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Before Signing Up for Internet Counseling: Read This.

With ever-changing technology, healthcare has a new landscape via telehealth. I say frequently that one of the few positive changes with COVID-19 was the swift and broad implementation of virtual healthcare over internet platforms. Receiving counseling has never before been so accessible regardless of locale or finances. Unfortunately, as with anything else, innovation can also lead to corruption. Though it is always my intention to encourage anyone interested in counseling to find a path to wellness that fits their lifestyle, I have been a vocal critic of many of the mass virtual counseling organizations, the drive-thru of counseling if you will. I think I have some good reasons to encourage folks to be wary.

My close friend Amanda is currently in school for counseling and recently we began discussing the dangers and pitfalls of these counseling conglomerates. She had much more organized thoughts on this matter, and much of what I relay stems from her recent deep dive into the issues with the onset of these types of businesses.

1) Who really is your therapist?

It is an unfortunate reality in this field that there are a lot of reasons someone might choose to be a counselor, not all of them virtuous. I had a colleague in grad school who stated openly and often, "I would never go see a counselor, I don't trust them" - red flag. As with any profession there are going to be better and worse counselors, but a recent study by Melanie Person with Counseling Today shared that at least three of these large online counseling businesses require limited to no vetting of their listed counselors. There were no questions related to counseling style, modality, experience, or specialty, and instead focused only on legal considerations regarding HIPAA that could lead to the group being sued. Finding a therapist one connects with can take time and careful consideration, these websites make it all too easy to be barraged by a constant stream of underqualified, or worse, unhealthy clinicians.

2) Overworked and Underpaid

For many, the financial aspect of these services may be a draw. Many major online counseling venues offer self-pay rates well below the industry standard which is understandably a motivating factor for selecting them. Unfortunately, when paying less for services your therapist is also paid less, way less. These sites do not give 100% of the rate you pay to your therapist, this means that the therapist has to see more clients to earn a living wage. This is similar to many community mental health services. When I worked at a nonprofit counseling agency I made less with my master's degree, working more hours, than I earned with just my bachelor's degree. The side-effect of this? Burnout. Though I hope no one ever has to understand this comparison, if ever in legal trouble do we expect better services from our court-appointed attorney or private-practice attorney? If a therapist has to see 30+ clients per week in order to stay afloat they are unlikely to provide the same quality of counseling as a therapist seeing only 15-20 clients per week. Remember, the hour we spend together in the room is one small part of the work I do for my clients each week.

It is also worth mentioning that many of these sites do not accept insurance and as such, many clients who might be able to receive quality counseling financed by their insurance would have to pay more out-of-pocket to use these websites.

3) Confidentiality and its Exceptions

Many clients may see the ability to remain anonymous as a benefit to online counseling. Many of these services offer text-only counseling options which allow users to conceal their identity within the counseling process. There are many issues with this. Though I offer telehealth counseling I only use the phone as a means of communication when all other options fail (internet outages), and I only ever use the phone for voice communication. On a therapeutic level, this stems from the importance of the connection between counselor and client. Research has indicated that upwards of 80% of client outcomes are influenced by the therapeutic relationship. I simply cannot build the same relationship and rapport with my clients via text that I can when we see each other's faces and hear each other's voices. Legally and ethically, this issue runs deeper. I've discussed the limitations to confidentiality more fully in an earlier post, but essentially it comes down to risk of imminent harm. If a client is in imminent danger of harming themselves or others counselors are legally and ethically obligated to go to great lengths to protect their client and others. These legal and ethical requirements are known as: "duty to protect" and "duty to warn". There is a rather famous case involving a counselor at the University of California who failed to notify proper authorities about threats made by a client. This client went on to murder the person they made threats about in session. I have never enjoyed notifying authorities about clients and I have never done it without discussing it with my client, but it is an essential part of my job. When clients maintain the level of anonymity offered by text-only counseling services there is no solid way for a counselor to know where a client is located or the severity and authenticity of threats against themselves or others.

On the same topic of confidentiality, two of these mass virtual counseling sites have recently been involved in legal proceedings regarding breaches in the confidentiality of their clients. I have little interest in being sued so I'll leave it there, but there is a lot of good information out there about this.

Ultimately, any counseling is going to be better than no counseling, with few exceptions. That being said, I encourage everyone to do their research before choosing to use these services. There are many free resources available to find therapists offering accessible services without the legal and ethical issues posed by these sites. I encourage anyone who needs support to reach out as needed, I'm here to help!

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