Practicing Outside The Box: Growing Tomatoes In Psychotherapy

Stuck in a therapeutic rut? Find inspiration from other therapist's creative strategies and get outside the box!

As therapists, especially those of us who have been practicing for a few years, it's easy to get into a rut and become less creative than we were as eager, bright-eyed interns. Feeling the need to be more creative in the therapy hour inspired me to reach out to other therapists for ideas and inspiration and start this series about practicing outside of the box.

Because I managed to kill every plant I have ever owned (I have a "black thumb") and because I have always fantasized about living in New York City, I was intrigued by psychotherapist Janet Zinn, LCSW's use of "outside the box" strategies to help her clients. Janet found that incorporating nature in the form of a garden in the middle of a New York City practice was a welcome and healing environment for her clients.

Here is what Janet said about her work with a female client:

I had a client who was diagnosed with a serious borderline personality disease. She had been hospitalized on a number of occasions.  She loved gardening, and we planted a tomato plant that she watered, cut back and cultivated twice a week. When the tomatoes grew in she had a sense of accomplishment. As someone who was always told that she was bad, here was something she could feel good about.

We used the tomato plant as a metaphor for her own process in life.  How could she treat herself in a kind and cultivating way? What would nourish her soul?  The tomato plant calmed her.  She felt less reactive when working with the tomato plant.  In the winter, we would use the tomato plant as a  metaphor of patience and the seasons became a lesson on the process of growth and change.

Have you found a creative niche, a unique office space, use non-traditional interventions, or have something that sets you apart from other private practice clinicians? I want to hear about it! Email me with "outside the box" in the subject line.

jacki-dee (catching up) via Compfight

Practicing Outside The Box: Psychotherapy On The Client's Couch

Michigan therapist finds niche providing in-home psychotherapy services

Would you travel to a client's home to provide therapy? After witnessing the high no-show rates while working at community mental health centers Michigan, therapist Tomanika Witherspoon, LMSW, CEO of Growing Counseling Services, decided to do just that.

She created an "outside of the box" specialty practice by focusing on providing in-home therapy.

In Witherspoon's experience, individuals who discontinued traditional therapy cited transportation, time and family responsibilities as the biggest barriers for receiving treatment. By providing in-home therapy, Witherspoon saves her clients travel time, travel expenses and time spent in an office waiting room.

What about her own travel time and expenses? Witherspon said that she does not bill for her travel time. However, to minimize the unpaid travel time and expenses, she only sees clients within a 20-mile radius of her location.

What about safety issues? "I typically do a phone-screening to gather the client's demographic information, insurance info, and the assurance that we will have somewhere to meet privately," Witherspoon says. "Safety is generally not a concern, but if it ever becomes one, I would meet in a colleague's office."

Providing in-home therapy services is not for everyone, but Ms. Witherspoon makes it work for her and her clients.

Visit GrowingCounseling.com to find out more about Tomanika Witherspoon, LMSW's "outside the box" practice.

Have you found a creative niche, a unique office space, use non-traditional interventions, or have something that sets you apart from other private practice clinicians?  I want to hear about it! Email me with "outside the box" in the subject line.

(c) Can Stock Photo

Creating Your Perfect Work Week (part 2)

In this guest blog Ashley Eder, LPC offers part 2 of "Creating Your Perfect Work Week." Ashley is a counselor and supervisor who believes we each have the potential to create a more satisfying life. Located in Boulder, CO, she works with clients and therapists through curiosity, self-awareness, and acceptance in order to create lasting change.

In Part I of Creating Your Perfect Work Week, I prompted you to evaluate how well your practice is performing as a non-monetary form of compensation. As a reminder, here are the questions for you to ask yourself to get an idea of how rewarding your private practice work week is for you now:

• Are you excited to go to work?
• Do you enjoy your clients?
• Can you maintain your personal relationships?
• Do you have time for self-care?
• Do you feel satisfied and complete at the end of the day?
• Are you resentment-free?
• Are you intellectually stimulated?
• Have you stopped doing the things you dread?

If you followed through with this exercise, you know that it really is possible to answer “yes” to all of those questions; you are ready to experiment with adding Satisfaction Builders into your week and you have a pretty good idea of where they may need to go.

Below are a handful of suggestions for ways you can re-design your practice to work better for you. Remember, the ideal practice is different for everyone! Use these ideas to get you started, then listen for your own voice to guide you in getting it just right.

Improve Your Work Satisfaction

• Play with the flow of your day. You might sprinkle “mini-breaks” into your day (just 15 minutes to get some fresh air or eat a quick lunch); take a bigger break so you can leave the office to meet a friend or take a nap, or work straight through followed by extended time off. Which schedule leaves you least harried and most refreshed?
• Experiment with separating client hours from administrative hours versus weaving them together. Does it feel more natural and productive to you to chart and return calls between sessions as you get time or all at once in a pre-determined window?
• Fiddle around with work/home boundaries. Are you happier leaving work-based activities like social media and returning emails at the office, or do you prefer integrating them into your home life so that they don’t build up so much and you can maintain a connection to your business?
• Pursue the clients who make your work meaningful and refer along those who do not. Trust that it is best for clients and therapists when we narrow our focus to serving our ideal clients, and allow other clients to seek help from clinicians who would be a more nourishing fit.
• Raise your fees until you feel adequately compensated. Check out these tips on deciding to do that and how to broach it with clients.
• Re-evaluate your mission statement. Why are you in private practice? Why did you become a therapist? Align your practice with your mission.
• Seek professional support. Would it would feel good to treat yourself to expert supervision for a while? Choose a modality or style you would like to explore. Try building your own consultation network, and do not spend time with people you do not want to emulate. Get clear on who feels good to learn from and seek their support.
• Study something new. Remember the intellectual stimulation of grad school? Well now you can have that without all of the homework. Seek continuing education that encourages you to expand your niche and work at your growing edge.
• Do your own work. Take an honest appraisal of your clinical boundaries around time, responsibility for oneself, and money. This may involve a personal inventory and some existential exploration of what you truly believe about the nature of people. Then ask yourself: “Are these beliefs current or outdated? Do I choose to hang onto them or is it time to challenge them and my own habitual limitations?”
• Trust yourself. If something feels “off” about your work experience, it probably is. Hang out with that observation, let it develop, and seek consultation with trusted colleagues. Your private practice is a work in progress. With your time, attention, and care, it will continue to flourish and nourish you back.
• Imagine giving yourself permission to quit doing the things that don’t take care of you. Perhaps start by choosing one thing to let go of and observe the ripples. What happens next? Is it as scary as you thought it might be? Does your practice feel the impact? How do you feel without it? Hint: follow your resentments to find the practices that no longer serve your higher self.
• Drop the dread. If you dread a part of your job, it is not feeding you. Be creative in your efforts to automate it, outsource it, or drop it entirely.
• Question The ‘Busy’ Trap. Make room for self-care, including the necessity to do nothing on a regular basis. Identify what self-care truly means for you and allow it. It might mean making lovely meals or giving yourself a night off from cooking. It could look like an hour at the gym or an hour on the couch. It’s personal, and you get to choose.
• Lighten your load. Examine your beliefs around how many client hours you should fit into a week. Would you be more energized by dropping 2 clinical hours, raising your rate $10, and writing for your professional blog or playing in nature? Do it!

As a business owner and psychotherapist, your practice really is your life. This can be an anchor weighing you down or an opportunity to build a flexible, satisfying life. Which do you choose?

Visit Ashley Eder, LPC’s practice website

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(c) Can Stock Photo

How To Get Paid For No Shows

photo credit: Marcin Wichary

Are you going to work and not getting paid?

Therapists in my consulting practice frequently complain of a high no-show rate, especially with new clients. They often feel powerless to enforce their policies fearing if they're too strict, clients will drop out of treatment.

I used to have this problem, too, and ended up feeling resentful when I had rushed to get to my scheduled session only to have a client no-show. There were also those days when a handful of clients who didn't show up or cancelled at the last minute. Since I was paying for child care there were times when I actually lost money by going to work. I knew something had to change.

While some clients would pay for the no-show or late cancellations at their next appointment, others would drop out of therapy, not return phone calls, and not respond to bills I sent to them. Additionally, many of the managed care panels I participated on at the time didn't reimburse for no-shows, and our contract didn't allow me to charge the client for sessions not attended. This was another reason I resigned from all managed care panels.

May I have your credit card number?

A few years ago, I started requiring new clients to provide a credit card number before they could schedule an initial appointment with me or any of the therapists at my clinic. New clients were informed that they would not be charged until the time of service, but that our policy is to charge the therapist's full-fee for no shows and cancellations made within 24 hours of the schedule appointment time.

If hotels, massage therapists, and hair salons can require a credit card to hold your room or appointment, why can't therapists require clients to make a financial investment in their treatment the actual sessions? Surprisingly, we've had no resistance from new clients when my office manager tells them about our policy and ask for their credit card number. Not surprisingly, my practice has very few no shows or late cancellations and the few that we do have, we charge for.

For my clinic of 13 therapists our percentage of no-show or late cancellation sessions that we don't collect our full-fee is less than 1% of our total number of sessions.

Suggested script for taking credit card number

I have an amazing office manager who screens all new client inquiries, informs them of how to access new client paperwork, takes down the credit card number and explains our financial policies Here's an example of what she says.

Yes, Julie has an opening next Wed. at 3:00PM. In order to confirm that appointment with Julie we require a credit card number on hold. You will not be charged until the time of service and you're free to use another form of payment at your session. What type of card would you like to use?

If for any reason you are unable to make your scheduled appointment time please give us at least 24 hours notice of cancellation or we will charge your credit card for the full session amount. Do you have any questions?

Tightening up our no-show policy has:

1. Weeded out the clients who aren't ready to commit fully to the therapeutic process.
2. Motivated our clients to be in charge of their appointment times and give us ample notice if they can't attend a scheduled session.
3. Allowed my therapists to get paid for sessions whether the client shows up or not.
4. Saved administrative costs and collection fees.
5. Trained clients to value and respect our time and services.

Is it time to tighten-up, modify, or enforce your no-show or late cancellation policies?

What challenges do you face in enforcing your policies?

Paper Or Electronic? Why I'm Grieving My Paper Files

Call me a bad therapist. It wouldn't be the first time. But I write my case notes during sessions. It's not "writing" really. It's more like "jotting" a few important things down as I go. I sign and date the note at the end of the session and I'm done. Call me crazy, but I like to complete all work, notes, letter writing on behalf of the client during the session. I have resistance to adding and hour or so at the end of my day for case notes.

If you haven't been able to tell from past posts, I tend to be an early adopter when it comes to technology. I had a therapy website in the early 2000's. I've been on Facebook and Twitter for 4 years (which is a long time for the over 40 crowd). I love my iPhone and iPad. I developed an app. But, I haven't yet transition to electronic notes and health records, until now.

Starting today my therapy clinic is finally transitioning to an electronic records and practice management system. After a lot of research we decided to go with Care Paths.

For practical reasons it's a good move for us. Having opened a second location last Fall, it makes sense to use a web-based practice management and records system to have all records in one place, online.  I love that clients will be able to log in, fill out initial paperwork, print their own statements and forms to submit to insurance for reimbursement, or to check their appointment times. I like that we'll be able to sign notes electronically. Supervisors will be able to review and sign supervisee's notes online. I'm thrilled that we'll easily be able to fulfill request for records. As a director, I'm glad that I'll be able to easily audit case notes, outcomes reports, and files. It makes sense.

Yes, this is a good move but I am going to miss being done with my notes at the end of each session. I'm going to miss my own   handwritten visual reminders on case notes - my little arrows and stars highlighting something important. My handwritten signature will no longer matter. There are some things that you give up when you trade paper for electronic and I'm sad about that.

Do you still use paper files or have you transitioned to digital notes? Which program do you use and why? I'd love to hear your comments below.

photo credit: Cokul