The Online Counseling Myth: What Online Therapy Won’t Do For Your Practice
Anthony Centore
Every week, for the past several years, I’ve received calls from counselors who’ve decided to begin offering online therapy. I used to respond to these calls with excitement: “Great! Congratulations! Welcome to the club!” I would say. However, more recently I’ve become a bit hesitant with my cheers, “wait a second” I might say, “What are you expecting to happen when you start offering online therapy?”
Too often, the counselor’s response sounds something like this. “Well, I’m getting fewer new clients in my face-to-face practice, so I was thinking that online counseling would provide a much larger pool of potential clients.” Then the counselor will ask me, “How long do you think it will take for me to have a full caseload?”
“Well, that’s the thing,” I’ll say, “Caseloads of online clients don’t just happen; they take a lot of effort to build. Being on the Internet isn’t the solution to all your private practice woes.”
And then, I will tell them what I’m about to tell you.
Online Counseling is a Small Pond
In the example above, the counselor is operating under an misconception—the syllogism is as follows:
Major Premise: Big Nets Catch Fish
Minor Premise: With Online Counseling, I Have a Big Net
Conclusion: With Online Counseling, I Will Catch Fish
Brings you back to undergraduate philosophy, doesn’t it? In less philosophical terms, the reasoning sounds like this: “There are millions of people online who want counseling. I should have no problem finding lots of clients!”
And here’s the flaw. An online counselor’s net may be huge, but the pond is small.
According to Google, in a recent month there were 1,220,000 web searches for the keyword “Counselor.” In the same month, there were 6,600 searches for the keyword “Online Counselor.”
Note huge difference: 1,213,400 more searches for “counselors”, compared to “online counselors.” Few clients are looking for online counseling (I wonder how many of those 6,600 searches were from counselors themselves!).
Other Nets in the Pond
When it comes to online counseling, there is more competition every day. While it is true that most counselors in the USA have no Internet presence what-so-ever, there are still thousands of therapists providing online services. In addition, the growing field of life coaching creates competition for counselors—and life coaches customarily provide services via telephone, or online.
Make no mistake, competition for online (and telephone) clients is strong, and any new online counselor is entering a competitive arena.
Immediate Benefits for Online Counselors
This article is not meant to discourage. All hope is not lost for the therapist considering online counseling! There are some immediate benefits to having an infrastructure for efficiently and ethically providing online counseling. Such will allow you to:
1. Retain some clients who relocate (a common problem in college towns like mine, Boston, MA)
2. Help clients who can’t make it to all of their appointments (stuck at work, stuck in traffic, traveling, etc.)
3. Attract a small number of new clients (your net will catch some fish)
The Competitive Online Counselor
Build a Business
Going online is not an alternative to the arduous task of building a counseling business. Therapists need to develop a solid strategic plan. Develop a brand. Become a thought leader in the field. One even needs advertising and PR. For starters, I recommend that every aspiring online therapist should become an active part of the online communities where they are hanging their virtual shingle.
Find a Niche
Client X needs counseling. What makes you the best choice?
One way to attract online clients is to specialize. Focus your efforts on a specific type of client: clients with liver cancer, clients with pregnant teens, clients who have lost a child, desperate housewives, Americans living in Japan, Japanese living in the Americas…you get the picture.
People are more likely to try online counseling if they feel they will be able to talk with the expert in the exact area that they need help.
Remember…
Online counseling is not your niche! It is a method of delivering service. Don’t just be online—be so valuable that people across the country are calling and emailing you to ask—“Do you see online clients?”
Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .
Interesting and accurate post – thankyou. We have a chapter on The Business of Online Therapy in Anthony & Nagel (2010) – Online Therapy [a practical guide] that readers may find of interest, particularly with regard to the alternative of joining an e-clinic and which I would be interested in hearing your views on (does this give you a bigger net and/or pond, I wonder?)
Thanks!
My question would also be … what are you doing to marketing your standard practice?
Thanks, Anthony, for telling it like it really is. Every day I speak with mental health professionals who throw around the latest jargon related to distance counseling and social media as if they are cure-alls to an ailing practice.
Strong vibrant private practices don’t just happen – regardless of how clinically astute counselors are. They are the results of thoughtful business planning, strategic and effective marketing, and a bit of trial and error, too. Learning how to develop a niche, what does and doesn’t work in marketing a private practice, and consistent networking brings in clients and keeps them coming back.
I’m looking forward to reading more of your posts, Anthony. Keep up the good work!
Kate, Thanks for your Comment! About your question – all my experience about people who have joined online counseling websites has been that they (for the most part) needed to bring their own clients with them. Even with online directories for in-person counseling–it’s considered a win if you earn your directory fee back, and maybe a couple more clients a year (it’s not a practice building strategy). It’s great to hear from you Ann! I remember fondly our ISHMO discussion board conversations
Cheryl,
I’m doing all sorts of things to market and advertise, for not just me but for counselors around the country who are networked with me! It’s really a long answer– the advertising and marketing strategy.
I’ll publish an article on that soon!
Thanks!!
Tamara,
Thanks for your positive comment! I can’t tell you how encouraging that is
Excellent article. However, it is important to point out the ethics of online therapy. Find a good summary here: https://www.e-mhc.com/blog/2011/05/online-therapy-ethics-summary/
Hi there,
I may be confusing the rules of my state licensing board (California BBS and the ACA) yet I thought that as licensed counselors that we couldn’t offer telephone or Internet counseling? Can you please clarify?
Thanks!
Susan
Be very careful with online counseling. Be very careful. I did it for sometime with a very popular online company that used to be known as Kasamba and I would be very hesitant to do it again. That situation almost turned into a nightmare because whomever it was that I was counseling, they got very inappropriate with me where I had to (since it’s online you don’t know if its a man or woman)refuse their attempts to chat with me. My refusal to participate in their lewd behavior caused them to get upset with me. As a result, their anger turn into cyber stalking me online as well as in real life where they did research and found out where I lived, they started calling my home and job. They also begin to sumbit threats that could have compromised my state license with just pure non sense and lies. I was terrified and felt undignified because of he way the company that I was contracting with handled the situation. They allowed this person to take advantage of the situation in that since I refused to service this person, they disputed their credit card payments and the company put the charge backs on my account which left me in the red. The company that I was a contractor for didn’t have any regard for my safety and would not turn over any information to me nor law enforcement about this person; therefore, I had try to defend myself from a faceless cyber bully. There are some very unstable people online that are looking to hurt others and since people don’t give much verifiable info about who they are online, I would not ever do this again. It just left me too vulnerable in this situation and I glad that I survived it. It’s just too risky as far as coming in contact with very unstable people who can find out things about you (especially if the company requires that you post your full name and license #), but it’s not as easy to find out things about who you might be dealing with.
Counseling using any “method of delivering services” needs to all follow the same ethical rules, as a basic minimum requirement. We would never counsel someone in person without having all their information, and without their having understood and agreed to informed consent. Same rules apply for any kind of electronically mediated counseling, be that over the phone, email, written or video chat.
I also do not work with minors except in person, because I do not believe it is possible to maintain the ethical standards of working with a minor except in person. I could imagine some kind of exception with a pre-existing minor client, in a very proscribed emergency situation, but not as a regular thing.
As electronically mediated counseling expands, the process is maturing. Eventually, (less than five years, I imagine) I expect their will be standard courses for approaching counseling clients who are not co-located with the counselor.
Meanwhile, I am sticking to real-time interactions. I’ll reserve email for making and breaking appointments, newsletters, and the like.
Shulamit
This is great information. I am considering adding online counseling to my private practice so reading these comments as been very helpful.