Getting Paid: To Have an Office orNot have an Office—That's the Question on Many Therapists’ Minds Today
While some therapists continue to work with clients face-to-face in a therapy office as a result of stay at home orders across the country, a majority of mental health professionals find themselves working virtually with the clients in their practice doing video or phone sessions. This has caused many clinicians to wonder if they still need an office for private practice and if they should keep paying for an office when they only work with clients virtually now.
Facebook, Linked In, Instagram, Craigslist, and other therapist forums are full of postings by therapists who are vacating their offices and terminating their leases or who are looking for someone to take over a full time single or group office space lease. There are also numerous for sale postings for therapy office furnishings—couches, therapist chairs, desks, end tables, lamps, waiting room furniture, and wall art.
The therapy office landscape has definitely changed.
Months ago, therapists who sublet their office space and were only working virtually with clients, made the decision to jettison their offices as they quickly gave notice and stopped paying rent. Since office space has been plentiful in the past these therapists weren’t worried about subletting an office in the future should they desire to resume in office therapy sessions with clients. About 40% of clinicians in private practice usually sublet office space. Time will tell whether subletting an office will be as easy and inexpensive as it has been in the past since no one can predict how many therapists will retain their physical office space after practicing virtually.
Those therapists new to practice who leased their own office as well as those clinicians who depend on subletting office space to others to pay their office rent each month let their offices go and terminated their leasing agreements right away, too, since they no longer had the funds to pay their office rent while working virtually. About 10% of therapists were in this category of reluctantly, but necessarily, sacrificing their offices.
For about 10% of clinicians, there is no question of them giving up their office or not paying their office rent whether or not they are working with clients in person or virtually. They made their decision right away, too—they're keeping their offices. This group seems to have it the easiest when answering this question, as it’s a no-brainer for them to keep their physical office.
Currently many clinicians with longtime practices and full caseloads are questioning themselves as to whether they should continue to pay rent for an office or if they are wasting the money. A full 50% of therapists, with or without a full practice, are currently in the process of figuring out whether it’s prudent to give up their office space and eliminate their office rent expenditure.
This is an agonizing decision-making experience for this group of therapists who have a lease agreement with them as the sole signatory. This is the question that is on many a therapist’s mind and is being discussed with colleagues and in many therapy forums online. The answer comes after a lot of soul searching, number crunching, and scenario planning.
How does a therapist go about deciding whether or not to continue paying for an office location for their practice when they’re not working with clients from the office premises?
By reevaluating your practice.
A subgroup of therapists has decided that after doing virtual work with clients these past few months, their practice will remain virtual, no office space needed. This will be about 10-15% of therapists, overall and 10% of those who rented space full time. The answer to the question of an office for these therapists is an easy one, no physical office just a virtual one.
As therapists ask themselves whether to keep paying rent for an office or to relinquish it and stop, most are focused on the financial aspects. “Why should I keep paying for an office if I’m only seeing clients virtually and tele-sessions are either free or low cost? Isn’t money being wasted.”
Another aspect to consider besides the financial one is what a clinician actually needs a physical location and address for. Many therapists are opting for a low-cost P.O. Box address as their practice and mailing address when they don’t want their home address listed. For most professional things this works out fine, however, there is concern that some insurance companies may not pay therapists or reimburse client superbills for sessions without an actual physical address. Rumors abound. It’s always good to check with the insurance company for their requirements.
More concerning for private pratitioners is how the internet search engines rank practices and websites without a physical address. Current information is showing that Google searches show results in a searcher's local area first, so the concern for therapists is whether or not their practice listing is being included in as many search listings if they don't have a actual physical address. We’ll have to see how this plays out.
Overall, the biggest things to consider when evaluating whether or not to continue renting an office are time, money, and effort. How much time will it take to find, furnish, and set up an office that works for my practice if I give this one up? How much will I save if I give this office up and set up a new one later—include costs for moving, internet, cleaning, insurance, parking, etc.?
A clinician who has a month-to-month agreement with a low rental rate with an office that’s the right size, in a good location with easy and inexpensive parking, good ventilation, and soundproofing, may find it’s less costly and time consuming to pay office rent for a full year or even two, than to move out and find and set up the office again a year or two later. Crunch your numbers for this answer.
Another clinician, one who’s looking to make a change and find a better office space with more fitting parking, soundproofing, and ventilation, may find it’s much more beneficial and cost-effective to end their lease and look for a new office space when the time comes.
Think about what fits best for you as a clinician and business owner, your clientele, and your practice. The world is full of options for you to have the practice you desire. Take some time to figure out what’s best for you now.
Enjoy this opportunity to reevaluate your practice.
Getting Paid: How Your Email Signature Can Get You More Clients & Referrals & Create a Positive, Professional Image
When therapists talk about how to make their practices more successful, the first thing they want to know is how to get more clients and referrals. Good question, right?
The best answer about how to get the word out about you, your practice, and your work so you can get more paying clients, is to make sure your practice and contact information is clear and readily accessible to potential clients, colleagues, and referral sources whenever they need it. It’s a well-known fact that prospective clients and referral sources will only contact you if they know what your services are and they can easily locate your phone number to call or text you—or your email or social media page to write or message you.
Pre-Covid, when professionals did a lot of face-to-face networking, business cards usually did the job of getting a therapist’s name, services, and contact information in front of people. Online, websites, directory listings, and social media pages did the heavy lifting of providing the therapist’s contact details so people could connect with them and make an appointment.
With just about all professional events happening virtually now, it’s rare for therapists to exchange business cards, flyers, and practice swag—pens, note pads, Post-its—so a clinician’s contact details aren’t always close at hand. Yes, the information is still online for people to look up with Google or another search engine but that takes another few clicks and more time. People are impatient these days.
Think about how many times someone has emailed you or you read an email and wanted to contact the person by phone or text or look at their website or social media and none of that information was available, sometimes not even their last name because their email address didn’t include their full name either. Did you do a search or did you skip it? Most people skip it so these referrals and opportunities are lost.
What can a therapist do today to get their practice information and contact details out and in front of everyone’s eyes so their services are always top of mind and people can easily access the details whenever they have a question, want to connect, send a referral, talk to you about an opportunity or schedule a session?
Here’s where email signatures shine bright today. Email signatures are the savvy clinician’s new secret weapon for convenient online professional networking and practice marketing. Think about it. How many emails are you sending and receiving these days? Each person you write or reply to professionally or in your community has the power to become a referral source or a client—but only if they have the right information about your practice and how to contact you.
Today, the quickest, easiest, and most cost-effective way to disseminate your contact information, let people know about your work, and fill your practice, is to make the most of your email signature. Email signatures are the new business cards. They’re one of the best ways to present you, your services, and your contact information so it’s available whenever needed.
A thoughtfully crafted email signature is a small but powerful marketing tool that makes it easy for people to know more about you and what you offer—and to contact you or refer someone to you. It’s a recurring thing that recipients of your emails see over and over again and that develops trust and recognition.
What contact info needs to be in an email signature so that prospective clients and potential referral sources can contact you or refer someone to you? Email signatures should include all the ways there are to contact you professionally. Here are some examples.
The Basic Email Signature:
Include each of these.
The More Complex Email Signature:
All the above 1-6 plus any of these that your ideal clients, colleagues, and referral sources use and make it easy for them to contact you.
As you can see from the lists above, the information on your email signature can take many different forms. Depending on your target audience and preferred clients, you can also list new services, special offerings, free consultations, event information, specific blog content, awards, professional association positions, etc. Anything that delivers value to colleagues, prospective clients and referral sources, other professionals, community members, and, yes, even friends, neighbors, and relatives, can be embodied in an email signature.
It is absolutely amazing how much value can be put into such a few lines at the end of an email. Crafted with your client, services, and profession in mind, your email signature holds the power to create a positive, professional image, and reinforce and extend your branding and marketing efforts.
An added bonus is that you don’t have to hire a graphic designer or an app developer or a coder to put together your email signature and add it to your email footer. Additionally, there are plenty of excellent templates, generators, and editors to explore, many which are free.
Have some fun exploring other clinician’s email signatures and then crafting your own.
Most psychotherapists now have telepractices and conduct video and phone therapy sessions instead of face-to-face ones in an office because the majority of mental health providers switched to all, or primarily, Teletherapy sessions as a result of stay at home orders. While these types of online video or phone services are not for every client or practitioner, many therapists are reporting that, after moving their practices online and doing therapy with clients over several months, they find video or phone telesessions not only effective but convenient—and plan to keep offering some form of Teletherapy along with in-person sessions when they’re once again feasible.
However, clinicians are also reporting that when some new prospective clients find out in-person sessions are not an option they seem reluctant, resistant or unsure about beginning or making the switch to virtual therapy.
When this type of client reaction occurs, it causes psychotherapists to feel conflicted because client consent is needed in order to work virtually—and in-office sessions aren’t an option. Therapists also then wonder if it’s okay to influence a client towards Teletherapy when the client doesn’t seem to want it or is less than comfortable with it. Should therapists address the issue further when this happens or just refer? What's a therapist to do?
While there are many good reasons that people are reluctant to do teletherapy—no private place, no equipment but their phone, etc., it’s important to remember that when in-person services are not available some individuals may initially find it hard to switch to or commit to therapy that’s different from what they’ve thought about, imagined or come to expect. Teletherapy is that kind of different. No couch, just a screen.
While clinicians know that some reluctance or resistance to beginning therapy is usually present in any intake, and are used to addressing that, what counselors aren’t used to is handling intakes where the reluctance is around Teleservices--video or phone--when it's the only option available.
The truth is that many of the issues that are initially expressed as client reluctance about Teletherapy, they aren’t actually about the telesessions at all but are really just another manifestation of the client’s issues that are inherent to therapy—and these same types of objections or complaints would come up even if the therapy was face-to-face.
While it's important to keep in mind that online services are not right for every client or practitioner, a client’s reluctance, discomfort, and resistance is most often not about Teleservices, but about entering a new world where they are moving from a familiar way of operating to the therapy context where different rules apply. Our job as therapists begins with helping clients enter, become familiar with, and safely navigate the therapeutic context. We are, and need to be, their guide.
As you read the following information, be sure to remember:
What’s the best way to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when a therapist isn’t seeing clients in person in the office?
Teletherapy reticence, reluctance, discomfort, and resistance are clinical issues. The therapist needs to take charge of any conversations regarding teletherapy issues. Yes, it’s part of therapy and it’s the therapist’s job to aid-educate-facilitate pre-therapy (intake) or Teletherapy resistance conversations
New clients don’t really know what teletherapy is or what it’s like if they’ve never had therapy or online therapy before. They only have an idea of what it’s like or the description of what someone else told them.
Teletherapy with a clinician who is a good match can be a great option when in-person therapy is not available and many clients are great candidates for video or phone therapy.
Use your clinical skills to address and respond to a client or prospective client’s Teletherapy issues when they come up—just like you would address anything else. Treat the issues that come up about teletherapy sessions the same way you’d treat any other client issue.
Taking it personally = Countertransference!
Don’t take a client’s Teletherapy reluctance and resistance talk personally when clients demonstrate their issues and skill level in dealing with them—take or use a therapeutic stance just like you would about any other topic or issue. Under your guidance clients can then make an informed decision about beginning, continuing or ending Teletherapy.
Teletherapy is definitely here to stay. Its effectiveness is equivalent to face-to-face sessions and the flexible nature of video and phone sessions benefit both clients and clinicians. Add in the ease and convenience of scheduling a video or phone therapy session and talking with a mental health practitioner from the privacy of your home or another convenient location, and you find that these virtual services are a huge draw, especially for many people who are seeking therapy for the first time.
Telepsychiatry, teletherapy, telepsychology, and video therapy are more than just trends. In fact, a good number of mental health professionals are finding they prefer working with clients using teletherapy video and or phone sessions and will not be returning to in-office sessions. Yes, these therapists are reporting that they plan to keep their therapy practices solely virtual when in-office services become available again on a large scale.
Both in-person therapy and Teletherapy have advantages. Some view office sessions as a way to get some distance from problems at home and find it easier to see and deal with challenges objectively. Some clients prefer phone therapy, which works fine in many situations.
While Teletherapy and online services are not for every client or practitioner, online therapy is here to stay, like it or not. Consumers are changing, and so are therapists and their practices. Teletherapy has become another viable option for clients and mental health practitioners. It may not be the best option for everyone but the good news is that it is just as important and effective as the traditional therapist’s couch.
The biggest challenge therapists say they’re facing with telementalhealth, is how to talk with potential clients about doing teletherapy in place of in office sessions.
Since therapists now have telepractices doing video and phone sessions instead of face-to-face sessions in their office, they’ve discovered that having the initial contact--the intake or pre-therapy phone or email interaction—with a potential client is, and needs to be, a little bit different than the interaction a clinician is used to having when orienting a client to beginning in-office therapy sessions.
While clinicians are skilled and practiced in what to say and cover with potential clients during the first contact for in office therapy, now when potential clients call inquiring about therapy, therapists who aren’t doing in-office sessions find their biggest dilemma is what to say to introduce teletherapy video and phone sessions—and how to respond effectively to those potential clients who are resistant or reluctant to schedule an appointment or pay for these sessions.
When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions? What’s the best way to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person in the office? What should a therapist say to a new client to orient and prepare them for video or phone therapy sessions?
As you know, when clients come to therapy they are entering a new world. They are moving from a familiar way of operating to the therapy context where different rules apply. Our job as therapists begins with helping clients enter, become familiar with, and safely navigate the therapeutic context. We are their guide.
For successful therapy, clients need to experience a safe enough environment where they can be free to examine things and share their feelings. For most clinicians and clients this previously occurred in a therapist’s office that had been specifically created to insure a safe, confidential, and supportive environment.
Now that the therapy office is a virtual one with therapist and client in a different location, no longer does the clinician arrange for privacy and provide the Kleenex, bottled water, tea, coffee or snack; decorative pillow to hug, comforting blanket and client chair or couch. Gone, too, is therapist greeting the client in the waiting room and the comfortable small talk on the way to the office. Clients, prospective clients and the general public are familiar with and know what to expect from in-office therapy; teletherapy not so much.
With teletherapy it’s extra important for us to remember that when clients begin therapy and enter the therapeutic milieu via telehealth their experience of changing contexts is much more complex than with in-office therapy sessions. This means that not only are new clients moving from a world where they behave in certain ways to a place where they are expected to think and act differently in the therapeutic setting, with telementalhealth this includes adding another layer to that—a video screen or a phone and the therapist and client being in two locations. That’s quite different from driving to, parking, sitting in the waiting room, and walking into a therapist’s consulting room where therapy occurs and the client is taken care of in person by the therapist.
How can a therapist re-create that experience with teletherapy and convey to clients and prospective clients that it works? For most new and continuing clients this shift to creating and utilizing a virtual space for therapy takes learning and practice under guidance and direction of a competent therapist—and that starts with the very first phone conversation when Teletherapy is presented.
As you read the following information, be sure to remember:
1. When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions?
When doing in-person therapy sessions, during the intake conversation, therapists usually disclose their credentials, review the address and location of the office, frequency of appointments, session length, cost, type of payment accepted, directions to the office, where to park, etc.—and discuss why the client is seeking therapy to make sure it’s within their scope of practice.
When teletherapy is involved, whether or not a client has requested video or phone sessions, it’s up to the therapist to introduce, disclose, and orient the client to not only the usual therapy information but also the video and phone delivery model, treatment methods, and limitations of the telemental health services the therapist provides (Section 2290.5 of the Code). How every therapist does this is different.
Regardless of whether a client requests telementalhealth services, or the therapist is informing the client that therapy will be conducted remotely by video or phone, the opening statement and disclosures are the same.
Most therapists begin with a simple general statement like, “During this time of social distancing and stay at home orders I provide therapy through telementalhealth video and phone sessions.” Some also include, “In-office sessions may be resumed at a future date and I will let you know when that becomes an option.”
2. What should a therapist say a new client to prepare new clients for video or phone therapy sessions?
After an opening statement saying why teletherapy sessions are the sole therapeutic format, stating your own version of the following information is helpful and covers required disclosures:
3. What are the things therapists need to address with potential telementalhealth clients during that first pre-therapy interaction/intake?
Aside from informing the client or prospective client about teletherapy by introducing, disclosing, and orienting the client to the usual therapy information, and the video and phone delivery model, treatment methods, and limitations of the telementalhealth services the therapist provides, the California BBS: Standards of Practice for Telehealth also state that before the delivery of teletherapy the therapist needs to obtain verbal or written consent from the client for those services.
In addition, the therapist needs to document in the client notes that informed consent was obtained from the client. This is more specifically stated by the BBS, in Section 5,b.
That’s enough on introducing and talking with clients about doing teletherapy instead of in-office sessions. Next time we’ll focus on how to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person.
Teletherapy . . . Telehealth . . . Telemedicine . . . Telemental Health . . . Telepractice . . . Televideo . . . Internet Therapy . . . Online Therapy . . .
Teletherapy is everywhere. Like it or not, telehealth is here to stay during the current crisis—and is likely to stay in some form after it ends.
What’s a therapist to do? How can a therapist survive, and better yet, thrive, while doing so many live teletherapy sessions with clients?
Many therapists are now working from home for the first time doing therapy with clients using online video or telephone platforms in place of in person sessions. While working from home as a Teletherapy provider allows therapists to have a flexible work schedule and many other conveniences, the shift to virtual comes with many new challenges and stressors as we're adapting to what’s going on in the world and to this new setting and medium.
While Teletherapy is still therapy, it has idiosyncrasies. When doing a remote session it’s a much more exacting, labor intensive process for a skilled therapist to work effectively with the same things they do in person. Facilitating therapeutic communication and interaction is definitely different when you and your client aren’t in the same room—it requires another kind of focus, concentration, and energy. Add to that the fact that most therapists are now juggling a work-from-home therapy practice alongside home and family life while everyone's at home, too. The result? Therapists are reporting how exhausted they are after providing Teletherapy services to clients.
Teletherapy exhaustion, burnout, and fatigue are real.
Why is delivering Telehealth services so tiring? Conveying professionalism through a Teletherapy portal in your home requires that we develop and utilize a therapeutic telepresence and a “web-side” manner while conducting sessions through a screen—and that’s very fatiguing. Therapists are also finding that Telehealth delivery does not lend itself to the same type of marginless in-office scheduling where clients are seen back to back without any breaks.
Teletherapy is a much more strenuous delivery system than in-office therapy. That shouldn't be surprising since it’s well documented that sustained and prolonged use of digital devices—computers, tablets, smartwatches, smartphones—for video sessions and meetings leads to exhaustion, computer eye strain, dry eyes, focusing fatigue, and neck, shoulder, and back pain.
Here are tips for reducing the fatigue, stresses, and challenges of telehealth and conducting video therapy sessions, groups and meetings. Think of these tips as a menu of options. Try the ones that suit you, discard the ones that don’t.
Teletherapy Survival Tips for Clinicians
1. Teletherapy relies on a strong internet or phone connection.
Poor internet or phone quality is one thing that not only makes clients upset, it negatively impacts therapeutic communication, the therapist client connection, and the outcome of therapy. Anytime video gets glitchy and skips, sputters, gets pixelated or freezes the image—or the audio stops, develops, an echo or keeps cutting out—it becomes difficult to maintain therapeutic communication and the therapeutic connection diminishes.
Therapists need the best, most reliable internet connection—and Telehealth delivery platform—that they can get. Whether poor quality is on the client or therapist side, the experience of therapy deteriorates without solid audio and video. Poor internet or phone quality definitely interferes with progress, the outcome of the session, and the the therapeutic alliance.
Before scheduling a session, be sure to check whether the client has a good enough internet or phone connection, and the right type of equipment/device for video sessions, otherwise a different type of Teletherapy is needed.
2. Create the right environment for you.
Just as your office set-up is a key part of your in-person practice, how you arrange your remote office can make a big difference in your sessions.
3. Create the right environment for the client.
4. Ways to reduce exhaustion and minimize fatigue, dry eyes, computer eye strain, focusing fatigue, and back, neck, and shoulder pain.
5. Consider using phone sessions.
Today, during the COVID-19 public health emergency, the majority of licensed and registered mental health professionals in California have shifted to providing psychotherapy services using telehealth. Most are new to telemedicine and what’s required by the California Board of Behavioral Sciences (BBS). Questions abound . . .
What telehealth platforms can I use during the COVID-19 public health emergency? What communication technologies are still prohibited? What communication products or technologies can I use if I want a HIPAA compliant telehealth platform for my practice? What things am I required to do with each client when I begin telehealth services? What am I required to do with clients at the beginning of each telehealth session?
The answers to these questions and more are in the three following BBS telehealth documents presented here in full for easy use and reference—with links to the original documents.
Read them. Comply with them. Keep your license, and yourself, free from unprofessional conduct and disciplinary action.
1. BBS: Standards of Practice for Telehealth California Business and Professions Code
All persons engaging in the practice of marriage and family therapy, educational psychology, clinical social work, or professional clinical counseling via telehealth, as defined in Section 2290.5 of the Code, with a client who is physically located in this State must have a valid and current license or registration issued by the Board.
All psychotherapy services offered by board licensees and registrants via telehealth fall within the jurisdiction of the board just as traditional face-to-face services do. Therefore, all psychotherapy services offered via telehealth are subject to the board's statutes and regulations.
Upon initiation of telehealth services, a licensee or registrant shall do the following:
A licensee or registrant of this state may provide telehealth services to clients located in another jurisdiction only if the California licensee or registrant meets the requirements to lawfully provide services in that jurisdiction, and delivery of services via telehealth is allowed by that jurisdiction.
Failure to comply with these provisions shall be considered unprofessional conduct.
2. BBS statement on HHS Telehealth Announcement of Enforcement Discretion
U.S. Department of Health and Human Services (HHS) Announcement
of Enforcement Discretion for Telehealth Remote Communications
The Office for Civil Rights at the U.S. Department of Health and Human Services (HHS) has announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communication technologies during the COVID-19 public health emergency.
During this time, covered health care providers subject to HIPAA may provide telehealth services, in good faith, through remote communications technologies that may not fully comply with HIPAA requirements. This applies to telehealth provided for any reason, whether related to health conditions related to COVID-19 or not.
What Telehealth Platforms Can I Use?
HHS states that covered health care providers can use any non-public facing remote communication product that is available to communicate with patients. This includes popular applications that allow for video chats, such as the following:
What Platforms Are Still Prohibited?
HHS still prohibits using communication products that are public-facing. Therefore, do not use these types of platforms. Examples of public-facing communication products include, but are not limited to, the following:
I Still Want to Use a HIPAA Compliant Telehealth Platform For My Practice. What Are Some Examples Of These?
HHS provides some examples of products that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. (They stress that they have not reviewed the BAAs for the below entities, and that this is not an endorsement, certification, or recommendation):
HHS Notes That HIPAA Applies Only to Covered Entitles and Business Associates. How do I Know If It Applies To Me?
HHS provides the following bulletin HIPAA Privacy and Novel Coronavirus. This topic, HIPAA Applies Only to Covered Entities and Business Associates, is covered toward the end of Page 5.
Where Can I Find More Information?
You can use the following links for more information from HHS:
Detailed explanations regarding telehealth requirements, for licensees and registrants, are contained in the following statutes and regulations:
This section applies to clients who are physically located in California.
This section applies to clients who are physically located out-of-state.
Prior to the delivery of health care via telehealth, the provider initiating the use of telehealth shall:
Additional information regarding telehealth is contained in the following statutes and regulations:
Getting the word out about your therapy practice is important. To be successful in private practice, you need a steady stream of clients—QUALITY referrals that are a good match for you and your practice. Letting people know what you do therapeutically and how you can help them, not only helps fill your practice, it helps you help more people.
The more people who know about your therapy services and expertise, the easier it will be for those who need your services to find you and get the help they need. Consider the ways you can let colleagues, prospective clients, and referral sources know about you and your services.
1. Getting the word out about your practice is a community service.
Getting the word out about your therapy services and expertise is really about letting people in the community know about you, your practice and your services. It’s educating those in your community—your peers, prospective clients and referral sources—about what therapy is, who you serve in your practice and how you help them.
Tip: When clients go to your website, directory listing, and social media pages, what they are really looking for is: Who are you? What can you do for me? How can I contact you? Make sure your content on your website, directory listings, and social media pages gives them that information clearly and easily.
Tip: It doesn’t matter what you do to get the word out about your practice and services but you have to do something. Since you have to do something, ONLY do the things you like.
Tip: Remember, only do what fits or makes sense to you to get the word out—and always within legal and ethical guidelines! It’s okay to make things up to do that you like. However, you will have to try things out to see what you like.
Tip: Be sure to make the act of promoting yourself and your skills and services energy producing instead of energy draining.
2. Getting to know people in your community and letting them get to know you, the services you offer, and the type of work you do, brings in quality referrals.
People who already know about, like, or trust you are more likely to refer to you than anyone else. People trust their friends and people they know so that’s why word of mouth,whether in person or online, is the most valuable source of referrals for your practice.
Tip: Connect with local businesses. Introduce yourself to other local business owners who are your neighbors. One therapist I know who moved into a new office went to each one of the businesses around her—introduced herself, met and got to know the business owners and or those who worked there, found out about their businesses and gave them her business cards and brochures.
Tip: Join a professional organization or association. Attend meetings of professional groups, associations or organizations to get known in your community. Become a member. Volunteer. Register and attend a conference.
Tip: Post your professional and or practice information to a directory. GoodTherapy, Psychology Today, LinkedIn, etc. Remember that Linked In is social media for professionals, and is a trusted source for professional services and referrals.
Tip: Either donate products or volunteer your services to a worthy cause and get your name and the name of your practice out there to new people while doing a good deed.
Tip: Consider getting some promotional products with your name, website, phone number, email, and or practice specialties on them to hand out. Pens, notebooks, notepads, post-it notes, shopping bags, led flashlights, etc., are all favorite types of promotional swag that people appreciate.
3. Tapping into existing relationships is the fastest way to fill and grow your practice.
People trust other people and the experiences they have so that’s why when people hear from a friend, someone they know or a professional they trust, about a service or product they choose that one over others. For therapists, the first few referrals after you open your private practice will usually come through in person connections and relationships you’ve already built.
Tip: Build an email list. Who should you put on it? Include those you meet while networking but don’t stop there, add close friends, acquaintances, family members, extended family; neighbors, acquaintances. Professionals you have personally used—medical professionals such as doctors, physical therapists, psychiatrists, dentists, dental hygienists—as well as business professionals who are lawyers, estate planners, financial planners, as well as nutritionists, doulas, Lamaze instructors. Personal trainers, Pilates instructors, meditation instructors, massage therapists, aestheticians, hair stylists. Those who attend your church or who worked with you in the past as well as elementary, middle and high school teachers and coaches. Mentors, past clinical supervisors and professors, classmates and supervision group members. teachers, guidance counselors.
Tip: Send regular emails to your list to keep them informed of what you are doing in your practice—do this at least three times a year. Or start a free monthly email newsletter and send it to your email list.
Tip: Utilize Your Email Signature. Make sure your email signatures contain contact information for your business—links to your website, upcoming workshop, new book or audiobook, podcast, video, YouTube channel, etc. This makes it easy for people to know more about you and what you offer.
4. Consider using some type of social media to get the word out.
Today there are a lot of people who are looking for help—and most of them aren't asking their friends or family for referrals. They are looking on the internet at websites, social media platforms (Facebook, YouTube, Instagram, Messenger, Snapchat, Twitter, WhatsApp,LinkedIn, Tumblr, Tik Tok, Viber, Pinterest, etc.) and closed groups, discussion groups or forums (Quora, Reddit, etc.).
Because social media helps you build relationships, using social media to get the word out about your services allows you to showcase skills and expertise and to build relationships with existing and potential clients and referral sources.
When you post a variety of content on social media (blogs, articles, videos, quotes, podcasts—your content as well as other’s), you can build recognition, connect with your peers, referral sources, and potential clients to show them that you are trustworthy. You’ll definitely get some interest in your work from this—people will love your content and want more.
Tip: Not all social media platforms may be suitable for your business. Different customer segments frequent different social media. There's no point in spending time and money on promoting your business on a social network that your customers don't use.
Tip: When you blog or write articles regularly, social media is a great place for you to share that content. You can also share articles that you find interesting, inspirational quotes, podcasts, and videos that you think those following you would enjoy. All these are great relationship builders.
Tip: Record a video blog post and put it on your website or upload the video to YouTube. Record a Facebook Live or Instagram Stories short video. People love this content and enjoy getting to know you through what they see and hear on the videos.
5. Track what’s working and then do more of it.
Know the results you get from each thing you do to get the word out and repeat what works. Quit what doesn’t work.
These are all fairly low cost and not too time consuming tips for getting the word out. See which ones you enjoy doing and that work best to fill your practice.
Getting Paid: Fast, Easy, Convenient, & Cost-Effective Ways to Get Paid & Increase the Cash Flow in Your Practice
When clients pay for therapy in your practice, what type of payment do you accept?
Check? Cash? Credit Card? Debit Card? HSA or FSA Card? Money Order? Yes, they still issue money orders.
Today there are so many options to choose from for client payment. How do we decide which one is best for us and our practice? What are legal and ethical options available to therapists to get paid fast and not have to pay too much in bank or credit card charges?
This is the sixth article in a series on Getting Paid: Talking with Clients About Money Matters:
Not too long ago clients handed their therapist cash or a check before or after the session; were sent an invoice/billed at the end of the month; and then mailed or brought in their check or gave the therapist cash at the next therapy session.
Should you consider adding or changing the type of payment you accept for therapy charges?
How can a therapist decide which forms of payment are best for their therapy practice?
With whatever types of payment you decide to accept in your therapy practice, it’s important to look at how much it costs you or saves you—in time, energy, wait time for funds, as well as charges/money—to process those funds and get them into your practice bank account.
Therapists, like most small business owners, are always wanting to know what the best way is to get paid and increase their available cash. They want to know how to get their funds into the bank as quickly and easily as possible and how to pay the lowest possible amount to do that. Having earned this money, therapists want to take home as much of it as possible, save time, and have more clients.
In fact, the most common reason therapists give for accepting only check or cash is that it costs money (just under 3% of each transaction) to take credit cards. And, as you have probably heard, most therapists do not like to--or want to—pay any credit or debit card, or other type, of processing charges since this amount is subtracted from what the therapist is paid.
However, contrary to popular lore, whatever type of payment a therapist accepts for therapy sessions, it costs the therapist something. At the very least it costs time, energy, effort, and time before the funds can be accessed, and it can also cost money per transaction. How is it worth it for a therapist to take card and electronic payments and pay those transaction fees?
Giving your clients more ways to pay can increase the number of clients in your practice and improve your cash flow.
It's a fact that most clients expect to be able to use credit or debit cards when paying for things. Today’s clients, whether no matter what their age, find it convenient to pay via credit or debit card, or directly from their HSA or FSA. If you do phone, video or other types of virtual or remote sessions, credit card and electronic payments are essential because they enable the client to pay you before or after the session.
More payment options that are convenient means more access to care for a larger number of people—and result in more clients in your practice.
Whether a therapist accepts payment by electronic means--credit card, debit card, e-check, wire transfer, Zelle, Venmo, etc.—depends on both the therapist and clients’ preferences and needs. Many therapists find that their number of paid weekly client hours increase when they accept credit cards. Clients often like to get rewards--points or miles or cash back—when they pay for therapy.
If you don’t accept credit cards but accept checks or a bank transfer of funds, clients who want the rewards can use Plastiq. With Plastiq a client can pay with a credit card—and even split the charge between two different cards—and the therapist is sent a paper check or receives a bank transfer right away, just as if the client had paid with a credit card. Another benefit to the therapist with Plastiq is that the client pays the credit card processing fee, the therapist doesn’t. Many therapists love that because it means they receive all the money paid for the session.
For therapists, card and electronic payments can mean freeing up more time, energy, and effort—and quicker access to funds because of the following:
One way to increase income from your practice and not have to pay any transaction fees is to have your clients pay you using Zelle or Venmo.
One therapist I coached added Zelle to his practice in addition to credit cards as a payment option and increased his take home earnings $100 per month because he didn’t have to pay that amount in credit card fees. That was a very easy way to bring in $1200 more that year. Another therapist in one of my practice development groups added Venmo as a payment option when a client suggested it. When using Venmo, the client pays through the app at the end of the session—just a couple of clicks—then there's a ding on the smartphone, the therapist receives it, opens the app, clicks on the amount of the balance. then clicks on the deposit button. Voila! Two days later it’s in her account. If she wants it instantly then she clicks on the instant deposit button and pays a small fee, then it’s deposited in her account shortly after that.
Here are some descriptions of options for getting paid spelled out:
Credit Card processing companies that therapists report using are: Square, PayPal, Stripe, Ivy Pay or their bank. These companies also process debit cards and bank funds. These processors charge/keep a small percentage of the dollar amount of the transaction, usually just under 3%. Some therapists use a credit card terminal to swipe or insert cards—this is purchased from the card processor by the therapist—others use an app on their phone or tablet. I use the Square Terminal in my office and have it on my desk; it’s easy to read, insert cards in, and processes very rapidly. Very professional, convenient, and easy to use.
Venmo and Zelle transfer funds from the client’s bank account and deposits into the therapist’s bank account. They do not charge/keep any amount from the transaction. However, for instant transfers, Venmo does charge a small amount, equivalent to a credit card processing fee.
Plastiq, as described, charges the client’s credit card and deposits the full amount, no charge to the therapist, into the therapist’s bank account. The credit card processing charge is paid by the client in addition to the amount the therapist is paid.
HSA (Health Savings Account) and FSA (Flexible Savings Account) Cards are debit cards and are processed the same way. Clients who have HSA and FSA cards like to use those because they aren’t taxed on that income since it can only be used for qualified healthcare expenses—therapy is one. HSA and FSA cards help clients with high-deductible health insurance plans cover their out-of-pocket costs. Another thing to note about HSA cards is that contributions, up to the yearly IRS limit, can come from the client, the employer, a relative or anyone else who wants to add to the HSA.
So now you’ve had a presentation of a number of the options available to therapists for getting paid fast, and in easy, convenient, and cost-effective ways. By no means does this article include every option available to therapists as there are many more not mentioned here. Should you decide to add some new payment options to your practice it will, I’m sure, give you added time, money, and clients. See what differences these new options bring to your practice.
Getting Paid: Introducing & Talking About Sliding Scale, Adjusted Pricing & Specialized Alternatives—The Words You Use Make a Difference
Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference is the fourth article of the Getting Paid: Talking with Clients About Money Matters Series.
How much do you charge? What’s your sliding scale? Is that the lowest you charge?
How much can you slide? How low can you go?
If you dread hearing these questions you are not alone.
While questions about a lower price or a sliding scale used to be asked from time to time, therapists are reporting that now they are asked these questions all the time—from just about everyone who calls.
What’s problematic about this?
Well, before this recent phenomenon started, sliding scale requests came from just a few—usually those with a low income or reduced ability to pay, a financial hardship or significant unexpected expense. Now a majority of those asking for lower or sliding scale pricing more often have adequate resources, income, and an ability to pay. What’s a therapist to do?
Offering lower pricing to clients truly in financial need who require mental health services, is a time-honored tradition in the practice of therapy. Sliding scale and other types of price adjustments were instituted to make therapy services available to those whose economic circumstances didn’t allow payment for the full cost of services.
Having these accommodations available allows therapists, at their own discretion, to adjust the amount a client pays and can manage on a regular basis
Like most therapists in the mental health profession, I believe in, and support, making affordable therapy available to people who don’t have much money and those experiencing a financial hardship.
Clinicians, who are committed to this, routinely offer those in need a variety of options that allow them to afford and pay for needed mental health treatment. Many therapists also work with certain clients on a case-by-case basis to offer specialized arrangements based on their particular needs and circumstances.
Some of the options private practitioners use to make therapy affordable to clients in financial need are: pricing based on income; lower pricing; a percentage or number of lower priced client spaces; an allotted length of time or number of sessions of lowered pricing for a certain number of clients; flexible scheduling (three sessions per month, every other week, etc.); charging less for shorter sessions; payment plans; pro bono sessions for a client or two; charging less for sessions during slow periods of the day; special arrangements based on special circumstances; a limited number of reduced-price scholarships; sliding scale; etc.
With so many callers asking about the lowest prices they have, now therapists feel even more to reduce prices because
While clinicians believe it’s important to offer sliding scale pricing only when a client is genuinely in financial need, unfortunately, when repeatedly asked about sliding scale or lower pricing, many end up undercharging, letting clients determine the fee, maxing out the number of low-cost clients their practices can accommodate, cutting prices below the minimum amount needed to keep their practice open, and feeling resentful or taken advantage of by clients they gave a lower price to and then discovered were spending large amounts on luxuries (new, high priced cars, jewelry, vacations, designer clothing; dining at pricey restaurants, etc.) after they’d claimed they couldn’t afford to pay for therapy and needed a lower session price.
Sliding scale, special arrangements, and lower prices upon request were never meant to be offered as options to those who had resources, could afford to pay the full price, and who, for other reasons, don’t want to or think they should.
It’s also not financially feasible for any private practitioner who wants to remain in business, to give a discount to every single client who wants to pay the lowest possible price for therapy—after all we need to keep our practices up and running, be able to cover practice and professional expenses, and support ourselves and our household.
Responding to callers and clients who are asking, but don’t really need or qualify for a lower therapy rate, is a very different type of conversation than the one clinicians trained for and are familiar with—people who genuinely have, a financial need.
As therapists, our task is to find the right balance of how, and how much, we can adjust session prices, for which clients, and how many—and not go out of business. In the current climate, navigating talking about prices with these clients takes more specialized skills and requires a totally different mindset, approach, and vocabulary.
So, what’s the best way to respond to a caller or current client who wants a price accommodation but doesn’t need one?
Money Talk: Words & Phrases to Consider
Let’s look at some of the words that can make a difference when a clinician talks, writes, or communicates about money matters involving sliding scale and adjusted pricing for those with limited income—and how and why these words can affect the amount a person is willing to consider or pay for therapy services.
This information applies equally to phone calls, face-to-face conversations in real time or virtually, emails, texts, social media postings, and what’s printed in marketing materials or written on a website. Yes, each of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount clients are willing to pay for the clinical services you provide.
As you read the following information, be sure to remember:
Now about that vocabulary . . .
As noted in Getting Paid: Talking Fees, Pricing, Prices The Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference using fee, full fee, my, my fee, etc., currently seem to signal to those seeking therapy that any stated rate for clinical services is just a starting point. It’s automatically assumed therapists are open to requests and negotiating lower prices.
You’ll notice that the words listed aren’t used in this article—that’s why. To review alternate wording, click the link. Using some of these suggested words may eliminate a client who doesn’t need a sliding scale asking you about one.
1. Low, lowest, lower . . . Reduce, reduced . . . Discount, discounted . . .
Lowest price/prices/rates/amounts . . . reduced price/prices/pricing/rates/amounts . . . discounted price/prices/pricing/rates/amounts
Are the people who call us about our services seeking therapy or shopping for therapy?
In today’s world using any of the words listed seems to put people on the “I’m shopping” channel. Not exactly the best channel to be on to seek professional help for mental health issues or work, family and relationship problems, self-regulation skills, healing past traumas, addiction, recovery, anger management, parenting skills, growth, etc. It’s sometimes very easy for people to get mixed up about what type of professional help they need and what that costs.
Are people looking for a professional who’s trained and skilled in helping clients like them with their presenting issues? Or are they looking for the lowest possible price for counseling? How much is it necessary to pay? What difference does the price make?
These are all important questions for therapists to address when clients call about therapy and cost is discussed.
As mental health professionals who are highly skilled and experienced, we don’t want to add to any confusion, so it’s important we’re aware of the words we use when we talk or write about the price for therapy services so we don’t inadvertently encourage clients to shift into a shopping for the lowest price mindset or turn into a “therapy price shopper.”
Clinical services are valuable and worth paying for since stopping unhealthy behaviors, learning new skills, and how to take better care of yourself can save both money and time as well as help you take advantage of opportunities that make your life better.
How much does therapy save when you don’t get divorced, lose your job, get a DUI or???? When you compare the cost and benefit from what you receive then the price may seem worth paying—even if you must rearrange your budget, put it on a credit card, arrange a family loan or payment plan, etc.
Unless therapists are specializing in clients who only want to pay low, reduced or discounted prices for therapy services, in general, it’s best for those in private practice to use other words and not any variation of “low, reduce, discount” when referring to or stating pricing for therapy services.
2. Sliding Scale
When in conversation or writing, substituting one of the following words in place of “sliding scale,” price . . . rate . . . amount . . . pricing . . . cost . . . charge . . . along with adjust, adjusted, alternate, alternative, affordable, special, economy, helps clients understand, and cognitively register, that this isn’t the type of pricing range where a therapist will, upon request, “slide” all the way to zero, or some other very low price.
Adjusted price . . . economy rate . . . special pricing . . . cost adjustment . . . more affordable amount
Using this wording usually results in fewer requests and conversations from those not truly in financial need. With these words people, usually don’t just automatically try to negotiate to make a stated price lower.
Let’s look at this from another perspective . . . When you go to a doctor, attorney, dentist or other professional, do they use the term, sliding scale? Most likely these professionals use words like adjustment, introductory, limited time or another pricing term.
Clients are familiar with this wording. and when it’s used, don’t automatically assume that the price stated is open for negotiation to a lower one. Nor do they experience these definitive words as an invitation to ask for a discount or adjustment to a much lower number.
Now’s a good time to take a moment to think about and consider the words you are using with the people who call or clients who want to change the amount they pay, what you’ve read about this, and what your colleagues are saying about handling these things and if, and how, it’s working for them, and for you.
That’s enough for today on talking sliding scale pricing and getting paid. I hope you’ve found it useful to understand how the wording you use to talk about sliding scale pricing can increase or decrease the money you earn in your practice. See for yourself how the words you use can make a difference.
The next article, the fifth in the Getting Paid Series, covers sliding scale, part 2—specific suggestions about how to introduce and talk about your sliding scale, adjusted pricing and specialized alternatives.
Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference is the fourth article of the Getting Paid: Talking with Clients About Money Matters Series:
1. Talking with Clients About the Price & Value of Therapy
2. Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters Do Make a Difference
3. Talking Pricing, Services, Rates—The Words You Use to Talk with Clients About Your Services and Rates Make a Difference
Lynne Azpeitia, LMFT
For 10+ years Lynne Azpeitia has helped therapists to live richer and happier lives through her workshops, private practice and career coaching, and her practice consultation groups which train, support, and coach licensed therapists, interns & students how to create and maintain a successful, thriving clinical practice and a profitable career