Adventures in Online Counseling

[Art Matthews, MA LPC DCC]

I began using online therapy probably several years ago without even knowing it. I would have little conversations with clients who were canceling appointments or who were exploring if they wanted to enter counseling. Even though I was clear email was not very secure, they would send me emails and rarely ever wanted to talk over the phone. I've begun using chat as a form of counseling just in the last two years with students of mine who are out on clinical rotations (I have a day job of being a Professional Counselor for the students at the university where I'm employed). I've used video conference and chat using Skype.

Recently I signed up with several online counseling websites to earn extra money after hours. If you are considering this option, don't (do not) quit your day job. It's been difficult to get started and all I hear from the "old timers" in the field is that this is a very slow time for everyone related to the economy.

The sites I've been on include LivePerson "a world of experts" (sketchy reputation with "Spiritualists", Psychics and various unlicensed folks offering themselves up without much regulation from the site), Ether.com and ingenio.com (same org, different sites - only allows for phone counseling, no chat or email) and mytherapynet.com (very slow to get started but the most professional in that they actually verified all my claims and wanted me to have proof of insurance coverage).

I have discontinued with Ether and ingenio just because I felt I was spreading myself too thin and I really don't like phone counseling. Text is much better to me because both the client and I have a chance to reflect before responding and craft our messages. All have been a per minute charge so the client is focused on not wasting time, which can be problematic if they or you can't spell or type well. But they don't get into too much storytelling. I have had to fight the pressure to perform quickly and to push myself to ask questions when I want more info even though the client is wanting advice. I have had some return clients but not unlike F2F (face-to-face) counseling. There is a number of clients who do not return.

In my first month on LivePerson, I did not earn enough for them to send me a check (needed to earn more than $50 before they would issue a check. It took two months and I earned $128. This month I am up to $182. That does not reflect my complete billing, that is my portion. LivePerson keeps a portion... a sizable portion... to promote the site and provide us with online "office space". They have a fairly useful chat function and email with file sharing capability. The Expert Forums are close to your only way to communicate with fellow "Experts" unless you send them a client request and then you have all this issue with emailing back and forth without charging each other.

BEWARE: do not share any outside contact information with a client or another Expert. LivePerson is a vengeful god and will suspend you even when you do so without the intention of stealing clients away.

The cost of doing business with LP is high. My total billing for the month is around $350 and I am taking home $180. 'Nuf said.

The risk to clients and counselors alike seems high for a number of reasons, mainly related to site structure and limiting access to the posted requests for counseling and the LP Third Party Verification system. I have reported my concerns numerous times (to the point that LP is not happy with me) and little seems to change. Since I have had the most luck with LP, I am choosing to stay and hoping I can influence change from within. I do not know for certain but I believe that LP site developers are all internet developers and none have any expertise in the field of counseling or mental health. Client confidentiality is touted but LP staff apparently read email communications between counselor and client (I was accused of steering a client away from LP because of an email I sent to another Expert). LP must have some scanning software that looks into emails for suspicious activity and then staff read to verify. Guessing here but how else would they know? Also counselors are severely limited in that they can learn about their clients (such as client's actual name, address and phone number), so arranging emergency care or making mandated reports is more complicated. Old timers on the site claim they have never been limited or threatened with suspension when they made requests, however I made a request for contact info because of a mandated reporting issue and LP Customer Service threatened to suspend my account and said I could only request information in the case of threatened suicide. Again they had to have reviewed the client's communication in chat with me to see she hadn't threatened suicide, but they had no clue there was any other reason for needing that information.

I am going to a two day training this week for Distance Credentialed Counselor and will decide following this training how I want to proceed. I reported some of my concerns with the site to the Ethics Department of the National Board of Certified Counselors and was cautioned to get legal advice related to continuing to work with LP.

[Art Matthews, MA LPC DCC]

Yes and no. LivePerson oddly enough doesn't let cousnelors work under the Coaching heading unless you have a certificate or document that you can forward them that shows you are training in coaching. I've considered providing coaching as another career activity but I'm really a counselor. I think I just need to work on finding a site or creating my own that will allow me to feel really comfortable with the ethical and legal pitfalls associated with LP.

[Steve Borgman]

Have you considered going down the coaching road, so as to avoid some of the ethical quagmires that seem to surround offering traditional psychotherapy online?

[Art Matthews, MA LPC DCC]

Thanks, Mark. I will definitely get that article. I'm very concerned at the number of "professional" counselors on the site that seem shocked when I question LP policy/procedure and suggest the site follow ethical guidelines laid out by professional organizations... of course most of those rebuking me are folks who have been on LivePerson for some time and have a clientele built up (don't mess with their success). I am very encouraged to see places like the Online Therapy Institute, the International Society for Mental Health Online and specific attention paid to online ethical considerations by the National Board of Certified Counselors.

How do we stop the destruction of our collective professional reputation at the hands of our colleagues?

[Mark Nixon]

Thanks for sharing your experience!

If you're interested in learning more about what goes on behind the scenes at Liveperson, in addition to comparing your experience to a published case study of another professional extending their services via LivePerson, check out the following journal article. You're right about "LP must have some scanning software that looks into emails for suspicious activity and then staff read to verify" according to this article.

Finn, Jerry and Bruce, Sharon(2008)'The LivePerson Model for Delivery of Etherapy Services: A Case
Study',Journal of Technology in Human Services,26:2,282 — 309

Feel free to contact me for more information. :)