I am opening up this coaching blog to several of the top clinical experts and diverse private practice therapists around the U.S. and world.
I asked each colleague to share a top tip that has contributed to their success. I've outlined their fab responses below as a support to those of you who are new therapists and would like to open a private practice, or are new to private practice. Enjoy!
Tips from Mari - The Counselor's Coach
As a coach specializing in helping other therapists create successful private practices, I'll start this blog with my three top tips, and then I invite you scroll down to read the other wonderful tips from other successful therapists in the field...
Mari's Three Tips:
1. Diversify your practice and create multiple income streams, active, passive and leveraged to avoid professional burn out and to meet your financial goals. What does this mean?
A solo private practice is an example of an active income stream in that the therapist must be present with the client in order to make their fee. Leveraged income is when the therapist takes approximately the same amount of time, supporting more individuals, thus increases their income for that time. For example, group therapy, workshops, paid webinars, and paid speaking engagements are examples of leveraged income streams. Additional tip: If you are going to start facilitating group therapy, please be sure to have your procedures, policies and forms in place. You can read important and practical tips about starting a therapy group here.
Finally, add a passive income stream. This can be done by selling a book, an e-course, or a digital workbook for example. By diversifying this way you have many streams of income flowing into your professional bank account. You can read more about that process and how to set this up here.
2. Invest in a really good website that is rich in unique solid content, written in your own style, that is easy to navigate, is attractive, and speaks to your ideal client. You should be writing directly to your client's pain points and heart.
And remember, while content is incredibly important, SEO is King (or Queen as it were). With that in mind, for the love of all things website, be sure that you hire a website designer who is SEO savvy, or is at least willing to learn about SEO, or works with an SEO expert.
You don't want to spend a ton of money on a gorgeous website only to have it buried on the 10th page of a google search; your goals should include being one of the top websites that pops up on a google search. You can read more about this process here.
3. Make sure you have a solid set of clinical forms that cover you legally and ethically. Your forms should minimally include: a thorough informed consent, limits of confidentiality, bio/psycho/social evaluation, fee and fee increases, out of session contact, cancellation policy, sick policy, no secrets policy, social media policy, clinical boundaries, your specialization, release of information, and so forth. If you would prefer not to reinvent the wheel, you can download my complete forms packet here.
~ Mari A. Lee, LMFT, CSAT-S, Founder of Growth Counseling Services, Inc. a fee for service private practice center in Southern California, author of the best selling books, "Facing Heartbreak" and "The Creative Clinician", national speaker, and founder of The Counselor's Coach.
The Experts Weigh In
Let's hear from other successful private practice therapists and see what their top tips are:
3. Have a hobby or outside interest that has nothing to do with therapy!
~ Kaye B. Williams, LMFT, CSAT, Franklin, TN
From Mari: I love this wise tip from Kaye as it is one of the key supports in avoiding burn out. So, how does one build in regular time off while juggling life, work and building a successful private practice? This blog will outline extra tips on this topic and how I manage to take every 5th week off and still meet my financial goals (and no I am not independently wealthy, nor do I have a fairy godmother or godfather helping me out): http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/stuff-happens-the-personal-side-of-private-practice
4. My recommendation is to create as many connections with other therapists in your area as possible. This requires letting go of the "scarcity mindset" and adopting an abundant mindset. One that allows for the knowledge that there is more than enough business to go around. Creating authentic, collegial relationships with other therapists allows them to know you and your work and you to know theirs. This knowledge supports clients and business growth.
~ Traci Lowenthal, Psy.D. Redlands & Claremont, CA
5. The biggest piece of advice I would give is to start with a niche. This means knowing who you want to be your ideal client. It's hard to be patient for this when starting a new practice, but it can help you focus your marketing strategy.
~ Michael Salas, MA, LPC-S, CSAT, CST, Dallas, TX
From Mari: Michael is spot on with his advise to niche your practice. Because this can be confusing, I outline the niche process step-by-step in this blog, scroll down to Tip #7 on this link to learn exactly how this is done: http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/15-solid-tips-for-marketing-and-building-your-private-practice-in-the-first-year
6. Implement a strong court policy from the "get go." This is a great start to CYA, a must in any business. And if implemented early on, it will add protection, implement court fees, and set limits on what you don't want to do in your practice...i.e. court letters with opinions. CYA! Set the framework now.
~ Nicol Stolar-Peterson, LCSW, BCD, expert witness and court performance coach, Temecula, CA
From Mari: Loving this CYA tip (i.e. cover your ass) from expert Nicol. Spelling out your court policy in your clinical forms and intake packet is incredibly important, yet so few therapists understand this. If you need a court consultant, Nicol is your woman! This blog will go in to great detail on this tip and give you specific information to include in your own clinical consent forms so that you are covering your tush: http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/what-a-therapist-should-include-for-court-fees-in-their-informed-consent-forms?rq=court%20fees
7. I have a few tips for the phone: I try and answer texts and the phone when possible as it saves time for returning calls and a rescheduled client is a client who did not cancel means that money is not lost for that week. If they have other business outside of rescheduling, then I remind the client those topics are to be addressed at their appointment time during their session. I also load their name and info into the phone and add notes re crisis, missed apts and money owed so I am in the know before I take the call.
~ Tamara Allen, LPC-S, NCC, CSAT, Fort Worth and Bedford TX
From Mari: Such a great tip that Tamara has shared. Not only does this extend respect to the client in answering their call or email in a timely manner (or at least within 24 hours), it also saves you time in the long run. Important Note: Make sure that you are storing client's information in a HIPAA compliant manner, using encryption, password protection, and other important methods that are essential to uphold client confidentiality. Checking with your state board as staying on top of HIPAA laws is an important part of building a solid legal and ethical foundation for your practice.
8. My tip for a therapist new to private practice is to breathe through the anxiety and sense of overwhelm you may experience. Know that you can and will build a successful practice, but don't beat yourself up for not learning fast enough or making mis-steps along the way. Breathe, break your to do list into more manageable tasks, and ask for support when needed.
~ Sarah Leitschuh Counseling, MA, LMFT Eagan, MN
From Mari: Sarah's tip is one of my favorites! Here is a fun supportive tool that helps a therapist new to private practice learn to lean in to the risk of new beginnings and still stay centered while breathing through the process: http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/xog4pfeksxa0soxhab6m698ygtlbhn
9. Find a gifted mentor! No matter how skilled a clinician you may be, your first year in practice is filled with challenges of all different kinds. The ability to have someone that understands and has overcome similar challenges is invaluable! Be vulnerable and allow your mentor to help guide you and learn from your mistakes (which you will inevitably make along the way), support you in times of need, and celebrate your wins! Your mentor is always one of your most valuable resources!
~ Bren M. Chasse, LMFT, Pasadena, CA
From Mari: Such a great tip from our expert Bren! A side note on mentors vs. coaches: My coaching clients often share that they consider me as their coach and mentor, which always adds a smile to my heart. And they value my time, expertise and support by setting up sessions and paying me for my time. In between sessions a coaching client may reach out for a quick question, or to run something by me which I make room for on occasion.
Remember, a mentor is usually someone who is willing to give you compassionate encouragement or advise without payment. As such it is wise to make sure you are clear on what the expectations are in your relationship as some mentors do charge for their time after a certain point. I wrote a blog on this topic that has been very helpful for both the mentor in having good boundaries with their time, the coach in charging for their time, and the person in need of support in understanding how to honor their mentor or coaches time: http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/how-to-handle-freebie-requests-like-a-gracious-boss
10. My tip is that when new therapists struggle with whether they want to take a new client at a reduced fee. I was told a way to handle this is to offer a session at whatever this reduced fee is and tell the client "I can see you one time for X fee and during that time I can determine if I will be able to continue to see you at that fee (assuming the client wants to continue), or offer other qualified referrals. Then the therapist can decide if working with that person at that fee is a "worthwhile" hour. Over the years some of my favorite clients came to me that way. This way the therapist is not blindly agreeing to see someone who they might not enjoy at a sliding scale for longer time.
~ Cheryl Grant LMFT, CSAT, SEP. West Los Angeles and Sherman Oaks, CA
11. Do the work that feeds your soul! This is the best work that you can do, that will be of the most benefit to your ideal clients. Speak directly to them on your website, in your blog posts. And, please remember: Marketing is not about selling yourself, it’s about letting the folks you can serve best know that the help they need is available. You can’t help them if they can’t find you!"
~ Renee Beck, LMFT21060. Online in CA and Oakland office.
12. Come from an "abundance" mindset. I truly believe in supporting, helping and wishing success for therapists I know and trust. As we've all learned, what we put out returns to us, coming from a place of support and positivity has benefited me in many ways, and it just feels right. There really are enough clients for all of us, and it's beneficial for our profession for clients to find the right fit for them.
~ Stephanie Macadaan, LMFT, Los Angeles, CA
13. Schedule EVERYTHING. That way you can see exactly where your time is being spent. Time is not your enemy, you have as much as everyone else. One of two things will happen - you will realize that you are completely unrealistic with your expectations of yourself and time and you can make change and stop self shaming, OR you will realize you have a lot of time that can still be useful to you and others.
~ Jo Muirhead Founder & Principal Consultant. BHlthSc(Rehabilitation Counselling) MASRC, MCDAA
14. Choose to work with a niche that resonates strongly with you. This ensures coming into the office is a joyful journey daily. Define that niche, excel in that niche and run with it. Build your niche based practice and the clients will run to you.
~ Noreen Iqbal, LCSW, East Brunswick, New Jersey
15. Create a fee structure (fee range) and stick with it. Sliding outside that range just to get clients will pollute your fee model and disrupt your revenue stream, making it harder for you to command your full rate. You might have to work through some anxiety in the short term, but in the long run, your practice will be more financially sound. Additionally, having interns in your practice is a great way to cover the lower end of the fee spectrum. Clients who can't afford you, can work with a therapist who is under your supervision, which can be the next best thing.
~ Aaron Alan, MA, LMFT, CSAT-S. Los Angeles, CA
From Mari: I did a happy dance when I saw this tip come in from Aaron Alan, a very successful therapist in the L.A. area. Fees are one of the top anxiety points I address with coaching clients all around the U.S. and abroad. I wrote this blog (link below) to give you, the therapist new to private practice, some very clear perspective on fees and valuing your time. This goes right into the formula and breaks down fees, taxes, and net income in an easy format - even if you are not a "numbers person", you'll be able to follow this. Be prepared to have your eyes opened on why charging your worth from an income perspective is imperative: http://www.thecounselorscoach.com/practice-business-building-ideas-counselor-blog/those-therapists-must-be-raking-in-the-big-bucksand-other-myths
16. Our work in helping people usually feels so good, but dealing with difficult clients is one of the hardest things we need to navigate. When you’re confronted with a patient who is really hard to sit with or is resisting your help, try this tip: Find and Follow your Compassion. First of all, find your own self-compassion — recognize what’s getting triggered in you and attend to it as you need to (awareness, journaling, consultation). Secondly, find compassion for your client — what’s going on for them beneath that difficult exterior? Then attune to them there and speak right to that spot in them (if they will allow it), or hold it in your mind for understanding and tolerating those difficult moments with them in the meantime.
~ Sona DeLurgio, Psy.D, LMFT, Westlake Village, CA
From Mari: Sona has given expert advise with her tip, and I am so glad she included this. To piggy back on this wise information from Sona, it is good to remember that resistance is sometimes due to a person's impaired executive functioning.
As clinicians, we understand that executive functioning consists of various skills that assist a person's brain to organize and act on information.
Healthy executive functioning enables people to organize and focus, it assists with memory and helps the person prioritize and execute tasks fairly smoothly.
Additionally, healthy executive functioning also helps people use information and experiences from the past to solve current problems.
For people who have experienced head injuries, intense trauma, bullying, academic trauma, or other organic challenges that impact executive functioning (such as ADHD and anxiety), these clients can come across as "flakey", frightened, or unreliable, or resistant, or their trauma may show up on Axis II (for example Borderline Personality Disorder).
I have found that these individuals are incredibly intelligent and creative, but because of a history of critical push back from their families or their teachers, or their spouses or bosses, this has impacted their attachment and possibility their executive functioning. Their internal message is often shame based ("I am a fuck up, I am going to fail, I can never do this right, I am afraid to ask a question, therapy is scary, my therapist doesn't like me").
Shame can then fossilize and shift into defensiveness, self loathing, withdrawing from others (including the therapist), or even blaming others (including the therapist). Especially if the person has not been supported in therapy before and has no idea they deal with impaired executive functioning, or a personality disorder.
It is wise to seek a consult or supervision with a seasoned therapist, like Sona, if you find yourself in a difficult client relationship. Trying to figure it all out with out support, and staying isolated is often what lands therapists in hot water. So reach out and refer out as needed.
17. Having been in private practice for 5 years, my advice is to keep overheads low especially the rent, network in the community, in strategic online and print marketing, invest in a great website and online presence, create a niche with passion, and get certification for the same. Private Pay is different the first two years but if you persist and are patient , clients will seek you for your niche.
~ Darshana Doshi, Diamond Bar, CA
18. Like many people, I started my practice while working a full-time job. I had a tight budget, so I opted to share office space with another therapist as a way to reduce expenses. This was a great arrangement because I was only using the office a couple days a week anyway. And once I rented my own office, I subleased to a colleague who was building her practice. It was a win-win for both of us! As a sub-tenant be sure to sign a lease and get a copy of the master lease to protect yourself legally.
~ Sharon Martin, LCSW, San Jose, CA
19. Be ready for the Axis II's in your career. They sometimes will sneak up on you, make you feel special, and then - Wham!! You're the worse person in the world - just like the others who have let them down. Don't let Axis II's take the wind out of your sails. Have a mantra ready... "I've just been borderlined and I'm OK!"
~ Kate Pieper, LMFT, Auburn, CA
From Mari: To add to Kate's tip, when a clinician first opens their private practice, it can be tempting to agree to support any client who calls in as you build your practice. However, if you make screening part of your intake policy, and you have a good referral list of therapists in a variety of specializations, you can save yourself, and the client, future headaches if you are not the right clinical fit and visa versa.
As clinicians we know that the client whose trauma shows up with borderline features, or is diagnosed on Axis II is terrified of abandonment. Clients who suffer with BPD can sometimes lash out with rage or "punish" the therapist with silence when the work becomes too activating. These hurting people are ready to be hurt by others, and are often hyper vigilant toward anything that feels like a criticism.
As a new clinician, if you choose to work with this population of client, I encourage you to seek out specialized training (Dialectical Behavior Therapy is considered a gold standard treatment modality with Axis II borderline personality disorder). These hurting human beings need specialized treatment, and a focused process in therapy, other wise it can feel personal to the clinician.
For example, I have consulted with therapists who have felt frightened, confused, and abused by a client with BPD. I remind them that we cannot be all things to all clients/people. As other experts have shared in their tips, be sure to have a niche that you are certified and trained in, and even then refer out when needed. Make sure you have a solid termination process as well to avoid client abandonment.
Careful assessment, a policy with intaking new clients, excellent clinical forms, and a strong referral list, as well as good boundaries in and out of session will help you stay out of projective identification or clinical boundary collapses with BPD clients. If you need a complete clinical forms packet that covers all of these bases, you can find that here.
And to Kate's point, don't let a challenging client or two take the wind out of your sails. Seek consultation or supervision, have good boundaries, get the training you need, and document carefully in your progress notes.
20. As a therapist specializing in anger reduction, a top tip that really helped me when I first began my private practice was teaching clients a tool called, "Rating Your Stress". Teaching clients how to rate their stress level from 1-10 helps them catch those feelings before they get out of control. People tend to ignore their stress when it’s low because they think it’s not a problem. Unfortunately, that increases the person's stress until they finally explode. A good rule of thumb is when stress reaches a 5, remove yourself. This is the time to practice self-care, not try to resolve things. According the the Gottman Institute when you’re stressed, the ability to hear what’s being said accurately is greatly diminished which leads to escalated anger and more conflict.
~ Michelle Farris, LMFT, Anger Expert, San Jose, CA
FROM MARI: I love that Michelle, a therapist who is known for her expert work with anger reduction, is offering a tip that supports the client in therapy. When we have resources, materials, and exercises as part of our clinical practice, a tool box if you will, clients appreciate and respond well to this. Michelle has an excellent e-book and e-course called "Taming your Anger" located on her website specific to anger reduction (link above).
If you are in need of a workbook that has a variety of exercises that cover everything from family of origin, attachment, communication, mindfulness, addiction, shame and other such categories, I've received great feedback from our community on my e-book, "The Creative Clinician: Exercises and Activities for Clients and Group Therapy" located here.
Start building your "library" of resources to draw on - you'll be glad you did!
21. My top tip for opening a group private practice is to get people on your team quickly. For example: An acountant, a CPA, join a consultation group, or seek supervision. Also, be sure to stay on top of self-care and take vacations!
~ Sherry Shockey-Pope, LMFT, Riverside, CA
From Mari: I love that our expert Sherry has included a reminder for self care in her tip. We healers work so hard in this complex and sometimes draining profession, and it is so important to fill our cup with regular time off.
Running a business can be stressful at times and it is easy to put self care last on the list. However, simple steps like starting your day off with a healthy breakfast, incorporating a yoga class, or getting out in nature more often are small ways to take care of you first.
Sometimes we healers need a more intentional break, a chance to restore our minds, bodies and spirits. If you have been feeling burnt out and in need of an adult "time out", my colleague Anna Osborn and I are co-facilitating the Shine Retreat for Women (sorry guys!) the weekend of Sept. 27-29th, 2019 in beautiful Laguna Beach, CA. to help women restore, connect, and get their shine back on.
If you would like to join us and other kind, inclusive and heart centered women this fall, you can learn more at the link below. All women, no matter your age, size, ethnicity or orientation are welcome! We keep the retreat small and close it at 40 women in order to foster connection, self care, relaxation, and fun! Here is the link for more information: www.ShineRetreatForWomen.com
22. Get confidence around your fee and learn to say it with a period behind it. Don't state your fee and immediately talk about how and why it's high, and go into offering a sliding scale or a conversation around it.
Assume that anyone and everyone contacting you will pay your fee and let them bring up whether it's too high for them. I've found if I just say, "My fee is (blank)" most people have just said OK and we move onto other questions. If it is too high for them, they can tell me and I'll ask what they had in mind to pay and then start that conversation. Try it.
~ John Berndt, LMFT #92229 Culver City, CA
(And here is another great tip from John - I could not decide which one was better, so I added both...)
23. Pursue specialized training or a certification. I have completed Level 3 in The Gottman Method and this has helped bring in clients. About half of the clients who contact me have found me through The Gottman Referral Network, which is only offered to therapists who have completed their training. Being a part of this network has really increased my business.
~ John Berndt, LMFT #92229 Culver City, CA
24. Primary care doctors often don't know how to emotionally support a patient who comes in crying because their depressed or anxious over "life". That's the void you can fill be being both a resource for education and a referral source. Don't be afraid to let them know you can be of service to them and their patients. Wouldn't it be nice for their patients to leave with a rx AND a direct referral to you?
~ Kim Knight, MS, LMHC Long Island, NY
25. Do not claim specialist status in areas in which you have not had advanced training. "Common knowledge" about areas you may think are basic are usually not. For example, my specialization is in grief work, and working with grieving clients is in depth work, and needs training. The same goes for working in any specialty. Our agency specializations include adoption issues, trauma, and domestic violence. Market to your skills where you can really reach your client's needs.
~ Jill A. Johnson-Young, LCSW, Riverside, CA
26. My tip for therapists who are interested in working with interns or creating a group practice is to hire slow and fire fast. One way I do this is I have a 3 step interview process. My intake person does a phone screen for people who actually followed the directions and seem like a good fit. Then I do a casual interview, and if it's a go, I will set up a clinical interview with me and someone from my team. Oh and always check references!
~ Amber Hawley, LMFT, Fremont, CA
From Mari: Amber's tip and 3 step process is incredibly valuable. She has an excellent reputation as an expert in group practice and I'm glad she is discussing a challenging topic like hiring and firing. I'll add to her wise words by reminding you that if part of your current or future business plan is to include employees in your practice, be sure you understand the difference between W2 employees and 1099 employees - the IRS is a stickler about the difference and it is very important to make sure you understand laws around this. You can visit the IRS website, talk with your CPA, and/or an employment attorney as well.
Additionally, having a comprehensive employment manual that includes HIPAA guidelines is imperative for a group practice. This will help you clearly define HIPAA rules, a plan if HIPAA is breached, boundaries and expectations for your employee right out of the gate, as well as protect yourself from potential liability as a result of a disgruntled employee. If you prefer not to reinvent the wheel, I have an Employment/HIPAA manual here to support colleagues
27. Two important points when you are working to grow a company/practice beyond a solo practice: 1. Don't hesitate with decisions, make the call and go for it. 2. Never for get that even though you are the "owner" of the organization, you work for those who work for you. If you offer loving compassion to those who are "your staff" they will pass that to the clients who so desperately need it.
~ Darrin Ford, M.A., LMFT, CSAT, CMBAT-S, Long Beach, Newport Beach, Los Angeles
Founder & CEO of Sano Recovery - www.sanorecovery.com
28. My biggest piece of advice is to be clear in your "why" and trust your gut. You'll meet many other amazing clinicians who are running their practice in a way that is right for them. Don't let the greatness of what someone else is doing take away from your confidence or belief that this field needs your unique gifts. Clients and colleagues will be attracted to your practice because you consistently show up in a way that's authentic to you! Confidence and poise always shine through.
~Anna Osborn, LMFT, LPCC. Sacramento, Ca
www.myhappycouple.com and www.herlifeunscripted.com
From Mari: I will add two final tips as a support that have served me well over all of these years:
1. Be sure you have all of your ducks in a row with your intake process. Having a thorough client forms packet that includes informed consent, limits of confidentiality, your fee and fee increases, social media boundaries, terminating, secret keeping, cancellation policy, out of session contact, termination, a bio/psycho/social assessment, illness policy, release of information form, superbill, and other such forms are a must. If you would like to save yourself the time in creating this, you can find a complete client therapy forms packet here.
2. Surround yourself with a tribe of colleagues who have your back, and stay away from the Negative Nellies, Fearful Freds, and Envious Irma's who will simply drain your energy while you move forward toward your practice dreams and goals.
As therapists, each one of us starts somewhere when we enter this field, no one is exempt from the learning curve, and every clinician's journey toward success is unique, important, and inspiring.
Remember: What you set your intention on you can accomplish. Let integrity, ethics, joy and kindness be your journey companions in this process.
In closing, I hope these expert tips have offered you encouragement and have added some wind under your wings.
And if you need support, reach out, I'd love to work with you! None of us can do this all alone, and we don't need to feel isolated and stressed. You can schedule a coaching call here: http://www.thecounselorscoach.com/schedule/
If you like, you can read what other therapists have to say about their experience in working with me as a coach here:http://www.thecounselorscoach.com/business-coaching-testimonials/
Finally, if you are new to private practice and would like to introduce yourself, you are welcome to share in the comment section below.
Kindly and in support,
Mari A. Lee, LMFT, CSAT-S
The Counselor's Coach