6 Reasons You Don't Have Enough Clients

Getting and keeping clients is a common struggle for private practitioners. Here are 6 potential barriers to a full practice and what to do about them.

1) You're not keeping the clients you have

It takes a lot less time, money, and energy to keep a client engaged in meaningful therapy than to find a new client. Keeping clients engaged in the therapeutic process requires additional skills. New skills might include setting expectations during the initial session that therapy is an on-going process. Recommend  that new clients schedule ahead 3-6 weeks (depending on your assessment of their need during the first session) instead of scheduling one week at a time.

Another strategy that will boost client retention is reaching out to clients who've dropped out of treatment without proper termination. I encourage my team of therapists to do this regularly by writing a hand-written card with their business card enclosed to clients who have not returned to therapy. The cards say something like, "You've been on my mind. I want you to know that I am here if you need me. If you'd like to take a break from therapy for a while that's fine. I'd like to offer you a free 25 min "wrap up" session where we can say goodbye." Many clients are very touched by this gesture and it is just the encouragement they need to continue coming to therapy. Even if clients don't continue in therapy, you've modeled how to say a healthy "goodbye".

2) You're not offering anything valuable to potential referral sources

I love that I'm approached regularly by a therapists trying to network and ask for referrals. You know the ones who I will refer to? I will refer to the therapists who approach our relationship as a mutually beneficial relationship. I am more likely to refer to therapists who, in addition to asking for referrals, offer their time, expertise, or referrals to me and my practice.

Several years ago I had a therapist contact me asking if I would refer couples to her for therapy. While she did offer to take me to lunch (which I didn't have time to do) she wasn't offering herself as a resource to me in any way. Additionally, I was annoyed because had this therapist had done her homework and looked at my website she would have seen that I work with couples and that I have several colleagues at my clinic who also work with couples. The key to developing strong referral relationships is to create mutually beneficial relationship, offering yourself as a resource to the other person.

3) Your online presence is weak

Have you Googled yourself lately? Have you searched for key terms in your geographic location to see where your website ranks? Potential clients are searching for therapists online and will generally click on websites listed on the first page or two of Google searches. If your information is easily found make sure the information found about you and your practice is accurate. Here are some resources to help you strengthen your online presence and make it easier for new clients to find you.

Does Google love your therapy practice? 5 elements of an effective practice website 4 reasons to start creating online content

4) You're not as good as you think you are

Most therapists think they are more effective than they actually are.  Therapists, like any other professionals have varying level or skill and success, but it seems that on the whole we are an overly-confident group.

A 2003 survey asked 143 counselors to grade their job performance on a scale from A to F... Of the counselors, 66 percent rated themselves as A or better. None saw himself or herself as below average (Sapyta, Riemer, Bickman, 2005, p. 147).

How do you find out if your clinical skills are above average, mediocre, or below average therapist? Start collecting outcome data from your sessions. A few years ago I tracked every session using the ORS and SRS rating scales for an entire year through MyOutcomes.com. This allowed me to establish a baseline, track each client's progress, and see where your scores fall compared to therapists around the world. I was relieved to know that according to these ratings scales I was indeed an "above average"  therapist, but I was not as good as I thought I was.

5) Your attachment style is sabotaging you

A therapist's own attachment style and relationship history impact their ability to keep clients engaged in meaningful therapy and maintain consistent referral sources. While I only have anecdotal evidence, my experience training therapists in a private practice setting suggests that therapists with a secure attachment style or slightly anxious attachment do better in private practice setting than therapists who lean toward the avoidant end of the attachment continuum. Additionally, if therapists have done their own work in therapy and have a handle on their own issues, they tend to be more successful than therapists who haven't resolved their own emotional wounds. If you're having a difficult time getting or keeping clients, may I suggest calling your own therapist and working on your own attachment issues?

6) You appear desperate

Therapists who are new to private practice may feel particularly overwhelmed by the details of running a business, and the difficulty of establishing a consistent clientele. Feelings of desperation are also felt by seasoned therapists whose client numbers ebb during seasonal changes, economic conditions, or other reasons.  Potential clients and referral sources can "sniff out" desperation, and whether they are consciously aware of it or not, they will be less likely to trust you and your services. Here are some questions to ask yourself to see if you're coming off as overly desperate.

• Have you become  too accommodating when it comes to scheduling clients?
• Do you feel overly discouraged if a new referral chooses not to schedule with you?
• When talking about your practice do you talk fast and feel anxious inside?
• Do you follow up with potential referral sources more than once a month?

I suggest  that you "act as if" and "talk as if" you have a moderately busy practice. Lead with the aspects of your practice and your expertise that you are confident in and you'll find more success getting and keeping clients.

References:

Sapyta, Jeffrey, Manuel Riemer, and Leonard Bickman. “Feedback to Clinicians: Theory, Research, and Practice.” Journal of Clinical Psychology: In Session 61, no. 2 (2005):145–53.

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5 Steps To Resigning From Insurance Panels

One of the most common questions that private practice therapists ask me is "How do I get off of insurance panels?" This question just came up today in my Private Practice Toolbox Facebook Group so I thought it would be a great topic for a blog post. In previous posts I've written about why I broke up with managed care (part 1) & (part 2), but this post will focus on how to do it.

The thought of letting go of the comfort of being on insurance panels can create a lot of anxiety for private practice therapists. After all, if we don't have clients, we don't get paid. Find comfort in knowing this equation. You only need about half the number of clients in a self-pay practice to make the same income (or more) than you made in an insurance based practice. Once I realized this fact, I felt a lot more comfortable resigning from insurance panels. Let's do the math...

Insurance:

Say you are seeing 20 managed care clients per week and you are reimbursed an average of $70 per client.

20 clients x $70 session = $1,400

20 clients x $70 session x 4 weeks = $5,600 per month

(then subtract your time or money spent in billing and paperwork)

Fee-for-service:

2o clients x $125 = $2500/wk

20 clients x $125 session x 4 weeks = $10,000 per month

10 clients x $125 session x 4 weeks = $5,000 per month

(with NO extra paperwork, NO delay in payment, NO denied claims, NO required diagnosis...)

So often we focus on number of clients instead of the quality of clients and the amount collected per client.

5 Steps To Resigning From Health Insurance Panels

1) Rank the insurance companies

Make a list of insurance panels and rank them from your most favorite to least favorite based on:

• reimbursement rates
• paper work requirements
• how quickly you're paid
• number of clients you see from each panel
• the type of clients generally referred
• your general feeling working with each panel

2) Resign in waves starting with your least favorite

Generally, I recommend to my consulting clients to resign in waves over the course of a year. Resign first from the panels with the lowest ranking - the ones that pay the least and are the most difficult to work with.

3) Check your contract for resignation requirements

Review your contract to check on the resignation process that you agreed to. Look at the time frame required. Do you need to give them 30, 60, or 90 days notice? Do you need to send in a written letter?

4) Beef up your web presence

As part of your plan to resign from insurance panels, it critical to invest in creating other referral sources. The most important being your web presence. Google is my #1 referral source. The majority of our clients who come to my clinic Wasatch Family Therapy find us online. The benefit of clients finding you online is that they've already read about you, your services, and your philosophy on your website and have chosen to contact you. This increases the likelihood that they will be willing to pay your full fee.

• Website - If you don't have a website, make that a top priority. If you have a website, make sure it's effective. Here are some common website mistakes and how to fix them.
• Blog - If you don't have a blog on your site, add one and start blogging weekly.
• Therapist finder sites - join PsychologyToday.com, GoodTherapy.org, and your professional organization's "find a therapist" site to help potential clients find you.

5) Know the benefits of self-pay and be prepared to educate clients

There are benefits to the client for paying out of pocket, instead of going through their insurance company, that they may not be aware of. As you make the transition away from managed care to a fee-for-service practice it's important to familiarize yourself with these benefits so you can educate your clients. A few of those benefits are: control over which provider you choose to work with, the course of treatment decided on by client and therapist instead of insurance company, and no diagnosis requirement.

Here's an example of how a provider educates her patients on the benefits of self-pay. Utah Psychiatrist Kelli Hyland, MD my colleague and consultation client, shares her philosophy in this blog post "Why Self-pay?"

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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!

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The 3-Letter Word That Gets More Clients

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A simple practice-building skill that many private practice therapists overlook is to ASK directly for new clients referrals. Some shrinks assume that if they're skilled clinically colleagues, clients, and acquaintances will automatically refer clients to them. While that may be true for some therapists, in my consulting experience, building a thriving private practice takes conscious effort and deliberate action.

Asking for referrals is important so you are on the "top of mind" for your referrals sources. Potential referral sources may assume that you're too busy, that you're not taking new clients, they don't remember your name or contact information, or it just didn't occur to them to refer a client to you.

Here are a few ways you can ask for referrals when you need to fill some of your appointment slots without seeming desperate.

1) Send A Note Or Email

Get some nice note cards and periodically send a personal note to referral sources. Let them know that you'd love to work with their clients, that you have openings, and include some business cards.

Shoot off an email to referral sources who've sent clients your way in the past. Make sure that you include all of your contact information in the email to make it easy for someone to contact you. Here's an example of what I have said in an email to a relationship coach.

Dear __________,

I hope all is well with you. I hear great things about your coaching practice and have sent a few clients to your marriage classes. I wanted to let you know that I currently have a few openings for individual or couples clients who need some help with with deeper issues that may need to be addressed in therapy. Feel free to contact me if you have any questions or if you want to discuss how I can help any of your coaching clients who are "stuck."

Warmly,

Julie

(detailed contact info here, including website, phone, etc.)

2) Ask Over Lunch

Invite a referral source to lunch on you and ask for referrals then. Everyone needs to eat. I've found that people, especially professionals, are more likely to meet with you if you feed them. When you meet, remember to bring something to the table (no pun intended) to offer to them.

Consider ways that you can spread the word about their practice or business, offer a free training to their staff on your area of expertise, or make yourself available for free consultations or coaching on mental health issues.

3) Ask For Referrals In Casual Conversation

Number of client hours can vary greatly in private practice. There is an art to keeping consistent direct care numbers.  If your client numbers are down, don't be afraid to mention your openings in casual conversations with colleagues, doctors, friends, and other associates that you have openings in your practice. It's your job to remind people that you are in private practice and that you'd appreciate more business.

How comfortable are you asking for new referrals from colleagues, associates, professionals, and friends?

5 Common Website Mistakes And How To Fix Them

Your most powerful tool to build your private therapy practice in the digital age is an effective practice website. The Internet allows us to talk directly to potential clients who are seeking mental health information and services. The majority of Americans, 62 percent, use the Internet to find health care information (Pew Internet and Family Life Study, 2009). Few therapists have training in website programing and design, but as technology evolves, more options become available to create a cheap or free website that looks professional and accurately represents your practice. My websites are built on Wordpress, a fairly easy platform on which to build a website or blog. There are thousands and thousands of free Wordpress themes that you can use to customize your practice website. Therapy Sites, another website resource for therapists, allows you to select a template and customize it for your practice based on a monthly fee.

As I've consulted with therapists, developed my own websites, and done a lot of internet research, I've noticed some common mistakes that therapists frequently make when it comes to building websites.  These are the top five mistakes I've seen and suggestions for how to fix the problem to make your website more effective.

Mistake #1: Contact information is difficult to find

How to fix it --> Put contact information on every page in a prominent place

Even if you are starting small with a single page site, your contact information is the most important information to feature. After all, you want clients to actually contact you to schedule a session, right? I suggest putting your contact information on every page of your website with a "call to action".

Mistake #2: Feels too Impersonal

How to fix it --> Write website text in first person and include a photo

When potential clients visit your site they should have a feel for who you are as a person. Always include a photo and a personal statement. While your bio can be written in third person, the rest of your site should feel like you're talking to your potential client.

Mistake #3: Too much "psychobabble"

How to fix it --> Focus on benefits of your service in layman's terms

Most potential clients aren't going to be familiar with psychological acronyms or detailed information about every credential and training. Your potential clients care less about your training and more about if and how you can help them. Write your website text with your ideal client in mind.

Mistake #4: Confusing site navigation

How to fix it --> Feature the the four topics above in your site navigation

Your website should be easy to navigate. You don't want your site to be an additional source of stress for potential clients. Visit other private practice therapist's websites and notice what you like and don't like, what works and what doesn't. Put yourself in the client's shoes. What information are potential clients looking for? Here are the top 4 things potential clients want to find on your website:

• who you are (your basic information)
• what you do (services)
• how you can help them (benefits of your services)
• how to contact you (contact information)

Mistake #5: Bad design

How to fix it --> pick one or two fonts and stick with a consistent theme throughout your site

Simple and clean is best when it comes to websites. Unfortunately, many therapists with "do-it-yourself" websites, in an attempt to be creative, end up using too many design elements. When designing your website, keep in mind who you're ideal client is, and let your basic message guide your choice of colors and fonts to create a cohesive feel that represents who you are as a therapist.

Are you guilty of making any of these mistakes on your private practice website? Post the link below and I'll give you feedback about your site.

photo credit: twm1340