The Resilient Mental Health Practice

Nourishing Your Business, Your Clients, and Yourself

Jennifer M. Ossege, Richard W. Sears

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317374947
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The Resilient Mental Health Practice: Nourishing Your Business, Your Clients, and Yourself is a fundamental resource for mental health professionals, designed to serve as a comprehensive yet parsimonious handbook to inspire and inform novice, developing, and experienced mental health professionals. Replete with case studies, The Resilient Mental Health Practice gives readers a big-picture view of private practice, including detailed explorations of various topics related to therapist self-care and preventing burnout. Chapters provide a range of ways in which clinicians can build a resilient and sustainable practice while also taking care of their clients and themselves.

PART I

PRACTICE MANAGEMENT

Nourishing Your Business

Chapter 1
Independent Practice and Consultation Services as a Solo Practitioner

Richard W. Sears

So, you’re finally ready to strike out on your own, and hang your own shingle. Maybe you just received your license and have longed for this day, or maybe you are tired of working for someone else, twice as hard for half the pay you could be getting. Or maybe you just want to supplement your income with a small practice on the side, even for just a day or two a week.

Independent private practice can take two forms—completely alone, or alone with others. You could have your own private office space, or you could share an office with others. In either case, you are only paying for rent or specific services, and you are not subject to anyone else’s rules or control.

Some prefer the structure and support of a group practice, which will be covered in the next chapter by Jennifer and Ted Ossege. When you are in a group practice, you can often rely on others to help deal with the business side of practice, but when you’re going solo, it’s all up to you.

Solo private practice is not for everyone. Even if other therapists rent space in the same building, it can be very lonely, since everyone is alone in their own offices all day. Those in solo practice like having their own space and independence, and find other ways to find professional support and connection (see Chapter 7 on peer consultation by Joy McGhee).

You will also need to have at least some degree of entrepreneurial spirit. In giving up the steady paycheck and benefits of a job, solo practice requires you to have a tolerance for ambiguity and risk. You will also have to be proactive to educate yourself about and take care of administrative and marketing tasks.

Some feel that managed health care organizations have taken away the freedom and profitability of practicing independently. However, there are a large number of clinicians who are effectively utilizing creative marketing strategies to maintain thriving practices. You can lament the negative effects of managed healthcare on private practice and give up trying to be independent, or you can take action and creatively establish a thriving practice.

You probably received great clinical training in your graduate program equipping you to deal with a wide range of diverse individuals and complicated presenting issues. Unfortunately, few programs emphasize the details of setting up your own private practice. Many clinicians actively shy away from matters of business, but when your livelihood and your family depend on your steady income, at least some degree of business savvy becomes essential to your survival. While you won’t need an MBA to run your own business, you will need a plan.

DEVELOPING A BUSINESS PLAN

Too often, people dive into new business ventures head first and sort of make things up as they go along. While in some cases, this courage to seize opportunities is quite desirable and helpful, in other cases, it can lead to disaster.

Strategic planning is essential to any successful business venture. It involves clarifying your purpose, assessing your own strengths and weakness, analyzing the opportunities and threats in the external environment, choosing and implementing your business strategies, and monitoring and evaluating how things are going. Though plans should be reviewed and adapted over time, they serve as compass headings to keep you on track toward developing and maintaining a successful practice.

Before you decide what to do, you need to decide what you want.

Vision Statement

In the business world, a vision statement typically expresses the direction the organization wants to take over the next 5 years. It involves clarifying big-picture strategies. While your long-term vision may change and evolve with time, be sure to consciously pay attention to where you ultimately want to go. If you find yourself chasing after dozens of different opportunities as they pop up, you may end up losing your focus on where you really want to be in the future.

Before you can even begin to plan your business strategies, try to become as clear as possible about what you want your practice to ideally be. Just as we ask our clients, ask yourself what you would want 5 years from now, if you had that magic wand and did not have to figure out yet how to make it happen. Begin with a brainstorming session. Let your mind creatively think through what you would want if you had that proverbial magic wand. Editing your thoughts too quickly can stifle your creativity.

How many clients do you want every week? What kind of clients do you want to work with? What types of services do you want to provide? How much variety do you want in your workday or in your workweek? How often do you want to take vacations? How flexible do you want your schedule to be?

Your vision should include more than just your professional goals. Be sure to include all the things that you value, to build motivation to do the hard work that will come with building your private practice. One of my mentors, Stephen K. Hayes (2012), recommends keeping a document of what your perfect day would be like. It will change over time, but it can inspire you to keep focused on where you want to be. From the time you wake up in the morning, till the time you go to bed, what will your days be like? Do you want to spend more time with family? Greet your children when they get home from school? Where do you want to go on vacation? What hobbies do you want to pursue? How will you nurture your physical and emotional health? What do you want to do for fun? While private practice work can be very fulfilling, don’t forget to enjoy your life along the way.

Mission Statement

Once you have a vision of where you want to be down the road, you will need to work backwards to develop a concrete, realistic, workable plan. A mission statement clarifies an organization’s tactical plans, or short-term goals, typically for a 1-year period. It should concretely describe what you want to be involved with on a day-to-day basis for the coming year.

Keeping in mind your long-term vision, consider the practical short-term goals, such as making sure all your expenses are covered, and that you can earn a living. For example, your long-term vision may be to see 30 clients a week in your office, but as you are building your caseload, you might choose to adjunct teach at a local university, do evaluations at a local retirement community, and/or give regular public presentations to make connections in the community. If you don’t plan your time well, and forget your mission, you may end up wasting a lot of time doing tasks that seem urgent but are not important (like checking emails too often) instead of engaging in tasks that are important but not urgent (like engaging in marketing activities) (Covey, 2004).

SWOT Analysis

Once you know what you want, it is important to do a SWOT analysis—Strengths, Weaknesses, Opportunities, and Threats (David, 2014; DuBrin, 2012; Whetten & Cameron, 2016). The first two involve an in-depth and honest look at your own personal strengths and weaknesses in the present, and the latter two involve investigating the opportunities and threats in the external environment that are likely to arise in the future.

Strengths

Begin by taking an inventory of your own personal strengths—the things you do well.

A good place to start is to take an inventory of your own character strengths using an instrument such as the VIA Survey of Character Strengths (www.viacharacter.org), which is a free resource and very user friendly.

Next, take inventory of your professional strengths. What do you do well? What specialized training or experience do you have? What populations are you passionate about? Over time, we can get so focused on our areas of growth, or on what we don’t know, that we forget how much we really do know. You may be pleasantly surprised to realize how special you are when you begin to have people seeking you out for your unique talents and passions.

Weaknesses

It will also be important to honestly assess your areas of weakness. Knowing these areas will help you plan strategies to work around them, or at least to minimize the harm they might create for your business.

Again, begin with your personal areas of weakness. Do you have trouble getting going first thing in the morning? Are you easily bored by doing the same activity all day? Do you have trouble keeping up with details, such as administrative tasks? Are you comfortable with computers and technology? Do you have difficulty tooting your own horn (i.e., marketing yourself)? For example, I know that I simply don’t have the patience to deal with insurance companies, and I don’t want to take the time to keep up with the numerous and changing requirements of each company. Hence, my practice is entirely fee-for-service, eliminating the need for me to engage with insurance companies. While this may limit the number of clients who can work with me, knowing this about myself helps me focus on more fulfilling clinical work, such as personal growth counseling and organizational consultation, which are not covered by insurance anyway.

What are your professional weaknesses? Do you have deficits in your clinical training? How comfortable are you working with crises, such as suicidal and homicidal ideation? Do you have adequate training to assess for and work with the power and control issues characteristic of domestic violence situations? How competent are you to work with diverse populations? Have you been trained to work with all ages, or only a specific age range?

You may simply be able to avoid some of your weaknesses, as I do with avoiding insurance companies, or by making it clear that you only work with a certain age group. However, some areas you may simply have to work on, such as keeping up with the legal requirements of documentation or handling unexpected crises. While you may be able to make referrals when you feel that you are not competent to work with an unexpected issue that arises in therapy, incompetence to work with issues such as domestic violence could literally result in the death of your client and/or the loss of your license if not handled properly. Increasingly, clinicians are also getting reprimanded by state boards for working with cultural groups for which they have had inadequate training.

You can begin to address your weaknesses with regular consultations from colleagues, perhaps from local professional associations, or a peer supervision group (see Chapter 7 by Joy McGhee). Seeking professional consultation and continuing education workshops can help to ameliorate your clinical weaknesses. Sometimes technology, such as psychotherapy documentation software, can be helpful. Some services, such as accounting and collections, can be contracted out to specialty companies on an as-needed basis.

Opportunities

Once you have identified your strengths and weaknesses, it is important to assess the opportunities that exist in the external environment, in this case, the community where you will provide services. If you are conducting only traditional psychotherapy, this may encompass a fairly small geographic region. However, if you engage in activities like speaking or consultation, or provide services virtually through teletherapy, your environment may reach far beyond your local region.

If you have lived for a while in your local community, you may already be well aware of current gaps in services, and the opportunities that exist to fill them. Otherwise, networking will be important, both for assessing community needs and for fostering referral sources. Join your local professional association, attend meetings, and reach out to other providers. Let people know you are opening a private practice, and ask them directly what needs there are for services in your community.

To determine the needs that may exist at a regional, national, or international level, it is important to get involved in regional, national, and international professional associations. Professional publications and listservs often discuss these issues in depth, and can give you a sense of where needs and opportunities exist. It can also be helpful to approach experts in whatever area you are interested in, whether in person, by phone, or by email, and ask them directly about their experiences and what recommendations they would make to someone getting started in that area.

If there are already others doing what you would like to do, you should not necessarily give up on your plans. There is no shortage of suffering people in the world who need help, and there will always be opportunities for competent, passionate clinicians who do good clinical work.

Threats

Threats are potential environmental issues that could arise to create problems for your practice. Staying informed through local, regional, and national professional associations, relevant listservs, and business-savvy colleagues can help you stay abreast of changing conditions in the economy, laws, regulations, and with possible competition for your services. While you should not automatically despair when negative predictions are made, as they are often over-exaggerated, it is good to be prepared.

Once you know where you want to go, what you can do, and what the external environment is like, you are ready to plan the steps to make your vision a reality. You will need to develop both clinical strategies and business strategies.

DEVELOPING YOUR CLINICAL STRATEGIES

When I first began my private practice, I wanted to be all things to all people. When colleagues asked me what I specialized in, I basically said, “I do everything,” and I wondered why I wasn’t getting very many referrals. I specifically remember a turning point in my practice. I received a random phone call asking if I would do contract psychological assessment work for a company that did independent medical evaluations (IMEs). Even though I was busy with a teaching job, since my caseload was low, I began thinking through what it would take to get involved. While I had the necessary clinical training and experience, it dawned on me how different that kind of work was from the areas that were my real passions. I became keenly aware of the fact that even though doing IMEs might make me a few bucks in the short run, in the long run, it would hurt me by distracting me from my more important long-term goals.

While rural areas often need generalists, those in the city who say they do “everything” do not distinguish themselves from the hundreds of other psychotherapists in their communities. They also run the risk of spreading themselves too thin. It takes a lot of time and money to keep abreast of dozens of practice areas.

Having a specialty niche, or even several, provides a powerful marketing tool. Once I narrowed down my specialties to mindfulness, anxiety, and organizational consultation, I suddenly found myself with a steady stream of referrals.

On the other hand, you should also be careful about putting all your eggs into one basket. Some practice areas may be “feast or famine,” so it can be helpful to diversify income streams. For those who dislike doing the same thing all day, having several areas of interest can provide stimulation and variety.

Managed care has eaten away at the profits of private practices throughout the United States. However, you do not have to be dependent upon insurance companies. While there are many thriving private practitioners who take insurance and practice in the “traditional” way, you should not automatically limit yourself to a practice based on the “medical model” of working only with those with serious mental health disorders. Our specialty is human behavior, and our skills are useful for a wide variety of applications, such as executive coaching, career counseling, enhancement of interpersonal skills, and development of parenting skills.

The areas below are meant to stimulate creative thinking, and are not meant to be exhaustive. Of course, as with any specialty, make sure you receive proper training and supervision before attempting a new practice area, and check your state board rules for what is allowed in your profession’s scope of practice.

Psychotherapy Specialties

Due to the diverse range of human beings and the challenges that come up for them, there are many opportunities for specialization. Practitioners can choose to focus on specific age ranges, presenting issues, diversity variables, or a specific combination of factors. Sometimes clients and referral sources are seeking practitioners who are competent with certain treatment interventions, such as cognitive behavioral therapy, dialectical behavior therapy, or mindfulness. Some clinicians gain strong reputations for their abilities to work with couples and families.

Conducting psychotherapy in a group format can be more efficient and profitable for the clinician, and can be more affordable and effective for many clients than individual psychotherapy, yet this modality is often underutilized (Corey, 2012; Yalom & Leszcz, 2005). There are quite a variety of types of group therapy, from generally open personal development groups, to groups focusing on specific populations and presenting issues, to psychoeducational groups. Conducting groups can be more challenging than individua...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Tables
• Acknowledgments
• About the Editors
• About the Contributors
• Introduction
• Part I: Practice Management: Nourishing Your Business
• Part II: Caring for the Caregiver: Nourishing Yourself
• Index