eCounseling Therapists Must Adopt More Stringent Security Protocols to Ensure Client Confidentiality

Google recently updated Gmail’s security standards. Users of the webmail service will notice that Gmail’s default URL setting has changed from HTTP:// to a more secure HTTPS:// location. However, this change has been misunderstood by some users. The HTTPS:// setting does not provide a solution for messages sent using Gmail to be ‘encrypted’. The new default HTTPS:// setting, by Google’s description, instead provides greater security when users are logged into their accounts while using public WIFI hotspots.

Dr. Anthony Centore, Founder of eCounseling.com, states “Many counselors don’t realize that while they and their clients need a password to access their respective email accounts, email is still inherently unsecure. When emails are sent between counselor and client, there are several places along the delivery pathway that an email could be opened and read by someone other than the intended recipient.”

An article on Wikipedia.org titled, “Email Privacy” provides a clear warning to email users, stating: “Because e-mail connects through many routers and mail servers on its way to the recipient, it is inherently vulnerable to both physical and virtual eavesdropping. Current industry standards do not place emphasis on security; information is transferred in plain text,…every e-mail leaves a digital papertrail in its wake that can be easily inspected months or years later.”

Ethical codes, such as one released by the American Counseling Association (ACA), states in section A.12. Technology Applications, “When the use of encryption is not possible, counselors notify clients of this fact and limit electronic transmissions to general communications that are not client specific.” By this standard, the use of Gmail for online counseling, even with HTTPS:// protocols, still violates published ethical standards for online counseling.

As a way to provide a secure method of communication for online counseling, websites such as eCounseling.com have developed platforms where emails messages can be sent between counselor and client without the risks inherent in email. Instead of utilizing typical email delivery methods where messages travel across the internet, at eCounseling.com all communications are stored on a secure server and both counselor and client use assigned passwords to log in to the website. The website, utilizing secure socket layer technology, complies with the ethical standards of the ACA.

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About eCounseling.com

eCounseling.com is the leading provider of Online Counseling and Telephone Counseling technologies, and exists to connect professional counselors to clients in need, 24 hours a day, 365 days a year. eCounseling.com was created by counselors who perceived a need for better online counseling methods. Its founding directors include Dr. Anthony Centore, who practices therapy at Thrive Boston Counseling, and Ryan Neace, of the nearly 50,000-member American Association of Christian Counselors.

For more information, contact Dr. Anthony Centore, Founder of eCounseling.com, who practices counseling at Thrive Boston Therapy, in Cambridge, MA.

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At a recent marketing convention, a keynote speaker addressed the audience. He said, “Everyone I meet wants to have the #1 website on Google, have the biggest and most responsive email list, and have the most followers on Twitter. Today, I have a surprise for you…” The speaker looked out over the crowd—there were 1000 people in attendance.

“I have placed a bright green card under one of your chairs. If you have that card, you will receive all those things today. Take a look, and whoever has the card, come up on stage and tell everyone why you deserve to have all these things.” The speaker then waited a moment as the crowd started to shuffle and reach under their chairs. Then he said, “Ok I lied. There’s no card, but you should have seen your faces! First TERRIFIED it was going to be you, and then smug, as if you were thinking to yourself ‘I can’t wait to hear what that poor sucker with the card is going to say.’”

The persons in the audience were nervous about the reward because, simply, they didn’t deserve it. No one in the room was worthy of the things the “green card” was supposed to bring them. Hence, the number one rule of being online famous: you need to be worthy of that fame.

How to Become Worthy of Online Counseling Fame

How does the story above apply to online therapists? Very well, in fact. Here are a few things to keep in mind as you are promoting your therapy services online.

1)      Find a Therapy Niche

Imagine the Internet as a loud, crowded room. As someone who wants to be seen by others, you need to stand out. You need to find a niche. Often I encounter people who think that “online counseling” is their niche. It’s not. Online counseling (or telephone counseling) is simply the portal through which therapists provide their niche services.

Similarly, Christian therapy is too big to be a niche. Maybe if you are providing Christian therapy in an underserved area, you can be known as the town’s local Christian therapist, but online there are thousands of Christian therapists, so you won’t stand out. Need ideas? Here are some examples of niches: Christian Anorexia Specialist, Sports Psychology for X Games Athletes, Broken Heart Recovery Therapist.

Many therapists avoid niches, trying to make their area of focus as broad as possible. The hope: broad offerings will appeal to more people. This is not true online. The question of potential clients is often “why see a therapist by computer, if I can see one in my home city?” Answer: because the X Games athlete specialist is too far away to see in person, and that’s the person who can help them the most.

2)      Speak, speak,  and speak some more

Once you decide on your niche (hopefully one in which you have a genuine competency), then it’s time to speak on it, and speak on it, and speak on it some more. It’s time to establish yourself as the quintessential professional on the topic.

Often times, a person will have great ambitions, but their enthusiasm wanes before they can see the fruit of their labors. An example of this would be someone who decides on a title for their blog, and then never writes anything; or someone who has a Facebook profile without so much as a personal photo uploaded.

Even if you are time-starved, you can still work toward being an online famous counselor. The general consensus is that a person can grow their online fame with an hour a day of contribution. Micro-blogging (i.e., Twitter.com) has made it easier to post frequently, because every post is limited to 140 characters. One of the great things about this format is that, if you don’t have time to generate new content, it’s completely acceptable to point people to other people’s content on your topic. Matt drudge (Drudge Report) almost exclusively directs readers to content created by others, and he has one of the most visited websites on the web (give Matt Drudge the green card, and he’ll tell you exactly why he deserves it—he broke the Monica Lewinski story in 1998, and now he updates the news on his web site every 3 minutes, 24/7/365. He posts top news stories, written by others, in a no-frills format).

3)      Master the Online Tools

If you are serious about becoming famous online, you must become an expert with online social platforms. Buys books on Twitter, Facebook, Myspace, and any Blogging, Vlogging, or Web 2.0 application you might use. Attend seminars, webinars, and adult education classes. Spend time learning these tools and it will pay off.

I tell this to some counseling professionals and they say, “I’m not interested in all that. That’s not what I want to do.” They expect that their web developer can take care of “the technical side”. But when it comes to online social networking, it doesn’t work that way. You can’t be ignorant to how things work, and expect to appear competent —not unless you hire someone to sit next to you and tell you when to post, what to title your post, where to tag it, how to bookmark it, who to syndicate it to, and so on.  Just knowing about therapy isn’t enough.

A final word of advice: As you move forward, I promise you will do a lot of things wrong, but you will do more things right. Just being online, communicating and interacting will lead people to your niche; in time, an hour a day will make you worthy of the online fame you’re destined for! 

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Being a spokesperson for the online therapy field, I have, every week for the past several years, received calls from counselors who have recently listed their name and practice information on an online counseling website (such as eCounseling.com), or who are having someone build them an online counseling website of their own. I usually meet these calls with a certain level of excitement: “Great! Super! Excellent! Congratulations! Welcome to the club!” I will say. But I have recently grown to be a bit hesitant with my cheers, “wait a second” I might say, “What are you expecting to happen when you start your online therapy practice?”

Too often, the counselor’s response sounds something like this. “Well, I’m getting fewer new clients at my face-to-face practice, so I was thinking that, with online counseling, I would have 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, especially caseloads of online clients, don’t just happen; they are BUILT with a lot of effort. Being on the Internet is a great start, in some ways it even puts you miles ahead, but it 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 Smaller Pond

In the example above, the counselor is operating under an understandable 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: “As an online counselor, my reach is a million times longer than it is offline. Therefore, even if I don’t put a lot of effort into promoting my practice, I should still get more than enough clients!”

And here’s the flaw. One’s net may be huge, but how big is the pond?

According to Google, in January, 2009 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 the magnitude of the difference: 1,213,400 more searches for “counselors”, compared to “online counselors”. Hence, while an online counselor’s net may be huge, the pond is (for now) relatively small.

Other Nets in the Pond

When it comes to online counseling, there is increasing 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 column is not meant to discourage. All hope is not lost for the therapist considering online counseling! There are some immediate benefits to having online counseling training, and having an infrastructure for efficiently and ethically providing online or telephone counseling. Such will allow you to:

1.       Retain clients who relocate (a common problem in college areas like my hometown, 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 company structure. Measure growth. One needs advertising and PR. One needs a marketing plan that takes into account the online audience. I recommend every online therapist create content and publish it on the web in order to begin becoming an active part of the online community 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, office spouses, desperate housewives, Americans living in Japan, Japanese living in the Americas…you get the picture.

Remember…

Online counseling is not your niche! It is a method of delivering service. It is added value to your in-person clients. Build your practice. Find a target audience and help them. Don’t just be online—be so valuable that people across the country are calling and emailing you to ask—Do you take online clients?

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Crisis situations are a common concern for eCounselors – and rightly so. To be ethical, counselors of all philosophies and practice settings need to handle these situations carefully. If you haven’t been concerned, consider that failures to make efforts to prevent client suicide account for 42% of the dollars paid in malpractice settlements.1 Thankfully, one can make prevention efforts and handle crisis situations successfully with online counseling (and telephone counseling).

Emphasis on Crisis

In contrast to in-person clients who visit a counseling center (which is a safe and neutral environment separate from their life-issues), online counseling clients receive help from within the settings where their problems take place. Hence, when a client says, “I hate my apartment, it reminds me of my ex-husband,” she is saying this from inside that apartment. This can increase the intensity of the counseling process.
In addition to the uncontrolled setting, online and telephone counseling clients seek help during a problem, not after it. They may seek help at odd hours of the night or morning when they feel the worst. eCounselors can be contacted by clients who just experienced violence, clients in fear of violence, or clients feeling guilty over committing violence. And, perhaps most unsettling, eCounselors are sometimes contacted by persons seriously considering suicide.

I’m not saying online Counselors are overwhelmed with emergency calls – that is a common misperception. In fact, emergency calls (such as the suicidal caller) are quite rare. One crisis hotline recently reported that out of more than 500 calls a month, only 10% of callers reported being suicidal. The majority of callers were not in an emergency, but simply felt they were having a personal crisis. The fact is, a client can be in “crisis” whether she is a stressed-out teen or a panic-stricken elderly woman calling because she can’t make her mortgage payment.2

Helping Suicidal Clients

Online counseling and telephone counseling are obviously not the gold standard treatment for clients in a life-threatening crisis. However, it is certainly better than no treatment at all, and could be a lifesaver for persons who refuse, or are unable to receive, help in another manner. This idea is not new. The Samaritans, a group in England, “provide emotional support to any person who is suicidal or despairing” through telephone and online care.3 Similarly, 1-800-SUICIDE is just one of several U.S.-based hotlines that has been providing crisis care for decades.

Responding to an Emergency

An important issue when dealing with suicidal, or homicidal/violent, clients is whether a counselor is able to respond effectively to an emergency situation. With some preparation, online and telephone counselors can be sufficiently equipped to respond.

Online counselors and telephone counselors, like in-person counselors, should have an official intake process where clients provide their address/location, multiple contact methods, and an emergency contact person. Electronic filing makes this information easy to retrieve, and electronic payment (i.e., credit card; a common eCounseling payment method) provides a verified client address. Hence, in a situation where there is a threat to a client’s self or others, eCounselors can be well equipped to contact relevant local agencies, and even warn parties in potential danger.

Preparing for the Unexpected

Here are some more specific preparation tips:
Before you begin taking clients…
* Have a reliable suicide assessment tool on hand
* Make public (by posting online) a policy explaining if or how you provide care to suicidal/violent clients
* Recommend (by posting online) alternative treatments for persons battling suicide (in-person care, hospitalization, etc.)
* Prepare a thorough informed consent processes that includes confidentiality limits

Before an Emergency occurs…

* Establish contact with a counselor local to the client in case in-person care is needed
* Obtain accurate client information including name, location, and permanent address
* Obtain back-up contact methods, including the contact information of several people the client knows and trusts
* Obtain the contact information of emergency services that are local to the client
* Create an agreed-upon emergency plan with at-risk clients

About the Author:

Anthony J. Centore, Ph.D. is author of The Clinical Training Guide for Online Counseling and Telephone Counseling. Anthony practices counseling in Boston and Cambridge, Massachusetts (See www.ThriveBoston.com).

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