4 Ways a Private Pay Practice Model Benefits Clients

The value of using a private pay model (instead of a managed care system) for your therapy practice is clear: less stress about additional paperwork requirements, greater autonomy to provide the services you deem are in the client's best interest, and immediate payment of your full fee are some of the main advantages. But some therapists are understandably hesitant about how to make the switch because of the potential impact this choice it might have on their clients. Some common fears are “Clients might stop getting the therapy they need because they can’t afford me” or “charging a higher fee is selfish and means I care more about money than helping people.” When I was considering making the switch, I too had thoughts like these cross my mind. But I discovered that the opposite was true; breaking up with managed care and embracing the new way of structuring my practice actually benefited clients who received services. Here are 4 ways that a private pay model benefits clients:

1) No Mandatory Diagnosis

Many managed care systems require that you diagnose a client's specific mental health condition condition prior to paying you for your services. In some cases, insurance companies will only pay for certain diagnoses. Often, relationship issues are not covered. However, this can turn in to serious ethical problems.

I remember years ago I was referred an urgent client - a child who was sexually assaulted. I determined that she had no clear-cut symptoms and didn't meet a diagnosis that her insurance benefits would cover. I was in a terrible dilemma: do I give an inaccurate diagnosis to satisfy the requirements of managed care, or do I get paid for the initial? No therapist should ever have to find him/herself in this kind of a situation, and no client should be subject to this either.

One of the best parts of employing a private pay model is that there is obviously no such requirement. Diagnosis can be used as a tool, but you are not obligated to provide one. By eliminating the need to diagnosis a condition that may or may not fully exist, you can ensure that your clients receive ethical, honest, and accurate care.

2) Higher Quality of Service

Back when I used a managed care system, I was receiving approximately 40-70% of my stated fee. This meant I was in survival mode, seeing more and more clients just to try to get by and meet my own financial needs. And all the while, I still had the stressful task of running the business side of things. It’s not surprising then that I wasn’t able to give as much to my clients. As much as I tried, unfortunately the standard of care I could provide was compromised. That was unfair to me and unfair to the people who were paying me to help them.

By changing to a private pay model, I was able to see fewer clients and, which reduced my stress, which allowed me to be more present for my clients. I also no longer spending hours per week on phone calls and paperwork that came with using a managed care system, which freed up my energy to give to those I served.

3) Better Therapist/Client Match

A private pay model also lends itself to a better fit between the therapist and the client. If you have fewer clients, you can be selective about the ones you see. The opposite is also true; if someone is willing to pay more for professional therapy, it’s likely that he/ she has done his/ her research and sought you out because of your specialty and the expertise you provide. To put it simply, you want them, and they want you.

I’ve found that using this financial model attracts highly-motivated clients. Although they are required to pay more, they place high value on therapy and budget accordingly.

4) More Clients Reached

A private pay therapy model allows you to have a greater outreach and help more clients. This may initially seem counter-intuitive; how does seeing less clients serve more people? The answer is that if you have a surplus of potential clients or have people come to you with needs that are different that the expertise of your practice, you can refer them to trusted outside resources. You’re helping other therapists while simultaneously ensuring that clients receive the best care specifically for them.

The other thing I have found is that the income stability provided by a private pay model allows my colleagues and me to do more pro bono work. Paradoxically, because we earn more, we can provide more volunteer service when we choose.

All in all, switching to a private pay model was one of the best business decisions I made to benefit not only myself, not only my practice, but the clients and the community we serve. Charging a higher fee does not mean you are inconsiderate or selfish; it means you are valuing yourself and providing the best quality care to your clients.

*If you find that finances are legitimately a concern for some of your clients, you may decide to provide alternative choices, such as reduced fee sessions with Masters’ student interns. My practice Wasatch Family Therapy does this, and it works well for those looking for a more affordable option.

Get practice tips and blog updates in your inbox. Sign up for the Private Practice Toolbox Newsletter here.

Learn about my private practice consulting

Join my Private Practice Toolbox Facebook group and connect with 3000 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you'll be added to the group.

Adventures In Private Practice: Trauma Specialist Leticia Reed, LCSW

Less than one year ago Leticia Reed, LCSW opened her private practice in Long Beach, CA. Find out what resources and tools have helped Ms. Reed muster the courage to open her own practice, what she's learned from clients, and how she manages her roles as "therapist" and "business owner".

Tell me about your private practice...

I opened Reed Behavioral Solution in March of 2012. My practice mission is: "Helping individuals, couples and families achieve hope, healing, wellness and freedom. Empowering my clients to leave better than they arrived is what drives me to provide the best and most effective services. I specialize in women's empowerment and trauma, although I provide a wide range of services to other populations in my practice. I also offer Christian counseling for those seeking spiritual connectedness as a means of coping and regaining a sense of purpose and hope.

Why did you decide to open a private practice?

I began my practice after leaving employment with the County of Los Angeles and feeling like individuals were being failed by the system as they were only treated as a number that became lost in a revolving door. I felt like opening my practice provided me with an opportunity to make a significant impact, one with real rehabilitation and healing.

Clients that therapists find to be the most “difficult” are sometimes the ones who can teach them the most. What have you learned from your toughest clients?

I agree that "difficult" clients provide the most meaningful learning experiences. Through my more challenging cases, I have learned the importance of patience, tolerance, unconditional positive regard as well as the real importance of "starting where the client is" to guide them towards healing. The technique- Motivational interviewing has been the principle that I have incorporated to achieve this while increasing motivation.

What’s your biggest pet peeve about private practice?

One of my biggest pet peeve would be the amount of documentation required as it takes away from my time spent in direct contact with my clients. However, it's necessary as it also provides me with a blueprint and framework that guides my treatment and goals.

How did you discover or develop your practice “niche”?

My niche sort of evolved as the majority of my clientele seeking services has been women with self-esteem and trauma related issues.

What resource (book, website, person) helped you the most when setting up your private practice?

The various resources that have aided me in starting my private practice has been the following: Nakeya Fields of Fields Family Counseling who offers a workshop geared towards assisting individuals starts their private practice, while providing lifelong networking and consultation with other group members. I also used and received a wealth of information from Ofer Zur Institute Practice Handbook for HIPAA friendly forms and regulations. My mentor Cynthia G. Langely, my prior clinical supervisor who has many years in the field serving in various positions, including on the CA BBS panel when the Oral examinations were required, has continued to provide me with a wealth of information and support. Lastly, The various Facebook groups I am currently in, including Julie Hanks’s Private Practice Facebook group have also increased my knowledge that has been instrumental in keeping me current in the field.

What has surprised you most about being in private practice?

The things that have surprised me the most about building a private practice has to be the amount of work it takes to stay afloat and monetary resources needed to build and maintain operation. Another surprise has to do with the number of people hurting and in search of HOPE, some of which are fellow colleagues.

Has your private practice helped you grow professionally?

My private has influenced my growth professionally in the sense that it has taught me the importance of being organized, detailed oriented, punctual, and the importance of networking/collaboration.

Has it helped you grow personally, too?

On a personal level it has made me to be more grateful and attuned to the world and my purpose in it, helping me to not take anything for granted.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?  

Self-care is extremely important to me. I love pampering myself, traveling and engaging in church activities, reading my bible and praying. I also make it a point to surround myself with positive people that are encouraging and uplifting.

How do you cope with the inevitable stressors involved with being your own boss?

I cope with the stressors of being my own boss by consulting with colleagues in practice and digging my heels in the sand and "just doing it". My tenacious spirit and optimistic personality as well as my strong Faith in God has assisted me in my success in this short amount of time I have been practice. Colleagues that know when I began have commented on my rapid success. I am a very blessed woman and I am looking forward to even more expansion in 2013 and beyond.

Find out more about Leticia Reed's private practice at www.reedbsolutions.com

How To Find Top Student Interns To Grow Your Practice

There is an "it" factor when looking for interns to train in your private practice.

Here's how I've found amazing interns that stay at my clinic even after graduation.

Over the past several years I have trained and mentored many graduate students and new graduates working toward clinical licensure. Working with interns has been a great way to build my practice, leverage my time, and satisfy the part of me that loves mentoring.

Most graduate students who train at my clinic during school are offered a therapist position after graduation which creates a win-win situation -- the student gets a job they're already trained for and I get to add talented and enthusiastic therapists to my team! After interviewing several therapists, I've learned to be very selective about who I bring on at Wasatch Family Therapy.

I recently consulted with a private practice therapist who has a waiting list for new clients. As we started exploring the option of hiring a graduate student to train she expressed some concerns. Her biggest questions were:

• How do you find talented graduates students?
• When interviewing potential student interns, what qualities do you look for?
• How do you know if they're going to be a good therapist and work well with your private practice clientele?

So, here's what I've learned after several years of interviewing and hiring student interns...

How do you find gifted graduate students?

• Contact local graduate programs in your discipline and see if they are  looking for internship/practicum placements for their students.
• Fill out the necessary paperwork to be an approved placement at local schools, even if you're not quite ready to bring on a student. When you're ready to train an intern you'll already be approved.
• Reach out to traditional and for-profit schools. I've found that the for-profit programs (Argosy University and University of Phoenix in UT) are more flexible in terms of internship start times and the number of clinical hours per week required. I have been very pleased with the caliber of students from private, for-profit universities.

When interviewing potential student interns, what qualities do you look for?

• After interviewing grad students for several years now, the biggest "it" factor I look for is likeability. I know that sounds simple, but it's true. If I enjoy talking to them and I trust them during the interview process, then it's likely they will quickly put clients at ease, too.
• I look for people were "born" therapists and just need the formal credentials and trainig in order to actually to all themselves a therapist.
• I look for people who have long-term goals that include working in a private practice setting, like mine, beyond the internship.
• I always ask about their style of handling conflict, feedback, or direction in work settings and discuss several scenarios that might arise in private practice.

How do you know if they're going to be a good therapist and work well with your private practice clientele?

• You don't. There's no guarantee that someone will be an effective clinician. I suggest that you make sure that there is a clause in your contract that you can stop training a grad student that isn't working well with your clientele.
• I often require that interested graduate students volunteer at my clinic for several months before securing a clinical internship. There is such a high demand for interns in my area that we can be extremely selective. This volunteer time gives us both a chance to make sure it's a good fit.
• A 3-step interview process helps screen potential interns before bringing on.  I do an initial interview, a second interview, and a "mock" case presentation at team meeting. While I ultimately decide which intern we will "hire," I trust my team's input as to whether the student would be a good fit.

While it's always a risk bringing on a new student to my team, I find comfort in the fact that the number one predictor of client outcome is the strength of the therapeutic alliance. Generally, if it's easy for me and my team to connect with a grad student in the interview process, it's safe to say that clients will feel the same way about them. Ultimately, it's your practice and your reputation on the line as the owner of your practice.

Have you trained interns in your private practice? I'd love to hear about where you find them, how you screen them, and if it's worked to build your practice!

Download the free Private Practice Toolbox App here

(c) Can Stock Photo

Therapist Media Cheat Sheet: Get More Clients By Maximizing TV Interviews

While TV interviews and appearances rarely lead to an immediate increase in new clients, they do raise awareness of your private practice and your specialty areas, expose thousands of people to your practice, and set you up as a credible expert in your field. Marketing experts say that it generally takes 7 exposures to your business brand before a client will actually try your products or services. In recent posts I share how to get TV interviews and how to present your best self during interviews. Here are some tips for getting the most mileage out of interviews to build your credibility and increase referrals to your practice.

1) Be explicit about how you'd like to be introduced

Reporters aren't worried about your branding, they're concerned about their story. It is your responsibility to protect your practice name and brand by being explicit about how the interviewer should refer to you on camera. After having a few interviews where they say my practice name incorrectly, or didn't mention it at all, I've learned to clearly spell out how I want to be introduced. In email correspondence with media contact I request something like this:

Please refer to me on camera as "Therapist Julie Hanks LCSW, Director of Wasatch Family." I also request a lower-third banner (the text box graphic that pops up at the bottom of the screen during interviews) with my name, credential, practice name, and website during the interview. Here's what I ask for: "Julie Hanks LCSW, Director of Wasatch Family Therapy, WasatchFamilyTherapy.com".

2) Request a link to your website

Always request that the interviewer mention your website address during the interview and shows your website address on  a lower-third banner. You want to make it as easy as possible for potential clients to find your practice website, and ultimately, set an appointment. Additionally, if the TV station posts a web article or video online request that they post a link to your website. Having large websites link to your website improves your visibility Google searches.

3) Capture the video to post on your website

I suggest keeping an archive of all TV interviews so you can use them on your own practice website. Many TV stations post the interviews online and allow you to imbed them on your own website without uploading and converting the video. If the interview is not available online, you can request a DVD copy of the segment from the TV station.

4) Post on social media

Social media video sites, like YouTube, allow TV interviews to reach beyond the live TV viewership. I upload every TV interview to my YouTube channel and set up feeds to my websites and social media profiles and pages. The Men's Doc Will Courtenay, PhD, LCSW says that many clients have viewed his interview clips online before actually meeting with him:

Now that we can post TV interviews on websites and YouTube, they're really a great opportunity for marketing. And it's really the best kind of marketing, because the television show or news station has identified you as an expert. Today, many people search for and Google psychotherapists to see what they can find out about them before they meet with them.

Psychotherapist Terrence Alspaugh, LCPC says that YouTube videos give potential clients a feel for his style and expertise giving them the confidence to set an appointment.

I had the interview posted on YouTube with a link from my website, and that exposure has helped to attract new clients. Several prospective clients told me that they watched the YouTube clip first, and as they were favorably impressed, they contacted me about couples counseling. The interview has been watched by over 400 people, so it serves as a way for prospective clients to see me in action before meeting me.

Private practice therapist with YouTube channels

Enjoy watching these private practice therapists videos on their YouTube channels.

Dr. Will Courtenay

Eileen Kennedy Moore, PhD

Shift You Life Now Tracy Latz, M.D., M.S.

Julie de Azevedo Hanks LCSW