Adventures in Private Practice: Weight Management Counselor Michelle Lewis, LCSW

This series highlights the successful private practitioners' journey in private practice so you can learn from their successes and missteps. One of the unexpected benefits of writing this blog is that I've been able to meet and connect with practitioners around the globe. The therapist featured today actually is not on the other side of the world, but is in the same city, and practices only a few blocks away from my practice. Michelle Lewis, LCSW and I worked together for one consultation and since then, I've been able to watch her really dig in, focus on her niche, and develop a successful practice. She is not only a great practice owner, but is a compassionate person and passionate about her work. Get to know Michelle.

Tell me about your practice…   

I own a group practice called Salt Lake Weight Counseling. We specialize in helping clients identify and overcome emotional barriers to weight management. We specifically target emotional eating, food addiction, body image, and patterns of self-sabotage. Working with these issues, we also treat a significant amount of trauma. By addressing the trauma, we are able to help  clients heal their relationship with food and end the war with their body.

Why did you decide to open a private practice?

I worked in a residential treatment with adolescents for many years, and the stress really started burning me out, so I took a job in a corporate wellness program through an insurance company. They hired me to work with members to identify emotional barriers related to their health goals. I worked with a lot of clients who struggled with self-sabotage in weight loss. They would yo-yo up and down with the same 10, 20, or 50 pounds over and over again and could not figure out why this happened. I started using my training as an addictions counselor and helped those clients experience success that they had never seen prior. During this time, I had started building a part-time private practice. I wasn't sure if full-time private practice was for me, but as I developed my specialty, I found myself more and more drawn to the idea. Once I took the leap, I really looked forward to my time in my own office and loved the passion that came with my work. I also loved having total control over my schedule and the clients I was working with. Since moving from my full-time corporate job to full-time private practice, the passion and excitement around my work has continued to grow. I love the energy that comes with developing an expertise and working with your ideal client every day!

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?

My toughest clients challenge me to be a better therapist. It is easy to get stuck in a rut when you find a formula that works well. When I find clients who struggle to heal, it forces me to try new methods and educate myself on new skills. It actually revives the passion I feel about this work!

What’s your biggest pet peeve about private practice?

Handling money. I think the cliché about therapists being allergic to money is so true! The greatest thing about working for someone else is not having to ask anyone for money. I hate having to follow up with people who have overdue bills, so we started keeping a credit card to avoid the hassle. That has made life so much easier!

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

I am passionate about health and wellness in general. I am an avid cyclist and hiker, so when I found my job through the insurance company's wellness program, I jumped at the chance. It felt like it was what I was made to do. For the first time, I really felt connected to my work in a meaningful way.

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

Honestly, you helped me the most, Julie. I set up one consultation session, and you helped me clarify my goals and direct my marketing to my ideal client. My practice really took off after that session.

What has surprised you most about being in private practice?

How rewarding it is! I have had jobs that felt rewarding, but this has taken my work to a whole new level. When I started thinking about private practice, I saw it as a way to work less and make more. This is true, but it goes beyond the financial benefits. This isn't just my career, it is my calling. I think having control over what I do and how I do it has helped me expand my horizons beyond what I thought was possible.

Has your private practice helped you grow professionally?

It forces me to stay on top of my game by constantly exploring new skills and techniques. I am always reading and attending trainings beyond the required number of CEUs. I love learning as much as possible to help my clients heal.

Has it helped you grow personally, too?

It helps me live the life I want. It gives me flexibility to travel, hike, bike, and engage in other activities that keep me balanced and energized.

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

Spending time with friends, my husband, and my dog are key. When I am having a stressful day, my favorite activity is walking my dog while I listen to an audiobook.

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

Self-care is key. By taking care of my physical and emotional health consistently, the stressors aren't as powerful. I try to be solution-minded. Instead of getting caught up in the stress, I try to come up with a game plan and then identify potential pitfalls in the future.

What personal strengths have helped you succeed in private practice?

Organizational skills are key! You have to know who's on first at all times! Also, dedication and determination are so important. I feel a dedication to my clients and work tirelessly to help them achieve their goals. I am also determined when it comes to my business. I am consistently looking for ways to improve the work we do.

To learn more about Michelle's practice, visit www.SLWeightCounseling.com.

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4 Steps to Breaking Up with Managed Care

Breaking Up is Hard to Do

We've talked a lot recently about the benefits of switching from using a managed care system to a private pay model. It benefits your clients, it benefits you, and overall it just benefits your practice (click here for a post detailing the math and financial advantage of a self-pay model)! But how exactly do you do it? It's quite a change, so it can be difficult to know where to start. Here are 4 strategies to help you make the transition:

 1) Resign in Waves       

Instead of trying to go cold turkey by leaving your panels at once, pick one or two to begin. I suggest choosing the companies that cause you the most headaches, give you unreasonable hoops to jump through, are infamous for not paying on time, and have the lowest reimbursement rates (most therapists I've consulted have no problem identifying which ones these are). Make the transition by weaning off of managed care panels one at a time.

While you are doing this, you need to be ramping up your REST "marketing" process. This will help you attract full-fee clients. Do them simultaneously to secure future business for your practice.

2) Review Your Contract   

Carefully and meticulously read the details of your contract with the insurance companies. What is the length of time required before resignation? You don't want to get hit with fees or have your transition timeline thrown off because you didn't quite understand your contractual obligations, so do your research and give yourself plenty of time.

3) Write An Official Resignation Letter    

After you've determined the timetable you have, sit down and write your letter to officially resign from the insurance panel(s) you've chosen. Be clear, concise, and professional. No need to go into detail about your reasons for ending your business with a certain company. Firmly express your decision to resign. Also, it's a good idea to follow up to ensure that your letter was received.  

4) Prepare Your Clients

And finally, perhaps the most important step to take in making the transition to a private pay model is to let your clients know. Give them plenty of notice (three months minimum), and present them with a considerate and professional letter that clearly states the upcoming changes. Also, offer them options. If they are close to completing treatment, work with them to finish their sessions before you resign from that particular panel. If your clients desire to stay with you and will be transitioning to paying out of pocket, begin to decrease the length or frequency of their sessions if needs be. It's amazing how some people can turn on the motivation when they have to! You also can educate your clients and encourage them to explore out-of-network benefits. Or you might prepare to transfer clients to a trusted colleague.

When I made the change, my clients were exceptionally understanding. I believe part of this was that I informed them in a confident and considerate way, and I was open to feedback and helping clients process their emotions about it. I was also able to use this experience as a way to model self-care and making difficult decisions. Overall, this was remarkably successful, and the majority of my clients stayed with me!

Click here for access to the full webinar of all the ins and outs of Breaking Up With Managed Care.

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4 Ways a Private Pay Practice Model Benefits Clients

The value of using a private pay model (instead of a managed care system) for your therapy practice is clear: less stress about additional paperwork requirements, greater autonomy to provide the services you deem are in the client's best interest, and immediate payment of your full fee are some of the main advantages. But some therapists are understandably hesitant about how to make the switch because of the potential impact this choice it might have on their clients. Some common fears are “Clients might stop getting the therapy they need because they can’t afford me” or “charging a higher fee is selfish and means I care more about money than helping people.” When I was considering making the switch, I too had thoughts like these cross my mind. But I discovered that the opposite was true; breaking up with managed care and embracing the new way of structuring my practice actually benefited clients who received services. Here are 4 ways that a private pay model benefits clients:

1) No Mandatory Diagnosis

Many managed care systems require that you diagnose a client's specific mental health condition condition prior to paying you for your services. In some cases, insurance companies will only pay for certain diagnoses. Often, relationship issues are not covered. However, this can turn in to serious ethical problems.

I remember years ago I was referred an urgent client - a child who was sexually assaulted. I determined that she had no clear-cut symptoms and didn't meet a diagnosis that her insurance benefits would cover. I was in a terrible dilemma: do I give an inaccurate diagnosis to satisfy the requirements of managed care, or do I get paid for the initial? No therapist should ever have to find him/herself in this kind of a situation, and no client should be subject to this either.

One of the best parts of employing a private pay model is that there is obviously no such requirement. Diagnosis can be used as a tool, but you are not obligated to provide one. By eliminating the need to diagnosis a condition that may or may not fully exist, you can ensure that your clients receive ethical, honest, and accurate care.

2) Higher Quality of Service

Back when I used a managed care system, I was receiving approximately 40-70% of my stated fee. This meant I was in survival mode, seeing more and more clients just to try to get by and meet my own financial needs. And all the while, I still had the stressful task of running the business side of things. It’s not surprising then that I wasn’t able to give as much to my clients. As much as I tried, unfortunately the standard of care I could provide was compromised. That was unfair to me and unfair to the people who were paying me to help them.

By changing to a private pay model, I was able to see fewer clients and, which reduced my stress, which allowed me to be more present for my clients. I also no longer spending hours per week on phone calls and paperwork that came with using a managed care system, which freed up my energy to give to those I served.

3) Better Therapist/Client Match

A private pay model also lends itself to a better fit between the therapist and the client. If you have fewer clients, you can be selective about the ones you see. The opposite is also true; if someone is willing to pay more for professional therapy, it’s likely that he/ she has done his/ her research and sought you out because of your specialty and the expertise you provide. To put it simply, you want them, and they want you.

I’ve found that using this financial model attracts highly-motivated clients. Although they are required to pay more, they place high value on therapy and budget accordingly.

4) More Clients Reached

A private pay therapy model allows you to have a greater outreach and help more clients. This may initially seem counter-intuitive; how does seeing less clients serve more people? The answer is that if you have a surplus of potential clients or have people come to you with needs that are different that the expertise of your practice, you can refer them to trusted outside resources. You’re helping other therapists while simultaneously ensuring that clients receive the best care specifically for them.

The other thing I have found is that the income stability provided by a private pay model allows my colleagues and me to do more pro bono work. Paradoxically, because we earn more, we can provide more volunteer service when we choose.

All in all, switching to a private pay model was one of the best business decisions I made to benefit not only myself, not only my practice, but the clients and the community we serve. Charging a higher fee does not mean you are inconsiderate or selfish; it means you are valuing yourself and providing the best quality care to your clients.

*If you find that finances are legitimately a concern for some of your clients, you may decide to provide alternative choices, such as reduced fee sessions with Masters’ student interns. My practice Wasatch Family Therapy does this, and it works well for those looking for a more affordable option.

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Top 10 Best Books for Building Your Practice

I asked members of my Private Practice Toolbox Facebook Group what books have helped them succeed in Private Practice and added them to the list of my favorites. Some of the following are specific to the mental health profession, while others offer insight that applies to the business world in general, but all of them can teach you valuable tips and strategies to use for your practice. 1) "Building Your Ideal Private Practice" by Lynn Grodzki

This groundbreaking book is first on the list for a reason. Dr. Grodzski leads the way in offering time-tested strategies to grow and improve your therapy practice (read here).

2) "Be a Wealthy Therapist" by Casey Truffo

This one shows you strategies to be a great clinician and earn a robust living. You worked hard to be a therapist, and you should likewise be compensated well (read here).

3) "Book Yourself Solid" by Michael Port

Port lays out in detail how to obtain more and more clients. A great resource for those just starting out (read here).

4) "Million Dollar Private Practice" by David Steele

This book guides you in how to channel your expertise to create additional income streams and reach a bigger audience (read here).

5) "Earning a Living Outside of Managed Care: 50 Ways to Expand Your Practice" by Steve Walfish

Walfish gives you strategies for ditching managed care and instead embracing a fee-for-service model. He also includes examples of counselors who found success by carving out a niche for themselves in different areas of therapy (read here).

6) "Never Eat Alone: And Other Secrets to Success, One Relationship at a Time" by Keith Ferrazzi

This classic teaches the ins-and-outs of successfully forging networks and relationships in a way that is authentic and can help you reach your career goals (read here).

7) "Launch" by Jeff Walker

An internet millionaire gives you the inside scoop on how to leverage your business online to reach massive success (read here).

8) "Platform: Get Noticed in a Busy World" by Michael Hyatt

You may already have a great service, but Hyatt teaches you how to utilize your platform to get your message out there. As a well-sought after speaker and blogger, he shows you the power of social media to expand your outreach (read here).  

 9) "The Private Practice Field Guide" by Daniel Franz

Written by someone who took the leap from working for a company to starting his own practice, this book addresses the concerns of therapists looking to do the same. Franz gives strategies and tips on such topics as marketing, streamlining business practices, and working with insurance panels (read here).  

10) "The Portable Lawyer for Mental Health Professionals: An A-Z Guide to Protecting Your Clients, Your Practice, and Yourself" by Thomas Hartsell

This book will answer some of the tough legal/ ethical dilemmas we might encounter. The author is an attorney and private practice mediator from Dallas, so he definitely knows his stuff (read here)!

Phew, that's a lot of great reading material!

What other books can you suggest that have helped you?

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4 Common Business Blunders of Newbie Private Practitioners

"Learn from the mistakes of others. You can't live long enough to make them all yourself."

-Eleanor Roosevelt

When starting out in private practice, there's a lot to know. A lot. The learning curve can be painfully steep, particularly in ways for which we received no official training (finances, hiring practices, etc.). And no matter how knowledgeable or skilled a clinician is, he/she will inevitably take a few wrong steps. And that's okay!

We recently opened up a discussion on our Facebook page to get feedback about common business mistakes that therapists made when they were getting started in private practice. The responses were overwhelming; it seems many of you were eager to reflect on and share lessons that you learned the hard way! Though there were many answers given, a select few kept coming up that are worth addressing. Here are 4 common business mistakes to avoid when starting private practice:

1) Taking Clients Who Are Not Ideal  

Building a clientele from scratch can be daunting, and if you're desperate for business, it might be tempting to take just anyone. But agreeing to see someone who is not your ideal client can be a miserable experience for both you as a therapist and the individual who is paying for professional services. Instead, politely refer to a therapist who is a better fit, continue to market yourself using the REST strategy, and wait for the right clients to come along.

2) Not Hiring a Good Accountant

Many in our group regretted that they hadn't taken on a CPA sooner to handle the finances, bookkeeping, and taxes (especially quarterly ones!). As so many in our Private Practice Toolbox group can attest, it's a worthy investment. One woman explained how she had initially set up her LLC incorrectly and later had to pay thousands of dollars to fix her mistake and get her business running smoothly again. Moral of the story: hiring a skilled accountant may be a bit expensive, but it's absolutely worth it!

3) Insufficient Infrastructure for Unexpected Growth  

For those new to the game, having an influx of clients might sound like a good thing, but the reality is quite different. Having too many clients can cause burnout, being short-staffed, and getting behind on administrative tasks. Don't be afraid to refer potential clients to trusted and reputable colleagues. Making sure your practice is secure and stable will make it so that you can handle the growth over time.

4) Not Understanding Insurance Companies         

Insurance panels are notorious for being confusing and complicated. Enlist a seasoned friend or mentor in your local area to help you navigate the process. Don't wait until you encounter a business emergency or financial crisis to understand all the ins and outs of insurance companies (such as understanding how client health benefits are different from behavioral health benefits). Become as versed and experienced in how to work with them as you possibly can so that you can avoid problems and get properly paid on time.

(I do hope that your goal is to eventually get off of insurance panels altogether and instead adopt a fee-for-service model. Click here to access my webinar about how to do so.)

What mistakes have YOU made that you would advise others against?

What did you learn from them?

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