Are you preparing to accept payment for your professional services by credit card?  Before you decide which credit cards to accept in your private practice, check out Cracking the Code by Jennifer Gill.  In her post, Jennifer lists 8 common credit card fees including skimming, debit cards (which are not always accepted), billbacks, and even hidden fees that you may incur and should be aware of when comparing costs.

Jennifer suggests that to determine what your merchant account is actually costing, you should divide your monthly credit card sales by the total merchant account fees.

Are you accepting credit cards in your practice?  Got any horror stories or tips to share?

Tags: billbacks / chargebacks, credit card fees, debit cards, hidden fees, merchant accounts, skimming

Instructors nor colleagues ever spoke to me . . . in a classroom, as a supervisor, one on one, or even in a text about therapists’  mishaps and what to do about them.  No one ever spoke about them being opportunities for learning and growth.

Instead, when errors were made, I was taught that they were embarrassments, shameful, and dangerous for any mental health professional. They were things to be talked about behind closed doors with an attorney or forgotten about and not to be discussed with clients and colleagues and under certain circumstances maybe even lied about . . . .

Then, several years back, I attended a workshop at an annual conference for the Association of Women in Psychology. The workshop focused on discussing those very things that I was taught should not be discussed . . . clinical misjudgments, errors in thinking, and client-related mishaps.  It was, for me, a practice-altering experience . . . to be in the presence of counselors, psychologists, and social workers candidly speaking about their professional and sometimes costly gaffs.  It was also a very healing experience . . . to learn that other professionals (many more experienced than me and a few quite well-known) also made mistakes . . . as we grappled together with how to responsibly and ethically admit our mistakes, make amends for our transgressions, and learn from our own misjudgments.

Ours is not the only profession that struggles with how to undo any damage that we may have caused.  Physicians are also taught to play it safe when errors are made and keep their gaffs to themselves.  However, research is increasingly showing that it is often in a client’s  best interest for medical professionals to ‘fess up and admit mistakes made.  Check out When Doctors Admit Their Mistakes and also Risk Management: Extreme Honesty May Be the Best Policy.

Here’s my point . . . . I am a better therapist when I am able and willing to tell the truth . . . the whole truth to myself, to my colleagues and to my clients.  I am a better person when I am able to tell the truth.   And, my clients deserve the best therapist that I can be . . . 100% of the time.  Until the mental health professions are able to create a culture and space in which we can take responsibility for and  learn from our own mistakes, we are not the professionals that our clients deserve.

Surely I’m not a lone voice for shedding the embarrassment over clinical misjudgment and shelving the self-imposed shame of making errors with clients.  When well-trained therapists with good intentions make choices that, in hindsight, are not the most helpful ones to our clients,  I believe it should be the standard of our professions to create a space for owning our mistakes and making amends to our clients with dignity and heartfelt regrets.

It’s time for our professional associations and our graduate institutions of learning to model healthy and appropriate ways to create spaces for dialogue and healing and forgiveness when therapists err.  It’s the right thing to do . . . for our clients, for ourselves, and for our profession. If you, like me, have ever made a mistake and felt the tug to do the right thing and yet have also felt the fear of doing the right thing, today is a good day to start the dialogue.

Tags: Choice, Continuous Learning, Dialogue, Ethics, Self Care, Standard of Care, Truth

“Fat . . . Borderline . . . Retard . . . .”

It is always shocking to me how easy it is for medical and mental health professionals to reduce their clients to less-than-desirable and less-than-accurate one dimensional labels behind closed doors.  I’ve heard excuses that range from minimizing (“oh-he-knows-I-don’t-mean-it”) to intellectualizing (“it’s just a short-hand way to refer efficiently to a particular group of symptoms).

Whatever the reason . . . ignorance, mean-spiritedness, or just plain old laziness . . . if you’ve been tempted to mock a client or speak derisively about a client behind closed doors, you might want to check out Tara Parker-Pope’s post on professionals mocking their clients. It’s one of those things that wasn’t discussed in my ethics classes  but probably should have been.  After all, if we are reducing our clients and all of their complexities to a simple one word label, it’s likely we don’t have our client’s best interest at heart.

Tags: Boundaries, Ethics, Judgment

In 1977, Ilya Prigogine was awarded the Nobel Prize in Chemistry for his work on “dissipative structures.“  Prigogine contends that because dissipative structures are disturbed i.e. shaken up by definition, they are able to change and evolve.  On the other hand, those structures that are too well insulated, and thus unable to be disturbed, will simply stagnate and die.  According to Ilya,  friction is a good thing!

I was reading about Ilya’s work and got to thinking about how friction has served my practice well over the years. Here’s what I’m talking about . . . .

When my referral sources are disturbed . . . they call me to consult when they are in over their heads.  They call me with referrals. Or, they call me wanting referrals.  They do something different.

When my community is disturbed . . . by elections, substance abuse, suicides, natural disasters, my community gets busy!  It get activated! And, they do something different, too.

When my clients are disturbed . . . they are motivated to pick up the phone and call me. They make appointments and come to see me. They follow through with their homework in between sessions.  And, if they are disturbed with me, the tell me!  And, all of that serves me (and my clients) well.  They do something different.

And, when I am disturbed . . . I seek additional information.  Or, I take action.  I tell someone just to be heard.  I take a class or seek consultation. I learn a new strategy.  I, too,  do something different.

Although I’m always up for a new adventure, I must admit, I don’t always relish the unpredictability of my work being disturbed.  But . . . does it help in the long run?  Keep me on my toes?  Sharpen me mentally and emotionally?  Help me stay flexible and alive in my practice?  You bet!  And, that flexibility and willingness to do something different helps my business stay vibrant and thriving.

So maybe tomorrow . . . when chaos looms out of no where to disturb my daily practice . . . . Maybe, just maybe I’ll remember Ilya Prigogine’s ideas and instead of digging in my heels and whining, I’ll say “thank you” for my dissipative practice and the wisdom to see the gift!

How about you?  Got a dissipative practice?  Or have you gone rigid and stagnate?  Needing a little help loosening up and learning to ride the waves?  If so, email me!  I’m happy to help you get unstuck and start enjoying the fruits of a little disruption.

Tags: Change, Continuous Learning, Disruption

My e-friend, David P. Diana, was kind enough to send a copy of his new book to me.  I’ve only read one hundred pages into Marketing for the Mental Health Professional but already I can tell you that it is an excellent addition to your practice-building library.

As David notes in the preface, this is a book full of ” innovation, opportunity, and abundance.”  He is quick to remind you of what you already know . . . understanding human behavior . . . while teaching you what you may not know as well . . . the tools of marketing, business, and sales.

Here are some of the nuggets that I have already gleaned from David to help you grow your business:

• On making mental health relevant – Become “part of the conversation people are having both online and offline.  Offer helpful information.  Build awareness by sharing your expertise.  Reach out to others in ways that show you genuinely care about them.”
• When you are doing something right – ” . . . you are highly visible within the marketplace . . . ” and  ” . . . you are viewed as a valuable resource and partner, people begin to seek you out without any soliciting on your part.”
• To gain power and influence when networking – “Take some time to notice when you are rushing your speech and begin making an effort to slow down, relax, and confidently present your point.”
• Concerning the need to establish credibility – If you (or any other mental health professional) do not have “distinguishing characteristics or credentials, then why would someone choose that person when so many options are available?”
• About strategic use of your time and energy – “. . . shifting your time and energy in new and more productive ways can have such a powerful impact.”
• On the art of public speaking – “Try to identify two to three new concepts and ideas that you will feature in your presentation.  Your audience will buy you and your message if you are able to do so.”

• And, here’s a tip that I didn’t know – “When customers consider a particular set of choices (services or products), they tend to favor alternatives that are so-called compromise choices. These are choices that fall between what a person needs at a minimum, and what they could possibly spend and fully desire at a maximum.”(Thanks to David, I’m actively re-thinking my menu of services and ways to include more-than-the-minimum compromise choices.)

So have I peaked your interest in Marketing for the Mental Health Professional? If I’m learning from it, I’m betting you have some things to learn, too.  Run out and get the book.  Read it.  Apply it.  And, let me and David P. Diana know what is changing because of it!

Tags: Choice, Credibility, Menu of Services, Power and Influence, Public Speaking

Dr. Keely Kolmes of San Francisco continues  to be a valuable resource for therapists engaging in social media.  Check out her blog post dated August 5th in which she exposes the privacy concerns  caused by Psychology Today’s newly implemented call tracking.

I just changed the setting on my own listing to decline call tracking and, I’m encouraging you to do the same.

[Thanks, Keely, for continuing to keep us informed on these matters!]

Tags: Privacy, Social Media, Telephone

Are you looking back to the “good ole days” when your practice was shiny and new . . . ? Remembering when your appointment book was full and you had a two week waiting list and wondering where all the clients have gone?

Well, I’m here to tell you that they are all still right here . . . right around the corner from you and they are wondering what happened to their bright and enthusiastic therapist that you used to be!  That’s right!  You heard me!  Any client will tell you that s/he would rather return to the same therapist s/he’s seen before rather than change to a new one.  They only change when they have no choice but to go elsewhere to get the help they are seeking.

If your old clients are going elsewhere for their counseling services, then it might be time for you to give your practice a facelift and that means taking a fresh look at your office, your office practices, and yourself.

Outside the Office

• Take a look at the appearance of your building.  Has it fallen into disrepair?  Does it need trim work or to be repainted?
• Is the landscaping well-tended?
• Is the parking for your clients easily accessible and is the lot well-lit?  Does it feel safe?
• Are the windows clean?

Inside the Office

• Inside the office, take a look at the paint on the walls.  Is it dingy?
• Is the carpet dirty or stained?
• How does your office smell?
• Is the lighting warm and welcoming?
• Is your office well-insulated for privacy?
• Is the temperature in your office comfortable?

Office Practices

• Does your office staff greet your returning clients as warmly as they greet your new clients?
• Is your staff well-trained on respecting clients’ privacy?
• Are you records safely locked away out of sight so that clients do not see information about other clients?

Self Check

• Are you taking care of yourself outside of the office?  Eating and exercising?  Getting enough rest?  Attending to your personal relationships?
• Are you arriving at the office in time to get settled in and appear calm and focused when your clients arrive? Or are you rushing in harried at the last minute?
• Are you scheduling your clients far enough apart that you have time to attend to phone calls, go to the bathroom, and complete your notes in between appointments?
• Do you have a plan for continuing your professional competency and are you following it? Are you continuing to learn new and interesting things to help you in your clinical work?

These are useful things to discuss with your peer consultation group.  A fresh pair of eyes can help you identify areas that need a bit of a facelift.  And, that, in turn, may help you re-engage some of those wayward clients.

Can you think of other areas in your practice that may need a facelift?  If so, I hope you will let me know!

Tags: Location, Office, Records & Documentation, Self Care

Tim Berry, President of Palo Alto Software, wrote this blog post,  3 Marketing Truths I Wish I’d Known Sooner.  It got me to thinking about some of the marketing truths that I wish I had known sooner . . .  like these . . . .

• Don’t slack off on your marketing efforts when your client load is full.  In fact, that’s exactly when you should amp it up!
• It’s easier to market when your practice is full and you are feeling good about yourself than when you are sitting in the office with time to spare.
• Meeting a colleague’s need (or, for that matter, any other potential referral source’s need) is the best type of marketing.
• Successful marketing is determined by the quality of your relationships rather than number of your relationships.

I’m sure you’ve got your own stories and truths to tell about marketing.  Care to share them with me here?

Tags: Relationships

My lists of subscribers and readers are swelling!  Thank you, thank you for passing along info about this blog to your colleagues and your professors (and to your massage therapists and your chiropractors and your physicians and all the other allied health professionals that you knew would be interested)!

If you are new to Private Practice from the Inside Out, I thought this post might be a really simple way to help you get to know me and start to get a a handle on the scope of information available to you right here.

My Very First Post

Working on Your Business – Working in your business is not the same as working on your business.  Here’s the difference and why it’s important to do both.

I Enjoyed This Post the Most

You Know Your Private Practice is In Trouble When You Say . . . . – If you hear any of these lines start to come out of your mouth, it’s time to check in . . . with yourself, with a coach, with a seasoned colleague that can help you get back on track.  Don’t let your practice suffer because you didn’t notice one of these 25 uh-oh lines.

A Post That Needs Your Input

Best and Worst of the Week -Need a place to vent and brag? Add your highs and lows in private practice here.

My Most Helpful Post

20 Questions to Ask Other Therapists – A tool to help you do your research before you hang your shingle out.

My Favorite Post

The Therapist’s Networking Guide: Introduction – This is actually a series on how to network effectively to build your private practice.

A Post You Shouldn’t Miss

Clinical Supervision and ‘Money Gouging’ – What your professors may not have told you about your clinical supervision and why clinical supervision costs so much.

A Post I Wish I Had Written

How to Conduct Your Own Annual Review – Chris Gillebeau at The Art of Nonconformity speaks my language.   This post talks about engaging in an annual self-review and goal setting.

If you are one of my regular readers and you missed some of these posts, subscribe to this blog (It’s FREE!) to receive email notifications of  new posts.

Tags: Assessment, Goals, Network, Private Practice from the Inside Out Annual Series, Work with Tamara

Writing and publishing can help you establish credibility, build your professional reputation, and position you as one who makes lasting contributions to your profession.  All of these can, in turn, contribute to your success  in private practice.

Whether you are still in graduate school or you are already hard at work out in the professional world, if you are in need of online tools to help you format your works in APA style, here are some resources for you:

• APA Style
• Purdue Online Writing Lab
• Ohio State University APA Citation Guide
• University of Minnesota Library’s Quick Study on Citing Resources Using APA Style

If you have other online resources related to APA formatting, I hope you will share them below!

Tags: APA Format, Documentation, Website

Although I’m not a fan of  “manualized” treatment of clients, according to professional standards of care and the American Counseling Association’s Code of Ethics (Section C on Professional Responsibility), a professional counselor has a “responsibility to engage in counseling practices that are based on rigorous research methodologies.”

Here are some online resources to help you quickly identify researched based methodologies:

• Society for Clinical Psychology’s Website on Research-Supported Psychological Treatments

• Evidence-Based Behavioral Practices

• National Institute for Health and Clinical Excellence

• SAMHSA’s National Registry of Evidence-based Programs and Practices
  

• Association for Behavioral and Cognitive Therapies
  

And, if you happen to know of other online resources for evidence-based treatment in counseling, I hope you will share them below!

Tags: Ethics, Website

Now that you know that you need to engage in clinical consultation on a regular basis and you know how to put your own peer consultation group together, do you know what is supposed to happen during your meeting with your consultation group? You actually have lots of options but my point is that you need to plan ahead of time how you want your meetings to proceed.  Otherwise, it can end up looking more like a clinical coffee klatch than clinical consultation.

Start with the end in mind. Consider what you want to accomplish at your meetings.  Do you want feedback from your peers?  Do you want to learn about a  particular theory or methodology?  Do you want to formally staff cases?  Are you looking for resources for a particular client?  All of these are possible but you’ll need to structure your meetings accordingly.

It’s about you and your performance. Clinical consultation is an opportunity for you to seek and receive feedback about your performance from other professionals that you respect.  Give some thought to how you (and the others in your group) want to receive that feedback.  Is the culture of your consultation group such that unsolicited feedback is acceptable?  Do you need to be invited to provide difficult feedback before you actually do so?  Some might say that by virtue of simply being in a consultation group, that all feedback is welcome.  However, unless stated up front (and again as new professionals join you), you will need to state it if that is the case.  This is especially important for those who are not familiar with the use of consultation groups.

Present clinical cases professionally. If you are going to focus on formally staffing cases (and even if you are not), you may find it helpful to agree upon a structure for presenting your cases to your group.  There is no one “right” way but agreeing ahead of time will make sure everyone is covering the basics.

Share the time. One of the decisions to be made is how will you share the time you have allotted for your consultation group. Does everyone get a chance to share?  Or, are a select few participants assigned to present cases?  You don’t want to simply “wing it” only to discover that no one or everyone wants to talk.

Decide on the structure of your meetings. Do you want to allow time for a “check in?”  Do you want to jump right in to clinical discussion?  Do you want time to to share resources and events?  By deciding and agreeing on this ahead of time, you will avoid your meeting turning into a social hour.

These are some of the considerations we took into account while creating our consultation group.    Can you think of other things that might be helpful?

Tags: Consultation, Ethics

I’ve told you that every mental health professional needs regular consultation and I’ve told you about the benefits of peer consultation groups.  Today I’m going to tell you how to put together a peer consultation group that ROCKS! Here are some things for you to consider as you put your own peer consultation group together.

• Mix it up.  Diversity in the composition of your consultation group matters.  It keep things interesting and increases the likelihood that biases are not overlooked. Those differences can help you stretch beyond your usual thinking and outside of your typical comfort zone.
• Consider safety.  You are going to be talking about your strengths and your weaknesses in a consultation group.  Although the discussion will most often be structured around your clients, the purpose of your consultation group is to expand and support your choices and your behaviors in therapy.  As such, you are going to have your own blind spots and vulnerabilities pointed out and talked about.  It’s important to choose colleagues that you can learn to trust.
• Similarity matters.  If the individuals in your group are too different from you in their disciplines, ethics, or processes, you may find that there is no sense of safety in which to discuss your own vulnerabilities.
• Expertise matters, too.  Look for colleagues that know more than you in at least one or two areas so that you can trust their feedback when you need it.
• Plan on mentoring. Including colleagues who know less than you in a particular area allows you an opportunity to mentor others in the field.  Take advantage the mentoring that you can provide and take advantage of the mentoring that you can receive!
• Size of group. Just like in group therapy, I think 7-9 is optimal.  This affords for someone to miss a group and you still have a group.  And, it’s not so many that you get overlooked in the group.
• Stable composition. A consultation group functions best when the composition remains stable.  In my current group, we must unanimously vote someone in  before they can join us.
• Frequency of meetings. I prefer peer consultation groups that meet on a regular schedule.  Mine meets monthly.  Of course, we are free to consult by phone in between our regularly scheduled meetings.
• Attendance. Sketchy attendance at peer consultation groups can sabotage your group.  When forming your consultation group, set the expectation for a commitment to attend each month.  Obviously exceptions will crop up in anyone’s schedule.  However, consistent attendance and full participation will go a long way toward building trust and confidence in your group.

So now that you know what I consider to be important when putting your consultation group together, drop me a note below and tell me about yours.  Did I miss any important elements?  Is yours decidedly different?

Tags: Consultation, Diversity, Ethics, Expertise, Mentor

Every mental health professional needs consultation on a regular basis.  I wrote about that in my last post.  If you work in an agency or organization, it’s likely that consultation is built into the system.  However, if you have ventured out into private practice, you have to work a little harder to get your consultation needs met.

Many therapists choose to pay an individual counselor for their clinical consultation on a regular basis.  If that is what you prefer, then you can expect to pay whatever that therapist’s usual and customary hourly fee is for his / her consulting and therapeutic services.

However, here are nine benefits to creating a peer consultation group to meet your consultation needs:

1. As a solo practitioner, you remain isolated most of the day except for seeing your clients.  A peer consultation group allows you to meet some of your basic social needs.
2. It also exposes you to new / different ideas, perspectives, and energies.
3. It allows you to learn about other therapists’ business and clinical practices.
4. It may give you a broader range of professionals to refer to.
5. It exposes you to more professionals who may refer to you.
6. It exposes you indirectly to more resources in your community.
7. It can serve as a knowledge bank for clinical issues that you are not familiar with.
8. It can serve as a check point for potential ethical issues.
9. It’s free!

Have I convinced you yet of the huge benefits to participating in a peer consultation group?  In my next post, I’ll tell you How to Create a Peer Consultation Group that ROCKS!

Tags: Consultation, Ethics, Network

Back in the Day . . . .

When I was in graduate school, no one talked about the need for a professional counselor to participate in ongoing consultation post-graduation.  Instead, as I remember, we were taught that ethical therapists seek consultation when they do not know how to proceed with a particular client.  Nothing was said about seeking ongoing regular consultation at all!

The New Standard of Practice

However, times have changed and these days regular clinical consultation is increasingly considered the minimum standard of practice. Unless you are under clinical supervision (which is different than clinical consultation), every practicing mental health professional should either pay for regular i.e. ongoing individual clinical consultation or be involved in a peer consultation group.

What Consultation Can Look Like

Thankfully, I had access to clinical consultation for most of the two decades that I have been in mental health.  However, what that has looked like has varied considerably. . .

• One on one clinical consultation . . . .
• Agency-required “staffings” . . . .
• Treatment team meetings in a psychiatric hospital . . . .
• Small-group consultations that were spontaneous in format and content . . . .
• Thematically-focused peer consultation groups (where I learned how to apply solution-focused brief therapies and, in another one, clinical hypnosis) . . . .
• And, for the last two years, I have been attending a monthly peer consultation group with 6  other therapists. You can check them out here: 
  • Valerie Varan, MS, LPC,
  • Amy Maddox, MAEd., LPC,
  • Leslie Vogt, MA,
  • John Harder, LCSW, ACSW,
  • Julie Uhernik, RN, LPC, and
  • Donna Schwartz, MA, CACIII.

Peer Consultation for Tamara

A peer consultation group can look and function in a lot of different ways. My current group is a really interesting mix of backgrounds.  In addition to the varied disciplines that you can deduce from the credentials above, one of us is child-focused, one is addiction-focused, three are heavily trained in energy medicine (and the rest of us are interested and learning as we can), one works with equine therapy, one is heavily trained in Western medicine, and I practice with a dual emphasis on systemic and depth psychology.

Still not sure that you need regular, professional consultation?  In my next post, I’ll talk to you about the benefits of peer consultation groups.

Tags: Consultation, Ethics