Tag Archives: Private Practice Management

Private Practice Management

Establishing a private practice

By Laurie Meyers March 22, 2019

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

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

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

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

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

 

Tapping into the power of the internet

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Knowing your strengths and maintaining flexibility

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

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

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

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

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

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

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

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

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

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

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

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

 

Identifying a need and growing into a group practice

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

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

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

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

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

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

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

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

 

Keeping clinical skills sharp as a counselor educator

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

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

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

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

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

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

 

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Additional resources

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

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

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

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

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

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

  • Self-Care

 

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

Letters to the editor: ct@counseling.org

 

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

 

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.