Mistakes Happen
Despite our best efforts, it’s virtually impossible to be in private practice for 20 years without making a mistake or two and occasionally having regrets concerning your choices at work.
Therapists are human.
Mistakes happen.
Recently, I stumbled across Chogyam Trungpa Rinpoche‘s teaching on “the mishap lineage,” the practice of using misfortune as steppingstones toward spiritual growth . . . .
This teaching reminds me of what I learned a long time ago . . . that imperfection is not a failure . . . but failing to learn from your mistakes is a failure.
I’ve had more than one opportunity to learn from my mistakes over the last 20 years and I’m betting you have, too.
Here are the first (and biggest) 3 mistakes I made starting out in private practice . . . .
- Not setting up systems with my future busy practice in mind,
- Not realizing that clinical skills would not be enough to build and sustain a private practice, and
- Not investing in me and my business from the very beginning.
Habits and Systems in Private Practice
It was simple when I started out in private practice with only 1 client to spend oodles of unstructured time on the phone with potential clients.
I had all the time in the world to write up a handout or think about how I wanted to follow up with a referral source when I had just 3 or 4 clients.
But, as my practice continued to grow, one day I woke up and realized just how many times I was reinventing the wheel, duplicating my efforts, and wasting my increasingly valuable time.
It’s harder then . . . a year or ten down the road to erase old habits and implement new systems .
It’s like learning to write with your non-dominant hand at 50 years of age!
But that’s exactly what I had to do because I didn’t think and plan out far enough ahead.
Even if you have only 1 client, now is the time to establish the habits and create the systems you are going to need once your practice is ridiculously full.
More Than Just Clinical Skills
It also never occurred to me when I hung my shingle out that I needed to know much of anything beyond clinical skills.
My naive assumption was that as a new therapist I would hang out my shingle and the clients would come.
As I’ve mentioned before, if you have no training in entrepreneurial businesses and no one modeled the entrepreneurial way, there’s a strong possibility that you may be making that very same mistake as you begin your practice.
I waited and waited far too long but the clients never did show up . . . until I learned what I needed to learn about the business of private practice.
If your clinical skills are sufficient and you’ve hung your shingle out in the wind only to watch it get more action than your telephone, it’s time to take a look at what it is you don’t know . . . and make the commitment to learn it.
You need a plan to get that phone ringing.
You need to know how to start and grow a business – just like every other entrepreneur out there.
Just because you have placed yourself out in the world to do good doesn’t mean anyone else knows about you or your business.
And, it doesn’t mean anyone else really cares.
You can learn about the business of private practice and how to get potential referral sources to care in lots of different ways.
There are books to read, blogs to subscribe to, people to interview, podcasts to listen to, videos to watch, classes to take, and mentor-coaches to hire.
Decide what combination is going to work best for you.
If slow and steady is your game plan, then you can absolutely learn on your own.
And, if your plan is to grow your practice more quickly, then enlist the support you can afford as you are able.
But, what you cannot do is rely on your amazing clinical skills and training and forego the business skills if private practice is your calling.
Self-of-the Therapist – Invest in You
And, certainly, this is the mistake that embarrasses me the most – refusing to invest in me and my business.
I say “refusing” because although I didn’t feel like I had the time / money to invest in my business, I always had money to buy books, time to take trips to see family and friends, pick up a Starbucks whenever I wanted, and buy a new scarf or new plant to pot up.
What I seemingly “never” had time or money to invest in during the early years of private practice was the physical and personal infrastructures for my business.i.e. proper telephone systems, software, etc. or in my own personal and professional support i.e. legal and clinical consultations, my own therapy, business coaching and classes, etc.
The truth is that not making those investments cost me time in ramping up to a full-time practice.
That, in turn, made me question often what I was doing wrong.
And, all of that cost me money, time, and confidence that, in turn, affected my effectiveness as a clinician and a business woman.
I’m wondering . . . what were your first mistakes that, in turn, have impacted your clinical or business practice . . . and what lessons can you pass on to mental health professionals that are coming behind you?
One of the mistakes my colleagues and I made was not doing a full research of the area of our office. We always visited during the day and it seemed so quiet. However, after we signed our lease and was at the office one evening painting, we realized that not only did we have tenants who lived directly over our office with small kids, but also it was a high traffic area (drug dealer). After further research, we learned so much about our office bldg that we had to move out 9 months early for our safety and the safety of our clients.
Hi, Natasha! Welcome to Private Practice from the Inside Out!
Thanks so much for taking time to drop in and share this mistake!
It’s one I just got lucky and missed but you’re so right about pointing this out.
Not only does it sound like your safety was at risk but also that of your clients, too.
Location matters – not just for safety but also for attracting your ideal client.
I hope you ended up in a better location in the end!
My first mistakes were not setting limits with time and sticking to policies in the beginning. It has turned into a lot of late nights I didn’t plan on. Readjusting my schedule is working but a slow process
Hi, Jill! Welcome back! I’ve missed your voice here!
Oh, my goodness, YES!
I was guilty of that, too.
It’s easy to do when we first start out with only one or two clients, right?
We have more time on our hands than we know what to do with and it’s easy to rationalize our lousy boundaries around time and no shows by saying “What can it hurt? I don’t have a client coming in right after this . . . . What’s an extra 15 minutes here and there?”
And, once I made a habit of that, it was so hard to break that habit!
Thanks, Jill, for making this point so that others don’t have to step into the same holes!
1. Marketing, or the lack of. I thought I’d deliver a few donuts, create a website and the referrals would flow in. I finally realized it takes a website, community out-reach, taking clients for a reduced fee, networking in the community, doing luncheons at doctor’s offices and schmoozing with other therapists at open houses and NASW workshops, NAWBO events, Powerful You chapter events etc., Meetup.com groups for peer supervision, low-cost teen groups, women-in-transition groups, and other creative ways to get my name and what I can offer out there. It did pay off. I have been practicing for 11 years in the same office and have to refer out I am so busy. It has been that way consistently for the past 10 of those years.
2. If you can swing it, don’t sign up to become an insurance provider. I never made that mistake, but a lot of my fellow therapists have and don’t know how to get out. Being an out-of-network therapist is the smartest thing I have done. It took a while to build a steady client and referral base. But so worth it. For every 3 clients I see, a fellow therapist who gets all her referrals through insurance co’s as a provider sees 8. Sure, you will receive referrals right away as opposed to staying out-of network and working hard to be known in the community (that’s the marketing part) at first. But now she sees 7-8 clients a day to earn what I do seeing 3 clients a day. If you can stay out-of-insurance networks! Taking risks and believing in yourself is imperative. And it works 😉
Hi, Christine! I’m so glad you could join us today!
Thank you for taking the time to share so thoughtfully with our community here at Private Practice from the Inside Out!
It looks like you and I shared the same learning curve . . . except that I did start out working directly with managed care companies.
However, I eventually wised up and moved into a cash-only practice.
It was for me, as it was for you, the best decision I ever made.
One thing that you didn’t point out is that while your colleague is seeing 7-8 clients / day, you have the ability to see 3 cash-paying clients and a pro-bono client or two if you wish . . . and still have more freedom in your day!
I’m so happy for all your successes and hope you will drop in often to chat about them!
Thank you Tamara! I have a “turn no one away policy” actually. Unless they are not within my scope of practice of course. I take a certain amount of low-fee clients or pro bono clients because it is the right thing to do. Other therapists think if they do that it will hurt their practice or take up a paying client’s time slot. But I take a spiritual approach and it hasn’t failed me in 11 years. It always comes back. I don’t advertise it, but I do take Family Care or Medicaid kids whenever they are referred. Did you know Medicaid people can only go to a mental health clinic or center to be treated by an LCSW or LPC in New Jersey (thank you Chris Christie)? The waiting lists are 4-6 months for therapy. Otherwise the only individual therapists in they can see are psychologists in private practice. Do you know any psychologists who accept Medicaiid? Me neither! So I feel a certain obligation of service, or to give back. And as you pointed out, not relying on cramming my day full of $60 insurance reimbursement-type clients allows me to help others even more. I have actually been mulling over the idea of offering reduced rent or no rent to therapists willing to take Medicaid or uninsured clients. My offices are near empty on the weekends. It’s just in the idea stage.
@Roy I have worked through the pitfalls. I have an excellent BS detector lol.
I rent from a network that gives deep rent discounts to therapists who charge low fees. There’s a precedent! http://portland-therapist.com/
I just checked out the link and that is AMAZING. I feel more inspired now….Thank you Roy!
I would be careful about underpricing yourself. Deciding to provide low-cost therapy is one thing (and a lovely thing!), but it’s not the same as going low cost because you believe it’s the only way to get business.
There are a lot of pitfalls to lowballing your fees without a specific, self care-affirming intentionality behind it.
Ooooh, yes!
Thanks for adding this!
That would have been #4 on my list.
Did you do this, Roy?
It would have been so much smarter (and easier) if I had just started out at the usual and customary fee that others in my area charged!
I kind of did this. Yes. I can imagine it would have been much harder on me if I hadn’t been at least as specifically intentional as I was.
One of the mistakes I made when starting out as part of a group practice is with regards to subpoenas. I was well aware, as a child & adolescent therapist, of the possibility of me being subpoenaed but I was never ready for the work involved in not only protecting your “investments” but also your name. I have gotten way more savvy with experience. It isn’t always easy to determine the real reason for a family pursuing therapy in the middle of custody and divorce battles but it is important to clarify your role upfront and operate within the realm of your personal and professional ethical principles.
I agree. I’m a child and family therapist too with a lot of parents in the divorce process seeking therapy. I give the same schpeil about not putting anything in writing for either attorney (unless subpeonaed by a judge of course). Whenever I get subpeonas from attorney now I don’t even answer them. I’m not getting pulled into that. I shared office space once with a therapist who would not only answer them, but put in writing what the child told her in session about the other parent and her (non-clinical) opinion about how the child feels about overnights, etc! I know, what?!
Hi, Christine! Thanks so much for stopping by to make this point and offer these examples of things not to do.
I’m sure, early on, many of us had good intentions and still made poor choices.
You reluctance to put information in writing is wise for sure!
I’m sure that both you and your client benefit from this practice.
Hi, Tamara! Thank you so much for sharing this “oops.”
“Failing to clarify your role” is something that many therapists struggle with in the beginning.
And, of course, in order to clarify your role, you first need to understand and know what the limitations of your role are!
You can’t answer unasked questions if you can’t even anticipate what they might be.
It sounds like you’ve likely learned this “by fire” along the way so I look forward to hearing more about your experiences, too.