Tough Love: How to Be Firm About Finances

When you decided to go into the field of professional psychotherapy, it's likely that your reasons had little to do with money. Even as you first started, you probably didn't have dollars on the brain all the time (payments, insurance, fees, collections, etc.). Billing specialists deal with that stuff, not us, right? But those of us in private practice quickly discover how important it is to acknowledge and successfully navigate the financial aspect of our businesses. And resigning from managed care panels and switching to a fee-for-service model means that the responsibility to collect fees relies on the individual therapy practice; now, it's our job.

I certainly understand that it can be awkward. People get weird about money. I used to be uncomfortable asking clients for payment after they'd born their souls to me. But thankfully, there's a way to conquer money anxiety, serve your clients, and still meet the needs of your practice and of yourself. Here are some strategies I've discovered about how to be firm about finances and present your stated fees to clients with confidence:

(Re)Consider the Purpose of Money

Your own personal history may lead to your feeling anxiety about money. It may help to rethink the role it plays and the reason why we even have it in the first place: you are offering your time, energy, and skills to therapy, and in return, the client is offering you the resource of money. It's an energy exchange that can be emotionally neutral. It doesn't mean you are greedy or uncaring; not at all!

Value Yourself and Your Services

When I first started, I had a hard time seeing myself as a professional, which meant that I wasn't as confident or assertive about asking for money. But my supervisor helped me understand the training, skills, education, and experience I could offer. Remember what you're worth: you can provide valuable insight to those who are struggling, and you deserve to be compensated for your work. Keeping this in mind will help make it easier to accept payments and communicate about money issues.

Charge Before the Session

It works best to ask for payment at the beginning of the session before attempting to conquer tough emotional issues. This gets it out of the way right away and avoids the potentially awkward exchange at the end. There's no surprise, no uncomfortable conversation about fees owed. There's also something about being paid up front that is gratifying and enforcing for the therapist.

Use a "Money Script"

When possible, it's best to keep a separation between the therapist and the finances because it helps the client not associate his/her counselor with money. Use a planned and rehearsed script to communicate about payments. It may go something like this:

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."

Have a Clearly Stated Payment Policy and Stick to It

Don't skimp on this. Take the time to develop and implement a carefully thought-out policy concerning payments, no-shows, cancellations, etc. By setting clear expectations, you can pave the way for an efficiently run practice with clients who attend sessions and take therapy seriously. Your actions and attitudes about finances will set the tone: if you feel anxious discussing money, your client likely will as well. But if you're professional, positive, and confident, a client will feel at ease.

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 (read here for more about how to get paid for no-shows) . Therapist Leland Clipperton of Counseling & Mediation has a system in place where a client can actually receive a discount by pre-paying for 4 sessions in advance. Do some research, ask around, and get creative and innovative in developing a policy payment or tweaking your existing one.

You may find it helpful to have a system to notify your clients about their upcoming sessions. Making phone calls or using your EHR to send automated text messages or emails a day or two beforehand can serve as important reminders and reinforce the value of therapy. So if they're making the financial investment, we might consider making an extra effort to encourage them to be there.

In my 12 years in private practice, I've gotten extremely comfortable talking about financial issues with clients. With time, experience, and the use of these strategies, I am confident that the same can be true of you.

 How are YOU firm about finances?

What money tips and strategies that have benefitted your practice can you share?

Click here to access my webinar "How to Break Up With Managed Care" and learn more about how to improve your therapy practice.

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Therapist Roll Call: Join The Private Practice Pinterest List

Do you use Pinterest? I do and I have found some amazing relationship and emotional health resources for my clients and practice building resources. I've also found that it's a great way to direct visitors to my website and learn about my services.

In the past, I've featured a roll call for therapists so we could connect on Twitter and Facebook, and it was very well received. I'd like to continue that tradition so we can get to know each other more on social media.

I recently wrote about how Pinterest can benefit your practice. So let's all add our Pinterest information and see what kinds of things we're pinning on our boards. Connect with me on Pinterest here

Follow Private Practice Toolbox boards:

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Post a comment below and include:

1. your name
2. a link to your Pinterest page or board
3. your city and state
4. specialty area

Webinar: How to 'Break Up' With Managed Care and Build a Fee-For-Service Practice

New webinar this Wednesday on building a fee-for-service private practice

I've written previously about my decisions to 'break up' with managed care and build a fee-for-service only practice. This topic comes up often in my Private Practice Toolbox Facebook Group. Group members often ask questions like:

• Is it really possible for private practitioners to build a cash-pay practice in our current economy?
• How do you find clients who are willing to pay your full fee at each session?
• How do I overcome the fear of losing all of my clientele if I resign from insurance panels?
• How do you address the needs of those in your community who can't afford your services if you don't work with insurance?

If you've ever wondered these questions, you may be interested in my upcoming webinar this Wednesday.

Date: Wed. Oct 10, 2014*

Time: 11:00 a.m. (PT)/Noon (MT)/1:00 p.m. (CT)/2:00 pm (ET)

Length: 90-minutes

*If you can't make the live webinar at that date & time, no problem! You'll receive a link to watch the replay video at your convenience, but you do need to register.

Reserve your seat here

Here's why I resigned from managed care:

• Excessive paperwork: I was spending almost as much time performing unpaid work (paperwork, phone calls, tracking authorizations, and billing) as I was spending seeing clients. I went into this field to do therapy, not paperwork.
• Reduced income: I resented writing off 40-60% of my fee upfront just to be placed on a list with dozens and dozens of other therapists. The managed care companies weren’t doing anything to market my practice, and yet I was being asked to take a huge pay cut to work with their clients.
• Mandatory diagnosing: I grew tired of having to diagnose every client who walked into my office in order to get paid. When I met with a client who didn’t have clearly diagnosable symptoms, I was faced with a dilemma. Do I stretch a diagnosis just so I can get paid, or do I do free therapy because insurance won’t reimburse without a diagnosis?
• Denied or delayed payments: Being denied reimbursement for a variety of reasons and receiving payment weeks or months after I had performed the service was extremely frustrating.

Here's what has happened since 'breaking up' with managed care:

• Exponential growth: My private practice grew from a solo practice to a clinic of 20 providers and 3 locations in a fee-for-service model during an economic downturn.
• Immediate payments: We get paid our full fee at each session (including late cancellations and no shows)
• Streamlined paperwork: We do assessment, case notes, and discharge summary.
• Motivated clientele: We work with clients who value our time and expertise because they are more financially invested in the therapy process.
• Diagnosis has become a tool, not a requirement for payment: We don't have to diagnose anyone.

In this webinar, I'll show you how to:

• Identify and attract your ideal clients.
• Demonstrate the value of your services to your community through building a strong online and media presence so clients will be willing to pay your full fee at each session.
• Wean off of managed care contracts and smooth this transition for your current clients by offering many options.
• Talk confidently about your services, your fees, and financial policies.
• Provide options for potential clients who can not afford your full fee or who want to use their insurance benefits.

The decision to resign from manage care panels and build a fee-for-service practice is not the right path for every practitioner. However, there are some private practitioners who want to go this direction but lack the knowledge, skills, or confidence to implement their desired changes. If you fall into this second group, this webinar is designed for you.

I hope to see you on Wednesday!

Here's the link to reserve your spot for the webinar and access to the replay video

Oh, and if you have any specific questions you'd like me to address in this upcoming webinar, contact me here with "Managed care webinar Q" in the subject line.

4 Ways To Use Pinterest To Build Your Practice

Pinterest is a social media platform that therapists might overlook when building their online presence. It may seem more tailored toward foodies, pop culture junkies, or book lovers than for people wanting or providng professional counseling. However, Pinterest can be a valuable way to serve your online community and also get the word out about yourself and the clinical services you offer. Joe Sanock, an LPC who also works as a private practice consultant, explains that “People who go on Pinterest are dreaming about having a new life. It could be a new hair style, a new dress, or a renovation. They are in a mindset of change. As counselors, we fit perfectly into that mindset.” He says that Pinterest is his leading referral for both his private practice and consulting business. Bottom line: Pinterest can work as a great marketing tool for you (read more about Joe's experience here).

Here is some more information and tips for using Pinterest to benefit your practice:

1) Regularly Pin and Re-pin Inspiring and Informative Material 

Make a point to pin and re-pin inspiring quotes and ideas that are relevant to your work as a therapist. Quotes about change and personal development often work best. Try to use quotes that are universal enough to not seem super technical or boring, but specific enough to establish that your niche deals with emotional and relational well-being. Use original material as well as curating existing content.

It’s a good idea to strategically include your name and website links on your graphics or memes (see left for an image I pinned as an example). This can be helpful when you get share and re-pins. It’s more than okay to tap into the promotional side of using Pinterest.

There is of course no cut-and-dry rule about how regularly you should post. But as is the case with any social media platform you utilize, you must commit to make content creation and curation an ongoing thing if you want it to make a difference in your marketing; pinning a new picture or idea once every month is not going to do much for establishing and maintaining your online presence.

2) Optimize Your Bio and Profile

The bio at the top of your Pinterest page is your "hello" to new followers. First impressions are important, and you want to introduce yourself professionally and accurately to your viewers. It should have your picture, a clear description of your speciality, and links to your main website. Optimizing your biography is also good for SEO (making your stuff for findable on the web). See screenshot below for my example:

3) Be Deliberate in Selecting Categories and Board Titles

Similar to your biography, be strategic about your titles, categories and boards; they're more important than you might think. Not only do they give a clear indication of the nature of your material, but they're also good for the search engines because your titles are your keywords. Not every one of your boards must be directly related to the field; it's good to diversify and show your followers that you're a multi-dimensional person. For example, you might have a board of humorous memes.

4) Follow Others in Your Niche

And finally, we come to the social part of the social media of Pinterest. Follow other relevant users. Look at the categories and boards of those who re-pin your stuff and see if they are similar to yours. Engage in Pinterest not just for yourself, but use it as a way to learn more and continue to be inspired. Check out other people's pins as well. And yes, follow to be followed (among other reasons).

So there's some tips to get you started or help you more with using Pinterest. It can be a useful tool to engage with the online community, invite more visitors to your website, as well as build your own professional online presence.

What's your experience using Pinterest for your practice?

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3 Ethical Fears of Being a Therapist Online and How to Resolve Them

Every therapist knows that ethics is a critical component of working with clients. Once you add social media into the mix, things can get even more complicated. I’ve noticed that unfortunately, some in the profession are resistant to embracing technology and building an online presence related to their practice because of fear of the potential ethical problems. It’s true that there are risks involved in going online, but we don’t need to be run by this fear; the risks can be managed, and, as we’ve talked about so many times before, the benefits are staggering.

Here are 3 Ethical Fears of Being a Therapist Online, and How to Resolve Them:

1) A Client Breaking Professional Boundaries

If you’re findable on the internet, naturally you’re easier to contact as well. And while we find that most clients respect boundaries with their therapist, some may choose to disregard common rules of protocol, especially when a professional’s online presence facilitates their ability to do so.

Mari A. Lee, an LMFT who specializes in sex addiction recovery, prevents this by having her clients sign a social media form as part of the intake packet. “I do not allow clients to post to my business Facebook page or private message me,” she explains. “I do not accept friend requests or professional links from therapy clients on LinkedIn.” Mari describes how the few times that a client has attempted to add her, she simply redirects them back to her policy. By doing, she has never encountered an incident of professional boundaries being crossed (read more about Mari’s experience here).

Overall, being clear about what is and is not acceptable for your clients with regards to social media will all but prevent problems from occurring. Develop a social media policy for your practice, include it in your initial client paperwork, and have it available on your website (read more about developing a social media policy here). While you must be firm about your boundaries, try to communicate your expectations in a way that is not alienating or harsh. A client reading your content online is a good thing, so you don’t necessarily need to discourage all forms of social media engagement; it is direct contact that is prohibited.

2) The Risky Possibility of Dual Relationships

We all know that therapists in private practice should be cautious when entering dual relationships with clients and be mindful of  the potential risk of exploitation or harm to the client. This caution extends to online dual relationships as well. If you as a therapist have an online presence and engage in multiple professional activities (publishing, consulting, etc.), you might be worried that a client could feel pressured to purchase additional services or products from you. Whereas before you were a person that your client saw in an isolated setting, you are now an established figure that he/she can read about or follow anytime on the internet.

This fear really is unfounded. It’s okay for someone to find you online and understand that you are selling something in addition to seeing clients. As long as you’re not soliciting these things during a private session, you don’t need to try and hide the fact that you do other things. Your ethics courses taught you what need to know about avoiding these kinds of interactions.

If you think there might be a legitimate possibility that your outside professional activities encroach on the ethical integrity of your counseling, consider the following: Dr. William Doverspike, a licensed psychologist and president of the Georgia Psychological Association, proposes a very simple ethics test when contemplating dual relationships. Ask yourself these 5 questions to determine whether or not your online activities are ethically sound in relation to your clinical practice:

Is there a chance of:

1. loss of effectiveness of the professional?
2. loss of objectivity of the professional?
3. loss of competence of the professional?
4. risk of exploitation of the client?
5. risk of harm of the client?

If you can answer an honest no to all of these questions, you’re just fine in pursuing your other activities.

3) Posting TMI

Most of us have witnessed someone who gets too personal on Facebook or on other social media outlets. These platforms can be great for sharing information and photos and keeping in touch with one another, but sometimes people go too far.

Being cautious with social media activities becomes even more important for a therapist with an online presence. Where does your personal life begin and your work life end? Would your relationship with your client be jeopardized by something you posted about your own life? Is it possible for something to be appropriate for your personal page but not for your business page? Keep in mind that social media platform privacy settings are constantly shifting and that there is no guarantee that some information posted on personal profiles may still be accessible.

I trust that my friends reading this right now aren’t the type who post blatantly inappropriate or disrespectful material, but it can still be challenging to find that line. Here is the rule that I’ve created for myself that has worked well for me: if I wouldn’t feel comfortable with anyone in the world viewing it, I won’t post it at all. It’s that simple.

Once again, this potential ethical problem is easy to avert. Use common sense, your ethics training, a social media policy, and your best judgment. Overall, just trust yourself as to what to post; you are a professional after all!

The point of this post is that you don’t need to be run by fear when it comes to social media engagement. I encourage you to embrace the technological world and let it benefit both you and your clients.

I wrote an in-depth article about social media ethics. Click here to read it.

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