I have learned a few things about running a business and providing counseling, supervision, and training over ten years, and I expect to learn a lot more in the years ahead. I expect never to achieve expert status, only competence. That is why they do not call it private “perfect”.
· In an attempt to build my private practice I joined several therapy directories, purchased advertising in various media, attended many professional forums to distribute business cards and brochures, and sent out e-mail appeals to referral sources. Most of these investments had no returns. I still receive most of my referrals from existing clients, attendants at my trainings, and directly from insurance companies.
· As a social worker and therapist it is sometimes difficult to ask for and talk about money and payments. However, in terms of professional practice it is unethical not to. I have learned to make sure up front that I will be paid for each and every session. I cannot stay in business providing services for free and allowing a client balance to grow interferes with therapy and results in lost income that cannot always be written off.
· My practice model for working with parents and children includes an assessment of the parents’ trauma history and attachment styles. Sometimes, when parents are in a hurry to see results, when they seem “too nice and normal” to ask, or when the child is in crisis, I have moved forward with family therapy. Every time I have gone against my better judgment, it has come back to haunt me and to stall progress. It becomes a sticking point I cannot ignore and must address, which I could have known up front.
· While I would like to be on the cutting edge of new media with the use of texting, e-mail, and online counseling, it just does not work for me. I have no desire to be constantly available to clients by texting. I started with openness to e-mailing with clients but I quickly learned the hard way that I can misinterpret what a client is asking and clients have misinterpreted my comments in response. So, while clients may feel the need to explain themselves in detail in an e-mail, I have learned to respond only in person so that I can clarify the client’s concerns and check and correct any misunderstandings. Now, I tell clients I can make, change, and cancel appointments by e-mail and that I will read client e-mail, but that I will not respond by e-mail but only in person during our next session.
· Sometimes, you just have to apologize for making mistakes or for not being able to help. Therapists are human, too. Despite consultation and supervision, sometimes personal issues interfere and cause a break or disconnection with a client. It is therapeutic to own it and apologize. It can even propel the process forward. Other times, in an effort to be helpful I have accepted clients I could not help and needed to send them on to another therapist. The quicker I can figure that out and make the appropriate referral, the better.
· To that end, while, at first, I was anxious to have clients and schedule appointments, I have learned that it saves a lot of time and frustration to conduct a more comprehensive intake interview over the telephone or even an initial consultation before scheduling a first session. Some of the questions I need to answer during the intake: who is the client and is that person willing to participate. Sometimes a spouse or parent will try to make an appointment for an adult who is not seeking therapy on their own. If the client is a child, who has physical and legal custody, who will participate with the child in therapy, who has the legal right to consent to treatment with the child. I have had step parents and grandparents seek therapy for children for whom they do not have custody or legal rights. Finally, is the issue or concern something for which I have training and experience.
· When I started I was intent on being as open and helpful to clients as possible. And, so I would tolerate clients for therapy and supervision not keeping appointments, cancelling at the last minute, and showing up late. I rescheduled them time and again, even calling and reminding clients to make and keep appointments. Then, I decided I needed to keep better boundaries in this regard. And, so now I do not call clients to remind them or follow up after no shows, do not reschedule clients after two no shows, and collect no show fees before scheduling any more appointments.