It goes like this: I get a phone call from a potential client. We chat about therapy and their individual needs. We discuss appointment days and times. Then they ask if I take insurance. Instead of simply saying, “No, I don’t, I’m cash-pay only,” my first instinct is to say, “I am really sorry, I only take cash.”
Another scenario: I charge full-price to clients that fail to give a 24-hour notice of cancelling an appointment. This cancellation policy is clearly stated on my website, as well as in all intake paperwork signed by my clients. I also verbally state my policy to all clients in person when they fill out their credit card form (which I keep on file to charge no-shows). I’ve had to implement this policy on ocassion, and each time I found myself telling the client, “I’m sorry, but I have to charge you.”
Why, oh why, am I always compelled to say “I’m sorry?”
Studies have shown that women like to apologize. A lot. We do it in our personal and professional lives on a daily basis. In fact, in a 2010 study in Psychological Science, it states that women are more likely to see a need for an apologies in everyday situations, and suggests that men apologize less frequently than women because they have a higher threshold for what they consider offensive behavior.
So here’s the thing.
Nearly one-year into running my private practice, I am going to stop apologizing for my business policies. The truth is, I’m not sorry I don’t take insurance. I’m not sorry that I charge no-shows for my time. And I’m certainly not sorry that my latest policy is to charge for my intake upon making the appointment (no-shows at 8:00 a.m. on a Saturday morning or 8:00 p.m. at night – and I’ve had both – make me totally not sorry for this one).
I’m in a person-centered, helping profession, but at the end of the day, I have a business to run. My policies are sound and fair, and clearly spelled-out from the get-go. Apologizing makes me sound as if I did something wrong or am worried that I offended someone.
So I’m sorry – wait, not sorry, that I’m done apologizing. I’m proud of my business, and my practices, and for that, I’m not sorry.
Most senior parents (like I am) are in the throes of picking out XL twin sheets, hoarding Bed Bath & Beyond coupons, planning graduation parties and trying not to bawl like a baby at every senior night event.
Aside from the hunting and gathering, there are other things to prepare yourself – and your kids for – as they prepare to leave home. The number one thing I ask parents of the college-bound is how much allowance do they plan on giving them? And how do you plan on giving it?
One friend told me her child is getting $100.00 a week. Cash. “How is she getting it?” I asked. “Why, the ATM,” she replied.
Her answer, as my daughter would say, was cringy.
Not the amount. The amount was not cringy – heck, give your kids as much money or as little money as you think is reasonable. That’s purely a budget decision. But please, please, pretty please, this Drug Counselor begs you: do not give them access to large amounts of unaccounted cash. Period. Do Not Do It.
Why?
Because your friendly neighborhood drug dealer only accepts cash. And because the students who could potentially supply your child with large amounts of alcohol for a binge drinking night only want cash. Cash is untraceable, as is your child. So limit this option.
I see a few college students in my clinic that got in way over their heads with some serious drinking and various drug use. Luckily, there were no sentinal events, but two landed in the hospital, one is now in rehab, and all were extremely lucky. Their parents were completely unaware of the level of their partying of course, because how could they possibly keep tabs on someone that’s not under their roof 24/7?
I know, I know. You’re reading this and thinking to yourself “Oh, this won’t happen to MY kid. MY kid’s not like that.” Trust me, I get it. That’s what we all think. The aforementioned kids all came from “good” families that live in “good” neighborhoods. But here’s the thing. According to a recent study by the National Institute on Alcohol Abuse and Alcoholism, almost 60 percent of college students aged 18-22 drank alcohol in the past month, and almost 2 out of 3 of them engaged in binge drinking during that same timeframe. And, in 2015, a University of Michigan study revealed that 38 percent of college students reported smoking marijuana in the past 12 months.
I plan on giving my son allowance, but he will use the credit card and debit card for most to all of his transactions. I know there are times when he will need cash, and he’ll have access to it, but it’s going to be extremely limited. And he’s going to have to account for every dime.
So please, please, add “little to no cash access” on your college kid’s list in the number one slot. This item is way more important than choosing the perfect comforter.
“Were you happy you woke up?”
It’s a question my boss taught me to ask people that came into our clinic, a 24-hour, 7-day a week, 365-days-a-year free Crisis Clinic. Many that walked through the door presented with suicidal ideation (S/I), or had made previous unsuccessful attempts.
This particular client was a young Hispanic female, maybe mid-20s, with a history of past attempts, the last one being an overdose of prescription pills. It was one of my first S/I cases, and I wanted to make sure I did everything right. As I staffed the case with my boss, she asked if I asked the client if they were happy they woke up after last attempt. I hadn’t even thought to ask.
Some of the questions we were trained to ask clients who expressed suicidal ideation included the following:
- Are you planning to kill yourself?
- How are you planning on killing yourself?
- Have you tried to kill yourself in the past?
- How did you try and kill yourself?
Notice the words “kill yourself.” We didn’t use “hurt” or “harm” or “do something” – we were trained to look people straight in the eye and use the word “kill.” We were also trained to say it in regular conversation voice, as if we were asking them what they ate for dinner last night, or who happens to be their favorite celebrity crush of the week.
But asking someone if they were happy when they woke up? That wasn’t part of my “formal training.”
“Go ask her,” my boss said. “See what she says, then take it from there. But always, always ask that question, and document the answer. Her answer will change how you treat and approach this case. It personalizes it beyond the ‘checklist’ questions.”
I went back to the room, monitored now by a co-worker (standard protocol for a person with S/I). I asked the client again about her past attempts, then asked her to think about the very last time: when she woke up in the hospital, was she happy to wake up?
She hesitated for a long time, staring at the floor, then looked at me. “Yeah. Yeah I was happy to wake up,” she said. “I was glad it didn’t work. My mom was sitting there crying and I’ll never forget it.”
Turns out no one had ever asked her that particular question. I told her how happy I was that she came to get help for herself today and how I wanted her to wake up tomorrow. We talked about her current plan to kill herself. She was feeling depressed and hopeless but was also, what we call in clinical terms, futuristic. She wanted to feel better but talked about upcoming events she needed to attend, school she wanted to finish, things she wanted to accomplish. Her depression was untreated and unmanaged
Our clinic staff put her on the road to treatment. I told her how happy I was that she sought help and how I wanted her to wake up tomorrow in her home, not in a hospital, or worse….to successfully complete the suicide and not wake up at all.
I now always, always ask clients that express S/I or have attempted to kill themselves in the past if they were happy they woke up. It starts a rich conversation and explores areas to apply to a treatment plan. We examine days that they were happy when they woke up, what was going on that particular day, and if they don’t feel happy now…..what do they need to do to get there, or what do they want to be different? We implement safety plans to remove means from their environment.
Sometimes, one simple question can make a huge difference. We just need to ask.
When I wrote my original business plan, I had a concrete vision for what I wanted my private practice to look like and the clients I wanted to serve. Adults, 18 and above only, 8-5, Monday through Friday. Period. This was my plan from the beginning, and whenever I closed my eyes and pictured my clients, that was what I saw. Although I had experience working with youth in during my graduate school clinical rotations and previous agency work, I was calling my own shots now and wanted to see only the clients who I wanted to see. And that meant adults, 18 and above only.
Did I say that I only wanted to see adults, 18 and above only?
Rookie mistake Numero Uno.
Guess who my very first, paying client was? One who called and wanted my very first available appointment, same day or next day, if possible? You guessed it. The parent of an 8 –year-old boy.
My next call was for a teenage girl. Then my next call was a middle-school aged girl. And the call after that was for a teenage boy at-risk for substance use and abuse.
Well, you get the picture. None of these calls were for adults. None of these clients were over 18. But guess what? They all wanted to see me. And I had many slots to fill in my practice. And since empty slots don’t pay the rent, I booked the appointments.
The teens and tweens, as I like to now call them, starting coming in. And a funny thing happened. I was enjoying my work with them. They gave me a new energy and excitement that spilled over to my counseling approach and to my practice. There’s something awesome about a kid bouncing into your office, kicking off their shoes, plopping down to LIE on my couch, covering themselves in one of my blankets and stating, “Mind if I just lie here and be a load today while we talk? I have a lot to tell you and I need to be comfy!” Adults simply don’t do that! And it’s great.
I began reading up on the latest research on cutting, social media trends among middle and high school kids and brain development through the ages. I ordered games that encouraged talking and interaction, stocked a shelf with coloring books and colored pencils and printed out many “worksheets” for 8-18 year-olds that focus on core values, anxiety, anger management, gender/sexuality and depression. I attend “teen-centric” CEUs on bullying, cyber bullying and social media. I now assign journaling, and keep up on Netflix Series such as “13 Reasons Why.”
So much for my practice of adults, 18 and above only.
My business plan changed just like that, and I changed along with it. At this point, nearly 10 months in my private practice, more than half of my clients are under the age of 18. My hours are heavy from 3-8, Monday through Friday, and occasional Saturdays, not 8-5 as I originally thought. Kids can’t miss school for therapy, so I accommodate them as needed. I still see many adults, 18 and above, per my original plan, but I love love love working with my tweens and teens.
If your business plan veers off in an unexpected direction, or you find a niche that needs to be filled – go with it – as long as the clients you serve are within your scope of expertise. Change it up when and where you have to ensure success – and a full schedule. If I didn’t change it up, I would’ve missed out on these great kids. And the personal and professional growth that they’ve brought – most unexpectedly – to my career.
I am nine months-plus into owning and running my private practice. From my first night in grad school through successive various agency work, it was my goal to work for myself as a sole practitioner. I opened my official doors on August 1, 2016 and want to share with you so far what I’ve learned.
There have been successes and set backs, and pretty much everything in between. I’m going to write about all of them here. I want to teach others who are considering hanging their own shingle over a shop certain things to do, and absolutely what not to do based on my own humble (and eye-opening) experience.
There’s a huge misconception in the mental health field about opening up your own business. The misconception is this: that people will care. I mean….don’t flatter yourself. You might be great at what you do. You might be marginally good-looking and charming. But you are 100%, absolutely, completely, unequivocally wrong that anyone will care. Trust me, I was one of those people with the same misperception before I started.
No one, I repeat, no one cares about your business.
Yeah, I said it.
Why does no one care? Because. Because there are other people out there that have the exact same thing, offer the exact same service or the exact same product. They’ve done it longer than you. They know more about it than you. Even if they don’t do it better than you, no one cares about that, either.
But you care. Of course you do, otherwise you wouldn’t have taken the leap of faith and done it.
So how do you make other people care? Here are five things I did to make my private practice turn a reasonable profit in nine short months, and to make people care about (and utilize) my business:
- Find Your Niche – In San Antonio, counselors are everywhere. In my zip code alone, there are 40+ counselors within a 10-mile radius. So why choose me? Because I meet people in their homes. Because I provide “Walk & Talk” sessions, where I meet people at work, parks, trails, etc. Because I have dual licenses in Counseling and Substance Abuse. None of those other 40+ people do what I do. And that’s not an accident on my part.
- Hustle – I am a constant marketer. I tell people what I do all the time and am shameless about self-promotion. In the hours I am not seeing client, I am busy marketing. I launched this website (with help). I had marketing materials and business cards made that I hand out on the regular. I’ll write more in-depth about my marketing practices – and the hustle – in future posts.
- LinkedIn Yoself – LinkedIn has been invaluable for me in reaching out to the local mental health community (and beyond) to let people know I am available. I engage with local businesses and agencies as well as individuals about my practice.
- Meet Up – My goal this year is to have one meeting per week with an agency, individual or company that could utilize my services (and that I can refer clients to if needed). This has proved invaluable during the hours that I don’t see clients. If I have a blank day (and believe me, there are some of those), I reach out and set up a meeting or tour of a facility. I’ve had three of those “meetings” so far this week. I’m aiming for 52 meetings (minimum) in 2017.
- Social Media-ize – Build a social media presence for your counseling practice. It doesn’t take a ton of time or energy, just some effort and advance planning. You can find me on Twitter, Instagram and Facebook as @jenniferseelpc. I am on Linkedin as well (see #3). I have a blog on my website (duh, obviously, you are reading). All of these help build my presence and spread my message, as well as connect with a vast audience and potential future clients.
I care about my business. I care about it a lot. I know you care about your counseling practice, too. So start making others care about it. Good luck to you, and check back here for more Private Practice Chronicles.
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