Why Some Shrinks Fly Solo

In past posts I've explored the the positives and negatives of joining a group private practice. Now, it's time to focus on the pros and cons of running a solo private mental health practice. When I opened Wasatch Family Therapy nearly 10 years ago, it started out as a solo practice that slowly built over time into a group practice. While I like being "in charge" and autonomous, I'm also an extravert and I highly value my connections with others.

I reached out to other private practice therapists who practice alone to see why they chose to "fly solo."

Autonomy

Florida social worker and healthy eating expert Therapist Karen R. Koenig, LCSW, M.Ed. grew up as an only child, so she's used to being independent and working alone. That autonomy and comfort level has helped her to succeed. “I love being in private practice. I make my own schedule, decide whom I want to see and whom I don’t, set the fee schedule and slide if I want, and get to have an office in my home which makes both life and work easy,” Koenig shares.

Self-expression

Creating an environment that accurately reflects who you are is important to North Carolina therapist Erika Myers, LPC. "Having your own space in which to practice in a way that feels authentic to you, building an individual reputation rather than relying on a group name for recognition,” are reasons why Myers chooses to practice in a solo setting.

Flexibility

Illinois counselor Melanie Dillon, LCPC of Center For Wellness, Inc. practiced independently for 17 years. Of her experience she says, "Private practice gave me a very flexible schedule and autonomy. It also helped me grow to learn all aspects of being a small business owner. It was ideal for parenting and having a second income.” Eventually Dillon developed a mind/body group practice with two chiropractors when she found herself as a single mom and needed to provide a stable income.

As the second oldest of nine children in my family of origin I am used to being "in charge" and in having close connections with others. So, it makes sense that eventually, I grew my own solo practice into a group practice where I am still the sole owner and decision maker. Guess I just can't get away from being the "bossy" older sister.

photo credit: cuatrok77

The 'Dark Side' Of Joining A Group Private Practice (part 2)

Last week, I blogged about the benefits of joining a private practice group. Today, I'll discuss the downside of being in business with other practitioners. I briefly worked in a group practice where all therapists owned equal parts of an LLC (Limited Liability Company). At first it sounded like a good idea. After a while, I could see that it wouldn't work long-term for me and for my practice.

The Drawbacks of Joining a Group Practice

1) Liability concerns

After several months in a group practice, I realized that the drawbacks far outweighed the benefits. One of the biggest drawbacks was sharing liability for other mental health provider's actions and decisions, of which I ultimately had no control. Therapist Melissa J Templeton, MA, LPC, LMFT agrees, “It's really important to be aware of the legal entanglements of being in practice with another mental health provider, as it exposes you to all kinds of liability. Being in the same building even without a formal partnership agreement could open you up to being sued by someone who was injured on the property or who accuses your co-leaser of a criminal or civil action.”

Psychologist Wes Crenshaw PhD, ABPP of Family Psychological Services, LLC strongly cautions other therapists against creating legal partnerships in group therapy practice.

The best advice I ever received was to avoid creating a partnerships, and I ignored it. When one is say, a 25% owner of something, one is an owner of nothing. The only groups that work well this way are those with a clear 51% managing partner. Unfortunately, psychotherapy practices are not traditional businesses in the sense that they produce a profit above payroll sufficient to take distributions. They are instead a conduit by which money flows from the client/insurance company pockets into the provider. Without the attributes of a normal business (e.g. a profit margin above salary) there is no good reason to form a fiduciary obligation with other providers.

2) Loss of autonomy

When I joined a group I realized that the decision making process, even for minimal office expenses, was extremely inefficient. It was frustrating and even painful for me. I like see things change and move forward quickly. Since everyone owned equal shares no one was really "in charge" and able to make quick decisions, or to create a cohesive vision, or to take the lead of the group.

Arizona psychologist Christina G. Hibbert, Psy.D. was employed by a group practice but now is in solo private practice. Of her group experience Hibbert says, "Sure it’s great to have less responsibility but that also usually means having less input into decisions regarding everything from office décor to how things run." Illinois counselor Melanie Dillon, LCPC, at Center For Wellness, Inc also notes that a drawback of a group practice is the loss of say "over who I counseled and what my hours would be.”

3) Less control over income

Like Dr. Crenshaw warned, when you're legally partnered with others they have a say in business decisions that affect your income. When you're part of a group, others may have already dictate the cost of joining the partnership, or the amount you'll be paid when employed by a group practice. “I had put off joining a group practice because of the dramatic decrease in hourly income," Dillon adds.

When I was in a practice group with five other therapist I was contributing 1/5 of the overhead even though I was practicing part-time.  I quickly realized that, although I enjoyed working with other therapists, I could run a solo practice for a lot less that I was paying to be a part of the group. I decided to venture out on my own and started Wasatch Family Therapy.

Since then, I have built my solo private practice into a private clinic with a dozen employees. I am the sole owner and can make decisions quickly. In upcoming articles I'll walk through the pros and cons of going into solo private practice.

Based on your experience, what are the drawbacks of being in a group private practice?

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20 Ways Shrinks Stay Sane

It's mental health month! Like many of you, I've been actively sharing mental health information as a way to increase education and reduce stigma surrounding mental illness. While it's an honor to be in a profession that focuses on supporting the mental health of others, being a therapist often requires regularly going to "dark" places with clients, and that can take a toll on our own mental health. After nearly 20 years in the field, I've noticed that a lot of therapists (myself included) tend to be caretakers, people-pleasers, and self-sacrificers, making us particularly vulnerable to neglecting our own mental health in the name of caring for others. I have learned to become fiercely dedicated to self-care, self- awareness and to maintaining my own relationships in order to protect and nurture my own mental health.

I wanted to reach out beyond my own experience to therapists around the world to see how they nurture their own mental health in a profession that can be emotionally and mentally exhausting. Here's what they had to say.

1. Live in the present

"I make myself more present by asking 'Where am I in space right now? What do i hear? What do I feel? What do I taste and smell? What do I see?' " Natalie Robinson Garfield.

"I find 20 minutes a day to escape from the world and enjoy the peace and quiet." Deborah Serani, Ph.D.

"I meditate regularly and journal about my dreams."  Dr. Will Courtenay

2. Surround yourself with positive people

"I rid myself of toxic relationships and situations immediately and I engage in religious activities, especially prayer," says Leticia R. Reed, LCSW.

Surrounding yourself with positive people also includes you. Kim Olver, LCPC checks the stories she tells herself about her own life. "If they serve me great, if they don't I'll change them. I'm the one who makes them up after all," says Olver.

3. Go to your own therapy

"I go to my own therapy on a regular basis." Dr. Will Courtenay

"I take care of my mental health by checking in with my own counselor when I need someone objective to bounce things off of and get centered or grounded." Xiomara A. Sosa

"I have entered therapy 3 times since my core training. 3 different styles to suit the issues I was experiencing. I also do workshops and retreats throughout the year for personal/spiritual development." Jodie Gale

4. Get moving

"I have two Labrador retrievers who demand a lot of attention. I find a great escape just going out into the backyard and throwing the Frisbee for an hour." Regina Bright, LMHC

“I salsa dance! I rely on the nonverbal connection with my partner and happy music to get through some challenging weeks.” Dr. Amy E. Keller

"Every day I take time to meditate or participate in Pilates or yoga." Diane Petrella, MSW

5. Nurture a sense of humor 

"I try to maintain a good sense of humor and find ways to laugh during life’s challenges." Ashley Bretting, LMFT

"My spouse and I attend a comedy show every week."  Stacey Kinney, LMFT

6. Maintain friendships

“I make sure to have tea or lunch at least once a week with a friend that is supportive and makes me laugh." Nerina Garcia-Arcement, Ph.D.

"I find that participating through friendship in the life of someone outside the field is even more refreshing and grounding than the peer consultation we used to do." Mark E. Sharp, Ph.D.

7. Take a break

"I love vacationing to Costa Rica."Dr. Amy E. Keller

"I enjoy watching funny and/or inspirational YouTube videos." Hugh A Forde, PhD

"Hiking is a great activity that helps reduce my stress levels." Dr. Karen Sherman

8. Catch some zzzz's regularly

This one is an important one for me. I try to take a long naps every Sunday afternoon.

"My goal is to get at least eight hours of sleep every night." Stephanie Moulton Sarkis PhD

9. Uplifting media

"I like to read books, listen to music, and subscribe to inspirational Facebook pages." Dr. Matthew Clark

10. Reach out to those in need

“I do volunteer work with Mission Outreach, a non-profit group that collects unused medical supplies in the United States and sends them to third world countries. Being able to help others in such a simple, easy way does wonders for one's outlook on life.” Sujatha Ramakrishna, M.D.

11. Create fun each day

"I ask myself, 'Have I had fun today?' If the answer is no, then make it happen before the night is over!" Natalie Robinson Garfield

“I pursue my hobbies of photography, painting, and jewelry making.” Stacey Brown 

12. Say no

"I have found that out is easier to say "no" when I realize that if you say "no" to one thing, you are always saying "yes" to something else. If I say "no" to a new client, I am saying "yes" to time with family and a less busy mind." Joseph R. Sanok, LPC

"I hold stringently to my practice days and hours—keeping mornings for myself to exercise and write, using afternoon to early evening for clients, and taking off Fridays for whatever I want to do." Karen R. Koenig, LCSW, M.Ed.

13. Celebrate nature

"I love to spend time in nature by walking through the woods or listening to the birds chirp." Sujatha Ramakrishna, M.D.

"I work in a professional office setting and need to be reminded that I am an animal. Getting out to a park or the beach or a hike in the mountain, or even a drive up the coast with the top down are instant healing techniques." Nancy B. Irwin Psy.D

14) Express yourself creatively

"I nurture my own mental health through my other profession which is as a comic/writer....in writing my own material I get to see the humor in almost every situation and in performing it, I get to bring laughter...one of the greatest stress reducers of life....to others." Jane Stroll

"I write in a journal often." Xiomara A. Sosa

"I take a writing class, so that I can stay creative and do something that's just for me!" Janet Zinn, LCSW

15. Get pampered

My personal favorites are a message and a pedicure. I try to do at least two pampering activities a month to help me relax and to nurture myself.  Ashley Bretting, MFT gets pampered by having her hair washed by someone else. Whether it's a hot bubble bath or a leisurely walk, do something that feels nurturing on a regular basis.

16. Be a kid

Ashley Bretting "I bring out her inner child by coloring with crayons or paints!"

“I spend time with animals and children. The unconditional, pure love and affection from these creatures soothes the soul.” Nancy B. Irwin Psy.D

17. Get out of your head

“I bike to work as much as I can -- this is a 30 minute commute by bike, 20 minutes by car.  In doing this, I ensure that I arrive at work very relaxed & calm (having just spent time close to nature -- hearing the birds chirp and the wind blow and seeing green around).  When I leave the office at the end of the day, all of my worries get worked out by the time I get home.  So, I arrive at home very relaxed also!” Sally Palaian, PhD

18. Process your feelings regularly

Karen Hylen, Ph.D, of Summit Malibu Treatment Center suggest regularly sharing  your feelings with a friend or a loved one to avoid emotional explosions. Hylen shares this analogy:

When you bottle up your emotions, you are figuratively assembling a bomb in your head. Each feeling you bury in your head is you  putting together another piece of the bomb. Keep enough of your feelings to yourself and before you know it you'll have an emotional explosion.

19. Focus on family

I enjoy spending time with my family. Going to the beach and reading or walking is especially refreshing. I take two trips a year with the family and then one with just my husband. Regina Bright, LMHC

"I make sure I make time for my loved ones. It is an anchoring force," shares Dr. Anandhi Narasimhan.

20. Consult regularly on difficult situations

When I first went into independent practice I set up to have lunch or breakfast with a colleague also in independent practice every couple of weeks. It allowed us to bounce ideas off of each other and not feel so isolated in our work. Mark Sharp, Ph.D. I want to hear your mental health tips! Post them below

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