Private Practice & The Power of No

Recently, a coaching client of mine told me this story. She was amongst therapist colleagues, and they were congratulating her on how well her practice was growing. She thanked them, but said part of the credit was due to the coaching and consulting she was doing with me. She was very surprised at the negative and critical responses she got from them after they heard that. She wondered why people are so down on working with someone to grow their practice or modernize it with technology.

Although I was not surprised by this response, it is something I have wondered myself from time to time. Here are some of the reasons I have noticed, along with my translations:

  • “I’m too old to learn about technology.” AKA, “I have internalized ageism and am now using it to assert that I no longer am required to learn anything new.”
  • “My practice is doing fine just the way it is.”  AKA, “Although I have noticed a decline in my referrals I will continue to assert that it is insurance, the government, or patient resistance that is to blame, not my disinterest in change.”
  • “I can’t afford to pay for supervision, coaching or consulting.”  AKA, “I have decided that supervision, coaching, or consulting is optional rather than integral to starting a therapy business. I have furthermore planned to launch or grow my business without having an operating budget.”
  • “I don’t have time to make an appointment with a coach, consultant or supervisor.”  AKA “my unwritten business plan (because I didn’t have time write it) is that I plan to rent out someone’s office for 4 hours a week and market in my spare time.”
  • “Those people who do coaching are only in it for the money.” AKA, “Despite my clinical training which taught me to see global thinking and negative attributions about people as a sign of pathology, I have decided that these people are one-dimensional. Furthermore, I am hoping that I can split off that part of me that wants to make money doing therapy while at the same time make money.”
  • “I can get everything I need from my peer supervision group, and it is free.” AKA, “I truly believe that by surrounding myself with others who are trying to build up their practice, I will get lots of referrals (thus eliminating the need for a business plan) even though this group is least likely to give away referrals because they too are trying to build up their practice. Besides, I find our shared complaints about the field comforting.”
  • “Ok, I know I should hire a coach, consultant, or supervisor, but I am afraid to take the plunge.” AKA, “Despite what I have learned about insight being necessary but insufficient for change, I’m going to express my feelings and hope that that ‘counts’ as change, and take that insight as the goal rather than the starting point.”

Part of what I am gunning against here is the surrounding of oneself with internal and external naysayers. Julia Cameron, author of the Writer’s Way, talks about crazy-makers, and I think that naysayers are a particular type of crazy-maker.  Naysayers operate solidly from within the depressive stance.  These are the folks that say you can’t make it in private practice, or that it is harder nowadays, and that things aren’t the way they used to be.  Take a good look at them before you buy into it: Do you really want to take pointers from someone with a failing business?

Yes, things are different nowadays.  And in many ways that’s a good thing.  Health Care Reform is going to provide more people with more coverage for mental illness than ever before.  But my prediction is that it will be a two-tiered system, where insurance pays for symptom reduction and chronic mental health conditions for the most part.  Therapy for insight, relationship improvement and quality of life issues will become more and more private pay, and/or more and more time limited if insurance does cover it.  Hey, wait Mike, aren’t you being a naysayer here?

I don’t think so, because I think that both parts of the system will have places for therapists.  I think that people who want to work primarily in a medical model will find they have a steady flow of brief episodic treatments, and folks that want to work in a private model will have a vibrant practice if they set it up like a business.  If anything, the only people I think who are getting short shrift here are the poor, whom our government will treat as if they have no inner world.  But therapists will have plenty of opportunities.  If you work for them.  What will change is this idea that getting into telephone books and on insurance panels is the extent of the work you need to do.  And that in many ways is what people are complaining about.

If you want to be in private practice full time and make $200 an hour, I have no problem with that.  Unless your business plan is to sit in your office like a film noir gumshoe with your feet on the desk.  Nope, for top dollar you’d better be generating content outside the therapy hour, whether it be a book, podcast, video or workshops.  That will be how people can determine “why you?” and that will be what sets you apart from the legions of gumshoes who are sitting in their offices waiting for the phone to ring, or commiserating in groups.

Am I saying you should hire me?  Not necessarily.  In fact, if this post annoys you you definitely shouldn’t, because this is my style and modus operandi.  I give away a lot of free content, but I’m not gilding lilies.  What I am saying is hire someone, after you do some research.  Look into a person’s recommendations on LinkedIn or their website.  Follow them on Twitter for a while.  Look at their online and offline content to be sure they are more than hype.  But then take the plunge, and invest in your business, i.e., pay someone.  And if a colleague of yours says they are working with a coach, applaud their initiative rather than criticize them.

There are plenty of reasons people don’t hire a consultant, coach or supervisor, but I have yet to hear a good one.

Like this post? You can work with me too. 

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Comments

  1. How sad that people’s who profession is to make a living helping people, criticize a peer reaching out to get help to make a better living. I agree with you about the depressive stance and the naysayers and crazy makers. ULtimately, each professional, no matter what profession, needs to take a realistic look at their goals and career trajectory and make independent decisions about what tools they need to reach those benchmarks. And any peer group that negates their efforts to learn and grow and make a good living isn’t one that is healthy to spend significant time with.
    And if people think that those of us who help people build business are “only in it for the money”, they should take into consideration that we generate more free content in a month than most will get out of a book they pay $50 for.

    • “only in it for the money” In general, this mindset kills me. You might not like saying you do what you do for the money, but last time I checked, there was no rent/food/student loan fairy (or WoW fairy, or travel fairy, etc.) You can get on your high horse all you want, but we are living in a material world, people.

      • Never hear this mindset applied to an electrician or a dentist. Is it because we are primarily ‘care givers’ that we are not allowed to earn actual money for our work. Who made that rule?!

      • Mike Langlois, LICSW says:

        Heather, good point. We may not like capitalism, but we live in a capitalist economy.

  2. Mike – yet another inspiring and truthful blog. Here in the UK it seems to be frowned upon if you ‘confess’ to wanting a healthy career (personally, professionally and financially rewarding) as a counsellor/therapist. During my own training I was repeatedly told there was ‘no money in counselling’. Talk about red rag to a bull!! Not only do I now run a thriving private practice, but I also train other therapists how to do the same, by engaging some of the strategies you mention here and showing what does and does not work for us in our own practices.

    Interestingly, I have recently had my first ‘person-centered hate email’ telling me to stop helping people get clients in an already ‘saturated’ counselling market place! How sad that this person felt threatened instead of inspired to join up and get in on some of the action. Might also explain why my fellow counsellors within my geographical area have stopped speaking to me too – after all – I do dominate on P1 of Google!

    • Mike Langlois, LICSW says:

      Hi Sue, thanks for giving us a snapshot of how things are in the UK. I think we need to pay close attention to how you all are dealing with things, because I think you’re where our health care reform is heading us in the US!!

      Grats on your Google domination! 🙂

  3. I’ve got a lot out of this, and one of your previous posts about Ding and Grats.

    Something I’ve discovered about myself is that, when times start feeling tough, I respond by imagining creative ways of ‘putting myself out there’ more. This other part of me then takes on the form of the nay-sayers and comes up with ethical arguments against self-promotion etc.

    I guess what I’ve got most from your posts is the morale boost of hearing someone else argue for what I think: that authentic self-promotion is about knowing I have something to offer and making sure people know what that is and how to find me.

    And when it comes down to it, if I as a therapist am not willing to over-come my internalised nay-sayers and say ‘I am a therapist, I might be able to help you, here’s how to find me’, am I really going to be able to support other people in over-coming their own crippling internalised nay-sayers?

    So thanks, this blog is good for my morale! 🙂

  4. A psychotherapy practice IS a business! Let me put that out there as my basic premise. That said, I can think of NO other area of business which operates without a planned approach to budgeting, to the recruiting or acquisition of clients/patients/customers (you chose which label applies to the business you are in), to the acquisition of needed space and supplies and to marketing. I left marketing for the end of the list to draw attention to it. If you don’t impress upon the cohort of individuals who need your professional services in psychology, social work or counselling that YOU are worthy of their consideration, no one else is going to, at least not often enough to make your practice profitable. Studies have repeatedly shown that one of the top 5 reasons people cite for working is to make money. Why should you or I as professional therapists see ourselves as so different? Beats me!! My degrees are in psychology. It takes a collosal degree of arrogance to assume that a doctorate in clinical psychology equips me with the skills to run a successful business. PS. I’m not that arrogant; my practice is full-time and thriving; and, I sought professional help to acquire the business skill set I needed to get there. Go for it!

    • Mike Langlois, LICSW says:

      Preach it, brother. I think you are right on about how this exposes the colossal arrogance, and entitlement, that often seem to be prevalent in our profession. We need to get over our bad selves. 🙂

  5. Nicely stated Mike! Wonderful synopsis of the excuses!

    I’ve come to find that there are two (talk about generalizing) kinds of people on either side of this argument:

    – the people who have had coaching, learned from it, improved their business, and consider giving back to others through coaching.
    – those who haven’t, still struggle, but choose external excuses rather than working with someone to do the internal business work.

    If we are going to encourage clients to do the hard work of looking at themselves and making important changes in their lives, shouldn’t we be willing to do the same with our business and our business attitudes?

  6. There are so many nay-sayers out there! So many internalized stereotypes of how a therapist is supposed to be. Ethics are vital to the foundation of our profession. Though, even within the ethical framework, so many therapists lose sight of who they are and who they may become. I know because I have been there and done that. And worst yet, to keep any well-meaning therapist from fighting these stereotypes, and become more of the professional they hope and dream to be, the big banner of a supposed ethical dilemma is often raised, and very few people dare to dispute this all-seeing eye of “ethics.”

    Why is self-promotion a bad thing? Frankly, if all therapists were just sitting around waiting to be found, little would happen. Coaching, mentoring, supervision, should always be interwoven into our profession. And, the ones who shamelessly self promote, 9 times out of 10, it’s because they are passionate about what they do! They have something to say! What’s wrong with that passion? What’s wrong with having a voice? Nothing!

    And the thing is this, you never know who your message will reach. Maybe a future client. Maybe a fellow professional in the field. Or maybe a stranger who will simply read your material for years to come. All these things are good! Though if we don’t toot our own horn, how is someone to find us? If we don’t toot our own horn, we are more likely to be run over by the big semi-truck barreling down the highway of life.

    I am proof that Mike’s self-promotion works. I would have never had any reason to search for a gaming therapist. It was just by coincidence that he and I were on the same professional discussion board. He had posted a link to his blog. I skimmed one of the entries. Found it rather interesting. Though that one exposure wasn’t enough. Then, yet again, another discussion arose on this discussion board, and I found myself with yet another easy click-able link to his blog. That second time, was all it took!

    For all those self-promotion nay-sayers out there, if you don’t like the look of the link, then don’t click on it! If you are upset that the self-promoter took up two seconds of your time, take a deep breath and relax.

    Here’s to all the yay-sayers out there! Cheers to us!

  7. Nicely stated. I do believe that if I wanted to take over the maintenance of my vehicle, I would not just start tinkering, thinking that I have seen others do it so I can do it too. Just because one is a good therapist, doesn’t make one a good operational business person. Learning a new way of operating keeps us open to what can be, not just want we see others do before us.

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