Tag Archives: Private Practice Management

Private Practice Management

Marathon vs. sprint: Building a sustainable career as a professional counselor

Compiled by Bethany Bray March 27, 2020

Professional clinical counselors who sustain their careers over decades have literally thousands of clients come through their doors. There’s no denying that the job is rewarding, but the daily grind of helping people overcome trauma, loss, addiction and other “heavy” challenges can wear on even the most resilient of practitioners.

This begs a question: How do counseling professionals maintain their energy and motivation across the years? What does it take to stay fresh and inspired day in, day out, rather than growing stagnant over time?

Lynda Diane Noffsinger, a licensed clinical mental health counselor supervisor in Winston-Salem, North Carolina, has found that her answer to this question is to stay curious. Noffsinger has been a professional counselor for close to three decades but says she is still learning every day. Just last year, she earned her credential as a certified eating disorder specialist.

Noffsinger has worked as a counselor in a variety of settings — at a mental health hospital, at a residential substance abuse program, at a college counseling center and in a private practice that she owned for 20 years. She says each role taught her not just new counseling skills and techniques but also more about herself.

For instance, when she worked briefly as a clinical counselor at a residential and outpatient eating disorders program, “I learned that I do not like an administrative role. I missed direct counseling, and I missed the community I called home,” says Noffsinger, a member of the American Counseling Association since 1999.

Most recently, in her role as a counselor at a practice that specializes in helping adults and adolescents with mood disorders, she immersed herself in a 30-hour online training program in dialectical behavior therapy. “From this work experience, I’ve learned I’m a clinician, and that’s what I do best. I have spread myself too thin at times, experienced burnout at times and, some days, I’ve ended the day bone-tired,” Noffsinger says. “However, since 1993, I wake up every workday and, as Viktor Frankl would say, I know what my purpose is and [that] my life has meaning. Twenty-seven years later, I still love the counseling profession.”

What does it take to stay fresh, inspired and energized over the long haul of a counseling career? Counseling Today recently collected insights about career longevity from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

What has kept you energized across the years of your career? How have you avoided stagnation? Add your voice to the conversation by leaving a comment at the bottom of this article.

 

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In my 33rd year of private practice, I am grateful for a profession where we can work as long as we choose and our clients often see working with an older counselor as a good thing.

Compared with the early years of my practice, my clients have become a more diverse group. Half my clients are under 40. They come from a variety of ethnicities, races, religions and sexual orientations. My days are both busy and varied — what one client brings to therapy looks very different from the previous client or the next one. Along with continuing to work on my professional skills, maintaining cultural competence and relevance helps keep my professional life from becoming too routine. My clients challenge me to see life from fresh perspectives.

For more than 15 years, I’ve been part of a small peer supervision group. The group has been an enormous gift. We support and challenge each other and provide different points of view. As someone in a solo private practice, relationships with peers have helped me avoid feeling isolated or stale.

In talking with newer counselors — and in reflecting on my own development — I’ve often thought that counselors prioritize caring for clients over self-care. That’s hazardous. I’ve learned not to be endlessly accommodating of clients’ need to reschedule if that would overload my schedule and leave me exhausted. And I’ve learned to become comfortable with the business side of my practice.

As a young counselor, I knew I wanted a practice where my clients and I would make decisions about our work without interference from insurance providers. Choosing not to sit on insurance panels meant that my practice grew more slowly. In the early days, I worked part time for nonprofit [organizations] to make ends meet. Having a vision of how I wanted to work has allowed me to build a practice where I can earn a comfortable living while also maintaining reduced-fee spaces for limited-income clients.

Someone told me early in my career that the world doesn’t need any more “burned out do-gooders.” I have taken that advice to heart, and I’m grateful to my younger self for the faith, patience and commitment needed to build a professional life that sustains me while allowing me to be useful to my clients.

— John Ballew, a licensed professional counselor (LPC) with a solo private practice in Atlanta

 

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What an honor it is to have been providing counseling services for over 35 years. I may be simply lucky, but I’d like to think that the fact that I have never experienced burnout and am still in love with my profession has more to do with an intentional emphasis on taking care of my own mental health.

There are a number of intentional activities that have sustained my balance, hope and energy for the profession over three-and-a-half decades. The most potent of these might be to stay in my own lane. Regardless of the job I do, I recognize that others will do it differently and not comparatively. I’ve both supervised and provided counseling for other professionals who find their energy zapped, their attitudes hostile and their work disrupted due to a comparative evaluation of colleagues as either better or worse in some area of the job.

An early mentor of mine encouraged me to realize that what another [counselor] does — except in cases of gatekeeping — is none of my worry and that others might rise if they feel support and care. This has led me to celebrate my peers’ work, to be open to learning from them, and to generally feel positive about heading into the workplace in each of the venues [in which] I’ve been honored to work. The closest I’ve come to burnout involved colleagues who were unjustly negative. It’s truly an art to turn that around.

This leads me to the second most powerful agent of enthusiasm building: learning. I am a lifelong learner. I deeply value finding new theory, technique, strategy and skill and, even more, a deeper understanding and wisdom regarding the human condition. I just reread, along with one of my Gonzaga classes, [Viktor Frankl’s] Man’s Search for Meaning to jump-start our trek of discovery this semester.

This is related to a third factor: I mix up my work and the populations I serve. I teach, provide community prevention services, crisis intervention, group work, couples and family work, and individual counseling with as diverse a set of individuals as I can in my community. It’s never dull, I am never bored, and I am constantly learning more about each person and about humanity at large. I’m constantly reminded to advocate where needed but to not turn my attention to embitterment.

  Elisabeth Bennett, a professor at Gonzaga University who has had a counseling practice treating couples, families and individuals in Spokane, Washington, for 35 years

 

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Sixty years ago, with new graduate degree in hand, I was hired as a school counselor. My counseling career had begun. Over the years, it has taken different shapes as jobs, settings, responsibilities and functions changed. Then, 21 years ago, I gave up tenure, license, income and position to retire. From the beginning to the official end of my active career, I have been energized, shaped, nurtured and sustained by an intense fascination with people.

My graduate education, combined with my fascination, shaped the way I interacted with people when I wore the hat of counselor or educator. Focusing on how people communicate and relate as casual friends continues to hold my attention. In both my professional and personal life, I have worked to be aware of that fuzzy line that separates intense conversation from therapeutic response, and I have worked hard to respect boundaries — both for myself and for the person or persons in the other half of the communication.

Early in my graduate education, I was given the maxim: “Counselor, know thyself.” It has been a guiding principle. Throughout my active career, regional and national conferences fed me with new ideas, refined techniques, and gave me rewarding interactions with professional colleagues and friends. I have always tried to have a group to whom I felt some accountability and who could assist me in that self-knowledge arena. In retirement, I have a regular group of friends to keep me grounded but without the professional expectation.

In retirement, I increased my volunteer activities in noncounseling situations that still required that I be a listening, caring individual. As example, for several years I facilitated a group of caregivers who met to share the pain and stress accompanying that role. I was facilitator, not group therapist. It worked for them and for me and was richly rewarding.

There came a day when I realized that my hearing loss and my inability to keep all the details of a conversation in my mind were affecting my facilitation skill. I knew myself. And I knew that my performance fell short of my expectations. Knowing myself means knowing what to do; it also means knowing when to quit.

I have had a good professional life. The fascination with people that moved me into my career remains high. It continues to sustain me in retirement. I hope it will continue to do so.

  Brooke B. Collison, an emeritus professor of counselor education at Oregon State University and a fellow and past president (1987-1988) of ACA

 

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When I started my counseling training in 1990, I knew I wanted to pair expressive arts therapies with counseling. That has helped me build a long-term career. We artists recognize creation as a metaphoric marathon versus a sprint. The first draft of an art project does not have the rich depth of the final product.

Artists recognize that the path of producing a work of art — like an actual marathon in comparison to a sprint — travels a variety of landscapes such that the path often doubles back on itself. You revisit various aspects of each work of art and massage each aspect until each art piece feels completed.

Others, of course, have spoken of the art of counseling. I add to their words as I invite the dance of creation, which is different than a marathon or a sprint because creation involves movement that is more varied than running. When we are schooled, we are advised to do our own therapy, and that is key.

As we do the energetic dance of relationship with our clients, those dances will stir the dances we have shut down. Stephen Porges’ polyvagal theory and Peter Levine’s understanding of trauma patterning help us recognize the burst of intense feeling that awakens moves that have been mired in shutdown.

When we lose interest in expanding our movement repertoire because we sense an intense awakening, we may push ourselves to work robotically and eventually burn out. When we risk the drama, we awaken a presence that brightens our time with our grandchildren [and] helps us appreciate the journeys of our adult kids and those of our lovers. Finding presence allows us to pause to snuggle with our cats and walk our dogs around the block.

  Dee Wagner, an LPC and board-certified dance therapist at The Link Counseling Center in Atlanta for 26 years

 

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What does it take to sustain a counselor over the long haul of a professional career?

For me, it has taken a lot of work on myself and paying attention to my needs outside of the counseling chair. If I have put my mask on first for oxygen, I am much more able to help others with theirs. When I haven’t done so, I struggle more, I stagnate more, and I find myself more frustrated. I also have truly come to believe that everything you ask a client to do, you better have done yourself. Whether that’s a sand tray therapy exercise, an expressive art technique, thought stopping, or getting to the gym, you have to do the work too.

What has kept you passionate?

There are two things that have really kept me passionate. First, every kid and family I have worked with and their willingness to show me their world and be vulnerable. This inspires me each day, and I try not to forget it. Second, supervising counselors-in-training, seeing them wade through this wonderful process, and being a part of their professional journey.

What are some lessons you’ve learned?

I think the biggest lesson I have learned so far is that I really feel like I know less and less each day. What I mean by that is I have learned to trust the process and pay attention to when I am trying too hard. When I first started practicing, I had no idea what this phrase “trust the process” meant. Now, I can feel it, see it, and have really come to appreciate it.

What does it take to stay fresh, day in, day out, and avoid stagnation?

Kids in the playroom always keep things exciting. Moreover, I try to remember that counseling is difficult for people, and I will never be doing them a service by merely making them feel good about themselves. Care is only shown in the tough stuff. Remembering that it is an honor and privilege to do this work always pulls me out of a jam in my own headspace.

  Quinn K. Smelser, an LPC, registered play therapist and doctoral candidate in counseling at George Washington University who has specialized in play therapy and trauma training. She is also a clinical instructor at Loyola University Maryland, where she teaches school counseling students and will soon offer play therapy courses.

 

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When you’re at the beginning of your career is probably when you have the most stamina. You’re excited, you’re pumped, and you have great ideas. You’ve spent years and years learning and deciding on what you’ll do, and you’ve been dreaming about the day when you’re finally there. You get the career, and the hardest part in the beginning is [that] you still have to learn some more. You must master the specifics about your colleagues, your location and your administration. More importantly, you have to learn what you’re capable of. The first few years is more learning, and you need the patience to dedicate the time to observe. Whenever a race is started, we all fight the instinct to jump out of the gate, but you need patience and persistence if your goal is long term.

As you’re learning the career and carefully collecting knowledge, it’s important to build up your reputation, also known as your street credibility or “street cred.” You build up your reputation by showing up, being reliable and completing tasks. Be careful not to overcommit because if you miss deadlines or turn in inferior work, that becomes your reputation. The learning years help you figure out what that perfect balance will be — how much you can handle, what you can complete quickly, and what requires more effort and dedication on your part.

Once you have a good reputation and you’ve figured out the key players, you build up your crew, your squad, your allies, etc. Finding this group will help you brainstorm when you’re stuck, vent when you’re fed up and considering quitting, and inspire you to keep going. How do you meet these amazing people? Professional organizations. Attending conferences, meeting like-minded professionals and joining committees is where you’ll find these treasures. Stay in touch, and make the effort to stay involved with each other in between conferences. Having good people in your inner circle is worth their weight in gold.

Lastly, create healthy boundaries. We are not only our careers. We are family members, we are artists, we enjoy hobbies, and we’re involved in our communities in different capacities. Make sure you are getting fulfilled in all areas of your life, and dedicate time to all the things that matter. Practice makes perfect, and you will find out the equations and quantities that work best for you.

  Margarita Martinez, an academic success counselor and curriculum chair for student development at Northern Virginia Community College who also serves as vice president for Latinx concerns for the Association for Multicultural Counseling and Development (AMCD), as secretary of the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling

 

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The person of the counselor is one of the most important elements in the counseling office. Participating in one’s own counseling, then, is crucially important. Creating a space to address one’s own past hurts and current relational self makes a counselor more able to see and to have compassion for themselves and for those sitting across from them.

When I participate in my own counseling, it helps me to remember what it is like to sit in the waiting room, in that awkward space of waiting, with ambivalence and yet longing to be seen. It helps me to remember the anxiety over what to say or how to answer a difficult question. But most importantly, tending to my own ongoing healing creates a generativity in me for this work. It produces more space within me to care for others in deep and authentic ways.

Also, we must continue to cultivate our own interests. This year I have been on a growth edge, learning how the feminine body holds stories in its fiber and its tissues. I have found a renewed sense of excitement as I learn. Learning can be fun, and it can also be restorative. Such learning, then, has a direct impact in the counseling room. When I am excited and growing, my work with others is much more fluid and energetic.

In addition to the above, gathering a good community of people around oneself bodes well for long-term health. Health is found in belonging. Counseling is often isolating, and it can be an easy place to hide. Such hiding and isolation are the stuff of guilt and shame and not of health and healing. Because of such potential workplace hazards, I have a consult group of friends and colleagues whom I respect. They are people who push deep into my life and into my work. They are people who challenge me and know my inner world. I would not be able to do the work I do without having these people — and others like them — in my life, caring for and loving on me, in my goodness but also in my messiness. Honesty with my consult group turns into honesty in my counseling office, all the while keeping me grounded in remembrance of how hard it is to be vulnerable.

  Laura Wade Shirley, a wife, mother of three, licensed mental health counselor (LMHC) and teacher in Washington state. She worked with children and families in community mental health for three years, prior to opening a private practice in 2003. Since 2006, she has also taught and supervised students at the Seattle School of Theology & Psychology in practicum and case conference classes.

 

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When I reflect on lessons learned to sustain my counseling career, two thoughts come to mind. The first is accepting who I am and who I am not. The second is the importance of a peer group whom I can be completely vulnerable with.

We often talk to our clients about being true to themselves. Previously, I was comparing myself to other counselors, which is not mentally healthy. I saw other counselors were receiving the most up-to-date training in their niche areas, and I wondered if I was doing enough. However, in checking in with myself, I was setting myself up for burnout. Comparing myself or going for training because I see others doing so, not because it is my area of specialization, is not what is going to sustain me for the long haul. However, I also know the importance of avoiding stagnation. It is then that I realized I need to attend my own training to keep my clinical skills sharp, while focusing on pursing additional training in my own area of focus. One cannot be an expert in everything. I had to be true to myself, just as we ask of our clients.

The second realization I had is how invaluable a group of peers is who will listen and not judge. In Irvin Yalom’s book Becoming Myself, he discusses a peer group he met with where they could talk about anything that might be impacting their practice while [still] respecting client privacy. This could range from personal problems to countertransference. While I am an advocate of counselors attending their own counseling as needed, I have also found my group of peers — whom I know I can have honest discussions with about myself, or them with me — to be the primary source of keeping me fresh and available, day in, day out, to my clients. Having peers who are available and nonjudgmental is fundamental.

Having a solid identity as a clinician and knowing who my people are, are major factors in not only sustaining my career but maintaining my inspiration and motivation.

  Deanna Johnston, an LPC who owns a private practice in College Station, Texas

 

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When I think about [career] sustainability, I think about feeling appreciated and respected by my immediate supervisor and included by my colleagues with whom I have a trusting and supportive environment. And, of course, I need to feel compensated for my work and feel that I am valued by the institution in terms of my pay. With those things in place, I’ve always felt that I can tackle the tasks at hand and be creative. That being said, I have enjoyed collaborating with colleagues, early career professionals and students at all levels — undergraduate, master’s and doctoral.

This is how I would define workplace sustainability and job satisfaction. These are my most critical factors in remaining in a career for the long haul. This has been especially true for people of color and members of other marginalized groups. Research findings have suggested that we are far too often not supported by our peers nor by our supervisors and, as a result, we become targets of workplace bullying and implicit bias. This has led to the exodus of many talented counselors [and] counselor educators who are pushed out of promising careers.

What keeps me passionate about the work are, by far, my mentoring experiences. In every position that I’ve held, I have tried to pass on my knowledge about leadership, research, teaching and relationship-building. It has been a tremendous pleasure to see my former students acquire jobs and begin mentoring others. I feel content knowing that there is another generation of counselor educators and practitioners who have embraced the ideals that I have shared and wish to pass on these ways of being to others. I am thrilled to see how they have owned and advanced my research and teaching philosophy. And I am constantly challenged by new ideas and beliefs that they hold.

My most important lesson learned is that I am only a cog in a wheel. I have contributed to the profession to the best of my ability, but my ultimate goal is to be replaced by more energetic and passionate early career scholars and practitioners. I love to stay, but I’ll love to go even more. Generativity is a good thing.

  Cirecie A. West-Olatunji, a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana. She is also editor of the Journal of Multicultural Counseling and Development and a past president of both ACA (2013-2014) and AMCD.

 

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There are many things that I have worked on in order to prevent burning out. One of the main factors in preventing burnout has been maintaining strong boundaries when it comes to my family. It is necessary for me to put my family first and not allow my work to overshadow them. The first thing I did after establishing my LLC [limited liability company counseling practice] was to purchase a separate phone so that I could shut it off when necessary. I do not take on more clients or supervisees than my schedule can handle, and I have learned to say “no.” This can be challenging when, as counselors, we just want to be there for everyone.

What has kept me passionate? Clients. Listening to, processing and being a part of clients’ stories gives me life. There have been times in my career when I was not seeing clients due to school or pregnancy. When I stepped back into the counseling space, I was renewed and reminded of what I love about being a counselor. I have also found that working with students and young professionals has been rejuvenating. I can recall being in their shoes. Assisting them on their journey to become a counselor is immensely rewarding.

A valuable lesson that I have learned is to live each moment of your process rather than completing things simply to check boxes. I did that, to a degree, early on in my training and career. I have since learned the importance of growing with each experience and not for a moment thinking that I have it all figured out. Continuing to learn from my peers, my clients and my mentors is a process I will never outgrow.

Education and learning have always been central in my life. Staying interested in what is new or on the horizon helps me to avoid stagnation as a clinician and supervisor. I can always try something new — or even something old in a new way. Working with populations that I love and feeling that I am helping others in some small way allow me to continue without feeling my work is mundane.

Clients and supervisees will never cease to amaze me with their stories, their strength and their resilience. I feel honored to be able to be a small part of their story.

  Christina McGrath Fair, an LMHC at GentleWave Counseling, Consultation and Clinical Supervision in Stuart, Florida

 

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The challenge to remain fresh depends greatly on my ability to effectively manage my time. Revelations surrounding my career — sex therapy — are an everyday occurrence, with issues ranging from sex education [and] advocacy [to] societal influences and legislation. My task is to discern how much time and energy are placed on the given subject. One day, a legislative bill threatens the rights of sexual minorities; the next day, multicultural interventions for the trans community are explored.

Human sexuality is so fluid, any staleness on my part would deem me an ineffective counselor. I often choose topics [to explore] that I am unfamiliar with or that are highly controversial. The opportunities to stay fresh on things relevant to sexuality are ubiquitous. It is just a matter of allocating the appropriate time to the appropriate issue.

I truly believe that I embarked on my counseling career decades ago, although I have been seeing clients for [only] two years. A long-term counseling career is synonymous with a long-term parenting career or long-term partner career. Counseling, similar to parenting and partnering, is innately what I do and have done for years. The particulars — CEUs, licensure, certifications, etc. — are the extenuating factors, but I have been educating, advocating, learning and counseling for years.

For me, building a long-term counseling career comes as natural as breathing. The less organic aspect is establishing a business based on my counseling career. Fortunately, my awesome support system and deep respect for entrepreneurship allow me to feel optimistic and excited about building a business around my career as a sex therapist.

Sustaining my motivation or passion for sex therapy is relatively easy. I don’t have to plan for it or think about it. When I awake in the morning, I’m reminded of the importance of intimacy and communication with my partner. As I interact with my daughters every morning, I’m reminded of the importance of sex-positive messages that occur throughout their formative years, particularly as they develop their sexual identities. When I talk or listen to people about their insecurities or their level of dissonance, I’m reminded of how misinformation, society, trauma and self-perceptions can adversely alter the trajectory of a beautiful soul.

There is no plan or preemptive thought of how to stay motivated. Life is gracious enough to constantly remind me that people deserve to exist without the harsh barriers that impede sexual wellness.

  Cheryl D. Walker, a sex therapist and associate professional counselor in private practice in Atlanta

 

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The climb to a successful career as a licensed mental health counselor has been both challenging and satisfying.

As a middle-aged woman returning to higher education, this was my first challenge as I struggled just with that decision. Did I really want to dive in, and would I be ready for the rigor of learning? Would I do well with the time and expense commitment? Would my children and husband be supportive … and was it truly OK to be self-full? I knew it was now or never as the clock ticked on.

I know now it was the right timing and decision. I know appreciating the classroom learning, possibly for the first time in my life, was a huge benefit because I could fully direct my focus without the distractions of starting and caring for a young family.

No sugarcoating here: Working in agencies was truly brutal from a systems perspective. I took some solid lumps by inadvertently stepping on management toes. The challenge of working with clients, while most important, became second to fulfilling the job requirement of productivity. I remain very grateful to have survived the mill-type atmosphere of clients in and out. I gained such amazing clinical experience and somehow managed to be regarded as a good counselor professionally. I would encourage people going through this portion of the climb to connect with counselors, co-workers and physicians with whom they feel commonality because they will be your future collaborators and colleagues in private practice or agency [work].

What sustained me was keeping my focus on my professional goal to be a licensed counselor and eventually to own my private practice. I look back and realize I was strong even when I felt inadequate or resource-less. I’ve learned these feelings are transient and never fixed, so I trust the journey.

Seeking your professional “peeps” in regular monthly meetings that you commit to in your schedule is golden and leads to the gifts of shared respect, as well as referral pools for your — and their — clients.

I’ve learned to value what I still need to learn, [including] aspects of private practice not covered in my education or practical work and the business end of owning a business. [I recommend that counselors] hire out what you don’t know or aren’t great at until you learn it yourself. Also, keep up with learning new theories because the freshness of exploring interesting trainings [will] always complement what you know so well already. My practice is eclectic because I enjoy variety, and it has been truly exciting.

The best advice I can give now that I’ve been self-employed for a while is to allow yourself regular self-care with vacations or staycations filled with calm, fun and levity. The balance is needed, not at all a luxury.

  Lena Kieliszak, an LMHC in private practice in Rochester, New York

 

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We all sing the songs we need to hear. By trade, I am a counselor educator and a counselor whose practice is made up largely of clients who are serving in helping, healing or ministry positions. Really, in many ways, my clients are people just like me.

So, what’s your song? Kindness? Self-compassion? Tending to empty thought patterns? Engaging in better self-care? It is our humanity that frees and guides us in our work with others. It is our humanity that breeds care and compassion, the hallmarks of neural/psychological/interpersonal integration, per Dan Siegel. Because I am human, I have needs and wants, not all of which get met. I know what it means to suffer. I know what it means to experience pain and to wish for ways to relieve it or deny it. I know what it’s like to find myself returning to unhelpful patterns of thinking and acting, time and time again. Because I am human, I have a song to sing.

I hope it can be said that I am far more human than I was when I first started this work 20 years ago. If we are all on a journey of becoming who we already are, then engaging with the work of others has offered me tender moments of being mirrored in my own humanity. The reality is that I need connection just as much as my clients do. Our profession has nomenclature — countertransference, getting triggered or activated, projection, collusion, etc. — that can tend to pathologize the humanness of the encounters we may experience with those who sit across from us. But part of the rich delight in doing this work — and part of what has allowed me to log 20 years at it and to be ready for another 20 more — is that I get to hear myself say things that I need to hear as much as my clients [need to hear them]. The frame of counseling and the counseling relationship holds not just my clients, but me too.

For me, what’s most sustaining is what inevitably comes when I am full and receptive: [being] open to hearing, in whatever form and from whatever voice possible, the song I need to hear. My humanity, my work and my longevity in the field all depend on it.

  Doug Shirley, an LMHC with a private practice in the Seattle area and assistant professor of counseling at the Seattle School of Theology & Psychology

 

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Early in my career as a professional counselor, I began to see that stepping into the world of [my] clients on a regular basis with my full attention and whole heart could leave me depleted and carrying concern for these clients long after the sessions were over. In response, I took care of myself by journaling, drawing and painting to allow space for my mind to simply be and to process my experiences. I began to set boundaries to remind myself when I could just be “Adele,” take care of my own needs, and engage in living life to the fullest.

There were times I took a break from the counseling field and worked in other similar people-oriented fields, but I missed that deep personal meaning from the counseling experience. So, I sought variety in the positions or environments in which I could engage in this role rather than stepping out of it completely. Through time, I also found a wider range of ways to express myself and release tension, stress or worry, such as running, taking drawing classes and enjoying acupuncture or massage.

Later, I invigorated my therapeutic approach by becoming trained in using sand tray therapy to bring clients’ experiences to life in ways they could not simply tell me. Seeing the power of clients exploring their experiences in the sand and seeing their issues in a new way was so exciting. Most recently, I became certified in yoga to apply the powerful healing effects of mindfulness, meditation and release of tension. Invigorating my counseling practice by attending more specialized workshops allowed me to draw upon new methods and delivery of a range of treatment strategies that are impactful, effective and, at times, even fun.

Compassion fatigue from the demands of this role can take its toll on counselors. During my doctoral studies on this topic, I uncovered that counselors continually engage in empathy but may not find ways to close the deep concern needed to draw upon empathy. This was a real “aha!” moment for me. No supervisor had ever quite framed it for me this way. So, I developed ways to extend client empathy with purpose but then to step back out of it with clear intention.

Focusing on growing, being curious, and engaging in self-care has helped me to stay buoyant while navigating these powerful and deeply fulfilling experiences over the past 25 years.

  Adele Logan O’Keefe, an LPC and owner/director of Sage Counseling & Wellness in Lexington, Virginia

 

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I have managed my own private practice since 2006, and maintaining meaning and engagement has been a purposeful and intentional goal. I enjoy the marketing aspect of being a business owner, and I have made it a priority to stay current with technology and move into areas that do not come naturally to me, such as blogging and social media.

Thanks to Twitter, I follow meaningful cultural shifts worldwide. I listen to radio stations and podcasts with differing political views, as well as trending corporate leadership. Our mental health care reach is limitless, with DIY videos on YouTube, numerous virtual specialty groups on Facebook, and compelling personal disclosure at the hands of terrific authors with diverse backgrounds. I enjoy reading the Stoics as well as firsthand accounts of military culture from Navy SEALs [and of] high-achieving athletes — true psychological warriors reminding me to be the best version of myself.

It is healthy and appropriate to recognize my own areas of expertise and competence (therapists can be ambitious and confident too). As I learn my strengths and feel confident in that footing, I am more comfortable admitting to areas that need more growth and insight.

I so appreciate colleagues who have become friends. We chat often, consult, meet for walks and coffee. This is integral to my well-being and mental health. Private practice is a lonely proposition, and no one should go it alone.

I recently organized an open house for my office building. It was a true hodgepodge of small business owners with the primary goal to provide public awareness. The secondary gain was cross-referred business and a budding community.

An annual live continuing education training is always beneficial, and preferably not in my own backyard. Most recently, I drove an hour away, checked into a hotel and ordered room service (an act of self-care). The next day brought new friends and colleagues.

I encourage fresh ideas and the continued advancement of our field, such as Silicon Valley’s tech money currently being invested in psychedelic research.

My daily unwind is a meditative, 1,000-piece puzzle in the evenings. If my family feels like chatting, they can find me there. A completed puzzle gives me a sense of accomplishment. Every piece found its niche and is perfect in the end.

  Christina Neumeyer, a licensed marriage and family therapist in Carlsbad, California

 

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My identity as a professional counselor has grown in importance to me over the years as I’ve come to witness and experience the extraordinary need for our work and the positive impact we can make for individuals, families and communities. Witnessing growth, change and increased well-being with clients has been a sustaining factor in my ability to stay fresh, passionate and engaged during my career. Also, the ability to shift my focus from being a school-based counselor to becoming a health educator/coach while using my skill set and strong commitment to wellness has fed my ability to sustain. Becoming more involved in cross-cultural trainings as a trainee and then facilitator has been integral these past few years to actively address injustices and inequitable situations that clients suffer from. I feel strongly compelled to do this work as our world becomes more challenging to live within for so many people.

Keeping myself well so that I may do this work includes intentionally eating healthfully, physically moving my body in ways I joyfully anticipate regularly, drinking lots of water, getting adequate sleep and rest, receiving supportive supervision and personal counseling, and pursuing my pleasures as often as possible (time with family and friends, reading, traveling, and playing with my kitten, Daisy).

I never want to leave the profession because it is a part of me. I think I will always want to do this work in some capacity for at least a bit of time as I age.

Knowing what I know now, I could give this advice to myself at the beginning of my career: “Relax! You’ve got this. You are well-suited to share love and support with those you encounter. Take care of yourself as well as you encourage others to do for themselves.”

  Julie Bloomfield, an LPC and health educator and coach at Henry Ford Allegiance Health in Jackson, Michigan

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Can you hear me now? Ways to reduce sound transfer between rooms

By “Doc Warren” Corson III February 24, 2020

Many of us who own or work in a counseling office have been there: We do everything we can to make sure that our client’s personal information is safe and secure. We train staff on confidentiality, buy expensive cabinets to house client charts and related documentation, and may even have an electronic medical records system so that we are compliant with all privacy laws. But then, sitting in our office, we notice that we can practically hear the heartbeat of the clinician in the office next door. How can we maintain privacy for our clients if the sound transfer is so bad?

If you are building or remodeling, there are many things that you can do, and we will explore some of those ideas in a bit. But what if you already have an office and cannot afford or are not allowed a full remodel? Fear not, there are a few things you can do to reduce sound transfer without breaking the bank. The best part is that most of them are easily undone should you leave your current digs.

Ideas to reduce sound transfer in offices that can’t be remodeled

  • White noise machine or a radio: Placing a white noise machine or a radio in waiting areas will help reduce the ability of others to hear what is being said in your office. These items can be placed in the counseling office themselves if needed, depending on the level of sound transfer.
  • Rugs: If you cannot do wall-to-wall carpeting, then throw rugs can help absorb noise. A thick rug is best, but be sure to consider tripping hazards and client mobility. Wheel chairs, canes and walkers do well on flat surfaces, whereas shag or fuzzy rugs can impact mobility, so give it some thought prior to purchasing.
  • Seating layout: Do not face seating directly toward the door because this will direct sound to the door opening, which is the most vulnerable spot in most offices. Instead, have the seating face a wall so that the sound carries toward the walls rather than toward door openings. This will help reduce the amount of sound transfer from vulnerable door area gaps. This is especially key should you have a hollow core door.
  • Fabric placements: Drapes or wall hangings can help absorb sound and reduce transfer. Also add pillows to furniture — the more the better, so long as they do not get in the way.
  • Drop ceilings: If your office has drop ceilings, you can put insulation above the ceiling tiles to help reduce sound transfer.
  • Wait times: One way to reduce the chances of people hearing what is happening in the clinical office is simple and free: Stagger the times of sessions so that one session is likely to be over before the next client arrives. This works regardless of the number of offices and requires just a bit of coordination.

 

Building or redesigning offices with sound in mind

You might rent or lease a building that allows you to build an office to suit your needs. In certain cases, the building owner may even assume some or all of the costs. In other cases, you will own the building and have the ability to remodel as you desire, so long as you follow building codes and secure the proper permits. Whether you are doing the work yourself or will simply supervise the project, here are some things to keep in mind to reduce sound transfer and increase overall privacy.

  • Acoustical substitutes for wallboard: In some areas, it may be beneficial to not use traditional wallboard (Sheetrock) and instead to use one of the specialty acoustical boards on the market. Each offers superior sound deadening, but they can be expensive (five to 10 times the material cost of traditional wallboard). In all of the offices that I have transformed, we opted to use these products once, on one very sensitive wall.
  • Acoustical putties, sealers, etc.: Often used with the substitute board, acoustical putty is used to seal around any cutouts in the board such as outlets, light fixtures, etc. The sealer goes on all wall studs and any surface with which the wallboard will come into contact. It cuts down on sound transfer. I have used this only in the most problematic areas where I used acoustical wallboard.
  • Solid core doors: Although they are more expensive than hollow core doors, solid core doors offer more sound deadening/sound deflection. Some solid core doors are made of solid wood, whereas others offer a composite interior that is designed to block more sound. The choice is yours because both have much to offer. Should your office be very problematic, doors designed to block sound are the way to go. In recent remodels, we have chosen to install prehung exterior doors that come with weatherstripping for our offices. While they are designed to keep air out, they also offer superior sound deadening compared with general interior doors that are on the market, and yet they cost about the same as a good quality interior door.
  • Wall-to-wall carpeting: Hard wood or other hard surface floors are beautiful and can last a lifetime compared with wall-to-wall carpeting, but carpeting does more to absorb sound than hard surfaces can.
  • Sound-deadening insulation: If the walls have not yet been built or are going to be opened up, sound-deadening insulation is a must. Materials for an average-size office will cost hundreds of dollars but will also offer some of the most effective sound deadening. When framing new walls, building codes may allow for 24-inch spacing of the wall studs. However, it is often far more cost-effective to stick with 16-inch-on-center setup, meaning that every wall stud is installed 16 inches apart from the one next to it if measured from the center of the stud. This is the most commonly used spacing for walls that are being insulated. As such, the cost of the insulation for 16 inch is far cheaper.

It is important to remember to do all walls, including the interior walls, to have effective sound deadening in the office. Whenever possible, also ad sound-deadening insulation in the ceilings and floors.

  • Doorway placement: Doorways can be one of the biggest sources of sound transfer. If you have the option, avoid having office doors open directly into waiting areas. Instead, try to have a hallway between so that any sound that may escape does not go directly into the waiting area. If this is not possible, see the earlier suggestions for seating layout and white noise machines.
  • Avoid trendy: More and more old buildings are being converted from factories into office spaces. These areas are often beautifully urban and ultra-trendy. One of the biggest drawbacks to these spaces, however, is the trend to build the walls only 8 feet tall even though the ceilings may be 14 to 20 feet.

Our current office was once designed to look like a barn, so some of the space once had two-and-a-half-story-tall walls. Instead of open air at 8 feet, we added a ceiling. It helped prevent sound transfer and also added 1,600 square feet of additional office space on the new floor above.

Failing to close the overhead area tends to give you a glorified cubicle because the gap between the walls and the ceiling allows for sound to move freely. In a sense, these spaces are even worse than cubicles sound wise because cubicles often have soft materials on their walls to help absorb sound. Some even come with doors and ceilings for added privacy. No sound machine, carpet or other items can overcome several feet of open space (unless the noise machine is set very loud, and that would also affect the session space).

Should your space have very tall ceilings, spend the money to bring the walls up to meet them, or have a lower ceiling built on top of the walls.

  • Supervise the build: Some of us will tackle all or most of these jobs ourselves and do well. Many of us, however, lack the time or ability to take on some of these tasks. Should you hire all or some of the work out to contractors, do not be shy about making your requirements and desires known. Go out to the job site and supervise every aspect of the build. Make sure that sound-deadening insulation is used in every area (there are many brands with various levels of deadening, so be sure that the right one is used for your project).

Sometimes, a busy crew might neglect some of the cavities that require custom cuts to the insulation. Other times, they may honestly forget to install something that you ordered. Whatever the case, having you there with the plans can help ensure that the build goes as desired. Remember that in most cases, a mistake is just that — so present it to the contractors in a polite manner, without accusation. Whenever possible, find a contractor with experience in sound abatement because that should increase the likelihood of the process going smoothly.

Sound transfer remains a large issue for many offices, whether for-profit or nonprofit. With a bit of research and planning, much can be done. A little elbow grease and some creativity can take you far.

 

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“Doc Warren” Corson III is a counselor, educator and writer, and the founder, developer, and clinical and executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He is certified as a counselor and counsellor supervisor in the United States and Canada. Contact him at docwarren@docwarren.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Billing guilt

By Gregory K. Moffatt February 18, 2020

I am a very poor bookkeeper. I will admit that up front. I am capable, but I just don’t enjoy managing the finances of my clinical setting. Perhaps more importantly, for many years I felt guilty about charging my private practice clients.

Therefore, I was hesitant to mention overdue balances or to expect payment from my clients at the time of service. It just felt awkward. If clients didn’t pay their bills, I often would let their accounts slide into history and eventually ended up closing their files with an amount due in the ledger.

Then one day, many years into my practice, I got some new accounting software and decided to clean up my old books. For no reason other than curiosity, I went back through all my overdue accounts and was stunned. The total owed by overdue clients was in the thousands of dollars.

Granted, this was over a long period of time — more than 10 years — but those individual accounts that I let slide had added up. I could have bought a new car with that money. Fortunately, my private practice was not my primary source of income. Otherwise, I very likely would have been operating in the red.

It is uncomfortable asking for payment, but this seems to be true only for counselors. Can you think of any other service in which the vendor is hesitant about asking for payment? I can’t. Whether they are plumbers, mechanics, dentists, morticians or babysitters, people get paid for providing a service.

Nearly all of my new counselors, interns and supervisees express some hesitation about charging clients. One experienced counselor, in fact, asked me to look over her revamped informed consent. Her fees were clearly listed.

“You aren’t charging enough,” I told her.

“Really?” she said sheepishly. “I don’t want to be greedy.”

I asked her what her time, education and experience were worth. She had two degrees, was fully licensed both as a professional counselor and as a marriage and family therapist, and had several years of practice under her belt. Yet her fees were the same as when she was still in supervision.

I asked, “Are you providing a service that has value to your clients?” Of course, she said yes.

“Then there is nothing wrong with being paid what you are worth, at least within the market standards.”

She decided to raise her rate — and she deserved the higher fees. She also saw no change in her client base. In other words, none of her clients questioned paying a rate consistent with the standard in the field. As it should be.

One of my colleagues who has run a successful private practice for many years taught me something on this topic. She had a basket in her waiting area with a sign: “Check goes in the basket before you come back” (to the therapy room).

These days, her sign probably says something like, “Payment on my cash app must come through before therapy starts.” I don’t know. But the point is that she set an expectation for payment that was reasonable and clear, and people lived up to her expectations.

Even though my informed consent said payment was due at the time of service, I wasn’t clear about what my expectations for my clients were. My practice demonstrated vague expectations, so my clients back then lived down to them.

I completely understand why we feel guilty about charging as professional counselors. After all, we are helpers, not mercenaries. But few things in life are free.

If a client balks at my fee, I’m happy to provide referrals. I’m also very generous with pro bono hours — as are most therapists. But I no longer feel any guilt about charging my clients or my supervisees. I’ve invested in my career, it costs me money to run my practice, and I’m good at what I do.

“How much is your marriage worth to you?” I asked one potential client who hesitated at starting marriage counseling. (Sometimes I asked, “How much does a divorce cost?” That usually put things in perspective.)

“I guess it is worth $150 an hour,” he said, referring to the fee his therapist was charging. And it was worth it for the therapist too. She used her expertise to help heal a damaged relationship just as a physician might use medication or surgery to help the body heal.

Regardless of whether you have a sliding scale or a fixed rate, accept third-party payments or are cash only, you are providing a service. You spent time, money and energy developing and maintaining your expertise. You deserve to be compensated.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Hey, Siri: Did you break confidentiality, or did I?

By Nicole M. Arcuri Sanders January 14, 2020

Did you know that your tech devices have the potential to break your clients’ confidentiality just by being in the counseling setting with you? Imagine that you have worked a full day seeing an array of clients for the various concerns they are facing. Then, at the end of the day, you snuggle up on the couch and scroll through your phone’s applications. You notice numerous ads and suggestions that relate to the topics clients have shared. For instance, imagine a client sharing about a traumatic event that happened in the Catskills, and now you have Airbnb suggestions for that area, along with resources for dealing with sexual abuse.

You may be wondering, “How did that happen? Was my phone listening to our session?” The answer might be yes.

In other cases, you might not be made aware that your phone was listening, but it is important to know that it has that capability. The reason for this is the voice assistant technology on your devices. While on, these devices are constantly listening. For instance, Apple iPhone is listening for the word “Siri”; anything said after that is considered a command. The same is true with Amazon’s voice assistant Alexa and with Google Assistant. Each of these devices is waiting for its name to be called so that it can follow up with whatever assistance the person using it desires.

However, it has been found that the devices sometimes mistake certain words and are activated unintentionally.

This past July, The Guardian newspaper shared shocking reports from an Apple contractor. This whistleblower reported that Apple contractors “regularly hear confidential medical information, drug deals, and recordings of couples having sex, as part of [Apple contractors’] job providing quality control.” These workers are tasked with listening to grade the responses of the company’s Siri voice assistant. For example, the workers will grade if the response from Siri was accidental or deliberate and if Siri’s response was appropriate.

But what does this mean for professional counselors? Just think invasion of privacy and breach of confidentiality concerns.

Voice assistant concerns in the counseling setting

This next section is going to present a hypothetical counseling office to address some of the confidentiality concerns that surround the counseling experience with technological voice assistants. Consider whether you address these concerns in your informed consent with clients. Would these occurrences align with Health Insurance Portability and Accountability Act (HIPAA) regulations?

Waiting room: Counselors strive to create a warm and inviting setting to foster a comfortable feeling for clients because they are in a vulnerable situation. Perhaps some relaxing music is playing in the waiting room. Consider Alexa being programed to shuffle through various playlists of calming songs throughout the day.

As clients await their sessions or end their sessions, they may need to discuss billing with the front-desk assistant or call their insurance companies. Clients may even take a call during this time for other purposes. Alexa hears all of these conversations throughout the day. Therefore, the potential is there for the entrance to this “safe place” for clients to instead become a place where personal information is leaked to Alexa and to those who monitor Alexa or have access to Alexa’s recordings.

Additionally, clients may not even realize that while they are in your office discussing billing, diagnosis, and plans moving forward, their smartphone’s voice assistant can be eavesdropping as well. The same goes for all of the other smartphones located in the waiting room, including those being used by personnel working the front desk.

In session: When clients and counselors meet in an office, safety is a concern. Therefore, counselors may choose to keep their phones in their pocket or nearby in case they need to call for help. Some sites may even have a policy requesting that counselors have their cellphones on them at all times. However, now these phones’ voice assistants can have access to the dialogue that occurs within the room. This also means that whoever is monitoring the voice assistants have access. What was intended to be a safe place for clients to navigate and process concerns is now compromised.

Can you imagine if you, as the counselor, were facilitating a group and each client had a smartphone with a voice assistant? Consider also if you take notes on an iPad that has voice assistant technology. As counselors, we understand there are some limits to confidentiality. However, these voice assistant technologies have the capability to leak what clients and counselors once believed to be confidential information.

 

Disconnect: Don’t be considered liable

A number of considerations need to be taken into account by both the counselor and the client regarding confidentiality of sessions when voice assistant technologies are present. First and foremost, this issue should be addressed. Now that you are aware of the implications for your practice, you are ethically responsible for addressing these possibilities with your clients.

According to the 2014 ACA Code of Ethics, clients have the right to confidentiality and an explanation of it limits (Standard A.2.b.). Understanding these limits, clients have the right to make an informed decision regarding whether they would like to participate in counseling services with you (Standard A.2.a.).

Therefore, if you choose to utilize voice assistant technologies, you need to inform clients of the benefits and risks prior to them beginning counseling services. This explanation is not limited only to the counselor using these technologies but also acknowledging whether the counseling site allows its staff or clients to use them. If your site chooses not to utilize voice assistant technologies, you will need to address what your protocol is concerning this matter. For instance, will all cellphones be turned off? How will this be regulated?

What if your site requires cellphones for safety concerns or if clients are not willing to turn their phones off? How can you still protect client confidentiality and be in alignment with HIPAA regulations? The simple answer is to turn off your voice assistant technologies. You might consider noting the confidentiality risks in your informed consent and then sharing some of the directions noted below for how to disable these technologies.

 

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For iPhones and iPads, to turn off Siri, complete the following directions:

1) Open your settings.

2) Click Siri and Search.

3) Toggle OFF, listen for “Hey Siri.”

4) Toggle OFF, Press Home (or side button) for Siri.

5) Toggle OFF, allow Siri when locked.

 

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To turn off “Hey/OK Google,” complete the following directions:

1) Open your settings.

2) Under Google Assistant, tap Settings again.

3) Under Devices, tap Phone.

4) Turn OFF Access with Voice Match/Assistant.

 

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To turn off Amazon Alexa, complete the following directions:

1) Open your settings.

2) Select Alexa Privacy.

3) Tap Manage How Your Data Improves Alexa.

4) Turn “Help Improve Amazon Services and Develop New Features” OFF by tapping the switch.

5) Confirm your decision.

 

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These steps can provide clients with a choice while also informing them of the risks of their choices. In group counseling, however, as a safeguard to clients’ confidentiality, I would recommend not allowing any client to keep their cellphones, iPads or any other voice assistant technologies on.

Because these devices may travel with us basically everywhere we go, our conversations are being monitored for product improvements, but in the process, our confidentiality is being breached. Currently, with some simple options for turning off these technologies, clients can continue to maintain the level of confidentiality to which they originally thought they were agreeing.

As counselors, we take many safeguards to protect our clients’ confidentiality. I encourage you to toggle off your voice assistant technology options to keep your devices from being the reason you are held liable for breaking confidentiality. Moving forward, as technologies continue to transform, we as counselors need to be ready to address implications in the counseling setting.

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Nicole M. Arcuri Sanders is a licensed professional counselor, national certified counselors, approved clinical supervisor, and core faculty at Capella University within the School of Counseling and Human Services. Contact her at Nicole.ArcuriSanders@capella.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Establishing a private practice

By Laurie Meyers March 22, 2019

“If you build it, they will come.” Most of us are familiar with this popular misquote from the movie Field of Dreams (the actual quote is “he will come”), in which a ghostly voice urges Kevin Costner’s Iowa farmer to build a baseball diamond in his cornfield. Following through on this vision despite the risk of bankruptcy, Costner’s faith is eventually rewarded when he gets the chance to reconcile with his deceased father and multitudes of fans start flocking to his “field of dreams” to watch baseball games.

It’s an attractive and enchanting thought: Give the people what they want (or need), pursue your dreams, and the rest will follow. However …

Remember the dream part? In real life, establishing a small business such as a private counseling practice requires a lot of preparation, planning and ongoing maintenance. Being a good clinician is not enough. Counselors who have established their own practices say that the other major requirement for success is business skill — and more of it than many of them expected they would need.

How will you market your practice? Who will do the scheduling and billing? File the paperwork? Balance the books? These are just a few of the questions counselors need to consider as they contemplate establishing a private practice.

Counseling Today asked four American Counseling Association members with experience in private practice to share their stories, their lessons learned and tips for others in the profession who might be looking to strike out on their own.

 

Tapping into the power of the internet

Ryan Thomas Neace, a licensed professional counselor (LPC) and founder of Change Inc., a private practice located in St. Louis, first discovered his entrepreneurial spirit when he established himself as a local DJ at age 15. Neace started working in entry-level mental health positions during his first year of graduate school, and over the course of eight years gained experience in residential, agency, school, in-home, college and community counseling. Along the way, he discovered something crucial: He was an excellent clinician but a terrible employee.

“I tended to do first and ask forgiveness later, whether or not it coincided with what I thought management might want, because I typically thought my ideas were better and less bound to inside-the-box thinking,” Neace says. “I was right, I think, but it wasn’t a very good way to
stay employed.”

Fortunately, Neace’s entrepreneurial spirit and good connections put him on the path to self-employment. “In the course of all of that action [working in numerous counseling environments], I had latched on to a mentor who saw a lot of promise in me and recognized I was gifted in some ways he was not — business acumen, administration, etc. — and he asked me whether I’d consider starting a private practice with him in Virginia. We started brainstorming, and that was that. He put up about $10,000 for office furniture and technology, and we found the space we liked.”

Neace and his mentor co-owned and ran the practice together for several years, but, eventually, both wanted to move to different areas of the country. “I moved back to St. Louis in 2013 and started my first sole ownership practice there,” Neace says. “Five years later, it has two locations, 12 therapists, several support staff, and we’re conducting approximately 700 client sessions per month.”

Although Neace’s move was obviously a success, he acknowledges that it took a substantial amount of hard work and planning to achieve. “About 18 months before I moved back to St. Louis, I started looking online at where all of the counseling practices were,” he says. “I noticed that there tended to be a large accumulation of practices in the western county parts of the metropolitan area but not a ton in the up-and-coming urban areas that for several years were being revitalized and developed. While the county regions were clearly where a majority of the local wealth was, I decided that if I priced our services effectively, there was a decided advantage to being more local to the city itself. We could pick up [gain] residents who were tired of driving to the county for mental health services, and we could even get county residents who were dissatisfied with the kinds of therapists who dominated the landscape in their neck of the woods or [those residents] who worked in the city and might find the idea of getting therapy in the city attractive from a convenience standpoint — [for example] on their lunch hour — or from the perspective of having a bit of geographic distance between themselves and their therapist’s location.”

During this period of research, Neace was also building a website for his practice on WordPress. He already had some experience working with websites, and anything that he didn’t know, he found through online tutorials or support forums. Recognizing that the most essential part of having an online presence is showing up in search results, Neace sought help from a friend who was an expert in search engine optimization (SEO).

The friend taught Neace how to ensure that Change Inc. would show up whenever someone searched online for terms such as “St. Louis____ (anxiety, depression, LGBTQ, etc.) counseling.” Three to six months before Neace was even scheduled to make the move to St. Louis, he was already getting one to two phone calls per week from prospective clients. One month before Neace opened the doors to his new practice, he already had his first few clients scheduled.

Today, Neace’s practice continues to focus on SEO even as it has developed a stream of referrals from previous clients and area clinicians with whom Neace has built relationships. Change Inc. has also taken a nontraditional approach to marketing.

“Instead of spending money on traditional print or other marketing efforts, we partner with other small businesses — typically nonprofits — that have a mission we feel is supportive of our own and that reach a target demographic similar to our own,” Neace says. “We offer these organizations financial support in exchange for direct marketing opportunities to their target audiences and brand association, [such as] event or web advertising where our brand and their brand is featured together in a prominent way.”

Neace acknowledges that owning his own practice can be demanding, but for him, it produces less anxiety than trying to work within someone else’s confines. “Certainly, owning a practice increases the stress, though I think it’s a qualitatively different kind of stress,” he says. “Perhaps the most prominent difficulty in ownership for me is the heightening of my personal sense of loneliness, in that no one sees how much I’ve risked or how hard it can be, simply by virtue of the fact that they aren’t owners. But if you’re an entrepreneur of my kind, it is a labor of love where the rewards far outweigh the additional stress.

“Again, I’m highly motivated by the autonomy and independent decision-making, as well as the notion that each decision I make stands to increase my interests financially and otherwise. And I love getting to create an environment that prioritizes the elements of counseling that I believe are most important to transformational clinical work.”

When asked what advice he would give to counselors interested in setting up their own practices, Neace emphasized the following:

  • “Learn and implement SEO like your life depends on it. People should be able to search ‘Your city, Your industry, _____’ and you come up in the top five every time.”
  • “Find someone you trust who has a business that is thriving and ask them every question [you have]. Trust that if you are annoying them or if they don’t want to answer, they will tell you. Otherwise, be totally relentless about learning from them.”
  • “Remember that most people selling business how-tos are actually in the business of selling business how-tos, not in the business of having a successful, meaningful business. Most of the good information is free [from] mentors/friends … or next to free [from] books.” (Neace particularly recommends The E-Myth Revisited: Why Most Small Businesses Don’t Work and What to Do About It, by Michael Gerber, and Built to Sell: Building a Business That Can Thrive Without You, by John Warrillow.)
  • “Don’t be bogged down by convention. Do it the way you want to unless it absolutely makes no [financial] sense. Expect that people will tell you you’re breaking the rules and to generally be appalled that you have the audacity to think outside the box.”
  • “When you get scared and want to quit, run the numbers. Calculate the amount of money you need to keep the business afloat each month, and let that be your true north.”
  • “It helped that I had a side hustle [adjunct teaching online]. On the other hand, eventually it will eat into your ability to do the business. There’s definitely something to being all-in. If you keep a side hustle, keep one that doesn’t give you enough to live on. Let the hunger you feel drive you.”
  • “Don’t try to have everything at once. For the first two years, I worked in a space with old carpet and paint, three empty offices and a waiting room with the couch from my basement and some chairs I bought off Craigslist. Rome wasn’t built in a day.”

 

Knowing your strengths and maintaining flexibility

“In my 25 years as a therapist, I’ve been in and out of private practice depending on the needs of myself and my family,” explains Keri Riggs, an LPC currently practicing full time in the Dallas area. “So, I’ve worked full time as executive director of a nonprofit and full time as an intensive outpatient coordinator at a hospital. I always wanted to keep my hand in counseling, so I often contracted through agencies or under other therapists or had a solo practice while still being employed.”

“I believe when counselors are just starting out, the decision about solo practice depends a great deal on their economic or marital status,” Riggs says. “If you have a stable family income with benefits, your options are different than if you are a single parent or sole income provider for your household.”

Riggs cautions others to think carefully about giving up additional sources of income while building a practice. “I … regretted quitting my part-time agency work while building my practice. I only made $17,000 that year, and it was the toughest year ever,” she says.

Riggs has used a variety of methods to attract clients. “I see many resources on Facebook or online promising people can have a flourishing full-pay, noninsurance practice within a year, but that hasn’t been my experience,” she says. “I believe it depends on demand in the geographical area [and whether] a counselor elects to accept insurance or employee assistance program work.”

In Riggs’ experience, it usually takes two to three years to build a full practice. “I do believe it’s valuable to network and to have a niche but also not to over-focus on that,” she says.

However, Riggs does recommends that counselors focus their marketing efforts. “Don’t just send flyers to doctors’ offices. They end up in the trash before a doctor ever sees them,” she says. Instead, she advises that private practitioners find ways to speak directly to their target client populations, such as by holding workshops or giving presentations at service organizations.

Riggs enjoys running her own practice but grants that being a CEO and a counselor is a tough balancing act. “There’s a saying: You can’t work on the business when you’re working in the business. So, if I’m seeing clients, I can’t be working on marketing, billing/accounting, networking, blogging.”

In addition to seeing clients and running the business side of things, it’s essential that self-employed counselors continue to devote time to self-care, Riggs says. “I’ve discovered my magic number of clients I can see in a row and in a day,” she says. “I’ve blocked time in my calendar as I’ve gotten busier to eat, return phone calls and do administrative tasks. Occasionally, I block a mental health day for myself and spend time with non-therapist friends.” Peer consultation is also essential, Riggs adds.

Riggs doesn’t have office support staff but does outsource certain tasks. She employs an accountant and someone to manage her website and consults with a social media expert. She does her own scheduling, billing and filing of health insurance claims with a little technological assistance. Riggs uses practice management software that allows clients to schedule online, sends clients appointment reminders, bills insurance, posts payments and even provides a central place for Riggs to take progress notes and write treatment plans. “I couldn’t manage without it,” she says.

Not having the luxury of sick time or paid leave as a private practitioner can be difficult, but Riggs thinks the trade-off is worth it. “I love the freedom and I love being my own boss,” she says. “I can arrange to go to the kids’ school or doctors’ appointments or even take a recharge nap on my office couch in between clients if I need to.”

When asked what advice she would give to counselors interested in setting up their own practices, Riggs says the following:

  • “Work with your own personality strengths and weaknesses. If you procrastinate on accounting and hate it but have a talent for writing, spend your time writing and hire someone to help with the financial aspects.”
  • “If you don’t want to deal with the administrative aspects of your practice, don’t. Get with a group [that] provides that for you and willingly pay the costs involved.”
  • “Don’t feel like you have to do everything all at once. Serve the clients you have and serve them well.”
  • “Find a supportive accountability partner if needed, and engage in regular peer consultation with other counselors.”
  • “Be kind to yourself. Keep learning and growing.”
  • “Make sure you have a life outside of work.”

 

Identifying a need and growing into a group practice

Michael Stokes, an LPC and founder of Stokes Counseling Services LLC, in Naugatuck, Connecticut, set up his own practice because he wanted to develop a niche devoted to treating LGBTQ individuals and their families. “There were not agencies focused on LGBTQ services in my area, and this was a significant unmet need in my community,” he explains.

To get up and running, Stokes networked with other counselors in private practice, but he says he owes the most to a former supervisor. “Her guidance around logistics helped me develop a step-by-step process for opening my practice. The first step was finding an office location [and] community I wanted to practice in. This was not difficult since I knew exactly the town where I wanted to set up my practice. From there, I needed to find office space I could afford. Living paycheck to paycheck, I needed something extremely cheap. I cashed in my saving bonds from when I was a baby and used that $500 to secure my lease on the office space. After the office space, I finalized my paperwork [and] insurance paneling and started to let others know I [would] be open for business Oct. 1.”

Like other first-time small-business owners of all stripes, Stokes was unaware of how much business knowledge he would need to run his own practice. “I had no formal training,” he says, “so I dove straight into reading, researching and seeking out experts in the field of private practice.”

Initially, Stokes’ practice was part time, but as he grew more confident with the business side, he decided to go full time. Suddenly, his practice mushroomed.

“When I took the leap into private practice full time in April 2012, I was eager to build my caseload to a place that was comfortable,” he says. “What I found instead was that I was seeing way too many clients, and the referrals were not stopping anytime soon. I was seeing about 40 clients a week and knew I could not sustain that level of practice.” Stokes realized that without additional help, he would have to start turning clients away, which he was loath to do.

“Simultaneously, colleagues from other agencies were reaching out to understand my experiences in private practice and asked if they could start to see a few clients in my office when I was not there. Little did I know, this was my starting point of group practice development. Being able to serve more clients was an amazing experience. As I began to cultivate my group [practice], I knew it was important for me to bring clinicians on who had different styles, theoretical orientations, different niche areas and populations. This allowed us to build a cohesive practice of clinical services. We now have over 50 licensed clinicians who serve thousands of clients in our state.”

Stokes started with a mission of providing help to the underserved LGBTQ community, but he didn’t anticipate just how much private practice would reignite his passion for clinical work. “I was working in clinics and nonprofits throughout my career. Feeling very overwhelmed, overworked [and] underpaid, I was on the path for early burnout,” he says. “Having my own space was empowering because I was able to design a safe place for myself and my clients. To this day, I am a huge advocate for private practice and helping clinicians find success in this arena.”

When asked what guidance he would give counselors who are thinking of setting up their own practices, Stokes says, “My best advice … would be explore all of your opportunities. Have a good handle on who your ideal client is, where you want to serve and what supports you need [to have] in place as you go down the path of private practice work.”

 

Keeping clinical skills sharp as a counselor educator

Misty Ginicola, a professor in the counseling and school psychology department at Southern Connecticut State University, is primarily a counselor educator. She began her career teaching, but decided that she wanted to keep her clinical skills sharp.

“I wanted to be a more effective professor,” she says. “It definitely helps students to have plenty of narratives on how something might work with a client.”

Ginicola, now an LPC with a private practice in West Haven, Connecticut, decided to focus on two specific populations — LGBTQ individuals and highly sensitive people. She purchased a website and started the process of completing the business application process for her town, registering for tax purposes, applying for a National Provider Identifier number, and getting on insurance boards, all of which took longer and proved to be more complicated than she had anticipated. Ginicola says she fervently wishes she had known enough beforehand to find someone with insurance board experience to guide her through the process.

Striking a balance between teaching, consulting on and conducting research projects, doing clinical work and all of her other commitments requires a bit of juggling and a lot of self-care on Ginicola’s part.

“I put limits on the number of clients I take. I only take a maximum of five clients at a time. I also only see clients during times when it will not interfere with family time,” says Ginicola, the mother of two small children and the president-elect of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. “My self-care is vast and it really has to be. I practice pranayama — breathing practices — throughout my day and coherent breathing every night. I practice yoga every day and am a yoga teacher. I teach three times a week, and it really keeps me working on my own wellness, as I have to practice through the week and stay true to my own physical wellness. I make sure to be honest with myself and to communicate clearly with others what I need. I have learned to say no to lots of things that do not bring me happiness or speak to what I feel is my life purpose, or dharma. By really focusing in on those things, I do not feel overwhelmed. Everything I do truly feeds my soul.”

When asked what advice she would give to counselors who want to set up their own practices, Ginicola says, “Really understand that it involves being a business owner, not just a counselor. Therefore, if it is going to be your primary source of income, it takes a lot of work in setting up and retaining a thriving practice. As a part-time practice owner, the demand is not as much to make a good income at it. I can put a limit on my number of clients, I can choose what insurance boards I truly want to work with, and I can specialize in specific issues. I think establishing a specialization is an excellent way to attract clients and gain referrals.”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Private Practice: The Ethics and HIPAA of Technology” with Rob Reinhardt and John P. Duggan (WEBA18007)
  • “Private Practice: Building Your Brand” with Deb Legge and John P. Duggan (WEBA17007)
  • “Private Practice: Managing Your Business” with John P. Duggan and Deb Legge (WEBA18002)
  • “Private Practice: Getting Off to a Strong Start” with Deb Legge and John P. Duggan (WEBA17005)
  • “Counselor Risk Management: Counselors and Technology — A Two-Edged Sword” with Anne Marie “Nancy” Wheeler and John P. Duggan (WEBL18005)
  • “Private Practice: Choosing a Best Fit” with Rob Reinhardt and John P. Duggan (WEBA18004)
  • “Ethics and Values in Real-Life Counseling Practice” with Stephanie F. Dailey and John P. Duggan (WEBA17006)
  • “Counselor Risk Management: What You Didn’t Learn in Grad School That Could Lead to a Lawsuit or Licensure Board Complaint” with Anne Marie “Nancy” Wheeler and John P. Duggan (WEBA18001)
  • “Does One Size Fit All? How to Successfully Get and Keep Your Clients” with Janis Manalang (CPA20695)

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • The Counselor and the Law: A Guide to Legal and Ethical Practice, eighth edition, by Anne Marie “Nancy” Wheeler & Burt Bertram
  • ACA Ethical Standards Casebook, seventh edition, by Barbara Herlihy and Gerald Corey
  • Ethics Desk Reference for Counselors, second edition, by Jeffrey E. Barnett and W. Brad Johnson
  • The Secrets of Exceptional Counselors by Jeffrey A. Kottler
  • Counselor Self-Care by Gerald Corey, Michelle Muratoni, Jude T. Austin II and Julius A. Austin
  • Cognitive Behavior Therapies: A Guidebook for Practitioners edited by Ann Vernon and Kristene A. Doyle
  • Creating Your Professional Path: Lessons From My Journey by Gerald Corey

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources/self-care-resources)

  • Self-Care

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.