This past week, I got hit – and I mean, hit hard – by compassion fatigue. I didn’t recognize the signs at first but here they are, in no particular order:
- I wasn’t sleeping well.
- I was thinking about my clients round the clock.
- I was leaving as late as I could from home and arriving justintime for my appointments.
- My daily runs were going by the wayside because my planned running time became consumed with adding more client appointments and in-between session phone calls with clients and their families.
- I was declining lunch and coffee dates with my friends and spending a lot of my days alone, reading and preparing for my late afternoon and night sessions.
- Some friends were having personal crisis situations and calling/texting me around the clock.
- Oh, and did I mention that this month has been my biggest month of success, if you measure it strictly in monetary terms?
This candle was burning at both ends, hot and bright. It doesn’t take a genius to see where this was heading.
I was keeping it together in sessions, but out of them? I was crying during my daughter’s marching band performances. I was crying when, after a few late nights at the office, the custodians at my building who were cleaning would stop by and ask me for a piece of candy out of my dish. I was crying when I walked my dog and I saw a dad throwing a football with his daughter in my neighborhood.
Historically, when other therapists or anyone in the helping profession would talk about compassion fatigue, I gotta admit, I half-listened, and maybe even rolled my smug eyes. I sat through my mandatory agency trainings and read the statistics and listened to other people talk about their experiences but honestly? I secretly (and naively) thought that compassion fatigue was simply something that, well…..was never, ever gonna happen to me. Why? Because I got this!!! I can do it!! I’m different then everyone else. I’m a machine.
This month, and this last week in particular, work was extremely intense. I performed an intervention. I placed two clients in treatment. Three clients from yesteryear contacted me asking me to restart therapy. Two people told me that I single-handedly saved their life. It all was taking a toll. Big. Time.
So now I get it. Compassion Fatigue. It’s real, y’all.
Mother Theresa insisted that her nuns take one year off every 4-5 years to allow them to heal from the effects of their helping-focused work. I was barely eating a proper lunch or dinner most days.
This week, I redirected myself. I bought some new candles for my office. I reached out to friends and scheduled get-togethers. I took my daughter shopping and bought her some new clothes. I made a conscious decision to stop reading about work at home and instead, read for pleasure. I made time to run, and signed up for a few upcoming races to ensure I continue to train. I’ve blocked off a few upcoming days in November for leisure and family and travel – and for just ME.
No one is a machine. Machines don’t cry, people do.
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.
I rarely self-reveal to my clients during session, but a question I’ll always answer is this one:
Do you see a therapist?
Yes. Hells yes I do.
I’m always more than baffled when I talk with a counseling colleague and I discover they are not seeing a therapist. If you are an active, practicing therapist, be it in private practice or an agency setting, I feel like it’s a must.
In graduate school, the idea was presented by a professor that all therapists should be in therapy. Of course, being a busy grad student with two small children my first thought was……yeah, right. Ain’t nobody got time (or money!) for that. I thought of therapy as only something for the rich or elite – a luxury rather than a necessity. I had never been in therapy before. Pretty ironic for someone who was planning on dedicating the rest of her life being a therapist, right?
My first exposure to personal therapy was a mandatory group class. We were required to participate, once a week, in a group session. I was skeptical at best and quite resistant to the entire process. What I discovered in group therapy (once I got over my bad, close-minded self) was how my parent’s divorce when I was 14 affected me, plus how I had not resolved one issue related to my mother’s unexpected and sudden death when I was 32..
After that, I ran…..not walked……into individual therapy. And I’ve been there ever since.
Like many professions, being a therapist is stressful. My clients come to me with trauma, grief, suicide ideation and everything in-between. I don’t always want to bring that stress home and try to release it in other ways. Therapy helps me figure out ways to do that, how to process, how to not transfer or counter-transfer, and helps me reset myself when I feel this area of my life gets off track. Sometimes I utilize my own therapy appointments to staff difficult cases. Being a sole practitioner, I don’t have a business partner in the next office to bounce problems or challenges off of, and my very-seasoned therapist is awesome at this. More often than not, my own therapy appointment is spent discussing family challenges, personal struggles or whatever it is that is happening in my life.
Admittedly, it took time to find the right therapist for me, but I’ve been seeing the same one now for 4 years and have no plans on stopping. I kick up my appointment frequency when things are going awry, and I stretch it out when things are humming alone quite nicely. But I’ll never, ever stop going. Therapy is a lifeline for me. It’s not a luxury – it’s a necessity for my own mental health. I couldn’t imagine my life without it.
So therapists, listen up: there is a reason why Dr. Yalom wrote the book “The Gift of Therapy.” Therapy is a gift, one you give your clients everyday but one that you need to give yourself. Honor yourself – and your own mental health- with this most-important gift.
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.
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