I’m not really sure how well this post is going to over with you guys but I just want to vent . . . .

I went to lunch this week with a colleague who has just recently ventured into private practice and, truthfully, he’s having a really hard time getting that first client.  You can relate, right?  You either are right there with him starting your own practice or you remember when you were back there hustling trying to get that phone to ring.  It’s a hurdle for all of us to get that first warm body in the office . . . and it feels like it’s never going to happen . . . until it does.

So Jason and I are dining in this great little Japanese restaurant and the conversation goes like this . . . .

Jason:  I’m starving to death!  I still don’t have a client yet.  And, I don’t know what to do!

Me:  What have you tried?

Jason:  Well, I’ve sent out my business cards and brochures to treatment facilities and I’m showing up at networking events every month.  I’ve been meeting therapists and community providers.  I’m reading books on marketing and how to get clients.  I’ve joined the Board of a local non-profit and I’m offering my services at a reduced rate.

Me:  Wow! That sounds like a lot of work!  Are you getting any referrals?  Are clients finding you?

Jason:  Oh, sure!  I’m getting 4 – 5  phone calls from potential clients each week but not one is making an appointment.

Me:  (So I have a hunch that one of the things that Jason is doing is keeping The Secret That You Absolutely Must Tell.)  So Jason, it sounds like your referral sources don’t really understand who you want to work with.  They are sending you unqualified referrals.

Jason:  Oh, no!  They know exactly who I work with!  I’ve been very clear that I work with XYZ.  It’s on my brochures and my business cards and that’s exactly how I introduce myself when I’m networking.

Me: Well, then, let’s look at how the conversation goes on the phone.  What do you say when your potential client calls?

Jason:  Oh, I’m very personable!  You know me . . . I can talk to anybody!  I tell them what my credentials are and what I offer – individual therapy for XYZ.  Then I ask them if they have any questions and if they want to book an appointment.

Me:  OK, Jason, so those are important things to cover but there might be a better way to cover them.  What I’ve found to be useful is . . . . (This is where I’m telling him about my 98% conversion rate to booked appointments and what my process is.)

Jason:  (And, THIS is the response I got.)  Yes, but . . . that takes up too much of my time to go through all of that and anyway, it’s all in my disclosure statement. . . . Anyway, I’m really great at marketing but I’m not getting any appointments booked. Blah, blah, blah.

Well, Jason says that he knows all about marketing but I’m not so sure he knows much about how to make a sale.  After all, if he did, he would be speaking the language of his potential clients, booking appointments with them, and seeing clients in his private practice.  Instead, he’s busy telling me how much he knows about marketing.  He’s not interested in learning how successful therapists do those things.  And, I’m not interested in telling him.

There!  I’ve said it! And, I’m feeling better already!

Back in May I wrote a post telling you The Secret that You Absolutely Must Tell.  So today, I’m telling you that it’s also important to tell who you absolutely do not want to work with. 

For me, that’s Yes-Butters!  So, I’m wondering who is it for you that you absolutely do NOT want to work with?

Tags: Appointments, Business Card, Fee, Work with Tamara

This is the 4th  post in the series
Reduced Fees, Sliding Scales, and Lessons Learned.
The series actually begins here.

How Does Your Reduced Fee Reflect on Your Overall Reputation?

Are you thinking about advertising the fact that you offer a sliding scale fee?  I strongly discourage mental health professionals from doing this and here’s the reason why . . . .

Once referral sources discover that you routinely provide services for a reduced fee, that is the idea that becomes attached to your name i.e. you provide the cheap stuff.

That’s NOT what you want to be known for even if you run a non-profit and routinely charge less than the Usual and Customary Fee for your services.

Your reputation should be based on the services that you provide and what differentiates you from your peers . . . not on having the lowest rates in town.

Tags: Fee, Reputation

This is the 3rd  post in the series
Reduced Fees, Sliding Scales, and Lessons Learned.
The series actually begins here.

If You Choose to Provide  a Reduced Fee, How Long Should You Do So?

I’ve had clients who were unemployed when they began working with me, so I offered my services at a reduced fee.   Later, when they secured six figure incomes, they continued to pay the reduced fees.

Lesson learned?  Yep . . . .

Lesson #1

My own issues with money got in the way.  Otherwise, when it came to my attention that my clients were in better financial situations, I would have addressed it directly with each of them rather than feeling taken advantage of.  If that is true for you, you have some work to do and a good therapist can well be worth her full fee to get that cleaned up early.

Lesson #2

What is understood to be “less than enough” by one person may appear to be “more than enough” to another . . . and vice versa.  Get really clear about the circumstances under which you are comfortable providing reduced fees.

Lesson #3

Reduced fees need to have time limits.    Unless you are operating as a charitable organization, consider how long is “long enough” to help someone access your professional services. Limits are good for your client and they are good for you.

Lesson #4

If you offer anyone a “good deal,” they’ll probably take it.  Make sure to think through the offers you want to make before you make them.

Drop me a line and let’s talk about if / how you provide services to clients at a reduced fee.  What does that look like in your practice?  Is it working well for you and your clients?

Tags: Boundaries, Fee, Gullible

This is the 2nd  post in the series
Reduced Fees, Sliding Scales, and Lessons Learned.
The series actually begins here.

Does Your Client Need or Just Want a Reduced Fee?

I don’t know anyone these days who isn’t looking for a bargain – including me.  It’s important to determine ahead of time if your client really needs a reduced fee to access your services.

I learned this lesson when one of my clients

(who was receiving a substantial discount on my fee) mentioned that he would be out of town the following week.  He was vacationing at a rather pricey resort. That was a clue . . . .

Then, I decided to walk him out to the parking lot where he proceeded to get into his shiny, late model car . . . that cost about twice as much as my car.

Of course, most of us need a break and most of us need reliable transportation.  However, my goal was not to fund those needs for my client before I could fund them for myself. It’s important to determine how you will decide who needs the reduced fee and who does not.

Do you have similar stories that you can share?  If so, drop us a line below so that we can chuckle at your lessons learned, too.

Tags: Fee, Guillible

This is the 1st  post in the series
Reduced Fees, Sliding Scales, and Lessons Learned

When I first went into private practice, I tripped over several issues when offering my services for a reduced fee.  Before you begin advertising that you reduce your fees for clients, there’s a few things you may want to take into consideration to avoid the same mistakes that I made.  Here’s the first one . . . .

Are You Meeting Your Own Financial Needs?

Generosity is certainly admirable  . . . if you can afford it.   Airlines tell you to put your oxygen mask on before you try to help someone else with theirs.  And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.

There are other ways to do good in this world and hopefully you are doing them.  But make sure that you are financially sound before you go trying to meet your clients’  financial needs.

And, if you are out there already doing good in this world without or in addition to reducing your fees, why don’t you take a moment to let us know about your good works!

Tags: Fee, Self Care

One of the choices every practitioner in private practice has to make is how to set your fees.

Karlaye from Arizona writes . . .

. . . I set my base fee at $ 125 per hour . . . but the insurance companies that I work for set it at $85-95. If I have a private patient, its fine, but when I have a client that wants to use their insurance, I can only set it at that price. Is that correct?”

And, Jason from Colorado asks . . .

Is it OK to charge my cash-paying clients $85 / hour and charge my insurance- paying clients $100 / hour?  It’s the only way I can see surviving in this economy.”

When setting your fees, you need to be careful.  Health care providers are the most common perpetrators of insurance fraud.  Sometimes such fraud occurs out of greed; however, it is much more likely that you may be engaging in fee-related practices that are illegal and not even know it.

If you have chosen to work with insurance companies, make sure that you are not charging you cash-paying clients a different rate than those who are filing on their insurance. Regardless of your intent, charging different clients different fees for the same service  (based only on whether or not your client pays cash / uses insurance) is not OK.

Look for a future post when I discuss reduced fees and sliding scale fees.

Tags: Fee, Fraud

If you are a regular member of our community here, you already know that my practice is a

"Money Fight" by HikingArtist.com

fee-for-service-only practice.  However, if you are a provider who bills insurance companies for your services and you are having difficulty recouping your fees, check out this post about a doctor in Florida who got his money back by taking an insurance company to small claims court.

And, if you have had success in working with insurance / managed care companies and recouping your fees, I hope you’ll drop in here to share your insights / experiences.

Tags: Fee

I just realized that many of you are asking about what’s happening in the 2009 Annual Series of Private Practice from the Inside Out and I haven’t been very good about letting you know.  Here’s what they’re saying after our last session . . . .

It was really good for me to look at my low confidence and speak it out loud.”

“Direct feedback on my business cards and brochures was the best part about our class today.  It took the concepts we had talked about and it made them practical, usable and real.”

“My energy and excitement continues to grow as we talk about (and as I write / journal about) building our practices.”

“I am encouraged and motivated to do get my business cards made . . . and to create the language I want to use for my business.”

If you are interested in joining me for the 2010 Annual Series of Private Practice from the Inside Out, drop me an email back channel and I’ll put you on my tickler list!

Tags: Brand, Business Card, Continuous Learning, Fee, Menu of Services, Name Recognition, Niche

Have you given any thought to your cancellation policy?  If not, you should. Cancellation policies provide clarity for your clients and reinforce professional courtesy and boundaries for you.

It is common for mental health professionals to require a 24-48 hour notice for clients to cancel a scheduled appointment.  Under such a policy, the client who fails to give appropriate notice for canceling an appointment typically pays the therapist’s usual and customary fee.  Therapists who implement this type of policy often stipulate exceptions for emergencies and illness.

"Cancelled" by Paul G.

My cancellation policy reads as follows:  “  A cancelled appointment delays our work.  When you must cancel, please give me at least 24 hours notice.  I am rarely able to fill a cancelled session unless I know at least 24 hours in advance.  In you are unable to provide at least 24 hours notice when you cancel, you will be charged the full fee for your session unless I am able to fill it with another client.  (You should note that insurance companies do not typically reimburse for missed appointments.)  The only time I will waive this fee is in the event of serious or contagious illness or emergency.”

Should you decide to implement a cancellation policy in your practice, make sure that you include it in your written statement of disclosure.

Tags: Appointments, Disclosure Statement, Fee, Policy

If you are looking at your marketing calendar and trying to decide where to focus your energy for the month of October, how about Breast Cancer Awareness Month?

According to the American Cancer Society, almost 200,000 new cases of invasive breast cancer will be diagnosed in 2009.  Over 40,000 women are expected to die from this disease this year.  It is the second leading cause of death (lung cancer is the first) in women in the United States so you have plenty of good reasons to get involved.

Here are some ways to make a difference

"Ducks for the Cure" by Kim Baker

AND get your practice noticed . . . .

• Invite a physician into your practice to discuss breast cancer with your clients.
• Send a letter to health care providers letting them know that you will be providing extended hours or reduced fees for referrals breast cancer patients during the month of October.
• Provide a free breast cancer support group.  Hold it at the local library and let the local newspaper know the details.
• Join one of the many fund raising opportunities like the Avon Walk for Breast Cancer in New York.
• If you’ve had a personal experience with breast cancer, consider writing / speaking about the experience to women’s groups around your area.
• Create your own fundraiser.  Ask other therapists to help you.  Get the media involved.

You can find a list of additional ways to help promote National Breast Cancer Awareness Month here.

Tags: Calendar, Fee, Media, Physician, Public Speaking, Support Group

Within just a few years of obtaining my license as a Licensed Professional Counselor, I began receiving invitations to grandfather in  to organizations (that I had not even heard of) to receive additional credentials.  I (wrongly) thought that since I was licensed, no other certifications would be of merit so I opted to let those opportunities (with the National Association for Alcoholism and Drug Abuse Counselors and the National Board for Certified Counselors) slip away.  Soon after the grandfathering periods expired, those two organizations mushroomed in influence and credibility and I regretted my decisions.

Since then, I’ve also received invitations to join national boards, accrue additional “degrees” and “licenses,” be included in national directories of “prominent therapists.” and receive additional certifications from other organizations.  It’s all very flattering at first glimpse. It’s also easy to see how new therapists can be particularly susceptible to the ploys of these vanity boards and diploma mills.

The truth is anyone including you can set up a board or “school,” provide training in EMDR, hypnosis or any other body of knowledge, and then provide a “certification.”  The training may have surpassed the standards in your profession

"(Fake) Certificates" by Rosered

or it may not.  My point is that if you are new to this body of work, you won’t necessarily know enough to know about the quality of the training.  And, in either case, the certification that you receive may mean nothing.

After contacting the American Counseling Association, mentors and professors across the United States, here is what I know for sure:

• Reputable certifying boards are familiar with the National Commission for Certifying Agencies and have membership in the National Organization for Competency Assurance.  Check this out first.
• The certifying board should include prominent individuals in your field and you should be able to research them.
• Reputable boards function to actually meet the needs of the members that they certify. You want more than just a certificate for your wall or directory listing for your money.
• Reputable boards function independently.  Certification is NOT contingent upon joining a particular organization; however, they are closely affiliated with professional associations that you belong to. If your professional association does not refer to a certifying board as a resource, you should question why.
  
• They are typically not-for-profit.  Ask and verify.
• Reputable certifying agencies are transparent.  They are easy to research including their policies and procedures, established complaint and grievance processes, and codes of ethics / conduct.  If you can’t research on line or get a phone call returned in a timely manner, you should be questioning the veracity of this  organization.
• Fees for certification should be comparable to those charged by similar certifying bodies.
• Legitimate certifying bodies typically require you to provide proof of attaining certain levels of education and experience.  They don’t just take your word for it!
• They often require an exam or submission of a sample of your work to verify that you possess the requisite body of knowledge.

You should question the credibility and motivation of any organization that claims to provide certifications or similar statements of worth but fail to adhere to the above standards.  Such organizations are often shams — more interested in your credit card than your profession and they are known as vanity boards or diploma mills.

Whether you stumble into them unknowingly or choose to use them to pad your vita and boost your ego, the end result is the same.  The general public is misled and you are at risk of tripping on your professional code of ethics . As a professional in the field of mental health, you are required to display only credentials that mean something.  As such, you need to do your research before thoughtlessly passing along your credit card for another certificate to post on your “Look At Me” wall.

Tags: Credential, Diploma Mill, Fee, Grandfather, Vanity Board

The Basics of Clinical Supervision

Lately, I’ve found myself in a lot of conversations about clinical supervision.  If you’re getting ready to graduate from your clinical program in one of the mental health professions, it’s time to start thinking about your own clinical supervision.

Prior to obtaining your license as a professional counselor, social worker, or psychologist, you will be required to obtain 1500-4000 hours under clinical supervision.   If you are fortunate enough to work in an agency, hospital, or school, it is likely that your employer will provide clinical supervision for you on site at no expense to you.  If that’s the case, consider it a benefit of the job.

However, if following graduate school you attempt to go directly into private practice (as is the option in some states) or end up working for an employer that does not provide your clinical supervision, then you will need to find a supervisor and pay for supervision on your own.  (Look for 10 Questions You Must Ask Your Potential Supervisor next week to learn more about how to find a great supervisor.)

"Money Jar" by Automania / Mike

Supervision and Money

I’m not sure why but not one of my professors in graduate school ever thought to talk with us about those additional costs that we would incur following graduation.  So . . . let me break the news to you. . . .

One of the many reasons you may want to start out working for an agency that provides your clinical supervision is that it can be expensive if you have to pay for it on your own. If you are paying out of pocket, you should expect to pay whatever a typical clinical hour costs in your geographic area.

I charge the UCR – usual and customary rates – for those working on the Front Range in Colorado.  My fees are $100 – $125 / hour for individual counseling  and $60 / hour for group counseling.  I charge the same rates / hour for clinical supervision and you will find that most reputable supervisors charge based on their hourly clinical rate as well.

Too Expensive

If  you find those rates to be objectionable, you have a right to understand why these are actually reasonable fees and that good supervisors are not simply gouging you for “easy  money” (as one new graduate noted this week on a discussion list).  Here are some things to consider . . . .

• The professional standard for clinical supervision has shifted in recent years.  Your clinical supervisor is now expected (and in many cases, required) to obtain formal training in clinical supervision at her own expense.  In the State of Texas, that requirement is a minimum of 40 hours plus ongoing continuing education in the area of supervision.
• Your clinical supervisor is legally and ethically responsible for each and every client that you come in contact with.  S/he is also responsible for every decision that you do / do not make and every action that you do / do not take.  That’s a LOT of additional responsibility.
• Your supervisor is responsible for reading every bit of your initial client assessments, progress notes, all correspondence, and termination paperwork and providing feedback as needed.  That’s a LOT of time.
• Your clinical supervisor will typically meet with you on a weekly basis for 1-2 years.  That’s additional time out of her schedule every week s/he could be using to see a client and earn her hourly fee.
• During your weekly meeting with your clinical supervisor, s/he is required to essentially develop your abilities as a mental health professional.  Her roles will alternate between teacher, mentor, consultant and evaluator.
• For every hour that your clinical supervisor spends with you, s/he is most likely spending another hour in preparation — completing paperwork, refining a plan to help develop you as a counselor, gathering materials, reviewing literature to meet your unique needs and interests.  That’s MORE TIME.
• Your clinical supervisor remains on call for you 24 hours / day.
• And, long after you have completed your hours of clinical supervision, s/he remains liable for all those decisions you made while under supervision.  Assuming you are seeing 20-30 clients / week while your supervisor is also seeing that many clients / week, her choice to supervise you, in effect, doubles her risk of being sued.

I’m sure there are other risks / costs involved in being a clinical supervisor.  If you can think of them, please share them with us here so that new graduates will have a clearer understanding of why fees are set the way they are.

And, if you are a new or soon-to-be-new graduate who is considering clinical supervision, let me know if any of this is new information for you.

Tags: Clinical Supervision / Consultation, Consultation, Fee, On Call, Paperwork, UCR

Fast Company just sent me their online newsletter with an article (well, really a slide show)  titled, “The Kanye Curriculum: 7 Ways to Be a Success.”  According to Kanye West, the very first key to success is “Know your worth.” I agree.

For psychotherapists, artists, and healing arts professionals, knowing what you’re worth is key to attracting your ideal client and building a strong practice.

If you don’t know what your services are worth,

"Money Grab" by Steve Wampler

here are four ways to find out:

• Call your state licensing board and ask them what the UCR, Usual and Customary Rate, is for someone with your credentials.  When I moved to Colorado, I called the Licensed Professional Counselors Board of Examiners to ask what LPC’s charge.  (In 2002, their response was ” between $80 and $125 per hour.”)
• Poll the professionals in your geographic area.  Call them up, introduce yourself and explain that you are doing a survey of your profession’s fees in the area.  Ask them what they charge for their hourly fee. (And, offer to share your results with them.  Better yet, offer to share it with us here at All Things Private Practice)
• Check out Psychotherapy Finances.  They poll their subscribers each year and do the work for you!
• Contact the state division of your professional association.  For me, that’s the Colorado Counseling Association. Most state organizations will have this type of information available to share with the general public.

And, do the rest of us a favor . . . let us know what you learn about UCRs in your geographic area and tell us where you got your information.

Tags: Fee, UCR