Understanding the Keys to a Successful Online Counseling Practice

You’re planning to offer online counseling. You’ve crunched the numbers and determined there are at least a billion people on the Internet. To be successful, you need to attract about 30 of them. This should be easy, right?

Maybe not … . Here’s why.

1. Most Clients Don’t Want Online Counseling

A counselor interested in offering online counseling can list the benefits.

A client:

  1. Doesn’t need to travel/commute to their session
  2. Has a greater sense of safety and anonymity
  3. Can participate from the comfort of home
  4. And so on …

The problem with this list is that these are attributes of online counseling that the counselor perceives as valuable. They are not, typically, solving a problem for the counselor’s clients. No client has sat in their office and said, “This is okay, but man would this be better if I was at home on my couch.”

Perhaps, rather than a keen sense of what the market wants, the above is a type of projection — they’re benefits the counselor will enjoy: working from the comfort of home, etc.

At my practices’ centralized contact center, we regularly get calls from potential clients located in areas where we don’t have a convenient location. In these instances, we’ll usually offer an online option.

The outcome: Even when someone has reached out specifically to our company, a strong majority of callers will decline the online offer and continue his/her search for someone he/she can literally “go see.”

The fact is, counseling is an incredibly personal endeavor, and while tech-savvy consumers communicate with friends and family using Snapchat, WhatsApp and FaceTime, when confiding in a counselor it seems that most clients still want the in-person experience.

This might change. New ideas can take time to catch on.

Videoconference was widely available for a decade before people really began using it. There was a time in the 1990s when consumers rejected the concept of Clorox wipes because, “Why would anyone need that?” Today, paper towels pre-soaked in disinfectant is a huge business. As far as online counseling is concerned, the market has spoken … for the moment.

2. The Problem of Money

While there are some exceptions, most third-party payers won’t reimburse for online counseling (even during winter storm emergencies this year, we couldn’t get private insurance companies to budge on this).

For insurance companies that do cover telehealth services, many still require the patient to report to an office to participate. Did you catch that? Here’s an example: At our Richmond, Virginia, office, we can employ a psychiatrist from Alexandria, Virginia, and pipe him/her in via videoconference.

However, clients still need to come to the office for the session if they want their insurance to pay. Hence, online doesn’t necessarily mean home-based.

3. State Licensure Lines

In the 90s and early 00s there was a debate related to the issue of “point-of-service”, which refers to where an online counseling session actually takes place. Some argued that the point-of-service should be where the client resides, while others contended that it should be where the provider is delivering service. With the later, the client would figuratively travel on the “information superhighway” to exercise his/her right to solicit the services of an expert outside his/her state or providence.

I liked the, “where the provider resides” position. It made sense. The counselor would abide by the rules and regulations of his/her state of licensure, and wouldn’t have to worry about from where their client was hailing. Alternatively, making the point of service where the client resides would shut down legitimate online providers but do nothing to stop unscrupulous unlicensed ‘counselors’ offering services on the web.

Unfortunately, according to most licensure boards the point of service has been determined to be where a client resides. Hence, even if you’re practicing within your state of licensure, you better make sure your clients are also residing in your state.

Making it Work

Now that I’ve mentioned some reasons why online counseling practices struggle, here’s how to beat the odds and make yours work.

1. Specialize

Instead of viewing online counseling as a “convenient” alternative to in-person sessions, consider it an inconvenience that some clients might be willing to make to seek your specific counsel. Earn this honor through thought leadership.

For example, a client is struggling after receiving a rejection letter from a college or grad school. You’ve written highly insightful and helpful articles on exactly that topic. After finding and reading your insights online, the client is willing to sacrifice an in-person connection with a local counselor to connect with you — someone he or she knows understands his/her disappointment and difficult situation.

2. Transition

While it’s difficult to convert potential clients seeking counseling into online clients, it’s much easier to transition in-person clients to online clients once a relationship has been established. Hence, if you have a caseload and you’re looking to transplant yourself, you may find that most of your clients are willing to go online to continue your work together.

3. Snow Days

If you’re in a northern state, consider introducing online counseling as an alternative to a day of cancelled sessions during a snow emergency. Of course, third-party payers still aren’t likely to pay for online sessions. For insurance clients, consider accepting their usual co-pay as full payment for the session (sometimes a $25 co-pay is better than $0 for the hour).

4. Coaching

While you will need to proceed with extreme caution, for persons soliciting your services outside your state, while you (in most circumstances) won’t be able to provide mental health counseling, you may be able to provide coaching.

With coaching, you can’t diagnose or treat mental health issues, but you might be able to help with non-clinical life issues. Be sure to check with your licensure board and also have a very clear informed written consent process detailing the scope of the services you can provide in a coaching relationship.

Beating the Odds

Starting an online practice isn’t easy. There are clinical, administrative and ethical implications of offering online services. Do your homework before hanging a virtual shingle.

Question of the month: Have you offered online services? How did clients respond? Let me know by commenting below or on Twitter.

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Dr. Anthony Centore

Anthony Centore

Anthony Centore, PhD, is Founder and Chair at Thriveworks — a counseling practice focused on premium client care, with 340+ locations across the US. Anthony is a Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and author of "How to Thrive in Counseling Private Practice". He is a multistate Licensed Professional Counselor (LPC) and has been quoted in national media sources including The Boston Globe, the Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."