Tag Archives: Private Practice Management

Private Practice Management

Nonprofit News: Taking safety seriously: Common issues found in small practices

By “Doc Warren” Corson III October 26, 2017

As a writer, educator and counselor certified in two countries, I find myself consulting with folks all over the globe. I belong to various counseling-related groups and find much inspiration therein. I’ve also found many a post or question that made me cringe. Not because these professionals were less bright, energetic or talented than others, but because it would appear that their educational programs and real-world experiences have been lacking in some key areas that would help ensure not just the highest quality of care but also the highest level of safety for them, their staff members and their clients.

I’m often asked why I write for so many places pro bono, and my reply is simple: I’m trying to give back to the profession that has enabled me to help so many in need while also providing a good life for me and mine. If we fail to feed our profession, if we fail to fill the current training and experiential gaps that currently affect our programing, then the future of the counseling profession will begin to look bleak. Sharing knowledge freely is one of the best ways to make lasting change in our profession.

As you read over the following issues that I have found to be very common, think about how they may apply to you or to someone with whom you work. If they apply, consider ways you can move to improve the situation. We are all on the same team, and we will ALL make mistakes in our work. Let’s do what we can to ensure that when we do make errors, that we remain safe, both physically and from a liability standpoint.

 

Issue: Having only one staff member working in the office when it is open for business

Concerns: Being the only person in an office (other than clients) increases the risk to a clinician in many ways. It can pose a physical safety risk should a client become physically or sexually threatening. It can pose a health risk should a major health issue such as an injury, heart attack or other collapse occur. It also can make it much harder to defend yourself should a current or former client ever make an accusation against you. Having another staff member available to report that nothing out of the ordinary happened that day and that no signs of impropriety were present can make a difference.

Ways to avoid: Always make it a practice to have at least two people in the office area at all times. This doesn’t mean that you need two clinicians. The people present might be a receptionist, an assistant, interns, a biller or even volunteers. My offices have a system in place to ensure that two people are in every office every day (last-minute health issues notwithstanding). Sometimes the “extra” person is a staff member; other times it is a graduate, doctoral or undergraduate intern or volunteer.

 

Issue: Not having documentation for services provided, often because you do not work with third-party payers

Concerns: I’ve seen this happen many times over the years. A clinician, often in a small private practice, decides that he or she will not take insurance payments and thus will no longer keep therapeutic records of any kind. Instead, the clinician determines simply to keep a tally of billable hours. I’ve also seen cash-only practices that keep no records whatsoever.

This leaves so many issues that it could be an article unto itself. Treatment record are required regardless of insurance. They are part of the profession and are subject to ethical and legal requirements (see Standard A.1.b., Records and Documentation, of the 2014 ACA Code of Ethics, as well as state and national laws).

Ways to avoid: Avoid going by what another counselor tells you and instead consult the ACA Code of Ethics and applicable laws. Review and use online resources, and develop documentation and a system to keep all records secure. Some free resources can be found here at docwarren.org/images/Documentational_Requirements_for_Practice.pdf and docwarren.org/supervisionservices/resourcesforclinicians.html.

 

Issue: Little to no prescreening of clients

Concerns: Without proper screening, you risk accepting clients with needs that are beyond the scope of your practice, knowledge, experience and education. This lack of screening can lead to safety issues, such as in a case in which the client is potentially violent. It also can lead to wasted session times and time-consuming referral services and follow-up that could have been avoided with a simple screening.

Ways to avoid: Use a prescreening form and process at the time of first contact with potential clients to ensure that they are a good fit for your program. If they are, schedule them accordingly. Should they not be a good fit, have a list of more appropriate placements, complete with phone numbers and other contact information, at the ready to offer them. This will potentially save hours, both for you and for the prospective client.

 

Issue: Keeping a clear path between you and the exit

Concerns: In the case of client violence or client physical collapse, having a clear path between you and the office door can greatly increase your chances of a positive outcome. I have consulted with clinicians who were assaulted by clients and found that they had no system in place for keeping a clear path to the door. In addition, they lacked safety training (see below).

Ways to avoid: Furniture placement can do wonders to increase safety in an office environment. Place “your” chair or other furniture as close to the door as possible, while placing client seating a bit farther from the door (even a few extra inches can make a difference). When greeting or exiting the room with a client, try to be the one to open the door for them. Once the door is open, you can allow them to walk out before you because with the door open, there is less risk. Plus, chances are great that your office opens into a public space.

 

Issue: Lack of safety training/not knowing what to do if a problem arises

Concerns: In many instances I have consulted on after a clinician has been assaulted, the clinician lacked basic insights into or training for when a problem might arise. Don’t get me wrong — depending on the situation, an injury can result no matter the amount of training a clinician has received, but a lack of knowledge only increases the odds of injury.

Ways to avoid: Depending on the treatment setting, the use of body alarms, comprehensive safety training and awareness exercises can be beneficial. Body alarms may not be needed in the average program, but those who serve violent offenders or those with a history of violence can surely justify the expense. For the average counseling program, consider having someone conduct a safety assessment who is knowledgeable both about safety and your treatment setting. Conduct regular in-service trainings and exercises, and make basic skill training part of new employee orientation. The few hours and few dollars spent can make a huge difference.

 

Issue: No way to communicate to other staff should an emergency arise

Concerns: Some nonprofit counseling programs are small, with just a few offices that share common walls. Other programs have large campuses that utilize different buildings or are spread across multiple acres, making it difficult (if not impossible) to hear a staff member in distress and in need of assistance.

Ways to avoid: Have a means of communication in place for all employees based on the office or campus setup. In our programs, staff members use handheld walkie-talkies whenever they are out of range of the reception or other high-traffic areas. These radios are only used in the event of an emergency, so there is little worry of intrusion or distraction. Our reception staff always have one with them in their area so that they can call for assistance if needed. Systems can range from about $100 into the thousands, depending on the number of handsets needed and type of system.

 

Issue: No receptionist or other staff in the waiting area

Concerns: Often, treatment records, schedules, cash boxes and other vital information are stored at the reception desk. Failure to keep this station manned can lead to theft of charts, especially if a volatile legal case (such as a divorce or custody hearing) is going on that involves one of your clients. An unmanned reception area can also lead to the loss of valuable property, folks wondering around the building and interrupting sessions, and a host of other issues.

Years ago, two different local programs contacted me about potentially wanting to partner on a few projects with my program. Both had great credentials, and as the program director, I decided to explore the options. If nothing else, I figured they could be referral sources. One day, I had a last-minute cancellation and decided to visit the programs.

At the first one, I found the door unlocked and the reception area deserted. I was able to roam the halls and noticed no white noise machines or other means of ensuring privacy. I also found confidential mail in plain view next to a few office doors.

I was greeted by much of the same at the second program, in addition to unlocked chart cabinets and confidential information sitting on top of a desk. The desk was also unlocked, as evidenced by several partially open drawers. Needless to say, I passed on any possible partnerships or referrals.

Ways to avoid: Keep cabinets locked and valuables secured when not in use. Hire staff or take on interns and volunteers whenever needed and train them on privacy laws, safety and securing documentation.

 

*****

 

Although this article is far from comprehensive, it highlights some of the more commonly found safety issues in smaller programming. Do what you can to keep your nonprofit program running smoothly while addressing safety and liability concerns. With a bit of prevention and an eye toward being proactive, we can do much to lower our liability and keep ourselves (and our staff members and clients) safer. People are counting on us.

 

****

 

Nonprofit News looks at issues that are of interest to counselor clinicians, with a focus on those who are working in nonprofit settings.

 

Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

 

****

 

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.

Group counseling: Neglected modality in private practice

By Kevin Doyle March 7, 2017

After approximately 25 years of working in private agencies, I started a part-time private practice a few years ago focusing on my specialty area of working with clients with substance use disorders. Having worked largely with adolescents, I was looking forward to working more frequently with adults, especially after I had the realization that I was growing older and the adolescents were not.

One of my first efforts at outreach was to my state’s monitoring program for licensed health care providers (doctors, nurses, dentists, veterinarians and so on) because I was aware that these professionals are at high risk of substance use problems for a variety of reasons. Over the past eight-plus years, I have found this area of practice to be both stimulating and professionally rewarding.

As is the case in most states, my state mandates that health care professionals must, following an issue related to a substance use or mental health disorder, participate in its monitoring program for five years to ensure professional oversight during the transition back to practice. I quickly realized that the need for individual counseling throughout the full five years, although potentially appropriate in some cases, was likely not indicated in many instances. So, I approached several nurses in the monitoring program about starting a counseling group. They were open to the idea and even enthusiastic. Eventually, I asked them about including a physician. Their response to my question was memorable: “Don’t worry. We can handle him.”

Since that time, the group has grown to include several other health professions and has ranged in size from six to eight individuals. According to the participants’ report, it is helpful to be exposed to the input and perspective of others who have been through the process of addiction (sometimes diverting medications from patients and facing criminal prosecution) as they work to put their lives back together and obtain approval to return to professional practice.

Using this experience, I have subsequently established two more recovery support groups in my practice. Both groups are for men in early recovery from substance use disorders, which constitutes a large portion of my clientele these days. In talking with other counselors in private practice, however, I have learned that very few offer group counseling, preferring to stick to the traditional model of one-on-one counseling. Why don’t more counselors offer group counseling?

Potential advantages

The ACA Code of Ethics includes standards relating to group counseling, including A.9. (Group Work) and B.4. (Groups and Families). Although these standards identify responsibilities that counselors have when choosing to provide group counseling services, none of them includes any admonition for counselors to consider offering group work.

What, then, are the potential advantages? Let’s look at three that are most commonly identified.

1) Cost to the client/payer: A ballpark calculation, based on discussions I have had with other counselors, as well as rates posted on websites, is that the per person rate for group counseling is about one-third to one-fourth of the rate that counselors tend to charge for individual sessions. Using an example on the higher end, a counselor who charges $150 for a traditional therapeutic hour (a 45- to 50-minute session) would probably charge $40-$50 per person for group counseling. Many counselors also extend group sessions to 70-90 minutes to allow adequate time for each member to participate. In this day of tightly managed insurance benefits, the cost to the payer is much less in group counseling and tends to give clients the ability to participate for longer periods of time, which is often extremely beneficial.

2) Additional revenue for the practice: Not to be overlooked is the potential that group counseling offers for a practice to enhance revenues. There are only so many hours in the week and a limit to how many clients an individual practitioner can be effective in seeing. High-end estimates tend to run to seeing clients 25 to (at most) 30 hours per week, thus still leaving time for documentation, marketing, practice management, breaks, supervision, etc. Given overhead expenses such as liability insurance, rent, phone service, office supplies and equipment, internet/web access, licensing fees and more, it is challenging for counselors to make an adequate living without following sound business practices. One of these practices can be to offer group services.

3) Enhanced therapeutic value: Finally, as the ACA Code of Ethics stresses, we should ultimately make decisions with our clients in mind, keeping whatever is best for them paramount in our thinking. Both research and anecdotal evidence support the provision of group services as an important part of addressing many clients’ needs, with substance use disorder being a clear example. The experience of hearing from other people who are both struggling with the same issues and having success addressing those issues can be life-changing for clients. Likewise, establishing a support network that people can draw on outside of sessions can also be very therapeutic and is an important outgrowth of group work.

Potential disadvantages 

What, then, might be the disadvantages, and why do so few counselors in private practice offer group services?

1) Scheduling: One of the great benefits of owning a private practice for many counselors is the flexibility it affords them in both their personal and professional lives. In my experience, the days of the client who comes in every Wednesday at 10 a.m. are no longer; in most cases, they have been replaced with a more flexible, variable style. This also gives the counselor the ability to work around a full- or part-time job, family obligations, vacations and other scheduling issues.

Groups, however, typically do meet at the same time every week, every other week or monthly. Rescheduling a group involves potentially inconveniencing eight to 10 participants, as well as the counselor, and is much more complex and problematic than rescheduling an individual client. Although I will occasionally reschedule a group in my practice, I usually hire another local practitioner to cover the group, obtaining a release of information from group members to facilitate client coordination with the other practitioner. Having a substitute counselor can supply a healthy change of pace for groups and can enhance the group process in future sessions too.

2) Lack of comfort with group modality: Group counseling classes are included in most counselor training programs, but it is possible for counselors to move quickly into a comfort zone of providing services on a one-to-one, individual basis and allow their group counseling skills to grow rusty. For many counselors, the transition to private practice begins as a part-time arrangement in combination with another full-time job. Thus, it may be many years before the counselor is fully engaged in private practice work as his or her primary activity. This may further contribute to the lengthy delay between when a counselor receives group skills training and finally implements those skills in a private practice setting. This is not the only scenario under which counselors move into working privately for themselves, but this pattern may partially explain why so few private practitioners offer groups.

3) Too much effort to establish: Finally, and related to the scheduling challenges noted earlier, there is the effort required to get a group off the ground. Persuading clients that group counseling is an option worth considering can sometimes be a formidable obstacle.

I recall one particular client of mine who was dead set against group work, indicating that he did not want to share his “personal business” with a group of strangers. After nearly two years of relatively successful individual counseling related to his problems with alcohol, he experienced a serious relapse, leading to inpatient treatment — where groups were a large part of the service delivery system. Upon returning to the community, he has engaged with his group and finds it to be an essential part of his overall recovery program.

On a more mundane level, simply finding a time that works for all potential members and the counselor can be a significant challenge. I have had some luck holding groups early in the morning, before many people start their workdays. Other options might include lunch-hour meetings, evening sessions or even weekend slots. Sometimes, however, the difficulty of establishing a regular meeting time can be so daunting that it prevents counselors in private practice from even attempting to start groups.

Conclusion

In summary, groups can provide a tremendous therapeutic opportunity for our clients to address their issues with the assistance of others who are confronting similar problems. Counselors should consider this modality more frequently as they look to simultaneously improve their work with clients and solidify their private practices from both a quality and financial standpoint.

Opportunities for retraining for those professionals who have not had group experience since graduate school are abundant. These opportunities include myriad continuing education options such as conferences, webinars and self-paced reading. Additionally, counselors can partner with other professionals in a co-facilitation arrangement. This may negate some of the financial upside of group work, but it can also assist in providing built-in coverage should a counselor need to miss a session.

Ultimately, as we ponder as counselors how best to meet the needs of our clients, group work should be something that we all consider as part of our ethical responsibility.

 

****

 

Kevin Doyle, a licensed professional counselor and licensed substance abuse treatment practitioner, is chair of the Department of Education and Special Education and an assistant professor of counselor education at Longwood University in Virginia. Contact him at doyleks@longwood.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

****

 

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.
 

Nonprofit News: Independent contractor or employee?

By “Doc Warren” Corson III January 10, 2017

As I review job postings for clinicians, I see a disturbing trend of nonprofits hiring independent contractors rather than full- or part-time employees. Although there can be some benefits for both the nonprofit and the contractor at times, many liabilities can come into play as well. This article is not meant to be an exhaustive exploration of the topic, and I am far from a legal or tax expert, but my hope is that this column might inspire you to think carefully before posting or replying to an ad for an independent contractor.

The status that you work or hire under can offer either liability or protection, depending on the situation. The liability can come in the form of IRS penalties and potential loss of eligibility for unemployment protection and malpractice insurance protection. FindLaw (findlaw.com) and EmployeeIssues.com are two resources that can help you learn the basics of these issues, but there is no replacement for meeting with an expert if you are contemplating moving your hires to independent contractors. Personally, I prefer to hire folks for my nonprofit as part-time employees so I can avoid potential issues with the state department of labor and the IRS. I can hire them as part-time clinicians who are paid by the session if that is what I need, but this way we both know we have certain protections in place. The choice, however, is yours.

 

Overview of employee vs. independent contractor

Here are a few quick points concerning the differences between an employee and a contractor.

 

Employees:

  • Typically work full or part time for one or more employers with set work hours and days (which can change week to week in some cases)
  • Have some type of benefits package
  • Have needed parts and supplies furnished by the employer
  • Have taxes taken out of their salary and are eligible for unemployment compensation should work stop
  • Have employment protections, including workers’ compensation
  • Are protected by minimum wage and other labor laws
  • Must have cause to lose their job unless hired “at will”

 

Independent contractors:

  • Provide consulting or other services for a wide range of places
  • Set their hours and days as they see fit
  • Have their own offices independent of their placements, although they may also be given access to an office to use while at their job sites
  • Receive no benefits from the employer
  • Do not have their supplies covered by the employer
  • Do not have taxes taken out by the employer, nor are they covered by workers’ compensation or other policies
  • Have a set contract time period and hours
  • Generally are not protected by employment laws

 

When it can get murky

Years ago, I was a consultant for a local Head Start program. I had a contract that made it clear how much I would be paid per hour, how many hours I was allowed to work during the contract period and the hours the program was open so I could be sure to complete my time within those parameters. For the most part, I came and went as I decided and used my own agency forms for performing tasks. Although I contributed to the organization’s newsletter, I was able to pick the topics and allowed to opt out of an issue if I so desired. To me, this was a classic example of what an independent contractor’s role should be.

A few years later, however, several changes occurred that made my independent contractor status a bit harder to justify. I now had set forms to use, supplied by the agency, and was given less ability to customize how I did my job. I also needed to follow set protocols and several other parameters that I had experienced in the past only as an employee. I opted not to continue the contract after the initial time period, partially because it felt like I got to experience all of the red tape of being an employee without enjoying any of the protections or benefits.

 

The IRS view

The IRS looks into common law to help determine the proper classification of employees. It uses three broad categories in helping to make this determination: behavioral control, financial control and the relationship between the parties. The following is taken directly from the IRS website (see irs.gov/taxtopics/tc762.html):

Behavioral Control covers facts that show if the business has a right to direct and control what work is accomplished and how the work is done, through instructions, training, or other means.

 

Financial Control covers facts that show if the business has a right to direct or control the financial and business aspects of the worker’s job. This includes:

  • The extent to which the worker has unreimbursed business expenses
  • The extent of the worker’s investment in the facilities or tools used in performing services
  • The extent to which the worker makes his or her services available to the relevant market
  • How the business pays the worker, and
  • The extent to which the worker can realize a profit or incur a loss

 

Relationship of the Parties covers facts that show the type of relationship the parties had. This includes:

  • Written contracts describing the relationship the parties intended to create
  • Whether the business provides the worker with employee-type benefits, such as insurance, a pension plan, vacation pay, or sick pay
  • The permanency of the relationship, and
  • The extent to which services performed by the worker are a key aspect of the regular business of the company

 

*****

 

As we start the new year and contemplate either adding workers or signing on to an existing agency, it is imperative that we consider the type of position we are becoming associated with and the potential implications from a liability standpoint. Here, as in many other situations, doing a little homework and consulting with knowledgeable professionals can go a long way toward protecting yourself or your nonprofit program.

 

*****

 

Sources:

 

****

 

Dr. Warren Corson III

 

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

 

 

 

****

 

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.

Becoming your own boss

By Lynne Shallcross January 27, 2016

A year after Cyndi Briggs graduated with her master’s degree in counseling, she was working as an addictions counselor. The work and the clients were important to her, but it was also a difficult job, and the hours were long. She eventually found herself dealing with symptoms of depression.

Briggs went to talk with a career counselor, and the meeting led to an “aha!” moment for Briggs. “He said, ‘Why do you take low-paying, high-stress jobs?’” says Briggs, a member of the American Counseling Association. “And I [had] literally never considered that there was another option.”

Fifteen years later, Briggs is living her ideal life as a counselor. She works full time as a core faculty member in the clinical mental health counseling program at Walden University, but she also maintains a number of what she calls “side gigs,” including corporate training work and speaking Branding-Images_Officeengagements. Briggs has run a private practice in the past, earned her coaching certification and, for a handful of years, wrote a blog aimed at helping counselors think outside the box. While writing the blog, one of her central messages to counselors was that they could apply their many skills and talents in a variety of professional settings where they could also earn a good living.

Deb Legge shares a similar message with her clients in the coaching and consulting practice that she runs, in which she helps mental health professionals build and grow private practices. Like Briggs, Legge knows from personal experience what it’s like to have a desire to become, and then succeed in becoming, your own boss.

Counseling was a second career for Legge. At the time she was earning her master’s degree in counseling, she was a single mother, which meant that taking her new degree into an entry-level, low-paying job wasn’t an option. From day one in graduate school, Legge says, she was laying the foundation to establish her own private practice, which she now runs in Buffalo, New York (her private counseling practice is separate from her coaching/consulting practice).

Counselors and other mental health professionals who approach Legge for help with the how-tos of starting their own private practices have a variety of reasons for wanting to become their own bosses. But oftentimes, Legge says, it boils down to seeking freedom and better financial opportunities. “My experience has been that most people decide to do it because they are either really burned out from working for someone else, overworked [and] underpaid for too long, or their life circumstances change and they really do need more autonomy and money,” explains Legge, a member of ACA.

When Briggs presents on this topic, there are often weary counselors in the audience who raise their hands and want to know more about how to transition into private practice or become their own bosses in another way. Many times, Briggs says, these counselors have been working in nonprofit settings for many years and are feeling burned out because of overwhelming caseloads and too little pay. “For a lot of people,” she observes, “it’s just rediscovering the joy of why they wanted to be counselors in the first place.”

Risks and rewards

Running a private practice comes with a variety of upsides for counselors, Legge says, from control over their schedules to control over which clients they work with and what work they do with those clients. For example, some of Legge’s clients who are starting out in private practice will ask if they can conduct a daylong seminar, a weekend retreat for couples or an hourlong session with a particular client. “As long as you’re being ethical, and as long as you’re being legal, and as long as you’re abiding by the rules of an insurance company if you’re participating with them, there are no rules,” Legge tells her clients.

But before launching a private practice, counselors need to become licensed. And once they’re licensed, Legge says, they also need to honestly evaluate whether they possess enough clinical experience to set out on their own and whether they have set up the necessary supports and guidance, including supervision, to lean on as they get established.

Going into private practice isn’t the right fit or even the desired end goal for every counselor. For one thing, it requires embracing a certain amount of tolerance for risk and responsibility, Legge cautions. “I don’t want to give people the impression that it’s for everyone or that it’s a bad thing not to be in private practice,” Legge says, adding that she is grateful for all the counselors who choose to work in agencies, schools, hospitals and other settings.

Starting a private practice also isn’t the only way that counselors can become their own bosses. In fact, putting your counseling skills to use in a variety of “gigs” — from consulting to running a private practice to adjunct teaching — can be financially beneficial, says Briggs, who has served as a consultant in various settings. “There’s lots of security from that,” she says. “You’re not relying on one entity to pay your income every month.”

Whatever the environment, working for yourself is creatively empowering, Briggs says, in part because of the flexibility it allows. “You get to decide what you do every day and change it if you need to change it,” she says.

But that freedom also comes with risk and responsibility, Legge points out. “You have to be OK with the fact that when things go wrong, the only person you can look at to turn things around is yourself,” she says.

Likewise, when you become your own boss, some of the security that comes from working for someone else goes away, such as a steady paycheck and covered benefits. Legge refers to those kinds of benefits as “golden handcuffs” because, while valuable, people tend to cling to them at the expense of their larger dreams. They’re “the things that can and do keep them from getting what they say they really want,” Legge observes. “Each one of those things is just a dollar figure that can be figured into a budget so you know how much you need to make to pay for those things yourself.”

Before launching a private practice, Legge recommends that counselors imagine the kind of life they want to live and then design their private practice to fit that life. For instance, if counselors imagine living a life in which they spend more time with their families, then they might want to choose target markets based on clients who won’t routinely need appointments on weeknights and Saturdays, Legge says.

The question counselors need to ask themselves before jumping into anything, Legge says, is “What are you willing to do to get what you say you want?” For many counselors, in the end, the benefits of going into private practice or becoming their own boss in another way far outweigh the risks, she says.

Even so, when counselors strike out on their own, one of their biggest initial fears is that they will fail, Briggs says. “I think we all carry that [fear], like ‘I’m going to fall on my face, and the world’s going to laugh at me, and I’m going to be broke and living in a box under a railroad trestle.’”

Along those same lines, Legge says, counselors who are transitioning to private practice commonly worry whether they are skilled enough and qualified enough to warrant clients coming to their practice. They might start questioning why anyone would choose to see them when there are already so many other counselors in town. “Unfortunately, there are more than enough people who are in need to go around,” says Legge. She encourages the clients from her consulting practice to view those other counselors in their communities as colleagues and potential collaborators.

Some counselors even worry that they’re somehow selling out by moving into private practice, Briggs adds, recalling that when she left her job as an addictions counselor, she initially felt guilty. Because working with clients who struggled with addictions felt so meaningful and honorable, Briggs even wondered whether she was shallow for leaving that position to find a job she enjoyed more.

“A lot of us struggle with that: ‘People are going to think I’m a bad person if instead of working with the homeless population, I’m going to choose to work with college students,’” Briggs says. But her thinking has evolved since those early days. “Everybody’s got their place, and you just have to find the right place for you,” she asserts.

Let’s talk money

Counselors striking out on their own commonly worry about their bottom line, wondering if they will be able to make enough money to survive and keep their doors open. Complicating those worries, Legge and Briggs agree, is that the topic of money is already uncomfortable for many counselors. “I don’t know how it happens, but we’re socialized in [the] helping professions to think that helping others and making lots of money are contradictory,” Legge says.

Briggs concurs. Many times, she says, when counselors enter the profession, they hold tight to the attitude that they are choosing this career path to help people, not to make money. “It’s almost like those things are mutually exclusive, and I have a really big problem with that,” she says. “We’re never taught to be empowered around our skill set. We’re never taught how to ask for a livable wage around what we do. We sort of think, ‘If I’m not helping people directly, if I’m not with the most needy population, then I’m being greedy and squandering my skills.’”

That viewpoint is “absolutely inaccurate,” Briggs stresses. “Helping people and earning a good living are not mutually exclusive.”

Legge has received her fair share of criticism through the years for talking about how mental health professionals can make more money. She says much of the criticism has come from her fellow mental health professionals, including some who label her views as “mercenary.”

“What I come back with is, if you want to be in private practice in three years for [the sake of] your clients, then you have a responsibility to be a good businessperson and to make a living [so] that you can continue to be in private practice,”
Legge says.

Counselors planning to go into private practice need to address any hang-ups they have around money early on, Legge says. “If you want to draw money into your business, you’ve got to deal with your issues regarding money,” she says. “You just have to do it. If you’re afraid to ask for a copay, your client is going to pick that up in a heartbeat. If you’re uncomfortable telling a client over the phone what your fees are, they’re going to pick that up in a heartbeat.”

Legge has found that the more comfortable counselors are talking about money, the more comfortable their clients are with the topic, and the less likely it is to become an issue between them. In addition, counselors need to keep sight of their worth when talking about their fees or collecting payments from clients, she says.

“What is it worth to save a marriage? To save a kid? To live a better life? To save that job? What is it worth to my client?” Legge asks. “You’ve got to think about your worth in terms of what the value is to your client.”

When Briggs was doing a job for one of her first corporate clients a few years ago, she cited her fee for a one-hour presentation. The client replied by suggesting that she research the company and come back with a different price. Briggs returned with a quote five times that of what she had originally asked for, and the client accepted it. “That was really good for me to hear,” she says.

Although Briggs acknowledges that fees are still a topic she wrestles with from time to time, she says it is important for counselors to reach clarity on what they truly need as a livable wage and then to feel confident in stating that to others. To that end, Briggs says, when counselors are determining the fees they will charge, whether in private practice or in another setting, they should calculate what their livable wage is. That number should take into account expenses that are typically covered when working for someone else, such as health insurance and some amount of paid vacation, she says.

Putting yourself out there

Although business owners are responsible for growing their businesses and attracting clients, many counselors bristle at the concept of marketing and sales. When Legge works with helping professionals who want to start or grow a private practice, she reassures them that sales and marketing don’t have to feel “slimy.” A “brand” needs to be nothing more than how you want to be seen in the world — whom you serve, what you do and why you do it, Legge says.

Marketing starts with a paradigm shift that encompasses “going from the fear of being sales-y” to the perspective of getting to know your community and your target market in particular, Legge says, “so they can rely on you, build a relationship with you and so that when they need you, they’ll know where to find you.”

Briggs echoes the point about counselors changing their perspective on what it means to market or sell themselves. Many people equate business with greed, marketing with sleazy sales tactics and networking with schmoozing, but that isn’t necessarily true, she says.

“Networking is walking into a room full of really cool people and getting to know them. Counselors are great at that,” Briggs says. “And marketing is about building relationships — counselors are great at that. And business is about finding a way to apply your skills so that you can benefit the world and earn a decent income. There’s nothing sleazy about any of it when you reframe it in a way that’s authentic for you. The goal really becomes to redefine it in a way that’s authentic for you and [to] own that. And then it stops being creepy and weird and starts feeling more natural.”

David P. Diana is a marketing consultant and licensed professional counselor who runs a marketing firm specializing in serving health care organizations and practices. He is also the author of the book Marketing for the Mental Health Professional: An Innovative Guide for Practitioners. He points out that marketing isn’t a quick-fix process for mental health professionals but rather something that happens over time based on a clinician’s work and actions.

“Too often, people look at marketing in crisis mode,” Diana says. “Perhaps they lose several clients, and then they say to themselves, ‘I need to get the word out about my work to fill these holes.’ The problem with this reactionary mode of marketing is that it rarely works. People often make the decision to advertise their practice, hand out fliers, etc., in the hopes that the phone will ring again. However, marketing involves much more work than that to create change and interest.”

That said, Diana offers a few key points for mental health professionals to consider when they think about marketing. First, he says, put the emphasis on why you do what you do as a counselor, offering potential clients a mission and a story with which they might connect.

Second, Diana says, don’t devote time, energy and resources trying to be the right clinician for everyone. “If you focus on your why, then you have a chance to share a story with an audience that wants to hear that story,” he says. “When your values [and] purpose match up with a group of people with similar values [and] purpose, then you have found your audience.”

Diana concludes by reminding counselors that advertising is not marketing. “Marketing is about conversations and connecting your story to an audience that wants and needs to hear that story,” he explains. “Marketing to a mass audience via advertising yields very little results because there are so many fragmented markets and because we, as consumers, have access to so much information.”

Marketing comes from a “heart of service,” Legge adds, and from a desire to help the community. “If you believe you’re meant to serve others,” she says, “then you have a responsibility to let the community know you exist as a viable resource for them.”

Putting that brand of marketing into action begins by building relationships, Legge says. Especially initially, it means that counselors concentrate not on where they’ll get their next referral, she says, but on finding out more about their target market — what those potential clients in their community need, what their biggest problems are and how that counselor can help.

In getting to know people in their communities, Legge says, counselors will learn about what those people need and where to find them. In turn, those people will learn about the counselor, see that the counselor has credibility and come to rely on and trust the counselor, she says.

Briggs calls word-of-mouth a huge force in driving new clients to counselors. Having a web presence can also help counselors get their message out, “even if it’s just a professional Facebook page where you’re advertising who you are, what you do and what you’re about,” she says. At the same time, Briggs says, social media requires that counselors engage in a “delicate dance” in which they take advantage of the inherent marketing opportunities while simultaneously ensuring that they don’t violate any ethical boundaries.

Briggs also recommends that entrepreneurial counselors offer something for free — but get feedback in return. For instance, if you have a presentation for which you would eventually like to be paid, start out by offering it somewhere for free, but ask for comments and critiques. Another idea Briggs suggests is starting a blog or website focused on what you are interested in offering as a counselor. If you want to work with children, for example, establish a blog for moms and offer parenting tips. “Once people see the information and knowledge you have, they’re much more likely to pay you for it,” Briggs says.

The business of balance

Seeing clients while simultaneously running the logistics of a business can be challenging. Juggling both means a heavy dose of decision-making and delegating, Legge says. For example, it may not make sense to do business with every insurance company, she says. Consider the workload each insurance company would require of you and whether the company pays fairly before choosing to work with it.

Similar decisions must be made about other business tasks such as bookkeeping, billing and taxes, Legge says. “Depending on your talents and your interests, you may choose to do some of those things. But it may be much more reasonable to farm out some of this stuff, even though you’re going to pay to do it,” she says. Private practitioners have to consider the return on investment, she adds. “Does it make sense not to pay the $80 a month for the billing platform when you’re spending three hours a week on billing by hand?”

In terms of juggling client work with business tasks, Legge says each counselor has to figure out what process works best. She likes to finish her to-do list at the end of every workday, but she knows other mental health professionals who are more productive when they pile up their business tasks and do them all at once on a deadline.

Making it all work is a balancing act, says Briggs, who has side gigs that take up 20-30 hours a week on top of her full-time teaching job. One key for her has been learning to say no. She clarifies what her priorities are and dedicates time for them, even if it means saying no to another interesting opportunity.

Both Legge and Briggs recommend that counselors who are running their own businesses reassess their situations and business models regularly, but ideally every 90 days. They suggest reviewing what you’ve been doing, how it has been going, what you might like to change and whether you’re still enjoying the work.

Look before you leap

Although graduate counseling programs are already packed with requirements, Briggs says it seems “criminal” that electives in marketing and entrepreneurship aren’t offered more widely considering how many counselors are interested in private practice.

Many counselors feel very much on their own when they are learning to run a business, Legge says. That’s why many turn to books and blogs for helpful tips and information. In addition, she points out, some communities of mental health professionals have come together to support one another, and business coaches can also help.

One piece of wisdom Legge sometimes passes along to clients starting out in private practice is that they won’t be able to serve everyone all the time. That’s not always welcome news. Legge says some of her clients have expressed frustration that she can’t show them how to make a comfortable living working exclusively with individuals and families with low incomes, for examples. In that instance, she might tell counselors that although some of their practice can be dedicated to working with that client population, they also have a responsibility to supplement that with higher-paying work so they can stay in business for all of their clients. “Dollars are dollars, and it’s got to balance out at the end of the month,” Legge says.

It’s imperative for counselors to have a sense of what they’re stepping into, plus an understanding that it might require them to take baby steps in that direction rather than one big jump, Briggs says. “I’m not an advocate of quitting your job without a plan,” she asserts. Instead, counselors might consider giving themselves a two-year timeline during which they work full time and take a couple of side jobs to “test the waters,” Briggs says.

“Don’t think the bravest thing you can do is quit your day job,” Briggs counsels. Instead, go at the pace that’s right for you as you explore your entrepreneurial options, she says. “Take whatever time you need to take the leap, and don’t push yourself beyond where you’re comfortable.”

Legge further suggests finding support through a national association, continuing education classes or a group of peer clinicians who can provide guidance, encouragement and even group supervision.

Reflecting back to her advice about marketing, Legge says it is also important for counselors to build a foundation before launching their practice. Sometimes, she says, counselors work hard to start their business, hand out business cards and create a website, but then the phone doesn’t ring. The preemptive solution, she says, is to build relationships before starting a practice so that people in the community will know who you are, what you do and why you want to serve your fellow community members.

And perhaps most important, Briggs says, is for counselors to know their true value. “Get really clear on what you’re worth,” she says. “Know that what we do has immense value to others. People are going to be willing to pay for what you’re worth, and you can ask for it.”

 

****

To contact the individuals interviewed for this article, email:

 

****

 

Lynne Shallcross, a former associate editor and senior writer at Counseling Today, works for Kaiser Health News as a web producer. Contact her at lshallcross@gmail.com.

Letters to the editorct@counseling.org

 

****

Related reading

I want what I’m worth,” one counselor’s journey to diversify her work and take the road less traveled

Look before you leap,” an in-depth piece on what it takes to go into private practice

 

money1

Nonprofit News: Avoiding bankruptcy

By “Doc Warren” Corson III January 25, 2016

Depositphotos_1500242_l-2015Nonprofit News is dedicated to examining issues that are of particular interest to clinicians working in nonprofit settings.

Among the biggest fears for directors of nonprofit programs are bankruptcy, closure, takeover and termination. These problems can be headed off by providing good leadership, making wise decisions and ensuring the overall health of your programming. In fact, many of the skills you often use in general therapy can be applied to managing your program. Exploring options, consulting with others and staying current on related literature and techniques can make the difference between a stagnant program and one that is vibrant, both in the clinical and administrative positions.

There is no single way to run a successful program, but the following items may help in the decision-making process.

Don’t jump into expansion: Many nonprofit programs find themselves getting into trouble as a result of an expansion that overreaches or is simply unsustainable.

In my consulting work, I have seen startup programs that were developing a “dream sequence” of services and an office space that was impossible to pay for. Some programs used all of their startup and maintenance money (the typically two- to three-years’ worth of money set aside to cover day-to-day costs while building a client base) just to rent and renovate their space. Although their new offices were beyond amazing and often offered state-of-the-art luxuries, this did little to help the programs, which soon shuttered their doors due to a lack of funds to cover costs while they established themselves.

I have also witnessed established nonprofit programs “go for broke” and gamble on new buildings, programs or other large infrastructure items. The thinking of these programs is that the improvements will lift them to a higher level and thus “pay for itself in no time.” Only later do they realize that the anticipated demand was not there.

Doing a little homework may have helped these programs realize that it takes time to become self-sustaining, even with limited overhead. By getting into massive debt, they all but assured themselves that they would fail. Market analysis is good, but it is little more than a guide and, in my opinion, should never be considered a guarantee. Sure, there is a demand in your area, but who says the community will embrace you? You may be much better off opening modestly and growing steadily as demand dictates rather than starting off at a full gallop only to find clients trickling in.

With the nonprofit program that I started, we opened our doors with a personal loan of $7,000. We were beyond humble: hand-me-down furniture, no fax machine and no advertising other than a press release. But we had a business model that called for modest and immediate reinvestment. Within weeks, we had the basic business equipment necessary, and within a year, our offices had been greatly improved, including the addition of durable furniture, most of which is still in use and in fine shape more than a decade later. (Helpful hint: Avoid trendy furniture and go for leather. It can be timeless and, although it costs more at purchase, it lasts far longer than fabric, which tends to look dingy after a few years of constant use).

Avoid loans and other financing when possible: Only use loans when absolutely necessary. Mortgages are often a part of life, but keep them to a minimum. It’s easy to get a loan for an addition when you have collateral, but this money needs to be repaid with interest. So unless you can afford to make that payment without counting on new revenue streams that may or may not materialize as part of the remodel, you could find yourself in dire straits. Sure, the model I am promoting may slow the pace of program growth, but it allows for real and sustained growth that also provides a healthier bottom line.

Look at trends (both emerging and waning) and know your audience: Knowing the state of your profession and your area can make a big difference. Look for things that may be at the verge of a great shift. Consider trying these things so long as they fit your overall mission. Also be prepared to scale back programs that may have hit their terminal velocity and are poised for reduced demand in the near future.

Consider your core client base: What do they want? What will they likely continue to want? What are they asking for that you currently lack?

In 2006, I saw a landscape that I thought might be on the verge of changing. For years, the focus had been on city life, high finance, and flashy clothes and lifestyle. I felt this trend was becoming played out to a large extent, at least in my part of the world. Always being a naturist at heart, I began exploring more earth- and nature-centered programming while staying true to my behaviorist mindset (I have an autographed picture of Albert Ellis in my main office). We explored ways to incorporate open space and nontraditional methods. Not all of our clients embraced the change, but we made it possible so that they were able to keep the traditional programming they loved as well. In time, we leased a local farm, and in short order we purchased the first chunk of it, as well as a few buildings. We steadily improved the land and buildings and built proper offices, without loans other than our mortgage. We continue to build steadily year after year and have experienced a large following and swell of support.

Here we are in 2016, and now you can Google “therapeutic farms” and find programs in many areas. This trend too will one day wane, but when it does, we should maintain well because of our lack of extended credit lines. Find your niche, but do not go too far into debt to pay for it.

Screen staff and maintain standards: Being good at what you do will enable you and your program to do well. But as you grow and need to add additional staff, maintaining standards can be difficult. Make sure to properly screen potential employees and thoroughly impart to them your core beliefs, philosophies and expectations for performance. Even this does not ensure quality care, but it will increase the likelihood of keeping turnover low. Many nonprofit programs suffer from hiring folks who turn from the program’s core philosophy and attempt to superimpose their own. Oversight and thorough supervision can help prevent this.

Remember your core mission: Mission creep can kill a program. Although there will be a need to expand services from time to time to meet the needs of your clients and to improve programming, it is important to regularly review your mission statement and core values to ensure that the changes meet the spirit (if not the actual letter) of the original intent. Mission statements can be altered when needed, but moving too far from your original mission can cause undue dilution of an otherwise solid program. Such dilution can confuse your client base and result in a reduction of referrals and other calls for services.

Build your board of directors: A board of directors is the steering wheel of any charity. Though not directly involved in day-to-day operations and activities, the board of directors is charged with guiding the charity in areas such as programming, financing, infrastructure and future development. When selecting potential board members, it is imperative to approach individuals who have a full understanding of the program’s core values, mission statement, psychology and mindset. By selecting members who “get” the charity, you are more likely to have a group of directors that is dedicated to your core values and to sustaining the overall feel and function of the programming.

Although each new year brings many challenges, with good fiscal sense and wise planning, there is little to fear and much to become excited about. The threat of bankruptcy need not be a specter hanging over your nonprofit.

 

****

 

Dr. Warren Corson III

Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org.