10 Self-Care Strategies For Private Practice Shrinks

Compassion fatigue, vicarious trauma, and caregiver burnout are common among helping professionals, including psychotherapists. Psychologist Herbert Freudenberger, who coined the word burnout, defines it as ‘‘the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results” (source). Many of us come into the field with devotion to helping others and idealized expectations about our ability influence other's lives. Once we enter the field we come face-to-face with the realization of our own impotence - that we can't take away our client's pain or help them quickly solve the complex situations they face. Have you felt an "extinction of motivation or incentive" in your clinical work? I sure have.

After having been in the mental health field for twenty years, most of those years in a private practice setting, I've learned a few things about the importance of self-care. Here are a few things I've learned from my own experience and from the experiences of private practice therapists I've worked with in my consulting practice.

1) Feel and express a broad range of emotions

Take of your "therapist hat" off every day and allow yourself to feel your feelings. Helping others manage their life crises can get us out of the habit of acknowledging and feeling our deepest feelings. Tune in and allow yourself the freedom to express whatever you are feeling. Journaling, meditation, and prayer can be helpful in acknowledging your own experiences.

2) Nurture your physical self during your work day

Don't give away your self-care time to your clients. Every time you go over your allotted session time you are giving away your self-care time. Over the long-run, this is actually a disservice to your clients. Have water and food handy so you don't go too long without eating or drinking. Take regular bathroom breaks. Take a quick walk around the block.

3) Practice daily self-compassion

Allow yourself to make mistakes, professionally and personally. In Dr. Kristin Neff's book Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind (2011) she defines self-compassion as having three components: self-kindness, common humanity, and mindfulness. Self-kindness is simply treating yourself as you would treat another person who is suffering. Common humanity is the concept that, while human tendency is to shrink from others when we have made mistakes or are faced with imperfection, suffering is the common experience of all humanity. We are not alone in our suffering. Mindfulness is the ability to experience what is present, without judgement.

4) Reclaim child-like joy

Childlike joy is the antidote to burnout. Think of something that you loved to do as a child -- something that allowed you to be in the moment and full of joy. Find a way to bring that activity back into your life. It can be as simple as blowing bubbles, hiking, laying on the grass, playing the piano. Recreate the child-like happiness in your adult life on a regular basis.

5) Consult regularly with other professionals

Isolation is the universal form of torture. Where are dangerous or unruly prisoners sent?  They are put in solitary confinement. Many a solo practitioner is in self-imposed isolation because it takes effort to seek out other professionals. We know from attachment theory that we are wired to connect with others. In addition to our familial relationships, this also applies to our professional relationships. We need to know that we are not alone. We need to feel emotionally supported.

6) Have clinical back up so you can take time off

Many therapists I've consulted with haven't taken the needed maternity leave or sick time because they had no one to cover their clients in an extended absence. Reach out to other practitioners and find someone with whom you trust clinically. Work out an arrangement where you are willing to cover each other's clients in the event of an emergency, illness, or vacation. Build in the support you need so you don't have to worry about taking time off.

7) Prioritize your close relationships

It's much easier to help clients with their relationship problems than to work on our own. Part of self-care is nurturing our own intimate relationships with family and friends. Build in time to spend with your partner or child or friend and make sure that your relationships are thriving.

8) Get your own therapist

Therapists need emotional support, an objective perspective and a place to vent. I recommend to therapists that I train and consult with to find a therapist and check in with periodically as part of a self-care plan. Some areas have therapist support groups. Honor the psychological toll that being a therapist can have on our own emotions and psyche.

9) Diversify your professional activities

Burnout and compassion fatigue can be prevented by adding variety to your professional life. If you are seeing a lot of intense clients with abuse histories, for example, change up your schedule by some teaching university students, writing your first book, or offering professional trainings.

10) Charge more than you feel you are worth

The best way to take care of your self is to make sure that your own needs are met. Part of this process is valuing your time, your education, and your expertise by charging more for your services. I have yet to consult with a therapist who in private practice where I've recommended lowering their fee. Most therapists charge too little and give away too much of their time and energy.

Find out more about my book The Burnout Cure: An Emotional Survival Guide for Overwhelmed Women

Counselor Self-Care Practices

Guest Post: Hollie L. Hancock, M.S., CMHC

Reflect on how well you take care of your own needs. Help me learn more by filling out a counselor self-care practices questionnaire.

While attending an ethics conference last week, I took the opportunity to solicit participation from my fellow counselors and psychotherapists for my dissertation research.  As I described the study, and as the words “counselor self-care” crossed my lips, a loud and obvious laugh erupted from various corners of the large ballroom where the conference was being held.  From the front of the room I saw people looking at one another, laughing, and rolling their eyes; I even read the lips of one man in the front row as he said to the woman next to him, “Yeah, right!”

Honestly, I was not surprised.  In fact, I almost expected this type of response.  The laughter, snickers, and side-ways comments are exactly the reason I am researching counselor and psychotherapist self-care practices.

As therapists, we use our education, training, and skills to help patients live more rewarding and healthy lifestyles, independently.  Ironically, many therapists seem reluctant to offer themselves the same kind of understanding and care.  Yet, in reality, it is this self-care, both personal and professional, that ultimately is the most important, not just for patients, but also for we as therapists as well.  It is quite possible that mental health professionals are one of the few professions that does not purchase or utilize their own product.

Lack or absence of self-care practices among mental health professionals appears to be almost synonymous with compassion fatigue and burnout.  The literature seemingly suggests that by mentioning self-care – counseling professionals are burned out or experiencing compassion fatigue to some degree.  Do a small research study of your own: Conduct a Google search using the words “counselor self-care”.  You are likely to find half of the top results include the word “burnout”.

Participate in my dissertation research on counselor self-care practices

In an effort to understand the possible phenomenon of the lack of self-care practices among counselors and psychotherapists, I am asking colleagues across the nation and even around the world, to provide responses to a brief questionnaire created for my dissertation research.  Therefore, you are cordially invited to participate in a study that will ask questions about your experiences with self-care practices as a counselor or psychotherapist. This inventory is called The DEFT Questionnaire. “DEFT” represents what counselors and psychotherapists “do” for self-care, how they “experience burnout”, how they “feel” about their self-care practices, and finally what counselors and psychotherapists “think” about self-care. The purpose of this study is to explore whether or not there is a correlation between self-care practices and burnout among counseling professionals.  Completing the questionnaire will take about 15 minutes of your time.

To be better clinicians in our roles as counselors and psychotherapists, we owe it to our patients, and more importantly ourselves, to be aware of our self-care needs, and adjust our behaviors accordingly if necessary to avoid impairment, burnout, compassion fatigue, and even post traumatic stress disorder.

I have provided the link to the questionnaire below.  I respectfully ask that you take 15 minutes of your time to complete the questionnaire.  Then, please share the link with your peers and colleagues.  I thank you in advance for contributing to the body of literature available regarding counselor self-care practices!

Fill out the counselor self-care survey here:

https://acsurvey.qualtrics.com/SE/?SID=SV_cvWrM4l8iqBWU1D

The questionnaire will be available until March 31, 2013

Hollie L. Hancock, M.S., CMHC is in private practice at Iron Mountain Counseling is a Doctoral Candidate in Counseling Psychology, Argosy University, Salt Lake City, UT

Adventures In Private Practice: Child Therapist April Forella, LMHC

Tell me about your practice...

I am a solo practitioner with an office in beautiful Palm Beach Gardens, Florida. I opened my private practice a year ago. As an experienced child, adolescent and family therapist, I understand how difficult it can be to find resources and help for children and adolescents who are suffering from emotional and behavioral issues. In my private practice I specialize in working with children 6+ and adolescents who are experiencing difficulty in their functioning and ability to navigate life’s challenges and relationships. I enjoy seeing children and families learn how to respectfully express their emotions and improve communication. Children and adolescent’s unique situations are addressed with a deep understanding of today’s youth and their specific challenges.

I am an Accredited Standard Triple P Provider (Level 4 & 5).  Triple P is an evidence-based multi-level family intervention and parenting support strategy which is designed to reduce the prevalence of behavioral and emotional problems in children and adolescents.

Why did you decide to open a private practice?

I entered graduate school in mid-life with the goal of opening a private practice. My twenty years of experience working in business (advertising & marketing) prior to entering the field have assisted me in knowing how to reach my target audience. I also wanted the freedom to set my own hours and to foster hope and build relationships with my clients. I knew that having my own practice would allow me to achieve all of these goals.

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?

Young children and adolescents with challenging behavior problems try the patience of parents and caregivers and can be challenging for therapists. I have learned from the most “difficult” clients the importance of meeting them where they are, along with being patient and finding ways to connect and build rapport. By being with a child and engaging them in art, play or games I gain an understanding of what the child’s interests and needs are. Once a child is heard and understood we can begin implementing strategies to meet the child’s needs and overcome challenging behaviors. Understanding the child from the child’s perspective is the key to the process.

What’s your biggest pet peeve about private practice?

The fluctuating streams of income. There are cycles when I’m busy and when I’m not.  I continue to learn and expand my knowledge of marketing utilizing social media and networking to grow my practice. I supplement my income with offering trainings to schools, other professionals, and coaching.

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

My passion in working with children and adolescents has been important to me before enrolling in graduate school. I took course work related to counseling children, completed an internship at an agency specializing in working with at-risk children. Once I was licensed and opened my practice I already had a solid skill base as a child, adolescent and family therapist. I also had the skills necessary to work collaboratively with parents. It was a natural fit.

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

I attended a training by Lyn Kelley, Ph.D., LMFT, CPC “Promote Your Practice Exclusively to a Well-Pay, Fee-for-Service Clientele”, consulted with other professionals and utilize the internet to find other successful private practice clinicians, including Julie Hanks, LCSW's “Private Practice Toolbox”, Tamara G. Suttle, M.Ed., LPC “Private Practice from the Inside Out—All Things Private Practice”. The book The Paper Office by Edward L. Zuckerman, Ph.D has been helpful in getting organized and developing good professional habits. The book provides forms, guidelines, and resources to make your practice work ethically, legally and profitably.

What has surprised you most about being in private practice?

I have found my life’s purpose in helping others. I am truly passionate about coming along side my clients and find it rewarding in so many ways.  The hard work in building my practice is all worth it when I see clients grow.

Has your private practice helped you grow professionally?

I have gained self-confidence not only in my ability to provide quality therapeutic services but in my ability to manage the business side of my practice. I continue to set goals to challenge myself personally and professionally. I plan to present at conferences and seminars to develop public speaking skills, and begin blogging and continuing to utilize social media to develop my practice.

Has it helped you grow personally, too?

On a personal level it has made me aware of the importance of pursuing my passion and the fulfillment that it brings me.  It’s a privilege to come along side the amazing people that I work with and the things they teach me about life.

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

I make it a priority to have time alone to relax, pray, read the Bible and recharge myself. My support system is an amazing loving family and lots of great friends. I enjoy spending time at the beach, listening to music, regular massage to release stress and tension in the body, and going on walks.

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

I handle all of the day to day details of my practice myself. I am an organized person and rely on to-do lists. It can be overwhelming at times! However, the rewards of having flexibility and freedom to make my own schedule out way the stressors.

What personal strengths have helped you succeed in private practice?

My social skills are strong and connecting with people is natural for me. I like to network and build relationships. My business experience has helped me to understand marketing. I also understand that growing and maintaining a private practice is a process that takes a lot of work, perseverance and the need to reach out to my peers for support and encouragement.

To learn more about April Forella’s private practice visit www.aprilforella.com.

The $12,000 Mistake Many Therapists Make

Ending sessions on time or charging more for extended sessions not only models good boundaries, it's good for your business.

What's the big deal about giving a few extra minutes to your clients? After all, we are in this field to help others and we are generous souls by nature, right? Yes, we are. However, an on-going pattern of giving away a few minutes each session adds up over a year's time.

Let's say you see 10 clients for 50 minute sessions per week= 500 minutes. If you go over 10 minutes with each client you're doing 600 minutes of therapy and only being paid for 500 minutes. That means you're giving away 100 minutes of therapy every week. After one year of giving away 100 minutes every week you are giving away 5200 minutes of free therapy. 5200 minutes is the equivalent of 104 free 50 minute sessions every year. If you charge $115 per session your practice is giving away $11, 960 of free therapy a year!

In addition to thousands of dollars of lost income, therapists who have a habit of giving away their time carry the stress of running late for other sessions, not taking adequate time for self-care, and falling behind on clinical notes and other administrative tasks. These chronic patterns may ironically lead to you being a less effective therapist with a less successful practice.

Now, just to be clear, I am all for pro bono work. The problem with this kind of "pro bono" work is that therapists don't realize they're giving it away and clients often don't realize they are being given a gift of therapist's time. Clients may come to expect 60-minute sessions because therapists have taught them that this is the norm and may then feel ripped-off when their therapist decides to start setting firmer boundaries.

Setting firm boundaries with session ending times, and charging for additional time allows you to consciously take on pro-bono clients, because you have more time, energy, and resources to offer free services. If you struggle to end sessions on time, here are a few suggestions to help you.

Suggestions for setting boundaries with session length:

1. Set the expectations from the very first session. It's a lot easier to set the norm of ending sessions on time, than to bring it up later in the course of therapy.
2. Keep your agreement. In your initial consent for treatment paperwork be explicit about how you will handle longer sessions. Let the client know that if they need more time they will have to pay more. If I am in a session and it seems like the client would like to go longer, and I have the flexibility of giving additional time, I might say something like, "Our session is just about over. It seems there's more here to work on. I have an additional 15 available today, would you like to keep going with session even if it adds additional cost?"  Since I charge $150 per 45-50min session. If a session goes 15 minutes over I charge an additional 1/3 of the session fee.
3. Recommend scheduling longer or more frequent sessions. For clients who seem to have difficulty processing their issues and containing their affect in a 45-50 minute session, schedule longer sessions (75 or 100 minute sessions), or offer to see them an additional session per week.
4. Start wrapping up 10-15 minutes before end of session. Give them explicit verbal cues like, "We have about 15 minutes left in the session. Let me tell you what I've heard today..." Physical cues like sitting up straight in your chair or standing up when the session is over may help you send a congruent message that the session is over.

Eric Gjerde via Compfight

Pause Before Posting About Work On Social Media Pages (part 2)

Guest post by Kimberly Sandstrom, MFTI

We all have days where we need to let out a little steam about a difficult day at work. Social media is not the place to do it.

In the first post on this topic, my goal was to bring awareness to our community about the hazards of posting personally about clients. Although our clients may not see our personal posts (see Julie Hanks Digital Dual Relationship Dilemmas), our own personal communities will, and our reputation is built on that community.

While my personal profiles are private, my extended friendship community and family I am connected with on these sites, trust me and my ability to keep things confidential for their referrals What I portray on my personal and professional sites will reflect the reputation I have as a therapist.

Does this mean we cannot post anything at all about the work we do on our personal accounts? Certainly not! My heart is for fostering a safe environment for consumers so they will feel comfortable sharing with us in the intimate space of our offices, and assurance that their stories will be kept contained within the walls of our office. Here are some tips to protecting not only yourself but our therapeutic community at large when posting about your therapeutic work.

Think before you post

Ask yourself these questions: If my client saw this, would they like what I posted about them? Is this fostering a positive message about my therapeutic community? What are my motives for posting this (i.e., vent frustration, draw others to me through humor, etc.)? Am I venting my frustration in a way that protects my client and my reputation? Would it be better if I shared this with another colleague privately?

Keep your posts about work general and positive

After a recent couples intensive weekend, my co-facilitator and I were so blessed to see the positive transformation in the couples that attended our workshop. It inspired us. I posted on my personal Facebook profile, “So blessed to watch couples transform their relationships over this weekend at the couples retreat. I love my job!”  Nothing specific about what conversations took place. If one of the participants to read this, it would most likely reflect their own positive experience of the weekend. Occasionally, I have asked for permission from clients to share their inspiring story or something they have written (poem, inspiring reflection) in a blog or to post on my professional social media sites, and again, I keep the information general and positive. And I make sure it is in a place they can see this posted (even though I do not accept former or current clients on these sites—they are open to the public to view).

Develop safe relationships with like-minded colleagues in your own community

We all have funny and frustrating stories from work—no matter what profession we are in. Developing relationships with other therapists in your community can provide you with a group that follows the same values of confidentiality that you do. You can vent your day to them, share funny stories (without giving identifying information about your clients, of course!), and explore your own triggers and countertransference in confidence, instead of publicly.

Have grace with fellow clinicians who may violate this gray area

If you feel inclined, send them a private message with your concerns about their post. If it is done with a spirit of helpfulness, gentleness, and affirms their good intention, they will most likely be grateful.  If, after reading this, you realize that you may have posted something about a client that qualifies as negative or comical, have mercy on yourself! We are human, fallible and worthy of lots of grace in the uncharted territory of social media etiquette!

Kimberly Sandstrom is a Marriage & Family Therapist Intern and Relationship Educator, Supervised by Kathryn de Bruin, LMFT, working in private practice in San Diego, CA. Married for 24 years, she and her husband are raising three daughters, two of whom are now adults.  She works with couples, and families to create emotionally safe and enduring connections in their most cherished relationships.

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