17 Years

Why Some Shrinks Fly Solo

WHITE IBISIn past posts I've explored the the positives and negatives of joining a group private practice. Now, it's time to focus on the pros and cons of running a solo private mental health practice. When I opened Wasatch Family Therapy nearly 10 years ago, it started out as a solo practice that slowly built over time into a group practice. While I like being "in charge" and autonomous, I'm also an extravert and I highly value my connections with others.

I reached out to other private practice therapists who practice alone to see why they chose to "fly solo."

Autonomy

Florida social worker and healthy eating expert Therapist Karen R. Koenig, LCSW, M.Ed. grew up as an only child, so she's used to being independent and working alone. That autonomy and comfort level has helped her to succeed. “I love being in private practice. I make my own schedule, decide whom I want to see and whom I don’t, set the fee schedule and slide if I want, and get to have an office in my home which makes both life and work easy,” Koenig shares.

Self-expression

Creating an environment that accurately reflects who you are is important to North Carolina therapist Erika Myers, LPC. "Having your own space in which to practice in a way that feels authentic to you, building an individual reputation rather than relying on a group name for recognition,” are reasons why Myers chooses to practice in a solo setting.

Flexibility

Illinois counselor Melanie Dillon, LCPC of Center For Wellness, Inc. practiced independently for 17 years. Of her experience she says, "Private practice gave me a very flexible schedule and autonomy. It also helped me grow to learn all aspects of being a small business owner. It was ideal for parenting and having a second income.” Eventually Dillon developed a mind/body group practice with two chiropractors when she found herself as a single mom and needed to provide a stable income.

As the second oldest of nine children in my family of origin I am used to being "in charge" and in having close connections with others. So, it makes sense that eventually, I grew my own solo practice into a group practice where I am still the sole owner and decision maker. Guess I just can't get away from being the "bossy" older sister.

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Are You Comfortable Asking Clients For Money?

Wallet - MoneyDuring my graduate school practicum placements I never had to think about the financial aspect of seeing clients. Billing specialists took care of collections. That was their job. After graduation I worked in a private practice setting where I was required to ask clients directly for...money. It was awkward at first to have clients share their pain with me, open their hearts, and be so vulnerable, and then ask them to pay me.

Adding to my money anxiety was the fact that I was charging the same rate as my clinical supervisor and I didn't believe my services were worth it. My supervisor helped me gain confidence by explaining that clients aren't just paying for my time and skill, but they're also paying for her years of expertise. I hadn't thought about it from that perspective before.

My supervisor also helped me to view myself as a professional. Even though I wasn't licensed to practice independently I did had a graduate degree and two years of practicum, and I was licensed to practice under supervision. I had valuable experience, knowledge, skills and tools to help my clients.

Almost 10 years ago I started a solo private practice. Suddenly, I was the therapist, the receptionist, the webmaster, the marketer, and the billing specialist/collections department. I realized that I had to get even more comfortable bringing up money with clients if I was going to build a successful practice. Through the years I've become extremely comfortable addressing the financial aspect of clinical practice with clients. Here are a few things I've learned to help you get more comfortable with money in your private practice.

1) Value your expertise

Keep in mind the time, money, energy, and passion you've invested in your education and training. The more confident you feel in yourself, the easier it will be to accept client's payments and comfortably bring up money issues.

2) Think of money as energy exchange

Money can be such a loaded topic, fraught with baggage from your own upbringing. It may help to reframe money in a more emotionally neutral way, as energy. You are offering your gift of investing energy in the therapeutic experience in order to help your client, and they are offering you their energy resource called "money."

3) Ask for payment at the beginning of the session

I've found that it works best for me to bring up money related issues at the beginning of sessions before delving into deeper therapeutic issues. It's awkward to ask for money after a client shared deep pain during their session.

4) Set firm payment policies and stick to them

Clients will take your lead with money issues. Setting consistent policies regarding payment from the onset of therapy teaches your client what you expect in the therapeutic relationship. If you're anxious about asking for money, your client will feel uncomfortable too. If you're confident, they'll likely respond positively. My clinic policy is that if you are one session behind in payment your therapy is on hold until your account is up to date. Also, we charge full fee for no shows and late cancellations, even on initial sessions, unless there is an emergency.

5) Money is a clinical issue

If you have clients who resist paying you, who "forget" their checkbook, who cancel at the last minute and don't want to pay you, treat the resistance as a clinical issue. Consider how the client's money patterns are part of the larger issues brings them into therapy and address it openly in your session.

6) Write a "money script" and practice it

I've recommended to several therapists I've supervised or consulted with who feel anxiety bringing up money with clients to write down a brief script and role play. Here's an example of the phrases I use in my practice.

At the beginning of the session, before walking into my office I ask, "How would you like to pay for your session today?"

When potential clients ask, "Do you work with my insurance company?" I respond, "While we don't bill insurance directly, I'm happy to provide you with a receipt to submit for reimbursement from your insurance company. You may want to check with them and ask if you have out-of-network mental health benefits."

Do you have money anxiety? What blocks do you have when it comes to asking clients for payment? How have your overcome them? Feel free to post your thoughts and comments below.

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