The management of a consulting practice requires heart and mind. To be successful, private practitioners must strike a balance between two roles: that of the caring, empathetic, and customer-focused clinician, and that of the astute business owner, which necessarily involves collecting fees and making money.
Most people entering the counseling profession do so primarily because they feel called to help others. At the same time, many counselors dream of one day owning their own practice, and that includes chores that sometimes go against the grain of their helping instincts. Charging fees for clients who skip appointments or track non-payment or a declined credit card can be unnatural for counseling clinicians, especially after spending multiple sessions listening to the person talking about the painful life challenges they face.
"For many therapists, including myself, this is a difficult area," says Dawn Altman, a licensed professional counselor (LPC) with a practice in Bryn Mawr, Pennsylvania. “In my experience, the hardest area to navigate is my own attitude towards money and my sense of worth. … Most therapists come into this area with the mere desire to help people overcome emotional difficulties and live busier lives. It feels kind of "sticky" to ask for money to support someone who is struggling. The lines between what most of us take for granted – helping others – and the need to pay for our services are blurring. "
Money, money, money
A major aspect of maintaining the balance between heart and mind in private practice is the setting and enforcement of rates and fees.
When she started her practice, Altman set her fees low because she doubted her own worth. “Looking back, the so-called cheat syndrome came up for me – this internal experience of believing that you are not as competent as others perceive you to be. This is especially true for so many women, ”says Altman. “I really had to delve into and ask myself, 'Do you fear success as a business owner more than you want to? & # 39; The answer was of course no, so I just had to tear the plaster off and feel the fear and bill [clients] anyway. "
Now, after years of practice, Altman has found that her case count feels balanced when she reserves three slots in her schedule for customers paying on a relay. If a prospect requests staggering and those three spots are already filled, Altman has a list of practitioners to refer the client to so they don't run out of options. "I find this system works for me because I can still provide service to those who may not be able to afford my normal fee, but I don't get annoyed that I work for pennies," says Altman , a member of the American Counseling Association.
Norm Dasenbrook, a Licensed Clinical Specialist Advisor (LCPC) with a practice in Rockford, Illinois, believes that the counselors' ethical mandate to keep pace with self-sufficiency includes financial self-sufficiency. It is not greedy to calculate what you are worth. it is necessary, he says.
"When I think about how to pay the rent for my office when I have a customer in front of me, that's not the best care," says Dasenbrook, who also runs a consulting firm that offers training and workshops on management a therapy practice. "Recharging what you are worth is the best care for customers because you don't think about these things when a customer is in front of you. We [counselors] work hard and should be paid for it."
Dasenbrook advises private practitioners who are just starting to ask local colleagues about their tariffs in order to find the “community standard”. From there, they should opt for comparable tariffs and fees and adhere to them. Private practitioners should also keep in mind that most clients won't shop and will choose a therapist based on their hourly rate, he says. Rather, this decision revolves around many factors, from a practitioner's specialty to their reputation.
From Dasenbrook's point of view, the business and empathic sides of private practice are not mutually exclusive. Practitioners can find ways to accommodate customers with empathy while they are still getting paid, he says. For example, Dasenbrook will work out a payment plan for customers with financial difficulties that will allow them to pay in small installments, or it will offer them half-hour sessions for a lower fee. In other cases, he will refer clients to local charities or agencies that offer free or discounted therapies. These measures all ensure that clients are treated with care and continue to receive the help they need, which is empathic, says Dasenbrook.
“For me, [the caring and business sides of counseling] belong together. They offer a service and charge a fee. Nothing is mutually exclusive. You can do both with empathy, ”says Dasenbrook, who has carried out private practice consultations at the ACA Conference & Expo in recent years.
Private practice consultants struggling with the idea of fee collection should consider how other service professions deal with it, says Dasenbrook. He points out that plumbers and auto mechanics shouldn't feel guilty about asking what's a service's worth, and he stresses that consultants shouldn't either.
"Don't lower your fees," he urges consultants in private practice. “Think about other professions. A cardiologist out of school charges the same as someone who has been in the field for 10 years. "
Bethany Lato, an ACA member with two offices in the Milwaukee area, also notes that intentionality and purposefulness can weave the empathic and business sides of practice management.
"One way I can [incorporate empathy] maintain a clear vision, purpose, and foundation for what my business is and for whom it is," says Lato. “When I focus on tasks like finance, sales and marketing, web presence, and long-term business planning, I tend to wear the entrepreneurial hat. I'm thinking about it from a business perspective: what makes the most sense financially and commercially to accomplish this mission?
“From there I return to empathy: How does this serve my customers and the people I want to reach? Do I make sure I take care of my needs and also take care of others? By starting my job and finishing my job from a place of empathy, I want to find that balance and never get too involved in the business side or just make money. Sometimes this goes without saying, and sometimes it's a conscious effort to focus on the true mission and what feels really aligned to me and the clients I work with. "
Drop load issues
Determining the size of the drop load and finding the “right” number of customers who can be seen in the private practice per day is an individual decision. Consultants need to charge high enough fees and hire enough clients to make money and stay solvent, yet keep their case numbers and daily schedules from getting so full that they can't give clients (or themselves) the time and attention to that they need.
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It is a balance that is different for every private practitioner and that often has to be determined by experience. Kristy Crump, an LCPC in Bel Air, Maryland, continued to work in an agency setting three days a week when she started her private practice in 2014. Within a year she was fully booked and was able to leave the agency and move on to a private practice full-time.
Finding the right balance was a matter of trial and error, she says. “You have to evaluate how you feel at the end of the day, at the end of the week. I saw 10 or 12 customers in a day and was exhausted and struggling to keep up. It only took me some time to figure out what was right, ”says Crump. “Now my balance is six [clients per day]. I have some colleagues who say "four is enough for me" and others who say they can do 10. You have to find out [a schedule] where you still feel like you at the end of the day. "
Dasenbrook recommends that private practitioners start with an end goal when determining their optimal sample size. Do you want to get a second source of income such as teaching or advice while running a private practice? How many vacation days would you like to take per year? Do you want to retire in a few years? Once private practitioners have set their long-term goals, from there they can figure out how many clients they need to see (or allow time for) to meet those goals, says Dasenbrook.
Developing a reliable list of referral sources is also an important part of managing case numbers as a private practitioner, Altman says. Over the years she has found that she works best when she sees fewer than 20 customers a week. This helps her balance with other facets of her life, including the time she spent with family and her identity as a "lifelong student."
“I quickly found out that it doesn't work for me to see more than 20 [clients] a week. I feel drawn in too many directions and my family life is suffering, as is my own physical and emotional wellbeing, ”says Altman. “I'm very deliberate about the type of customers I want to see and while it is difficult to turn people away, I now have a waiting list for those who want to wait for me specifically, and I have a list of five or more More Six trusted therapists in the community to refer to when I cannot accommodate the client. … That alone made a huge difference in my work-life balance for me, as I enjoy each of my clients and at the end of each week I don't get burned out. "
Got out of hand
Bryan G. Stare, an LPC and counseling educator with private practice experience, criticizes what they call the capitalist US healthcare industry. Many of the decision-makers who own private practices have to grapple with the bottom line of their business – whether they see fewer clients, whether they waive fees, or whether they volunteer. This is a topic that often runs counter to the counseling profession's commitment to social justice, says Stare.
"You are in a difficult position in private practice. You have paid a lot of money for this training, whether it is a Masters or a Ph.D. In order to live comfortably, there is often pressure to do more for your services. But many of us entered this profession because we called for help or social justice. … There is some commotion there, ”said Stare, assistant professor and director of the clinical mental health counseling program at the university of North Carolina in Charlotte. "We have to take care of ourselves and our business in order to serve our customers in the best possible way. If I don't, I can't create a safe place to serve my customers. If I'm too thin, I can customers do not supervise ethically and competently. [But] The system is not designed for this, it is a profit-oriented system that aims to accumulate company assets and people suffer e.g. u let. "
To achieve this balance, private practitioners must always monitor how they feel about their workload. Only consultants themselves can tell when their balance is wrong and when they are spending too much time on either business or customer care.
For Crump, it depends on how she feels at the end of the work day. If she is irritable or exhausted, it means that she needs to reassess her workload. "If I'm not 100%, I'm not helping [clients] much," she says.
Crump admits that this balance was lost when the COVID-19 pandemic caused them to move all of their customer sessions to a virtual platform. Crump specializes in anxiety disorders, and she says some of her clients have become needy under the stressors of the pandemic. Conducting meetings and other aspects of her practice from home blurred the line between her work and her absence. Crump says she needs to check herself out and take a step back to regain balance.
“Of course I would like to take crisis calls, but I would soon find three sessions over my limit [for the day]. It's a struggle because you have that control. You can say yes. I don't have a front desk that says, "Sorry, it's booked for today," says Crump.
Stare, an ACA member who advises a small number of clients in addition to teaching and research, agrees that emotions are a barometer. Private practitioners should recognize signs of burnout and process their own feelings on a regular basis. The Stare support group consists of trusted friends, colleagues and mentors with whom Stare can consult.
Several private practitioners interviewed for this article report that their body gives them cues – such as feeling tired, worn out, or painful – that indicate that their professional balance is not in balance.
"We teach our customers this, and we have to listen to our own bodies and needs and take care of ourselves as we tell our customers to do," says Crump. “We have to step back and think. It gets very stressful. Some days are very difficult. I'm a full believer that every therapist should have a therapist – they can also help keep you in check. "
Lato notes that somatic cues tell her not only when her workload is unbalanced, but also when things are going well. When their work is in balance, "I am really excited about my business and my practice, rejuvenated from my sessions with clients and with vivid dreams and visions about what the business may be in the future," says Lato. “It is this vision that often brings me through difficult, unbalanced times. I spend a lot of time journaling, meditating and vision boarding about the future of the company and my practice and always find it important to know where you are going. With that clear vision and direction, it becomes easier to see when things are out of whack. "
Write it down
The consultants interviewed for this article agreed that one of the best ways for private practitioners to minimize the need for difficult discussions with clients about payments is to offer clear, thorough communication about fees and expectations before consulting .
Crump provides a full explanation of their policies in the informed consent that clients sign upon admission, but she also reviews the guidelines with each new client before starting the consultation. "It took me a while to get some flow to talk to customers about it," admits Crump, an ACA member. "It's hard to say," Hello, hello, I have a cancellation policy. "… [But] If you are genuine, you will get this back. If I [clients] publish my limits and no-show fees, I'll be honest. I declare that it is" housekeeping ". It it is important to talk about it, to get it out of the way and to divide the sessions into advisory and non-advisory work. "
Enforcing professional boundaries, such as charging cancellation fees to a customer who repeatedly fails to show up, also models healthy behavior for customers, adds Crump. "I teach all my clients limits so I want to make sure I have limits myself," she says. “From day one I make sure that I set limits for the customers. I'm direct and when I answer a crisis phone call in the evening I talk about how this doesn't become a normal thing. "
Crump admits, however, that even after years of private practice, she still finds it difficult to collect fees. It depresses her empathic reflex, she says, because she doesn't want to prevent people from seeking advice.
"I hate to have a conversation to this day," she says. "It's difficult because we play a helping role. We're here to help and it doesn't match what we've been taught. They put a limit on them, but unfortunately that's part of business. There is nobody who can enforce this except me. It's easier to talk [when] about it in advance than to wait for it to happen and then impose a fee on them. It's a necessary evil that you must do. Ultimately, you lead a business and have to pay your bills yourself. "
Crump and the other private practitioners interviewed for this article say they typically extend a one-time grace period for clients who miss an appointment before enforcing a cancellation fee. They also make exceptions for late or lesser payments from existing customers facing difficulties like an unexpected job loss. However, they do agree that charging customers who are chronically late with payments or who repeatedly miss appointments is a necessity.
"I usually tell the customer in writing:" Twenty-four hours "[cancellation] gives me the opportunity to offer your appointment time to a customer who may be on a waiting list or who needs an urgent appointment. I hope you understand that I have to bill you for missed appointments, ”says Altman. "It is critical to discuss fees and payment options beforehand in order to build a good relationship with the customer, and [establishes] the clear line that therapy is a valuable service that is expected to be paid for."
The enforcement of fees not only helps to keep a private practitioner's finances in the black. It also sends a message that counseling requires commitment and intention from both parties – counselor and client.
"If at the end of the day I don't set a limit, I may not be able to act therapeutically," observes Stare. "If we do not meet regularly or in a semicircle, whichever [a client’s] is cause for concern, we will not get any therapeutic benefit." Ethically, I cannot offer services that will not help. "
Dasenbrook urges private practitioners to spend time preparing thorough consent forms. Including details like the hourly fee for services provided outside of counseling sessions (e.g. writing letters, filing court documents) ensures clients are fully informed prior to billing, he says.
The language, which focuses on customer consent, privacy laws, and other practical issues, varies from state to state. Therefore, private practitioners should obtain training when preparing informed consent documents and consult with local colleagues and their national advisory associations. "These are the people who will know the funky laws," claims Dasenbrook in your state.
The language in informed consent documents must be thorough and firm, but welcoming and calming, adds Dasenbrook. Clients filling out these forms are seeking therapy so they may not be in their best mental state, he points out. They shouldn't feel like doing something like they're signing the seemingly endless number of pages that go with buying a home. Breaking the informed consent into sections – treating minors, telehealth health, fee plans, privacy laws / posting customer information, etc. – makes it easier for customers to digest and allows advisors to remove sections that do not apply to certain customers. The 2014 ACA Code of Ethics requires practitioners to provide information about alternative / continued service options in the event the counselor experiences an emergency or dies.
Ultimately, the time spent creating thorough informed consent forms should mean less confrontations with customers regarding fees and other policies across the board. "The business part [of private practice] should be done in your declaration of consent," says Dasenbrook. "It should be communicated in advance before we even say, 'What brings you here today? "
“Write it down and get it all out in time. … You want to take out the coin as well as possible [counseling] and therefore [I do it] everything in advance. "
Getting down to business
The professionals interviewed for this article shared the following tips and insights about mixing the caring instincts of counselors with the business side of running a private practice.
>> Maintain separate rooms: Stare uses an existential humanistic approach that recognizes the importance of feelings of place. With this in mind, Stare recommends requesting and accepting customer payments in a separate room from the consultation room. If possible, keep a credit card machine or other payment mechanism in another room and go there with the customer to take the payment. By not sitting in the same chair and room where therapy is taking place to accept payment, the two concepts for counselor and client alike can be separated, says Stare.
>> Pay first, then speak: Crump recommends receiving payments from customers at the beginning of a session before consulting. Crump didn't always follow this process, eventually adopting the approach in order to avoid the awkwardness of moving from discussing serious therapeutic issues to solicitation.
Retaining a customer's credit card number for automatic top-up can be beneficial even when practitioners deem it appropriate. Dasenbrook notes that private practitioners now have many convenient payment options, including apps like Venmo and PayPal, compared to when he started his career three decades ago.
>> Keep track of housekeeping: Dealing with these unattractive tasks immediately can be beneficial for private practitioners and their clients. For example, Dasenbrook says if a customer's credit card is declined, give them a call right away. Don't postpone it or even wait for them to come to their next session. Fixing the problem immediately will fix the problem and make a payment more likely.
Similarly, Crump emphasizes the importance of filing insurance claims and documentation as soon as possible after customer treatment. This is especially important for new clients to find out if the private practitioner's services are covered or if the client has a deductible to pay. The sooner a practice owner knows that there is a gap in a customer's insurance coverage, the sooner payment agreements can be made, especially as long as the meeting is still in the customer's memory. "Although these case notes take longer, it's worth it [to file right away]," says Crump.
Altman notes that sometimes a persistent approach is required when tackling tasks that may violate the empathic nature of a counselor. “I used to offer monthly invoices that the customer could then submit for reimbursement. However, I have found that several customers would simply forget to pay. Their bills were increasing and I was angry that I wasn't getting paid and that I had to do the math every few weeks.
“A customer in particular would not pay me on time and their bill would not be paid for several weeks. I emailed multiple reminders that he didn't respond to. When the bill was a month past due, I emailed him one last time with the bill and told him I couldn't provide the zoom link for our next session until he cleaned up his account. He paid the bill right away, and at our next meeting I started asking about the payment. We agreed that in the future he would just pay weekly, which he has been doing since then. "
>> Play by the rules: Crump recommends that those who practice practice lay down their “hard and fast” rules and adhere to them. For Crump, this means taking Friday and Sunday off every week. She blocks these days off in her customer plan. Although she doesn't mind working occasionally in the evening, she will add time to her schedule in a later morning or afternoon to catch up on administrative tasks.
Another rule that Crump made for himself is never to send a customer to collections for non-payment. "I don't see any need to do this [clients] unnecessary damage. If they could pay, they probably would have done it. It just doesn't feel right," says Crump. "Besides, it's [collections] just one more thing to to learn how to do it and keep up with it. "
>> Don't Do Everything: A great way for private practitioners not to get overwhelmed is to use technology to their advantage, says Dasenbrook. This includes creating a practice website with customer admission and review forms that ask for a person's home address, insurance details, emergency contacts, and other basic information. This prevents consultants from having to spend time requesting and transcribing this information in person or over the phone.
Dasenbrook also recommends that practice owners use software or hire a professional to do administrative tasks that they do not like or that they cannot do themselves. Dasenbrook does that with accounting. "If there are tasks you don't like, hire them [out]," he says. “You can try doing it yourself first to learn and save money, but ultimately it makes sense to take out a rent if it is causing a headache and takes too much time. As your practice grows, start expanding on some of these things. "
>> Search and supervision: "The number 1 tip I would offer is to spend the money on high-quality supervision," says Altman. „Ich hatte einen unglaublich begabten Vorgesetzten, mit dem ich zu Beginn zusammengearbeitet habe, und es machte einen großen Unterschied in der Zeit, die ich damit verbringen musste, ihn zu„ beflügeln “. Die meisten unserer Aufsichtsstunden wurden für Fallbesprechungen aufgewendet, aber manchmal auch für uns sprach [about] über das Geschäft der Privatpraxis. Es war für mich als Geschäftsinhaber enorm hilfreich. Peer Supervision ist eine weitere großartige Möglichkeit, mit anderen in Kontakt zu treten, um Tipps und Erkenntnisse auszutauschen und nur einen Resonanzboden für Fälle oder für das Leben als Therapeut in privater Praxis zu haben. “
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Notwendige Fähigkeiten
Das Management privater Praxen erfordert eine Vielzahl von Fähigkeiten, von der Überwachung der Planung und Abrechnung bis zur Bestimmung der Fallgröße und der Bearbeitung von Kundenempfehlungen. Ein erfolgreicher Privatpraktiker muss auch eine Reihe von Fähigkeiten verbessern, die über die eigentlichen Aufgaben der Leitung einer Praxis hinausgehen, sagt Norm Dasenbrook, eine lizenzierte klinische Fachberaterin mit einer Praxis in Rockford, Illinois.
Dasenbrook betrachtet die folgenden Eigenschaften als „Muss“ für Privatpraktiker:
Klinische Kompetenz und Exzellenz
Gesundes Selbstwertgefühl, Selbstbewusstsein und die Fähigkeit, Grenzen zu setzen: Dazu gehört, zu wissen, was Sie können und was nicht, rät Dasenbrook.
Die Fähigkeit zu wissen, wann Sie beruflich über den Kopf gehen: Dies beinhaltet die Erkenntnis, wann die Bedürfnisse eines Kunden über Ihre Fähigkeiten hinausgehen und dass Sie sich beraten lassen sollten. Dasenbrook ist seit drei Jahrzehnten Berater und stößt immer noch auf Probleme, für die er sich von Gleichaltrigen beraten lässt. "Es passiert jedem – wenn Sie in einer Sitzung sitzen und keine Ahnung haben [how to help a client]. Das haben wir alle schon durchgemacht. Ich war schon oft dort “, sagt er.
Eine geschäftliche Denkweise und Neigung zur Buchhaltung, Planung, Führung von Krankenakten und anderen administrativen Aufgaben
Mit Risiken umgehen können: „Manchmal scheitern wir, aber wir machen weiter“, sagt Dasenbrook. „Sie müssen sich als Unternehmer sehen. Einige Dinge klappen nicht, aber du lernst daraus und machst weiter. "
Welche Fähigkeiten würden Sie dieser Liste hinzufügen? Veröffentlichen Sie Ihre Gedanken im Kommentarbereich dieses Artikels unten.
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Handlungsschritte, um mehr zu erfahren
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Pro bono: Ja oder nein?
Der ACA-Ethikkodex von 2014 ermutigt Berater, „einen Beitrag zur Gesellschaft zu leisten, indem sie einen Teil ihrer beruflichen Tätigkeit Dienstleistungen widmen, für die es keine oder nur eine geringe finanzielle Rendite gibt.“
Welche Rolle spielt die Pro-Bono-Arbeit für Privatpraktiker, die versuchen, ihr Einfühlungsvermögen mit der finanziellen Seite eines Unternehmens in Einklang zu bringen?
Erforschen Sie dieses Thema in einem Online-Begleitartikel zu dieser Titelgeschichte „Pro-Bono-Beratung: Wie es funktioniert“.
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Bethany Bray ist eine leitende Autorin und Koordinatorin für soziale Medien bei Counseling Today. Kontaktieren Sie sie unter [email protected].
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Es sollte nicht davon ausgegangen werden, dass Meinungen und Aussagen in Artikeln, die auf CT Online erscheinen, die Meinungen der Herausgeber oder Richtlinien der American Counseling Association widerspiegeln.
