Remote Therapy and Continuity of Care

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A client I haven't seen for a while sent me the following:

"I just went online to schedule an appointment and was surprised to see you aren't coming to Park City any longer. When did you make this change? It is such a long drive for you I can understand but from a selfish perspective I am so disappointed! I just wanted to let you know that I am sorry to know you aren't available here in Park City any longer. Even though I didn't come to see you very often it was always a comfort to know you were here. Thanks for all you do."

I replied as follows:

I'm so sorry about the inconvenience and disappointment associated with my no longer coming to Park City. I greatly appreciate your trust and confidence in me. That means so much. I made this decision to close my Park City office a couple of months ago after much thought. I need to simplify the administration of my business as I am spending more time in my speaking and workshop delivery this year.

However, I do want you to know that we can still work together. Fortunately, due to the wonders of modern technology I am able to continue to work with clients who've moved away who now live all over the country and around the world via phone and/or video sessions (via Skype or Google Hangouts). The only difference here is that instead of them moving, I moved. While it's not quite the same as meeting face-to-face, it is amazing to me how really good it is—especially for you and I since we already know each other from meeting in person. In fact, I even have clients I've never met in person before (people who've been referred to me by other clients) and yet the quality of the relationship and personal connection we feel works extremely well. Just this morning I met with an American couple who live in China. We've been working together via Skype for a few months now and they find it very helpful. Most importantly for them, this option gave them the freedom and power to choose to work with who they wanted to work with vs. who was just available locally—and locally they didn't have many options to begin with in their area.  Further, tomorrow I'm meeting with another client in Colorado and later this week with clients in Texas and Norway.

Personally, for you and I, the ability of getting to work with someone you already know and trust is a major advantage of this technology. In the past, when a therapist or client moved that was it. There was no option for what in the field we call "continuity of care" and the client would be left with stopping counseling or finding a new therapist. More often than not the former was more likely as the thought of starting over with a new therapist, bringing that therapist up-to-speed, and not knowing whether or not it would even be a good therapeutic fit is all too daunting for many clients. But now there is the option for continuity of care.

So that's just one option: phone and/or vid sessions--which cost no extra as Skype and Google Hangouts is free and the costs of long-distance calling are a thing of the past. There are other options, too. I do have some clients who drive down to meet me at my American Fork office and others who have me come to home visits in Park City (there is the additional cost of travel time, of course).

Let me know your thoughts. I would love to have the opportunity to continue our work together and to be there for you.

Best,

Jonathan

See these related posts:

• Practice Builders: Technology and Remote Counseling.
• Telehealth: Giving Clients Greater Choice.
• FAQ: "I live across the country from you, yet I see you work with clients all over the world. How do you work with people remotely?"

Practice Builders—Technology and Remote Counseling

I wonder, I wonder, I wonder how technology will influence/change the nature of my field 10 years from now. National and International

10 years ago I never would've had clients in these states: Arizona, California, Colorado, Illinois, Kentucky, Michigan, Missouri, New York, Tennessee, Texas, Virginia, Washington AND these countries: Afghanistan, Canada (Alberta and Ontario), England, Mexico, Nigeria, Norway, ALL of whom I've been able to work with from the comfort of my own office and that they've been able to work with me from the comfort of their own homes or offices.

"Continuity of Care" and "Client-Centered" Realized

In the past it was local or nothing. Now my clients can choose who they work with. They can have real "continuity of care" rather than hope they find a good therapist when they move (and as we know, most don't make that transition to a new therapist successfully, and more than often drop out of counseling altogether). They no longer have to start over with someone new and tell their whole story fresh again. They have the freedom of continuing the work they began. And new clients from these places get to access who they want to work with. It is truly making it more and more client-centered, which is what we believe in this field, but sometimes isn't realized. Technology is giving my clients more choice and with choice comes power.

I am truly grateful for amazing technology and ALL the brilliant minds that have come together to make this all so "easy." Due props to all you awesome geeks and nerds out there!

Clients on Facebook? Okay or Not?

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Q: A therapist colleague asked me:

Do you ever say yes to a client's friend request on Facebook? And if so what are your rules about it? I have some that want to keep in touch with me after I move but I am just not sure and don't want to make a bad choice but there isn't much said about 'internet' and 'Facebook' stuff?"

A: Great question. Yes, I do. And yes, I know there's some controversy on this topic. I've read a lot on the subject and have given it a good deal of thought. Admittedly, for the field as a whole, this is still mostly uncharted territory. But it's one that isn't going away, and old school practitioners are going to find it hard to compete if they don't learn to adapt to where their clients are—which is where the market is.

For me and my clients, I'm all for embracing current technology and how people (our clients) communicate in real life. For example, I also do coaching via phone and Skype with clients all over the country and internationally. Some say it's not as good as face to face (I agree). However what it does for:

1. Continuity of care for clients is simply phenomenal,

2. Providing greater choice to clients in their selection of providers is unparalleled, especially in rural areas, as well as

3. Greater flexibility and convenience in scheduling (just consider the convenience of a single mother or young couple not needing to arrange for a babysitter).

Face-to-face cannot always provide for these three very significant factors. There are pros and cons for each method.

I've always been an early adopter of integrating technology in our field as well as being a proactive marketer of wellness rather than passively waiting for clients to find me. I believe we as therapists have specialized knowledge and skill sets that are too important to just wait in our offices until people's problems reach the crisis point that they then start searching for a therapist. I'd much rather people get to know a good therapist long before they "need" one... Then when the need arises they don't have to scramble "hoping" they find someone that will work. The latter does not seem like good client care to me. Giving them the chance to pre-decide way ahead of time is much better for all as it insures a more proper "fit" with client and therapist which predicts greater successful outcomes for both.

So, to answer your question here are a few points (in no particular order and by no means comprehensive) I use on Facebook:

1. First of all, I work with a high functioning clientele, so boundary issues are rarely (haven't had any yet actually) an issue. If I still worked for a community mental health agency I would very likely not "friend" my clients for the most part, even though they were wonderful people. Generally, in the discussion around where does coaching and therapy begin/leave-off, the thinking is that GAF (Global Assessment of Functioning) scores of 70+ are more "coaching" clients. That is open to debate, but it's the general thinking on the topic. When I say "high-functioning", though, that is what I'm talking about;

2. My Facebook page is first and foremost for networking, so I stay mindful that my posts and pics will be seen by clients, colleagues, referrers, as well as friends and family. So is what I post something I'd feel sharing posting on a bulletin board or discussing in a seminar? Yes. Sometimes it's clinical. Sometimes funny. Sometime personal. The point in both therapy and social networking is to always be real, relevant and relatable;

3. The broad mix of Facebook friends I feel provides the same anonymity and confidentiality that any other public social environment affords, such as the grocery store and the same rules there apply. For example, the client owns the relationship--meaning I won't acknowledge them as a client unless they want to self-identify publicly in a post that way such as, "You helped our marriage so much. Thanks!" Otherwise as far as anyone else knows they are just another acquaintance. It's similar if I run into a client in the grocery store--if they come up to me I'm happy to talk. If not, I politely avoid them to protect their privacy. If my kids ask who was that, I just say, "A friend of mine" to protect their confidentiality;

4. Contrary, to conventional practice (which some of the research now supports me) I do believe in a good deal of self-disclosure. Many clients over the years have expressed frustration that they want a great relationship with their spouse or kids but have never seen that modeled in real life. The medium of Facebook and appropriate self-disclosure provides that. I'm by no means THE model, but I am one very real life example of a guy doing his level best at practicing about 80% as a husband and father of what he preaches as a therapist.

5. I'm also pretty down to earth, silly and frank in my Facebook posts. This serves a dual purpose: 1. To remove the stigma of the stuffy, clinical therapist and 2. Markets myself to my ideal clients (ie., those who value plainness and authenticity) and screens out my non-ideal clients (ie., the ones who take themselves too seriously). This leads to a better fit on both sides. Potential clients get to "check me out" in advance and decide whether I will be a good fit for their style and their needs. Yellow Page ads and websites just don't give the same level of relate-ability or transparency that clients really want and value;

6. After all that, I re-read your question and realized I neglected to directly answer your first question. Yes, I do accept my clients "friend" requests (remember my caveat: I have a high-functioning clientele with good boundaries). I also didn't mention what is likely obvious: Most people don't consider Facebook "friends" to be the same as friends in the traditional sense unless their page is strictly limited to immediate friends and family. This is one reason I don't consider my client who is also my Facebook "friend" as being a dual relationship anymore than I would consider having a friendly conversation with a client I happened to meet at the grocery store a dual relationship.

Now there may be others who will say you should never "friend" clients on Facebook. And they may be right depending on the population they work with or their own preferences. However, for me it's worked great. Client feedback is they value it. My approach has always to be client-centered and customer-driven. So, bottom line: I'm all about effectiveness. If it works keep doing it. If it doesn't, don't.

Your thoughts? Other questions?

Peace,

Jonathan

This colleague then replied as follows:

“No, I agree, and it’s good insight too. I agree with what you have said. With my clients, I have always taken an honest approach. That when I felt I should share moments of my life. I have great relations with my clients. I know that for those who want this its a way for them to feel valued. That I didn't just toss them to the curb, even though I am moving away. That I value them as a person and am here if they still need me for anything, even though I will be 11 hours away. I know that there will be times when a few of them are going to get married and will want to do couples therapy. I want to use technology be able to do that for them or be able to give them a referral that I know will be good for them. I love the idea of Skype and all those ways in which you can have a session without having to be one-on-one. There is power in the relationship between a therapist and a client. To be a tool and means through therapy is important to me. I like your advice and will use it to help me professionally. It is wise and very helpful. It also helps me to remember that if I do this, what I say matters even more than it currently does on here, and that needs to stay the most important thing. Thanks, really, it was truly helpful.”