Tag Archives: Private Practice Management

Private Practice Management

Nonprofit News: Who are you and why should I use your services?

By “Doc Warren” Corson III March 5, 2018

In the past few months, emails from several continents have come in asking about ways to establish a nonprofit and attract clients. While the “how-tos” of starting a nonprofit vary from country to country and state to state (province to province) based on tax and other laws, the “how to” of attracting clients starts by answering a simple question: Who are you and why should I use your services? If you know this answer, you are well on your way to promoting the program.

Each of your employees should be able to give an “elevator pitch”— a short impromptu presentation promoting your program. The pitch gets its name from the idea that you might find yourself on an elevator next to a potential client, employer, funding source or whomever/whatever you are looking for. How can you sell yourself — and your services — in the time it takes for them to get to their destination? You may have a few minutes or just 30 seconds, but you definitely do not have the time to give a full-fledged presentation complete with 27 glossy 8 x 10 color photos, a business plan and market analysis. Instead, you have at best a few hundred words, or the amount that you have read of this column so far, to impress them. It’s not easy, but once you have it down, you can do it on command at any time.

When I work with folks, I often ask them to pitch me their program. Pitching can be distasteful for many of us — as counselors, we do not like to think of our work as selling. But we need to promote what makes our program special. In most cities and towns there are many programs that offer the same or similar services — why should people pick us?

What makes your program special? What makes you unique? Is there something that you or your program offers that you feel no other program does or does in the same way? What separates you from the competition? In our case, the other programs in the area featured sterile office environments and a “take a number” deli feel. In response to we pitched that we offered a homelike setting focused on the individual and that we incorporated nature.

When you pitch, you need not tell your audience everything about what you’re pitching. You simply need to tell your listeners enough to whet their interest and then give them a chance to reply and ask questions. Below are some examples of an elevator pitch with varying amounts of information based on what you think you may have time wise. You can develop some of your own, and they need not be the same basic pitch with additional information; each one can be unique if you prefer.

Examples:

“We are a nonprofit mental health counseling and wellness program serving all ages regardless of their ability to pay, via two program locations, one being a therapeutic farm. We are in Bristol and Wolcott, Connecticut.” – 35 words

 

“We are a nonprofit mental health counseling and wellness program serving all ages regardless of their ability to pay, via two program locations; one being a therapeutic farm that has hiking trails, therapeutic gardens, therapeutic animals and educational programming. We are in Bristol and Wolcott, Connecticut.” – 46 words

 

“We are a nonprofit mental health counseling and wellness program serving all ages regardless of their ability to pay, via two program locations; one being a therapeutic farm that has hiking trails, therapeutic gardens, therapeutic animals and educational programming. We also provide training for clinical professionals. We are in Bristol and Wolcott, Connecticut. We do this with a team of paid and volunteer staff, and we serve hundreds of individuals and families for less money than some companies spend on catering.” – 81 words

 

“I founded a nonprofit mental health and wellness program in 2005 because I was unhappy with what I saw as a diminished focus on individual needs in favor of generic one size fits all programming. Since then, via a mostly volunteer team with some paid staff, we have expanded to two locations including a therapeutic farm that has about 50 acres of fields and forests, trails and therapeutic animal and gardening areas including greenhouses that offer ADA compliant beds. We serve all ages in an environment that helps people feel welcome, included, valued and above all comfortable. We are in Bristol and Wolcott, Connecticut.” – 104 words

 

What to consider:

When developing your pitch try to answer the following questions:

  • Who do you serve?
  • What is your specialty area?
  • What services do you offer?
  • What is the hook? Why you instead of the others? (Never put down the competition — simply highlight things that you have that others may lack.)

Do you have email and web addresses that are easy to remember? A person may not ask you for a card but may be curious later. An easy to remember email or web address can save the day. Your address need not be the name of your program. For instance, the farm we purchased was named “Pillwillop Farm,” and we simply added therapeutic to it. Few folks can recall it and when they do most mispronounce it and cannot even guess how to spell it. When they do try, “pillowtop farm” is the most frequent result. While we did purchase “Pillwillop.org” as a site, we went with the far easier “docwarren.org” and docwarren@docwarren.org for the main domain and email addresses. With these in place, people are much more likely to remember them or at least get them close enough that their web browser will pick up on it and direct them to us. In fact, our web and email addresses came at the suggestion of our clients; they knew what they wanted, and we gave it to them.

 

Once your pitch is done do not be afraid of silence — your audience may be considering what you had to say. Also, try not to push your card or other information on folks. I personally prefer to wait to see if they request it. The questions your pitch audience poses may surprise you, and the conversation may take a path that you never considered. Learn from these conversations and adjust your pitch as you see the need.

Take some time and think about who you are and why folks should use your services. You likely offer far more than you realize.

 

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

 

“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.

 

 

 

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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.

The Counseling Connoisseur: Compassion and self-care during flu season

By Cheryl Fisher February 16, 2018

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” ― Audre Lorde

 

The familiar buzz from my bedside wakes me. Squinting, I pick up my cell phone, and I see that a client is notifying me of her current malady. She describes, in detail, her symptoms which include a fever, digestive discontent and upper respiratory discomfort. “But I plan on coming to my appointment tomorrow, Dr. Fisher,” she writes. I bolt up from the comfort of my bed, now fully awake at the thought of this client infecting my office, and reply as therapeutically as I can at 2 a.m., “Oh my goodness, no. Please stay home, drink lots of liquids and get your rest. We can reschedule for next week.” Whew! Crisis averted. Dodged that one! I roll over and resume my sleep, albeit a bit less restful.

A few hours later, I am (again) awakened by my phone. It is another client who has been up all night vomiting. She will not be in today. Thank goodness! Again, I write a compassionate and caring response wishing her a speedy recovery. I roll over and surrender to an extra hour of sleep.

My alarm sounds and I roll out of bed and prepare for my very full day — minus the two clients who are ill.

My phone rings. It’s a client who was driving to the office and had to stop because she doubled over in intestinal distress. Another client ill! No worries —

I have paperwork to do. I settle in front of my computer, and I notice an email — another client is sick and won’t be making her appointment.

I begin making calls from my cancellation list as I wait for my next client. I am able to fill most of the open spaces. I note the time — my next client should have arrived. I open my office door and walk to the waiting area, where my next client sits, complete with glazed and droopy eyes and a red runny nose. With a deep cough, he stands and extends his hand, which is stuffed with tissues.

It’s flu season!

As counselors, we sit with people who are in emotional and psychological pain and discomfort. We provide them with a compassionate and welcoming space to express their pain with the hope of lightening the load and identifying strategies for care. Our physical wellness informs our mental comfort and we certainly want to be available for our clients. I would like to think of myself as a compassionate person. I know my clients certainly hold me to this standard. However, how do we offer compassion and promote self-care?

Here are a few tips to get you and your clients through this cold and flu season:

  1. Wash your hands frequently: The U.S. Centers for Disease Control and Prevention (CDC) recommends thoroughly washing hands frequently throughout the day. If soap and water are not accessible, keep a bottle of alcohol-based hand sanitizer in your office and waiting area.
  2. Offer tissues: As counselors, we understand the comfort in a box of tissues. Be certain to have several boxes on hand for clients. Do not forget to also have multiple trash receptacles available.
  3. Keep fluids on hand: I offer my clients filtered water, coffee, hot chocolate, or tea. I like to keep a variety of teas including echinacea, peppermint, ginger and chamomile for their various soothing qualities. I also have local honey on hand.
  4. Assemble a care kit: Keep a care kit of lip balm (for yourself), lotion and hard candies. I keep separate hand lotion for clients by the sinks in my kitchenette and in the bathroom. I have a bowl of Key lime-flavored hard candy in my office and waiting areas. This extra effort can offer great comfort during the cold season.
  5. Disinfect your office: I spray my office at the beginning and end of my day with a natural disinfectant spray to eliminate possible contaminants. It cleanses the air and makes the office smell great.
  6. Use sanitary wipes to clean surfaces: I keep a container of sanitary wipes on hand to wipe down my phone, desktop, computer and the arms and backs of furniture. Body oils (and germs) can build up and remain on furniture.
  7. Clarify your cancellation policy: I inform my clients during the intake that I will waive the late cancellation fee for illness. I prefer that they stay home and rest rather than come into the office — for everyone’s sake.
  8. Consider offering teletherapy: I became a distance certified counselor (DCC) many years ago and provide phone and web-based counseling sessions under a variety of circumstances. Many of my clients opt for teletherapy when the weather is poor while caring for a sick relative, or when they are not feeling well but want the support of therapy. Counselors need not be certified to offer teletherapy, but I highly recommend it. Some insurance companies offer reimbursement for distance counseling, so check with your provider.

 

This time of year offers multiple challenges including colds and flu. As counselors, we can provide our clients with psychoeducation around the importance of self-care, rest, nutrition, exercise and fresh air. We can model good care by engaging in a healthy lifestyle. And, when we do succumb to the flu, we can demonstrate care by taking the time off to get the rest we need. We can offer compassion while promoting self-care.

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty at Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

 

 

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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.

 

 

 

 

 

Technology Tutor: Scams aimed at counselors

By Rob Reinhardt January 18, 2018

Unlike social media, scams aren’t something new brought on by the advent of technology and the internet. Con artists, swindlers, charlatans, grifters — whatever you might call them — have existed since the dawn of humanity. What is new, however, is that these purveyors of fraud can carry out their schemes with more reach, speed and efficiency because of technology. A number of these scams are even targeted directly at mental health professionals. I have heard about some of these scams often enough over the past few years that I thought it would be helpful to summarize a few of them here to help prevent counselors from getting ensnared.

This is by no means an exhaustive list because new scams are cropping up all the time. We can expect continued and probably increased attempts aimed at mental health professionals because medical data carry such high value. It probably doesn’t help that counselors are altruistic and potentially more prone to easily trusting others. This makes many of us ideal targets for scammers.

The overpayment scam

In my experience, the overpayment scam has been the most prevalent in recent years. It starts with the counselor receiving an email requesting services from someone. Typically, the prospective client suggests that they are out of town or out of the country but want to secure several appointments for when they return. They offer to send a check for payment upfront for multiple sessions.

Shortly after the check is received, the person contacts the counselor, saying either that they have “mistakenly overpaid” or suddenly realized that they won’t be in town for all of the sessions for which they have paid. The person then asks the counselor to send a refund for the difference, typically via wire transfer. The scam is that the check the person sent is fraudulent. The counselor sends the refund, only to find out later that the check has bounced or been identified as a forgery, so the counselor has no recourse.

There are slight variants to this scam, including the con artist stating upfront that they are going to overpay and request a refund. In another frequent variant, the con artist suggests that they want to pay for services for a child, relative or friend who lives in the counselor’s area. In one of the most convincing versions I have heard about, the scammer suggests that he or she is part of a couple seeking counseling. The person goes into great detail about their issues and their desire to get several counseling sessions in while they are “back in town.” Alternatively, they have a very convincing reason why they can’t attend counseling where they live and thus are seeking services elsewhere.

Sadly, counselors who fall victim to this scam can end up dealing with more trouble than a simple loss of funds. If they cash the fraudulent check, the bank and, potentially, federal investigators may investigate to ensure that the counselor is not a willing participant in the scheme.

HIPAA phishing email

Although I haven’t seen the HIPAA phishing email lately, it’s a good example of how convincing phishing scams can look. A phishing attack is when someone with less than good intentions attempts to get information from you, typically by posing as another entity.

At the end of 2016, many medical professionals received what appeared to be an official email from the federal Department of Health and Human Services (HHS) Office for Civil Rights (OCR), the folks responsible for enforcing the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The email came from OSOCRAudit@hhs-gov.us and directed people to a website:
www.hhs-gov.us.

The email was on mock HHS letterhead and suggested that the recipient might be included in the HIPAA Privacy, Security and Breach Rules Audit Program. The link led to a website that was marketing cybersecurity services. It was convincing, in part, because of how similar the addresses were to the legitimate HHS website, which exists at hhs.gov, and the HHS email address of OSOCRAudit@hhs.gov.

For more details on phishing scams and tips for recognizing and avoiding them, read my blog post at bit.ly/TYPphishing.

You too can be a radio host

The following scenario might be filed under “disingenuous” rather than full-blown scam. It starts with an email or phone call suggesting that you would be a great person to have their own radio show on a popular radio or podcasting network. You may or may not have heard of this network. The questionable part of this scheme is that they only tell you further along in the process that you actually have to pay for “radio time.”

In a variant to this, you are invited to interview on an existing show. After the recording and a producer raving about how you’re “a natural” for radio, they spell out what it will cost to have your own show.

Not a scam: Informational audits

Many counselors have been receiving requests from third-party vendors, purportedly on behalf of private insurance companies, requesting client documentation for purposes of a “chart audit.” These can actually be legitimate requests. Insurance companies use this information for internal purposes, such as Affordable Care Act reporting, justifying rate increases and more. The chart audit isn’t the same as an audit to gauge medical necessity. It is more about quantifying things such as the frequency of certain diagnoses and codes.

Interestingly, the letters, emails and phone calls from these third-party vendors tend to be vague and ask for complete charts when those aren’t always necessary. This makes these requests look like scams. It can be especially concerning when something resembles a scam, yet the vendor mentions specific clients and dates of birth within the communication.

If you are in network with the insurance company, some question exists about whether you need to participate in these audits. Review your contract and consult with an attorney if you are unsure. As a first step, ask the third-party vendor to provide official documentation from the insurance company proving that the vendor is carrying out official business on the insurance company’s behalf. It is also prudent to verify this directly with the insurance company. My understanding is that counselors who are out-of-network providers are under no obligation to respond.

 

Ways to avoid scams

Trust your instincts: If red flags are raised for you, stop and investigate. Seek consultation, ask colleagues about it and do an internet search to determine whether the situation you are encountering has been seen before by others. Typical warning signs include prospective clients stating how many sessions they want and when, providing false phone numbers and asking for very specific modalities of treatment without apparent justification or understanding. In addition, any request from an unknown entity made via email or over the phone for client information or sensitive clinician information should be met with a healthy dose of skepticism.

Take your time: As natural helpers, our instinct may be to respond to requests promptly. If a request makes you feel uneasy, however, it is important to slow down and ensure that it is legitimate.

Use caution with checks: Especially in this day and age when credit card payments are the norm, accept payment via check only from trusted parties and only for the correct amount. It is important to note that you are responsible for any funds deposited via check. You are not safe just because a check initially clears. If the check is later discovered to be fraudulent, you will have to refund that money to the bank.

Report it: Many government agencies are involved with battling fraud and crime. The following website can help you determine where to report a scam: usa.gov/stop-scams-frauds.

 

Have you received a communication that you’re unsure about? Do you think you may have identified a new scam? Drop me a line at rob@tameyourpractice.com so we can investigate.

 

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Related reading from the Counseling Today archives, on the overpayment scam: “Fraudster targets counselor’s innate empathy

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editorct@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.

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.

 

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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.

 

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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.

 

 

 

 

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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.

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.

 

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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.

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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.

 

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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.