How online coaching or counseling can kick-start your private practice-Part 1

One option that many people don’t consider when they are first establishing or growing a private practice is online counseling or coaching.  Most of us have more questions than answers when it comes to working online.  In addition, the benefits of offering this option to your clients aren’t always obvious.

Since we are all looking for ways to get going or get bigger in private practice, I thought I’d blog about how online coaching or counseling can kick start your practice.  Part 1 of this post will address the most common questions I get on this topic.  Part 2 will focus on how you can use online coaching or counseling  to grow your practice.

Part 1… Here are a few of the questions (about online work) that  I am often asked by my coaching students:

1.  What types of online services can I provide?

Wow.  Don’t get me started.  How about:  general counseling, life coaching, niche related support (i.e. daily check-in for folks with ADD, desensitization for folks with agoraphobia or panic attacks, support for those who cannot leave their homes), supervision, trainings, workshops, etc.

2.  What about confidentiality?

In any work we do, confidentiality is limited by many things.  If you are in an office, it is limited by things like soundproofing, a sign-in sheet at the front desk, or a therapist who announces your name when getting you from the waiting room.  Our job is to protect a client’s confidentiality to the best of our ability, and to make them aware of the limitations of confidentiality.

I feel it is important to have intake paperwork unique to your online work.  In it, be sure to let the client know that confidentiality is limited to the extent of  security which  exists online.  You cannot guarantee the security that exists on SKYPE or your (or their) email provider.  You cannot guarantee the security of the internet in general.

If someone is looking for the convenience of online counseling or coaching, they must understand that there are risks involved.  Most people who seek these services do.  But, you still must have them acknowledge that understanding by including it in your contract with them.

3.  I am licensed in my state — can i provide online counseling to someone in another state?

Well, you should certainly check with your specific state regulations however, a good rule of thumb is to remember that you are only licensed to practice “counseling: in the state(s) in which you hold a license.  Let’s say you are licensed in NY and you have a client who lives in Albany.  Because she is a NY resident, you can do online “counseling” with her (even if she is spending the winter in Florida).

Now, let’s say that you get a call from someone who is a resident of Ohio, who is looking for online “counseling”.  She will be in Ohio when you have your phone or SKYPE sessions.  This is a horse of a different color.  You are now doing “counseling” with a resident of another state.  If she comes to your office in NY, it is not a problem.  If, however, you are online with her, you are now providing “counseling” to an Ohio resident, outside of NY and therefore you are practicing out of your jurisdiction.

In this case, you can screen that Ohio client to see if “coaching” would be appropriate to fit her needs.  Perhaps she is struggling with career issues and wants to work on that.  If you deem her needs appropriate for “coaching”, you can offer that to her.  If, however, she has PtSD and is in crisis, “coaching” probably is not appropriate and a referral is indicated.

Be sure to have a different set of intake paperwork for your “coaching” practice; be sure it clearly describes the differences between “counseling” and “coaching” and the limitations of “coaching.  Make this a part of the contract so the client acknowledges and understanding of this with her signature.

 

4.  What is the difference between online “counseling” and “coaching?

 I think this information sheet from ACA does a good job of describing the differences between the two:  Coaching vs. Counseling – ACA

 

Hopefully the answers to these questions have triggered some excitement and many more questions for you to research before you broaden your services to include online work.  In Part 2 of this post, we’ll look at how adding online counseling or coaching can benefit you and your clients.

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26 Comments

  1. Sean /Reply

    Deb,

    The link to the ACA sheet comes as a zip file full of xml documents that I can’t make sense of. Is there another way to acess the sheet?

    Thanks for your great post!

    –Sean Stanek

  2. Deborah Burns /Reply

    Hi! Thanks for posting this information. I have worked as a counselor for several years (LPC) in North Carolina. I have a budding interest in beginning an online business and do not know where to start. I just happened on your link. Are there other sites or links to information to which you can direct me? Is there other information you have written?
    Thank you.

    1. Deborah Legge PhD CRC LMHC /Reply

      @Deborah – Hi Deborah and thanks for your inquiry. Most of what I write is on the Influential Therapist website, but I am also a blogger for the ACA website and starting in January, you will find my monthly articles in the AMHCA Advocate. With regard to just getting started,I would recommend coaching. I can help you to identify your goals, and set up a coaching program that will help you get that online business up and running. Let me know more about your and your business and how I can best help you!

  3. Ciaran O'Connor /Reply

    Hey, thanks for this. I’m thinking about getting involved in online counselling. I’m curious as to what people think are the best ways to go about advertising this? So far I’ve made up an SEO’d Online counselling page but it’s not fairing so well at the moment. Thoughts?

  4. amy /Reply

    Deb,
    Im a LCSW in the state of Texas, i want to start my own online private practice. I will be moving out of the country. Can i still offer online counseling to clients that are residents of Texas?
    Or do i need to physically be in the state of Texas?

    1. Deborah Legge PhD CRC LMHC /Reply

      @Amy = it is my understanding that you can only provide online counseling to people who are residents in the state in which you are licensed. You’ll want to check with Texas to find out what happens to your license once you move out of the country and are no longer a resident of the U.S.

    1. Deborah Legge PhD CRC LMHC /Reply

      @W.Dimitrius: You’d have to check your state laws to see what the requirements are for you to open a private counseling practice. Counseling is a licensed profession in all states, so you must have your license before you can call yourself a counselor. Coaching, on the other hand, is not licensed. That being said, there are plenty of good coaching programs where you can become certified as a coach. Essentially you need to be prepared and ready to do competent work with your coaching clients. I hope that helps.

  5. Scarlett /Reply

    Hi Deborah,

    In the state of Colorado, one is not required to be licensed to practice as a therapist. One can start a private practice even without the proper degree (sad, but true–that’s why clients need to check therapist’s credentials!). I will have my Masters in Counseling next Spring, and would like to start an online private practice. This said, I know I can legally practice in Colorado ( I will register with DORA) and see Colorado residents in an online practice without yet having my LPC, but shouldn’t I also be able to see clients in states that have similar regulations to Colorado (i.e do not require one to be licensed) and perhaps even abroad?

    1. Deborah Legge PhD CRC LMHC /Reply

      @Scarlett — When it comes to tele therapy, the rule of thumb is that you are limited to working within your state, or with residents of your state (i.e. students who are away at school or snowbirds who are residents of the state in which you are licensed). In order to provide services to someone outside of your state (or someone who is not a resident of your state when you are working online), you should contact the state in which the client is a resident. They may give you temporary permission, or you may have to apply for licensure in that state. Check first; protect your license!

  6. Jessica Dettmann /Reply

    Hi Dr. Legge,

    I am working for a private practice, however, business is really slow and due to being a student in a PhD program I do not have the flexibility of moving, so I am looking into alternative work options. I have my LPC in Colorado and Michigan and am currently living in Michigan. As far as you know should there be any issues with me seeing clients, online, who are residents of both states? Also, do you know the rules of seeing clients who are students in either state, but, not residents?

    1. Deborah Legge PhD CRC LMHC /Reply

      @Jessica – I’m sorry to hear that business is slow. Good for you for finding ways to increase your clients by doing some online therapy. It is my understanding that you may provide services to people who are residents of the state(s) in which you are licensed. Further, you may provide services (face-to-face) with people who are residents of any state, as long as you are providing those services in the state(s) in which you are licensed. However, the key here is that you are either doing business in your licensing state (face-to-face) or you are providing online services to residents of your licensing states. I hope that helps. I’d love to teach you how to get Booked Solid so you can increase your face-to-face practice as well 🙂

  7. Alex /Reply

    Thank you for publishing this article. I was inspired by Pretty Padded Room to entertain the thought of online counseling. I’ve contacted my board (Florida) and they noted that there are no rules that say I can or cannot provide online counseling here in the state or across state borders. Anyone else in FL practice online therapy that could possibly enlighten me on to whether this is 100% accurate?

    1. Deborah Legge PhD CRC LMHC /Reply

      @Alex – I’ve done a Google search and could not find anything to the contrary. The best bet is to contact the Florida licensing board and get their response in writing. I’d also encourage you to contact your malpractice insurance company to be sure they will cover your teletherapy services. Good luck to you Alex!

      1. Alex /Reply

        Thank You Deborah for getting back with me. Would you suggest any malpractice insurance? I currently have my insurance through CPH.

  8. Teri /Reply

    I am a Drug and Alcohol COunsellor. I graduated from Fleming College in 2013 and am a Canadian living in the state of Ohio. I am wondering about starting my own website for counselling addicts. Is this at all possible? I am currently a stay at home Mom since we have moved here and I have a lot of free time on my hands and just feel like if I can get back to counselling I would be accomplishing something other than “stay at home Mommy duties” right now. Thanks

    1. legge /Reply

      @Teri – You’ll need to check with the laws in the State of Ohio. Chances are you will need to be a licensed professional in your state to provide addictions or counseling services. Good luck to you!

  9. Shauna /Reply

    Hello Dr. Legge,

    Thank You for your article it has been very difficult to find information on online coaching/counseling. I am currently a LPCA and most likely a year or so away from becoming fully licensed. Lately I have been doing a lot of thinking and find that I would like to begin coaching. I would like to work specifically with young adults who are trying to figure out how to build a particular lifestyle. In my state you are unable to start a private practice as a counselor without being fully licensed. In the ACA article it mentioned that counselors acting as a coach are still bound to the counselor ethical guidelines. Would this be true for counselors acting as coaches when it comes to licensing laws?

    1. legge /Reply

      Because you are a counselor you are bound by the Code as a part of your life. Stick to that in everything you do, and you’ll never have to worry about your license.

  10. Melissa /Reply

    Hi!
    Thank you for your post. I have my PhD and have my LMHC with a thriving private practice. However, I am thinking of moving to Florida. Can I still accept insurance if I start seeing people online? I was planing on seeing my Ct’s here in MA online in Florida and was wondering if I can still accept their insurance. I would still advertise on my website counseling services but only online services to MA folks. I am on all the major insurance panels.
    Just wondering how that works?

    1. legge /Reply

      @Melissa – You’ll have to check with each insurance company to find out if they cover online therapy and what codes to use for billing. Then you will have to check with the licensing body in each state to find out the regulations for online counseling. The general rule is that you can only provide counseling services to people in the state in which you are licensed. Make sure to find out and follow the regs — you do not want to jeopardize your license by practicing outside of the laws of your state. Don’t forget to check with your malpractice carrier to see if you have coverage for online therapy and what their rules are regarding where you practice. Good luck to you.

  11. marcelo /Reply

    I’m curious about this topic not as a counselor, but as someone seeking counseling. An online therapy practice just opened up in my city (http://thriveworks.com/online-counseling), and I want to know: have there ever been any reported privacy-breach issues from online counseling? I imagine you’d have to have a pretty serious system to not be subject to hackers.

    Thanks in advance!

    1. legge /Reply

      @ Marcelo — You raise a very important question here, Marcelo. You might ask the company whose services you are seeking, to find out if they have had any breaches and to find out their levels of security and compliance with HIPAA. I don’t track the research in this area, but I’m sure even a Google search might give you some direction as to where you can get up to date info about this important concern.

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