Just today, I received an inquiry from a therapist on a post I wrote two years ago, 8 Reasons Why I Do Not Work with Managed Care Companies and What I Tell My Clients. I decided to reply here in a blog post because I get these questions often . . . .
Hello. I am a LICSW who
recently left a position at a community mental health agency in order to develop a private practice. I knew I wanted to practice free of insurance restraints however, it was appropriate therapeutically for certain clients to follow me into the private world and these are all Medicaid/Medicare folks. My hope was to build up the rest of my practice as an out of network provider. I find I am turning people away right and left because of this.
Tamara, I wonder if you would share a concise but thorough explanation that you use to educate clients about the benefits of working w/ an out of network provider. Do you market your practice via local paper etc. and/or via letters to psychiatrists, inpatient facilities? I do not have a sliding scale but have agreed “in the moment” to reduce my fees for a few pvt pay folks who request this at the end of our first session.
FYI, I use a [software] program to set up client files, bill etc. Have been very happy w/ this software and the tech support. Cost is only $19.95/month.”
Congrats to you on stepping out into private practice! I know you must be excited and maybe a little scared, too. I know I was! But, what I have learned is that if you actually take the time to create a plan, it’s a whole lot easier than flying by the seat of your pants! Here’s the super-concise version of how I do it.
- I educate my clients from the get-go. I post it on my clinical website. I follow it up with my initial conversation on the phone with a client. And, it’s spelled out again in my disclosure statement and my informed consent process. Truthfully, after that initial conversation on the phone, my clients rarely if ever bring it up again. The key, I think, is that I am clear in my own mind and conscience about what I will and won’t accept and do. And, that clarity comes across in my discussions with my clients. I don’t coerce or scare my clients or attempt in any way to persuade them and I think they get that . . . that I am simply providing all the information that I have in order for them to make a fully informed choice.
- I don’t routinely advertise my clinical or my consulting work. Check out 4 Things You Must Know Before You Decide to Advertise to see why. (Hint – Most therapists do this wrong and blow a lot of money.) Instead, I market my practices by networking in two specific ways – face-to-face and online. And, yes, I believe you must do both for the long-term health of your practice unless you intend to operate a 100% online practice.
- All marketing is about relationship building. . . . with potential and current clients . . . with colleagues . . . with professionals in my communities (both face-to-face and online) . . . . It’s about investing in individual relationships by planting seeds, nurturing in those individuals, and celebrating their successes . . . knowing and trusting that you, too, will also bear fruit from those relationships. That means . . . letters to psychiatrists (and others) without following up to build personal relationships with them are useless . . . and “marketing” to agencies, organizations, and hospitals (rather than to individuals) isn’t really marketing at all because you can’t build a relationship with something other than a person.
That’s it! That’s the “concise” version of what I do. To thrive in private practice – regardless of whether you are directly with managed care or not – the key is that you have to build relationships. And, that’s the good news because that’s the very first things that therapists are taught!
OK, gang, can you chime in here and offer your own strategies for how you are successfully building your practices? [ Updated 11-05-19]
Tamara you are so write about having a plan and also knowing clearly what you will and won’t do for clients. I find that when I do have pitfalls with clients, or misunderstandings is that I was either not clear enough in my own mind first about what I will/won’t offer. I think the key is to write down your plan and consult with colleagues that can help in the accountability department. I know for my own personality I am really good at wanting to be nice and please my clients, and writing it down helps me to clarify my limits for myself and my clients.
Oh, Jill, that’s been true for me. If I list the 10 worst decisions I’ve ever made in private practice, not one of them was to blame on “getting bad advice” or “clients manipulating” or me not having “a choice.” They always 100% of the time were (and are) about me not being clear about my own values, intentions, or plans. It sounds so simple, doesn’t it, to know what your value, what your intentions and plan are related to private practice? But, the truth is . . . as good as your graduate program was . . . as good as your supervision was . . . and as good as you intend to be, it’s really really difficult to foresee the multiplicity of circumstances that will intersect in your particular practice that will, in turn, highlight the many places that can trip you up in private practice.
That’s exactly why the standards of practice in mental health have moved to include ongoing routine clinical consultation. And, for those of you who have yet to make that happen, here’s a post I wrote to tell you How to Put Together a Consultation Group that Rocks!<
Great post Tamara! I too have found it is all about relationships and when I have a sturdy plan, I can relax and not feel worried or anxious about clients coming in because I know the plan works…when I implement, evaluate and adjust. And…as you know, having a coach is invaluable in this process! Cheers to you and the good work you do!
Hey, Jenny! It’s so good to find you here! Thanks for dropping in! And, yes, I do know that having the right coach can take a practice to a new level but since I do some coaching, I try to keep my pitchy spiels to a minimum. Thanks for you kind words!
Tamara, you said something a couple of months ago about networking that really stuck with me. Of course I can’t remember the exact lingo you used, but it was something to the effect that “We don’t effectively market ourselves by trying to sell ourselves to clients or to potential referral sources, we effectively market ourselves by showing up authentically, as we are, and building a relationship of give-and-receive with referral sources so that they know exactly who we are and can feel comfortable referring to us. With clients, it’s similar in that they get to know us truly as we are and are not trying to ‘mold’ ourselves. This is also beneficial for ourselves because we are not so exhausted by trying to put ourselves out there when it doesn’t always feel right”. Something like that 🙂 I really follow those guidelines and find that I attract the type of clients who are ideal for me because I am projecting positive, healthy, real energy myself.
Thanks for your always wise insight, Tamara!
🙂 Hi, Kate – that’s so kind of you to take the time to drop in and let me know how this fits for you! Perhaps I told you earlier . . . I initially officed with a wonderfully talented therapist who was quite comfortable circulating among the Country Club set when I was in my early 30’s. She took me under her wing, mentored me beautifully, introduced me to her circle, and encouraged me to network at her Country Club, too. I did everything she suggested I do. I changed everything including what I wore and how I did my makeup . . . to no avail.
While I got busy attending meetings and joining committees and met scores of wonderful women, my practice continued to limp along. It took two full years before I finally realized the problem all along had been . . . it wasn’t ME! I was never comfortable in that setting, pretending to be someone I was not . . . and, most likely, they all knew that at some level. The minute I started showing up – really showing up – where I was most comfortable, my clients showed up, too! And, the more real I was willing to be in those settings (that really felt like “home” to me), the more my ideal clients were willing to be real with me.
I know it sound so simple . . . now . . . in hindsight, but at the time . . . newly in private practice . . . it wasn’t so simple at all. In retrospect, it was moments of self-awareness . . . and many small acts of courage. And, while some reading this may mistakenly think that this was about chronological age, I don’t think so. That really is too simplistic. I think, instead, it was much more about the developmental stages we go through . . . . Some seem to spring out of the womb screaming authenticity; others, re-learn it at 20 or 30 . . . . And, still others figure it out at 50 or 70 . . . while others never do.
Developing a niche is has been instrumental. Clients want to work with me because of my expertise. I also network with therapists and other professionals who provide complimentary services. For example, I work with children and sometimes their parents are in need of couples counseling so I refer to my network of couples therapists. They in turn refer clients to me as they often have couples who are separating/divorcing and the children are in need of therapy to help them adjust.
Hey, Pam, I’m so glad you dropped in to add to this conversation! You’re talking about what I call reciprocal referring relationships. I do the same thing. I think sometimes new or hungry therapists can be so fear-based that they fail to do what is in their clients’ and their own long-term best interests by referring out to colleagues and complimentary services. In my experience, the wider we build our nets in our net-works, the more security and support we have in our communities for our individual practices.
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Thanks for sharing this blog for future private practice people! I think you gave a lot of good information in a concise manner. I agree that what has helped me be successful has been my relationships with others in the community and my clients! Great bit of knowledge!
The more I read your blogs, Tamara, the more I realize that the decision to go directly into a private practice is the right one for me, it is scary, I would not lie, but it is also so empowering! I am learning tremendously from all of your blogs, and from all great therapists and other professionals who comment on your postings, and it is such an enlightening experience to me to digest it all! I wonder if you are still offering supervision for mater level graduates, I am in the process of starting my private practice and looking for supervisor who would challenge me to be the best I can be and you do inspire me!
Nelly, welcome back to Private Practice from the Inside Out! I do offer clinical supervision for those pursuing licensure as a Professional Counselor. Where are you in school and when do you graduate?
Hi Tamara,
We have chatted briefly on LinkedIn a few times… can you please telll me more about being a Professional Counselor and the supervision you are able to provide? Thanks!
Hi, Desiree! Of course, I recognize you! I remember your beautiful smile standing next to an airplane on your website. Were you a pilot at one time . . . or do you work with the airline industry? That’s what I make up about you – not sure if that’s accurate though:)! Welcome to Private Practice from the Inside Out! So . . . you’re asking about being a professional counselor and I’m not exactly sure which part of that you are asking about. The American Counseling Association is the professional association in the USA for professional counselors. The requirements to become a professional counselor vary from state to state and at this time there is still no portability of license across all states. Unlike coaching, there are typically laws in each state dictating who is a professional counselor and what they may and may not do under that title.
I provide clinical supervision to counselors who are pursuing licensure in the state of Colorado. I also provide clinical consultation / coaching to mental health professionals worldwide. I’m not sure if I’m answering your questions sufficiently or if you are looking for specific info. If the latter, you may reply here or reach out to me back channel at Tamara at TamaraSuttle dot com.
It’s good to find your voice here, Desiree! I hope you’ll drop back in often and share your thoughts and resources, too! Have a great week!
Hi Tamara!
Thank you for the nice compliments, flattery will get you everywhere 🙂
Here is the background story about why I specialize with the Airline Industry- I have a family member currently flying for the Air Force in one of the “Stans,” and I am married to a man with 15 years in the Air force (3 years in the Marines and 3years in the Army). I began to work in the Carlsbad Airport and my “marriage” to all people “plane” related took off. It is actually an FAA rule that we tenants have a “flying” specialty. For example, the attorneys in the building specialize in plane crashes (yikes!) and other issues, etc. My clients who are not connected to the airport really enjoy being able to go out on the balcony over the flight line in my big conference room–Airplanes taking off and landing are strangely therapeutic–very graceful and noble beasts.
I do Skype (and visit) with clients all over the United States and I am beginning to wonder about the possible benefits of being licensed in other states… and skiing in Colorado could be fun 🙂
-des
Des, what a perfect niche you have carved out for you! My partner works on airport properties so I am a little bit familiar with the additional requirements that their tenants work under. I love how you talk about your work environment – it’s obviously a great fit for you and your clients!
Licensed mental health professionals who transmit any type of Protected Health Information must be HIPAA compliant. As an extension of this, offering distance counseling sessions must done via HIPAA-compliant technology – which Skype is not. That means you would need to use a different tool but that’s not difficult to do. DeeAnna Nagel’s Online Therapy Institute is the place to go to learn this aspect of distance counseling (and they work with as many coaches as therapists, too). A second issue that you would want to consider is that if you will be doing distance counseling as a licensed practitioner, you will need to be licensed in each state that your clients are in. Until portability of licensure is in place or the state laws change, this is going to restrict the work that licensed mental health professionals can do.
I hope you do end up in Colorado and will let me know when you are headed this way!
Desiree, here’s a link to show you how to set up a gravatar so that your little photo of you shows up next to your comments here (and elsewhere online).