money issues

10 Things I Accidentally Did Right In Building My Private Practice

As I reflecting back on 10  years in private practice I did a few things right, mostly by chance.

With a business license, professional license, and big dreams, I opened a private practice ten years ago. Having never taken a business, marketing, or management course, I have learned "on the job" how to be a small business owner. Hopefully, you can learn from what I accidentally did right and intentionally apply them as you build your private practice.

1) Start small, think big

At the time I opened the doors I was a solo practitioner. Those of you in solo practice know that means I was the receptionist, the billing manager, the webmaster, the marketing specialist...Being a "one woman show" for a few years not only taught me what it takes to run a practice, but also how to teach others what I had learned as the practice grew. My vision was to grow my practice into a group with several practitioners and over time, that has happened.

2) Grow slowly

I didn't know it then, but one of the main reasons new businesses fail is because they grow too quickly. As a mother of 3 children at the time, I was fine growing slowly so I could manage the multiple demands on my time. Turns out it was good for business too. Growing slowly allowed me to build a business without loans or going into debt.

3) Charge more than you think you're worth

From my first day in private practice I have always charged a higher fee than I felt I was worth. This forced me to deal with my own money issues, and to learn to value my own services and skills more highly. I came to understand the value of the perceived value of my services as clients assumed that I must be very skilled in order to charge at the high end of the scale for my location.

4) Think like a business owner

My family of origin tends to have an entrepreneurial mindset where self-employment, flexibility, and freedom are highly valued. This framework helped me to be able to think like a business owner and a therapist and to find an emotional place where those two roles weren't mutually exclusive. Although they are occasionally in conflict, I've found that that is a rare occasion. Thinking like a small business owner has helped me to set better therapeutic boundaries with clients as well.

5) Trust your gut

In all areas of practice, from office location, to logo design, to who to hire, to which practice software to purchase, after researching the best options I ultimately followed my intuition in making key decisions for my private practice. While the path hasn't been perfect, I can't think of one decision where I trusted my gut and regretted it.

6) Hire qualified people that you trust with your reputation

One of the scariest things in growing from a solo practitioner to a larger practice is hiring people who have the power to impact  your professional and business reputation. In addition to hiring very qualified staff, also hire people that you'd trust and train them how to present themselves in a way that builds your credibility.

7) Set strong boundaries with money

Whether it's following through with your office policies regarding collections, or saving for those dips in client numbers, I have tried to be consistent with money policies. This also applies when hiring employees. My tendency was to give away a little too much at first, because of my inexperience. I soon learned that there is a cost, emotionally and financially, to having employees, and that I deserve to get paid for management time and for holding all of the liability in the practice setting.

8) Create a home away from home

Creating a comfortable yet professional office space has helped me, and my clients, to feel welcomed and safe. I've found self-expression in my private office environment and decor helps foster a sense of safety and nurturing and creates a space where I feel at ease.

9) Integrate your passions into your practice

I have always integrated current interests and passions into my private practice. If there's a film that I really like, I'll use that with clients. More recently I've become a tech geek, so I've integrated technology into my private practice by launching an online therapy division, moving to electronic records, and building a social media following.

10) Take good care of you

Personal self care has always been high on my priority list. I've known that if my own needs were going to get met it was my job to make it happen. Whether it's scheduling exercise, bringing healthy food to work, making time for social events, or attending my own therapy, I am fiercely committed to making sure I am taking care of me. I think those habits have allowed me to energetically continue investing in my clients, my practice, and my employees without feeling burned out.

What things have you accidentally done right in building your practice? Please share so we can learn from each other!

5 Signs It's Time To Raise Your Fees

10.02.09It's common for therapists in private practice to have anxiety around money issues like how much to charge per session, how to ask clients for payment, and when to raise your fees. Getting comfortable talking about fees with clients is crucial to private practice success. After all, you own a business. In general, I think therapists charge too little for their services.

Several years ago, I resigned from managed care and I raised my psychotherapy fees at the same time. Fortunately, my practice didn't suffer financially from those decisions. What surprised me most about raising my per session fee was that the perceived value of my services went up. "You don't take insurance and charge a lot? You must be really good," was a sentiment that I heard frequently from potential clients.

Interestingly, I've found that clients tend to invest more in the therapy process because they are investing more money out of their own pocket for treatment.

If you're considering raising your fees, consider these 5 signs that the time has come to raise your fees.

1) You haven't raised your psychotherapy rate in over 5 years

If it's been over five years since you've raised your therapy fees, it's time to revisit the issue. Your cost of living goes up approximately 2% every year due to inflation. If you haven't raised your fees you are likely making less than you made five years ago.

2) Your full fee is equal to insurance reimbursement

If you set your fees based on what insurance companies are willing to reimburse, then your fees are too low. Historically, insurance companies reimburse at a much lower rate than the providers full fee.

3) You aren't making enough money to pay your bills

Your private practice needs to serve your clients and provide a sufficient income for you. If you are not making ends meet in your practice or your personal life you may need to reduces expenses and increase your rates.

4) You have a waiting list

A waiting list is a sign that your services are in demand and that clients will pay more for your services.

5) You've completed specialized training or certification

Your added expertise deserves additional compensation. If you have recently completed advanced training, like certification in DBT or Emotionally Focused Couples therapy, for example, you may want to charge more.

When is the last time you raised your rates? How do you decide when to increase your fees?

Creative Commons License photo credit: Corey Holms

Are You Comfortable Asking Clients For Money?

Wallet - MoneyDuring 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 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.

Creative Commons License photo credit: 401K

World Mental Health Day: I've Never Met A Shrink Who Didn't Need One

I blog for World Mental Health DayMy grandpa used to say, "I never met a shrink who didn't need one," as if that was a valid reason for not seeking help for mental health problems. After being a therapist for nearly two decades, I totally agree with my Grandpa.

Therapists are an interesting and colorful bunch and we definitely have our own share of mental health problems. I'd take grandpa's phrase even farther by saying I've never met a person who didn't need a shrink. We can all benefit from examining our experiences and getting an outside perspective from a mental health professional during difficult times.

The most effective therapists I've worked with, as a colleague and as a client, are those who've already worked through some of their own mental health and relationship struggles with a therapist, have a handle on their own pain and vulnerability, understand their family relationship patterns, and are comfortable walking with others through their pain. Not only is working through issues with your own therapist good for your own mental health and personal relationships, it's also good for your therapy practice.

Here are 5 Reasons Your Own Therapy Is Good For Your Practice:

1- Increased empathy for and effectiveness with clients

Being willing to be "the client" in therapy is a gift to your own clients. Just like it's impossible to be a trail guide on a mountain you've never climbed, it's impossible to take a client into emotional terrain you've never traveled before. As we sit with clients in their painful crises, we are better able to "go there" with them in the therapy process if we can access of our own experiences.

2- Awareness of countertransference keep clients engaged in therapy

After training and managing therapists for several years, I've noticed that those who've done their own work in therapy have a better handle on countertransference issues that arise with their clients, they are less overwhelmed by the feelings, and they are more willing to process their own emotions in supervision. Therapists who have done their own therapeutic work  are better able to keep clients engaged in meaningful therapy, which is crucial to success in private practice.

3- Feel deserving of success and financial compensation

Therapist's I've supervised or consulted with who have difficulty collecting fees, setting boundaries, or allowing themselves to be successful in their practice are usually plagued by unresolved issues from their past. Working through your own childhood wounds, past trauma, or family of origin issues can free you to create and to embrace your own success in private practice.

4- Healthy boundaries with client's and colleagues

Therapists who've done their own work are less likely to enact their unresolved issues with colleagues and clients. They are also able to set and maintain appropriate boundaries with clients with out guilt. For example, if a therapist is still stuck in trying to please a parent, it may be extremely difficult for a therapist to tell a client that they don't have any evening appointments available because they may want to avoid dealing the client's disappointment.

5- Create a meaningful practice and avoid burnout

Your own work in therapy allows you to be a healthier individual and create a thriving therapy practice. Unresolved and untreated mental health issues will block your success. Your business will likely mirror the places you're stuck personally.  Doing your own therapy work will allow you to feel empowered to work with clients that energize you, work from an abundance mindset, and feel worthy of professional success.

How has your own work in therapy impacted your private practice?

Read my World Mental Health Day blog post on "Do your emotional family history"

6 Ways To Give Yourself A Raise

Dollar billYou're in the mental health field because you want to make a difference AND an income. Too many therapists are making a big difference but only making a small income. Here are 6 ways you can make your private practice more profitable within the next month. 1) Cut expenses

Look more closely at your recurring monthly expenses. Can you find a way to reduce any of them? You might want to sub-lease your office on the days you're not there so you're paying less rent. Do you pay monthly for a therapist referral listing that rarely sends referrals your way that you could cancel? How about buying bulk printer paper of files online? We recently cut expenses by replacing water bottles that we offered to for all clients with a water cooler in the waiting area. This save $100 a month. The little things add up.

2) Raise your fees

When is the last time you raised your fees? Do some research on therapist's fees in your area with similar level of experience are charging and see where you fall in comparison. Ask yourself what is keeping you from raising your fees?

3) Hire an office manager

Most therapists who don't hire a billing person or office manager because of the added expense. I want you to count up the minutes and hours you spend doing clerical work each week. Let's say it's 10 hours per week. If you saw additional 10 clients at $100 per session that's $1000 of additional income per week, or $4000 more every month. With that additional income you can hire an office assistant for $13 per hour for 10 hours per week. You'd be paying out only $130 a week or $520 per month for the additional support. After paying your assistant you'd be bringing in $3480 every month just by replacing your time spent doing clerical hours with clinical hours.

4) Charge more if sessions go over

Do you allow clients to go over the scheduled session time without paying for it? Consider this...If you're seeing 6 clients in a day and 5 of them go over 10 minutes, you're giving away the equivalent of one session that day. If you charge $100 for a 45-50 minute session that means that you're losing $100 a day of income if you don't charge additional fee for additional time. If you charge for additional time you'll make $100 (or your session fee) each day you work. You will have given yourself a raise of several dollars in a month.

5) Charge full fee for no-shows or late cancellations

What's your no show or late cancellation policy? Do you stick to it? I don't like being at work and not getting paid, do you? For years I've charged full fee for no shows and late cancellations, even for first sessions. And a few years ago, I started requiring a credit card in order to schedule an appointment with me or one of my therapists. New clients were notified that if they failed to cancel with more than 24 hours notice they will be billed for the entire session. Guess what? We rarely have no shows and if we do, clients pay the full fee for the therapist's time. I've found that when I require the client to invest something from the get-go they invest more in the therapy process.

6) Tighten up your collection policies

If you're in solo practice, I know how easy it is to let client accounts get out of control. You didn't get into ther therapy business to do accounting. Try scheduling some time to review your client accounts, send out bills and follow up with clients who owe you money. In my clinic, our policy is if I client is more than one session behind in payments their therapy is "on hold" until their account is current.

More on therapist and money in upcoming posts, but until then, I challenge you to try one of these suggestions this month and give yourself a raise.

Creative Commons License photo credit: ZeRo`SKiLL