Like most of the world, I’ve spent way too much time online during COVID, scrolling through my feeds looking at funny memes.
One meme in particular popped up on my various social media channels. I’m sure you’ve seen it. It’s a woman, filtered to look like she’s from the 1800s, knitting a large noose as a “gift” to her husband. The tag line: After 2 weeks of quarantine with her husband, Gertrude decided to knit him a scarf.
You know, so he can hang himself. Noose..……hanging…..suicide? Get it?
Funny, right?
Hardly.
I’ve also seen mothers across the country, stuck at home working and homeschooling their kids, posting comments such as: “Shoot. Me. Now. ” or “I’m seriously going to jump if these kids don’t go back to school.”
We seriously need to stop with the COVID suicide jokes. There is absolutely nothing funny about suicide.
The COVID lockdown has brought about myriad challenges including unemployment, social isolation, families cooped up together with no place to go, and uncertainty and stress on top of the fear of getting sick and dying.
According to a recent study by the CDC, elevated levels of adverse mental health conditions, substance use and suicide ideation were reported by adults in June 2020. 11% of those surveyed reported serious consideration of suicide.
In my private practice, I often work with families that are dealing with the death of a loved one from suicide. To label the grief from a suicide death as “complicated grief” is a gross understatement.
I’ve personally attended three funerals of people who took their lives in the last four years. The devastation left from a suicide is truly incomparable to other deaths. It’s haunting. As one mother said to me recently……”This wasn’t my choice at all to be in this life without my daughter. She made that choice for me.”
Think twice before making a “joke” about suicide. I love to laugh and have needed to desperately during this time, but let’s not ever make suicide the punch line.
I started writing this “Private Practice Chronicles” series two years ago when I opened my practice. It was a way for me to write about the ups, downs and everything in-between. My chronicles of PP have been some of my most-read blogs, and it’s been fun for me to re-read them to see how far I’ve come in a relatively short period of time.
I’ve written about my mistakes here and here. Looking back over the last two years, though….well, I know I’ve made mistakes but, dang, I’ve also done a lot of things right. So today, I’m sharing six things I feel I’ve done well:
- I don’t try to solve everyone’s problems – When I first started out, I felt immense pressure to fix everyone and everything that walked through the door. That’s what a good counselor does, right? WRONG. I know here are some things that are simply not fixable. The only thing that can change is the level of acceptance in the client, and my job is to help them get there anyway I can.
- I set boundaries – Of course, I’m admittedly still a work in progress on this one, but I’m getting much, much better. I’m not answering every email or phone call or text that comes through on the weekends (or all hours, for that matter), and I end my last appointment of the day at 7:00 p.m. (I used to take 9:00 pm appointments, even on a Friday)!
- I keep the hustle up – Just because your practice starts taking off doesn’t mean you can sit back and rest on your laurels. I am constantly marketing myself and thinking of new ways to get new business in the door.
- I screw up – and own it. Double-booked clients? Been there. Called a client by another client’s name? Done that. Completely forgot about a business meeting I set up with someone I admire who squeezed me into his busy schedule? Yup, that’s me. I’m a human being. I’m imperfect. I never make excuses for my mistakes, I can only own them, apologize, then do my damndest not to repeat them.
- I stick to my guns – People told me to take insurance (I don’t). People told me to see everyone that walks through me door to grow my business (I don’t). People told me to take on a partner (I haven’t). People advised me to take on business contracts that, while lucrative…..would be the only reason why I was doing it. People told me to do lots of thing that, in my gut, I knew weren’t right for me or my business. It’s your practice, to run your way – not anyone else’s.
- Listen to others – Contrary to my previous point, there have been times where I have sought out advice from older and more experienced clinicians in private practice. Something a colleague said to me has resonated with me since my early days. We were talking about marketing and he told me he doesn’t spend a lot of time or money on it. Why not? I asked him, almost incredulous at his answer. He said this: “I spend my time reading and learning and just trying to be the best therapist I can be for my clients, and when I do that, I find that my business grows itself.” He has a successful practice, and this statement of his is true on many levels.
So there you have it, the six things I’ve done well. I’d love to hear from you and what you do well in your practice. Keep going and keep growing.
It’s usually the first question I am asked when a potential client calls or emails me. Do you take United/Aetna/Humana/BCBS/Tricare?
No, no, no, no and no. And here’s why:
Before opening my doors of my practice back in July of 2016, I struggled with this choice. Being a cash-pay only clinician is not for everyone. The advantage of paneling with insurance companies is that there is a built-in referral network and a relatively full clinic in a short amount of time.
But here’s the deal with insurance: if you come to me even once or twice needing to sort out a work problem or a relationship problem or just trying to figure out a general struggle or issue, I have to slap a mental health diagnosis, or ICD-10 code on you so I get paid. And that stays on your permanent medical record. And I’m just not okay with that.
Oftentimes, insurance companies limit the number of sessions for a client (depending on diagnosis). So eventually, if you wanted to continue with me for a longer term (and I have many long-term clients), you’d max out your benefit and have to pay cash anyway. I’ve heard a few horror stories from some of my clinician friends who were audited by the insurance companies (and one who had to refund payment!) and see messages on many of the social media business groups I am in griping about delayed payment or submitted billing that was kicked back or questioned.
No thanks.
When I opened my clinic, I didn’t have one paying client (Read more about that craziness here). I knew I’d have to hustle and grind and market myself hard to fill my clinic with cash-pay clients. The funny thing is that my clinic filled relatively quickly, with many clients that called originally asking what insurance I took and hearing my answer of “none.” In 2017, my sales increased by 526% over my opening year. So far as of this writing in 2018, my sales are up 74%.
It’s risky being cash-pay. I meet with many other clinicians and physicians that are in the insurance game, and there is a love/hate relationship. They battle the insurance companies and spend lots of time and money billing – but their clinics are full. And oftentimes, their clinics have waiting lists.
The advantages of seeing a cash-pay only clinician? There are many. I’m not bound by the limitations set by insurance companies, and especially ones I don’t agree with for the treatment path of my clients. I also spend my time reading and educating myself on the latest news, trends and counseling techniques instead of billing and battling. Another advantage is that if my client’s insurance changes and I’m not on that panel, it doesn’t affect them in the least. They can continue their care with me instead of making a switch.
I have recently been afforded some opportunities that continue to help me circumvent taking insurance. These include two EAP contracts – one with a Fortune 500 company, and one with – ahem, an insurance company – as well as a contract with a state agency for substance use and abuse assessments and various writing assignments. How do I get paid for all of those?
In cash.
As the insurance companies get bigger and their mental health benefits shrink or change, it has zero bearing on how I run my business or serve my clients. And in the end, that’s all I care about.
So you’ve decided to go to therapy. Congrats on making such a big decision, and giving the gift of “you” to yourself! Of course I’m biased, but I believe therapy is one of the greatest things you can do for your overall health and wellness.
Finding a therapist can be daunting, and oftentimes people aren’t sure how to begin the process – or they give up before they make a first appointment. Here are some things to consider when searching for a therapist:
Shop Around – You shouldn’t make an appointment with the first therapist you Google. Ask around for reccomendations in your area, either from friends or your primary care physician. Research a few different therapy websites to read about what kind of client they serve and the type of therapy they offer. Talk to a few for an initial free phone consultation (I give a free initial 15 minute one).
Get the Deets – Does the therapist take insurance, or are they cash-pay only? Do they offer after-working hour and weekend appointments, or M-F, 8-5 only? Do they see children under 18 or only adults over 18? Do they have specializations or certifications in an area that you are seeking, such as addiction, play therapy or hypnotherapy? Do you have to travel into their office, or are they willing to come to you or do video/phone sessions? Find out as many details about the practice as you can so you can ensure a good fit for your needs.
Commit – Therapy is a process, and not always a quick, one-or-two session fix. Therapy takes time and money, so be sure you are willing and able to commit to regularly, scheduled meetings for a few months (or more, depending on the issues). Teenagers and children especially benefit most from consistently scheduled appointments.
Do the Work – Anyone that comes into my office will be told this: I’m one hour of your week. There are 167 others. So if your therapist gives you readings to do, assignments to compete, or activities to participate in – do them. It’s all part of the work that needs to be done out of the therapy appointment time, and to maximize the overall success of your therapy.
Change – Much like a doctor, lawyer, or hairdresser, sometimes the therapist you try simply isn’t the right fit for you. That’s ok! Therapy will only work if you feel you can work with that person, so don’t be afraid to stop services with one and get referred elsewhere.
Give Feedback – Some of the best work I’ve done with clients were the ones who were truthful when I asked them, a few sessions in, how they thought therapy was going. Your therapist wants your feedback and honesty to ensure your are getting the most out of your therapy time. If your therapist isn’t working on the things you want or need, or you feel stalled – tell them! The best clients I have give me feedback on what they think is or isn’t working for them during our sessions.
I hope this helps in your search for a therapist. Best of luck!
I’m a year-and-a-half into owning my private practice (woot, woot!!). I wrote a blog back in June about my first set of Rookie Mistakes, and now I’m back to share Part Two of a few things I’ve learned the hard way.
I know in retrospect when I read these they seem so obvious…like, DUH-obvious……but the fact of the matter is these things are easy to overlook when you’re flying solo.
So here are five more Rookie Mistakes for you to avoid if/when you are thinking of opening your own private practice:
1) Keep your Forms Updated – Then Update some More – I had an emergency contact space on my original form…..oh wait, no I didn’t!!! I mean, can you believe I did that? How did I discover this huge oversight? When I had a client in a really bad situation contact me and I needed to get in touch with a family member. Only when I pulled his file did I realize this horrible mistake. I now get at LEAST one emergency contact name and number per client. And I’m constantly updating my forms to add other crucial info (pregnancies, miscarriages, etc.)
2) RUN the Credit Card your Clients give you to Keep on File – One of my business practices includes keeping a client’s credit card on file to charge future appointments (or no-shows and less than 24-hour’s notice of cancellation). I have a form where clients voluntarily fill in their Credit Card info, then I manually run them at the end of the day. Oh, how naive I was to think they were writing down the correct number!!!! This is especially crucial for a cash-pay only business. Run that card with them in the office first to ensure it is a valid card.
3) Don’t Scrimp on Office Space – My first office space didn’t have a window, because, quite frankly, I didn’t have any clients and a window seemed like an unneccessary luxury. My practice grew quickly, and soon my tiny windowless office just wasn’t adequate for my clients – or myself. Upgrading to an office with a window makes all the difference in the world. So get the best office space you can (even if it means you have to hustle extra). I chose a secure building in a nice area with a shared receptionist and coffee/tea service included. It’s a nice space for my clients, who are spending their hard-earned money to come and see me. And now they have a window!!!
4) Wasting Precious Advertising Dollars – When you start out, everyone and their brother is going to call you (and call on you) to advertise with them. I have a marketing background, so I know the value of advertising and I needed to grow my business. One of the worst investments I made was buying a very expensive print ad in a local paper. I didn’t receive one call or email from that ad, and I think I’m the only person that saw it. My dollars would have been better spent on online advertising, where I receive the most return on my investment.
5) Not Setting Personal Boundaries – Starting a business is a 24/7 venture. It’s not a 9-5, Monday through Friday job. You must feed it constantly, or it simply won’t grow. But here was my problem: You want a 7:00 a.m. slot? Yes. You want an 8:00 Saturday morning slot? Yes. You need to text me at 10:00 at night? Yes. You need an 8:00 pm slot? Yes. Answer my business line at 10:00 a.m or 10:00 p.m. on Sunday? Yes. Pretty soon all of these “Yeses” were taking a personal toll, on both myself and my family. I’m still working hard on this one, but I’m setting more limits starting with phone and email activity, and I have a hard and fast last 7:00 p.m. appointment during the week.
My mistakes are and have been an amazing way for me to learn and grow, both personally and professionally. What are your (if any) rookie mistakes? I’d love to hear about them, how you discovered them, and how you handled them.
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