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!

Adventures In Private Practice: Vocational Social Worker Dawn Vincent

Specializing in vocational rehabilitation and work/life issues, Australian social worker Dawn Vincent has been  in the mental health field for 25 years. Like many therapists, she considered opening a private practice, but says she lacked the confidence to actually do it. Read how one private practice course helped her muster up the courage to open her private practice in Camberwell, Victoria, Australia where she helps clients work toward mental health and well-being and navigate changes and choices in life and in work.

Why did you decide to open a private practice?

I had thought about it for about 10 years, but lacked the confidence to go ahead.  After spending over 20 years in vocational rehabilitation I decided to take my long service leave and think about my options.  After an overseas trip I came home and enrolled in an Introduction to Private Practice course run by the Australian Association of Social Workers.  At that time there were only a small number of Social Workers in private practice and it was still somewhat controversial here in Australia.

The profession has a very strong welfare orientation where most Social Workers are employed by the Commonwealth or State governments or work in hospitals and community based settings. Having worked for a large government bureaucracy myself, I liked the idea of the independence and autonomy private practice seemed to offer. I had been a bit of a workaholic and I wanted to move to a better work/life balance and be able to work my own hours.  The course helped me to decide that private practice was what I wanted and I committed to this goal.

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?

Before private practice I had worked with clients with physical, intellectual and psychological disabilities, helping them to enter or re-enter the workforce after injury or disability.  At times it was very challenging and distressing working with people with acquired brain impairments and severe physical disabilities, particularly the younger ones whose lives were permanently changed.

I found I was drawn to the mental health clients and tended to specialise in this group and continue to do so in my private work. Working with people with disabilities reminds me how lucky I am to be fit and healthy and not take this for granted. It has also taught me about the dignity of risk and courage and resilience in life. Helping people overcome their barriers and live a full and meaningful life is incredibly rewarding. I learn from my clients daily and I am a better person from my interactions with them.

What's your biggest pet peeve about private practice?

The uncertainty of income. There are obviously times of the year when referrals are quiet and I used to worry about when I would get my next referral. Over recent years I have become more relaxed about this and accept it as part of the natural seasonal variations. I do get annoyed when clients cancel at the last minute when I have made a special time to see them outside of my normal schedule, although fortunately this does not happen often.  As a member of both the Australian Association of Social Workers and the Career Development Association of Australia I have double fees and professional development requirements from these bodies which becomes very expensive.

How did you discover or develop your practice "niche"?

As mentioned above, my background is in vocational rehabilitation specializing in working with people with psychological disabilities.  I always enjoyed working with this client group and was fascinated by the workings of the mind.  When I entered private practice I was naturally drawn to working with mental health clients. Originally I had intended to focus on general counselling and psychotherapy, but I found that some of my colleagues were referring clients to me for career counselling.

With my experience in general counselling and vocational counselling it made sense to continue to use my skills in both areas and mix the two streams of work.  I now see approx. 70% of clients for personal counselling and psychotherapy and the other 30%  for career counselling, although sometimes there is an overlap as people may have psychological issues which impact on their career decisions. I find the career work provides some “light relief” from the common presentations of anxiety, depression and relationship problems as it is shorter in nature and less intense.

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

The Introduction to Private Practice course I did was based on Lynn Grodzki’s workbook Twelve Months to Your Ideal Private Practice. I worked my way through this workbook and reported back to the group each week. I found this helped me to be well prepared for the realities of private practice.

I still frequently refer to Lynn’s books when I need to focus on how to develop my practice further. One of the social workers who ran the course allowed me to rent her room for half a day a week and on the days I went there we would spend some time talking about my practice and she provided ongoing support and advice to me as I waited for my client base to build up. My husband was incredibly supportive and encouraging.

What has surprised you most about being in private practice?

The number of people who have been prepared to help me learn what I need to know about running a business and the amount of resources available to support this.

I belong to several business networks which have been very useful in making contacts with various professionals with expertise in website development, social media, business systems, coaching etc.  It took me a while to find these, but they are out there if you ask and look.

Has your private practice helped you grow professionally? How so?

Every day I am learning new things. The longer I am in private practice, the more I realize there is to learn. Working with people and studying the human condition  is  exciting and stimulating. My skills and knowledge are continually growing as no matter what I may know about any topic or therapeutic approach, there is a constant stream of new knowledge out there.

Being in private practice makes me resource myself. I am responsible for my professional development – no one else, so I seek out opportunities to grow my knowledge and skills so I can continue to provide my clients with the best service I can and deepen my satisfaction at work.

Has it helped you grow personally, too? How so?

Absolutely. My confidence and self belief  have developed as a result of taking a risk and putting myself “out there”.  I could have continued in my former job with a safe, secure income and never grown to be the person I am now.   It is great to have been able to overcome my own fears and insecurities and put in the hard work required to realize my dream.

I have had to learn about marketing, networking, managing a business, budgets, Business Plans, etc.  I am more independent and I have a better understanding of myself, what I need and what I am capable of.   I am happy doing work that I love and which I believe makes a difference in people’s lives.  It is for me the perfect combination.

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

I am a great believer in self care and I constantly talk to my clients about this so I make an effort to practice what I preach.  Some days it can be emotionally draining working with human pain and giving out to people. I debrief with professional colleagues as needed and I attend monthly private supervision. I try to exercise regularly, get enough sleep and eat healthily.  My husband and I love travel and we visit our daughter in New York annually and have mini breaks in between.   I make sure I catch up with family and friends on a regular basis.  I use mindfulness breathing and meditation to help me relax and I listen to music and go for walks or do some gardening to unwind.

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

I love being my own boss so I don’t find it too stressful, but I imagine you are referring to having to do everything myself. I have no office assistance so I manage my appointments, type my invoices and reports, do my own marketing, pay the bills etc.  I’m pretty organised and I am a bit of a control freak so it does not bother me to do all this myself. Sometimes I think it would be nice to have someone take on some of the small practical things while I focus on the things only I can do.

What personal strengths have helped you succeed in private practice?

Well, I think I am persistent and resilient and if I make up my mind to do something I don’t give up easily.  I am quite disciplined and conscientious and hardworking. I am happy spending time alone so although I sometimes do miss having a team of people to work with, I operate better when I have time to think, reflect and plan. Private practice requires a lot of this.

I have good people skills and I have no problem forming trusting relationships with my clients. I network well and I seek out other people when I need social contact, but I don’t need a lot of people around me all the time. I am not afraid to ask for help when I need it and I am committed to life long learning.

To learn more about Dawn's practice visit her website http://www.dawnvincent.com.au

A Day In The Life: Meet Anxiety Expert Marla W. Deibler, Psy.D.

Peek into a work day in the life of private practitioner and licensed clinical psychologist Marla W. Deibler, Psy.D. Founder and Director of The Center for Emotional Health of Greater Philadelphia, LLC. Her outpatient behavioral health group practice specializes in the treatment of anxiety and obsessive-compulsive spectrum disorders.

She's also a wife and a mother of three children and has found a nice work/life balance working 2.5 days per week at her clinic, and spending time the rest of the time home with her children. Thanks to email, phone, and text, Dr. Deibler operates her business remotely "in spurt" during the days she's at her home. And apparently, she doesn't sleep much!

Here's a day in the life of one of Dr. Deibler's "work" days:

A Day In The Life

November 16, 2011

6:15am – 8:15am

Woke up and got my children ready for school and myself ready for work. Ate breakfast. Checked my email, responded to several emails, including an email to our web designer who is working on our new website (very exciting), and forwarded a few visual voicemail emails to my office manager for return phone calls later in the day. Quickly scanned personal and business Facebook newsfeeds and scanned my Twitter feed.

8:15am-9am

Took my second grader to board his school bus and took my 1 year-old and 4 year-old to day care.

9:30am-10am

Arrived at my office, large cup of caffeinated tea in hand that I brewed before leaving home.  Turned on all office lights and computers, collected billing slips and receivables, returned two phone calls, one from a potential patient who had a question and one from a TV network with whom I’ve worked. Review my clinical schedule for the day: it looks like I’ll be working with adults and children today with difficulties including, OCD, compulsive hoarding, tourette’s disorder, depression, panic disorder, and trichotillomania.

10am-11am

Saw a therapy patient.

11am – 12:45pm

Supervision meeting with one of my post-doctoral fellows. Discussed cases and other clinical and practice management issues. Discussed planning co-presenter workshop proposals for the Trichotillomania Learning Center (www.trich.org) annual conference in May 2012. The deadline is quickly approaching, so we have to finalize our proposals over the next 10 days.

12:45pm – 1pm

Pulled testing measures to create charts for this week’s pre-bariatric surgery psychological evaluations. Received incoming mail. Checked email and forwarded visual voicemail emails to my office manager for return calls.

1pm – 2pm

Weekly staff luncheon. Enjoyed great salads from a nearby restaurant that delivers while we discussed cases with one another and other practice issues.

2pm – 3pm

Supervision meeting with another post-doctoral fellow who has just returned to work on a limited basis from maternity leave. This was particularly nice, as she brought her 8 week-old baby while we discussed her cases and other work-life balance issues. I manage my facility in an employee-focused, family-focused manner; each clinician is valued professionally and given the flexibility to create their own schedule so that they can create happy work and personal lives (I whole-heartedly believe this happiness is reflected in their work with patients, so it’s a win-win approach to practice management). In this clinician’s case, she presently sees patients on Saturdays, when her husband is home caring for their child.  On Wednesdays, she brings him to the office for her weekly meeting with me.

3pm – 6:30pm

Saw therapy patients.

6:30pm – 6:45pm

Left the office for the day and drove home to my family. My husband is also a psychologist. He works at a special services school, so he gets off from work at 3:30pm and tends to the children until I come home (Mondays and Wednesdays I work late).

7pm-8:30pm

Spent time with my husband and children. Ate dinner. Ensured that homework was done. Put the baby to bed. Supervised bath time for the older children. Read bedtime stories and tucked the big kids in.

8:30pm-9:30pm

Sat with my husband in our bedroom, while each of us spent some winding down time on our Apple devices –We love this technology. (My husband read news and such on his iPhone, talking about some of the day’s events with me), while I logged into my electronic medical records system (www.carepaths.com), signed off on billing, reviewed and signed off on clinical documentation written by post-doctoral fellows, and submitted batched electronic insurance claims for the day’s in-network patients. Contemplated a run on the treadmill, but today is usually a “rest day” for me and I have too much to do this evening, so it will have to wait until tomorrow.

9:30pm-10pm

Brewed a cup of tea and planned our Thanksgiving dinner menu (as well as ordering our turkey and when I’m going to grocery shop—I’ve got to begin with making butternut squash soup this weekend). I cook Thanksgiving dinner for my family and my brother’s family every year.

10pm-2am

Procrastinated work a bit here and there, intermittently throughout, by checking and returning emails, both personal and professional (needs to be done anyway), checking Facebook, and exploring professional and practice growth opportunities.

Reviewed a post-doctoral fellow’s lengthy forensic report. Completed business accounting tasks for the week. Created to do list with particular attention to the insurance claims/pre-authorizations about which I need to inquire.  Filed a freelance writing/consulting application.

2:30am

Went to sleep (Yes, it is very late. Wednesday is by far my latest night of the week; it’s a worthwhile tradeoff for more time with my family on other days). Tomorrow is a new day. I’m home with my two youngest children to enjoy time with this and take care of household tasks, while managing the practice via email/phone for the day.

For more information on Dr. Deibler and her practice visit www.thecenterforemotionalhealth.com, or connect on Twitter, YouTube, or Facebook.