Working With Clients

Who's Afraid Of Online Counseling?

Eleven years ago I ventured briefly into the world of providing online counseling services. It was short-lived because there was not enough interest from potential clients in online counseling. At the time, there was a sense that online interventions would revolutionize counseling, and that it might even become a preferred method of treatment for many. While online counseling, also known as telemental health, and e-therapy, hasn't "taken over" the field of therapy in the past decade, electronic delivery methods have steadily grown.

According to APA’s Center for Workforce Studies, the use of videoconferencing jumped from 2 to 10 percent between the years 2000 - 2008, and the use of email for service delivery tripled during that same time frame.

The ethical concerns and uncertainties surrounding online counseling haven't changed much in the past decade. Is it really confidential? What problems are appropriate to treat online? Can you treat clients across state lines? What ages are appropriate to treat?

Professional guidelines and state laws still don't clearly outline what's appropriate and what's not when it comes to working with clients online which brings up a lot of anxiety for therapists, including me.

In spite of the questions that linger, my clinic is venturing into the world of online therapy this month. There is enough evidence of it's effectiveness, new secure delivery platforms, and enough client interest to offer online services.

Here's how my colleagues and I are managing our own anxiety about offering online counseling:

1) Pre-screening clients for appropriateness of online counseling prior to initial session.

2) Online counseling training for my therapists who are interested in offering online counseling.

3) Signed consent form by client acknowledging risks and benefits of online service delivery.

4) Working online with clients in our state.

5) Selecting a secure, easy-to-use online counseling platform. (We decided to go with CounSol)

If you're afraid of online counseling, here are a few resources that might help you get the courage to try offering services online:

Do you provide online counseling services? Why are why not? I want to hear about your experiences!

A Day In The Life: Meet Divorce Counselor Misty E. Vogel, MA

A ten year career in the mortgage banking industry not only prepared Misty Vogel, M.A., NCC for many of the business aspects of self-employment, but also for managing the intense emotions that come with major life transitions.

Helping clients buy homes seems far from providing therapy, but the process of helping mortgage clients navigate intense emotions that surface during home purchasing has been added to Vogel's therapeutic skill set.

Fresh out of graduate school, Vogel is just starting to build her practice in Denver and in Evergreen while she continues to work as an extern at Evergreen Psychotherapy Center, a practice specializing in treatment of attachment disordered children and families.

In her private practice, Vogel combines her experience doing attachment work with her passion to help children and families navigate the difficulties of divorce and custody issues. Vogel's own parents divorced when she was 5 so she knows first-hand the impact divorce can have on the entire family. Peek into a day in the life of a therapist just beginning to build her private practice and see what it takes!

A Day In The Life

February 13, 2012

6:30AM

Alarm is sounding and my husband is up and out of bed quickly. I, on the other hand, reach for my phone which is next to me on my nightstand, easy to check email from here. I turn on the local news to check the weather. No snow and warmer temperatures… happy about this, as it means I can go for a walk later (self-care).

7:00AM – 8:15AM

Getting ready for my day includes planning lunch and a change of clothes. My externship is located in the foothills outside of Denver in Evergreen, about a 30 minute commute on a good day.

8:15AM – 8:50AM

On my commute to Evergreen! I can’t complain, this drive is often quite picturesque – many times the moon is setting to the west, or the snow capped mountains are glistening in the sun rising upon them, and, more often than not, I am fortunate enough to spot wildlife – buffalo, coyotes, elk, hawks, and even eagles once in a while! I also am lucky to use this time to make a few phone calls. (When I was still studying for the NCE exam, I used this commute to listen to Dr. Rosenthal’s study CDs!)

9:00AM – 12:00PM

In session, an intensive at my externship. Our current family is in real crisis. Mondays of the second week can be very tense because the families have just spent a couple of days outside of treatment and often they fall back to old patterns. Unfortunately, in this case, the crisis may not be diverted and it appears this week is going to be a tough one.

12:00PM-12:50PM

An hour with an individual client – my own client, not part of the externship. Without a break between the intensive and my individual session, I am feeling some hunger pains! Those almonds didn’t quite cut it.

1:00PM – 1:30PM

Commute back to Denver, meeting up with an old co-worker and friend who has a networking group she wants to introduce me to.

1:30PM – 2:45PM

Lunch with friend. Networking is essential at this stage of opening my own practice. I also attend a Private Practice support group as well as numerous workshops and conferences.

3:00PM – 4:00PM

Changed into walking clothes at the restaurant and went for a walk at the park. This is my self-care time!

4:15PM – 6:30PM

Back at my home office. I make finishing touches to my post card announcements for my new practice and two offices. Order those online – some will be mailed to a small database and the rest will be distributed in local coffee shops and local hang-outs. Post a quote on my business Facebook page – I find that if I do this every day, people are more likely to remember me and my practice. Open up the project I am currently dreading…building my website. I am trying to determine if I chose the right web page host; it hasn’t been a user-friendly experience thus far.

6:30PM – 7:45PM

Cook and eat dinner with my husband. Catching up on one another’s day. He is working on a start up company and we are also beginning the journey of seeking out fertility options. The journey has just begun – I filled my husband in on the task at hand getting in for a consultation with the fertility doc, information gathered on a phone call during my commute this morning.

7:45PM – 9:00PM

Took a little time to read up on divorce and attachment. I had downloaded a few articles over the weekend. I am considering writing a blog targeted to this population.

9:00PM-10:00PM

Both my husband and I are exhausted. We treated ourselves to a few TV shows on the DVR. Turning off our brains before heading to bed tends to produce better sleep!

10:00PM

Turning in – thinking about the family I’ll see tomorrow at Evergreen. They have been on my mind a great deal this afternoon.

Find out more about Misty's practice at  www.mistyvogel.com.

If you'd like to submit a day in your life for this series, please contact me here.

Adventures In Private Practice: Healthy Eating Expert Karen R. Koenig, LCSW

When I launched this blog in July I had no idea that one of the perks would be connecting with so many amazing therapists who've created successful practices. I've been inspired by shrinks around the globe who demonstrate the varied ways to make a living, and make a difference with their clients and I thought you'd be too.

I'm thrilled to interview Karen R. Koenig, LCSW for the first in an ongoing series "Adventures In Private Practice" so you can learn from her experiences to improve your practice. I first learned of Karen's work when I bought her  "Food and Feelings" workbook that I used with several of my eating disordered clients.

I've been impressed by Karen's passion for helping clients struggling with food issues, while writing to raise public awareness of how to relate with food in a healthy way, and maintaining excellent self-care.

Tell us a little about your practice...

Although I have been doing general psychotherapy for 30+ years, my expertise is in the psychology of eating--the why and how, not the what of it.  I teach troubled eaters the life and appetite skills they need to eat "normally" and attain and maintain a healthy weight for life without dieting.  I also do Skype and telephone coaching on eating and weight concerns.

Why did you decide to open a private practice?

After graduating social work school and working at a methadone clinic for six years in MA, I decided I wanted more time to try my hand at writing fiction, which meant working for myself.  I applied to be a provider on insurance plans, joined the MA social work chapter’s private practice support group (and learned a lot), and was fortunate to find a peer consultation group that fit my needs.

Clients that therapists find to be the most "difficult" are sometimes the ones who can teach them the most. What have you learned from your toughest clients?

I learned to, as my second year internship supervisor advised, “get my wind out of their sails.”  I think we try to control our most difficult clients more than easier ones which only creates more of a backlash.  Through them I’ve learned patience and to expect as much work from them as other clients.  My biggest shock has been working with clients who in many ways aren’t awfully functional, only to find they’re way ahead of me on a thorny issue.  I always get a kick out of that.

What's your biggest pet peeve about private practice?

Working with numbers.  I’m pretty pathetic when forced to do math and have anxiety about even filling out forms for my accountant at tax time.  I just know I’m putting in the wrong figures.  Also keeping up with my license fee, social work dues, malpractice and commercial insurance payments.

How did you discover or develop your practice "niche"?

After recovering from my own binge-eating problems, I taught in a training program for troubled eaters.  After class, students would ask to meet with me privately and I soon had a small practice.  That’s when I realized that if I was going to do therapy, I needed more training and returned to pursue an MSW.  Shortly after that, I started writing books about eating and weight and teaching my own workshops.  After many decades and books and clients, I became an expert.

What resource (book, website, person) helped you the most when setting up your private practice?

I can’t say there was one thing.  To start a practice in MA, I took a class on opening/running a private practice and that was useful for the basics, and also talked with other practitioners.  One in particular was very generous with her time and let me call her when I had questions.  I think the NASW private practice group was enormously helpful with financial and ethical concerns.  When I moved to FL six years ago, I started all over again.  I decided to take only self-pay clients, which meant lots of marketing work was ahead.  I joined the local social work chapter (unimpressed, I dropped out fairly quickly), but networked with therapists I met here and there, especially in the field of eating disorders.  I volunteered to do talks on eating and did as many book signings as possible.  Slowly my practice grew and continues to flourish.

What has surprised you most about being in private practice?

I've been surprised at how my client load stays fairly steady. I do a tremendous amount of marketing—such as answering requests like this one, hiring someone to manage my social media and pr, doing talks, running a message board, blogging twice weekly, expanding my therapy practice to worldwide eating coach via Skype and the telephone, writing online articles.

Has your private practice helped you grow professionally? How so…

My books, articles, and talks on eating and weight feed (pardon the pun) my practice and my practice boosts my book sales.

Has it helped you grow personally, too? How so…

Well, it’s made me face this I’m-bad-with-numbers perception I have.  I still do get anxious, but I’m pretty on top of things.  When I’m really in a panic, I ask my husband (the math guy) for help.  I love being responsible for my own schedule. I’ve learned to manage time well and to balance work and play.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?

I now don’t treat clients on Fridays.  At 65, though, I can’t imagine retiring any time soon.  I get energized from my work and rarely feel emotionally exhausted because I no longer see back-to-back clients every day.  Instead, I teach occasionally, write articles, am in the middle of writing two eating manuscripts, and am working with an agency to develop a Facebook eating app.  Switching gears and not having only a private practice keeps me feeling creative.

How do you cope with the inevitable stressors involved with being your own boss?

I don’t feel that stressed except if I have more than three clients in a row.  As I said, I’m fortunate that I don’t need to have a large caseload because I make money other ways.  But I set up my life this way because I didn’t want to be drained and there were other things I wanted to do.  I’m very good about managing my time, though I work many hours and often through the weekend on projects I enjoy (I’m starting to write songs suddenly—lyrics and melody!).  I only wish I could clone myself to do all I want to do which would include a bit more down time.

What personal strengths have helped you succeed in private practice?

I had two neurotically organized parents so I inherited that strength.  I am good at starting and ending sessions on time, maintaining email contact with clients between sessions at a pace I can tolerate and which meets their needs.  I like things easy and accessible so I work at home and have a separate wing of my house for my office and a client bathroom.  Every day I follow a routine of blog writing, checking emails and my message board, then exercising, and getting ready for the day.  I work during the hours I have the most energy 12:15-7:15p, turning away morning clients or those who need appointments at night.  Because I get to meet my needs, I don’t feel resentful.  My biggest strength is taking excellent care of myself and picking a husband who is extremely supportive of all I do.

To learn more about Karen's work and practice visit EatingNormal.com.

If you'd like to be interviewed and featured in "Adventures In Private Practice" contact me here.