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FAQs
Why
would I Choose online counseling?
Is
online counseling as good as traditional face-to-face therapy?
How exactly
does Online Therapy work and exactly how do I start the process?
How
do I know if I am a good candidate for Online Therapy?
What
sort of problems can you help with?
Why
is Empowerment Therapy considered to be cost-effective?
What
is the difference between psychotherapy, therapy and counseling?
Q. Why would I Choose online counseling?
A. You may live in a rural community with few resources available. You may also feel that you may not be able to keep your counseling private and anonymousif you sought help in your own town.
You feel you can express yourself better and more freely in written form.
You may not feel comfortable, at this time, with face-to-face counseling.
You are too busy to commit to traditional weekly office appointments. You can read and write email at your own convenience and as often as you want. No appointments necessary. My online "office" is always open. Response time will often be within 24 to 48 hours upon receipt of payment. (However, due tounforeseen events, this cannot always be guaranteed.)
You may not want to feel pressured into committing to long-term therapy and/or you only have a small issue you would like some one-time or short-term help with.
You may have a physical disability or transportation problems that may limit mobility.
You may be dealing with an anxiety disorder that makes leaving the home or going to a strange office very difficult for you.
You may just need someone objective and uninvolved in your personal life to communicate some of your issues with.
You feel you need a professional therapist, but you don't want to burden or worry your family or friends with your problems. You just need someone unbiased and qualified to communicate with.
You may feel trapped at home alone with a problem and few options to get help.
You can't afford traditional therapy (typically $60 to $150 per 50 minute session).
Q. Is online counseling as good as traditional face-to-face therapy?
A. I have researched this issue extensively and have learned, along with my online experience that the answer is a qualified no, not yet anyway. It is generally agreed by the professional mental health community that face-to-face therapy is superior in quality to online therapy. However, the Surgeon General has recently stated that two thirds of people who could greatly benefit from therapy are not getting it for one reason or another. Thus, the professional consensus is that online therapy is much better than no therapy at all. It is also conceded that online therapy is becoming more and more the choice of therapy. To this end, it is also believed that online therapy will be equal in quality, if not superior, to traditional face-to-face therapy. Furthermore, if online therapy can only go so far and goals are not satisfactorily met as deemed by both therapist and consumer, online therapy can very likely break the barriers that will lead to traditional therapy.
Q. What are the advantages and disadvantages of Online counseling, including online Empowerment Therapy?
A. The benefits of Online Therapy are numerous. First, online counseling is very convenient. You can send email at any day or time. Furthermore, you can e-mail from the privacy or your home or office, wherever you choose.
You can ask questions when you think of them-in the privacy and comfort of your home or office. In other words, you don't have to fight traffic while driving to a physical office location. Additionally, there is no time wasted sitting in a waiting room, where it is possible to be seen by others. And, you don't have to endure interruptions during the session, which take away from the time you've paid for.
Secondly, you do not have the long waiting period, which can be up to a month or more, to see a therapist. I typically respond to emails within 24 hours-even on the weekend. This can not always be guaranteed, but a 24 hour turnaround is typical, about 90% of the time. If it will be longer than 24 hours, a short note will be e mailed advising you of this and when a reply can be expected. Very rarely, is the e-mail reply longer than 48 hours. It depends on demand for my time. Thirdly, you obtain more privacy than you would have during an office visit. While Online Therapy is not completely private, it does offer more privacy than traditional psychotherapy. So, if your e-mail messages are delicate, we can exchange detailed e-mails, exploring tough or potentially embarrassing issues without having to do it in a face-to-face office visit.
Additionally, writing out troubles and problems can be highly therapeutical for many people. This type of writing and therapeutical communication can serve as a highly effective medium for reflection, self-awareness, and inner exploration of troubling conflicts. Since Online Therapy involves email exchanges, you have a verbatim copy of the session. These records provide both of us an opportunity for review and evaluation at any time. This means that you can print our discussions and refer to them as often as you like, rather than trying to recall the content of the therapy session, much of it being very important. Finally, since I have time to read your e-mail message and reflect on it, I can provide you helpful responses that can include support, insight, expanded awareness, an array of options and specific suggestions for consideration. These clinical responses undoubtedly, if taken seriously and with careful contemplation, will lead to relief from your troubling problems.
In other words, you get an detailed response to your questions or problems and no stone is left unturned. This may mean that, from time to time, I will need to ask more questions for specific clarification, but if this is required, the provision of support, awareness, insight, options and suggestions will still be provided in the process of gathering more specific information. This clarification process is very much like traditional office therapy, but because you will still be receiving feedback through the clarification process, it is entirely up to you as the consumer to decide if you want to continue with the provision of further clarification. Added clarification through the online counseling process undoubtedly will be helpful, but you may decide you have enough help for now.
While I have listed many advantages to Online counseling, there are disadvantages, just like every circumstance in life has upsides and downsides. The biggest one is the absence of non-verbal cues. With face-to-face meetings, we are able to use all of our senses. These subtle non-verbal cues are missing with Online Therapy, even with video conferencing(although the technology of video conferencing is expected to improve allowing for much more reliable observations). This could lead to misunderstandings. But, even in traditional face-to-face meetings, there have been misunderstandings and misinterpreted non-verbal cues. However, because of my visual impairment, this is not a factor. In fact, the absence of sight has provided me with invaluable clinical skills and intuitions that are especially helpful in online counseling.
Q. How exactly does Online Therapy work and exactly how do I start the process?
A. It really is quite simple. First, you have to decide if you want to work with me. Second, it is necessary that you review the Client Agreement. Then you fill out the Questionnaire and click on the ‘Submit’ button. You will note there is a box to indicate whether or not you choose Empowerment Therapy, the specialized modality that addresses significant losses in life. If you only wish to complete the initial questionnaire, you will need to go to the Fees section and purchase 45 minutes of time, or $60. If you wish to purchase specialized Empowerment Therapy with the initial questionnaire (ET cannot be completed without doing the initial questionnaire first), then you will need to purchase 90 minutes of time, or $120.
After your payment is received, and we have agreed that general online counseling is sufficient, I will send you a well thought-out reply to your questions or concerns. The reply will be framed within the context of your payment. So, if you choose to pay for 45 minutes, I will spend 45 minutes composing a thoughtful, genuine response. Additionally, I will indicate that I could be more helpful if I have additional information which I may ask for, but the choice is entirely yours if you wish to purchase additional time.
On the other hand, if you have selected ET, a specific Empowerment Therapy Questionnaire will be downloaded to you when you click on Empowerment Therapy. In fact, the completion of this ET questionnaire will be necessary before going to the ‘Services and Fees’ link and it will take a minimum of 90 minutes to provide you with a well thought out response. In office settings, my clients have made progress with only one forty five minute session, but the average number of sessions is anywhere between five to ten. Based on the type and severity of problems that ET addresses, it is safe to say that more time may be required than general online counseling, but you are the consumer and the time you desire and pay for will be absolutely honored. This is essentially no different from office therapy as it is the consumer who decides whether he or she wishes to return for another session. The purpose of this specific ET Questionnaire is to cut through the problem-saturated details and to get to the ‘nitty-gritty’ of the difficulties so that positive change is more likely to occur. Cutting through problem-saturated details does not mean that the problems are in denial, nor is there lack of respect for the anguish associated with them, but that problems are acknowledged, not amplified. ET is rooted in solution-focused thinking and behaviors and this is far more effective to getting on to the empowered path to recovery and accomplishing the ‘eight elements of empowerment’.
If you still have questions after reading through that information, please feel free to use the email link to titled ‘contact me’.
A. As stated in the Confidentiality section, my Internet security consultants and I believe communicating through the Internet is as safe as communicating with someone in an office visit. However, you may still wonder about someone else intercepting our communication while it is in progress. While it is technically possible for a third party to intercept email correspondence, it is highly unlikely.
Additionally, my security consultants and I have investigated the most effective methods for securing email correspondence, as well as, investigated the types of security systems available today to alleviate this possibility. Unfortunately, these security systems have two major disadvantages. The first disadvantage is that they are very expensive. The second disadvantage is that they make email correspondence awkward. These disadvantages outweigh the benefits, but future technological developments may change these disadvantages. Ultimately, proper precautions
on both of our ends will minimize any unauthorized invasions of our privacy. You may want to considering hard copying any transactions, or convert them to your words program, while giving the file title a coded name, anything that you are comfortable with, yet does not disrupt the flow of communication. This will allow the option of deleting messages. Also, copying to a floppy disk or CD will also prevent violations of confidentiality. Secure chat rooms will be explored, but, in my opinion, this procedure, as well as Instant Messaging, creates the disadvantage of not being able to maintain a permanent record or journal. This acquisition of a permanent record is just about the major hallmark of email communication. However, my greater priority is to meet the consumers’ needs, so if IM and secure chat rooms are desired, please contact me via my email ‘Contact’ link. Rest assured that I do hard copy the transactions, while maintaining secure records, while simultaneously copying into my words file with coded labels. In cases where sensitive information if provided, I provide a precautionary reminder to make such information as confidential as possible.
Q. How do I know if I am a good candidate for Online Therapy?
A. If you are currently having thoughts of suicide or homicide, you need help that cannot be provided online. If this is the case, stop reading right now and contact your local community mental health clinic (they are all required to provide emergency mental health services)or a mental health counselor in your direct area or contact a local suicide prevention hotline (e.g. The Samaritans www.samaritans.org )or, if you have any trouble contacting any of these resources, contact your local United Way’s Information and Referral service ( www.unitedway.org then type in your zip/postal code on the home page where it is asked for) If all else fails, and you need immediate assistance and are lacking patience to conduct searches, call 911 and tell them you need immediate assistance.
Likewise, if you are under 18 years of age and uncomfortable in conveying your thoughts and feelings in a written fashion, you may not be a good candidate for Online Therapy at this time, but that is a judgment only you can make with my assistance after reviewing your Questionnaire. Also, if you are under the age of 18, a parental or guardian release form must be signed and mailed through the postal service. However, if you are under 18, and really need professional help, but can not get approval from a parent or guardian, contact your local mental health agency and speak with someone at emergency services. Also, The Samaritans can take calls from minors.
On the other hand, if you are just plain busy, a little shy, geographically isolated, have a physical limitation, and are intrigued by the thought of doing therapy online, you are a great candidate for Online Therapy.
Q. What sort of problems can you help with?
A. As outlined in the section ‘About Empowerment Therapy’, I have thirty years of experience helping people with emotional problems associated with physical disabilities and chronic illness, depression, significant losses, traumatic losses, grief or bereavement, major life transitions, traumatic stress, anger management, stress reduction, chemical and other addictions, anxiety/phobias/panic attacks, parent-child problems, marital issues, and most other clinical diagnoses. There really isn’t much I haven’t worked with over the years.
How much does traditional office therapy provided by a licensed clinician (e.g. licensed clinical social worker, licensed clinical psychologist, licensed psychiatrist) cost?
The price of therapy varies. In general, therapy ranges from $80 to $200 per hour. Rates vary not only by state and by clinician experience, but also by localities within a state where overhead can be quite high. Reputation and specialties are also major factors of clinician fees. Although managed care plans were somewhat successful in ‘capping’ prices, many clinicians with many years experience, a solid reputation and a specialty were not participating in managed care programs. I am one of those. Thus my charge typically is $100 per 45 minute hour. I did allow some fee adjustments for those who demonstrated solid motivation and genuine need, but couldn’t afford the full fee.I charge
$20 for 15 minutes of my online professional expertise and time. I prorate my fee for the time I actually spend working on your issue or problem. You can find out more about my services by clicking on the following link: Services and Fees
Q. Why is therapy so expensive?
A. Therapy or counseling by a licensed or certified social worker, psychologist, or psychiatrist is a skilled service like those offered by other professionals, such as doctors, lawyers, and dentists. When you become my client, I make a commitment to you backed not only by my training and experience, but also by my professional ethics. The fee is your part of the bargain. My part includes accepting responsibility for our work together, maintaining confidentiality, behaving professionally toward you at all times, and giving priority to your emotional needs with my highly trained expertise.
I think the expense of therapy depends on your point of view. I am a highly trained professional with thirty years of diversified therapy experience. In addition, I have proven my clinical skills and competence to professional colleagues through a board certifications, Diplomate examinations and meeting the rigorous requirements for licensure in two states. The therapy you will be provided is based upon years of education and training, years of supervised clinical practice, peer consultation, providing supervision to other developing professionals and the scientific literature provided in Master’s level graduate education as well as Continuing Education. Remember, we are talking about your mental health which is very connected to your physical health.
Unfortunately, some insurance companies and managed care plans are not currently reimbursing for services that are not provided in a office visit.
This means that many people will have to pay directly. Please inquire with your insurance company to see if they will reimburse for Online Therapy or Teletherapy. However, the reduced cost of online counseling is actually comparable to ‘co-payments’ that are required for office visits. The co-payment of some insurances can be as high as 50%. While most insurance companies will directly pay for a portion of mental health provided in a professional office, some insurance companies reimburse consumers for mental health services if a bill is provided to the insurance company by the consumer (or patient). It is possible that some insurance companies will cover a portion if the bill is processed this way, but one must check with their own insurance company. Although not researched or documented by myself, it is my strong belief that insurances will be reimbursing more and more for online counseling as the validity, cost-effectiveness and value of online therapy becomes more recognized-especially for those ‘hard to reach’ clients such as the disabled, the very busy with inflexible and varying schedules, those living in remote rural areas, and those with mental conditions that make leaving the home a impenetrable barrier such as those with agoraphobia, panic disorders, and PTSD. Recently, the Surgeon General stated that two thirds of people who could greatly benefit from psychotherapy are not getting it for one reason or another.
In fact, a recent announcement was made in California about reimbursing for online counseling. To help its members get answers to their medical questions more quickly, Blue Shield of California is extending its physician-patient online communications' services to a segment of its HMO members and their providers. thousands of Blue Shield of California HMO members will have the opportunity to conduct online communications with their Blue Shield of California HMO providers who have enrolled in the program. Some of the new participating groups include Northern California-based Hill Physicians Medical Group and University of California Davis Health System. This program, the largest of its kind and the first to target HMO populations, is made available through RelayHealth, a clinical online communication service provider that gives providers and their patients an opportunity to communicate securely over the Internet.
Why are you practicing Online Therapy? As stated, my major reason is a result of Counseling for Independent Living (CIL), the nation’s first community-based program to provide mental health counseling by qualified professionals to disabled people and their families, as well as training to other professionals. Despite the innovativeness and quality services provided by CIL, we could only reach people in nearby areas. A medium that could reach all those in need was necessary. I attempted to bridge this global gap by writing FROM EMPTINESS TO EMPOWERMENT: Changing Physical and Other Losses into Strengths. But I needed a medium that would reach consumer in need of these specialized grief services focusing on loss on an individualized basis. Not only was the Internet a much appreciated solution, but the promise of the Internet for the future without a doubt assures that many new advantages will evolve, including advantages that will eradicate all of the current disadvantages (e.g. future superior quality in video conference that will be as reliable as face to face interviews, improvements in encryption, dictation methods that will make communication as feasible as speaking).
Overall, I decided to offer Internet based online counseling and online Empowerment Therapy because it is feasible and effective for many people today. The Internet has grown tremendously and many people are using it for business and personal purposes. Also, since health care in the US has grown worse over the years, largely due to managed care, fewer people have access to the services they need to become and stay healthy.
As a result, I think Online counseling definitely offers a great alternative for those people who are unable to access traditional counseling through office visits. Remember, the Surgeon General recently stated that two thirds of people who could be benefiting from therapy are not getting it-think of the reduction in violence, crimes, dropouts, hospitalizations, suicides improved work productivity etc. this could result in. Online counseling is a great resource for people who wish to improve their life skills and emotional and physical well-being. Plus, I believe people across the US should have access to highly experienced, quality mental health professionals regardless of their limitations and barriers (e.g. physical disability, chronic illness, home confinement, caretaker role, rural living, anxieties about leaving home, anxieties about office visits, lack of transportation, budget restrictions). Beyond that, I believe being mentally
and physically healthy results in being a more productive family, community and society member. Finally, the combination of my strong clinical background, my computer skills and my strong writing ability (author of two books, Empowerment Therapy and many articles)contributed to a clear eventuality that online counseling is what I, without a doubt, was destined for. that’s why I decided to offer Online Empowerment Therapy along with general online counseling. It is also my strong belief that online counseling will be the major medium in the future, especially with the continuing improvement in technology. In the future, improvements with videoconferencing, security encryption and these advanced computers, like TVs and telephones, are in the homes of just about every citizen, nationally and globally, many of life’s responsibilities and functions will be online. Look at the trend that banking, shopping and consultation services are going now. Theodore Reich stated in his famous book ’THE GREENING OF AMERICA’, published in 1970 that human consciousness was shaped by the bombardment of information provided by medium that we had no or little control over such as TV and newspapers. Now, with the advent of computer technology and the infiltration of the PC into the vast majority of people’s homes, we do have tremendous control over the information we gather, therefore, we have much greater control in shaping our own consciousness. Some people call the 21st Century as the Information Age, I would also like to call it the Age of Pro-Activism. These are the reasons that I jumped in with both feet to provide online counseling.
Q. Why is Empowerment Therapy considered to be cost effective?
A. Empowerment Therapy is designed to be provided with one, perhaps 2-3 sessions as it is a brief approach modeled on Solution Focused therapy, a model that spends much less time on the discussion of problems and much more time on the solutions for such problems. Because Empowerment Therapy, or ET, is designed to 'cut through' problem saturated life experiences that are quite typical of those suffering from the impact of physical disabilities, chronic medical illnesses and other major traumatic life experiences such as PTSDs or major adjustment issues, the goal of ET is to develop a beginning life plan to get on track with the process of becoming empowered, the ability to take control over one's life, regardless of the problems and challenges encountered. Also, ET is employed with the use of a pre-designed ET Questionnaire and ET Assessment that reduces time significantly and provides data that can be very helpful in the first steps in mapping out a life plan. Follow-up brief sessions requiring only 15 to 30 minutes will be likely to provide support in staying on track with the life plan developed, but in comparison with conventional ongoing, long-term psychotherapy, the cost of ET is very low.
Q. What is the difference between psychotherapy, therapy and counseling?
A. While these three terms are used randomly and is more of a matter of semantics rather than clinical meaning and there are major overlaps between these three practice modalities, there are some differences in my understanding that I would like to share with you. Psychotherapy tends to be associated with a process of psychological treatment that is longer-term and open ended. There are people who participate in psychotherapy, as well as psychoanalysis, for years, some up to even ten to twenty years. However, there are people who engage in psychotherapy for only a few sessions or a few months. To me, the key criteria for psychotherapy is that it is open-ended. The therapist and client do not discuss at the outset how long therapy will last or what the goals are. Therapy usually refers to the briefer model of goal-oriented treatment and tends to be closed-ended, with the clear understanding that the agreed upon termination date can be renegotiated. Proponents of briefer therapy approaches believed that the same, if not better outcomes, could be accomplished with less treatment time and research has corroborated this. In the wake of the movement to get mental patients out of hospitals (the community mental health movement focusing on de-institutionalization in the 50s), there was a strong need to find therapy approaches that would serve as many people as possible. The managed care movement originating in the 80s strengthened this need. Counseling is a more general term and can be practiced by other disciplines in other specialties such as rehabilitation counselors, pastoral counselors and mental health counselors (who, in general, are not licensed and educated with the same rigorous standards applied for psychiatrists, clinical psychologists, clinical social workers. While counseling can either be goal-oriented or open-ended, counselors tend to place more emphasis on the guidance role through the offering of directives such as advice, suggestions and even persuasion. While therapy may be goal ended, the ultimate goal is for the client to strengthen his own decision-making capabilities in an interdependent manner (or developing the ego), the goal of a counselor tends to be more of an outcome goal (e.g. a guidance counselor’s goal is for a particular student to be admitted to a certain university) However, there are far more generalities between the three practice modalities, and, in reality, some counselors practice more like therapists while some therapists practice more like counselors.
Similarly, there are many overlaps between clinical social workers, clinical psychologists and psychiatrists. The overlap between clinical psychologist and clinical social worker is the greatest, with the possible exception of clinical psychologists focusing on the individual and his psychic development and tending to practice more open-endedly, whereas the clinical social worker places slightly more emphasis on the individual’s relationship to his/her family/community/society. Licensed clinical psychologists must possess a PhD doctoral degree and the emphasis is on their academic training. Clinical social workers, who do the vast majority of mental health counseling in this country, do not require a PhD, but a Masters Degree that is followed up by at least three years of weekly clinical supervision, further followed up by passing a standard licensing test with a commitment to on-going supervision with peers as well as continuing education. The difference with the psychiatrist is that he/she tends to focus on neurology as well as psychology and is the only psychological discipline in which medications can be prescribed. But the overlaps between the three disciplines are far greater than the distinctions, and the three disciplines generally relate as peers. In fact, if a clinical social worker or clinical psychologist makes a recommendation to a physician, psychiatrist or otherwise (e.g. general practicioner, family medicine, internist), for the prescribing of medications, that medication will usually be prescribed. Thus, the distinction of a psychiatrist of being able to prescribe medications is not a major advantage by any means. Medications can be helpful, but their use must be made with sound judgment and discretion. Generally, I won’t recommend medications unless they are combined with therapy; however, this is not always the case.
Q. What are the legal implications of serving a client with online counseling if the client lives in a state outside of where I am licensed in?
A. You should understand that because Online Therapy is new, the legal profession has not addressed interstate (i.e., between states) psychotherapy practice boundaries. Therefore, professional organizations and state licensing bodies have not been willing to offer reciprocity to licensees in other states. This results in a system that cannot adequately protect, you, the consumer. As one example, if my Online counseling is physically located in Rhode Island and you are in Montana, my Online counseling practice could not be held accountable to Montana’s licensing laws-even though I took and passed the same national licensing exam that Montana uses to license its clinical social workers. The good news is that since my Online counseling practice is licensed in Rhode Island and Massachusetts , the Rhode Island and Massachusetts licensing boards can investigate and take corrective action(if needed)-even though you are physically located outside of Rhode Island’s and Massachusetts’s geographic boarders. This system actually provides you (the consumer) more protection than you would have otherwise.