Monthly Archives: June 2016

From the president: Meeting challenges with positivity and hope

By Catherine Roland June 30, 2016

Catherine Roland, ACA's 65th president

Catherine Roland, ACA’s 65th president

Dear Counseling Colleagues,

This month, I assume the presidency of the American Counseling Association, an organization I have called my professional home for 30 years. The roles I have taken on in my career as a professor, mentor and leader have all been shaped by my identity as a professional counselor. I am filled with pride at our great profession’s impact and what so many of you are doing each and every day. We are a dedicated, bright, empathic and wise community of professional counselors, in all venues where counseling takes place.

It is both very exciting and just a bit ominous to serve as the 65th president of ACA. Within that wide berth of feelings, I think humility emerges for me as the element that has always allowed me to practice, teach and mentor in what I hope some would say is an effective manner. My desire is that ACA will work with its divisions, regions and branches to continue our efforts at improving the profession and enhancing the work we do with our clients and students.

I’d like to share with you the general goals for my year as ACA president:

  • Focus on inclusion of marginalized populations and advocate for accessibility of counseling services for all those who seek counseling.
  • Through an adult development perspective, explore the diversity within each life stage of the LGBTQ population, within the lens of intersectionality.
  • Continue the good work of President Thelma Duffey (2015–-2016) in support of all members of our counseling profession.
  • Focus on mentoring toward leadership within the counseling profession to enhance various aspects of diversity at the state, regional and national levels, thus bringing a voice to all counselors.

In a future column, I will share how we can work together collectively, on various levels, toward the accomplishment of these goals.

We have a particularly challenging year ahead of us, both as ACA and as professional counselors who are dedicated to service and providing exemplary practice to constituents in clinics, schools and private practice in an entirely open and nondiscriminatory manner. A little over a year ago, I never would have dreamed that my first communication to my counseling colleagues would need to include the next sentence: We must continue to defend and protect our ACA Code of Ethics so that we remain the shining example of who professional counselors are and how we regard all people and our profession. Challenging, yes. Counselors, are we up for that challenge? You bet we are!

The concepts of my presidency are reflected in these words: positivity, hope, action and identity. I ask you to join me in embracing these actions because the challenges to marginalized communities such as the LGBTQ population are real. We remember that marginalization of certain groups has traveled through history for a number of cultures. We must speak and advocate, as we have done in the past, for nondiscriminatory and nonjudgmental counseling practice.

Advocacy, although an interesting concept to ponder, actually begs action. It’s a “doing” word. Advocacy requires us to show up, write something, join a group, and be verbal and vocal. There seems no better time to advocate for professional counselors, our constituents and the profession than right now. I want to offer my colleagues encouragement to remain positive, generate hope and stand together, with courage, confidence and an absence of fear to do the work we are here to do.

Our counseling identity and the ACA Code of Ethics are vital to the profession. Regardless of any state laws that may be discriminatory in nature and based on hate, we must stand firm in our convictions as professional counselors. No one can do it better, more fully or more skillfully than we can as professional counselors, counseling students, professors, mentors, supervisors and leaders.

I have had a long and rewarding relationship with ACA through various leadership roles. I am certain that, in concert with our excellent and innovative ACA leaders, ACA staff will continue the wonderful and sage support I’ve known for many years.

Very best,

Catherine

croland@thechicagoschool.edu 

Counseling’s connector-in-chief

By Bethany Bray

When you see Catherine Roland at a professional event, the number of lives she has touched throughout her career soon becomes clear.

“You can go to any American Counseling Association conference, and when [Roland] walks down the hall, people are constantly stopping her, running up to her, hugging her. She’s left behind quite a trail of very accomplished people,” says Vincent Viglione, clinical assistant professor at Fairleigh Dickinson University in New Jersey. “Without her, I would not be where I am today. And it’s not just me. She gives constant, very intentional support, good advice and goodwill through it all. She’s very interested in the betterment of the profession.”

Roland, chair of the counseling program at the Washington, D.C., campus of the Chicago School of Professional Psychology, becomes the American Counseling Association’s 65th president on July 1.

“I think of her as the pied piper of counselor educators. She has a gift for it,” says Larry Burlew, a retired counselor educator and licensed professional counselor (LPC) who worked with Roland at the University of New Orleans and Montclair State University. “She draws people in and knows how to connect well with people. She’s extremely friendly, very loyal and high energy. She’s the glue. She glues people together.”

Many of Roland’s former students have gone on to educator or leadership roles within the counseling profession. Some now pass on her example of mentorship to students of their own. A case in point: Monica Osburn, a past president of the American College Counseling Association, says she was one of five students from her Ph.D. cohort with Roland at the University of Arkansas who went on to become ACA division presidents.

Richard Balkin, another member of that Ph.D. cohort and a past president of the Association for Assessment and Research in Counseling, says Roland’s legacy extends to the students he graduates as a professor at the University of Louisville. “They all know who Catherine Roland is. They see her as part of their lineage,” Balkin says. “It really is an ACA family that she has created. … She’s very good at making connections. She’s very relational in her leadership approach. That’s one of the real treats of knowing Catherine and working with her.”

Although Roland has held many titles throughout her career, she says her role of mentor is one of the most important to her. “I was mentored well, and I’ve always thought that was important. You pay it back,” Roland says. “It’s something that you give to someone, and they give it to other people. … My book of students past is very long, and that is such a gift.”

Career journey

Roland brings a diverse skill set to the ACA presidency. She has worked in private practice; in student affairs as a college dean, residence life director and director of a college counseling

Catherine Roland, chair of the counseling program at the Washington, D.C., campus of the Chicago School of Professional Psychology

Catherine Roland, chair of the counseling program at the Washington, D.C., campus of the Chicago School of Professional Psychology

center; and as an educator, both in public school classrooms and as a counseling professor.

As a counselor, Roland’s areas of focus and expertise include LGBT issues, trauma and aging. She is a past president of the Association for Adult Development and Aging, a division of ACA, and has more than three decades of experience in private practice counseling couples, families and individuals. She has also been employed both at small private colleges and large state universities. A native of Long Island, Roland has worked and studied in eight different U.S. states, plus the District of Columbia.

Roland began her career as a high school English teacher at an inner-city school in Cincinnati, where she became good friends with a co-worker who was a school counselor. Through that friendship, Roland became more interested in the ways that counselors could support students and meet their needs.

“I took a couple of master’s classes in counseling, and I knew that was it,” Roland says. “When I was in doctorate work, I just fell in love with the clinical piece of [counseling]. I have always dealt with people of all ages. Counseling, in general, fits my personality very well. I really like working with families, couples … and some of the more difficult stuff — trauma, death and dying, and grief.”

After earning her master’s degree and doctorate from the University of Cincinnati, Roland transitioned from classroom teaching to student affairs, working at universities in Philadelphia, just outside New York City and New Orleans. She spent a decade in full-time private counseling practice in New Orleans before becoming a college professor.

While living in New Orleans, Roland was very involved in providing support services, both as a volunteer and as a professional counselor, to those in the community affected by AIDS. This was in the 1980s, when little was known about the disease and a crushing amount of stigma was attached. People would often lose their jobs because of the diagnosis, Roland says.

“There were no medications. … We didn’t know back then. We thought it was a death sentence,” she says. “I devoted most of my practice and personal time to HIV/AIDS work, and that’s what shaped me. It changed my life, and it changed my practice as well. I started doing a lot of pro bono work. … It was a very difficult time in the city, very tragic.”

Roland says she got involved because more and more of her clients were getting sick with HIV/AIDS. As a private practitioner with a background in student affairs, she frequently received referrals to work with young men and college students. When clients couldn’t pay, she counseled them pro bono.

“I can’t even begin to say how many personal friends I lost, one after the other after the other,” she says. “Of course, if you had the [counseling] license and the degree, you wanted to help. … [This experience] is part of who I am. These are the things that shape us. I learned a lot about adversity. It’s what you did. It’s not something to be congratulated [for]; it’s just what had to happen.”

Roland was involved in numerous agencies and nonprofits that supported those affected by HIV/AIDS in New Orleans in the 1980s and early 1990s, including serving as chairwoman of New Orleans Women Against AIDS. She also helped cowrite a training manual for HIV/AIDS counseling that is still used in New Orleans today.

Roland spent many hours counseling clients in a clinic that was housed in a New Orleans church basement. The operation was kept very hush-hush because of the stigma that was prevalent at that time surrounding AIDS. Part of the work involved opening a sealed envelope with the client that contained the person’s test results. Roland would then counsel the client about the diagnosis, which was most often HIV-positive.

“The indignity those guys must have felt, sitting in a cold room in the basement of a church,” Roland recalls. “You [the counselor] are on one side of the table, and the guy comes in, and he’s never seen you, you’ve never seen him. You’ve got an envelope in your hands which hasn’t been opened yet, so I’m also surprised when I see [the test results]. It never occurred to me that that was hard to do. In retrospect, it was horrendous. It was just what you did. Someone had to do that. … I think back, and I’m so happy to have been a part of that, so proud to have been a part of that.”

A mover and a shaker

Many of Roland’s former students say that she possesses the ability to see qualities and potential in people that they may not recognize in themselves. She is described as the type of mentor who applies pressure when needed but also gives students enough room to grow and learn on their own.

“There were times with me when [Roland] needed to sit back and let me go, and times when she needed to provide more mentorship or challenge me,” says Balkin, an LPC and ACA fellow who is the editor of the Journal of Counseling & Development. “I think she struck that balance very well.”

“She truly is one of the most intuitive people that I’ve ever met. As a student, that was kind of scary. You felt like she was peering into your soul,” says Balkin with a chuckle. “But that allows her to form deeper connections. … It’s not just what you do, but how you get there. That’s important to her.”

Osburn, director of the counseling center at North Carolina State University, describes her former professor and dissertation chair as a “seed planter.”

“She’s so unassuming. It’s just a series of small, building-block snippets that help turn you into this person you’d never thought you’d be. No one moment defines it. It just solidifies over time,” says Osburn, an LPC supervisor. “She is a quiet leader, intentional and thoughtful. She really has a knack for making you feel [that] you are the most capable and worthwhile person, which gives you the confidence to take a leap of faith that you maybe didn’t think you were ready for. And she’ll always be there to catch you if you fall too.”

“She sees things in people that they don’t even see themselves,” Viglione adds. “She sees their strengths, what they need, and she orchestrates it for them.”

In addition to being an intuitive and relational mentor, Roland is a visionary leader who is very driven, according to several people who know her well. “She’s extremely kind and giving of herself, her heart and her time,” Osburn says. “She is this unassuming, always-smiling person, but don’t let that fool you for a second. She is sharp — and fiery if she needs to be.”

Viglione, an LPC and clinical supervisor who has a private practice in Denville, New Jersey, studied under Roland at Montclair State and later worked with her in private practice, sharing an office. He expects that Roland, as ACA president, “will be a driving force — an absolute driving force. I’ve never seen her back down from anything or take shortcuts. She’s pretty straightforward. She knows what she wants, what she needs, and she pursues it single-mindedly. She’s a mover and a shaker, without a doubt.”

Viglione and Burlew saw these attributes come out in Roland as she worked to build a doctoral program at Montclair State a few years ago. When Roland joined the faculty at Montclair State, the university’s counselor education program offered only a master’s degree track. She soon crafted a proposal to introduce a Ph.D. program for counselor education and presented it to the university administration.

A Montclair State dean initially said no to the proposal, Burlew remembers, because the university was considering the creation of several other programs at the time. But that didn’t stop Roland. She worked diligently to rework, edit and finalize her proposal, and the school’s president bumped it to the head of the queue, according to Burlew.

Montclair State’s Ph.D. counseling program, of which Roland was the inaugural director, came to fruition in less than two years. At the time, it was the only counselor Ph.D. program in the tri-state area of New Jersey, New York and Connecticut, Viglione says.

“She hand-picked the professors, designed [the program] and made it happen,” Viglione says. “Everything she puts her hands on, she makes it the best possible thing it can be.”

Burlew also credits the program’s existence and growth to Roland’s effort, vision and initiative. “She just kept at it  [even] after people said, ‘This is never going to happen.’ … It was just like a whirlwind. It was like lightning. That’s how she works. She does things 200 percent. If it’s really important, she’ll figure out a way to work through barriers.”

Catherine Roland, surrounded by students from the first counselor Ph.D. cohort at Montclair State University, at a farewell dinner held for her as she was leaving the university in 2013. Roland was instrumental in creating the university’s counselor Ph.D. program. The students gave her this photo in a frame inscribed with the words “Thank you for believing in us!”

Catherine Roland, surrounded by students from the first counselor Ph.D. cohort at Montclair State University, at a farewell dinner held for her as she was leaving the university in 2013. Roland was instrumental in creating the university’s counselor Ph.D. program. The students gave her this photo in a frame inscribed with the words “Thank you for believing in us!”

The year ahead

Roland is taking the reins at ACA during what may appear to be a turbulent time. In May, the association announced its decision to move its 2017 annual conference out of Nashville after Tennessee passed a law allowing counselors to deny services to prospective clients based on “sincerely held principles.” Denying services based solely on a counselor’s personally held values is a violation of the ACA Code of Ethics (see cover story for more details).

Roland served as president-elect during the past fiscal year under outgoing ACA President Thelma Duffey. As president-elect and a member of the ACA Governing Council, Roland was involved in the discussions and decision to pull the conference out of Nashville. Roland says she is aware of and prepared for the extra demands that will be placed on her and the association in the year ahead.

“I never thought it would be an easy or a simple thing to be president, but this year more than ever, it will be more complicated and intricate,” Roland says. “It’s going to be a challenge, and I’m up for the challenge. … I think I can approach it with a good heart, ready to learn as much as I can, in addition to what I’ve learned [already].”

“Catherine is very approachable,” Burlew says. “If you feel things should be going in a different direction, you can talk to her and she’ll listen. She has an open-door policy. You can walk right up to her as an ACA member, and if she thinks action needs to be taken, she’ll take action.”

Balkin believes that thanks in part to Roland’s previous experience and professional focus on issues affecting the lesbian, gay, bisexual and transgender community, she is the right president at the right time for ACA. “She’s very in tune to the issues that are at the forefront of ACA today,” he says. “I think she’s going to have a very well-timed presidency. … She is a capable person who will, I think, articulate very clearly, compassionately and very empathically the direction that ACA is moving the profession.”

While serving as president, Roland says she will have two focuses: life span development of minority populations and bringing ACA’s branches, divisions and regions together for mentorship and leadership.

“I think we have a lot of things in common among us as far as ACA’s regions, divisions and branches [go]. I want to tap into that. We’re more alike than we are different,” Roland says. “I believe we have more common ground than we understand, and I want to harness that common ground. From that stems the best kind of leadership and leaders.”

 

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Meet Catherine Roland

Degrees: Ed.D. in counselor education and M.Ed. in guidance and counseling from the University of Cincinnati; B.A. in English literature and education from Marshall University in Huntington, West Virginia

Licensure: Licensed professional counselor, national certified counselor and licensed clinical supervisor

Has taught or worked at: The Chicago School of Professional Psychology, Washington, D.C., campus (current position); Georgia Regents University (now Augusta University), Augusta, Georgia; Montclair State University, Montclair, New Jersey; University of Arkansas, Fayetteville, Arkansas; University of New Orleans; Delgado Community College, New Orleans; St. Mary’s Dominican College, New Orleans; Manhattanville College, Purchase, New York; Temple University, Philadelphia; and University of Cincinnati (as a graduate assistant)

What ACA members may not know about her: She currently works a block and a half from the White House. She’s an only child from an Italian American family. She’s an animal lover and a self-described “cat lady.” She loves to travel (Cape Cod, New Orleans, New York City and the Maine coast are her favorite destinations). She also enjoys being outside and taking walks, photography, needlepoint, knitting and going to plays, musicals and museums. Her taste in music is wide-ranging; her favorite genres are opera, country music and rock ‘n’ roll.

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

CEO’s Message: Advance appreciation all around

By Richard Yep June 28, 2016

Richard Yep, ACA CEO

Richard Yep, ACA CEO

Over the past several weeks, a number of men and women completed their years of study and have been awarded graduate degrees. They can now refer to themselves as professional counselors or counselor educators. Some of these highly trained individuals will go on to serve clients and students well beyond the middle of this century. To each of these men and women, congratulations. Know how appreciative we are of the contributions you will make.

Some of you reading this column were instrumental in supporting, educating and guiding these recent grads in your roles as counselor educators and supervisors. That means you have “paid it forward,” and your impact on the profession will likely carry on long after you retire. Thanks, both to our recent graduates and to those who brought them to this point.

Each July signals the beginning of ACA’s program year. This means welcoming a whole new cadre of individuals who have chosen to volunteer their time, experience and scholarship in service to the profession. Led by our new ACA president, Catherine B. Roland, our new board and committee members will make significant contributions to many areas of counseling. The staff and I express our appreciation in advance for the work they will undertake during the next 12 months.

I also want to thank all of you — our members — for your patience and understanding as the ACA staff worked to identify a new location for our 2017 Conference & Expo, which originally was planned for Nashville, Tennessee. As many of you know, a new law in Tennessee now allows counselors to deny services to anyone based on the provider’s strongly held beliefs or values. This is a violation of the ACA Code of Ethics. Once the legislation became law in April, the ACA Governing Council made the difficult decision to relocate the ACA Conference & Expo. This is the first time in ACA’s history that this type of action has been taken, and it was done only after a great deal of discussion and thought.

We received numerous responses from cities around the United States that wanted to host our conference. By the time the “request for proposal” period had ended, more than 20 cities had expressed great interest. We are pleased to announce that the 2017 ACA Conference & Expo will be held in San Francisco March 16-19, with Pre-conference Learning Institutes taking place March 15-16.

We expect the 2017 ACA Conference & Expo to be one of the best ever, and we strongly encourage you and your colleagues to join us for our 65th anniversary event. The networking opportunities, the speakers, the content sessions, an improved career center and the chance to come together as a community after such a challenging year are things that you won’t want to miss.

Last but not least, this is one of those times when I absolutely must give a shoutout to the ACA staff. Each day, these fine individuals come to work to provide for the professional needs of our members, potential members and the public. As we begin each new endeavor — and continue to make enhancements to existing products and services — I am in awe of what has been and is being accomplished. I hope you will join me in my support and acknowledgment of these fine individuals. This past year was one of great accomplishment and challenge. The volunteer leadership was instrumental in providing strategic direction, and the staff’s ability to align our work with that direction is something for which I am very appreciative.

As always, I look forward to your comments, questions and thoughts. Feel free to contact me at 800.347.6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter: @RichYep.

Be well.

 

Nonprofit News: Taking insurance and charging fair fees as a nonprofit

By “Doc Warren” Corson III

NonprofitNewsOne of the great things about writing for CT Online is the correspondence I receive. This month, I have selected one of those pieces of correspondence that poses some questions about nonprofit counseling practices.

For ease of reading, I have broken it down with bullet points and answered as best as I can. Please remember that I am not a tax or law expert, so my answer shouldn’t serve as a replacement for a proper consultation with professionals in those fields.

 

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Jennifer Hurley writes: “I am a licensed professional counselor from Michigan thinking about starting a nonprofit counseling practice. I am wondering if you’re still able to take insurance for services as a nonprofit? If so, how do you separate insurance income earned from grant money and charitable sliding scale fees? Would a portion of insurance income go to the nonprofit, or does the clinician keep insurance profits and do pro bono work for the nonprofit? I have a genuine need to help people and want to cover all my bases before I decide how I will start my own practice. Can an employee of the nonprofit get a regular paycheck (with taxes taken out) and file their taxes yearly? As a counselor who runs a nonprofit, works for the nonprofit and accepts insurance, how do you file your taxes? Would an administrator of a nonprofit be on the payroll and receive a check with taxes taken out and pay taxes yearly [with] all private pay insurance earnings going to the agency? Or could an administrator of a nonprofit provide counseling services and keep all money earned from those services while also overseeing the agency? I guess I’m confused about making money as a nonprofit and growing as a nonprofit while spreading the wealth of the nonprofit in a charitable way. Are counselors who work for a nonprofit required to contribute a portion of their income to the nonprofit (like a 60-40 split)?”

  • Are you still able to take insurance for services as a nonprofit? A nonprofit clinical agency is simply one that puts products and services above profits. You can indeed work with private health insurance companies and any other source of third-party payer. In fact, most nonprofit clinical agencies contract with major and minor insurance carriers. You can also make a profit on any goods or services as long as that profit is not excessive and your primary purpose is not making a profit but instead providing a public good.
  • How do you separate insurance income earned from grant money and charitable sliding scale fees? This is done via accounting but is not that difficult. Grant money can be limiting depending on the grant (the same goes for donations). Some funding will tell you what it can and cannot be used for. For example, it may stipulate that the funding can be used only for services, repairs or another specific use. If the grant money or donation does not have a stipulation attached, then the board of directors or financial officer can apply it wherever the agency needs it to go. For the most part, the charity’s income can be used wherever it is needed — be it on salaries, repairs, expansion, etc. — unless the money had specific limitations when it was received.
  • Can an employee of the nonprofit get a regular paycheck (with taxes taken out) and file taxes yearly? All employees of a nonprofit need to receive a regular paycheck with all applicable taxes taken out and paid to the appropriate government agencies. Although the charity itself is exempt from taxes, the exemptions do not apply to employees or to payroll taxes. Your accountant or payroll professional will typically set this up for you. Payroll taxes are paid and filed quarterly.
  • As a counselor who runs a nonprofit, works for the nonprofit and accepts insurance, how do you file your taxes? This process is the same for any employee, regardless of whether that employee works for a for-profit or nonprofit agency.
  • Would an administrator of a nonprofit be on the payroll and receive a check with taxes taken out and pay taxes yearly with all private pay insurance earnings going to the agency? Any employee for a nonprofit agency would have taxes taken out by the employer, although the means of pay may differ. For the first decade or so of my charity, I was paid a percentage of what I actually made for the charity via services (meaning any pro bono session that the agency had me do was also a no-payment session for me). Later, as we grew and things got more complicated, I was moved to a salaried position. Now, no matter what I earn for the company and no matter how many donations or grants we receive, my pay is set at a yearly amount and paid out on a biweekly basis.
  • Could an administrator of a nonprofit provide counseling services and keep all money earned from those services while also overseeing the agency? The short answer: Yes. The longer answer is that pay would depend on the administrator’s contract. The contract is developed by the board or financial office and agreed to by the administrator/employee. Any money paid typically would come in through the nonprofit, be processed by the nonprofit and paid out as needed. You would not usually have money from work at the nonprofit go directly to the employee from clients because this would likely cause some IRS-related issues and concerns beyond just that of tax liabilities.
  • Are counselors who work for a nonprofit required to contribute a portion of their income to the nonprofit (like a 60-40 split)? Nope, not a cent. Donations, by definition, are strictly voluntary. Some folks, however, do agree to a split percentage of reimbursement, meaning that they are paid based not on the session but on the fee collected for the session. This is far different than a donation but helps protect both the agency and the employee.

For instance, if the employee agrees to a set fee for service — say $25 per individual and $45 per group — this could end up costing one party or the other a lot of money depending on the setup. If the session is pro bono, then it would be a 100 percent loss for the employer. If, however, some sessions pay differently, a flat fee could really impact the employee.

Years ago, I worked as an hourly clinician and was paid less than $14 per hour. I ran four to five groups per day with as many as 19 people per group. My employer was paid on a per session basis by insurance. The insurance paid approximately 40-50 percent for a group as it did for an individual session. If it was 50 percent, my employer made the equivalent of 38 to 47.5 therapeutic hours for every eight that it paid me. My employer was also paid at a much higher hourly rate than I was paid even when factoring in benefits (which were few). Had I been able to negotiate a fairer percentage, I would have made out much better.

The bottom line is that nonprofits are not easy, but neither are they beyond our abilities. In many ways, the day-to-day operations are much the same as any other type of business entity. The main difference is that nonprofits serve a public good, whereas a for-profit is typically set up to show a profit not only for the business in general but also for any potential stakeholders (by definition, a nonprofit owns itself).

 

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Dr. Warren Corson III

Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org.

Technology Tutor: Inside telehealth: A personal account of messaging therapy

By Rob Reinhardt June 27, 2016

 

Author’s note: In the time since I originally conducted the following interview, a number of legal, ethical and privacy concerns have been raised about TalkSpace. These issues are not easily summed up and are best read from their original sources:

As I originally indicated in the article (below), it is imperative that counselors vet any third party they might use in the provision of counseling services. This includes a consideration for whether that third-party vendor, and the service it provides, fits into and meshes with the counselor’s legal, ethical and HIPAA compliance framework.

 

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There’s no denying that telehealth is quickly growing in use as a medium for delivering counseling services. (Read my previous article on the ins and outs, ethics and legalities of telehealth at tameyourpractice.com/telehealth.) Although most of the focus is on the use of synchronous video, other modalities are growing in popularity too.

photo-1430165558479-de3cf8cf1478Recently, I had the opportunity to interview Tasha Holland-Kornegay, a licensed professional counselor supervisor who has been providing “messaging therapy” to clients through a platform called Talkspace. The service primarily consists of asynchronous messaging via text or web, although some video and audio options are also available. I was especially curious to hear how she was addressing some of the ethical and legal issues raised by this format.

 

Rob Reinhardt: I’m very curious to hear about your experience with messaging therapy but, first, can you tell me a little bit about yourself?

Tasha Holland-Kornegay: I am a licensed professional counselor, and I’m also an HIV advocate and have an HIV nonprofit (Partners Against Sexually Transmitted Diseases at pastd.org/). I go out into the community and speak to family members and educate individuals. Believe it or not, there’s still a lot of misinformation out there about it. So that’s another piece of what I do on top of counseling. In private practice (at ourtreatmentcenter.com/), I work with individuals anywhere from the age of 3 up to seniors.

RR: Very interesting. What is it that led you to messaging therapy? What made you say, “This looks like a great way to provide counseling services. Let’s give it a try.”

THK: I think it was a couple of things. With my passion for HIV [advocacy] and counseling, I have a Facebook page that I use as an educational forum. But a lot of times, once people find out that I’m a counselor, I’ll get private messages, and they’ll start with, “I just got tested.”

I knew that Facebook wasn’t a secure way to respond to them, and the messages were coming from all over the country. A lot of times I would make my response very basic and general and refer them to their local health department and HIV counseling and remind them that the Facebook page was more for informational purposes. But I didn’t want to turn my back on them; I wanted to help them more.

The second reason was that I recently had a baby, and I was thinking, “Oh my gosh, I don’t know how I’m going to continue what I have been doing and still have time home with the baby.”

RR: What convinced you that messaging therapy would meet the needs of more people and provide you more time at home with family while still practicing ethically and legally?

THK: I was a little nervous and skeptical because you don’t want to cross state lines and you want to make sure your clients will get everything your face-to-face clients would be getting. I spent a good month researching and processing. I think Talkspace, the company I work with, probably thought, “Is it her again?” because I was asking so many questions. But I wanted to be sure people were getting quality service and help.

So, I did a lot of research on the company and platform before I took the plunge. The company really does things well. They only allow you to have two clients when you first get started, and there are a lot of other things in place that addressed my concerns.

RR: It sounds like you got the answers you needed to make you feel confident in moving forward.

THK: Yes, and they were very fast to respond, and that was another quality that made me very comfortable with the platform. It was pretty much within the hour that they would respond, and they were very welcoming and informative.

RR: What was the process like once you decided to move forward?

THK: They signed me up and put me through a vigorous training process. I felt like I was back in school. They send you thorough lessons on how to navigate the platform and then on how to handle the relationship with the client, and there were tests. They want to be sure they are getting quality therapists, so there were case scenarios and “how would you deal with this?” Then you do one-on-one training with someone who tests your knowledge of the system and does mock counseling with you to be sure you’re ready.

After that, they set you up with your first two clients, and you have to let those clients know that you’re new. After about a month in training, they let you take four more clients, and then you are transferred out of training and into a mentoring group. My group has about five people in it. It really felt like a full-blown training program to make sure the clients are taken care of.

RR: So the people at Talkspace take an active role in setting the clients up with counselors?

THK: Yes. In a space in the app, all the clients are listed with age, gender and a general reason why they are seeking services. Then I can go in and say that I’m a good fit for this client because of my background, training and techniques, and I provide details. The employee who’s called the “consultation therapist” may even ask you for more details about why you’d be a good fit. Kind of like, what are you going to bring to the table for this client, because we want to make sure you’re a good fit. From there, they decide which therapist to assign the client to. Once you’re assigned, you connect with the client.

RR: Apart from the platform and environment, what has been different about providing messaging counseling from providing counseling services in your office?

THK: Because it’s unlimited texting and the clients take advantage, some clients will write a lot of journal entries. When I log in, there’s a lot to read and catch up on. I’d say 80 percent of my clients are active every day. So it feels like a lot of contact, unlike sessions in my office, where we meet and then go a week between.

I go into the platform five days a week, twice a day, and spend an hour and a half to three hours at a time replying to clients. You really end up forming a relationship with clients because you’re interacting with them a lot.

RR: If I understand, this process is asynchronous. You aren’t actually texting directly back and forth with clients, but rather reading and responding at different times of the day, unless they happen to be on at the same time as you.

THK: Exactly, unless they request it. And I’ve only had that happen once when a client was really antsy about a job interview and wanted to direct-message a couple hours before the interview. They do have a video option now, though I haven’t used it yet. People are working all day, and time zones are off, so it’s convenient for people to get it out and then wait for a response.

RR: Do you find yourself working with clients similar to those in your office?

THK: I’m currently dealing with a lot of clients with anxiety and relationship issues and some depression. It’s probably 75 percent clients dealing with anxiety. I’m not sure if that’s because I’m actively picking those [cases] or because of other reasons.

RR: I can see that making sense because people dealing with anxiety may be more likely to use online services.

THK: Yes, and I do see that a lot of these clients are experiencing counseling for the first time. They also find it to be really convenient, especially if they work a lot and don’t have time to go to a therapy office.

RR: In talking about what is different between counseling in your office and online, I thought you might say that working with clients online was briefer because these clients are looking to address a singular issue quickly. Has that been your experience?

THK: Actually, much like in the office, people will come in with surface issues and then later open up and reveal other layers — talk about their childhood and the fact that they’re actually experiencing anxiety in a lot of situations, for example. I’m finding myself working with clients over a period of time similar to [what I would] in the office.

RR: Do you find it challenging to deal with the lack of social and communication cues such as facial expression and tone of voice?

THK: The platform really does a great job of addressing this. They include the option to use audio, so if I feel that I’m not hearing a message clearly, I can propose to [the client], “For your next message to me, would you mind using audio?”

I also use a lot of emojis, and some of my clients don’t do written journals, they do voice journals. They can also send pictures to show me how they’re looking and feeling.

RR: So we can’t really refer to this as “text therapy” because it’s a lot more
than that.

THK: Yes, it really is. This platform was really thought out. It really answers a lot of the questions and needs in providing services in this environment.

RR: Speaking of questions, I know I have a lot of questions about how privacy and confidentiality, HIPAA (Health Insurance Portability and Accountability Act) compliance and other legal and ethical issues are handled. What things have you run into that you think are unique with this platform regarding those topics?

THK: The platform covers consent and not moving forward until you have the client’s consent. This includes clients consenting to working with you if you’re in a different state and that they agree to the license rules and laws of the state where the counselor is licensed. (Editor’s note: The American Counseling Association recommends that counselors check with the licensing board in the client’s state.)

I was also concerned about privacy. When clients and counselors log in, they are using their own username and password, and there’s a significant security and verification process that therapists have to go through.

RR: This concept of a client agreeing to abide by the laws of another state is an interesting one. I’m not an attorney, but I have to think the platform had its attorneys vet that policy. I’m not aware of it ever being tested in court though. This makes me wonder what might happen if a complaint is filed — how the courts or a licensure board might rule on it.

THK: I’ve thought about that, and I think we need to start somewhere. I think that it has been well planned and thought out. This is a national site with over 700 therapists. The client sees our full information about our license, and I think the wording in the consent is very tight.

I may well be in a “test group” because there are unanswered questions. We’re in a whole new world with technology, and we have to test it out. There are so many people out there who need help and may prefer to meet this way.

RR: Back to privacy. Is there any attempt on Talkspace’s part to verify the identity of clients? Are they allowed to stay anonymous?

THK: Talkspace verifies identity through things like credit card information. The client has the option of being anonymous with their therapist, but all of my clients tell me who they are and where they live. (Editor’s note: Standard H.3., Client Verification, of the ACA Code of Ethics states: “Counselors who engage in the use of distance counseling, technology and/or social media to interact with clients take steps to verify the client’s identity at the beginning and throughout the therapeutic process. Verification can include, but is not limited to, using code words, numbers, graphics or other nondescript identifiers.”) You’re building a rapport that’s remarkable like you’d never think you could do over texting.

RR: Because Talkspace does verify the client’s identity, does it have safety plans in place for crisis?

THK: They do. They warn clients up front that this isn’t an appropriate platform for crisis intervention. It states on the website that in crisis, clients should call the 24-hour National Suicide Prevention Lifeline at 1.800.273.8255 or 911.

And we do have a plan to address things as they arise. In addition to providing clients with local resources, we also always have a community and mentors to touch base with about situations to make sure that we and the clients get help if needed.

RR: You’re in a very interesting position of helping to innovate this new platform.

THK: Yes, and in some ways, it’s scary. But they have really done their homework with this platform and addressed the things I am most concerned about, so it helps me feel confident about working this way.

I think it’s fascinating that therapy and technology are finally merging in this way, and I feel good about it because there are so many people we haven’t been able to reach. This [lets] me know that I can help and reach more people and that I have a support system there that a lot of other people don’t have.

 

 

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Please note that I have not personally evaluated the Talkspace service. As Tasha Holland-Kornegay suggests, it is important that counselors fully investigate and evaluate any technology they might consider using to provide services to clients. This includes looking into the ethical implications of such use. Additionally, because state laws regulating telehealth vary widely, it is strongly recommended that you also consult with your state licensure board and a qualified attorney.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editor: ct@counseling.org