Adventures In Private Practice: Psychotherapist and Art Therapist Amy Tatsumi, LPC

Tell me a little about your practice... I am a board certified art therapist, licensed professional counselor and psychotherapist in Washington, DC. I see clients across the lifespan and specialize in working with Women Who Do Too Much.  I also see therapists in training and provide post graduate and post license supervision.  Through the creative process and talking, clients learn to connect their hearts and minds to live more wholeheartedly.

Why did you decide to open a private practice? 

I had a small private practice for a number of years while also working a full time job in public mental health.  After having my daughter and living in Japan for some time last year, I new that I needed a better work life balance.  In the summer of 2012, I decided to take the leap and step into the arena.  My mantra continues to be that things are happening in the right time and right way for my business.

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?

Some of the most challenging clients that I worked with were very angry and rightly so.  Underneath the anger was deep shame and fear.  This story  from Pema Chodron is one of the most special gifts those clients taught me: How To Defeat Fear: Once there was a young warrior. Her teacher told her that she had to do battle with fear. She didn’t want to do that. It seemed too aggressive; it was scary; it seemed unfriendly. But the teacher said she had to do it and gave instructions for the battle. The day arrived. The student warrior stood on one side, and fear stood on the other. The warrior was feeling very small, and fear was looking big and wrathful. The young warrior roused herself and went toward fear, prostrated three times, and asked, “May I have permission to go into battle with you?” Fear said, “Thank you for showing me so much respect that you ask permission.” Then the young warrior said, “How can I defeat you?” Fear replied, “My weapons are that I talk fast, and I get very close to your face. Then you get completely unnerved, and you do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, and you can have respect for me. You can even be convinced by me. But if you don’t do what I say, I have no power.”

What's your biggest pet peeve about private practice?

As with any new business, I would say mine is the growing pains.  I work in a heavily saturated mental health provider community.  I believe that there are enough clients for every provider.  Focusing on  building relationships in the community has been helpful to counterbalance the growing pains.

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

I know that many women are caught in many double binds and in the never enough culture.  Whether you a 20 something, single woman, a divorced working mother, a stay at home mother, a widow, or another woman in transition, I know that many women use people pleasing, perfectionism, numbing, and performing as a means of connecting, navigating relationships and settings, and as a guidepost for self worth.  In my practice, women learn to use their own heart~body~mind wisdom to meet and respond to destructive covert messages and to life's patterns and challenges, as well as value themselves and their thoughts, feelings and opinions.

In 2012, I started Dr. Brene Brown's Connections Certification process and provide a variety of related offerings.  The offering are especially supportive for adults and teenagers who feel stuck, unworthy, and never good enough and those who struggle with perfectionism.

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

Relationships with individuals and communities have really been the foundation for this start up phase of my private practice.  In Washington, DC, Jennifer Kogan started a network "DC Therapists Moms" for parents and people who would like to have children who are in the mental health profession.  It is truly a supportive and thoughtful community with over 400 members.  On Facebook, Julie Hanks's group, "Private Practice Toolbox" has be helpful for national and international brainstorming and information sharing.  Lynn Grodzki's book, 12 Months to Your Ideal Private Practice: A Workbook is a book that I cannot recommend enough.  It has practical and creative strategies to strengthen your practice from all perspectives.  Derek Halpern's blog : Social Triggers is direct and effective too.

What has surprised you most about being in private practice?

In the public mental health community, I had strong relationships, but my area of expertise for almost 10 years was in trauma and attachment.  In private practice, I have had start the relationship building process again, especially with securing referral sources. I have been filled with gratitude for my initial referral and cross referral sources.

Has your private practice helped you grow professionally?

Being a small business owner has reconnected me with parts of myself that I never knew.  At each point of developing my practice, I am having to acquire new skills from social media marketing to the business side of the practice to going through Dr. Brene Brown's Connections Certification process.

Has it helped you grow personally, too?

Finding the work life balance has been really been wonderful.  I am more present in my relationships and have more time for myself.  It takes work, but it is well worth it.

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

Finding time to just be is really restorative for me. Being an art therapist, I do try to make art regularly.  The creative process is centering for me.  Yoga Nidra is a form of meditation that I use.  I also love to be in nature, cook, practice yoga, and enjoy time with my family and friends.

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

I remember that failure is a necessary part of the creative and learning processes.  I see the failures as bumps in the road and try not to get stuck there.  People rarely get it right on the first try.  To find the best solution, one must keep trying with new approaches and strategies.

What personal strengths have helped you succeed in private practice? 

I believe in this work from a very core place.  I have witnessed so many lives changed, perspectives shift and relationships repaired and healed.  Staying grounded in the why I do this work keeps me in focused.

For more information on Amy's practice visit tatsumiandjones.com Join my Toolbox 2013 Therapist Blog Challenge and strengthen your online presence!

2 Good Reasons To Hire Office Support

Hiring an office employee, especially if it's the first time you've done so, can feel scary, overwhelming and stressful. Where do you find trustworthy employees? How do I know they're doing the billing correctly? Isn't it less personal if clients have to talk to someone other than the therapist?

Many therapists in private practice are reluctant to hire office support for a variety of reasons. The two most common reasons that I hear in my consulting practice are: 1) cost - "I don't want to pay out more money" and 2) control - "I don't want to give up control."

I had to overcome these two common barriers before I hired my first office manager.

It's Cheaper Than Doing It Yourself

When it comes to hiring office support staff, I find that it helps to think more like a business person and less like a therapist. Before I hired my first office employee I was concerned about increasing my overhead. Why should I pay someone to do something that I can do for free? Then, I realized that my time is money.

When I first started considering hiring an office manager I was billing $100 per clinical hour and seeing approximately 15-20 clients per week. If I spent those 10 administrative hours a week doing therapy instead of office administration, I could bring in an additional $1000/week to my practice. The cost of paying an office employee 10 hours per week, even at the high-end of the pay scale for my location, would only be $200 per week.

Hello? If you think like a business person, that's a no-brainer. I hired an office manager.

They'll Do A Better Job Than You

I struggled with the issue of control before hiring an office manager. I knew everything about every client account: what their co-pay was, how they prefer to pay, what their diagnosis is, how often they come to therapy, their balance and more. I had developed my personal style of answering new client phone calls and had finessed my techniques over a few years.

I knew how to describe my therapy style better than anyone else could. How could I trust them to answer the phone, handle the billing, or other office tasks the way I would?

Once I really looked at that issue, I realized that I could be OK if someone didn't do things exactly like I did. There are people who were trained in office administration, billing and office management, and they might know how to do things better than I was doing them. After all, I had no office management experience other than running my practice.

While there was a learning curve for me and for my first office employee, it turned out to be the beginning of significant growth in my practice. Having office support has allowed me to let go of the day-to-day tasks and focus on the bigger picture: my practice mission statement, community outreach, web marketing, training other therapists, business planning, and of course, providing therapy.

photo credit: Jerry Bunkers

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

Why I 'Broke Up' With Managed Care

At times, working with managed care insurance panels in private practice felt like dating a bad boyfriend. I was constantly investing more time and attention than "he" was in the "relationship" and it started to wear me down. I got up the nerve to break it off for good. I've never looked back. I understand that building a practice free of managed care isn't for every therapist. I am grateful for excellent colleagues who participate on insurance panel because and there is a great need for their services and I frequently refer clients to them. However, if you're a private practitioner considering building a practice outside of managed care, I share my experience of resigning from managed care to give you the courage to take the leap, and the faith to know that it can work. So here's my story...

After I received my clinical license I started applying to any health insurance panel. I just assumed that's how you're "supposed" to get clients in a private practice because every therapist I'd known had followed this path to get referrals. I was accepted to many panels and my practice started to grow. I was ecstatic.

However, as time went on I started to resent many aspects of working with managed care panels and it began to effect how I felt about my work in general. I felt overworked and drained and knew that something needed to shift if I was to be in private practice for the long haul. Here's what I started noticing about my relationship with managed care.

• Excessive paperwork: I was spending almost as much time performing unpaid work (paperwork, phone calls, tracking authorizations, and billing) as I was spending seeing clients. I went into this field to do therapy, not paperwork.
• Reduced income: I resented writing off 40-60% of my fee upfront just to be placed on a list with dozens and dozens of other therapists. The managed care companies weren't doing anything to market my practice and yet I was being asked to take a huge pay cut to work with their clients.
• Mandatory diagnosing: I grew tired of having to diagnose every client who walked into my office in order to get paid. When I met with a client who didn't have clearly diagnosable symptoms I was faced with a dilemma. Do I stretch a diagnosis just so I can get paid, or do I do free therapy because insurance won't reimburse without a diagnosis?
• Denied or delayed payments: Being denied reimbursement for a variety of reasons and receiving payment weeks or months after I had performed the service grew frustrating.

My uneasiness led me to critically look at the financial numbers and I was astounded by the amount of money I was writing off just to participate on managed care panels. I decided that there had to be a better way to for me to run my practice. I realized that if I resigned from managed care panels and transitioned to a fee for service practice, I could see half the number of clients weekly and make the same income. Or, I could see the same number of clients and double my income. To top it off, I could eliminate most of my unpaid paperwork hours. Work less and make more? It was a dream come true for a private practitioner and mother of young children.

I resigned from all managed care panels in 2007 and raised my fee by 10%. Since then, my private practice, Wasatch Family Therapy, has grown from a solo practice of one to a thriving clinic employing several therapists. We are adding a second office location later this month. It has taken some relentless marketing, consistent networking, and social media skills to keep a practice growing without managed care or any outside contracts, but it has worked. If I can do it, you can too.