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: Psychotherapy On The Client's Couch

Michigan therapist finds niche providing in-home psychotherapy services

Would you travel to a client's home to provide therapy? After witnessing the high no-show rates while working at community mental health centers Michigan, therapist Tomanika Witherspoon, LMSW, CEO of Growing Counseling Services, decided to do just that.

She created an "outside of the box" specialty practice by focusing on providing in-home therapy.

In Witherspoon's experience, individuals who discontinued traditional therapy cited transportation, time and family responsibilities as the biggest barriers for receiving treatment. By providing in-home therapy, Witherspoon saves her clients travel time, travel expenses and time spent in an office waiting room.

What about her own travel time and expenses? Witherspon said that she does not bill for her travel time. However, to minimize the unpaid travel time and expenses, she only sees clients within a 20-mile radius of her location.

What about safety issues? "I typically do a phone-screening to gather the client's demographic information, insurance info, and the assurance that we will have somewhere to meet privately," Witherspoon says. "Safety is generally not a concern, but if it ever becomes one, I would meet in a colleague's office."

Providing in-home therapy services is not for everyone, but Ms. Witherspoon makes it work for her and her clients.

Visit GrowingCounseling.com to find out more about Tomanika Witherspoon, LMSW's "outside the box" practice.

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.

(c) Can Stock Photo

Why I 'Broke Up' With Managed Care (Part 2)

Several months ago I wrote a post titled, "Why I Broke Up With Managed Care" that stirred up some passionate discussion! While I understand that it's not the route for every private practitioner, I have continued to build a private practice free of managed care and recently hired my 12th therapist.

While we don't bill insurance directly, we do give a superbill to clients so they can seek reimbursement from their health insurance so they can still use their benefits. As I've continued to write this blog, I've come across several therapists who have also "broke up" with managed care and asked them why they decided to build a fee-for-service therapy practice. Here's what they had to say:

Increased Reimbursement Rate

I've been in private practice for over 15 years. So, I experienced the first major transition of health care to "managed" care. I had friends and colleagues who began working in the managed care industry, and it quickly became clear to me that despite all the rhetoric about the necessity for evidenced-based care (which can be a very useful model of care), managed mental health care was really about making corporate the work of individual psychotherapists.

I also did the math. The last time I checked, insurance reimbursement was the average rate charged by psychotherapists in the 1980s. Today, I can afford to have two additional office hours available for new clients, by taking just one fee-for-service patient. This also allows me more discretion in seeing clients who are needing a low fee. Will Courtenay, PhD, LCSW "The Men's Doc"

Control Over Therapeutic Work

I wanted the freedom to determine, along with parents, the course and length of treatment and felt managed care would impede on that. Pam Dyson, LPC, RPT

My training is in social work, which is the source of the old adage "start where the client is at." That's my barometer for treatment, not where an insurance company believes my client and I should start or end our work. Will Courtenay, PhD, LCSW "The Men's Doc"

Increased Client Commitment to Therapeutic Process

Being a Christian counselor, by law I cannot bill insurance, even if I could I think private pay gives each person responsibility in the therapeutic efforts. When people  have to pay it makes them take their  therapy more seriously. Natalie Davis

No Diagnosis Required

My services are specialized in that I will work with children as young as three, something many therapists in my area will not do. The problems child clients present with are often not clinical but rooted in the parent-child relationship. I feel strongly that young children do not need a diagnosis on their permanent health record. Pam Dyson, LPC, RPT

More Time With Clients (Less Time Doing Paperwork)

I had worked in a managed care setting in the past, and I decided that in my practice that I want to avoid the incredible amount of paperwork, defending sessions, and over-diagnosing.  I also think it provides clients with more privacy. Sara Levitsky, LMSW, Birmingham Counseling For Women

Paperwork was the other major decision (in building a fee-for-service practice). I put a great deal of time and energy into my work with clients outside of our scheduled hours, including receiving professional consultation on a consistent basis. I have no time or patience for administrative busywork. Will Courtenay, PhD, LCSW "The Men's Doc"

More Flexibility To Offer Reduced Fees

Like Dr. Courtenay mentioned earlier in this article, when his practice is doing well financially, he has more (not less) time to devote to seeing clients at a reduced fee. I have found the same to be true. As my practice grows I am able to offer more free community workshops and do more pro bono work.

Do you run a fee-for-service mental health therapy practice? What led to your decision?

Private Practice Marketing Made Easy

Last week I spoke to group of local therapists on "Marketing Your Private Practice" and a record number of people attended the presentation. Why? Because therapists in private practice feel ill-equipped and uncomfortable with the business aspects of private practice. It's rare that a marketing course is included in a mental health graduate school curriculum, and few internships and practicums offer marketing mentorship. In my graduate program in social work, just the words "private practice" were treated as "bad words," as if making money while helping people was somehow morally wrong.

For some therapists  the word marketing brings up feelings of anxiety, even dread. "I am not comfortable with self-promoting," I've heard many therapists say.  "I'm not in this for the money so I hate to think that I have to market my services."

Over nearly 10 years in private practice I've learned that marketing isn't as difficult or scary as it sounds. Most therapists already have the relationship skills that make marketing effective. You're already good at building relationships and communicating. You just need to apply your skills differently.

 Build relationships of trust

You already know how to market, because marketing is simply building relationships of trust in a different way. Marketing requires reaching outside of your therapy office, and often beyond your comfort zone. Whatever strategy you use: talking to strangers, talking to friends and colleagues, meeting with physicians or schools, or finally getting a website, it's all about building relationships of trust.

Let 2 simple questions guide all of your marketing

• Who is your ideal client? Identifying your ideal client is  not just getting clear on the demographic and diagnoses that you like to work with, but also the characteristics, values, and traits that you look for in a client.
• What is your basic practice message? This is a simple message that focuses on one aspect of your work and emphasizes the benefits of your services in layman's terms.

Talk to everyone and anyone about what you do

In graduate school you learned how to communicate, build rapport, and put people at ease. Building relationships of trust isn't just limited to talking with your clients. Effective marketing is simply applying all of the skills you know to a broader group of people. Talk about who you want to work with what you do with strangers in the grocery store, neighbors, extended family members, or online communities, media contacts, or other professionals.

Remember you're promoting your passions, not yourself

Effective marketing isn't about pushing yourself on others, but about letting the things that you're passionate about shine through in every conversation, every blog post, every interview, an every page of your website.

It only takes three

According to private practice guru Lynn Grodski, it only takes a few "practice angels" to have a full practice-three people who will consistently refer your ideal clients to you. You probably already have three referral sources ready to refer to you. All you need to do is warm the connections you already have.

How do you feel about marketing your practice? What works and what doesn't? Share your comments below

photo credit: Hen3k Hen3k

Are You Comfortable Asking Clients For Money?

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

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

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

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

1) Value your expertise

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

2) Think of money as energy exchange

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

3) Ask for payment at the beginning of the session

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

4) Set firm payment policies and stick to them

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

5) Money is a clinical issue

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

6) Write a "money script" and practice it

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

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

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

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

photo credit: 401K