Viewing posts categorised under: Counseling-blog
You’re reading this because you’ve heard of online counseling and the benefits of it. These are the big benefits that we see come from online counseling.
You’re a busy person and you have no idea how counseling sessions will fit into your already packed schedule. Online counseling is a convenient solution for you. You are able to get on the phone or video chat with a counselor at a time that works for your schedule. Talk about convenience!
You work hard so that you can enjoy a certain comfort level and you like being comfortable. You expect nothing less than that same level of comfort in your counseling sessions. Staying at home in a familiar environment is a certain way to keep your comfort level stable. With online counseling you are able to do just that.
Maybe you’re a naturally shy person and you just don’t do well with face-to-face meetings. As a result of the shyness you’re a little more closed off than you would like to be. Online counseling is a great option for that problem. With online counseling you are able to either speak on the phone with or video chat with a counselor. This can help you to enhance how open you are with the counselor. There is something about the virtual world that makes being open a little easier.
Not only are online counseling sessions convenient, but also they are more affordable. Online counseling will give you the same results that going to a physical location will give you, but at a discounted rate. So save a few bucks and get online counseling.
Similarly, a survey of psychiatrists found that 45% use the telephone as an adjunct to face-to-face (FTF) sessions, and 19% use it as their primary medium for providing treatment. Also, research has found that for some medical practices up to 70% of problems are handled solely by telephone. In my own research study (published in the Journal of Mental Health Counseling) of 841 mental health professionals, 73% reported using telephone counseling.
Such data irrefutably shows that the use of the telephone in the delivery of mental health services is nearly universal, and this doesn’t even include para-counseling services, such as those provided through radio or television call-in programs.
There are several ways online counseling is provided. These methods include (1) email counseling, (2) text-chat counseling, and (3) videoconference counseling.
Computer Mediated Communication
Computer mediated communication (CMC) is a fancy way of saying “talking to someone through a computer,” and without it online counseling—the online part, anyway—would be limited to an online version of bibliotherapy. That is, without CMC, a person suffering from depression could find a website and read about depression, or watch a video on depression recovery, but back and forth dialogue between client and counselor would not be possible. Therefore, having at least a basic understanding of CMC will help us immensely as we begin to discuss online counseling.
CMC is commonplace for persons with Internet access, especially younger Internet users who use CMC to be part of online communities, and to connect emotionally with others. There are two basic types of CMC, asynchronous communication and synchronous communication.
Asynchronous communication is a conversation that is not in ‘real-time’. This means there is a significant time-delay between the period when one person makes a statement, and when another person responds. This is nothing new. Mailing letters back and forth with a friend is an example of asynchronous communication. A friend of mine participates in asynchronous communication when she uses a camcorder to record video-messages from her and her daughter, and then emails the file to her husband, who is overseas. On the Internet, asynchronous communication is very common and takes the form of email, discussion board forums, and bulletin boards.
Synchronous communication is a conversation in ‘real-time’. This means that two or more persons receive and immediately respond to each other’s dialogue. We are all experienced with synchronous communication—every in-person conversation we have ever had has been synchronous, as has every telephone conversation. Videoconference would also be an example of synchronous communication, as would text-chat.
Email counseling is a method of online counseling that comes with great flexibility for counselors and clients. First, it is a ‘low-tech’ method of online communication that
virtually any person with basic computer skills can use without additional technical training. Also, it makes counseling extremely convenient because (1) the counselor and client never need to meet in a certain place and (2) they never need to meet at a certain time. A client can write a counselor at any hour—even if the counselor is busy, or not working, or fast asleep! The counselor then has (usually negotiated to be) 24-48 hours to provide a well thought through response.
With Text-chat counseling, client and counselor meet in a secure ‘chat room’ for counseling. Since text-chat counseling is in real time, it closely emulates in-person dialogue. The emotion-rich back- and-forth between counselor and client can feel very similar to an in-person discussion, especially when both users are well acquainted with the modality. Also, like email counseling, text-chat counseling is relatively low tech. That is, it is not complicated to use a text-chat program for it has basically the same functionality as the Microsoft Word program I am using to type right now.
However, text-chat counseling is not as flexible as email counseling. Even though client and counselor do not meet at the same place, they do need to be available at the same time for a counseling session. To some, this is a limitation of the text-chat modality.
Finally, Videoconference counseling is the online counseling method that most closely resembles an in- person encounter. With videoconference counseling, both the counselor and client are able to view each other, usually from the shoulder-level up, by use of an Internet video camera (i.e., webcam) or cell phone camera. Both parties are able to communicate verbally back-and-forth in real time. The experience is so true to life, many persons who use videoconference say they “forget” the person they are talking to is not there “in-person” with them.
However, there are some exceptions to the videoconference experience. If only one person has a microphone, that person might speak, while the other person might type. If only one person has a webcam, one person will be visible but not the other. And perhaps the most interesting variety of videoconference counseling is video-email, which is when two persons communicate using audio and video, but the conversation does not take place in real time.
Online counseling is very convenient for counselors and for clients. It can help people overcome barriers and seek out help.
I was hoping I could pick your brain a bit regarding hiring a few part time folks at my practice. My thinking originally was to give a set percentage for each session that the licensed counselor performs but now for ease of payment I was thinking a flat hourly rate per session. Another agency in the state pays $30.00 per session regardless of the type. I personally never made more than $23 an hour working for someone else, but it was a fulltime job and offered benefits. I was considering $30 per regular session and $40 per group. In the future when we could afford it, we would then start hiring fulltime with benefits.
What are your thoughts? Any information would be greatly appreciated as this in NOT my area of expertise at all (I design programs and practices but have not been involved with HR related stuff).
I see you are burning up the pages of CT. Glad to have a guaranteed good read!
Take care and thanks again for the offer of help and guidance! (the offices should be sheet rocked in the next week or two!)
Of course I’d be happy to help.
There are really no “right” answers as it comes to this sort of thing.
Counselors do tend to prefer a flat rate over a % split, because they don’t need to worry about money coming in from clients or insurance companies. That being said, it seems that most small practices pay their licensed clinicians on a split. For independent contractors, a typical split is often 60%/40%, in the licensed clinician’s favor. Some practices pay more, and some pay less.
And some–like Thriveworks–pay their clinicians as employees (not independent contractors) and absorb a 7.65% payroll tax in addition to compensation fess paid. And offer benefits. Ouch.
Perhaps, instead of looking at what you pay per appointment, it would be best to look at whether someone could make a good living working with you. That’s going to keep your practice competitive, and help you to retain a good team. Losing a clinician is REALLY HARD on a practice, so you want to make sure that your clinicians are not going to depart to pursue better compensation elsewhere.
I have encountered too many practices that lose their best clinicians every couple years or so because they pay under market rate. These practices can recruit new clinicians, but most of them–at some point–decide to leave. This can hinder a practice’s growth and long term success. That said, I see just as many practices pay their clinicians too much (typically over 60% as employees, or over 65% as contractors). These practices never seem to have any money to grow the practice, because too much of their revenues are tied up in staff compensation.
I hope this helps John!!
- posted in Addiction, Blog, Career and Money, Counseling Blog, Depression, Happiness, Private Practice
“If it takes a village to raise a child”, a village (community) can help individuals when they are in the middle of divorce, struggling with addiction, working through relationship problems, or even struggling with depression.
If you have a question that you have been dying to ask, feel free to ask it on our community counseling forum. Or, if you have the ability to answer questions, feel free to respond to the community.
The basic ground rules for discussions on Thriveworks are simple: be polite. Our fellow community members will treat guests in these forums with courtesy and respect. The forum is a place for counselors and members alike to ask questions and receive help…
To start asking or answering, visit the community forums today.
Some of the forums already started:
- How to deal with depression?
- How do you overcome addiction?
- How have you forgiven someone that hurt you?
- When do you ask for financial management help?
- For Counselors: What are the best insurance panels to be on?
- For Counselors: Education is Expensive: Is it worth obtaining a Doctorate or a Ph. D degree in Marriage and Family Therapy?
Come Join Us!
As if preparing for battle, I carefully unfold and spread out 1 pair of tight black Capri pants, 1 chest squishing sports bra, my favorite purple dry-wick t-shirt, 1 pair of special support socks, 1 beloved pink/gray iPod sports band with hot pink headphones, 1 pair of slightly scuffed running shoes, and 1 cold bottle of water, on my bedspread. I step back to face down my running gear, fists on my hips, and assess my motivation for running today.
The back of my right knee has a dull throbbing pain, my left quad is as tight as a guitar string, and on the edge of my right scapula (in the most impossible place to stretch) I have a pea sized, sharp shooting spot of pain. My gremlin says, “What’s the point? You’ve been at the same pace and same training pattern for 4 weeks now. You’re not even getting any better.”
My mind tells the gremlin to “shut up” but even my heart recognizes the lack of conviction in my words. I’ve been training for a 5k…for the last 4 months…and yes, I’m still at the very beginning of the running intervals (2 minutes running then 2 minutes walking). I love the idea of running, but am less than thrilled with the reality of it. This is my plateau and the gremlin seems to be winning.
What am I meant to learn from this plateau? What do I need to overcome to move to the next level? And even if I can master control of my gremlin, overcome the negative thoughts, and believe in my abilities, do I still have the motivation to persevere?
There are many plateaus that we encounter in life; trying to lose weight (been there), on our career path (yep that one too), exercising (running – the bane of my existence at the moment), relationships that stagnate (overcame that one), and feeling “stuck” in the counseling process.
Once a client myself (all good therapist must know what the couch feels like), I hit that plateau…it was like running on the treadmill…working hard and getting nowhere fast. Frustrated, defeated, and close to giving up, my therapist introduced a different technique that helped me to get on a new path, with a nice change of scenery.
My therapeutic perspective is a strategic combination of biopsychosocial theory, energy psychology, and attachment theory with a hint of traditional psychodynamic perspective. This allows me the freedom to pull different “techniques” from my toolbox, when I need to help a client get “unstuck”. Every school of thought proposes a different approach to plateaus. What is your theoretical and practical perspective?
What tools are most appropriate in your practice to tackle these plateaus? If you are struggling with these questions, seek out guidance from your consultant or mentor. If your tools are scarce, search for workshop or training opportunities (provided by reputable and well qualified instructors) which will fill your toolbox.
Training for my 5k takes practice, determination, patience, and pursuit of a goal more important than listening to my gremlin. Providing therapy takes the same level of perseverance, and as the expert, it is your responsibility to assist your clients in overcoming the plateau. When I’m running (yes, I grudgingly put my running gear on and do it despite my gremlin), I keep in mind there are 3 types of people who see me on a run; runners – who think “that is hard stuff, glad I finished my run”, non-runner spectators – who think “that looks really hard, glad I’m not out there”, and those running on the same path – who think “this is really hard, let’s go get it!”
What kind of therapist are you – spectator or runner?
Lauren Somers holds a LPCC in the State of California, a Doctorate in Counseling Psychology, certification in EFT (energy psychology), and over 19 years of experience in delivering counseling to adolescents and adults in individual and group settings. She hosts a private practice in the beautiful San Francisco Bay Area where she endeavors to understand her client’s story and weaves the traditional therapeutic modalities with a bit of shamanic healing, energy psychology, and mindfulness to bring about growth and healing.
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5 Reasons Why Counseling Needs a Franchise
(And Why Counselors are Ready for it!)
In a previous article, I discussed 3 reasons why, despite the proliferation of healthcare franchises, a successful counseling franchise hasn’t existed. In this column, we’re going to investigate the issue from the opposite perspective—why a counseling franchise could work, and how a franchise could benefit both clients and the counseling industry as a whole.
1) Training, Guidance, and Support
When counselors go into private practice, the day they open their doors is often their first experience owning and running a business. In fact, some clinicians don’t realize they have a business at all; I’ve heard some counselors say, “I don’t think I have a business…I have a practice!”
Counselors love the work of counseling, and they often venture into private practice because they want to be their own boss, deliver excellent care, and find success working in their profession at a level above what other settings have offered. To this end, a franchise could be an asset to counselors. A ‘franchisee’ (one who purchases a franchise) is not an employee—he or she is a bona fide owner of his or her own company. At the same time, a franchisee receives valuable training, guidance, and support from the franchising company (the ‘franchisor’).
2) A “Turnkey” Business
While every counselor is unique and brings his or her own style to the counseling process, there are many parts of running a counseling business that are the same from one well-run practice to another: the phone needs to be answered, the appointments need to be scheduled, the bills need to be paid, etc. A franchise could help counselors because franchisees wouldn’t need to “reinvent the wheel” or participate in costly and time consuming “trial and error” figuring out what works, and what doesn’t. Franchises are designed to be “turnkey businesses,” which means that they include everything one needs to start running the business on day one—including a proven business model.
In addition, a counseling franchise could provide additional value to franchisees if it connected franchisees with operational services such as medical credentialing, medical billing, reception, scheduling, recruiting, Electronic Health Records, and other services. The more a franchise can take administrative burdens off the shoulders of counselor-franchisees, the more those franchisees could focus on building clinical teams, and their first passion—helping clients.
3) Brand Trust & Industry Standards
Starbucks re-invented the coffee industry in America. Pre Starbucks (i.e., before 1971), most Americans were drinking what Howard Schultz* describes as “swill”—coffee made from low grade Robusta coffee beans, instead of higher quality Arabica coffee beans. Many Americans settled for an inferior brew because they didn’t have high quality options, and they didn’t know what they were missing. While small coffeehouses love to pick on Starbucks for being too corporate, Starbucks set the bar in the industry.
Today, few coffeehouses will succeed by providing a low quality Robusta bean product. However, coffeehouses that offer a high-quality alternative to Starbucks coffee may do exceedingly well. Shultz explains, “Clearly there’s room for many different styles of coffee stores or coffeehouses…[customers] decide which coffeehouse to visit. They may vary their choice of establishments, depending on their need or mood. In the end all of us benefit.”
While many practices provide excellent care and service, a few bad apples can spoil the bunch, and this has led to a caricature, portrayed in movies and the media, of the ‘ditsy therapist.’ Some people who receive poor clinical care don’t know that they’ve stumbled upon a sub par practice. Because there’s no known standard, they think counseling is a sub par profession. A counseling brand could give clients a benchmark of service and care to expect; and the industry standard could serve to help improve the reputation of the counseling field as a whole. This is happening right now in the massage therapy field, with the proliferation of Massage Envy centers. The Massage Envy franchise is improving the reputation of massage, and even independent massage practices will benefit. Like massage therapy, and even coffee, counseling needs a brand to set the standard.
4) Community & The Family Effect
An irony of having a counseling practice is that even when counselors are in session with clients all day, counseling can still be a very lonely job. A counseling franchise could offer community to private practice owners—as well as peer supervision and support. Such a community could be unusually strong because, since every franchisee has a protected trade area (as is customary with franchises), no franchisee would be in competition with another. In fact, the exact opposite would exist! The success of any franchisee would benefit the system as a whole. Hence, each franchisee would have a vested interested in other franchisees’ successes, and therefore be incentivized to share openly their insights and learnings with the community at large.
5) Bargaining and Purchasing Power
While small mental health practices can struggle to make ends meet, being part of a larger system could lead to increased bargaining power in areas such as marketing, technology, recruitment, and perhaps even the ability to negotiate higher rates with insurance companies.
In addition, it’s reasonable to expect that a franchise would be better equipped than a traditional private practice to purchase or develop valuable resources and technologies. For instance, developing an EHR program, creating validated psychological tests, or even commissioning an iPhone or Android App might be outside the resources of a solo practice, but for a franchise—a community of practices—such endeavors could be just another day’s small investment in the pursuit to continually expand and improve service offerings.
When I first began considering whether a counseling franchise was a viable idea for our industry, I consulted with a number of professionals in the field. While many saw the value a franchise could bring, there were also concerns and “what ifs” such as:
• What if the franchise didn’t focus on quality clinical care?
• What if the standardization of practices took the “soul” out of therapy?
• What is the franchise interfered in the client-counselor therapeutic relationship?
It became clear that professionals who expressed concern weren’t worried about a Ritz Carlton- (who uses the motto “We are Ladies and Gentlemen Serving Ladies and Gentlemen”) or even a Starbucks-caliber brand joining the field, they worried about a Taco Bell or McDonalds harming the field by focusing on quantity over quality.
It was clear that if a franchised brand were to exist, that brand would need to be dedicated to excellent clinical care, clinician creativity, customer service, and the essence and power of counseling relationships.
While some worry about what will happen to the field if there is a recognizable brand, I tend to worry about what’s going to happen to the field if there’s not a recognizable brand. But no matter which worry you have, one thing is clear: the time to discuss the need for a recognizable counseling brand is now.
*Howard Schultz is Founder and CEO of Starbucks
First, the intake process consists of both the intake form and the initial session. Let’s examine the intake form. Usually it is best to have the client complete an intake form prior to the first session so that important information about the client is gathered and is kept on file. The counselor may want to consider how much to ask on this form as well as what most people may be comfortable sharing.
Whatever is not asked on the form (or filled out on the form), will need to be asked by the counselor in the intake session. In terms of the intake form, it is helpful to see, in the client’s own words, some of their history, their current situation and their counseling goals. Basic information all intake forms should contain are:
- Name of client
- Address of client and if the counselor may mail information to this address
- Phone number(s) of client and if the counselor may either leave a message or text the numbers(s)
- Email address for the client and if the counselor can send a message to the address
- Insurance information (their insurance, subscriber/group number, and their co-pay)
- Birthdate of client
- Referral source (i.e., how did the client find out about you?)
- Contact information for a person (i.e., name and phone number) is case there is an emergency associated with the client (for example, if the client becomes actively suicidal)
- Medical history as well as current medical problems; also ask about medical hospitalizations
- Current medications and amount taken each day; also obtain the name of the doctor who is providing medication management for the client and the doctor’s phone number
- Mental health history which includes questions about former mental health providers, any prior medical hospitalizations, and any suicide attempts
- Family members with a mental health history and ask for diagnosis (if known to client)
- Substance abuse history and any former treatment for substance abuse as well as any former or current issues with DUI or drug-related charges; also ask about current substance use
- History of abuse or trauma (i.e., physical, emotional, mental or sexual)
- Any current life transitions/issues the counselor should be aware of Specific behavioral, mental or physical symptoms related to depression or anxiety experienced in the last 30 days (i.e., upset stomach, feeling restless, feeling guilty, isolating from others, etc.)
- Current use of social media and time spent on Internet, Facebook or other forms of social media; also ask the client’s preferred mode of communication (texting, phone or in person), and ask if their use of social media is impacting any of their relationships
- Reason client is seeking counseling
- Goals for counseling and what the client would like to accomplish or see change as a result of counseling
Ask the client to complete the intake form prior to the initial session and to bring it in with them. Although it may be helpful to receive the intake form before the client actually comes in for the first meeting, keep in mind HIPPA regulations and confidential/privacy concerns. Email is not a secure form of communication, so this may not be a safe option for clients to use to share the intake form before the first counseling appointment. If a fax machine is available and confidentiality can be assured, having the client fax the form may be an option.
Additional information, beyond the questions listed above, is also helpful to acquire from the client, and this information may either be asked when meeting with the client face-to-face or added to the intake form. (Just keep in mind the length of the intake form and the amount of information requested on it).
Also be sure to note the non-verbal behaviors your client exhibits during their initial discussion with you as this needs to be noted as well as monitored in future sessions. In terms of other questions to ask, it is helpful to have knowledge of the following:
- Client’s level of education
- Client’s school and/or employment status
- If client is going to school, where and what grade/level
- If client is working, where and job title/brief description
- Background information regarding client’s education (i.e., did client switch schools a lot, like learning?) and client’s work history (has client held a lot of jobs, been in the same one for a number of years?)
- Client’s relationship status as well as relationship history (i.e., formerly married)
- Client’s religious affiliation
- What it was like for client growing up in terms of family structure, relationship with siblings, parents/guardians approach to discipline
- Information about client’s culture in terms of what client and family value, traditions, beliefs
- Client’s greatest successes and biggest challenges
- What makes the client feel happy, calm, peaceful
- What makes the client frustrated, angry and hurt
- Have the client verbalize their goals for counseling
Keep in mind that the intake consists of both the written information and the verbal exchange that occurs during the initial contacts with the client. The facts, experiences and perspectives the counselors gathers from the client, as well as the nonverbal behavior observed, all lay the foundation for the therapy work in which both the counselor and the client engage.
Too often in this day and age people are in a hurry to “get to the point” and rush to a solution. The intake process helps the therapist slow down the client, assists both the counselor and the client with obtaining a clear focus on past and present concerns, and it informs the counselor as to the direction to take in the counseling process.
Do not underestimate the importance of the intake process! It needs time, attention and details to make the therapy be a process that is effective and goal-directed.
Dr. Rhonda Sutton (Email) is a licensed counselor and a licensed counseling supervisor in Raleigh, North Carolina. She is the owner of InnerSights Counseling and Consultation, Inc. where she guides both clients and counselors-in-training in their professional and personal development. Her mission is to assist others in finding their own unique ways of leading productive and fulfilling lives. She specializes in couples counseling, trauma, crisis and life transitions and also serves as “the counselor’s counselor” in terms of supervision, mentoring, support and advice. Dr. Sutton is also president of STEP Notes, Inc., an e-tool that provides counselors a secure and systematic way to take progress notes. *Her intake forms are online and any information from it may be used by other counselors for their own intake forms.
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Medical Billing for Private Practices
Medical billing is a challenge for many counselors and healthcare providers alike, as it requires an extremely specific and detailed knowledge base. Because of the difficulties providers face with medical billing, it is not uncommon for providers to recoup up to 20% less than what they are due (and only after lengthily payment delays). In addition, medical billing is doubly difficult for small group and solo-practices, as reputable medical billing services are often uninterested in serving those smaller accounts.
A mental health professional’s job is important. A counselor’s job is important. But there is a behind the scenes job that is just as important: the medical billing team. The counselor and therapist each have important responsibilities, but they need help completing their jobs.
A counselor is only as good as their medical billing. If the medical billing is slow, the patients may become impatient, but even more, the counselor may not get paid. A counselor needs someone to make sure that claims get done properly, and correctly. Being up to date with insurance companies is extremely important – it means getting paid on time.
Medical Billing is an administrative role that works with the insurance companies (for your payments) and with the clients (to get information and help resolve issues).
Unfortunately, collecting insurance payments is no easy task. In fact, many medical practices collect less that 80 percent of the money they’re owed from insurance companies, and it’s not uncommon for even small practices to have hundreds of thousands of dollars outstanding in their accounts receivable reports.
Medical Billing is a challenge in any medical field, whether you are a PCP (Primary Care Provider), Chiropractor, or …fill in the blank.
However, mental health professionals seems to top the list when it comes to difficulties recieving reimbursement from insurance companies. There could be many reasons for this–the type of claims that are filed, the frequent need of pre-authorizations for sessions, the fact that insurance companies often outsource their mental health benefits to other insurance companies (for examples, Blue Cross might outsource their Mental Health Benefits to Magellan).
However, one major reason that many mental health practices don’t receive the revenues their due is because the staff (both the clinicians and the administrative staff) are flat-out overworked….and medical billing is not their specialty (okay, that’s really 2 reasons).
Thriveworks medical billing has years of experience helping their clients to get top dollar from insurance companies. It is our goal to partner with you, so that you can grow your business–and focus on what you do best…clinical care.
If you are not billing – you are not getting paid!
Thriveworks Medical Billing Service was designed to to help healthcare practices of any size get paid for their work! We are a US-based company that prides itself on professional and personal service for our clients. In addition, we are proud members of the Better Business Bureau, and maintain the highest possible rating!
Call us anytime for a no-pressure conversation about mental health billing. Our Toll Free number is 1-855-4-THRIVE (847483).
The use of online technology in counseling is here, and it’s not going away. For some counselors, this is a great opportunity to serve clients, and build their practices, in a new and effective way.
For less than the cost of one counseling session, you can learn from a major leader in online counseling, and find out what is necessary to stay ahead of the curve, and build your online counseling practice!
Update! The Insider’s Guide to Telephone and Online Counseling is not on its Second Edition!
Learn more and purchase the course book here: The New Online Counseling Course Book!
- posted in Private Practice
To meet the criteria of a 99214 code / service, a medical service must meed the following requirements:
1. The patient being serves is an established patient. It is not his/her first visit
2. The service must be an outpatient visit, meaning the service does not incorporate inpatient or hospital care
3. The service must meet or exceed two of the following three sub-criteria:
A) a detailed medical history is documented
B) a detailed medical exam is provided
C) the medical decision making entails at least moderate complexity
4. The severity of the presenting problem must be moderate to high
5. The doctor and the patient should have a minimum 25 minutes face time