Episode 109 - All About Email - Therapy Tech With Rob and Roy

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Rob and Roy discuss reasons why therapists need to use email, email, marketing, and email security. They are joined by Allison Puryear who presents her controversial opinion on email marketing for therapists in private practice.

Resources

Hushmail – Rob and Roy’s choice for secure, encrypted email communication. Sign up through our links here and save 15% for life!
Allison Puryear – Founder of Abundance Practice-Building and the Abundance party!
3 Kinds of Email Security: How to Make an Informed and HIPAA-Aware Choice (PCT) – That article Roy refers to in the episode
Making Good Choices About Using Email, Text, Voice, and Apps with Clients (PCT) – Roy’s article series about email and texting in practice

Show Notes

:13

Why Would Therapists Use Email?
2:20

The Essential-ness of Email
3:55

Asynchronous Benefits
7:11

Referrals
11:15

Marketing – Mailing Lists
13:00

Guest Spot – Allison Puryear – Controversial Opinions About Email Marketing Lists for Therapists
26:25

Describe Question – Allison, Tell us about a time when you felt powerful.
33:33

An Option for Email Marketing
35:06

Mailing List Tools
39:00

Email Security
40:19

Three Levels of Email Security
57:12

Informed Consent

59:45

Credits

Episode Transcript

Roy:	Therapy Tech with Rob and Roy, the most fun therapists can have listening to a podcast about technology.
	This episode of Therapy tech with Rob and Roy is sponsored by Hushmail, the secret to simple, secure communication. Hushmail.com.
	Welcome to episode 109. By that we mean season one, episode nine, of Therapy Tech with Rob and Roy. I'm Roy.
Rob:	And I'm Rob.
Roy:	This is our show. We're talking about email this month. It's kind of amazing, nine episodes, Rob, and we still haven't talked about email, it hasn't had its own topic yet.
Rob:	I know, we're kicking it old school, we're not talking about video or text, we're going old school and talking about email.
Roy:	Yeah, kicking it old school. Well, actually, speaking of old school, I have a story, which can segue into my question for you as a user of email.
Rob:	I always like stories.
Roy:	Stories are great, yeah. I heard this, this is a third-hand story, so it's going to get embellished in the telling, right? It was apparently an APA Trust CE sessions for psychologists, back in 2010-
Rob:	The olden days.
Roy:	The olden days, yes, everything had gold on it, it was gilded, and no one had any tech except for digital watches, this is so long ago, but they used digital watches to talk to each other. I don't know, I'm trying to make up historical things. Anyways, so it was a digital ethics training. Someone from the APA Trust, if you're not familiar with APA Trust, that's kind of the aspect of the APA where they do all the risk management advising, a lot of attorneys in the Trust, who help psychologists deal with legal, ethical issues and risk management. They have a lot of really good stuff.
	This training, apparently the trainer was a little behind the times, but someone ... He didn't say anything about email at all, email or texting, and someone asked about email, and the entire response, and the entire educational piece about email in this digital ethics training was, "Why would you want to use email?" That was the whole thing, he was like, "You wouldn't want to use email. Why would you want to use email?" That was apparently the entire response from this person. So, of course, people told me about it because they were like, "Wow, that was extremely unhelpful." I figure-
Rob:	That was nice and easy. That was buttoned up nice and easy, "Oh great, I just don't use email, that's simple. That keeps me out of trouble."
Roy:	I think that doesn't work very well.
Rob:	I think you're right.
Roy:	Yeah. Which is why I was going to ask you, Rob, why would a therapist want to use email?
Rob:	Yeah. I think the first answer is that it's kind of hard to avoid these days. I was thinking, as we were thinking about doing the email episode, how that has ... I've always been very techy and I've had secure contact forms on my website for quite some time, but over time, they've been used more and more. I'd say that as far as new client contact, it's probably 50/50 now between stuff coming through my secure contact form, which connects to my email, versus a phone call.
Roy:	Dude, mine is like 100% contact form.
Rob:	Yeah.
Roy:	Yeah, or 99%.
Rob:	I wonder. I wonder what everybody else ... This is, obviously, anecdotal, I wonder what everybody else's experience is. Hey, feel free to tag us on social media, tag us on Twitter or Facebook and let us know what your experience is, how much contact you're getting from clients, whether it's email or ... I'm sure we're going to, at some point, end up talking about texting. I don't get much in the way of new client contact with texting, but-
Roy:	I do invite people to reach out via Signal, my secure texting app.
Rob:	Right.
Roy:	I've only had one or two people do that.
Rob:	Yeah. That's the number one reason to be thinking about email is, clients want to reach out to you via email. If they're going to reach you through a website, a contact form, it's going to end up in your email, people are connected to thinks like Psychology Today, and that goes through your email. So, you kind of can't avoid it.
Roy:	Right. I find it's also pretty useful to be able to tell clients when you've got to make changes to scheduling.
Rob:	Yeah, I was just going to say, it's very convenient, too.
Roy:	Yeah.
Rob:	You've got the ability to have asynchronous communication now. "Oh, it's a snow storm out, I don't want to have to make 47 phone calls," or maybe it's not an immediate need, "Oh, I'm going to be on vacation, I want to let some clients know, I can send them a secure email," and we're going to talk about that secure piece later.
Roy:	Right.
Rob:	Maybe from the other side, especially with my secure contact form, I encourage clients, "Hey, you know how sometimes," especially when I work with clients who I have been working with a while, they're maybe not coming every week, "Hey, you know how we don't meet that frequently, and you come in and you say, 'Oh, there was something I wanted to tell you, and now I'm forgetting.' Well, don't wait. When you think of something, you say, 'Hey, I need to tell Rob this next time I'm in his office,' go ahead and drop me a secure email through the contact form, keep me posted."
Roy:	Yeah. Yeah. I have clients who, when I'm doing trauma work, and they want to be able to keep contact with me, like leave messages, or call me, or something, because they just want to know I'm there, so I'll say, "Well, why don't you just go ahead and just tell me what you're thinking in the secure contact form."
Rob:	Exactly.
Roy:	Yeah.
Rob:	It could be two in the morning, they're having trouble sleeping, they've got to get this off their chest, but they don't have to worry about waking you up, and I can still at least make that happen.
Roy:	Yeah, exactly. Yeah. That's pretty nice. You identified that jargon term that everyone loves in the therapy biz, asynchronous. That seems a key piece of email communication.
Rob:	Exactly.
Roy:	Yeah.
Rob:	Well, and I love it for business because you're like, "Okay, I can get to it when I get to it."
Roy:	Right.
Rob:	I can set aside email time to knock out those kinds of things.
Roy:	Right. Why don't we [crosstalk 00:05:48] asynchronous means though. That's actually [crosstalk 00:05:52] too there, buddy.
Rob:	I know. We get caught up in our tech heads and we think, "Oh, [crosstalk 00:05:58], we don't have to explain it." Yeah, asynchronous means it doesn't have to happen at the same ... It's not happening at the same time necessarily.
Roy:	Yeah. Yeah, that's right. [crosstalk 00:06:06]
Rob:	It's really not, even if somebody's sitting right there at their computer and they respond to you immediately, it's still asynchronous, it's not like they hear you typing the thing as you're typing it, there's still an offset of time there.
Roy:	Yep, exactly. Yeah, like a phone call is synchronous, you have to be on the phone together for it to work, but email is asynchronous, you don't have to be there at the same time.
Rob:	Yeah. Just to relate it to our video episode, where in most cases when you talk about doing distance therapy and you're using synchronous video, you're actually looking at the person at the same time.
Roy:	Yes, exactly. Right, yeah. That's important, that's actually a big part of why insurers and stuff want you using secure video, is that-
Rob:	Exactly.
Roy:	The visual and the audio, and the fact that it's synchronous. That's a whole other topic. Yeah, because asynchronous is super convenient, even if it's not as clinically effective. Although, certainly, I know there are some listeners that say, "Wait, I do email therapy, it's effective," I'm like, "Yes, I know." It is, it's true, but we want to talk about it as a convenient thing because it tends to be really convenient for practice management.
Rob:	Exactly, yeah.
Roy:	Okay, what are some other things we can do with email? We can tell clients what's going on, and clients can tell us what's going on, and everyone probably notices that Rob and I are both talking about clients using our secure contact form on our web pages, not just sending us an email. That's an important thing, we're going to talk about exactly what that is in the second half of the show. It's not just clients. Email is also the kind of thing that colleagues want to use. This is a thing we get office hours questions about pretty frequently, is people concerned about how referral sources are sending them information about referrals.
Rob:	Oh yeah.
Roy:	By that I mean like doctor's offices, or lawyers, especially lawyers or EAPs, where the person sending the referral is not a clinician. They'll just send [crosstalk 00:07:56] email with a bunch of information about this person. I always find it weird that apparently for attorneys, this is acceptable. I'm not entirely sure why, but that's the way it goes.
Rob:	For attorneys to send it to mental health clinicians or just attorneys in general.
Roy:	Attorneys in general. I know that a lot of people report attorneys doing that, it doesn't mean it's acceptable, of course-
Rob:	Sure.
Roy:	... but we see it a lot. They're attorneys, they should know, right?
Rob:	Well, they don't have HIPAA and they've got that little legalese at the bottom of the email that's meaningless.
Roy:	Right. Therefore, they're [crosstalk 00:08:24]. I don't know. Any attorneys out there who want to explain it in the comments, we would definitely welcome your legal analysis on our blog comments, we would love it.
Rob:	Yes, the question being, yes, we understand that you as attorneys have confidentiality with your clients, but how are you maintaining that through basically an unsecure email channel.
Roy:	Right, exactly. They just send conventional emails and so people ask us, "What do I got to do with that," and all these. Which we'll answer in the second half when we talk about security, but that's a big thing that happens, too. From a usefulness perspective that's important because referral sources who need to send referral information don't want to call, and they are increasingly not wanting to fax. They still fax, of course, they still do it, but they're increasingly not wanting to do that. So, we've had a number of people talking to us about their concerns about secure email, or about these non-secure ways that things are being emailed to them, and saying, "How can I get these people doing this stuff securely, but still get them to do it so I don't lose their referrals?"
Rob:	Yeah. It's important that you have some way. Like you said, they're looking for a way to do it. A lot of these providers, especially if they're medical providers and they've already gone through the meaningful use program, and they've got an interoperable EHR that lets them send referrals electronically to other medical providers. They're kind of looking for that, that's becoming the new norm. So when they're stepping outside of that and they're trying to refer to mental health, and they're like, "What do you mean I've got to call you?"
Roy:	Or send a fax.
Rob:	Yeah, or send a fax. They just want to press that button and get the referral sent. The easier you can make it for them, they more they're going to like you and want to continue to send you referrals.
Roy:	Right. I certainly tried talking to people about setting up that contact form, where someone else can also send a referral or send attachments. So far, I haven't had any reports from colleagues saying that they've managed to get medical, or legal, or governmental referral sources to go use them.
Rob:	I have, it's sporadic.
Roy:	Okay.
Rob:	I have some very specific referral sources who appreciate that and use it. I'm not sure what the barrier to adoption for other people is.
Roy:	Well-
Rob:	Because it is pretty straightforward. One barrier is, of course, they can't just do a quick click and send it out of their EHR, they have to type information in, and that sort of thing.
Roy:	What we get told by members who ask about it is that frequently the referral sources want to use whatever procedure they use, they don't want to do something special just for them, for this clinician.
Rob:	Yeah, sure.
Roy:	They're the only clinician they refer to who is concerned about the security of their referral.
Rob:	Right.
Roy:	That's one of the challenges, which is another call for all of us to think about security, because a rising tide raises all boats. That's referrals. So far, we're talking about practice management, we're talking about bringing in clients, which actually makes me think about marketing, which we do want to try to hit marketing as much as we can on this podcast. You and I, we talk about security so much, practice management so much, marketing is a big piece of technology, too. What do you know about email and marketing for a practice?
Rob:	Well, I know that people do it and I know that-
Roy:	Good job, Rob.
Rob:	I know that you and I do a good bit of marketing for our consulting businesses via email marketing.
Roy:	Absolutely. Yeah.
Rob:	I don't really do it for my practice. I've done some other brand marketing for my practice, whether it's blog articles or Facebook posts, but I've never really had a mailing list for my practice. So, we might benefit from bringing somebody on who's done that, or at least has some perspective on it. Maybe somebody who's a real expert on-
Roy:	Right.
Rob:	... cultivating a marketing list.
Roy:	I personally haven't done it either and I think probably for the same reasons you haven't. The way I do it for Person Centered Tech doesn't feel like something I want to do for my practice, whole different boundaries, but yeah, once again, I still really don't know either. I wish somebody could come on here. Especially somebody with a really controversial opinion that can create some scandal for us, I think that would be awesome.
Rob:	Yeah. I get tired of us always having the controversial opinions. We need somebody else to take the load off of us for a minute.
Roy:	That's right.
Rob:	I wonder who we could get. Are there other people with controversial opinions?
Roy:	Maybe.
Rob:	That would be great if we could find somebody.
Roy:	Right. Who is that Rob?
Rob:	Oh, let me go see. Oh, it's Allison, it's Allison Puryear.
Roy:	Oh, she's great. Yeah, she has all kinds of scandalous opinions.
	This episode is brought to you by Hushmail, your secret to super simple, secure communication. I have actually been a follower of Hushmail since about 2000, they were one of the first companies to start doing secure email and using encryption in email. That's actually why I picked up Hushmail for my own practice when I started. I should say I actually consult for Hushmail now, which is both a disclosure, but also lets me know they have a whole roadmap of things they plan to do specifically for the mental health community. So, I'm pretty excited about that.
Rob:	Yeah. I've been using Hushmail ever since I started my practice in 2007 and one of my favorite features, I really love that I can have an encrypted, secure contact form on my website.
Roy:	Yeah. The contact form is exactly how I do most of my initial contact with clients, that's a Hushmail form.
Rob:	Yeah. I've gotten so many positive comments from people because they appreciate that I am that serious about their privacy and confidentiality.
Roy:	Hushmail is also offering 15% off for life to our listeners, just go to hushmail.com/therapytech. Hushmail.com/therapytech, and you can also find that on the show notes page. That's Hushmail, your secret to simple, secure communication.
	Hey, everybody, we're here with Allison Puryear of the Abundance. You can find her at abundance.com or abundancepracticebuilders.com. Allison, is a private practice consultant and a really famous one, at that. You're well known, I see your name all of the place. [crosstalk 00:14:37]
Allison:	Well, thank you, I'll take it.
Roy:	Yeah. Also, we are here for Allison's latest controversial opinions, highly controversial opinions, about email, because this is the email episode. When we heard about this super controversial opinion she has about email, we thought we had to have her on the episode. So, Allison, tell us about your opinion. Unless, Rob, you want to throw in something before she starts?
Rob:	Yeah. We were talking with her, we've been talking about email, and how to use it securely, and fun stuff like that, and we're like, "Okay, who can we bring in that will talk about some other aspect of email?" We thought, "Well, hey, it would be neat to talk about maybe mailing lists and how those can be used for marketing, and whether you should use those for marketing as a therapist." We talked with Allison and we really were intrigued by what she had to say. So, Allison, how do you feel about therapists using email marketing lists?
Allison:	I think I'm one of the very few practice building coaches or consultants who is anti email list for therapists, so I have a very unpopular opinion.
Rob:	We're okay with those, we're comfortable with unpopular opinions.
Allison:	Yeah. I do want to say, it's not such a strongly held belief, I have very few extremely strongly held beliefs, and most of those aren't appropriate for your podcast, but it's not so strongly held that I think no one should have an email list if you're a therapist. If you're a therapist out there with an email list right now, I'm not trying to shame you about it. I'm going to talk some about why it's not a good fit for me, and basically for your consideration. I think we get told, "Do A, B, and C, and that'll help you build your practice," and sometimes we just kind of follow that because the people talking to us are trustworthy, but there might be some things that you might want to consider. I don't know, I'm going to throw them out there.
Roy:	Throw them out there.
Rob:	I think people, and therapists certainly are no exception, like the simple answers.
Allison:	Yeah.
Rob:	I like that you think this through a little further. So, tell us more about why it's not right for you.
Allison:	One thing is, I think about the informed consent piece, and I'm using the term super loosely, but when I sign up for an email, it's like I want freebie X from somebody that I'm following. I sign up for it, I'm really clear, I'm going to continue to get emails from them, because that's the world that I live in and in the consulting world. I don't know that my therapy clients are going to expect the same thing from their therapist that they expect from maybe a sale at Banana Republic or something. So they might not realize they're going to continue to get emails from you that might not be about scheduling or whatever else you might communicate about with email.
	As an eating disorder specialist, I would be really upset if a client came in and said, "Yeah, I was on this awesome date and then my email dinged and it lit up my screen and it said, 'How to not binge.'" I wouldn't want to accidentally create that kind of situation where somebody is outed for something that they don't want to be outed for.
Roy:	Right, gotcha. So you're talking about the fact that the email list is sending somebody emails besides the one you may have arranged in the room, in your intake, in your informed consent.
Allison:	Yeah.
Roy:	Okay. Yeah, that makes a lot of sense.
Allison:	Yeah. I think also there's a piece around boundaries. If I'm emailing my clients my blog posts once a week, what does that communicate about their ability to email me with how they're feeling multiple times a week?
Roy:	Right.
Allison:	It feels kind of strange to say like, "Well, yeah, you signed up for my email list, so you're going to get this really helpful emails that are going to be helping you ever week, do not email me back about clinical things." That doesn't feel balanced to me. It's just not a fit for me. Are you selling or are you focusing on helping? Certainly, one of the great reasons to create an email list for folks is to stay on top of people's minds, and that's part of why consistency is so important with any sort of blogging, or emailing, or anything like that. Personally, my ideal clients are really motivated and they know when they need help, and there's a process to get to a place where they're ready for it, but I don't want to nag them into coming in. I don't want therapy graduates who want to come back in to come back in because they kept hearing from me and they're like, "Yeah, I guess I should work on that." My people are super motivated when they come to me, they're like, "I'm miserable, I'm hating life." Yeah, I don't want to have to keep telling my clients or potential clients that I'm here.
Roy:	Gotcha, right. There are other ways to do it, like blogging can have less of the clinical concerns you're talking about, right?
Allison:	Yeah.
Roy:	Blogging, if the person subscribes to your blog by email, that's usually a clear distinction from getting mass emails.
Allison:	Right.
Roy:	Or hopefully the client understands that what it is, is they're just getting your blog feed as opposed to getting your email list.
Allison:	Right, or if you promoted on Facebook or something like that and they follow your Facebook page. There are ways that they can opt in where it's something that will pop up for them if they click follow on Facebook, when they're maybe in the mindset of being willing to look for it. I don't know.
Roy:	No, it makes sense. It's kind of the difference between push and pull, right?
Allison:	Mm-hmm (affirmative).
Roy:	Mailing lists are a push, like you push out the information to people. There are push ways of getting notified of Facebook posts or blog posts, but it's still something like it pushes out the notification that there's a post, and the person still needs to go look at the post.
Allison:	Right.
Roy:	Right, so there's a pull aspect to that. The client understands, at that point, that they're going over to look at your content. Then the way they interact with it is different. I like your idea or your point about replying to emails, or what are we communicating about email, because with blogs and such, you can control the way comments are moderated or the way responses are moderated, that kind of thing. That can go on your social media policy, that could be a little clearer, I think. I'm kind of just riffing on what you're saying. That could be a little clearer, I think, than when they start receiving emails from you about clinical issues, but you're trying to tell them, "Don't email me about clinical issues." I can see how that's more confusing.
Allison:	Yeah. Yeah.
Rob:	Well, about any issues, you're still sending that message, "I can email you, but you can't email me," which is ... Yeah, that's kind of strange.
Allison:	Yeah.
Roy:	Right.
Allison:	There's already that power dynamic that I think most of us try to minimize as much as possible in order to create that sense of safety. So, yeah, I do think it's kind of like, "It's fair for me, but not for you, don't bother me, I'll bother you."
Roy:	Right. Right, good call, yeah.
Rob:	Are there any other effective ways you feel people can reach those clients, accomplish that same level of brand advertising, which is what we're talking about here, instead of using mailing lists, Allison?
Allison:	Yeah. Well, I'm a huge fan of blogging, I feel like it's a really powerful tool, both in terms of marketing your practice, but also in giving to your community or potential community. I think blogging is still really powerful, and putting that out on your social media platforms, the ones that are appropriate for clients to follow, the ones that are meant for clients to follow, I think that, that can be powerful in boosting them or promoting them in some way so that more people see them. I think that's appropriate. It's not that I don't think that email is appropriate, it's just that it's not a fit for me, for these reasons. I think, too, there's something about protecting the sanctity of the therapeutic space, not to sound too therapist-y.
Rob:	Why would you do that?
Allison:	Should I start using really soft tones?
Rob:	Yes, please.
Allison:	I think that some of the catchy, "Seven ways to maintain boundaries!" Kind of thing, might not feel like something I'd want from my therapist in my inbox maybe. I think if you're going to do something like a blog, finding other ways to promote it that does feel like they can follow your RSS feed or something like that, but that it's not going to be pushed into anything that's going to light up on their phone.
Rob:	Yeah, I think that's an important point, it kind of underlines your point about, "Hey, it's going to pop up on their phone, it's going to be interspersed between all these other emails," and that is, to get people to read those emails out of the hundreds of emails that they get a day, you have to have this catchy headline that's going to pop up.
Allison:	Yeah. That's important from a business perspective if you're going to do it, don't just be like, "Hey, you might want to open this." It's nothing that's enticing and people are going to be like, "I want to know more," or something that's super clear so people will know exactly what they're going to get when they open it up.
Rob:	So that subject line is going to be right there amidst all the other subjects, so it could be that just a quick glance, if somebody's looking over their shoulder or what have you-
Allison:	Exactly.
Rob:	... they're more likely to see something like that.
Allison:	I just see my clients are pretty strong people, they're pretty ... They're in a tough spot, they're in a tough place with knowing what to do with their emotions, so there are some ways in which they're relying on me to hold and maintain the boundaries. I'm just really big on boundary setup and maintenance, and private practices in general, so we can all have some longevity in this field. I think that there's a certain amount of, if it's my job to set the tone, what works for me tone-wise?
Roy:	Yeah. That makes a lot of sense. I like that you're getting into talking about boundaries and private practice because one thing, everyone here loves private practice, that's what we do, all three of us. What's interesting is, when I kind of looked into boundary ethics, I started to realize that private practice is unnatural in terms of boundary ethics. It's like you're both a business person and a therapist at the same time, you can't avoid it. We talk about that all the time in terms of, you need to remember your practice is a business, treat it like a business, et cetera, et cetera, we all do that, all three of us do. There's also the fact that being a businessperson means you have a dual relationship with the client.
	You're a businessperson and their therapist, and if you go look at ethics codes, there's a bunch of stuff in there whose intention is to allow the private practitioner, businessperson, dual relationship to exist without it becoming a boundary violation to the client. Lots about fee setting, how you do termination, how collections work, things like that, that's all there to help ensure that, that boundary crossing of being a businessperson doesn't become a boundary violation.
	I think you're making some strong points in that model about email. Sending someone these emails, which are meant for marketing your business, kind of getting potentially into those violation areas of that dual relationship around your boundary. Of course, the client, if they want to go see how you're marketing your business and look at what you're doing, that's their choice always, they can do that. I see what you're saying about a thing about mailing lists is that push aspect, it pops up on their phone. On my computer, it would pop up on the corner of my computer, you might get a new mail and in the corner of my computer or something it pops up the subject line of the email. [crosstalk 00:25:12] Happen at work. There are things like that and you make a strong point about that.
Allison:	I think, too, and this isn't the blog post that I wrote, but it kind of came to me after the comments that were left on the blog posts, and the emails that I got about the blog post, is that there are so many different ways to market your practice, and when I posted this, people felt like it was permission to not have to take this on, too. I think it's also making sure that, and this is the flag I'm going to always stick in the sand is, because there are so many different ways to market your practice, choosing the ones that work for you and feel authentic to you as a person and your practice, there are plenty to choose from that will. So if this doesn't feel like a good fit for you, regardless of what we've said here, if you were already like, "I don't want to do that," then permission granted, man, don't do it.
Roy:	Right.
Rob:	Yeah, right on. Allison, we'll send you a signed permission slip.
Roy:	Oh, that's nice. That's sweet.
Allison:	There we go.
Roy:	You should make that one of the free downloads for people to subscribe to your newsletter, a permission slip not to use email marketing.
Rob:	Yes, or any marketing that feels off.
Roy:	Yeah. Yeah, for sure. Yeah, absolutely. There is another very important question I want to ask you, Allison.
Allison:	What is it?
Roy:	I don't know yet, it's going to be randomly chosen, I think.
Allison:	Oh yeah, from Describe.
Rob:	Is it time?
Roy:	I think it's time.
Rob:	Describe comes with over a dozen activities that can be used with clients of all ages. Find out more at describecards.com.
	Are you ready, Allison?
Allison:	I'm ready.
Rob:	All right, today's Describe word is powerful.
Allison:	That's a juicy one.
Roy:	Good one.
Rob:	Tell us about a time when you felt powerful.
Allison:	I think recently I've made some ... This is super ... I'm going to just throw my heart on the table and tell you about. We're therapists here, it's good.
Rob:	Absolutely.
Allison:	I've recently made some big decisions in my business to shift some things that was pretty scary, because it meant potentially leaving a bunch of money on the table and changing some of how I'm known. It was really scary, but despite the fear, I knew it was the right decision for, again, I'm real big on longevity in our career. So, for longevity in my career as a consultant, I needed to make some shifts, and spend more time with my adorable kid. I felt really powerful having made that decision and continue to be like, "Yeah, I'm pretty awesome for making that," even though it was scary.
Roy:	Now I'm curious, what was the decision? What did you do?
Allison:	I have my AbunDance Party, the membership site that I have, and then I also have this higher ... I've had this higher cost offering that's actually what started this business. I just knew a bunch of people who wanted to start private practices and I was like, "Well, why don't I just do a group with you guys, come on." So I've been running the Abundance practice building groups for years now, since 2014, and so, I recently decided that in order to keep all the balls in the air of my life and work, I needed to end those groups. They've been like my baby, so it was really scary to do that and hard in a lot of ways, but I knew that the AbunDance Party was going to allow for me to be able to reach more people because it is less expensive. So I actually just last week ended the very last group of the Abundance practice building group, and saying goodbye to it was ... It was interesting once I closed my computer, of just being like, "All right, bye."
Rob:	Oh wow, some bittersweet connection going on there.
Allison:	Yeah, absolutely. I think I only access feeling powerful when I'm scared, which is a cool thing.
Roy:	Oh wow, good. Good for you [crosstalk 00:29:01]-
Allison:	It makes being scared a little less scary in a way, because I'm like, "Yeah, look at me being so tough."
Rob:	I'm suddenly seeing you again flying in your video.
Allison:	Oh my gosh, yeah. People can watch me fly on a green screen at Abundanceparty.com.
Rob:	By the way, I know I've said this before, but I love that name, the AbunDance, I just want to say it all the time.
Allison:	Thank you. My husband came up with that, he's so ... He's one of those people if you met him, you wouldn't realize he was such a goof, it's only when you get to know him that he lets that out. Nobody would pin him for a punner, but he is.
Rob:	So when exactly did that happen? Because you've been doing Abundance for a while, when is it that he just said, "You know what? You should do AbunDance."
Allison:	Yeah, I think I was like, "I want to start this membership site," because I did it ... You guys will probably shake your head at me, but I was like, "I want to start a membership site and I want to launch it in three months." Melvin was like, "I've been at this a year and I haven't launched, Allison, you're insane," but I did it because I'm a fool and I set these deadlines for no apparent reason and make myself stick to them. Which is another part of what I'm learning in my powerfulness. I was like, "I'm stuck on a name, I can't come up with a name," he was like, "What about AbunDance Party," and I was like, "Done, thank you. Okay, now we can move forward." Yeah.
Roy:	That's perfect. That's great.
Rob:	Maybe you can tell our listeners a little bit more about what they can expect if they were to become members of the AbunDance Party.
Allison:	Yeah, sure. So, we've got a bunch of different courses in there. We have one that helps you get really clear on your niche and your ideal client. We have one called marketing fundamentals that walks you through the top ways to market yourself as a private practitioner, and the very first lesson in each of those modules is, "Is it for me?" So that you don't waste your time learning those things or doing those things if it's a poor fit, so I kind of help you assess that. Then we've got best practices, and resources, and all sorts of things under there, the common blocks I see with each method.
	I've also got a, "What to say when," scripts and templates for counselors in private practice, so it kind of gives you the language for all the business sides of things, whether it's converting calls into clients, or negotiating a lease, that kind of stuff. Then I have monthly trainings, you all are doing this month's. I usually tap into the folks that really, the people in the party are saying, "We want to understand more about HIPAA compliance and technology." So that's when I'm like, "Come on, guys," so we have a monthly training in there.
Rob:	Yeah, great.
Allison:	I have eight slots for one-on-ones with me, and we have a Facebook group where I literally reply to every single post.
Roy:	Whoa, that must take you a while.
Allison:	Yeah. It does. It does. I have designated Facebook time every morning just for the Party. Yeah, it's a good time though. Everybody in there's super motivated, like they all are committed to this. They're not doing a hobby practice, they want to be successful. It's awesome seeing how supportive those folks are.
Roy:	Wow, that's good stuff.
Rob:	Yeah. I can speak to the quality of the things that you put out. You've got this incredible checklist, starting a practice checklist, I don't know if that's officially what you call it. A number of other tools that I've seen that you've put out, that are just excellent.
Allison:	Well, thank you. You guys are actually ... Before I'd even met Roy, you guys were both ... You guys have been in the checklist for years because you're both awesome.
Roy:	Of course. I mean, oh, that's sweet. I'm like, of course. I mean, yes, it's very sweet. Yeah, that's great to hear though, yeah.
Rob:	Allison, it's been great to have you, appreciate you sharing your perspective. I actually agree with you about the boundary issues with email. Certainly, I agree with you also that people have to make their own choice for their practice.
Allison:	Yeah. Yeah. I'm glad to know there are at least a couple of us out there.
Roy:	Yeah, I actually had very similar misgivings and it's something we've discussed at office hours with Person Centered Tech a few times. I've always been like, "Well, this is kind of my opinion," although certainly, I'm not one of those experts who talks about using it, so maybe somebody who knows more about it could explain how they do it in such a way that helps with boundaries. It's kind of validating to hear you talk about it, Allison.
Allison:	Yeah. I think if people are coaches, or consultants, or things like that, it makes a lot of sense to have an email list, it's just the therapy relationship's different.
Roy:	Yeah. Absolutely. Well, thanks Allison, it was fantastic having you on.
Allison:	Yeah, thanks for having me.
Rob:	We hope to see you again ... Well, we are going to see you soon, although it'll be technically after we ... Before we broadcast this, so yeah, we're getting in a time loop here.
Allison:	You can geek out about that, for real.
Rob:	Time loop. Right.
Roy:	Well, that was great, and pretty validating for me. I'm not entirely sure that I think I really want to do that myself in terms of email marketing. What about you, Rob?
Rob:	Yeah, no, I'm going to stick with email marketing for Tame Your Practice, I'm going to leave that out of my clinical work. I agree with Allison. I'll tell you what, the one thing I have encouraged some of my consulting clients to do is do a mailing list, but have the people that sign up for your mailing list be your referral sources.
Roy:	What? What are you talking about?
Rob:	The purpose of having a mailing is to kind of have this brand recognition, this regular contact with people that you want to do business with.
Roy:	Sure.
Rob:	Or who are going to send you business. So, if you do a mailing list and you put out some really good information, like you've talked to one of your physicians in your area, "What kind of information would be valuable for you to receive about mental health issues?" Maybe they just want to regularly get these brief tidbits about mental health issues-
Roy:	That's brilliant.
Rob:	... and just getting that regular, brief stream of that is very valuable to them, they're going to sign onto your mailing list, and then who are they going to think of when it's time to refer out?
Roy:	They're going to think of me, right?
Rob:	Yes, exactly.
Roy:	Oh, man.
Rob:	I would not do it with clients, but you don't have those same boundary issues we talked about with Allison if you're connecting with referral sources and other people in the area.
Roy:	That's great. It's a great way to ensure that you can stay top of mind with people who might refer to you. That's a great idea.
Rob:	Yeah.
Roy:	What solution would people use to do that? I mean, we didn't talk about how people set up mailing lists, let's give some tips about [crosstalk 00:35:14]-
Rob:	Oh, yeah. Yeah, so I use MailChimp-
Roy:	So do I.
Rob:	... which I find incredibly user friendly, and they're pretty regularly adding features. You get quite a bit for the free version, which is free until I think 2,000 users.
Roy:	2,000 subscribers, yeah. Which for your idea of the referral source list, you might not ever have to pay for MailChimp. It doesn't have to be a very big list. Every person on that list is pretty valuable.
Rob:	Right. If you've got more than 2,000 referral sources, you probably can afford the paid version.
Roy:	That's probably true.
Rob:	I'm thinking.
Roy:	You probably run a pretty big practice at that point.
Rob:	Right. In MailChimp there's lots of tools for integrating it, so if you have a WordPress site, you can have some integration with your website. If you actually publish blog articles for that same audience, your referral sources, there can be some connection there.
Roy:	Yeah.
Rob:	Yeah, lots of good things, I could talk about MailChimp for a while because I like it. There's some others out there that I know people use and have heard good things about, AWeber is another one.
Roy:	Constant Contact.
Rob:	Constant Contact, yep. Those are the three main ones that I hear about, I'm sure there are other ones.
Roy:	Right. We actually had a Constant Contact question on office hours, our member office hours yesterday. Yesterday being the day before we recorded this. Someone asked, they're like, "What about Constant Contact for HIPAA?" Constant Contact is a mailing list program. Well, it turns out Constant Contact does execute business associate agreements.
Rob:	Oh, interesting.
Roy:	I know, I was also surprised. They have a page in which they talk about it, and they have a lot of information about the do's and don'ts, which is really interesting. It's kind of funny, the page actually lists a lot of information that would normally be in the actual business associate agreement contract that they sign. Usually when we read those, when we do vendor reviews, usually the stuff on this webpage at Constant Contact is usually inside the contract, so they're real clear about wanting you to know all that. Which is not usually my experience with Constant Contact, that they're so upfront about things, but they were. They were like, "Don't use it to send highly sensitive PHI," which is kind of like, what?
Rob:	Wait, wait, you had me until then.
Roy:	I know. I'm like, "What do you mean by that?" We kind of sussed out that it seems that Constant Contact is trying to set themselves up as an acceptable thing you can use if you have a mailing list for your clients. We kind of figured out, we were like, "Okay, what if you have something that's actually for the people you're seeing, that's like tips on managing depression, or tips on managing anxiety?" That kind of thing. It looks like Constant Contact will do the BAA you need in order to be able to use it as the system you use for that.
Rob:	Gotcha.
Roy:	Even though it says don't send mental health data, and we're like, well, that doesn't help a mental health practice very much, but I'm not entirely sure that, that's what ... I don't think that's what they meant. Tips on managing depression for everyone on your list, that may not be quite what they mean by, "Highly sensitive PHI."
Rob:	Yeah, I have to suspect they mean stuff having to do with treatment, and diagnosis, and things like that.
Roy:	Yeah. I think so, too. Probably something specific [crosstalk 00:38:15].
Rob:	I guess at least that's out there for those that might be interested in exploring having a mailing list for their clients. They might have at least an option where they can maintain their HIPAA compliance.
Roy:	Yeah. Yeah. We were surprised by it, but we figured it's good for letting clients know when groups are coming up or sometimes a tip kind of thing helps with retention, like getting clients coming back. I always wonder about the ethics of doing things like that, but certainly, sending people useful information can't be that terribly unethical. There's got to be an ethical way to do that. It's kind of a telemedicine or a telehealth kind of intervention, sort of keep up with giving people health advice that's relevant. Well, giving people useful health resources is what I want to say.
Rob:	Right.
Roy:	That does seem like a useful thing to do. Which, brings us to the other question of security, right? We were saying-
Rob:	Yeah.
Roy:	... we were going to talk about it in the second half of the show. What are your security concerns, Rob? When we started this, you immediately started talking about using a contact form as opposed to just putting your email address on there and letting people email you.
Rob:	Right.
Roy:	Why is that?
Rob:	Yeah. I was really excited several years ago, and that was one of the things that sold me on Hushmail, this was quite a while back, they were the only vendor, at the time, I could find that not only complied with HIPAA ... Now, this was before the omnibus rule, so business associate agreements weren't a thing, though they were on top of that when it was, but they also had a way for you to put a secure encrypted contact form on your website, so that it took that information and it immediately directly funneled it to the Hushmail server. So, it was encrypted and secure from the minute someone submitted it through your contact form.
Roy:	Yep.
Rob:	That was a big deal because most of the other ways that someone's just going to initiate email contact with you, they don't have a way to encrypt it to make sure it's secure. Now's probably a good time for, Roy, you to go over your different forms of emails. When you start talking about encrypted, and secure, and HIPAA secure email, so you might want to give you spiel and explain to people what all that means.
Roy:	Yeah. We talk about the three kinds of email, in general, in a general sense. By three kinds we mean three forms of email, vis-a-vis security. We say there's conventional email, that's your basic starting point. Conventional email is just when you use email every day through a normal email service, it's conventional email. Conventional email in the modern world might or might not have some security. Classically, there was nothing secure about conventional email, not even a little thing was secure about it. When it goes over the internet pipes, it would be completely exposed, like a postcard traveling through the postal system, and it would have no way of authenticating the sender. Like in college I would send my buddies emails that claimed to come from the dean of students or whatever, saying, "Hey, we caught you smoking pot," or we'd do things like that. This is how-
Rob:	Nice.
Roy:	... people doing phishing scams can send you emails that appear to come from people that you know, that sort of thing, because there's no way to authenticate the sender, you can put whatever sender you want on there.
Rob:	Right.
Roy:	Email tech is actually older than the internet, by a lot of-
Rob:	Wait.
Roy:	... people talk about it. Email tech was there before, when people just had local networks. So, it's not secure, it's not built to have security or checks for integrity or anything like that. That's classic email, but the protocol hasn't technically really changed about email, but a lot of the email services out there, most notably Google, but also Microsoft, and Yahoo, other big email providers, the big ones, not necessarily your local internet provider, but the big companies, they are still engaging in a kind of cooperative effort to exchange emails with each other in a secure fashion.
	What people need to understand is what we're talking about here is when they're sending it over the roadways of the internet, because that's usually the biggest concern people have about email is when I send it over the internet, which is a transportation system like roads, classically, sending an email was like sending a postcard. Any hands it passed through could read the contents of your email. So, when these major email providers are sending to each other, they're deciding, "Hey, what if we actually try to encrypt the emails we send each other." This is the thing that many therapists still need to get a handle on, or a little help understanding, is that encryption is not a vague thing in any way, encryption is a very specific hard thing.
	If you encrypt an email, what that means is that you have scrambled the contents of your email. You use a secret code to scramble the email contents. The only way to unscramble them is to have the encryption key that was used to scramble them in the first place. To speak very simply about it. Some techies who listen to this might start talking about public and private keys, and yada yada, yes, I know all that, I'm just talking about it simply. If you don't have the encryption key, you can't read the email. Which means that I can't just send you something that's encrypted and expect you to be able to read it, there has to be something that we do ahead of time to allow us to exchange encrypted information.
	The major email providers started doing that cooperative thing they have to do, so that they can exchange the emails with each other in a secure encrypted way. We won't go into the details, you can read my article, which we'll link in the show notes, which has diagrams, nice, friendly looking diagrams with pictures of things, so you can have a better visual of what I'm talking about, which helps.
Rob:	Oh, pictures.
Roy:	Yes, pictures are great. If Google and Microsoft exchange emails, because I'm going to ... Let's say I use Google Mail and Rob uses Microsoft Mail, and I send something to Rob, when Google sends my email over to Microsoft so that Microsoft can deliver it to Rob, they're going to encrypt their exchange with each other. That leg of the trip will actually use encryption. That leg of the trip is the biggest one we actually work about, because when I talk to Google in order to say to Google, "Hey, I want to write an email to send to Rob," me and Google are talking with encryption. When I go to the Google website, I've got the secure lock icon on my web browser, me and Google are speaking securely. Then it's when Google turns around and talks to Microsoft, that's usually where things go awry.
Rob:	Right.
Roy:	So, Google and Microsoft, and a lot of these other big companies, are working on making sure that when they talk to each other, they do it securely. Then, of course, when Microsoft turns around and talks to Rob, they do it securely, as well.
Rob:	Right.
Roy:	Right. So then we see the whole trip ends up being encrypted, you have an encrypted message, except for when Google's handling it and except for when Microsoft is handling it.
Rob:	But wait, Roy, I think you might have lost a few people right there. You were just talking about how they were cooperating and they were encrypting it, and Google will talk to Microsoft and it'll be secure, encrypted, and then you said, but then when it's on Google or Microsoft, it's not secure. I think you might need to explain that piece.
Roy:	I say it's not encrypted.
Rob:	Right.
Roy:	Yeah. So, when Google is handling my email, handling encrypted data doesn't do them any good, they can't ... I tell Google, "Send this message as an email," they can't do that with ... They can't take an encrypted bolus of information and do that. They have to have the actual message I want to send in their hands. Then when it gets to Microsoft, it's the same thing, they need to have the message in their hands so that they know where it's going, and know what to do with it. When they receive it, they receive it without encryption. It's just encrypted on the way, to keep all those bandits, those roadside bandits, out of it.
Rob:	Right.
Roy:	When the big companies that we use, that are involved in our practices ... Remember, these companies are involve din your practice, like Google's a part of my practice because I use them to handle my practice information. Which is why we need those business associate agreements with them. Let's say Rob is my client and I'm using Google to send an email to Rob, I need to have a business associate agreement with Google because Google is, as a company, handling my emails. It's like, imagine a room full of people sitting at computers, and let's say they receive a piece of mail from me, or like a message from me on a piece of paper, and they take that message and they turn around and transform it into an email, and send it off to Rob's email provider. That's basically what Google does on my behalf.
Rob:	Right.
Roy:	So that's why I need those agreements with them that they'll handle that information confidentially and they'll keep it safe.
Rob:	Well, I think it's important to point out that you are talking specifically about the paid G-Suite.
Roy:	I'm talking about how I need a business associate agreement.
Rob:	Right. Well-
Roy:	The paid G-Suite will do that, yes.
Rob:	Yeah.
Roy:	Yeah.
Rob:	You've been talking about Google and I suspect there are still some people out there that would just hear Google and maybe haven't gotten [crosstalk 00:47:14]-
Roy:	Yeah.
Rob:	... you've got to use the paid version, the G-Suite version, to get that business's associate agreement.
Roy:	Yeah, that's correct.
Rob:	In fact, there's two levels of that, and you really want the upper level of that in order to get all the things you need for HIPAA compliance.
Roy:	Only if you're a multi-person practice.
Rob:	Right, yes.
Roy:	If there's only one of you, you can use the basic paid G-Suite. Paid, but still the basic.
Rob:	Right. Maybe clarify for people the reason that they can't, apart from the business associate agreement, is there a reason they can't use the regular Google or other email that is obviously cooperating with other email services that are encrypting with each other?
Roy:	Yeah. Well, if there's no business associate agreement, then the company can do whatever they want with your emails, and they do, they do do whatever they want with your emails. Like, free Gmail will use your emails for data mining purposes. Let's say a client sends you an email talking about their current mental state, or about where they live or about their family, Google will then use everything they send to you to help learn more about your client, and do whatever they do with that information. Such as making advertising, or just creating other targeted data, big data targeted things, out of the fact that your client just indicated that they are connected to you, they said something about their family, they said something about their current state. Google will use all that information in that email for their own business purposes, that's the purpose of free Gmail.
Rob:	Exactly.
Roy:	When you use free Gmail, you and everyone you exchange emails with become the commodity that Google sells.
Rob:	So, you're saying, Roy, that there really is no free lunch.
Roy:	There really is no free lunch, that's right. Luckily, lunch costs five bucks a month if you want to buy it-
Rob:	That's right.
Roy:	... and get your business associate agreement, it's pretty cheap and totally worth it.
Rob:	[crosstalk 00:48:56] Good lunch. It's a quality lunch.
Roy:	It's a really high quality lunch when you're talking about google or Microsoft. Microsoft's 365, their paid service is also about five bucks a month. If you're a Microsoft person, it's great. You get the business associate agreements and it's not just email, the whole suite of Office products that Microsoft and Google give, they all get covered by this business associate agreement. You can go to our Google article to learn more about how Google handles that, the stuff besides email. The idea that you've got to remember is that your email provider is working in your practice, just like a front desk reception person, or just anybody who handles information for you and your clients. All these online services, they do the same thing. They have access to all the information, they do what they want with the information, unless they give you agreements that they're going to handle your information the same way you have to handle it, which means in compliance with HIPAA and your ethics code.
Rob:	I think that should clarify it for people. I think you have one more piece to cover, don't you?
Roy:	Yeah, I have a couple. We're talking about conventional email there, right? That's just conventional everyday email. Then there's what we call the TLS email, which is the one that encrypts while it goes over the internet roads. Now, conventional email can be come TLS email when the two companies want to cooperate. The example I gave earlier, when Google is talking to Microsoft, they will kind of upgrade themselves, they'll kind of move up into that zone of being TLS email for that one email exchange, because the two of them decide, "Okay, we're going to do TLS email together, which means we have an email that's secured as it goes over the internet."
	That's kind of the lower level of secure email, the way we think about secure email at Person Centered Tech. The reason we say that's a lower level is because it's great that the email is protected while it goes over the internet, but it still arrives at your inbox, like let's say Rob is my client, it arrives at Rob's inbox as a normal conventional email. It gets there safely, but it's still there and it's just like a normal email. Depending on what's in Rob's life, that may be totally fine. But let's pretend Rob doesn't use Microsoft email, let's pretend Rob uses his own employer's email. Let's say Rob's in the North Carolina research triangle, let's say he works at SAP, which is a big tech company in that area. They definitely will also cooperate with Google to make that exchange secure, but the thing is, it's a company email system, which means that Rob's managers have a legal right to read his email.
Rob:	Yeah.
Roy:	So, we probably want to be aware of that fact. If Rob doesn't want his managers to know anything about his counseling, or even that he's in counseling, we probably shouldn't be exchanging messages at that work email. Even though we're using this TLS email, this lower tier secure email, there are still privacy issues or security issues, but those issues are not HIPAA one because HIPAA says as soon as Rob receives that email, it's out of my HIPAA hands, HIPAA doesn't care what happens after that, or says, "It's not my responsibility." Ethically speaking, I do need to be concerned, or at least have some thought towards what's going to happen when I send an email to Rob at the address he gave me. So it gets there safely, it gets there privately, but then there's the question of what happens after it gets there.
	Now, let's say Rob lived with an abuser, which I happen to know Rob's wife, quite the opposite, but if you lived with a bad person, a bad guy, many abusers make their victims show them their emails or text messages, make them give them their passwords, things like that. So, yeah, the TLS email will get it there securely, but it doesn't necessarily mean that it's guaranteed to be safe once it gets there. Now, many of our clients in private practice are more worried, "Well, or they may have significant conditions, but they live in safe environments," in which case these concerns are fine. That's why risk analysis is part of therapists' life. Figure out what the risks are, is it safe for your client? Yep, okay, TLS email is a great way to do it then, because it goes directly to them, it's protected as it goes over the internet, but there's no special steps that the client has to take to read your email, it's right there in their inbox. That's nice and convenient, and if that's safe for them, then great, we're good.
	Now, if it's not safe for them, there's the highest level, the way we regard it at Person Centered Tech, which is actually called escrow email. If you ever use something called secure email and you found it to be a pain in the ass, you were using escrow email.
Rob:	Right.
Roy:	That's what that was. Escrow email is where you don't actually get the email in your inbox, in your inbox you get a little boiler plate message that says, "You just got a secure message from Roy, click this button to go read Roy's secure message." That's why it's called escrow, is because a secure message that I wrote is actually being held in escrow by my email provider at their website.
Rob:	Right.
Roy:	In my case, it's Hushmail. I know that is for you, as well, Rob.
Rob:	It is.
Roy:	If I send an escrow email to a client, they get this email that says, "Roy just send you a secure message using Hushmail, click this big blue button." They click the big blue button, it takes them over to the Hushmail website, and then usually they have to answer a security question, or Hushmail has some new features to make it a little easier, depending on circumstances, however they authenticate that they are my client. They then can read my message on the Hushmail website, it's not in their email, it's on the Hushmail website.
	The cool thing is I can send them attachments this way, that's how I send people super bills, is through escrow email. When you use a practice management system or an EHR, and it has a client portal, which many people are starting to do, the client portals usually use escrow email to do secure messaging client.
Rob:	Yes. Yeah, the ones that have secure messaging, that's how they're handling it.
Roy:	Yeah, they do escrow. That's because it's the highest level of security when it comes to being able to send an email. That's the three levels, there's conventional, which generally is not secure at all, but these days, a lot of conventional email, depending on who is sending and who's receiving, a lot of conventional email gets upgraded to TLS email. Now, the problem is, when you're using a conventional service, you don't know whether or not it's going to do that, and that's the downside. That's why you can't assume that using G-Suite means that you always are sending secured emails, because if it's not able to bump up to TLS, it sends your email without encryption, it just goes ahead and sends it. It can't fall back on saying, "Hey, there's no encryption, are you sure you want me to send this email?" It does not do that.
Rob:	Right.
Roy:	Which is too bad.
Rob:	It could, but it doesn't.
Roy:	Right, it could, but it doesn't. I'm actually kind of wondering, why don't they, guys? Give me a box, let me check a box that says, "Warn me."
Rob:	Yeah, they do that with websites, "Oh, this website doesn't look secure, don't put your information in there."
Roy:	I know. The only reason I could guess they don't do it is because that could actually hurt companies like Pobox, which are a secure email provider, but that focuses on the TLS email. That's their special thing is that they do that thing. If you use Pobox as your email provider, it focuses on using TLS email and when it's not able to do it because the other side, the person who's trying to receive your message, because that place won't do the TLS game and won't do the encryption game, it falls back on doing an escrow message. So, Pobox will ensure that your message is secured some way or another, but it falls back on that more convenient TLS.
	If Google started doing the same thing, I'm sure Pobox would lose all its business. I don't know if that's related, but Pobox also now can integrate right into your G-Suite, which is kind of an advantage there. It's conventional, which may get bumped up to TLS, and then there's escrow. Escrow is that one that is kind of your gold standard for sending protected health information, unless you've done some kind of process with a client where you determined that one of the other levels is appropriate.
Rob:	Gotcha. So, which one should people use, Roy?
Roy:	Depends on what you've got to do and who you're doing it with.
Rob:	Back to that risk management piece.
Roy:	It's risk management, it's risk analysis, and-
Rob:	Figuring out the situation, which solution is going to work.
Roy:	Yep, and doing it with your client, client by client. Clients have the right to tell us how they want their information, but what you've got to remember is that, that's with the client. When you're exchanging information with other people, with colleagues, with referral sources, even when it's somebody for whom you've got a common client, you've got to use secure methods. That could be the TLS, the TLS could be perfectly fine for that.
Rob:	This sounds like something that should probably be covered in informed consent, Roy.
Roy:	Yes, it should.
Rob:	Yeah. I know I do that, not just, "Hey, here's your paper, sign it," but specifically talking to people and advocating, make sure they understand. A lot of people, you know where I live, I live in a very highly tech [crosstalk 00:57:32]-
Roy:	Super techy, yeah.
Rob:	... research triangle park here, and I still run into plenty of people who will fill out the paperwork, and they'll give me what's obviously a work email, and I'll say, "Are you sure you want appointment reminders and those sorts of things sent to your work email address?" [crosstalk 00:57:51] "Oh, I didn't think about that."
Roy:	Right. Yeah, I get like a Nike email address or an Intel email address, and I'm like, "I don't think you want that."
Rob:	Right. "Do you want this in your HR database at work?"
Roy:	Yeah, right, exactly. Yeah.
Rob:	"No. You know, you're right, I don't think I do."
Roy:	I don't think I do. So, for those of you who are listening to this and going, "Oh my God, how can I remember all of this," and, "How can I do this assessment with my clients?" Be aware that one of the freebies at Person Centered Tech for people who subscribe to our newsletter is a questionnaire for email and texting risks. So it just has those little questions on it like, "Are you using a work address, are you using a school address, is there anyone in your home you wouldn't want to see emails or texts from me?" It has all that right there, so the things Rob and I are talking about are in that little questionnaire. It's a really little questionnaire, it doesn't take a long time to do.
	We also have a form for collecting consent to use the non-secure email. Basically, the lowest conventional non-secure, collecting consent for that. If you want to subscribe to the Person Centered Tech newsletter, you get all that for free.
Rob:	Just in case you missed that, maybe you're driving, on your way to work, and somebody laid on a horn, something distracted you, he said the key word there, these are free.
Roy:	Yeah, free, that's right. Free.
Rob:	Excellent. So, it sounds like people do have choices, they just have to spend a little bit of time with each client to decide which choice is going to work best for that client.
Roy:	This a little bit, for me, it's a minute with each client most of the time.
Rob:	Right.
Roy:	Yeah. Well, cool, I think we just loaded people's brains with plenty of information. We could probably let them go.
Rob:	All this about this ancient technology email. I don't know what's going to happen when we start talking about new stuff like texting, oh my gosh.
Roy:	Well, it'll be easier, because the fact that it's ancient is what makes it so hard.
Rob:	Yeah, that makes sense.
Roy:	Because there's so much that can go wrong with it. Well, that's everything for me. I'm Roy.
Rob:	And I'm Rob.
Roy:	See you guys next time.
Rob:	Thank you for tuning in to Therapy Tech with Rob and Roy. This episode has been sponsored by Hushmail, the secret to simple, secure communication.
	Episode notes and helpful resources can be found at www.therapytechrobroy.com. Until next time, may your joy be plentiful and your inbox reach zero.