, and that is helping people. However, from the business standpoint, they just wish it would just happen.
FP: They just wanna be able to be supported and make it simple. And it really has been a journey for us, because we’ve tried many different things such as even providing appointments with end clients for clinicians, but then we found out that, you know what, the clinicians know what they do best, and it’s not up to us to tell them. So we tried that, and we tried some other things that didn’t work out quite as well, saw some things we did quite well. Some things not so well. And as I like to say, it’s been a journey and continues to be a journey as we learn more and more about how we can help and what they want.
CC: Yeah. That’s great. I mean really listening to your audience and finding out what they need. So how many online therapists now are you working with?
FP: We have over 50.
FP: We’ve kinda been in a mode where we wanted to make sure that our platforms were good, we wanted to make sure that our business processes were good, and also to us the number one thing, it’s good to have the service, it’s good to be able to provide those, but we need it to be also be able to provide the support, and that’s very important to us. We want to grow, but we wanna grow responsibly, and do it right and make sure that we deliver the best possible service for our clinicians that we can.
CC: Well, I have to say that I am impressed with your work and that you really have developed a premier site with lots of features, but let’s go into those, and maybe this is a question for you, Nick, just starting with the foundation, this is a platform that is HIPAA compliant, audio-video. Tell me a little bit about that piece of it. And is this a plug-in, is this a downloadable app, or is this… Some people are creating these encrypted rooms that people go, tell me a little bit about the platform itself.
NF: Sure, yeah. So yeah, the video platform is an app that you can use, it’s available, you can access it through PC or Mac or various smartphones. HIPAA compliant as you mentioned, allows video chat also allows like you mentioned voice and can do text chat between each other. Yeah, that’s kind of, that’s the main piece that we offer, the main product is having access to that platform, being able to do the online counseling. Yeah.
CC: And this is an application that is downloaded and the client also downloads this app?
NF: Yeah, that’s correct, and it does allow multiple users to be in the session, so it doesn’t have to be one-on-one, it can be many.
CC: Really? Okay. ‘Cause I’m hearing a lot of questions from listeners of where do I go if I wanna do group online therapy? So it sounds like this offers that, is there a limit on the number of people that can be in a session?
NF: We haven’t hit it yet. We’ve added I think about a dozen and half at one point and that worked okay. Actually, that worked pretty well, not a lot of slow down or anything. So I’m sure there would be a point where it isn’t working well, but we haven’t hit that yet. And yeah, It seems that from the technology standpoint, absolutely, can definitely handle group sessions. It seems that that might be a little bit of a nebulous area still with sort of the regulations and whatnot. But I think if some therapists are interested in offering it, and they are checking their regulatory bodies and whatnot, then absolutely, that’s something we’re happy to facilitate.
CC: Okay. And where…
FP: Sorry, sorry. Could I add one thing to that?
FP: Alright, thank you. Again, Nick’s the technologist and he gets that, but one of the things that I like best about the platform is how much it mirrors a physical or a face-to-face session, like with a therapist. And that is that when a client comes in to the platform, they enter a virtual waiting room, and they’re sitting in the waiting room much like you would in a physical office, and then when the therapist is ready for them to come into their office, they literally click on one button and the session is joined. And so it kind of mirrors what happens and it’s intuitive, it makes sense and it’s simple, and to me that’s one of the things that stands out about it.
CC: That’s great, that’s great. And okay, so we’ve got a waiting room, we’ve got HIPAA compliant. One of the questions that I’ve talked to people about is… And I don’t know how to phrase it, so maybe Nick you can guide me on this. It’s this, if you have a broadband connection, and maybe let’s say me or my client, things get busy on the Internet, and that they are… Some platforms are able to negotiate how much data is going back and forth so that you never lose the connection, and that maybe the video quality goes down just a little bit that we wouldn’t notice. So how have you developed that? Is that a part of iTherapy, and maybe use more language that makes sense, because I’m fumbling here.
NF: Sure, yeah. The platform and the technology does scale down the resolution, that sort of thing, as there’s less bandwidth. I’m not gonna say that you’ll never lose connection, certainly that can happen. And for a lot of reasons that are outside of my control, but yeah, we do try to maintain connection, and what you can do if for some reason there are issues with video, you can turn off the video, and have a voice session that’s gonna take a lot less bandwidth. But I’ve commonly never heard of instances where the video isn’t working with therapists that are working with clients that are outside of the United States in maybe some sort of remote area. So take that with a grain of salt, I’m not saying it can’t happen, of course, but so far so good.
CC: Yeah, I think that I’ve heard that across the board, but just that you have that ability to monitor the connection and adjust when you need to. So let’s talk about some of the other features that iTherapy has, and for either one of you, talk about calendars and billing and all that kind of stuff. What does iTherapy provide for its members?
FP: Well, again, we package together services, we offer as we’ve already talked about. The Online Counseling platform. We also offer a profile on our website for clients to present themselves, we can actually do full websites now like if the client wants their own website in addition to that. We provide the EHR, the notes and Client Management Platform that allows for taking payments, for invoicing, for doing notes, for electronic claim submission. We also offer email, telephone and fax, and we’ll again package together those services depending upon what the clinician wants.
FP: Now, I will point out that some of our services, we provide ourselves and some of our services we do partner with other companies. And what we will do is that we have gone out and we’ve done research, and quite frankly, it just didn’t make sense for us to be recreating the wheel when there were wonderful companies out there providing the services. And so, again, we researched those and in those particular instances and we looked at the support they provided, the service itself, obviously pricing, because we wanna be able to deliver the best service for the best price that we can. And again, we package all of those together so that the clinicians can have one point of contact and one bill from us to make it simple for them. And then I’ll let Nick speak too. We actually offer services above and beyond that also, but those are our basic packages.
CC: Okay. Nick, anything to add to that?
NF: Yeah. Those services have been around for a while, but the profile on the website is kind of just… You could think of it as a directory listing. We’re not primarily a directory, but it provides some online presence for a therapist, so that if they don’t have anything else they can at least link to that. But yeah, most of these services we’ve kinda had for a while, but the thing that I think sets iTherapy apart is the support that we offer. And most of the time, you can dial our 1-800 number and actually talk with Forrest. We’re pretty committed to being there for our online therapists and making sure that we’re helping them out. We wanna be there to support them. But as we talked about before like learning what it is that the therapist want, we’ve been growing over the last year to offer more. So one of the things we’ve done is we call it jump start your practice, and we’ve partnered with a few other different companies that provide services that are important and valuable for people that are starting a practice.
NF: I will say, if you have an existing practice and you’re wanting to provide online therapy as well, we’re a great fit for that, and we’ll make it easy for you and we’ll make sure that you have your training so that you can get it done and you feel comfortable and you know where to look at on your camera, so that you’re actually making eye contact with the person. We’re here to help. But if you are just starting a practice, whether it’s online or in-office, that’s kind of an area that we’ve been focusing on a little bit more over the last year.
NF: So we’ve partnered with a company that does, well, licensing, to get you licensed if you’re that fresh out of school or if you wanna get licensed in another state and offer online across states. We’ve partnered with a company that does credentialing so that you can accept insurance, which can be a headache I guess, but it also could be very helpful, and certainly opens you up to other clients. But we partnered with a virtual assistant that can help with the headaches of being credential that sort of thing.
NF: So she can be there and help schedule your clients, reduce some of the paperwork for you. She’s worked with other therapists before and she knows the way things work. We’ve partnered with a woman who started her own online therapy practice and grew it to a full-time gig but that’s completely private pay within less than a year. And she provides business coaching and she’s great for helping you get started. We partnered also with a woman who does marketing specifically for private practice owners. So we have all these different resources and we try to make them available for our therapy providers, those are our customers, we call them providers. And we have exclusive discounts with these partners and that sort of thing. Yeah. Because we heard from our audience that they’re wanting to get started, they’re needing an extra helping hand, we’ve tried to help along with that, and make sure that… Again, the coaching and the marketing is a big piece of helping them grow their practice.
CC: I don’t even know, I’m impressed. I knew that you did a lot, and I talked to a lot of these platforms that are doing… We got the calendar, we got the payment but credentialing, working to get licensed, virtual assist, I’m just taking notes here, business coaching, marketing, it’s quite Impressive.
NF: Yeah, we kind of felt like we had a lot of the technology down, but there were just so many other pieces that we knew people need help with. And they were a little bit out of our wheelhouse but we knew we could partner with people, so we’ve got that together and that’s part of what we’re trying to bring to people, we wanna make… Our slogan is “Your practice made easy” and that’s what we try to be.
CC: Yeah. And I hear this so many times from people who have joined the directory of; Okay, I need help doing this and I don’t have the information for this over here. And it sound like you got all the answers there.
NF: We’ve had that question so many times for so many of these different things. We wanted to make sure that there was never an instance anymore where we were like, “No, we don’t know.” We wanted to make sure that there was always like an answer for whatever they’re looking for. And then, so just adding on that just one more piece like in conjunction with all that, just internally we started offering full websites as well. So we do full websites customized to someone’s practice. They are templated sites and there’s no set-up fee but there’s a monthly, an additional monthly fee if you wanna add the website on your iTherapy package, but it’s customized to your practice with your language and built search engine friendly, so that’s a new service along with the jump-start your practice that we started to offer just within the last few months, putting all of this together to make things really easy for someone getting starting.
CC: That’s great. And I’ll say to my listeners, I’m gonna ask Mike to clean up some of the feedback that we’re getting in this recording. But Forrest sounds like you wanted to say something in there?
FP: Yeah, it was just an interesting little anecdote that right before the holidays back to middle of December, I was speaking with someone, and they were talking about what they were doing as far as setting up their practice, and when I talked to them, and we do demonstrations of our services to people that wanna see it, and actually know what it looks like. And as I was doing this, at the end of it she said, “You know, I thought I was gonna spend my whole holiday looking for the services that I needed. Now I can relax and just use your service, and not have to worry about all of these things.”
CC: That’s incredible, that’s just incredible. And that I like that you would have found out other companies that were doing some of this really well and say, we’re gonna build on what they have and partner with them.
NF: Absolutely, yeah.
CC: Okay. So where should we take this conversation next? Maybe let’s talk about the different… Do you have different membership levels and let’s talk about pricing and that type of thing.
FP: Okay, we do. We have three different standard packages if you will, that begin with just the online counseling platform and the web browsers, and then we build upon that to add the electronic health records, the notes you collect, baggage bag, and even further build upon that, to add to things like the encrypted email, telephone, fax, and those things. And we start our packages at $79 per month. And the top in package with everything that we talk about is $179 a month. We don’t charge you anything for setup fees or initial fees. And we’re also strictly month to month, there are no contractual commitments. We firmly believe if you like our services you keep using them, if you don’t, you shouldn’t have to. And so that’s the way we’re set up. And again, we can also customize, if one of the three packages don’t fit you, we’ll customize it, if you said, “I want everything, but not necessarily the email,” or whatever the case may be.
CC: That’s remarkable. And I talk to people all the time. And then my listeners will know this, that when essentially when you were looking for a platform like this, you’re looking to create/rent a office. And my office in Manhattan is coming up on $2000 a month, so I would gladly change that to $179 a month, and I’d be able to work from home. And that’s the top end. It sounds like $79 a month is even… You could have a lot of what you need, just with that.
FP: Well, and again, another way to look at it is, when I talk to people and they’ll say, “Okay, so you want $179 for everything you offer, not including the website but even with the website it’s $239, which it does virtually give you everything you need to run your practice. And I said, “Here’s the way to look at it from a business perspective, two maybe three sessions a month with a client, will more than pay for your ‘rent’.” In the way that you look at it or what it takes to actually set up your office. And so if you look at it from that perspective, the pay back in this is quite small.
CC: Absolutely, absolutely. I do want to ask just a couple of questions and I’ll speak slower too. I think when I speak quickly, the feedback happens. The things that you are offering with a calendar, I’m assuming you have calendar scheduling, you accept payments, is that through Stripe?
FP: No, that’s through the platform that we utilize for the notes and client management. All of it, the calendaring, the scheduling, the invoicing, the payments, electronic claims divisions, are all done through that platform.
CC: Do you offer e-signatures, for, when a client is going to sign an informed consent. A lot of platforms are not offering that. Is that something that iTherapy offers?
FP: A great question, and the answer’s yes. Part of our services, there’s a client portal that allows clients to, if the clinician chooses to do so, they can allow of clients on an individual basis to be able to log into their client’s account if you will, and they can see any upcoming appointments they have, they can actually make credit card payments. They can also review forums such as privacy practice, informed consent. We have a standard intake questionnaire, that the client can review, initial acknowledge, fill out and e-sign, and it’s stored in the client records on the platform.
CC: Wow, okay. And it keeps coming back. Both of you have mentioned that what sets iTherapy apart is the support. Can you talk a little bit more about that?
FP: Well, I think from my standpoint it’s… And again, it is my background in business, is that I think the number one thing, people want things to work, obviously, and in the way that you promised them to work. But I think the thing that really makes the difference for our company is the personal service. And although it is becoming somewhat of a stretch now, I feel it’s very important that I train all of the initial providers that come on, because I wanna be able to hear what they’re saying, and I wanna be able to understand what they’re looking for, and where we need to make improvements or changes or additions, we need to know that. And so again, it’s just like that. And then I’ll have them come back, and in addition, I am one of the people that’s involved, and we do have a team of people in the background as you might suspect, that are doing a lot of the work, that are providing a lot of the customer support, and that type of thing.
FP: But the important thing for us, and we all have this philosophy because we all insist on it, is that; listen to your client, and try to help them in any way you can. The one thing that was taught to me a long time ago, was it’s okay to say, no. But only if you try to listen, understand what the person is looking for and then try your best to find out a way to do it. And so I think that we all have that belief and philosophy, that we may not be able to do everything and we may not be able to do it exactly the way you want it, but we are gonna try our darndest to make sure that you’re happy and you get the service you need.
CC: And it sounds like that you have a high level of excellence. If you’re gonna do something you’re gonna do it well.
FP: We like to think so, yes.
CC: So either one of you, could you talk to what you were seeing about the field in general. How telemental health is growing or changing what you’re seeing.
NF: Not to be overly dramatic, but I think it’s changing lives. I mean not only… Obviously the impact that it can make on a client is tremendous. It makes online therapy more accessible, it can potentially make it more affordable. But, it kinda makes me wanna make a point in that, with iTherapy. We provide the tools and then the therapist is entirely in their control of their practice and what they set prices on and that sort of thing.
NF: So you can make it more affordable, because you don’t have to pay the $2000 Manhattan rent, [chuckle] but that’s up to the client. But just being able to interact from a place that you’re comfortable with rather than having to go out and meet the therapist at the office can make such a tremendous impact. I have heard stories from therapists, where some of the therapists that work with us, they’ve worked with a client, and that they were working with a client on building like a… Packing certain things to get ready for an event or that sort of thing, and the client was kind of stressed out about it. And they said, “Wait, we’re here in your home, lets take the computer over to your bedroom lets go practice together. Let’s go do this, let’s work on this together in real time. Let’s do this.” And they were able to do it.
NF: I’ve heard from other people that being able to be at home and have their dogs with them during their session just makes them more comfortable, make some more easy to open up being in their own space and that sort of thing. But then also the impact that it’s having on therapists. You’re able to go on vacation and still be connected with your clients that need you. You are able to even relocate. We’ve had a couple of different online therapists that work with us that have completely moved to different states, but as long as they maintain their license in the state that they were previously at, they’re able to maintain the clients there. So yeah, I think online therapy is just such a great way to connect and such a meaningful and important way, its really pretty rewarding to be a part of.
CC: Yeah, incredible.
FP: I’ll put that out too, that I agree with all those things, obviously. And it’s also just almost exploding, the people at least wanting to explore and understand more about what to do with online counseling and how to do it. And so I think that that becomes very important. And you can hear story ofter story about reaching people that wouldn’t normally be reached, and working with people and doing this and its… As Nick says, it sounds overly dramatic, but it literally does change lives, on people and as well as clinicians. I’ve talk to many clinicians who are kinda towards the tail end of their careers but they don’t wanna stop, but they wanna kind of enjoy those things where I wanna travel, but I still wanna be able to offer services to my clients, and they can do that.
FP: I will also say that I think it’s important for people to understand when they get into online counseling. I always like to say; is for the right person in the right situation, it’s not for every person in every situation. And there are obvious things that can be done online and done quite effectively. But there are other things where I think the clinician just has to make a determination that, “Hey, maybe this is not the right situation for online counselling.” Or, “Maybe this is a better situation for online counseling.” But I think, again, you have to make that determination and of course that’s what most therapists are great in.
CC: Yeah, absolutely. And I remember a time when I was at the Psychotherapy Networker convention, and a therapist said she was going to retire to Florida, actually, and had hoped that she could continue to work, but she didn’t know how she was gonna do that. And online therapy was something she hadn’t considered, and since then she has… She has a part-time practice in Florida, and she’s continuing to work, because it’s a passion and she has the tools to do that. And what I love about iTherapy is I can’t think of another platform that is such a premier platform that offers so many answers to so many questions I have. I’m in a lot of these Facebook groups, and there are so many questions. It just seems like you have created answers to all those questions in one place, and it’s just good to know that you’re there, and on a really solid affordable option for therapists who are beginning to expand in this area.
NF: Yeah, that’s absolutely been our goal throughout all of 2017, was; what are the questions and how can we best have answers and solutions for them?
CC: So just wrapping up, anything that maybe we’ve missed or are just final thoughts on iTherapy.
FP: Well, the only thing I would say is, is that again, what we strive to do is to make the clinician be able to be more client focused by providing them a simple way to manage their practice. We don’t necessarily have all the answers, but we know a lot of the questions and a lot of the answers, and we’re more than willing, way more than willing to research to find answers in those areas that we don’t have the answer to.
NF: Yeah. Absolutely. Yeah, just to add to that, again, that’s absolutely at our core is trying to… Your practice made simple, trying to make it as simple as we can. Have those answers for you. We’re gonna continue that in 2018. Continue to help more and more therapists, and continue to improve our offerings, we have some ideas on how we can streamline some different things to make it easier to do some of the scheduling and that sort of thing. So there’ll be improvements throughout 2018, and we’ll just kinda continue to have our ear out to what we can do to help better and do more of that.
CC: Excellent. Well, if anyone has some questions, they want to explore iTherapy, you can find them at iTherapy.com. And Nick Fuller, and co-founder Forrest Pulley. Thank you so much for coming on, I really look forward to following you all and see how iTherapy continues to grow.
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