Practice Builders—Technology and Remote Counseling

I wonder, I wonder, I wonder how technology will influence/change the nature of my field 10 years from now. National and International

10 years ago I never would've had clients in these states: Arizona, California, Colorado, Illinois, Kentucky, Michigan, Missouri, New York, Tennessee, Texas, Virginia, Washington AND these countries: Afghanistan, Canada (Alberta and Ontario), England, Mexico, Nigeria, Norway, ALL of whom I've been able to work with from the comfort of my own office and that they've been able to work with me from the comfort of their own homes or offices.

"Continuity of Care" and "Client-Centered" Realized

In the past it was local or nothing. Now my clients can choose who they work with. They can have real "continuity of care" rather than hope they find a good therapist when they move (and as we know, most don't make that transition to a new therapist successfully, and more than often drop out of counseling altogether). They no longer have to start over with someone new and tell their whole story fresh again. They have the freedom of continuing the work they began. And new clients from these places get to access who they want to work with. It is truly making it more and more client-centered, which is what we believe in this field, but sometimes isn't realized. Technology is giving my clients more choice and with choice comes power.

I am truly grateful for amazing technology and ALL the brilliant minds that have come together to make this all so "easy." Due props to all you awesome geeks and nerds out there!

For My Colleagues: Making It as an Entrepreneur

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For my colleagues who desire to go out on their own into private practice, speaking business, etc. I highly recommend this GREAT article: How to Survive Your First Year as a Entrepreneur. Love it. Rings so true to my experience as an entrepreneur (minus the prostitutes). Great advice to anyone venturing into the fantastic world of entrepreneurship.

By the way, you still might fail on that first business. But now it’s too late for you. You’re never going back to the pencil factory. You’re an animal, you hunt in the wild, you dig your sharp teeth into flesh and enjoy it, and at the top of the mountain you roar like a lion and everyone cowers in fear."

Personally, there's no going back to the pencil factory for me (i.e., mental health agency or working for someone else in my case). LOVE working for self and CREATING!!! Tough, nerve-wracking, fantastic. If you've got the passion and heart to put yourself out there and aren't too risk-averse I highly recommend this crazy wonderful life.

Clients on Facebook? Okay or Not?

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Q: A therapist colleague asked me:

Do you ever say yes to a client's friend request on Facebook? And if so what are your rules about it? I have some that want to keep in touch with me after I move but I am just not sure and don't want to make a bad choice but there isn't much said about 'internet' and 'Facebook' stuff?"

A: Great question. Yes, I do. And yes, I know there's some controversy on this topic. I've read a lot on the subject and have given it a good deal of thought. Admittedly, for the field as a whole, this is still mostly uncharted territory. But it's one that isn't going away, and old school practitioners are going to find it hard to compete if they don't learn to adapt to where their clients are—which is where the market is.

For me and my clients, I'm all for embracing current technology and how people (our clients) communicate in real life. For example, I also do coaching via phone and Skype with clients all over the country and internationally. Some say it's not as good as face to face (I agree). However what it does for:

1. Continuity of care for clients is simply phenomenal,

2. Providing greater choice to clients in their selection of providers is unparalleled, especially in rural areas, as well as

3. Greater flexibility and convenience in scheduling (just consider the convenience of a single mother or young couple not needing to arrange for a babysitter).

Face-to-face cannot always provide for these three very significant factors. There are pros and cons for each method.

I've always been an early adopter of integrating technology in our field as well as being a proactive marketer of wellness rather than passively waiting for clients to find me. I believe we as therapists have specialized knowledge and skill sets that are too important to just wait in our offices until people's problems reach the crisis point that they then start searching for a therapist. I'd much rather people get to know a good therapist long before they "need" one... Then when the need arises they don't have to scramble "hoping" they find someone that will work. The latter does not seem like good client care to me. Giving them the chance to pre-decide way ahead of time is much better for all as it insures a more proper "fit" with client and therapist which predicts greater successful outcomes for both.

So, to answer your question here are a few points (in no particular order and by no means comprehensive) I use on Facebook:

1. First of all, I work with a high functioning clientele, so boundary issues are rarely (haven't had any yet actually) an issue. If I still worked for a community mental health agency I would very likely not "friend" my clients for the most part, even though they were wonderful people. Generally, in the discussion around where does coaching and therapy begin/leave-off, the thinking is that GAF (Global Assessment of Functioning) scores of 70+ are more "coaching" clients. That is open to debate, but it's the general thinking on the topic. When I say "high-functioning", though, that is what I'm talking about;

2. My Facebook page is first and foremost for networking, so I stay mindful that my posts and pics will be seen by clients, colleagues, referrers, as well as friends and family. So is what I post something I'd feel sharing posting on a bulletin board or discussing in a seminar? Yes. Sometimes it's clinical. Sometimes funny. Sometime personal. The point in both therapy and social networking is to always be real, relevant and relatable;

3. The broad mix of Facebook friends I feel provides the same anonymity and confidentiality that any other public social environment affords, such as the grocery store and the same rules there apply. For example, the client owns the relationship--meaning I won't acknowledge them as a client unless they want to self-identify publicly in a post that way such as, "You helped our marriage so much. Thanks!" Otherwise as far as anyone else knows they are just another acquaintance. It's similar if I run into a client in the grocery store--if they come up to me I'm happy to talk. If not, I politely avoid them to protect their privacy. If my kids ask who was that, I just say, "A friend of mine" to protect their confidentiality;

4. Contrary, to conventional practice (which some of the research now supports me) I do believe in a good deal of self-disclosure. Many clients over the years have expressed frustration that they want a great relationship with their spouse or kids but have never seen that modeled in real life. The medium of Facebook and appropriate self-disclosure provides that. I'm by no means THE model, but I am one very real life example of a guy doing his level best at practicing about 80% as a husband and father of what he preaches as a therapist.

5. I'm also pretty down to earth, silly and frank in my Facebook posts. This serves a dual purpose: 1. To remove the stigma of the stuffy, clinical therapist and 2. Markets myself to my ideal clients (ie., those who value plainness and authenticity) and screens out my non-ideal clients (ie., the ones who take themselves too seriously). This leads to a better fit on both sides. Potential clients get to "check me out" in advance and decide whether I will be a good fit for their style and their needs. Yellow Page ads and websites just don't give the same level of relate-ability or transparency that clients really want and value;

6. After all that, I re-read your question and realized I neglected to directly answer your first question. Yes, I do accept my clients "friend" requests (remember my caveat: I have a high-functioning clientele with good boundaries). I also didn't mention what is likely obvious: Most people don't consider Facebook "friends" to be the same as friends in the traditional sense unless their page is strictly limited to immediate friends and family. This is one reason I don't consider my client who is also my Facebook "friend" as being a dual relationship anymore than I would consider having a friendly conversation with a client I happened to meet at the grocery store a dual relationship.

Now there may be others who will say you should never "friend" clients on Facebook. And they may be right depending on the population they work with or their own preferences. However, for me it's worked great. Client feedback is they value it. My approach has always to be client-centered and customer-driven. So, bottom line: I'm all about effectiveness. If it works keep doing it. If it doesn't, don't.

Your thoughts? Other questions?

Peace,

Jonathan

This colleague then replied as follows:

“No, I agree, and it’s good insight too. I agree with what you have said. With my clients, I have always taken an honest approach. That when I felt I should share moments of my life. I have great relations with my clients. I know that for those who want this its a way for them to feel valued. That I didn't just toss them to the curb, even though I am moving away. That I value them as a person and am here if they still need me for anything, even though I will be 11 hours away. I know that there will be times when a few of them are going to get married and will want to do couples therapy. I want to use technology be able to do that for them or be able to give them a referral that I know will be good for them. I love the idea of Skype and all those ways in which you can have a session without having to be one-on-one. There is power in the relationship between a therapist and a client. To be a tool and means through therapy is important to me. I like your advice and will use it to help me professionally. It is wise and very helpful. It also helps me to remember that if I do this, what I say matters even more than it currently does on here, and that needs to stay the most important thing. Thanks, really, it was truly helpful.”

Tagline: Answer Their Pain

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Among the many things we talked about in today’s Networking Group, Mark mentioned a book that sounds promising: Be a Wealthy Therapist: Finally You Can Make a Living While Making a Difference (http://www.beawealthytherapist.com). He'll be reading it and sharing his take on it with us. One idea he shared was: Try to imagine what it is that wakes your clients up at 4 o'clock in the morning. That becomes your catch phrase for your practice, website, marketing materials etc. He gave the example of Julie de Azevedo-Hank's (http://www.juliehanks.com) use of this idea with their successful Wasatch Family Therapy (http://www.wasatchfamilytherapy.com) practice. You can visit her sites and see what we mean. I love that idea, and wished I had heard of that years ago when I was trying to figure out my approach as I would've been able to nail down my message a lot sooner. The basic idea is to them how you will answer their pain, not tell them about what you do or about yourself. For example, in my case, instead of "I do marriage counseling" (yawn), "I help people  not only save their marriages, I help them create phenomenally GREAT relationships." (Wow!) My tagline is "Create GREATness in Your Relationships". Another example: While Julie treats depression and women's issues she doesn't lead with that. Her sites proclaim, "Healing relationships" and  "Let your best self shine." In all of these examples people want to hear the solution to their pain and beyond, not just that  you will treat their pain.

We'd all love to hear your practice building ideas. What do you do that's working for you in your practice?

How to Thrive in Private Practice, Part 1

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UAMFT Annual Spring conference May 21-22, 2010 Panel: Shannon S. Boxley, MS, LMFT, Pamela Kings, MS, LMFT, Victor Nelson, STM, LMFT, Jonathan D. Sherman, MS, LMFT & Nancy Webb, MS, LMFT

Pam King compiled these “Tips From the Field” from the above panel members.

Professional Health 

1. Establish a good consulting group. If you practice in isolation you are putting yourself at risk as well as limiting your potential therapeutic impact.

2. Embrace "failure" learn from it.

3. See continuing education clinical skills and business skills

4. Identify your clinical and business resources

5. www.FamilyTherapyResources.net service of AAMFT

Personal Health 

1. Be flexible while maintaining the boundaries that are necessary to keep yourself healthy and assist your clients in the process.

2. Develop a fulfilling practice rather than a full practice

3. Embrace the seasons of your personal/family life as you make business decisions.

Financial Considerations 

1. Remember you are running a business (with all kinds of business expenses); don't apologize for requesting payment for your services!

2. Be able to offer clients the use of a debit/credit card machine to make payment easy for them.

3. Charge what you're really worth and for the value your clients are really getting

4. Develop a business mindset and diversify your income streams.

Advertising 

1. Get the word out

2. Change how you think about the money you spend on advertising-a $500/year ad in a phonebook or Psychology Today will be made back in one client in a few sessions, and everything after that is pure profit!

3. Look professional

4. Announce your practice, market your practice-use free media for publicity

5. Maintain an online presence

6. Leverage social media.

Develop and maintain referral sources 

1. Get a business card right away so you have something to leave with new referral contacts.

2. Network outside of your field

3. Identify your main referral sources and market to that audience.

Define your practice 

1. Limit the scope of your practice to a few areas of interest rather than being a generalist

2. Define your practice-Create a niche or specialty

3. Develop systems that work for you

4. Offer more than expected.