A Day In The Life: Meet Divorce Counselor Misty E. Vogel, MA

A ten year career in the mortgage banking industry not only prepared Misty Vogel, M.A., NCC for many of the business aspects of self-employment, but also for managing the intense emotions that come with major life transitions.

Helping clients buy homes seems far from providing therapy, but the process of helping mortgage clients navigate intense emotions that surface during home purchasing has been added to Vogel's therapeutic skill set.

Fresh out of graduate school, Vogel is just starting to build her practice in Denver and in Evergreen while she continues to work as an extern at Evergreen Psychotherapy Center, a practice specializing in treatment of attachment disordered children and families.

In her private practice, Vogel combines her experience doing attachment work with her passion to help children and families navigate the difficulties of divorce and custody issues. Vogel's own parents divorced when she was 5 so she knows first-hand the impact divorce can have on the entire family. Peek into a day in the life of a therapist just beginning to build her private practice and see what it takes!

A Day In The Life

February 13, 2012

6:30AM

Alarm is sounding and my husband is up and out of bed quickly. I, on the other hand, reach for my phone which is next to me on my nightstand, easy to check email from here. I turn on the local news to check the weather. No snow and warmer temperatures… happy about this, as it means I can go for a walk later (self-care).

7:00AM – 8:15AM

Getting ready for my day includes planning lunch and a change of clothes. My externship is located in the foothills outside of Denver in Evergreen, about a 30 minute commute on a good day.

8:15AM – 8:50AM

On my commute to Evergreen! I can’t complain, this drive is often quite picturesque – many times the moon is setting to the west, or the snow capped mountains are glistening in the sun rising upon them, and, more often than not, I am fortunate enough to spot wildlife – buffalo, coyotes, elk, hawks, and even eagles once in a while! I also am lucky to use this time to make a few phone calls. (When I was still studying for the NCE exam, I used this commute to listen to Dr. Rosenthal’s study CDs!)

9:00AM – 12:00PM

In session, an intensive at my externship. Our current family is in real crisis. Mondays of the second week can be very tense because the families have just spent a couple of days outside of treatment and often they fall back to old patterns. Unfortunately, in this case, the crisis may not be diverted and it appears this week is going to be a tough one.

12:00PM-12:50PM

An hour with an individual client – my own client, not part of the externship. Without a break between the intensive and my individual session, I am feeling some hunger pains! Those almonds didn’t quite cut it.

1:00PM – 1:30PM

Commute back to Denver, meeting up with an old co-worker and friend who has a networking group she wants to introduce me to.

1:30PM – 2:45PM

Lunch with friend. Networking is essential at this stage of opening my own practice. I also attend a Private Practice support group as well as numerous workshops and conferences.

3:00PM – 4:00PM

Changed into walking clothes at the restaurant and went for a walk at the park. This is my self-care time!

4:15PM – 6:30PM

Back at my home office. I make finishing touches to my post card announcements for my new practice and two offices. Order those online – some will be mailed to a small database and the rest will be distributed in local coffee shops and local hang-outs. Post a quote on my business Facebook page – I find that if I do this every day, people are more likely to remember me and my practice. Open up the project I am currently dreading…building my website. I am trying to determine if I chose the right web page host; it hasn’t been a user-friendly experience thus far.

6:30PM – 7:45PM

Cook and eat dinner with my husband. Catching up on one another’s day. He is working on a start up company and we are also beginning the journey of seeking out fertility options. The journey has just begun – I filled my husband in on the task at hand getting in for a consultation with the fertility doc, information gathered on a phone call during my commute this morning.

7:45PM – 9:00PM

Took a little time to read up on divorce and attachment. I had downloaded a few articles over the weekend. I am considering writing a blog targeted to this population.

9:00PM-10:00PM

Both my husband and I are exhausted. We treated ourselves to a few TV shows on the DVR. Turning off our brains before heading to bed tends to produce better sleep!

10:00PM

Turning in – thinking about the family I’ll see tomorrow at Evergreen. They have been on my mind a great deal this afternoon.

Find out more about Misty's practice at  www.mistyvogel.com.

If you'd like to submit a day in your life for this series, please contact me here.

Getting 3 'Fs' In Private Practice Is A Good Thing!

My motivation for starting my private practice, Wasatch Family Therapy, was very clear. I wanted to create my ideal work environment and I knew that no one else could do that for me. I felt called to help people heal themselves and their relationships.  I knew that I wanted work with therapy clients who valued my services and time, and who were dedicated to working hard to improve their life. I wanted the flexibility to set my own schedule and take time off to be with my children and attend school and sporting events. I wanted to do paperwork that was relevant and helpful for treatment. I wanted to invite other clinicians into my professional space who were gifted therapists, genuine people, and who I enjoyed spending time with. I wanted to work as a social worker part-time and make a full-time income (a lofty goal in a profession where many work full-time and make a part-time income).

I know why I chose to go into private practice but I was curious if other therapists and counselors around the country had similar motivation opening private practice. I recently asked several therapists about their reasons for taking the leap into the business world of owning their own practices and noticed three common themes emerged. I call them the 3 "F"s of private practice: flexibility, freedom, financial opportunity.

1) Flexibility

Therapists who take the leap into private practice value flexibility in their work schedule to better balance work and family life, and to pursue other interests.  Dr. Mary Sidhwani, a psychotherapist in private practice since 2000 in Ellicott City, Maryland opened her practice so she could have the flexibility to care for her two young children. "I wanted to be able to balance both my professional and family life; to be able to spend as much time with my children as possible while they were young."  Social worker Diane Spear, LCSW-R of New York City said, "I had worked at an agency with wonderful colleagues, but private practice gave me the opportunity to set my own hours and fees."

Of his decision to open his own practice psychologist Dr. John Duffy says, "I wanted to go into private practice as I wanted control over my career: my schedule, niche, fees, client base, whether I accepted insurance, and so on. I also wanted to be able to write, consult, speak, and expand my practice, or take fewer clients, as I went along."

2) Freedom

Freedom to select a particular client population to work with and choose your own approach to treatment has drawn many therapists to open a practice. After agency work left her overworked, underpaid and burned out, Esther Kane, MSW of British Columbia chose to open a private practice because it allowed her to focus on her passion - women's issues. Kane says she loves the "autonomy and flexibility of not having to answer to anyone."

Spear says she appreciated being able to choose who she worked with and how she approached treatment. "I wanted to choose level of pathology I want to treat, choose the theoretical orientation and supervisor I'm most comfortable with, and set the environment as I prefer. In short, autonomy, autonomy, autonomy!"

3) Financial Opportunity

It's a risk to open your own practice, but when it grows, you are the one who benefits most from the financial growth. Private practitioners have the opportunity to grow their income in ways that are unlikely to happen when you work for someone else. New York City therapist Emma K. Viglucci, CFT, LMFT, CIT experienced the growth potential first-hand. Since opening Metropolitan Marriage & Family Therapy, PLLC she says, "I've grown the practice to the point where I had 10 clinicians working with me as part of our clinical team. My practice has become an Internship Placement Site for MFTs in training."

Financial need helped Lisa Gomez MA, PLC of Surprise, AZ transition from part-time to full-time private practice. After being laid off from a full-time staff position due to budget cuts Gomez says it was "the perfect opportunity to take the step of faith into full-time private practice. I love private practice because I can be as successful as I want or as flexible as I want."

What motivated you to start your private practice?

If you're thinking about venturing into private practice, what do you hope to gain?

photo credit: Leo Reynolds

What I Wish I'd Known Before Starting A Private Practice

If you're considering going into private practice, it's always smart to talk to other clinicians who have been there. When I opened my practice years ago, I had very little business experience. Luckily, I did a few things right that allowed me to be profitable (and it didn't hurt to be married to a CPA). Over time, I learned that I have a knack for marketing and networking that has allowed my practice to continue to grow, even during a recession. Few private practitioners are armed with small business skills when they venture into private practice. According the U.S. Small Business Administration, around 50% of new businesses will close their doors within 5 years.  The realities of making a profit and running a successful private practice can be discouraging and exhausting. If you're considering opening a practice, I think you'll enjoy several seasoned practitioners answer the question,"What do you wish you'd know before starting your private practice?

Private practice is a business

Like most of therapists, Emma K. Viglucci, CFT, LMFT, CIT  of New York City didn't really understand what it takes to run a business when she opened her practice. "I had some ideas about running a business as both of my parents owned businesses, and about running a practice from assisting run my graduate program's clinic. But, I didn't know the nuts and bolts of being in business."

It's easy to overestimate profit and underestimate the amount of work it takes to start and build a private practice. Psychologist and professor Karen Sherman, Ph.D. says she wished she'd know that working for herself  "wasn't going to be as lucrative" as she thought.

Save for self-employment taxes

When you go into private practice you'll be paying self-employment taxes. If you're used to working for an agency where your taxes are automatically withdrawn each paycheck that catches new practitioners by surprise. Just to give you an idea of how much to save, self-employment taxes for 2011 in the U.S. are around 13% (SBA.gov).  Psychologist Roberta Temes, Ph.D learned about taxes the hard way. "My first year I did not diligently deposit half my fees into a bank account earmarked for taxes. That was a learning experience."

Understand managed care

Texas counselor Shannon Purtell MA, LPC, LPC-S, NCC wishes she'd better understood the world of behavioral health insurance before she opened her doors.

Before entering private practice, I wish that I had truly understood behavioral health insurance and Employee Assistance Programs. Trying to learn the ins and outs of insurance while building a private practice was not only frustrating and time consuming, it was costly. Without completely understanding the industry, I failed to negotiate better rates, was unable to qualify for certain panels, and did not always understand the reimbursement structure. Each company had a different way of handling referrals, authorizations, and reimbursement. Unfortunately, I started in private practice prior to electronic billing and online benefit verification/authorization which has dramatically streamlined the process.

Importance of marketing skills

New York City therapist Diane Spear, LCSW-R wished she'd been better armed with marketing know-how when she opened her doors. Spears says, "You can be a terrific therapist and have a tiny practice if you're not good at marketing. And if you're not naturally good at marketing and networking? Practice! A lot."

Developing a niche and area of expertise is what Clinical Psychologist and author Dr. John Duffy wished he'd known before opening his practice.

I wish I had known the importance of establishing a niche when I started, developing a particular expertise. I found that I work well with families, in particular teens, tweens and their parents. Specializing in this area, I've found that I have a strong knowledge base in this area, and I am more and more confident in my work. As a result, I have a full practice, a waiting list of clients, a popular book, speaking engagements. I am also now considered an expert in a number of media outlets.

Stay on top of billing and record keeping

When you're your own boss it's easy to set some of the less enjoyable and often tedious business details on the back burner. Arizona therapist Lisa Gomez MA, LPC wishes she'd known the importance of staying on top of those tedious administrative tasks. Gomez wishes she had understood the importance of staying "on top of your billing and having good records in regards to accounting."

Practice ebbs and flows

Many private practitioners are surprised by the fluidity of referrals and fluctuating direct care hours. My own practice always dips to the lowest number of referrals and fewest client hours every December. I learned through not getting a paycheck one December to save 10% each month throughout the year to cover the holiday lull.

Portland individual and couples counselor Julie Jeske M.S. has also learned by experience to trust the ebb and flow of her private practice. "I wish I had known more about the way things can fluctuate. Some weeks (or times of year) are really busy and others are slower. The first time things slowed down for me I got really nervous, but it always picks up again," Jeske says.

Solo practice can be isolating

When you practice in a clinic or agency it's easy to take social interaction and peer relationships for granted. There's always someone to grab lunch with or to consult with on difficult cases. For many therapists, the transition to private practice often means a loss of built in professional support system, and the need to actively seek social interaction and professional consultation.

When therapist Amy Luster, M.A., LMFT of Santa Monica, CA opened her practice she found solo practice to be isolating. Luster says, "It would have behooved me to learn about the benefits of participating in a group practice while I was in my graduate program."

Importance of setting boundaries

Maryland therapist Dr. Mary Sidhwani wished she'd know the importance of setting boundaries with clients.

Before I began my practice, I wish I would have created healthier boundaries. I wanted to be available for all my new clients and so returned phone calls and emails 24/7. As time went by, it became increasingly difficult to maintain that with the growing practice. I was able to put healthy boundaries in place, however, it would have been much easier if I had done that initially.

Now it's your turn. What do you wish you'd known before starting a private practice? Please post your comments below.

Business Planning: Does Your Private Practice Have A Treatment Plan?

Many private practice therapists don't have a business plan or think of themselves as a "business owner."  A private practice is a business and successful businesses have a plan to help guide their growth. Even if you've never taken a business course you already know how to write a business plan.  Think of your private practice as a "client" in need of a clinical treatment plan.  Here are some tips to transform your clinical assessment and treatment planning skills into a private practice business plan so you have a clear path to grow your practice.

Assessment

Presenting problems and current complaints Identify current problems or weaknesses in the business aspect of your practice. Do you need more weekly client hours? Are you having difficulty collecting money in a timely manner? Do you have inconsistent billing practices?  Are you barely breaking even because of high overhead?

Strengths and resources What personal strengths do you bring to your practice that will help you address the presenting problems? Do you have extensive referral network with physicians? Are you detail oriented when it comes to paperwork and billing? Are you a creative problem solver? Or maybe your an excellent writer. List your strengths.

Business history What events in your practice that have shaped your business practices? Did you have some rough patches where you weren't profitable that have left you feeling fearful and desperate for referrals? Have you experienced any kind of positive successes or painful experiences in the business end of your practice that haven't been resolved? Write them down.

Business support system Just as you'd assess for client support network, take a look at your business support system. Do you feel isolated? Are you using outdated computer software that makes billing tedious? Do you have some colleagues or business consultants that you can go to for professional consultation? Identify your current support network as well as areas where you could benefit from additional support.

Treatment plan

Setting goals Identify 3 business related goals for your private practice. Break your goals into specific, measurable, timed objectives. Finally, add three action items to move you toward each practice goal. Remember, you know how to do this for clients, just shift your mindset to the goals of your business. Here's an example of a treatment plan for your business:

Goal: Reach 20 clients hours weekly.

Objective: Cultivate 3 consistent referral sources in the next 90 days.

Action 1: Set up practice website on wordpress.com to build online referrals by Nov 15.

Action 1: Send letters and business cards to all family practice doctors within 10 miles of my practice by end of this month.

Action 1: Contact a local TV news station to seek interview on how to successfully blend step-families by this Friday.

Now it's your turn to write a treatment plan for your private practice.

photo credit: Digitalnative