Adventures In Private Practice: Psychotherapist and Art Therapist Amy Tatsumi, LPC

Tell me a little about your practice... I am a board certified art therapist, licensed professional counselor and psychotherapist in Washington, DC. I see clients across the lifespan and specialize in working with Women Who Do Too Much.  I also see therapists in training and provide post graduate and post license supervision.  Through the creative process and talking, clients learn to connect their hearts and minds to live more wholeheartedly.

Amy TatsumiWhy did you decide to open a private practice? 

I had a small private practice for a number of years while also working a full time job in public mental health.  After having my daughter and living in Japan for some time last year, I new that I needed a better work life balance.  In the summer of 2012, I decided to take the leap and step into the arena.  My mantra continues to be that things are happening in the right time and right way for my business.

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?

Some of the most challenging clients that I worked with were very angry and rightly so.  Underneath the anger was deep shame and fear.  This story  from Pema Chodron is one of the most special gifts those clients taught me: How To Defeat Fear: Once there was a young warrior. Her teacher told her that she had to do battle with fear. She didn’t want to do that. It seemed too aggressive; it was scary; it seemed unfriendly. But the teacher said she had to do it and gave instructions for the battle. The day arrived. The student warrior stood on one side, and fear stood on the other. The warrior was feeling very small, and fear was looking big and wrathful. The young warrior roused herself and went toward fear, prostrated three times, and asked, “May I have permission to go into battle with you?” Fear said, “Thank you for showing me so much respect that you ask permission.” Then the young warrior said, “How can I defeat you?” Fear replied, “My weapons are that I talk fast, and I get very close to your face. Then you get completely unnerved, and you do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, and you can have respect for me. You can even be convinced by me. But if you don’t do what I say, I have no power.”

What's your biggest pet peeve about private practice?

As with any new business, I would say mine is the growing pains.  I work in a heavily saturated mental health provider community.  I believe that there are enough clients for every provider.  Focusing on  building relationships in the community has been helpful to counterbalance the growing pains.

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

I know that many women are caught in many double binds and in the never enough culture.  Whether you a 20 something, single woman, a divorced working mother, a stay at home mother, a widow, or another woman in transition, I know that many women use people pleasing, perfectionism, numbing, and performing as a means of connecting, navigating relationships and settings, and as a guidepost for self worth.  In my practice, women learn to use their own heart~body~mind wisdom to meet and respond to destructive covert messages and to life's patterns and challenges, as well as value themselves and their thoughts, feelings and opinions.

In 2012, I started Dr. Brene Brown's Connections Certification process and provide a variety of related offerings.  The offering are especially supportive for adults and teenagers who feel stuck, unworthy, and never good enough and those who struggle with perfectionism.

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

Relationships with individuals and communities have really been the foundation for this start up phase of my private practice.  In Washington, DC, Jennifer Kogan started a network "DC Therapists Moms" for parents and people who would like to have children who are in the mental health profession.  It is truly a supportive and thoughtful community with over 400 members.  On Facebook, Julie Hanks's group, "Private Practice Toolbox" has be helpful for national and international brainstorming and information sharing.  Lynn Grodzki's book, 12 Months to Your Ideal Private Practice: A Workbook is a book that I cannot recommend enough.  It has practical and creative strategies to strengthen your practice from all perspectives.  Derek Halpern's blog : Social Triggers is direct and effective too.

What has surprised you most about being in private practice?

In the public mental health community, I had strong relationships, but my area of expertise for almost 10 years was in trauma and attachment.  In private practice, I have had start the relationship building process again, especially with securing referral sources. I have been filled with gratitude for my initial referral and cross referral sources.

Has your private practice helped you grow professionally?

Being a small business owner has reconnected me with parts of myself that I never knew.  At each point of developing my practice, I am having to acquire new skills from social media marketing to the business side of the practice to going through Dr. Brene Brown's Connections Certification process.

Has it helped you grow personally, too?

Finding the work life balance has been really been wonderful.  I am more present in my relationships and have more time for myself.  It takes work, but it is well worth it.

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

Finding time to just be is really restorative for me. Being an art therapist, I do try to make art regularly.  The creative process is centering for me.  Yoga Nidra is a form of meditation that I use.  I also love to be in nature, cook, practice yoga, and enjoy time with my family and friends.

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

I remember that failure is a necessary part of the creative and learning processes.  I see the failures as bumps in the road and try not to get stuck there.  People rarely get it right on the first try.  To find the best solution, one must keep trying with new approaches and strategies.

What personal strengths have helped you succeed in private practice? 

I believe in this work from a very core place.  I have witnessed so many lives changed, perspectives shift and relationships repaired and healed.  Staying grounded in the why I do this work keeps me in focused.

For more information on Amy's practice visit Join my Toolbox 2013 Therapist Blog Challenge and strengthen your online presence!

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!

Practicing Outside The Box: Growing Tomatoes In Psychotherapy

tomato in square

Stuck in a therapeutic rut? Find inspiration from other therapist's creative strategies and get outside the box!

As therapists, especially those of us who have been practicing for a few years, it's easy to get into a rut and become less creative than we were as eager, bright-eyed interns. Feeling the need to be more creative in the therapy hour inspired me to reach out to other therapists for ideas and inspiration and start this series about practicing outside of the box.

Because I managed to kill every plant I have ever owned (I have a "black thumb") and because I have always fantasized about living in New York City, I was intrigued by psychotherapist Janet Zinn, LCSW's use of "outside the box" strategies to help her clients. Janet found that incorporating nature in the form of a garden in the middle of a New York City practice was a welcome and healing environment for her clients.

Here is what Janet said about her work with a female client:

I had a client who was diagnosed with a serious borderline personality disease. She had been hospitalized on a number of occasions.  She loved gardening, and we planted a tomato plant that she watered, cut back and cultivated twice a week. When the tomatoes grew in she had a sense of accomplishment. As someone who was always told that she was bad, here was something she could feel good about.

We used the tomato plant as a metaphor for her own process in life.  How could she treat herself in a kind and cultivating way? What would nourish her soul?  The tomato plant calmed her.  She felt less reactive when working with the tomato plant.  In the winter, we would use the tomato plant as a  metaphor of patience and the seasons became a lesson on the process of growth and change.

Have you found a creative niche, a unique office space, use non-traditional interventions, or have something that sets you apart from other private practice clinicians? I want to hear about it! Email me with "outside the box" in the subject line.

Creative Commons License jacki-dee (catching up) via Compfight

Therapist Media Cheat Sheet: Look Good And Sound Smart On TV

TV interviews are a great way to educate about relationship and mental health topics and to raise visibility for your private practice. Over the past few years, I've actively sought out interview opportunities and have found that over time, they have bolstered my credibility, fostered trust in my knowledge and clinical skills, and raised visibility of my private practice. Thanks to social media, TV interviews can reach beyond the viewership of the live broadcast to a larger audience. One example is this short, live interview for a local Utah TV lifestyle program.  "How To Handle A Narcissistic Mother" has had over 9000 views on YouTube (and yes, I'm still working on not saying ,"um").

I reached out to other therapists to find out what they'd learned from their TV interview experience, what advice they'd give to therapists preparing for their first TV interview, and how these interviews have impacted their practice.

Here are 10 Tips to help you look and sound like an expert when TV interviews come your way.

1 - Do your homework

Find out who is interviewing you, how long the interview will be, and who watches the show so you can tailor your interview to fit the format and show yourself in your best light. Therapist Sharon Rivkin, MA, MFT and author of Breaking the Argument Cycle: How to Stop Fighting Without Therapy suggests researching the show's demographics, audience, and format so you can tailor the interview to the show's viewers. Before his local television news interview, Psychotherapist John Sovec, M.A., LMFT went online and found clips of the newscaster who'd be interviewing him to get familiar with his interview style.

2 - Develop talking points

From my own TV experience, mapping out 5-6 talking points is crucial to building my confidence, producers' confidence and interviewers appreciate the direction. Sovec adds, "The TV world moves fast and I always find that talking points help me to stay centered." Texas Psychologist Susan Fletcher, Ph.D., author of Working in the Smart Zone: Smart Strategies to be a Top Performer at Work and at Home found that "some TV anchors will stick to the talking points while others will veer off. Be prepared to go a little off topic and be flexible. You can always work your way back to the topic."

3 - Add visuals and examples

Fletcher suggests incorporating visual elements into your TV segments and shares this example: "One of the most visual segments I did was What to do on your Spring Break Staycation and I had visuals for everything you could do with your children. I've also used personal photos to show my points." According to Rivkin, giving specific examples to support your talking points makes interviews more compelling. She's learned through experience to " succinct, clear and direct. Give an example of a client you've worked with. Stories are more compelling and paint a clearer picture than descriptions."

4 - Prepare and practice

When preparing for a TV interview Terrence Alspaugh, LPCP, Psychotherapist of Family Solutions of Maryland wrote down and memorized talking points on index cards. "I practiced elaborating on each point with illustrations and examples. I wanted to be sure that I could say more about the points if time allowed." TV veteran Will Courtenay, PhD, LCSW, The Men's Doc always "over-prepares: for interviews and says he's always glad he did.

5 - Remember that you're the expert

If you're feeling a bit anxious about an upcoming TV interview David Simonsen M.S. LMFT of Creative Solutions Counseling suggests, "Remember that you are the expert and they are coming to you. Find comfort in the fact that you know your field and you have knowledge they don't."

6 - Speak in sound bites

A sound bite is a short phrase or a few phrases of information.  Speaking in sound bites requires therapists to use skills that aren't often practiced. Good therapists often speak slowly, reflect back, pause often, and go deeper. However, good TV interview skills require the opposite: speak quickly, don't reflect back, keep the interview moving, and stay on target. For taped TV interviews, remember to pause at the end of each thought or phrase to allow for clean editing.

7 - Wear comfortable and flattering clothing

From my own TV experience, I find it's important to wear something comfortable that reflects my professional personality and my practice. If something you're wearing feels awkward or out of place it will detract your focus from the interview. Here are a few "what to wear" tips:

  • Bright solid colors generally look better than prints or white.
  • Wear colors that have elicited the most compliments in the past.
  • Accessorize close to your face, drawing the eye upward.
  • Wear more makeup than usual, even for men. "Wearing some foundation is especially important for men, who often have oily skin -- which will look shiny on screen -- and are more likely to sweat," Courtenay suggests.

8 - Look at the interviewer

Unless instructed otherwise, look at the interviewer. If the show is filming with several cameras, it can be confusing to track which camera to look at. For the record, the camera with the red light is the one currently filming. On her first TV interview Fletcher wasn't sure if she should look at a camera or at the interviewer after the interview was over. She says, "I was advised to continue looking at the TV host."

9 - Be yourself

Rivkin suggests, "Don't be afraid to be yourself and let your personality show. If appropriate, use humor. It can make the interview more interesting." Courtenay gives the following advice for therapists preparing for TV interviews, "Think of your interviewers as friends and remember they really are interested in talking with you. Try to achieve some intimacy, as if you're talking one-on-one to a friend. Don't worry about making mistakes, everyone does; if you misstate something, just simply repeat it."

10 - Don't Expect Immediate Results

Media Psychiatrist Carole Lieberman M.D. and author of Bad Girls: Why Men Love Them & How Good Girls Can Learn Their Secrets says:

Therapists often think that this will grow their practice, but unless you offer some very specific niche therapy that the public may not be familiar with, and patients with this need happen to see your appearance, it is not the most efficient way to get patients. I do not do it to grow my practice. In fact, TV appearances interfere with practice because you often have to reschedule patients at the last minute to do a TV show.

Of her TV interview experience Melody Brooke, MA, LPC, LMFT, author of Oh Wow This Changes Everything says that they haven't made a difference in her practice. "Its given me a lot of street credibility, but other than that, my practice has not grown at all." Courtenay adds,  "Unfortunately, the impact of my TV appearances are hard to judge. However, many of my clients have told me that they've seen interviews with me before we met." Sovec says that he usually gets some calls after TV interviews but sees them as another step toward building public awareness about his work and to build his credibility as an expert.

In an upcoming post I'll share tips to maximize your TV exposure. Until then, watch and learn from these seasoned therapists' TV interviews.

Watch Dr. Will Courtenay

Watch Dr. Susan Fletcher

Dr. Carole Lieberman

Getting 3 'Fs' In Private Practice Is A Good Thing!

letter FMy motivation for starting my private practice, Wasatch Family Therapy, was very clear. I wanted to create my ideal work environment and I knew that no one else could do that for me. I felt called to help people heal themselves and their relationships.  I knew that I wanted work with therapy clients who valued my services and time, and who were dedicated to working hard to improve their life. I wanted the flexibility to set my own schedule and take time off to be with my children and attend school and sporting events. I wanted to do paperwork that was relevant and helpful for treatment. I wanted to invite other clinicians into my professional space who were gifted therapists, genuine people, and who I enjoyed spending time with. I wanted to work as a social worker part-time and make a full-time income (a lofty goal in a profession where many work full-time and make a part-time income).

I know why I chose to go into private practice but I was curious if other therapists and counselors around the country had similar motivation opening private practice. I recently asked several therapists about their reasons for taking the leap into the business world of owning their own practices and noticed three common themes emerged. I call them the 3 "F"s of private practice: flexibility, freedom, financial opportunity.

1) Flexibility

Therapists who take the leap into private practice value flexibility in their work schedule to better balance work and family life, and to pursue other interests.  Dr. Mary Sidhwani, a psychotherapist in private practice since 2000 in Ellicott City, Maryland opened her practice so she could have the flexibility to care for her two young children. "I wanted to be able to balance both my professional and family life; to be able to spend as much time with my children as possible while they were young."  Social worker Diane Spear, LCSW-R of New York City said, "I had worked at an agency with wonderful colleagues, but private practice gave me the opportunity to set my own hours and fees."

Of his decision to open his own practice psychologist Dr. John Duffy says, "I wanted to go into private practice as I wanted control over my career: my schedule, niche, fees, client base, whether I accepted insurance, and so on. I also wanted to be able to write, consult, speak, and expand my practice, or take fewer clients, as I went along."

2) Freedom

Freedom to select a particular client population to work with and choose your own approach to treatment has drawn many therapists to open a practice. After agency work left her overworked, underpaid and burned out, Esther Kane, MSW of British Columbia chose to open a private practice because it allowed her to focus on her passion - women's issues. Kane says she loves the "autonomy and flexibility of not having to answer to anyone."

Spear says she appreciated being able to choose who she worked with and how she approached treatment. "I wanted to choose level of pathology I want to treat, choose the theoretical orientation and supervisor I'm most comfortable with, and set the environment as I prefer. In short, autonomy, autonomy, autonomy!"

3) Financial Opportunity

It's a risk to open your own practice, but when it grows, you are the one who benefits most from the financial growth. Private practitioners have the opportunity to grow their income in ways that are unlikely to happen when you work for someone else. New York City therapist Emma K. Viglucci, CFT, LMFT, CIT experienced the growth potential first-hand. Since opening Metropolitan Marriage & Family Therapy, PLLC she says, "I've grown the practice to the point where I had 10 clinicians working with me as part of our clinical team. My practice has become an Internship Placement Site for MFTs in training."

Financial need helped Lisa Gomez MA, PLC of Surprise, AZ transition from part-time to full-time private practice. After being laid off from a full-time staff position due to budget cuts Gomez says it was "the perfect opportunity to take the step of faith into full-time private practice. I love private practice because I can be as successful as I want or as flexible as I want."

What motivated you to start your private practice?

If you're thinking about venturing into private practice, what do you hope to gain?


Creative Commons License photo credit: Leo Reynolds