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The Business of Private Practice
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7 Tips for Doing Online Clinical Mental Health Counseling

By Deb Legge, PhD, CRC, LMHC

One way to increase your market is to put your practice online. It’s also a great way to offer more options to your clients, and to have a business that can move with you.

People tend to have strong feelings (either way) about providing (or receiving) therapy online. Even if you are a proponent of using technology to provide services, there are some items you’ll want to consider carefully when it comes to online counseling. 

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#1: Therapeutic Concerns

What is gained and lost in the physical distance, even if you are simply a computer screen away from your client? Consider your beliefs about change and your therapeutic style, and think about how, if at all, the distance will affect the therapeutic relationship and the therapy.

#2: Concerns About Identity

If you plan to do therapy via telephone or email, how will you know if the person on the other end of the line is who he or she claims to be? Some clinical mental health counselors satisfy this concern by requiring that at least one session be in-person, or via video.

#3: Issues of Confidentiality

No matter what, you can only assure your client of confidentiality to the extent allowed by the source of transmission. This is an issue even if you are using a service that guarantees “HIPAA compliant” email, video, chat, etc. Your control over confidentiality is limited, and your clients must be made aware of that limitation and risk. 

#4: Technology Concerns

What if your client sends a text canceling the session, and you never receive it? What happens if you are mid-session and your server or Internet connection goes down? If these things happen, how do you handle financial liability for the sessions? How and when do you reschedule?

#5: Safety Issues

How do you manage things if your clients becomes seriously unstable, suicidal, or is actively abusing drugs or alcohol? What if you wake up to an “emergency” text from a client? These are situations that should be discussed as part of your policy when initiating the possibility of online options for clinical mental health counseling. 

#6: Protecting Your License

Remember that you are limited by your state license. You may be able to provide counseling to a college student or a vacationing client in another state (as long as they are still legal residents of the state in which you are licensed), but make sure you know the laws of your state when it comes to distance counseling.

#7: Ethics

Be sure to adhere to your professional code of ethics. 

Online therapy can be a great adjunct to your practice, and it can be a wonderful business model. Just do your homework to protect yourself and your clients in the process.

Visit AMHCA's Private Practice Library

Getting the information and support you need on “The Business of Private Practice” can help you to build a successful and sustainable business. Visit the AMHCA Member Library for additional articles by Deborah Legge, PhD, CRC, LMHC, on the business of private practice.

  • “Getting Started, Going Solo”(September)
  • “Policies and Procedures for Private Practice” (August)
  • “Marketing Your Private Practice” (July)
  • “Private Practice Website Tips” (June)
  • “Finding a Home for Your Private Practice” (May)
  • “Setting Your Fees” (April)
  • “Getting on Insurance Panels” (March)
  • “Finding Your Niche” (February)
  • “Is Private Practice Really for You?”(January)