Like most of the world, I’ve spent way too much time online during COVID, scrolling through my feeds looking at funny memes.
One meme in particular popped up on my various social media channels. I’m sure you’ve seen it. It’s a woman, filtered to look like she’s from the 1800s, knitting a large noose as a “gift” to her husband. The tag line: After 2 weeks of quarantine with her husband, Gertrude decided to knit him a scarf.
You know, so he can hang himself. Noose..……hanging…..suicide? Get it?
Funny, right?
Hardly.
I’ve also seen mothers across the country, stuck at home working and homeschooling their kids, posting comments such as: “Shoot. Me. Now. ” or “I’m seriously going to jump if these kids don’t go back to school.”
We seriously need to stop with the COVID suicide jokes. There is absolutely nothing funny about suicide.
The COVID lockdown has brought about myriad challenges including unemployment, social isolation, families cooped up together with no place to go, and uncertainty and stress on top of the fear of getting sick and dying.
According to a recent study by the CDC, elevated levels of adverse mental health conditions, substance use and suicide ideation were reported by adults in June 2020. 11% of those surveyed reported serious consideration of suicide.
In my private practice, I often work with families that are dealing with the death of a loved one from suicide. To label the grief from a suicide death as “complicated grief” is a gross understatement.
I’ve personally attended three funerals of people who took their lives in the last four years. The devastation left from a suicide is truly incomparable to other deaths. It’s haunting. As one mother said to me recently……”This wasn’t my choice at all to be in this life without my daughter. She made that choice for me.”
Think twice before making a “joke” about suicide. I love to laugh and have needed to desperately during this time, but let’s not ever make suicide the punch line.
I’m reading a lot about snowplow and lawnmower parenting, and it’s nowhere more apparent than the parents of college kids.
I see pictures of parents at sorority bid nights. There are parents visiting their kids with such frequency that I wonder if they’ve taken leaves of absences from their jobs. There are monthly local parent “chapters” for many universities that congregate to do things like assemble packages to send to little Johnny and Susie.
I know of a parent that took a day off of work to go meet with their kid (a senior) and his academic advisor to oversee the picking of next semester’s classes. Another parent told me that she can’t wait for Senior Year to be over because “we are spending hours online filling out job applications.” And by “we’ – she meant herself and her kid.
A friend of mine recently sent me a screenshot of a chat from a Parent Facebook page (yes, you read that right – a Parent Facebook page) from her son’s college. A parent posted a desperate plea – ‘IMPORTANT: PLEASE READ’ – asking if someone had an extra pair of mittens for Sally and could they bring them to Sally’s dorm because Sally lost hers and she didn’t want Sally going to class the next day in a snowstorm without any gloves.
I kid you not.
This is where we are at.
I’m all for being involved and staying connected with your kid, but this is getting out of hand. We are making it so that kids can’t problem solve anything – including getting themselves to Target to buy a new pair of gloves.
I have a college-aged sophomore at Baylor University. When I decided to write about this topic, I searched for Parent Facebook pages, because I honestly didn’t know these even existed. There were a few. Reading the comments alone seriously made my head want to blow off my neck. It was all kinds of nuts. These parents are spending serious time asking opinions about professors, apartment buildings, dorm food nutrition and myriad other things that their kids should be dealing with – not them.
College parents….and prospective college parents: you gotta back the F off. They are in college. They are young adults and they don’t need you there at every turn. They need to figure things out. You are not doing them any favors. In fact, you are stunting their growth and cognitive development and setting them up for a lifetime of needing you to be involved with any big – or little decision they make.
I’m seeing more and more “Failure to Launch” young adults in my clinic and believe me, these kids all come from families that have historically micromanaged every aspect of their lives from preschool on up.
It’s a balance. And a delicate one. Parenting is a game, and you need to be in the game. But your job is to be a cheerleader, a coach…..not as a player. Encourage them, instead, to be independent. They might make some good decisions, and probably some bad ones, but don’t fix their mistakes or troubleshoot everything. Be supportive and loving and present – but be in the background, not on the front line.
I cried. In session.
It wasn’t a full-on ugly cry, but it wasn’t simply tears welling up in my eyes, either.
In nearly 10 years of listening to people’s stories, I’ve never cried in front of a client. I’ve come close. I’ve cried many times after a session. I’ve cried at night, alone, thinking about the suicide, or the cancer diagnosis, or the childhood abuse or the self-injury my clients revealed that day.
But I’ve always held it together during sessions.
My client, a new one, barely said hello and dodged my eyes as I picked him up from the lobby and walked him back to my office. He sat down and began crying before he even spoke. He had cried on the phone setting up the appointment so I knew a little about the backstory. By the time he told me the full story, he was sobbing – the kind of crying that forces you to gasp for air between sobs, and is accompanied by both shaking shoulders and a runny rose.
And I began crying too. His story hit me. Hard.
I apologized right away, of course. Counselors aren’t supposed to cry! We are supposed to be the strong ones, the omniscient sounding boards for everyone else. It’s a lesson I learned in grad school, and was pounded into me during my 3,000 supervised clinical hours from various experienced clinicians: check your own emotions at the door before session.
We. Can’t. Get. Emotional.
When I apologized to him, he thanked me – thanked ME – for being real. And not a robot. I was sure he wasn’t going to come back, sure that I blew it for him. But he has. For many sessions. (And no, I haven’t cried since.)
Like my client reminded me…..counselors are humans…..we are not robots. Let’s be gentler with ourselves. It’s ok to be real and be genuine with our clients, and most of all….to show our own emotions.
You have decided to take the plunge, leave your agency and hang your own private practice shingle. Congrats! One of the biggest and most important decisions you now need to make is figuring out where to office your new practice.
Office space, my fellow therapists, is where you will be spending the majority of your time as well as your gross income. It is be the biggest piece of your expense pie, so you need to choose it carefully. Most important, it’s the space where your clients come for sessions – and you want (and need!) them to keep coming back!
My first office was shared 50/50 with another clinician. It had no window, as the inside offices in the building were way cheaper. As my practice grew, so did my space (yay for windows and my own office!) and the need to have an office 100% of the time for myself.
The hunt for office space is both exciting and overwhelming. Here are a few things to consider before picking your space and signing your name on the dotted lease line:
- Know your Market – I was a cash-pay only clinician going after cash-pay clients. I knew my clients would want – and expect – a nice office building with plenty of parking and amenities. My office provides that and more. Think of it this way: your office space is the first impression your clients will have of you, so make sure it’s a good one
- Location, Location, Location – This, of course, is the golden rule of real estate. I searched a lot of office spaces and settled on a location that had easy access from major highways, plus a Starbucks right across the street that many of my clients frequent en route to their appointment. My office also has a bus line outside – an important factor if you live in a metropolitan area or serve clients with transportation barriers. Plus, as a personal bonus, my office is a 10-minute drive from my home. If I have a break in between sessions, I can run home and let my dog out and I’m right around the corner from my daughter’s high school.
- Don’t Scrimp – One of the worst financial decisions I ever made was buying a cheap used car. I was downgrading from a nicer one with lots of amenities to save a little bit of money. I decided to forego leather seats and Sirius xm radio. One week later, driving my hour commute downtown and missing the channels I could no longer access, then spilling a coffee that soaked into my cloth seats, I knew I made a horrible mistake. My buyer’s remorse was instant and real. Same goes for your office space. Don’t cut an important corner to save a little bit of money; as your practice grows, you will certainly regret it. Get the best space you can get, and one where both you – and your clients – will thrive.
- Read the Fine Print about Amenities – Make sure you know exactly what amenities are included in your lease terms, and what are extra (and their costs). Are copies, faxing and wi-fi included? Coffee service? One month I was surprised with a rather large copy bill that I wasn’t expecting, because I didn’t realize X amount of copies were included, and I went over. An amenity I really enjoy with my space is a shared receptionist that announces when my clients arrive. I also have a back elevator for high-profile clients that don’t want to be recognized in the lobby.
- Lease Terms – I currently re-upped my lease in my building, which offers one or two-year lease terms. Starting out, I didn’t want to lock myself into a long lease in case one – I hated private practice; or two – my practice didn’t survive. I recently considered switching offices, but the lease terms were too long for my comfort (three to five years in some cases) and they didn’t offer the same level of amenities.
- Neighbors – Take a good look at the current tenants in the building and the types of businesses that are there. If you work with addiction, it’s probably best to stay away from a liquor store or vaping shop nearby. You also want to sit in the space for some time during the day to see how the noise level is through the walls. Does sound carry? Are the walls thin? Are people coming in and out of other offices constantly slamming doors? If the window faces a parking lot, can you hear cars coming and going? These are things that can’t be changed once you sign and move in, so make sure you do throrough research.
- Sub-leasing – I sub-lease my office to another clinician during the hours I don’t use it. It helps me offset my rent cost. See if your landlord will allow you to do that (some do, some don’t); it’s a great way to subsidize your rent.
- Expect Some Unexpected – I had to learn to put a sign on my door during my night sessions as the cleaning service would come and open and unlock the door and surprise the heck out of both me and my clients. Also, things will happen that are competely out of your control. The A/C went out recently and I had to reschedule my clients – you definitely need A/C in the 100 degree Texas summer heat!
I hope this helped you think about some things to consider for your office. Best of luck that you find the right fit for you and your practice!
2019 has been an incredible year of professional growth. My practice has grown exponentially – a good, no make that – great problem to have – but when you are a sole practitioner, too much growth too fast can bring some pretty big growing pains.
This year I was finding myself more and more drowning in the weeds. As a sole practitioner, I’m the one scheduling, re-scheduling, following-up on emails, answering the phone and doing consults, marketing, networking, working odd and crazy hours and doing all the things that keep my practice up and running.
But did I mention the errors I was making? Like, having the receptionist text me saying “Your 4:00 is here.” And then: “Oh, and your other 4:00 is here.” Or telling a client I’d email them something and then completely forgetting to do it until three days later I’d get an email saying, “sorry to bug you, but can you send me that thing we talked about in session?”
Yikes.
Full disclosure: last month, I made a huge appointment screw-up and lost a great new client – she was super-mad and I don’t blame her one bit. But instead of beating myself up (which I admittedly did for a full afternoon), I knew something had to change. And fast.
After whining and crying about my life to a trusty mentor, she suggested I hire a business coach.
I’m in a women’s entrepreneurial networking group that meets monthly here in San Antonio, and a woman in that group recently launched her own coaching business. Her name is Robin and since we already had an established relationship, I knew that she’d be up for the task of looking at my business practices and helping me tweak where needed.
And to help me get my business shit together.
Off the bat, she told me this: you’ve got to get your calendar under control. It has to be automated. No more excuses, just get it done. I use Google calendar, but it only sent appointment reminders to me, so if I was off (or if my client input a wrong date), there was no check or balance system in place. I’m currently in the process of using a new calendar system through www.therapynotes.com and it’s already a game-changer, sending automated appointment reminders and confirmations (which yours truly was doing, sporadically at best, and obviously not doing it well). Eventually a link will be added to my website so clients can schedule or re-schedule themselves 24/7 without my direct involvement.
Another problem was my crazy schedule. Most days I work 8-8 with a few breaks in the day but my schedule was killing me. I also began adding 7:00 a.m. appointments to accommodate my busy business executives. I was never home to eat dinner with my family and when I was walking through the door at 8:30 or 9:00, I was certainly not my best self. Robin told me to allocate, at most, one or two nights a week for late appointments for my “grandfathered” clients, but offer only daytime hours to any new clients.
Robin is coaching me on other aspects of my business and helping me plan and strategize for future goals (stay tuned!!) that I’ve been too overwhelmed to think about, much less implement. She is helping me narrow my focus as well as develop a timeline/schedule of action-steps and realistic deadlines (which this procrastinator desperately needs).
So my advice to any fellow practitioners, or small business owners struggling with either growing your business or simply keeping up with your current pace is this: getchu a business coach, and getchu one now. It is an invaluable investment in your business and yourself. My only wish is that I’d done it sooner!
A family came to me with their 17-year-old son, who was running – not walking – through every house rule. He wasn’t checking in with his parents as they requested. He was dabbling in substances, coming home high and/or drunk, well past his established curfew. Grades were suffering. The problems were many, the parents had lost control and all three were sitting on my couch, the parents in tears and the son, smirking and visibly high (unbeknownst to the parents).
“Sounds like a good time for a behavior contract,” I told all three.
A tool I use in my practice, and use often, is helping families write and implement behavior contracts. I have used behavior contracts with parents of tweens, teens and adult children (ones living at home as well as those living on their own in a college setting, or ones that have recently returned home after treatment).
Why a behavior contract? There are many reasons:
- It lays out expectations so there is no one saying “I didn’t know” or “You never told me that.” An example of this would be “Curfew on weekday nights is 10:00 p.m.; curfew on weekend nights is 12:00 a.m. sharp.”
- It keeps everyone accountable for both actions and consequences. i.e. failure to comply with stated curfew times will result in an immediate 48-hour phone surrender; there will be no video gaming when any one grade drops lower than a “B.”
- It sets boundaries – in writing for all parties involved to see – whereas prior to the contract boundaries may have been loose, or in some cases, non-existent: “There will be no smoking marijuana, vaping or drinking.”
- It clearly defines anything and everything that needs definition and clarification “you will be allowed to drive the Honda to and from school, and we will provide gas money, but any other driving beyond to and from school needs to be approved by one parent in advance.”
Behavior contracts are not completely punative; they can offer rewards – “six months of clean drug tests and your curfew will change from midnight to 1:00 a.m. on weekends.” or “we would like to host your friends over at least twice a month and we will order the food of your choice.”
The most important point about behavior contract is this: make sure you are willing to follow through with what you put on the document. For example, if you are not willing to drug test your child every month, and implement consequences for a failed test, then don’t put that on the contract.
I have firsthand seen many successes with behavior contracts. They are an excellent way for kids to earn back trust that’s been lost, to prove responsibility and for parents – to rein back control in areas where it’s been lost.
This past week, I got hit – and I mean, hit hard – by compassion fatigue. I didn’t recognize the signs at first but here they are, in no particular order:
- I wasn’t sleeping well.
- I was thinking about my clients round the clock.
- I was leaving as late as I could from home and arriving justintime for my appointments.
- My daily runs were going by the wayside because my planned running time became consumed with adding more client appointments and in-between session phone calls with clients and their families.
- I was declining lunch and coffee dates with my friends and spending a lot of my days alone, reading and preparing for my late afternoon and night sessions.
- Some friends were having personal crisis situations and calling/texting me around the clock.
- Oh, and did I mention that this month has been my biggest month of success, if you measure it strictly in monetary terms?
This candle was burning at both ends, hot and bright. It doesn’t take a genius to see where this was heading.
I was keeping it together in sessions, but out of them? I was crying during my daughter’s marching band performances. I was crying when, after a few late nights at the office, the custodians at my building who were cleaning would stop by and ask me for a piece of candy out of my dish. I was crying when I walked my dog and I saw a dad throwing a football with his daughter in my neighborhood.
Historically, when other therapists or anyone in the helping profession would talk about compassion fatigue, I gotta admit, I half-listened, and maybe even rolled my smug eyes. I sat through my mandatory agency trainings and read the statistics and listened to other people talk about their experiences but honestly? I secretly (and naively) thought that compassion fatigue was simply something that, well…..was never, ever gonna happen to me. Why? Because I got this!!! I can do it!! I’m different then everyone else. I’m a machine.
This month, and this last week in particular, work was extremely intense. I performed an intervention. I placed two clients in treatment. Three clients from yesteryear contacted me asking me to restart therapy. Two people told me that I single-handedly saved their life. It all was taking a toll. Big. Time.
So now I get it. Compassion Fatigue. It’s real, y’all.
Mother Theresa insisted that her nuns take one year off every 4-5 years to allow them to heal from the effects of their helping-focused work. I was barely eating a proper lunch or dinner most days.
This week, I redirected myself. I bought some new candles for my office. I reached out to friends and scheduled get-togethers. I took my daughter shopping and bought her some new clothes. I made a conscious decision to stop reading about work at home and instead, read for pleasure. I made time to run, and signed up for a few upcoming races to ensure I continue to train. I’ve blocked off a few upcoming days in November for leisure and family and travel – and for just ME.
No one is a machine. Machines don’t cry, people do.
I started writing this “Private Practice Chronicles” series two years ago when I opened my practice. It was a way for me to write about the ups, downs and everything in-between. My chronicles of PP have been some of my most-read blogs, and it’s been fun for me to re-read them to see how far I’ve come in a relatively short period of time.
I’ve written about my mistakes here and here. Looking back over the last two years, though….well, I know I’ve made mistakes but, dang, I’ve also done a lot of things right. So today, I’m sharing six things I feel I’ve done well:
- I don’t try to solve everyone’s problems – When I first started out, I felt immense pressure to fix everyone and everything that walked through the door. That’s what a good counselor does, right? WRONG. I know here are some things that are simply not fixable. The only thing that can change is the level of acceptance in the client, and my job is to help them get there anyway I can.
- I set boundaries – Of course, I’m admittedly still a work in progress on this one, but I’m getting much, much better. I’m not answering every email or phone call or text that comes through on the weekends (or all hours, for that matter), and I end my last appointment of the day at 7:00 p.m. (I used to take 9:00 pm appointments, even on a Friday)!
- I keep the hustle up – Just because your practice starts taking off doesn’t mean you can sit back and rest on your laurels. I am constantly marketing myself and thinking of new ways to get new business in the door.
- I screw up – and own it. Double-booked clients? Been there. Called a client by another client’s name? Done that. Completely forgot about a business meeting I set up with someone I admire who squeezed me into his busy schedule? Yup, that’s me. I’m a human being. I’m imperfect. I never make excuses for my mistakes, I can only own them, apologize, then do my damndest not to repeat them.
- I stick to my guns – People told me to take insurance (I don’t). People told me to see everyone that walks through me door to grow my business (I don’t). People told me to take on a partner (I haven’t). People advised me to take on business contracts that, while lucrative…..would be the only reason why I was doing it. People told me to do lots of thing that, in my gut, I knew weren’t right for me or my business. It’s your practice, to run your way – not anyone else’s.
- Listen to others – Contrary to my previous point, there have been times where I have sought out advice from older and more experienced clinicians in private practice. Something a colleague said to me has resonated with me since my early days. We were talking about marketing and he told me he doesn’t spend a lot of time or money on it. Why not? I asked him, almost incredulous at his answer. He said this: “I spend my time reading and learning and just trying to be the best therapist I can be for my clients, and when I do that, I find that my business grows itself.” He has a successful practice, and this statement of his is true on many levels.
So there you have it, the six things I’ve done well. I’d love to hear from you and what you do well in your practice. Keep going and keep growing.
I rarely self-reveal to my clients during session, but a question I’ll always answer is this one:
Do you see a therapist?
Yes. Hells yes I do.
I’m always more than baffled when I talk with a counseling colleague and I discover they are not seeing a therapist. If you are an active, practicing therapist, be it in private practice or an agency setting, I feel like it’s a must.
In graduate school, the idea was presented by a professor that all therapists should be in therapy. Of course, being a busy grad student with two small children my first thought was……yeah, right. Ain’t nobody got time (or money!) for that. I thought of therapy as only something for the rich or elite – a luxury rather than a necessity. I had never been in therapy before. Pretty ironic for someone who was planning on dedicating the rest of her life being a therapist, right?
My first exposure to personal therapy was a mandatory group class. We were required to participate, once a week, in a group session. I was skeptical at best and quite resistant to the entire process. What I discovered in group therapy (once I got over my bad, close-minded self) was how my parent’s divorce when I was 14 affected me, plus how I had not resolved one issue related to my mother’s unexpected and sudden death when I was 32..
After that, I ran…..not walked……into individual therapy. And I’ve been there ever since.
Like many professions, being a therapist is stressful. My clients come to me with trauma, grief, suicide ideation and everything in-between. I don’t always want to bring that stress home and try to release it in other ways. Therapy helps me figure out ways to do that, how to process, how to not transfer or counter-transfer, and helps me reset myself when I feel this area of my life gets off track. Sometimes I utilize my own therapy appointments to staff difficult cases. Being a sole practitioner, I don’t have a business partner in the next office to bounce problems or challenges off of, and my very-seasoned therapist is awesome at this. More often than not, my own therapy appointment is spent discussing family challenges, personal struggles or whatever it is that is happening in my life.
Admittedly, it took time to find the right therapist for me, but I’ve been seeing the same one now for 4 years and have no plans on stopping. I kick up my appointment frequency when things are going awry, and I stretch it out when things are humming alone quite nicely. But I’ll never, ever stop going. Therapy is a lifeline for me. It’s not a luxury – it’s a necessity for my own mental health. I couldn’t imagine my life without it.
So therapists, listen up: there is a reason why Dr. Yalom wrote the book “The Gift of Therapy.” Therapy is a gift, one you give your clients everyday but one that you need to give yourself. Honor yourself – and your own mental health- with this most-important gift.
It’s usually the first question I am asked when a potential client calls or emails me. Do you take United/Aetna/Humana/BCBS/Tricare?
No, no, no, no and no. And here’s why:
Before opening my doors of my practice back in July of 2016, I struggled with this choice. Being a cash-pay only clinician is not for everyone. The advantage of paneling with insurance companies is that there is a built-in referral network and a relatively full clinic in a short amount of time.
But here’s the deal with insurance: if you come to me even once or twice needing to sort out a work problem or a relationship problem or just trying to figure out a general struggle or issue, I have to slap a mental health diagnosis, or ICD-10 code on you so I get paid. And that stays on your permanent medical record. And I’m just not okay with that.
Oftentimes, insurance companies limit the number of sessions for a client (depending on diagnosis). So eventually, if you wanted to continue with me for a longer term (and I have many long-term clients), you’d max out your benefit and have to pay cash anyway. I’ve heard a few horror stories from some of my clinician friends who were audited by the insurance companies (and one who had to refund payment!) and see messages on many of the social media business groups I am in griping about delayed payment or submitted billing that was kicked back or questioned.
No thanks.
When I opened my clinic, I didn’t have one paying client (Read more about that craziness here). I knew I’d have to hustle and grind and market myself hard to fill my clinic with cash-pay clients. The funny thing is that my clinic filled relatively quickly, with many clients that called originally asking what insurance I took and hearing my answer of “none.” In 2017, my sales increased by 526% over my opening year. So far as of this writing in 2018, my sales are up 74%.
It’s risky being cash-pay. I meet with many other clinicians and physicians that are in the insurance game, and there is a love/hate relationship. They battle the insurance companies and spend lots of time and money billing – but their clinics are full. And oftentimes, their clinics have waiting lists.
The advantages of seeing a cash-pay only clinician? There are many. I’m not bound by the limitations set by insurance companies, and especially ones I don’t agree with for the treatment path of my clients. I also spend my time reading and educating myself on the latest news, trends and counseling techniques instead of billing and battling. Another advantage is that if my client’s insurance changes and I’m not on that panel, it doesn’t affect them in the least. They can continue their care with me instead of making a switch.
I have recently been afforded some opportunities that continue to help me circumvent taking insurance. These include two EAP contracts – one with a Fortune 500 company, and one with – ahem, an insurance company – as well as a contract with a state agency for substance use and abuse assessments and various writing assignments. How do I get paid for all of those?
In cash.
As the insurance companies get bigger and their mental health benefits shrink or change, it has zero bearing on how I run my business or serve my clients. And in the end, that’s all I care about.
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