Epilogue
Lessons Learned
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.
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