How to Build Trust with a Client Before the First Session

A strong online presence helps potentials clients trust you and choose you when they are ready for therapy. Clients sometimes have a hard time trusting a new therapist.  It’s understandable: who feels comfortable telling their innermost problems to a complete stranger?  But trust is a critical part of the client/ therapist relationship if any real progress is to be made.  Thankfully, there are ways to build trust before your client even walks in the door.

The best way to help your clients feel comfortable with you even before your first session is to establish yourself through your online presence.  Think of your website as your welcome sign.  This is a gateway for your potential customer to get to know you and understand what your practice is all about.  Your social media and web presence should display your professional accolades, but also should showcase you as a real, authenticate person.

Online Presence Builds Trust

There are multiple ways for readers to come across your material and get a sense of you who are.  Maybe a friend retweeted something of yours.  Maybe they saw a media interview you did or read a recent blog article on your private practice website.  Or maybe they found you organically through a Google search. Either way, you can make a significant impression by your online content.  Hopefully, readers will feel a connection to something you’ve written or said that will cause them to seek you out more.  In this way, they are learning to trust your opinion both as a professional and also as a person.

If and when someone does seek out your professional services, they feel more comfortable since they already know a good deal about you philosophy and therapy style.  This means you almost get to skip a step in therapy: the individual has already been introduced to you and likes you enough to have personally chosen you as his or her therapist.

Building Trust Takes Time

Creating a strong online presence to build trust with your clientele is a long-term strategy.  It won’t happen overnight.  You need to continually put work into creating content for your social media platforms, engage in the professional conversation, publish guest posts, etc. to build up that reputation.  I once had a customer who had heard me speak nine months earlier before she was ready to call and make an appointment.  It takes multiple exposure before someone decides to become a paying customer.

A relationship with a professional counselor is one of the most intimate relationships a person can have. An individual is very vulnerable as he/she shares deep struggles, insecurities, and pain.  Building trust and confidence is a critical part of therapy, and thankfully social media can facilitate the process.  Creating and maintaining a strong online presence can greatly contribute to your reputation as a credible professional and trustworthy confidant.

How do you build trust with potential (and existing) clients through your online presence?

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Why I Only Hire W-2 Therapists (W-2 vs. 1099 part 3)

I've noticed that private practice therapist tend to hire additional therapists as 1099 contract employees. Reasons frequently cited for choosing to hire therapists as 1099 employees is that they don't have to pay the therapists taxes. While it may be more "affordable" to hire therapists as contractors, in my experience, there are also "costs." (For an summary of the difference between W-2 and 1099 employees read part 1 in this series. To hear about my employment tax audit adventure read part 2.)

According to the IRS website, the general rule for classifying 1099 independent contractor is "if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done" (italics added). It also states that an employee is not a contract employee if the services "can be controlled by an employer (what will be done and how it will be done)" and if "the employer has the legal right to control the details of how the services are performed."

In consulting with therapists around the U.S. I've heard about some of the "costs" of hiring 1099 employees. Some of the costs high turnover rates due to the part-time and often temporary nature of contract employee relationships. Some of those "costs" include lack of control over how and where therapy is done, inability to require specific paperwork, inability to require attendance at staff meetings or trainings, inability to request that therapists network and participate in community outreach to boost referrals.

Here are the four main reasons I only hire therapists as W-2 employees:

1) Overall Cohesiveness

My vision for Wasatch Family Therapy has always been to build a cohesive team with a shared long-term vision of providing excellent clinical services to clients across the lifespan from an attachment perspective, not just have a group of therapist doing any kind of therapy they choose.  Now that we have grown into a clinic of 18 therapists at 3 locations cohesiveness is even more crucial. When therapists are hired as 1099 contractors employers are not supposed to tell the contract worker how to do therapy, or make other specific requirements of the worker, such attendance at trainings.

2) Higher Level of Quality Control

If a therapist is going to work under my name and my practice name or "brand", I want to be able to have a say in how, where, and when they do the work.  I've spend over 10 years building trust, credibility, and presence in my region and I want to be able to be able provide mentoring, direction, and training in how my clinical team provides services.

3) Ability to Require Certain Activities

I want to be able to require certain activities from my team members that hiring them as 1099 workers does not allow me to do. We have streamlined forms for notes and documentation in our EHR system. I require each therapist to engage in at least one outreach or networking activity each month in order to create strong referral sources. I require attendance at two monthly staff meetings, and a certain level of professional appearance at the office.

4) Implication of Long-Term Relationship

I am not interested in hiring temporary therapists to provide services. Hiring 1099 workers generally implies a short-term relationship. I am interested in hiring therapists who have a shared vision and who I can invest in long-term, and who will invest in building the practice long-term. I want to build mutually beneficial relationships not just provide services. Hiring therapists as W-2 employees shows a greater long-term commitment to them to build their practice for the long haul. I also allows me to expect a greater commitment from them.

Would Your Practice Survive An Employment Tax Audit? (1099 vs. W-2 part 2)

Does the state tax commission really take the time to audit small private practices? I didn't think so, until my practice was selected for an audit.

A few years ago my clinic was selected for an employment tax audit. Lucky me, right? When the auditor walked into my office suite and saw many offices with different names on the doors, he looked at me pleadingly and said, "Please, please don't tell me that these therapists are all classified as 1099 contractors."

I replied, "I won't. We're all W-2's."

There was a look of relief on his face.He then proceeded to tell me that health and mental health private practitioners are notorious for incorrectly classifying 1099 employees. In his experience many groups are set up as contract workers when they are acting like employees (I'll go over into detail about the the IRS criteria for how to classify  an employee as a 1099 vs. W2 employees in a forthcoming post).

The auditor requested access to all of my financial documents including bank accounts, accounting,  payroll information and tax documents. He asked us questions about any large checks written directly to employees to make sure we were paying our employment taxes. After a brief review of my payroll and tax documents the auditor thanked me for making his job easier and left with a smile. I breathed a huge sigh of relief.

Had I hired the therapists working with me as 1099 I may have been penalized with a hefty fine and required to pay back employment taxes on all of the therapists' income. I was not in a position to shell out thousands and thousands of dollars. Had I been incorrectly classifying employees it may have put my practice in jeopardy.

Do you know the IRS criteria for classifying 1099 contract workers vs. W-2 employees? It isn't based on whether or not you want to pay your therapist's taxes or want to have them pay self-employment taxes. It isn't based on whether they are full-time or part-time workers. It isn't based on whether or not you provide benefits.

There are many misconceptions about classifying employees in private practice. I'll address theses criteria for how to distinguish between hiring 1099 vs. W-2 therapists in upcoming posts.

Watch for the next Therapist Blog Challenge coming next week, too!

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4 Reasons To Start Creating Content Online

Creating consistent online content can help grow your practice faster than almost any other marketing or networking activity

According to PCMag.com digital content creation is "The development of newsworthy, educational and entertainment material for distribution over the Internet or other electronic media." It falls under the umbrella of content marketing which is a narrative form of sharing information that speaks to a potential client's need while sharing who you are and the benefits of what you do. Content creation is a way of building trust online and with potential clients by being a valuable resource without asking for anything in return.

Consistently creating compelling and relevant content is the primary reason my private practice has continued to grow in spite of the economic downturn of recent years. Not only has my clinic grown, but since I started regularly blogging, writing, producing videos, and doing media interviews amazing opportunities have come my way. Publishing offers, national media interviews, conference invitations, consulting business, and over 25,000 social followers across multiple social networks are just a few of the incredible doors that have opened to me since I started focusing on content creation.

Here are 4 reasons that becoming a content creator can help build your private practice:

1) Visibility

Posting new content on your own practice website will help your site rank higher in search engines. Creating content for other websites, like guest blogging or interviewing with local news agencies who post the video clip and story online, also provides a SEO boost because it demonstrates that you are relevant and it strengthens your online presence. The easier it is for potential clients to find you online, the quicker your practice will grow.

2) Presence

Because the majority of adults are searching for health information online a strong online presence is critical for growing your practice. A general marketing rule is that it takes about 7 exposures to a brand or product before someone will buy a product or service. Strengthening your online presence makes it more likely that potential clients will be exposed to your "brand" and chose to become your client.

3) Value

Content creation can be another form of community education and a way to provide value to everyone, whether or not they become clients. Content that shares helpful information and answers the needs of people you are qualified to help is tremendously valuable. From a business standpoint, content creation provides an incentive for visitors to return to your practice website for your valuable content, which helps build trust in your services.

4) Credibility

Content allows you to show or demonstrate your expertise and competence instead of just telling someone about it. While I have always been an early internet/technology adopter and I've owned a private practice for over a decade, it wasn't until I started writing this Private Practice Toolbox blog that I became a credible practice building "expert". Creating regular content that meets a need for private practice therapists has allowed me to connect with therapists around the globe and to add private practice consulting as an additional income stream. Largely due to content creation on this blog alone, I have been invited to present to the National Association Of Social Workers on building an online presence, to co-present with PsychCentral founder John Grohol at South By Southwest Conference, and to write the feature article for the current issue of Online Therapy Institute's TILT magazine, and have presented locally on practice building.

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9 Ways To Get Doctor Referrals

Want to build strong referral relationships with medical professionals? The key is offering them something of value.

A few therapists at my clinic have been focusing on networking with Doctor's offices as potential referral sources. Through my 10 years in private practice, I've wasted a lot of time visiting medical practices with little result. However, during that time I found a few doctors or health practitioners who have consistently referred to me so I put together an training and presented it at our staff meeting yesterday. I thought that some of you might appreciate some tips on how I've built relationships of trust with medical practices who have referred patients for mental health or relationship therapy.

1) Ask for referrals

Don't be afraid to be bold and ask specifically for referrals from the physician or health provider. Let them know that you currently have openings and will get their patients in as soon as possible. When they refer, be responsive and get their patients in as soon as possible.

2) Face to face builds trust

While sending an email or making a phone call are convenient ways to reach out to physicians, nothing can replace face-to-face interactions when it comes to building trust.

3) Educate them on your specialty areas

Be clear and concise about who you are, what you do, and how you can help their patients. Be clear with them about who you want to see: your ideal client. For more information about how to craft your basic practice message see my post Why Therapists Need An Elevator Speech.

4) Teach them how to make strong referrals

• Suggest that they write the prescription for therapy on an official RX pad
• Suggest that they (or an office assistant) call your office while the client is still in their office to make an appointment.
• Suggest that they strongly recommend you, specifically.

5) Make friends with the office staff

The office support staff, receptionist, nurse, medical assistant, or office manager may actually do more of the referring than the provider. Don't over look the power of building trust and rapport with the support staff in medical offices.

6)  Follow up every three months

Periodically following up with providers is important to staying at "top of mind" for referrals. I've found that contacting the provider every quarter is a good time frame for following up. You don't want to be a nuisance to busy medical practices, or appear desperate by following up too often, however, if you wait six months they may have run out of your cards or forgotten about you entirely.

7)  Make sure they have plenty of cards

Even though we live in a digital age, paper is sometimes the best method for communication. Having professional business cards and brochures printed and regularly stocked give physicians offices something concrete to give to patients and increases the likelihood that they will actually contact you after they leave the office.

8) Offer to be a resource

Healthy relationships need to be mutually beneficial. So, when you ask the doctors for referrals, be sure you have something to offer. I've offered to be an ongoing resource should they have questions about referrals. I often say, "Refer anyone to me and I'll make sure that your patient's get the mental health or relationship counseling they need." Another service you can offer is in-service trainings for their staff on topics relevant to their patients, speak at their staff meetings on something that is valuable to them.

9) Send personalized thank you cards

When you receive a referral from a physician office, be sure to acknowledge and share your appreciation. I've found that sending a personalized physical "thank you" card via "snail mail" makes an impact. Always include a few of your business cards, and ask for more referrals.

What tips have helped you build referral relationships with medical professionals? Please post them below.

(c) Can Stock Photo