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The Essentials of Online Counseling

Clay Cockrell, LCSW, is an expert when it comes to online counseling. Being featured on CNN, Good Morning America, The Wall Street Journal, and The NY Times this counselor has paved the way in the industry for online therapy. After moving to New York, Clay opened up a small practice because of his ‘love of stories’. He expressed, “storytelling is a primal thing for humans to do. If you use storytelling in the counseling realm and help a person change their story, you can help them change their life”. This is ultimately what drew him to psychotherapy.

Online counseling started when he found that he had difficulty with clients constantly rescheduling. He thought, “why don’t I just go to them?”. This is when was born. Clay and his clients would walk outside of their office, or even stroll around Central Park, and soon he found that this form of therapy took off. From there, the rest is history with Clay’s passion of reaching those that seem unreachable.

“Clay, what is the best advice you have ever received that relates to building a business and being an entrepreneur?”

Clay responded with one word – persistence. He went on to describe how perfection is boring, and you must allow yourself to make mistakes and not try to be perfect.

“So, what exactly is online counseling?”

The definition would be the idea of using technology to connect a therapist to a client. This practice goes by many names: E-counseling, E-therapy, internet counseling, online therapy, email therapy, and the list goes on.

Everything is changing because of the internet, and it was just a matter of time for psychotherapy to do this as well.

There are generally two main fears with this practice: HIPAA & State Licensure.

  1. HIPAA Compliancy -There are multiple ways we can connect with clients via the internet, but some are not HIPAA compliant (the main one would be Skype). -There are multiple other wonderful HIPAA compliant platforms – some are free, or some come with a small monthly fee. These were built for therapists. * * * * *

  2. State Licensure -Main lesson: You HAVE to be licensed in the state where your client sits. We think that licensure is where the therapist sits, but that is wrong. -How to get around this would be being licensed in multiple states, and utilizing that avenue with certain clients. Fortunately, there are no current regulations that prevent you from seeing clients all over the world. *Internationally speaking: In the US, there is one Mental Health Professional for every 790 people. In India, there is one for every 400,000 people. The massive mental health need across seas can be solved with this system.

  3. Has anyone ever gotten in trouble for counseling around state lines? No. But but it is important to follow state laws and rules.  

“So Clay, how do you get online clients and utilize marketing skills?”

  • Look at your website, and add a page that you offer online counseling. -Use some keywords such as: ‘online counseling’, ‘e-therapy’, ‘HIPAA compliant’, ‘connecting over internet’, and so on. -Explain exactly how you do the therapy and list some benefits and downsides.

  • is exactly like, except it is not limited by zip code. Clay’s website spans far greater than that – it is basically Psychology Today for therapists that are working online.

“When someone contacts you, what is your process?”

Clay makes sure he does a mini mental status exam. He asks crucial questions such as:

  • How did you find me?

  • Have you been to counseling before?

  • What issues are you currently dealing with?

It is important that your specialties and expertise are going to meet the clients need, the risk level is minimal, and the client can participate fully utilizing technology.

“What is your payment method?”

For the payment, Clay is aware of the different economies – he values his time and charges his regular rate, and he does have a sliding scale based on need. For example, if someone in Nigeria contacts him and does not have the ability to pay his fee, he makes a decision based on the need and ability to pay.

Generally, he does a full fee and utilizes PayPal in order to convert the correct currency.

“What are your hours?”

One great asset for scheduling is This is a free site where you can put in your time zone, and theirs and determine the difference. This is great for working with couples online – if one partner is deployed, perhaps the husband is in Dubai and the wife is in Denver.

“With working with couples, when interesting dynamics present themselves, what is that like?” –Earl Lewis, NJ

This is a way for the couple to connect without the heat of being in the same room in the case of high conflict issues.

“Is there something that is missed because I’m not in the same room?”

There is a learning curve, but there can be so many gains: convenience, the couple living apart because of military/work, etc.  Another thing that can be considered a positive and negative is “online disinhibition”. This means, for example, that some clients are more apt to say things online than they would say face to face. This can then translate to online counseling when, for example, the partner could say things that normally they wouldn’t have the courage to say in person. Because of this, you have to set boundaries just like traditional marriage counseling.

“In regards to safety issues, what are your steps for that?”

When beginning a session, it is imperative that you research the local police departments in their local city, retrieve their home address, a crisis contact, and also have their informed consent. All of things are going to protect the client and you as a therapist.

“Clay, what do you want to make sure our listeners take away from this message today?”

Do not be scared. There is a world out there in need and in pain. Be informed. Put something on your page and market. Set it and then wait for the world to come to you.

Clay’s giveaway is reducing the price of his online directory – from $24.95 per month to $19.95 for all of Startup Nation listeners!  To retrieve this, on the checkout page, click on ‘List My Practice’ and put in the code: K2DISCOUNT. This site gives a majority away to the non-profit arts, so you are supporting a great cause.

Be sure to check out the Show Notes page for Clay’s great book recommendation as well!

CLICK HERE to listen to Clay’s podcast, and be sure to check out his recommendations! Assure you subscribe so you can stay in the loop of ALL the podcasts we release. The Private Practice Startup would also be super grateful if you could rate and review our podcasts.  Thanks again for allowing us to Inspire YOU from Startup to Mastery!



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