Adventures In Private Practice: Trauma Specialist Leticia Reed, LCSW

Less than one year ago Leticia Reed, LCSW opened her private practice in Long Beach, CA. Find out what resources and tools have helped Ms. Reed muster the courage to open her own practice, what she's learned from clients, and how she manages her roles as "therapist" and "business owner".

Tell me about your private practice...

I opened Reed Behavioral Solution in March of 2012. My practice mission is: "Helping individuals, couples and families achieve hope, healing, wellness and freedom. Empowering my clients to leave better than they arrived is what drives me to provide the best and most effective services. I specialize in women's empowerment and trauma, although I provide a wide range of services to other populations in my practice. I also offer Christian counseling for those seeking spiritual connectedness as a means of coping and regaining a sense of purpose and hope.

Why did you decide to open a private practice?

I began my practice after leaving employment with the County of Los Angeles and feeling like individuals were being failed by the system as they were only treated as a number that became lost in a revolving door. I felt like opening my practice provided me with an opportunity to make a significant impact, one with real rehabilitation and healing.

Clients that therapists find to be the most “difficult” are sometimes the ones who can teach them the most. What have you learned from your toughest clients?

I agree that "difficult" clients provide the most meaningful learning experiences. Through my more challenging cases, I have learned the importance of patience, tolerance, unconditional positive regard as well as the real importance of "starting where the client is" to guide them towards healing. The technique- Motivational interviewing has been the principle that I have incorporated to achieve this while increasing motivation.

What’s your biggest pet peeve about private practice?

One of my biggest pet peeve would be the amount of documentation required as it takes away from my time spent in direct contact with my clients. However, it's necessary as it also provides me with a blueprint and framework that guides my treatment and goals.

How did you discover or develop your practice “niche”?

My niche sort of evolved as the majority of my clientele seeking services has been women with self-esteem and trauma related issues.

What resource (book, website, person) helped you the most when setting up your private practice?

The various resources that have aided me in starting my private practice has been the following: Nakeya Fields of Fields Family Counseling who offers a workshop geared towards assisting individuals starts their private practice, while providing lifelong networking and consultation with other group members. I also used and received a wealth of information from Ofer Zur Institute Practice Handbook for HIPAA friendly forms and regulations. My mentor Cynthia G. Langely, my prior clinical supervisor who has many years in the field serving in various positions, including on the CA BBS panel when the Oral examinations were required, has continued to provide me with a wealth of information and support. Lastly, The various Facebook groups I am currently in, including Julie Hanks’s Private Practice Facebook group have also increased my knowledge that has been instrumental in keeping me current in the field.

What has surprised you most about being in private practice?

The things that have surprised me the most about building a private practice has to be the amount of work it takes to stay afloat and monetary resources needed to build and maintain operation. Another surprise has to do with the number of people hurting and in search of HOPE, some of which are fellow colleagues.

Has your private practice helped you grow professionally?

My private has influenced my growth professionally in the sense that it has taught me the importance of being organized, detailed oriented, punctual, and the importance of networking/collaboration.

Has it helped you grow personally, too?

On a personal level it has made me to be more grateful and attuned to the world and my purpose in it, helping me to not take anything for granted.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?  

Self-care is extremely important to me. I love pampering myself, traveling and engaging in church activities, reading my bible and praying. I also make it a point to surround myself with positive people that are encouraging and uplifting.

How do you cope with the inevitable stressors involved with being your own boss?

I cope with the stressors of being my own boss by consulting with colleagues in practice and digging my heels in the sand and "just doing it". My tenacious spirit and optimistic personality as well as my strong Faith in God has assisted me in my success in this short amount of time I have been practice. Colleagues that know when I began have commented on my rapid success. I am a very blessed woman and I am looking forward to even more expansion in 2013 and beyond.

Find out more about Leticia Reed's private practice at www.reedbsolutions.com

6 Reasons You Don't Have Enough Clients

Getting and keeping clients is a common struggle for private practitioners. Here are 6 potential barriers to a full practice and what to do about them.

1) You're not keeping the clients you have

It takes a lot less time, money, and energy to keep a client engaged in meaningful therapy than to find a new client. Keeping clients engaged in the therapeutic process requires additional skills. New skills might include setting expectations during the initial session that therapy is an on-going process. Recommend  that new clients schedule ahead 3-6 weeks (depending on your assessment of their need during the first session) instead of scheduling one week at a time.

Another strategy that will boost client retention is reaching out to clients who've dropped out of treatment without proper termination. I encourage my team of therapists to do this regularly by writing a hand-written card with their business card enclosed to clients who have not returned to therapy. The cards say something like, "You've been on my mind. I want you to know that I am here if you need me. If you'd like to take a break from therapy for a while that's fine. I'd like to offer you a free 25 min "wrap up" session where we can say goodbye." Many clients are very touched by this gesture and it is just the encouragement they need to continue coming to therapy. Even if clients don't continue in therapy, you've modeled how to say a healthy "goodbye".

2) You're not offering anything valuable to potential referral sources

I love that I'm approached regularly by a therapists trying to network and ask for referrals. You know the ones who I will refer to? I will refer to the therapists who approach our relationship as a mutually beneficial relationship. I am more likely to refer to therapists who, in addition to asking for referrals, offer their time, expertise, or referrals to me and my practice.

Several years ago I had a therapist contact me asking if I would refer couples to her for therapy. While she did offer to take me to lunch (which I didn't have time to do) she wasn't offering herself as a resource to me in any way. Additionally, I was annoyed because had this therapist had done her homework and looked at my website she would have seen that I work with couples and that I have several colleagues at my clinic who also work with couples. The key to developing strong referral relationships is to create mutually beneficial relationship, offering yourself as a resource to the other person.

3) Your online presence is weak

Have you Googled yourself lately? Have you searched for key terms in your geographic location to see where your website ranks? Potential clients are searching for therapists online and will generally click on websites listed on the first page or two of Google searches. If your information is easily found make sure the information found about you and your practice is accurate. Here are some resources to help you strengthen your online presence and make it easier for new clients to find you.

Does Google love your therapy practice? 5 elements of an effective practice website 4 reasons to start creating online content

4) You're not as good as you think you are

Most therapists think they are more effective than they actually are.  Therapists, like any other professionals have varying level or skill and success, but it seems that on the whole we are an overly-confident group.

A 2003 survey asked 143 counselors to grade their job performance on a scale from A to F... Of the counselors, 66 percent rated themselves as A or better. None saw himself or herself as below average (Sapyta, Riemer, Bickman, 2005, p. 147).

How do you find out if your clinical skills are above average, mediocre, or below average therapist? Start collecting outcome data from your sessions. A few years ago I tracked every session using the ORS and SRS rating scales for an entire year through MyOutcomes.com. This allowed me to establish a baseline, track each client's progress, and see where your scores fall compared to therapists around the world. I was relieved to know that according to these ratings scales I was indeed an "above average"  therapist, but I was not as good as I thought I was.

5) Your attachment style is sabotaging you

A therapist's own attachment style and relationship history impact their ability to keep clients engaged in meaningful therapy and maintain consistent referral sources. While I only have anecdotal evidence, my experience training therapists in a private practice setting suggests that therapists with a secure attachment style or slightly anxious attachment do better in private practice setting than therapists who lean toward the avoidant end of the attachment continuum. Additionally, if therapists have done their own work in therapy and have a handle on their own issues, they tend to be more successful than therapists who haven't resolved their own emotional wounds. If you're having a difficult time getting or keeping clients, may I suggest calling your own therapist and working on your own attachment issues?

6) You appear desperate

Therapists who are new to private practice may feel particularly overwhelmed by the details of running a business, and the difficulty of establishing a consistent clientele. Feelings of desperation are also felt by seasoned therapists whose client numbers ebb during seasonal changes, economic conditions, or other reasons.  Potential clients and referral sources can "sniff out" desperation, and whether they are consciously aware of it or not, they will be less likely to trust you and your services. Here are some questions to ask yourself to see if you're coming off as overly desperate.

• Have you become  too accommodating when it comes to scheduling clients?
• Do you feel overly discouraged if a new referral chooses not to schedule with you?
• When talking about your practice do you talk fast and feel anxious inside?
• Do you follow up with potential referral sources more than once a month?

I suggest  that you "act as if" and "talk as if" you have a moderately busy practice. Lead with the aspects of your practice and your expertise that you are confident in and you'll find more success getting and keeping clients.

References:

Sapyta, Jeffrey, Manuel Riemer, and Leonard Bickman. “Feedback to Clinicians: Theory, Research, and Practice.” Journal of Clinical Psychology: In Session 61, no. 2 (2005):145–53.

Ani-Bee via Compfight

The 3-Letter Word That Gets More Clients

(c) Can Stock Photo

A simple practice-building skill that many private practice therapists overlook is to ASK directly for new clients referrals. Some shrinks assume that if they're skilled clinically colleagues, clients, and acquaintances will automatically refer clients to them. While that may be true for some therapists, in my consulting experience, building a thriving private practice takes conscious effort and deliberate action.

Asking for referrals is important so you are on the "top of mind" for your referrals sources. Potential referral sources may assume that you're too busy, that you're not taking new clients, they don't remember your name or contact information, or it just didn't occur to them to refer a client to you.

Here are a few ways you can ask for referrals when you need to fill some of your appointment slots without seeming desperate.

1) Send A Note Or Email

Get some nice note cards and periodically send a personal note to referral sources. Let them know that you'd love to work with their clients, that you have openings, and include some business cards.

Shoot off an email to referral sources who've sent clients your way in the past. Make sure that you include all of your contact information in the email to make it easy for someone to contact you. Here's an example of what I have said in an email to a relationship coach.

Dear __________,

I hope all is well with you. I hear great things about your coaching practice and have sent a few clients to your marriage classes. I wanted to let you know that I currently have a few openings for individual or couples clients who need some help with with deeper issues that may need to be addressed in therapy. Feel free to contact me if you have any questions or if you want to discuss how I can help any of your coaching clients who are "stuck."

Warmly,

Julie

(detailed contact info here, including website, phone, etc.)

2) Ask Over Lunch

Invite a referral source to lunch on you and ask for referrals then. Everyone needs to eat. I've found that people, especially professionals, are more likely to meet with you if you feed them. When you meet, remember to bring something to the table (no pun intended) to offer to them.

Consider ways that you can spread the word about their practice or business, offer a free training to their staff on your area of expertise, or make yourself available for free consultations or coaching on mental health issues.

3) Ask For Referrals In Casual Conversation

Number of client hours can vary greatly in private practice. There is an art to keeping consistent direct care numbers.  If your client numbers are down, don't be afraid to mention your openings in casual conversations with colleagues, doctors, friends, and other associates that you have openings in your practice. It's your job to remind people that you are in private practice and that you'd appreciate more business.

How comfortable are you asking for new referrals from colleagues, associates, professionals, and friends?

Adventures in Private Practice: Psychotherapist Diane Spear, LCSW

Get to know New York City licensed clinical social worker and psychotherapist Diane Spear, LCSW-R.

Tell us a little about your practice...

I’m a licensed clinical social worker in private practice over sixteen years. I treat people from older adolescents to senior citizens, in individual and couples sessions.  My practice approach can be described as psychodynamic, interactive, and reality-based, so I’m dealing with how a patient’s formative years affect his/her current conscious and unconscious attitudes about love, work, and play, so that they can build on what works and rethink what doesn’t in order to have a more satisfying life going forward.

Why did you decide to open a private practice?

I decided to open a private practice because I like the flexibility and autonomy of working when I want, setting my own fees, working with a theoretical orientation I find helpful, and choosing a supervisor whose way of working is compatible with mine.

What have you learned from your toughest clients?

What I’ve learned from my toughest patients—and my wonderful supervisor, Dr. Ed Campbell—is that they get to be crazy till they’re ready to listen, and that my responsibility is to “put it out there” consistently and to work hard at doing that, but that I’m not responsible for whether or not they are willing to take it in and use it consistently or at all.  That was enormously freeing!  And a great way to avoid burnout.

Some of my toughest patients are what my supervisor calls “help-rejecting complainers.”  Realizing that they have every right to reject my help, and learning to not take that personally—“You’re not listening to the great Diane Spear????!!!!”—has been really important!

What's your biggest pet peeve about private practice?

My biggest pet peeve (and it’s not very big at all, frankly) about private practice is that I don’t get paid sick days and vacation days.  But it’s a small trade-off for the autonomy I value.  Actually the worst deal is having to pay for my own health insurance.

How did you discover or develop your practice "niche"?

In terms of a niche, I originally worked with a lot of actors, artists, and writers, probably because I had an arts background.  Now I have patients from all walks of life, and I enjoy that variety.  My practice is a general one, and I enjoy that.

What resource (book, website, person) helped you the most when setting up your private practice?

The resources that have helped me the most in setting up my private practice have been my wonderful therapist, Nancy Becker, LCSW-R, and my tough-love supervisor, Ed Campbell, Ph.D., because they told me and modeled for me that if you want to have a successful practice, you have to treat it like a business and market it, and set it up in a way that’s fair to me.  This was a very different approach than what I learned in social work school, where it was politically incorrect to mention aspirations for a private practice.

What has surprised you most about being in private practice?

What has surprised me most about being in private practice was that my therapist and supervisor were right:  with hard work, a business attitude, and a commitment to learning theory and technique I could have a successful business, as they do.  In other words, their success wasn’t based on luck; if I wanted their results, I needed to put in the hard work they did and I could have a great business that I enjoy.

Has your private practice helped you grow professionally? How so?

My private practice has helped me grow professionally because there can be room for laziness at some agencies, without too many repercussions.   But if I’m lazy about learning theory and/or technique, or marketing, I will see the results in a failing practice, so having to be responsible to myself has forced me to have a better work ethic.

Has it helped you grow personally, too? How so?

Private practice has helped me grow personally, too, because I’m forced to confront my own narcissism on a daily basis with my patients, to know the limits of what I can do—I can’t change anyone except myself, though I can work with someone and help them change if they want to change.  And let’s face it:  anything that makes us confront our narcissism on a daily basis is going to help in every aspect of our lives!

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?

I avoid burnout by getting lots of treatment from my long-time therapist, and participating in a weekly supervision/study group.  What also helps is, once again, knowing that I can’t change anyone—all I can do is put it out there, and the patient is responsible for using it or not.

How do you cope with the inevitable stressors involved with being your own boss?

I cope with the stresses of being my own boss by setting up my business in a way that is fair to me, so that I don’t resent my patients.  When I started out, I paid $12 an hour for office space and my first patient paid me $20 per session.  I built from there, but had not learned to set it up yet in a way that was fair to me.  So when a patient cancelled on me, I rescheduled sessions, which meant that I had to pay $24 for office rent ($12 for the cancelled session and $12 for the make-up session), but just get paid $20 for the session.  No small surprise that I wound up resenting my patients!  My supervisor helped me set it up to be fair to myself with time and money.

What personal strengths have helped you succeed in private practice?

Creativity and a good sense of humor have worked well for me in private practice.  I enjoy coming up with analogies that will fit a particular patient’s situation or to explain a complex concept.  I’ve also found that humor can be a great way past a patient’s defenses.

To learn more about Diane Spear, LCSW-R visit her website

What Do You Love About Private Practice?

Ask me about my private practice and I light up. I love it. I just spent the last day and a half furnishing and decorating an additional office location in a neighboring city. I'm excited to be able to expand the reach of my practice and help clients in other geographic locations. There is such a satisfaction in feeling fully self-expressed professionally and to make a difference in the lives of my clients and my colleagues. My passion for building a private practice is why I asked Dr. John Grohol, CEO of PsychCentral.com if I could start this blog. I can't imagine being happier with a work situation and I want to help you develop the tools to feel the same way about your practice. I asked several successful private practice therapists the question, "What do you love about being in private practice?" I wanted to share their answers with you to inspire those of you who are considering going into private practice to do it! If you're unhappy with your practice, I hope you'll draw from these successful private practice experiences to create a practice that you love.

It's not "work"

Lynn Krown MA, MFT:

When you do something you are passionate about it's not work. I intend to work well into old age. The more life experience and mindfulness I have, the more wisdom I have to offer. I'm grateful to feel so fulfilled and alive as a psychotherapist age 70 this month.

Accurately represents who I am

Julie Jeske, M.S.:

I love it because it is mine. It is an accurate representation of who I am and the work I do. I truly love what I do and having a private practice gives me the freedom to really design and build my ideal practice. I can work when I want...in fact this summer I spent 5 weeks in Paris. I don't know if I could have done that if I didn't have my own practice.

I look forward to work

Gabby Acord, LCSW:

I look forward to my work and the days fly by. I don't get insurance benefits or paid time off, but I also earn 50% more than I would working full-time for the local University hospital and they pay very well. I feel good that my children know that my work is to help people and they don't resent the time away.

I'm my own boss

Amy Luster, M.A., LMFT:

I am passionate about maintaining a private practice as it grants me the ability to participate in the way that best suits me. I am an active parent to four elementary school aged children and I am able to schedule clients in a way that permits me to be present for my children. As they grow older and more independent, I am able to increase the amount of hours I can see clients in my private practice. I am not beholden to a specific way of working with each client, but rather, I'm able to respond to the needs of each individual, couple or family.

Allows me to refine my specialty

Geoff Steurer, MS, LMFT:

Private practice allows me to refine my specialty in working with marriages impacted by sexual betrayal. When I was working in an agency setting, I was required to see whatever cases walked through the door. So, in any given day I could end up working with children, teens, couples, elderly, and families. Even though I certainly enjoy the variety that comes from working in an agency setting, there is something deeply gratifying knowing that I'm developing a skill set that comes from working with the same types of cases day after day. I love knowing for certain that I can make a difference in the lives of the clients sitting across from me in my office.

I set the rules

Esther Kane, MSW:

I set the rules and love it! I’m independent and it suits my personality. I love the flexibility- going away whenever I choose and working hours I prefer. I get a highly-motivated client-base who are ready and willing to do the work. I own my own office overlooking the ocean and it’s like my second home.

It adapts to my changing lifestyle

Shannon Purtell MA, LPC:

In the last 3 years I have gotten married, and had 2 children. Private practice has allowed me to adapt to my changing lifestyle. It worked great when I was single and could work evenings/weekends, etc. and it works great now when I need to be home evenings and weekends to be with my family. Private practice affords me the opportunity to build a company that makes a difference in the lives of our clients, and provide a healthy work environment for my associates and interns.

It's a thrill to see people change

Eileen Kennedy-Moore, PhD:

There is no greater thrill than seeing people make real change for the better in their lives and being part of that change process. I'm grateful for the opportunity to do work I love, as my own boss, with hours that mesh with my family needs.

Meaningful connection with others

Loren A Olson MD, who is in the process of retiring from his psychiatry practice:

I have experienced the joy of connecting with people in the most emotionally intimate ways. I *know *them deeply and meaningfully. And although I've always maintained professional boundaries, I find that they know me, too. And so I grieve the loss of these relationships even while knowing that I am responsible for my own happiness. And as I retire I will find new ways to find pleasure in my life, but I also look back with a sense of satisfaction about having chosen such a meaningful profession.

Do you love being in private practice? Tell me about it! If you're not happy with your practice, what would you like to change?

If you have any topics you'd like me to write about, or specific questions for me comment below, ask me on Twitter @Julie_Hanks, or contact me directly here.