Pregnancy in Private Practice: 4 Key Questions To Help You Prepare For Maternity Leave

4 key questions to help you prepare personally and professionally for managing maternity leave in private practice.

I'm a mother of four children. My first two children were born during my educational journey and my last two were born while I was in private practice. Being in private practice provides many perks for balancing work and family life. The flexibility of being my own boss has been wonderful. However, taking time off for extended periods of time, like maternity leave, can prove to be tricky.  Unlike working for an agency, in private  you don't get paid leave in private practice,  you still have expenses to pay even when you're not seeing clients, and you have unpredictable income as you "wind down" to take time off and then build your client load back up after taking family leave.  Becoming pregnant while in private practice and planning for the new addition in your family requires some extra planning, coordinating, and saving.

How Much Time Will You Take Off?

These little babies can be a BIG adjustment. It's important to really think about taking enough time for you to adapt to being a parent to this new, little person. Dr. Jennifer Fee, psychologist from California found that one of the most helpful things was taking sufficient time off after giving birth. She suggests coming back gradually and not carrying a full load for awhile.

"Rushing back [to work] while you're adjusting to and bonding with a new baby is not good for you, your baby, or your clients. The great thing about private practice is that it's not an 'all or nothing' business. You can start practicing with a few clients rather than jumping back into a full load," says Dr. Fee.

Determining the length of your maternity or paternity leave can be extremely important in keeping your practice thriving. If you are a sole practitioner, taking a three month leave could potentially leave you with very few clients upon your return. You must decide not only how long is financially feasible but also how long works for your family and your clients.

Who will provide services to your clients in your absence?

It's important to consider who will provide clinical services to your clients while you are on maternity leave. If you are in solo practice, consider reaching out to another trusted private practice colleague who has openings to provide services to your clients while you are on leave. Make sure that your clients have the contact information of the therapist who'll be covering for you. I suggest that clients in crisis have appointments set up with this therapist before you take time off.

I recently talked with a private practice colleague who is pregnant with her third child. I suggested that she consider hiring another therapist to cover her clinical cases and also to generate income for her practice while she is on maternity leave.

When will you stop taking new clients?

You'll also want to think about when you will stop taking new clients. If you plan on taking new clients up until your leave I suggest that in your first conversation you inform them that you will be taking time off so they can have the option of seeing someone who can provide uninterrupted services.

Jennifer Venable-Humphrey, LCSW of Social Work Solutions stopped accepting new clients one month before her due date. When put on bed rest with her third child, Jennifer used Skype or phone sessions to check in with current clients that she had to stop seeing earlier than planned.

How will you cover your fixed expenses and lack of income?

Taking time off in private practice is tricky because you have to plan not only for lost income but for paying the fixed expenses of maintaining a practice while you are on leave. Expenses like rent, phone, internet, or perhaps the cost of support staff may need to be paid whether you are practicing or not.

Joseph Sanok, LLP, LPC of Mental Wellness Counseling in Traverse City, MI suggests considering the cost of being away from your family once you have returned to your clients. Sanok decided to increase his fee when his wife became pregnant. "For me, I knew that working in my practice was going to be difficult when I had the draw of a wonderful new addition. By raising my rates, it made it easier to give up the time."

I'm curious to learn more about the changes you made or creative ways that you found for your transition to parenthood in your private practice. Share those here!

Sharing Office Space With Your Spouse (part 1)

Today's guest post is by Christina G. Hibbert, Psy.D., Clinical Psychologist and expert on Postpartum Mental Health, Women’s Emotional Health, Grief & Loss, Motherhood and Parenting. Dr. Hibbert runs a successful private practice in Flagstaff, Arizona, housed in the same location as her husband's dental practice.

A few years back, after I had my fourth baby and we inherited our two nephews (that’s a long story for another day!), I quit working in the group practice I’d been with for four years. After staying home for two years to put our new family together, I felt it might be time to open a practice of my own. Being a mom of six, I was very nervous about adding a private practice to my already jam-packed “to-do” list. Thank goodness my husband was thinking for me.

“Why don’t we build you an office behind mine?” he suggested one day. My husband has a dental practice in downtown Flagstaff, Arizona.  The office is a little historic home that was converted years ago. It has a white picket fence and a hand-painted sign hanging from a shingle out front. Very quaint. Flagstaff is known for its interesting combination of businesses (airport/beauty salon; antique shop/physician), so why not dentist/psychologist? It seemed to make sense.

My husband and a couple of his buddies began construction in what was the small parking lot behind his office, and a few months later, my 12' x 12' little “house” was ready to go. I painted the outside blue with white trim and a flower box, decorated the inside comfortably, hooked up a new phone line, and we were in business.

There are a few definite perks to sharing an office space with your spouse:

1) No or low rent

The biggest perk, of course, is that I don’t actually pay rent. I added a line to his phone line and only use minimal utilities, so it is a real money saver!

2) No wasted space

My husband uses my office as a consultation room or lounge on the days I’m not there. Since I work part-time, it feels good to know I’m not wasting my space. It’s also a handy place for our kids to hang out on the off days when I’m out of town and they need to go to work with dad. We put toys and a TV in the office, so it’s ready for visitors of all kind (including all the babies that come in with the postpartum moms I see!).

3) Double-duty staff

Another perk is that I can utilize my husband’s staff to help me as needed. Though I take all my own phone calls and do my own scheduling, I am able to count on his office manager to help me check in clients, take payment, and give them a “waiting room” in the snowy winter months. His staff also helps clean my office, water my plants, and take care of the weekly postpartum support group that still needs to meet with my co-facilitator when I am out of town.

4) Built-in referrals

Sharing office space is an excellent referral network. Many of my clients end up in his dental chair and several of his patients end up on my couch.

5) Time together

Though it may not be a perk for all couples, my favorite thing about sharing office space is that we are working together. I don’t run his office and he doesn’t run mine, but we help each other out. We give suggestions and share tips. We chat in between clients and some days we get to “do lunch.” I always get to end my day with a hug goodbye as he stays to support the family financially and I leave to support the family as chauffeur and chef.

So, if you’re looking for a way to make a part-time practice work for you, consider office-sharing. In my case it’s with my husband, but whether it’s with your spouse, a friend, or a colleague, it just might be the solution you’re looking for!

Dr. Christina Hibbert is a Clinical Psychologist and expert on Postpartum Mental Health, Women’s Emotional Health, Grief & Loss, Motherhood and Parenting. She received her BA from Brigham Young University and her MA and Psy.D. from California School of Professional Psychology in Los Angeles. Dr. Hibbert is the Founder of the Arizona Postpartum Wellness Coalition, and is the producer of the internationally-sold DVD, Postpartum Couples.  Dr. Hibbert is a dynamic and engaging speaker and is currently finishing up her first book, This Is How We Grow. Mostly, though, Christina Hibbert is a happily married mother trying to keep up with six energetic children!

(c) Can Stock Photo

Social Media Ethics (part 2): Developing Your Social Media Policy

Social media ethics are starting to be addressed by mental health professional organizations or licensing boards but those guidelines, if they exist, are generally vague.

It's important for clinicians to take time to think through the implications of their online interactions on clients to avoid dual relationships, putting client's privacy at risk, or jeopardizing the therapeutic relationship.

Including a written social media policy as a client's initial treatment contract helps clarify how technology will be used in client-therapist interaction so it doesn't interfere with treatment.

On the forefront of the social media ethics discussion is licensed psychologist Keeley Kolmes. Psy.D. Dr. Kolmes' comprehensive social media policy has been a model for mental health therapists around the world. She generously allows clinicians to adapt her social media policy for their own use and frequently speaks, writes, and teaches on social media topics. I used it as a springboard for developing my own social media policy.

If you don't have a social media policy, I suggest that you develop one. The goal of your policy is to clearly outline your expectations regarding online interaction, educate the client of risks, and have a clear rationale for how you will or will not engage with clients online. Here are some suggested topics to cover in your policy and a few questions to help you solidify your philosophy regarding social media interaction.

Friending Will you accept friend requests on Facebook, Linked In, Google+? Why or why not?

Following Will you allow clients to follow you on Twitter, Blogs, Pinterest? If not, how will you handle it if they do follow you? Will you follow back?

Messaging Is it appropriate for clients to contact you via SMS? Or social media sites like Twitter DM? If so, what information is appropriate?

Business Review Sites What are the risks that clients take when reviewing your services on sites like Yelp or Healthgrades? Keep in mind that if a client gives you a negative review it is unethical to respond directly to the review as it breaks client confidentiality.

Google Reader What if a client wants to share an article with you through Google reader?

Search Engine Do you make a practice of Google searching your clients? Are there emergency situations where you would search for their information or information of someone close to them?

Location Based-Services If clients check-in to your location on GPS services like Foursquare or Facebook check-in are they aware of the risks that they might be identified as clients?

Email Correspondence What type of information is appropriate to send via email? How quickly a client can anticipate an email response?

Email/Newsletter Lists If you have a newsletter sign-up on your website do you expect clients to sign up on email or newsletter lists?

If you can think of a topic I missed in the list above, let me know.

Are you willing to share your social media policy? If so, please post the link in a comment below.

SEO For Shrinks: Can Potential Clients Find Your Practice Online?

Do therapists really need to care about search engine optimization (SEO)? If you're in private practice the answer is YES!

So, what is SEO? SEO is the process of improving your website's visibility in search engines like Google, Bing, Yahoo, etc.

Before you starting thinking about SEO, you first need a practice website. Even a single page site with your photo, practice description and contact information is better than nothing! I predict that in the near future it will be nearly impossible to build a successful private practice with clients who pay your full fee unless you have a website and strong professional online presence. If you don't have a website, stop reading here, and get busy creating a site. If you already have a site and you want to make it easier for potential clients to find your practice on the web, read on!

Since "meeting" Your Google Guy, Peter Hannah, LMHC, online I've marveled at the combination of his therapy education and telecommunications specialties. I couldn't wait to "pick his brain" about SEO basics for shrinks to help you succeed in attracting your ideal therapy clients to your private practice.

There's A Reason They're Called "Keywords"

The most common SEO mistakes that therapists make on the website is not understanding how crucial keyword are. Hannah suggests, "If you're a psychologist in Orlando, those two words should be prominent in your site and appear on each page of your website. They should also be in your meta tags. Because people will be searching "Orlando psychologist" to find you and people like you."

Another mistake that Hannah has observed in his consulting work with therapists will often omit their location on the homepage of their website, "Your home page acts as an orientation point to visitors. Who you are, what you do, and where you do it. Make sure it's all on there!"

Hannah says there are two parts to SEO work: on-page (your website) and off-page (out on the web). "On your site, making sure your website clearly has language in it that matches your city and your services is probably the easiest and most important. You might want to talk about "healing" and "journeys" as you write about your work, and that's good, but make sure you're also mentioning "counseling" or "psychotherapy" once in a while, too!", Hannah suggests.

Create Consistent Content

Hannah suggests consistently creating content on the web. This is what I  love to do, and it's what contributed to Sharecare Now naming me the #1 online influencer for depression. I've never met anyone who works with Sharecare, but because of the amount of mental health content and the number of channels on which I produce regular content (4 blogs/sites, 5 Facebook pages, Twitter, Google +, Linked In, iTunes podcast, blog posts, YouTube channel, links to my site from national sites) I came up on radar of a national health organization! Hannah suggests writing something helpful for potential clients your website blog and always have it link back to your website.

Get Listed, But Don't Pay A Dime

Paid therapist listing sites aren't as beneficial as shrinks might think. Hannah suggests finding site that list your business for free and write as much information as you can and provide links to your website. My therapy site is listed on Google places, Facebook places, Yelp!, All About Counseling, local university referral listings, City Search, and many other free listing sites. Also, remember to get listed on your professional organization referral lists.

Peter Hannah, MA (Counseling) MS (Telecommunications) is a Licensed Mental Health Counselor in Seattle, WA. He's also a former technology professional who helps therapists market their practices on the web. Since 2005, he's worked with several hundred therapists, marriage counselors and psychologists with SEO, Google Adwords and making their websites more effective.  Find out more at his website YourGoogleGuy.com.

photo credit: Flооd

What I Wish I'd Known Before Starting A Private Practice

If you're considering going into private practice, it's always smart to talk to other clinicians who have been there. When I opened my practice years ago, I had very little business experience. Luckily, I did a few things right that allowed me to be profitable (and it didn't hurt to be married to a CPA). Over time, I learned that I have a knack for marketing and networking that has allowed my practice to continue to grow, even during a recession. Few private practitioners are armed with small business skills when they venture into private practice. According the U.S. Small Business Administration, around 50% of new businesses will close their doors within 5 years.  The realities of making a profit and running a successful private practice can be discouraging and exhausting. If you're considering opening a practice, I think you'll enjoy several seasoned practitioners answer the question,"What do you wish you'd know before starting your private practice?

Private practice is a business

Like most of therapists, Emma K. Viglucci, CFT, LMFT, CIT  of New York City didn't really understand what it takes to run a business when she opened her practice. "I had some ideas about running a business as both of my parents owned businesses, and about running a practice from assisting run my graduate program's clinic. But, I didn't know the nuts and bolts of being in business."

It's easy to overestimate profit and underestimate the amount of work it takes to start and build a private practice. Psychologist and professor Karen Sherman, Ph.D. says she wished she'd know that working for herself  "wasn't going to be as lucrative" as she thought.

Save for self-employment taxes

When you go into private practice you'll be paying self-employment taxes. If you're used to working for an agency where your taxes are automatically withdrawn each paycheck that catches new practitioners by surprise. Just to give you an idea of how much to save, self-employment taxes for 2011 in the U.S. are around 13% (SBA.gov).  Psychologist Roberta Temes, Ph.D learned about taxes the hard way. "My first year I did not diligently deposit half my fees into a bank account earmarked for taxes. That was a learning experience."

Understand managed care

Texas counselor Shannon Purtell MA, LPC, LPC-S, NCC wishes she'd better understood the world of behavioral health insurance before she opened her doors.

Before entering private practice, I wish that I had truly understood behavioral health insurance and Employee Assistance Programs. Trying to learn the ins and outs of insurance while building a private practice was not only frustrating and time consuming, it was costly. Without completely understanding the industry, I failed to negotiate better rates, was unable to qualify for certain panels, and did not always understand the reimbursement structure. Each company had a different way of handling referrals, authorizations, and reimbursement. Unfortunately, I started in private practice prior to electronic billing and online benefit verification/authorization which has dramatically streamlined the process.

Importance of marketing skills

New York City therapist Diane Spear, LCSW-R wished she'd been better armed with marketing know-how when she opened her doors. Spears says, "You can be a terrific therapist and have a tiny practice if you're not good at marketing. And if you're not naturally good at marketing and networking? Practice! A lot."

Developing a niche and area of expertise is what Clinical Psychologist and author Dr. John Duffy wished he'd known before opening his practice.

I wish I had known the importance of establishing a niche when I started, developing a particular expertise. I found that I work well with families, in particular teens, tweens and their parents. Specializing in this area, I've found that I have a strong knowledge base in this area, and I am more and more confident in my work. As a result, I have a full practice, a waiting list of clients, a popular book, speaking engagements. I am also now considered an expert in a number of media outlets.

Stay on top of billing and record keeping

When you're your own boss it's easy to set some of the less enjoyable and often tedious business details on the back burner. Arizona therapist Lisa Gomez MA, LPC wishes she'd known the importance of staying on top of those tedious administrative tasks. Gomez wishes she had understood the importance of staying "on top of your billing and having good records in regards to accounting."

Practice ebbs and flows

Many private practitioners are surprised by the fluidity of referrals and fluctuating direct care hours. My own practice always dips to the lowest number of referrals and fewest client hours every December. I learned through not getting a paycheck one December to save 10% each month throughout the year to cover the holiday lull.

Portland individual and couples counselor Julie Jeske M.S. has also learned by experience to trust the ebb and flow of her private practice. "I wish I had known more about the way things can fluctuate. Some weeks (or times of year) are really busy and others are slower. The first time things slowed down for me I got really nervous, but it always picks up again," Jeske says.

Solo practice can be isolating

When you practice in a clinic or agency it's easy to take social interaction and peer relationships for granted. There's always someone to grab lunch with or to consult with on difficult cases. For many therapists, the transition to private practice often means a loss of built in professional support system, and the need to actively seek social interaction and professional consultation.

When therapist Amy Luster, M.A., LMFT of Santa Monica, CA opened her practice she found solo practice to be isolating. Luster says, "It would have behooved me to learn about the benefits of participating in a group practice while I was in my graduate program."

Importance of setting boundaries

Maryland therapist Dr. Mary Sidhwani wished she'd know the importance of setting boundaries with clients.

Before I began my practice, I wish I would have created healthier boundaries. I wanted to be available for all my new clients and so returned phone calls and emails 24/7. As time went by, it became increasingly difficult to maintain that with the growing practice. I was able to put healthy boundaries in place, however, it would have been much easier if I had done that initially.

Now it's your turn. What do you wish you'd known before starting a private practice? Please post your comments below.