I’m near the one year mark – one year! – of owning my private practice. It was a dream and ultimate career goal from the time I decided to go back to grad school in 2010. Seven years later, an opportunity arose, in the form of a sudden and unexpected (boy, I didn’t see that one coming) job layoff, some office space that became available, a person willing to share the rent and just like that, a dream became reality.
Shy of one year in my practice, I just re-signed a lease (solo, yikes!) and couldn’t be happier. I’ve had some big successes co-mingled with a lot of hard lessons. Here are five rookie mistakes for you to avoid if/when you are thinking of opening your own private practice.
1) Find a Niche – I was all over the map when I started. Honestly. As a therapist, you can’t be everything to everyone. So don’t make the mistake of taking all business just for the sake of taking business. Figure out your strengths (and weaknesses), find your niche, and work on perfecting it. Refer cases beyond your expertise to others in your community. In time, they’ll refer back to you.
2) Stay Organized – Owning a business means you are all departments – IT, accounting, scheduling, marketing and everything in between. This is a constant challenge for me. When I’m not seeing clients, I schedule time in my day for meetings, marketing, social media management, paperwork or general planning, depending on what needs to be done. Set up systems that work for you so that your practice can run efficiently.
3) Safety First – I’ve taken new clients at 8:00 p.m. and weekend slots where my usually-bustling office building was desolate and I was isolated and alone. Looking back, considering the line of work I’m in, some of those clients would have been better for me to see during normal business hours until I got to know them better. Looking forward, I only schedule my known and established clients during my irregular times.
4) Have a Business Plan – I’m going to make all you MBA-types (and my accountant) cringe right here: I didn’t write one. Well, not an official one. Oh, I had a list of things to do (website, PLLC, business accounts, etc) and lots of ideas swimming in my head. But get your business plan down on paper, including all start-up costs, projected expenses, and number of clients you need weekly to break-even, turn a profit, and cover expenses. Refer to your business plan monthly, and make revisions as needed.
5) Don’t Panic – Owning a business has its ups and downs. Some months are better than others. Case in point: my most profitable month was one where I was off for a week on vacation. The next month was slow (and I mean, slooooooooow). During this slow month, someone approached me coming to work for them – notice I said “for” not “with.” I considered this offer for a few days (what if I don’t make it? what if business continues this slow? What if what if what if?) but decided to continue working to build my practice. Sure enough, not two weeks after turning down the offer, some well-paying, substance-use contract-work came my way. If I had panicked and thrown in the towel, I would have been giving up not only my dream, but this other, better-suited opportunity.
I’m still making mistakes, and learning from each and every one. Mistakes are simply par for the course of owning your own business. Don’t dwell on them. They happen to everyone – just don’t repeat them, and learn from them. Best of luck with your own practice, and I hope reading about my rookie mistakes help you avoid making your own.
When I moved to Texas from the north 13 years ago, I had no idea what plants worked in the hot climate and Hill Country rocky soil. So I did what any good Yankee would do and went to the local nursery to find out. This black thumb (and I mean, I can kill a plant just by looking at it) asked the worker that saw me wandering lost and clueless among the aisles of unknown shrubs for the most resilient Texas plant.
Knock-out roses, she said. You can’t kill ’em even if you tried.
Watch me, I promised.
But she was right. We bought some knock-out roses, red ones, and boy were they resilient. They thrived and grew despite how much or how little water or sun or attention they got, and they were beautiful. Every house I’ve owned in Texas (and there have been three so far) I have planted them because, well, even I can keep them alive, no matter what.
I see these roses daily, in my own yard and on my runs throughout various areas and neighborhoods. They bring me such pleasure, especially knowing how hard they need to work to survive.
I talked about these roses with a client the other day. This client has experienced some particularly horrific life events, more in her young 18 years than most have in a lifetime. This client’s story is one that could have gone in a way different direction, but instead, this client is graduating high school and heading off to college and planning a future that is greatly unknown but wide open with possibility.
In our session, this client was running down on what she perceived to be negative qualities, such as “I’m self-destructive in relationships,” “People don’t like me as much as I like them,” “I hate most of my appearance,” and so on and so forth.
You need to give yourself credit, I replied. I compared her to a knock-out rose – resilient under the most trying of circumstances, and even thriving through it all. That’s a gift that you have, I told this client, and something that no one can ever take away – the ability to persevere and keep growing despite everything and everyone else.
At the end of the session, she was smiling. “I guess I am pretty resilient,” she said. “I hate that I always have to be, but I am.” We talked about where resilience can take you in life, and how she has already, unknowningly, applied it to her own life in many different areas.
I know I will think about this client every time I see those roses. And I know that she’ll be okay, no matter what comes her way. (more…)
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.
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