5 Common Barriers to Building a Fee-For-Service Practice

Building a fee-for-service practice can be scary, especially if it means resigning from insurance panels and finding other ways to attract clients. Others may have already made the switch, but don't know how to successfully navigate the change. I have found some strategies to help ease the transition. Here are 5 common barriers to building a fee-for-service practice and ways to overcome them: 1) "I'm uncomfortable marketing myself"

I often hear therapists say that marketing themselves feels like bragging or tooting their own horn by self-promoting. In order to move past this barrier, it's helpful to reframe the way you think about marketing. Consider it instead as REST: Relationships, Educating, Serving, and Trust Building. You are building relationships with potential clients who might see your website or other media, you're serving your community by educating them about important topics related to your niche, and you're establishing rapport and building trust with those who encounter you through your (online) content (REST is essentially why you're in the profession in the first place, right?). If you can focus on these 4 things, you can (and will!) attract clients who will pay your full fee. While your "marketing" strategy (I'm not a fan of that word, by the way) REST strategy is meant to benefit you by helping your community become familiar with you and your services, it's really about those who you can potentially help through receiving services through your practice. Don't be shy in getting the word out about yourself; it's a way for you to use your professional skills to serve and educate your community.

2) "I'm afraid of the ethical issues surrounding social media"

Those new to the world of social media may be wary to fully embrace it because of the potential ethical problems that may arise. Potential for unethical dual relationships, confidentiality concerns, and lack of knowledge are common fears. But these fears (and others) can be overcome: having an official social media policy included with your intake packet, avoiding directly soliciting your additional products or services to existing clients, being familiar with privacy settings online, and overall just using your ethics training and common sense will help you be prepared to face these potential issues.

Click here to read a more comprehensive article about overcoming fears associated with social media.

3) "I'm not good with technology"

The internet gives us incredible opportunities to communicate and reach an audience that is unprecedented in size. However, for those unfamiliar with all the ins and outs, it can also be intimidating, overwhelming, and frustrating to start. Mari A. Lee, an LMFT who specializes in sex addiction recovery, understands this feeling all too well. She describes being scared and resistant to learning new technologies. But she was able to overcome her "technophobia" by starting with manageable goals, finding a patient and persistent mentor, asking lots of questions, and setting aside time to devote to learning and practicing new tech skills. Her success in building an online presence paid off big time; she's currently a best-selling author! "If I can figure out how to blog, attend and facilitate webinars, host online trainings, navigate my Facebook business page, and so forth, anyone can... If this 52 year-old former tech scaredy cat can do it, so can you!" Mari explains (read more about her experience here). 

Understanding and applying the language of technology does not happen overnight. Be patient with yourself, as there's certainly some trial-and error learning here. Remember that everyone starts somewhere. And just like Mari, look for a mentor to guide you and bounce ideas and questions off of. You've proven yourself to be an apt and competent learner by becoming a licensed therapist; have the courage to learn another skill set as well.

4) "I can't do media appearances or speaking engagements because I hate seeing and hearing myself"

Therapists tend to get shy about media interviews. It's one thing to sit in front of a client and offer counsel in a one-on-one session, but speaking in front of large audiences can bring out anxiety in even the most confident clinicians. But remember how much you know; you are a trained and experienced expert. The aesthetic and "performance" aspect of media appearances will come with time. The more prepared you are, the more comfortable and relaxed you'll be. And if by chance you do feel like you bombed a television interview or radio podcast, learn from it and try to move on. It's not the end of the world if you make a mistake!

Read here for more tips on how to look good and sound professional in your media appearance.

5) "If I'm a great clinician, my work will speak for itself"

Some therapists plan to rely on their hard-earned reputation as an excellent mental health professional to be their main source of client referral. They then focus solely on refining their clinical skills, as they don't see the need to engage with their community beyond private sessions. While referrals can be an effective strategy to build your clientele, depending on others in the field to refer to you should not be the only way you attract people to your services. The harsh truth is that there are a lot of excellent therapists who fail in developing a successful private practice. Everyone has to start somewhere, and it takes time and experience to gain a loyal following and individuals who actively seek you out.

You may find that by being persistent in building trust in you and your services over time will be the major benefit to the growth of your practice. Because we have worked hard to establish ourselves as trusted professionals by embracing social media and building our online presence, my practice, Wasatch Family Therapy, receives most of our referrals from Google searches. This is something I feel very grateful for, and it's largely due to the fact that I stopped participating on managed care panels and consequently had to work within the community to build trust directly with potential clients.

Embracing a private pay practice model brings more than a few questions, unknowns, and worries. But by using these strategies, you can overcome barriers and build a thriving practice.

Besides the obstacles presented in this article, another major reason why clinicians may be wary of switching to private pay involves how they think their clients will be affected. I address (and debunk!) these fears here.

Click here to view my webinar and learn more strategies and tips about breaking up with managed care!

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3 Ethical Fears of Being a Therapist Online and How to Resolve Them

Every therapist knows that ethics is a critical component of working with clients. Once you add social media into the mix, things can get even more complicated. I’ve noticed that unfortunately, some in the profession are resistant to embracing technology and building an online presence related to their practice because of fear of the potential ethical problems. It’s true that there are risks involved in going online, but we don’t need to be run by this fear; the risks can be managed, and, as we’ve talked about so many times before, the benefits are staggering.

Here are 3 Ethical Fears of Being a Therapist Online, and How to Resolve Them:

1) A Client Breaking Professional Boundaries

If you’re findable on the internet, naturally you’re easier to contact as well. And while we find that most clients respect boundaries with their therapist, some may choose to disregard common rules of protocol, especially when a professional’s online presence facilitates their ability to do so.

Mari A. Lee, an LMFT who specializes in sex addiction recovery, prevents this by having her clients sign a social media form as part of the intake packet. “I do not allow clients to post to my business Facebook page or private message me,” she explains. “I do not accept friend requests or professional links from therapy clients on LinkedIn.” Mari describes how the few times that a client has attempted to add her, she simply redirects them back to her policy. By doing, she has never encountered an incident of professional boundaries being crossed (read more about Mari’s experience here).

Overall, being clear about what is and is not acceptable for your clients with regards to social media will all but prevent problems from occurring. Develop a social media policy for your practice, include it in your initial client paperwork, and have it available on your website (read more about developing a social media policy here). While you must be firm about your boundaries, try to communicate your expectations in a way that is not alienating or harsh. A client reading your content online is a good thing, so you don’t necessarily need to discourage all forms of social media engagement; it is direct contact that is prohibited.

2) The Risky Possibility of Dual Relationships

We all know that therapists in private practice should be cautious when entering dual relationships with clients and be mindful of  the potential risk of exploitation or harm to the client. This caution extends to online dual relationships as well. If you as a therapist have an online presence and engage in multiple professional activities (publishing, consulting, etc.), you might be worried that a client could feel pressured to purchase additional services or products from you. Whereas before you were a person that your client saw in an isolated setting, you are now an established figure that he/she can read about or follow anytime on the internet.

This fear really is unfounded. It’s okay for someone to find you online and understand that you are selling something in addition to seeing clients. As long as you’re not soliciting these things during a private session, you don’t need to try and hide the fact that you do other things. Your ethics courses taught you what need to know about avoiding these kinds of interactions.

If you think there might be a legitimate possibility that your outside professional activities encroach on the ethical integrity of your counseling, consider the following: Dr. William Doverspike, a licensed psychologist and president of the Georgia Psychological Association, proposes a very simple ethics test when contemplating dual relationships. Ask yourself these 5 questions to determine whether or not your online activities are ethically sound in relation to your clinical practice:

Is there a chance of:

1. loss of effectiveness of the professional?
2. loss of objectivity of the professional?
3. loss of competence of the professional?
4. risk of exploitation of the client?
5. risk of harm of the client?

If you can answer an honest no to all of these questions, you’re just fine in pursuing your other activities.

3) Posting TMI

Most of us have witnessed someone who gets too personal on Facebook or on other social media outlets. These platforms can be great for sharing information and photos and keeping in touch with one another, but sometimes people go too far.

Being cautious with social media activities becomes even more important for a therapist with an online presence. Where does your personal life begin and your work life end? Would your relationship with your client be jeopardized by something you posted about your own life? Is it possible for something to be appropriate for your personal page but not for your business page? Keep in mind that social media platform privacy settings are constantly shifting and that there is no guarantee that some information posted on personal profiles may still be accessible.

I trust that my friends reading this right now aren’t the type who post blatantly inappropriate or disrespectful material, but it can still be challenging to find that line. Here is the rule that I’ve created for myself that has worked well for me: if I wouldn’t feel comfortable with anyone in the world viewing it, I won’t post it at all. It’s that simple.

Once again, this potential ethical problem is easy to avert. Use common sense, your ethics training, a social media policy, and your best judgment. Overall, just trust yourself as to what to post; you are a professional after all!

The point of this post is that you don’t need to be run by fear when it comes to social media engagement. I encourage you to embrace the technological world and let it benefit both you and your clients.

I wrote an in-depth article about social media ethics. Click here to read it.

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The Power of Online Presence: Mari A. Lee, LMFT Overcame 'Technophobia' to Become Best-Selling Author

Discover how some very successful mental health professionals use blogging, social media, and other technologies as powerful tools for their therapy practices.   I've discussed in great length ways that my online presence has benefited my private practice. But don't just take my word for it. Many therapists have utilized the power of social media and blogging to get the word out about their practice, establish rapport, and build trust with those in their community. I've asked a few of my colleagues some questions about their experiences (the good and the bad) building their online presence.  This is the first of several interviews where you can learn from the professionals.  My hope is for you to read these and understand even more just how valuable an online presence can be, not just for attracting clients, but for opening up other professional opportunities. Our first featured therapist is Mari A. Lee, an LMFT who specializes in sex addiction recovery.

1)  When and how did you first start putting time and effort into maintaining a strong online presence?

 Nearly 10 years ago when I was first starting out as an intern, I knew I wanted to have a website and better understand how to build my brand. I worked with a coach and a web designer to help me understand the basics. I had a Facebook page and a LinkedIn profile to start.  Over the years, I began to understand even more the benefit of an online presence, so I eventually updated my website and then found ways to refine and streamline my social media.  

2)  Please describe what social platforms you currently use. 

Originally I started with a Squarespace website and a LinkedIn account; I still use both. However, I now have a Facebook business page where I frequently post and receive feedback.  I have a blog as well that I update regularly.  I do have a Twitter and a Google+ account, though truthfully, I don't use them often.  Also, I recently moved my professional email to a gmail account and am really enjoying all of the added benefits from Google mail.  

One thing I love about social media is how it can connect you to others in the field. I belong to 3 professional organizations for my specialization as a sex and love addiction therapist. I participate often and have found this to be an excellent resource to build my reputation and brand, as well as build trusted relationships with other therapists within my specialization.

3)  About how much time do you devote to your online presence?  How do you balance it with your other work responsibilities?  

I am an author, so writing is a first love to me.  I enjoy this practice and find it fun, therapeutic, and exciting to write each day. I write 5 days a week and spend about 30-60 min every morning nurturing my online presence. Though I have a very busy private practice, I really don't find this to be difficult to balance into my schedule.  I think part of this is because writing comes quite naturally to me, and also I have more time to devote to my online presence because I do not have to contend with insurance billing and such.  

4)  What kinds of things do you use to inspire your content creations; what do you write about?

I love this question! The sky is the limit with respect to what I find inspirational. It could be something from my personal life that I feel would be helpful and supportive. It might be a trend I am seeing with clients in my private practice (for example: Boundaries, Assumptions, Gratitude). It could be a poem I have read, or a movie I have seen, a hot topic in current media, a trend, a project I am working on.  

I draw from many sources, and I believe this keeps my writing authentic and "me." That said, it is important to keep the material relevant and fresh. Writing about female business owners in their 50s, might be a bit blah to someone doing a search, but writing about female business owners taking 10 weeks of vacation a year, making six figures, and writing top selling e-books may have more of an SEO draw.

5)  How do you best balance personal and professional in your online activities?  Please give examples.  

I tend to keep pretty tight boundaries on my personal and professional online activities. For example, I have a social media form for therapy clients as part of my intake packet that they sign. I do not allow clients to post to my business Facebook page or private message me. They may read an article, blog and so forth if they choose, but that is it. I do not accept friend requests or professional links from therapy clients on LinkedIn.  I have had a couple of clients attempt to add me as a friend.  When this happens I redirect them back to my policy and process in their next session. Thankfully, I have not had any issues to date with clients overstepping boundaries. If that should happen, I would address this as part of the clinical work.

6)  What is some tangible evidence that your online presence has grown your business?

My practice has grown to the point where I have recently raised my fees in order to reduce my waiting list.  I have been referring out about 15-20 clients per month to other trusted colleagues in my area. However, this is about to change, as I am getting ready to hire 2 new therapists in 2015.  I'd like to keep some of this income under Growth Counseling Services, and my business is telling me that it is time to grow.  I have also increased my income in the last 3 years by 25% and it grows higher each year.  I anticipate 2015 to be a large jump in business/income.  

7)  Besides attracting clients, what other ways has your strong online presence helped you?

I have so enjoyed connecting with other professionals. My amazing virtual assistant and I met via a Facebook professional group, and it is really fun and enjoyable to see colleagues who have become friends posting updates on their latest and greatest and cheering them on!  Additionally, I have been asked to do radio and podcast interviews, my 5-star Amazon book, "Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts" is now the #1 book in the world for spouses of sex addicts, and my e-book for therapists, "The Creative Clinician: Exercises and Activities for Clients and Group Therapy" has been flying off my website store based solely on therapists hearing about this, reading the testimonials and positive posts from other therapists, and then purchasing this resource. In the last year I have been hired three times for paid speaking gigs that paid several thousand dollars each. I could go on and on - the benefits and blessings are innumerable!

8)  What have been some of the biggest challenges you've encountered creating and maintaing your online presence?

I was scared and resistant to learning new technologies.  Miranda Palmer, who is a friend and a colleague, has been one of my biggest supports in being gently relentless (and incredibly patient) in supporting me. Additionally, my virtual assistant Kurt has been a huge help in walking me through some of the unknowns. I always share that if I can figure out how to blog, attend and facilitate webinars, host online trainings, navigate my FB business page, and so forth, anyone out there reading this can. I was the biggest scaredy cat of all!

9) How have you overcome those challenges?

I started out with small, focused goals. For example, I worked on my website a website presence, then updated my LinkedIn profile.  Pretty soon, I began to attend webinars and, then set aside a budget for paid coaching when needed. I hired a tech savvy virtual assistant who walked me through the world of Facebook and Twitter.   The most important thing I have done to help myself is to set aside time to practice each week.  I ask questions, I listen and read, I offer to others any information that I have found helpful in order to give back.  And I try to operate from a place of gratitude. A polite thank you and introduction with an offer to help the other person (instead of just asking for a hand out) goes a long way in the virtual community, and in real life!

10)  What tips or resources can you recommend to help therapists who are new to the online world of blogging, social media, SEO, etc.?

Trust that you CAN do this. Try to lean into your fears and don't bite off too much at a time. Make a list, and start at the top with a website. Even 3-4 pages is a good start. Hire experts and coaches when needed. Don't feel like you have to be the best writer in the world or a published author to have a blog or FB business page. Even posting a few short sentences and including a short video clip or inspirational quote is good enough. Baby steps! And here is my numero uno tip: Operate from a place of respect, gratitude, kindness and good will. People and professionals in the virtual communities and social media will get a real sense of who you are very quickly. If you are snarky, a know it all, or mean spirited, this will translate very quickly to the online world. I try to extend from a positive space and in doing so, attract other focused, joyful, interesting, and successful positive therapists and healers. When I come across a Negative Nellie, Envious Irma, Debbie Downer or Fear Fred, I just bow out politely from those kinds of interactions. You will notice right away within Facebook groups, LinkedIn feeds, professional list serves and Twitter who these folks are; these are the people who lead with fear, dire warnings, and rain on the parade vs. picking up a kazoo, jumping on the float and moving forward. I prefer to surround myself with like-minded, whole hearted, authentic colleagues of integrity who are out there making their dreams come true. Best wishes in creating your online presence.  If this 52 year-old former tech scaredy cat can do it, so can you!

Mari A. Lee, LMFT, CSAT-S 

Licensed Marriage & Family Therapist #47920

Certified Sex Addiction Therapist & CSAT-S Supervisor

Facebook Page: https://www.facebook.com/MariALeeTherapy

Author of: "The Creative Clinician: Exercises and Activities for Clients and Group Therapy"

Author of: "Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts"

    I'm excited to present these therapists' stories about building their online presence.

Stay tuned for more!

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