Getting Paid: The Gifts of Teletherapy—More Clients, Scheduling Flexibility, and Full Practices3/23/2021 The perfect schedule for you and your practice. Have you found it?
As a result of a year of providing therapy to clients through video and phone sessions, the structure of private practice is changing. The widespread use of teletherapy during this time of stay-at-home orders has brought with it many new opportunities, ideas, and possibilities for therapists as well as an increase in clients and income—and for many, the first time they’ve had a full practice. Providing teletherapy certainly has had its learning curve and challenges, however, one of the main gifts it’s brought to psychotherapists who have exclusively been doing therapy with phone and video sessions, is that of more scheduling flexibility. No longer bound by office hours, location, driving time or taking the time to park or find a place to park, practitioners have offered earlier sessions and later sessions in the day and evening. This small change has allowed professionals to accommodate a wider variety of clients than they normally would—and both therapists and clients have benefitted from this increased range of times available to book for therapy appointments, and clients have responded by booking them. Another surprising benefit from teletherapy turns out to be that therapists are now routinely working with clients out of their local area but still within the state. The result? Most have full caseloads and are having to refer clients to other therapists. Who knew that a full practice would be the result of teletherapy and stay-at-home orders! After the past year of providing teletherapy, mental health professionals understand that virtual services are now part of the psychotherapy universe—in both private practice and agency work. While teletherapy isn’t for everyone, all the time, what’s emerging is that about 15 percent of therapists who previously only worked with clients in person are planning to continue exclusively working with clients virtually using video and phone platforms. Yes, their offices will only be virtual. Another 15 percent of psychotherapists are declaring that when the widespread need for teletherapy ends they will exclusively work in person from their offices and will rarely, if ever, utilize video or the phone for client sessions. The remaining 70 percent of mental health professionals are making it known that their practices will be hybrid ones—offering in-person in office therapy as well as video and phone sessions. These practitioners like the best of both worlds. Those therapists who report that they’ll continue to provide teletherapy services state that they like the convenience of working from home or in any location, the ability to choose from more flexible windows of time during which they can schedule client sessions, the extra time saved from not commuting along with lower business overhead expenses. It’s also important to mention the benefit of working virtually with clients who live in the state but not within driving distance to the therapist’s locale. These additional clients have added a new segment to the people that therapists can now work with in their practice since the available technology makes providing services possible. It’s also become apparent to therapists that the use of teletherapy has also made counseling and psychotherapy services accessible to a whole new group of clients who weren’t previously utilizing therapy—those who weren’t willing or able to travel to an office location whether it be for lack of time or transportation or for physical or emotional or psychological reasons. It’s opened up a whole new population for therapists to serve. Needless to say, these clients are filling spaces in therapy practices. This population is one of the reasons that psychotherapists have had full practices for most of the past year. Therapists don’t want to stop providing services to this client population both for the clients’ sake as well as that of their practice. Another gift from providing teletherapy services besides an increased number of referrals and clients, is increased therapist confidence. Since more people have been calling about therapy services and have become clients, therapists have experienced an increase in confidence that their practice can be, and might possibly continue to be, filled. This also translates to an increase in income for the practitioner who is seeing more clients, and a willingness to make minor changes in scheduling that benefit their quality of life and work life balance. Have you changed any of your session time availability? Do you work earlier or later than you would if you were seeing clients solely in office? Do you take breaks or longer breaks in between client sessions? Would you like to change the days or number of hours you see clients now that you’ve had a year to experience teletherapy and having a full practice? If you could have your perfect schedule of days and hours seeing clients without any loss of income what would it be? How many clients would you see each day? Each week? These are all things that are worth thinking about. Allow yourself to consider your perfect schedule, your perfect practice, your perfect number of clients, your perfect day, your perfect week, your perfect month, your perfect year. Your perfect life. Let’s see what the next year brings as we harvest the opportunities that come to us through our practice of therapy. Stay tuned! Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com orwww.LAPracticeDevelopment.com.
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Consistent, effective, and ongoing local networking is the best way to get known in your community—and the fastest way to grow your practice and keep it full. This is true not only for private practice but for mental health centers, agencies, and any type of program, center or service whether public or private. What is local networking and how does it work? Local networking is raising awareness in your local communityabout what you do, who you work with, and the services you offer. It involves getting the word out on a consistent basis to those in the community around you—online, in person or in print—about who you are, the services you offer, and how you help people. The key to successful local networking is regularly contacting and connecting with everyone in your local community--those you know or have met--and keeping them up-to-date with you and what’s going on in your practice/career/business/project. Everyone in your local community? Yes, everyone. Relatives, friends, neighbors; your kid’s teacher, childcare person, dogwalker, plumber, gardener, housekeeper, mechanic, contractor, Uber/Lyft driver; social, business, and community contacts; nurses, doctors, lawyers, financial advisor; colleagues and other professionals; those attending church or temple as well as the minister, pastor, rabbi, deacon, cantor, choral director, and others; people you worked with previously or were in graduate school with or at a placement—and don’t forget your former professors and supervisors. The list is endless. Each one of these people is a potential referral source for your practice. Find a way to regularly keep in contact with them and to keep them current on you and your practice. Building your contact list, e-mail list, referral sources, and resource list is a long-term project. Start today! Getting the word out about what you do and the services you offer to the community also involves meeting new people and making new friends as you increase your practice’s visibility and grow your network. Who you know, those who know you, and those who refer to you are valuable resources for filling your practice with clients who need your services and will pay your fees. Think about it this way, when people know about your practice, and are familiar with your services, they can find you or refer to you when a therapist with your skills and abilities is needed. This type of local networking is viewed as a community service, so make sure your community knows how you can be of service to them. The more people, businesses, organizations, and professionals in your community who know about the work you do the faster your caseload will fill and stay full. Local networking can take a variety of forms. In person, online, radio, tv, digital or print advertising, talks, blogs, podcasts, videos, any type of social media, online forum or ??? It’s up to you to decide what works best for you, your practice, client market, available time, and budget. Take your pick. You get to choose. Try things out, then see what works best for you. Remember to keep things brief and upbeat. Local networking also means becoming familiar with your community and how your potential clients move through it via churches, schools, sports programs and teams, athletic and country clubs, theater arts, colleges, yoga centers, hospitals, libraries, parks and recreation, employee assistance programs, and many others. Understanding the needs of potential therapy clients in your area and how those needs are being or not being met makes practice building easier. Since therapists are an important part of every community, it’s important that we be visible so that our clients can find us when they need our services. The therapists I know who have a full enough practice with a consistent influx of clients are those who are known in, and know, their communities and keep up regular contact. Local networking also includes getting known in your professional community. Joining and attending your professional organization is a great way to get connected with other professionals in your area and to develop and maintain relationships and friendships as well as referral sources for your network. Through monthly networking events, workshops, member events, newsletter articles, classified advertising, and e-blasts, special interest groups, support groups, and special events, Professional organizations provide many volunteer and networking opportunities for therapists and related professionals to get known in the community and develop themselves and their relationships. As you can see, filling your practice with the clients you’re meant to work with requires that you find a way to connect with your community and let them know, on a regular basis, that your practice exists, what services you offer—and how people can go about contacting you when they desire your services. This success formula for attracting new clients, filling your schedule, and earning enough income, consists of raising awareness about your private practice in your community. So, go ahead, announce your presence to the world and raise community awareness about your practice. Keep me posted! I look forward to hearing about your success. Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com. The beginning of the year is always the time for resolutions, and this holds true for private practice, too. The top resolutions mental health professionals tell me they’re making this year are increasing practice income, cultivating new connections and referral sources, how to make dealing with insurance less time consuming and stressful, how to attract more ideal clients through branding, and publishing that book you want to write. Oh, and I almost forgot—how to add coaching to your practice.
So, here are the five best books to help you and your practice meet your goals for more and better with less stress in your private practice. 1. Increasing Practice Income If your New Year’s resolution is increasing the income in your practice by money, doing good, and having fun, then Chellie Campbell’s From Worry to Wealthy: A Woman's Guide to Financial Success Without the Stress is the one for you. Reading this will help guide you to creating a richer and more fulfilling practice based on your values, interests, and needs. So if you’re interested in more income, time off, time for home and family, charging a fair price while contributing to the greater good, From Worry to Wealthy is a practical and friendly ticket to fulfilling that resolution. 2. Cultivating New Connections and Referral Sources If you are not a natural networker—most therapists find networking challenging—and would like your own personal guide for what to do to make new connections with others and to cultivate new referral sources, How to Work a Room: The Ultimate Guide to Making Lasting Connections—In Person and Online by Susanne Roane will give you the guidance you need. This small book is the encyclopedia of how to easily and practically make connections with others whether you’re online or in person—just reading the table of contents is reassuring and encouraging! So whether you’re interested in opening lines for greeting and meeting, tips for introducing yourself and your practice or how to build bridges, bonds, and business relationships, check out How to Work a Room and find the answers you seek. 3. Make Dealing with Insurance Time Consuming and Less Stressful If your practice depends on insurance reimbursement as either an in-network or out-of-network provider, Barbara Griswold’s Navigating the Insurance Maze: The Therapist's Complete Guide to Working with Insurance—And Whether You Should is for you. Navigating the Insurance Maze is the must have reference for every therapist. This easy-to-use manual guides you through what every therapist needs to know about insurance—and answers the questions you have. Joining plans, instructions for claim forms, how to get more sessions approved, how to make appeals, common therapist mistakes, and how to stay out of trouble are all part of the great value of Barbara’s seventh edition. It’s well worth the price. 4. Attract More Clients Through Branding If your resolution for this year is to attract more clients—more ideal clients—to your practice then you'll be really interested in reading or listening on Audible to Robin Fisher Roffer’s Make a Name for Yourself: 8 Steps Every Woman Needs to Create a Personal Brand Strategy for Success. Robin says it best on her Big Fish Marketing Website because it greets you with the words, “We guide you to write, tell, and live your greatest story.” Her book does just that. Make a Name for Yourself shows you how to easily identify your own unique traits and talents for career success and personal fulfillment. This friendly, fun, practical, and easy to apply book is like attending a workshop and learning the 8 steps that “unearth your authentic self to develop a brand that reflects your natural talents, abilities, and passions.” I recommend this book to practice coaching clients and every single one has said that they were very surprised by how much they enjoyed reading this book and how effective it was in helping them to identify what attracted the clients they love to work with—and to more easily and authentically, write, tell, and share the story of who they work with, why, and how they successfully work with those in their practice. 5. Publish That Book You Want to Write If writing and publishing that book you’ve been wanting to write is your resolution for this year then Sylvia Cary, LMFT’s The Therapist Writer: Helping Mental Health Professionals Get Published is the book you’re going to want. As Sylvia tells it, getting a book published can lead to more—more attention, referrals, business, and money. She’s also right when she says it’s one of the quickest ways for a therapist to become known as an expert. The Therapist Writer is a practical, useful, easy to use guide that helps you make your book idea into a completed manuscript. With Sylvia’s guidance—and she knows the ropes since she’s a local LMFT as well as a writer and book coach—you’ll figure out what to write, how to get it written, and how to market and sell it once its complete. If you’re wanting to have your book published, then this little volume belongs on your bookshelf. This is the book I recommend to those I train and coach who have a book on their wish list. Make yours happen this year by getting this one. Bonus: How to Add Coaching to Your Practice If you’re interested in how you can add coaching to your practice this year then David B. Ellis’Life Coaching: A Manual for Helping Professionals is a good choice for you to purchase. This is one of the best overall coaching books I’ve come across, read, and used. It’s written to assist the currently practicing mental health professional—one who’s already been specifically trained as a counselor, minister or social worker—begin practicing as a life coach. Life Coaching, like the other books in this list, is a practical, easy to read and apply, step-by-step guide that helps therapists add coaching to their practices. One of the reasons I like this book is that David B. Ellis has an interesting approach to coaching. He doesn’t view it as merely skills training and advice, he views coaching as assisting people in creating their own solutions, arriving at their own answers, and discovering options for themselves through using a coaching framework and approach. This is a way of working that therapists can appreciate as well as enjoy when doing coaching work with clients. So now you have this recommended list to aid you in your goals for the year. Have fun in looking over these resources and choosing the one that’s right for you. Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com orwww.LAPracticeDevelopment.com. Getting Paid: Private Practice Success Without Stress—Top 10 Articles to Make Your Practice Better11/30/2020 ‘Tis the season to be giving, so…. My gift to you is 10 of the best articles I’ve come across that give the best answers to the questions that therapists have about how make and keep their practices profitable and successful—without having to spend a lot of time or money or effort to do so. Each of these articles is a short and easy read—and every single one of them is chock full of the best tips and information that therapists can quickly and easily use to make their practice better any time of the year. Reading any one of them will definitely give you more private practice success—and without stress! So, if you have a little time during this season to reflect on your practice and how to make it better, stronger, more profitable, and more, take a look at one of these and see what you think.
Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.
Your website represents your therapy practice. The best client friendly websites make it as easy as possible to find out about you and your therapy services and to contact you to schedule the first session.
Here are some things to remember and questions to consider to make sure your website does that! 1. Your website is one of the first places new clients look to decide whether or not you’re the therapist for them—even when they’re referred to you by a friend or one of your colleagues.
Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com. Therapists in private practice are always asking what they can do to have a full practice with clients they love working with. They want to know what the secrets are to making that happen without too much effort or expense. Now that we’re getting towards the end of the year it’s a good time to reveal some of those secrets, those best practices, that lead to a full, profitable, and rewarding practice.
Here are a few to keep in mind . . . 1. Make it convenient for prospective clients to
2. Let people know you are accepting new clients—and that you welcome referrals.
3. Set aside some time for networking and marketing in your community—online or in-person.
4. Only market in ways that feel authentic to you.
5. When times are tough the best way to keep your practice going is not to cut back on costs but to spend and invest in the right areas of your practice. Yes, this is a rather counter-intuitive approach, however, it does pay big dividends. While it can feel very scary or difficult to do, it’s one of the best ways to keep your practice full as well as make new connections.
Therapy Directories Professional Headshots Google Adwords Upgrade your smartphone, tablet, computer, headphones, computer desk chair Get Higher Internet speed Upgrade your Teletherapy portal Upgrade your Electronic Health Record (HER) Hire a Virtual Assistant, Accountant/Bookkeeper, Insurance Biller Pay for Business, Marketing or Financial Training Have a Professional Video made for your Website Logo Creation Sponsor an event What will you invest in instead of cutting back? That’s enough secret spilling for today. Pick one or two of these and try them out. See what happens. Our practices can always benefit from thoughtful attention and doing a little something new. Have some fun experimenting with these and check out what happens when you do. Private practice is always an adventure so enjoy yours! Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com. 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. 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, 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. To review:
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. |
Lynne Azpeitia, LMFTFor 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 Archives
February 2022
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