The Practice of Therapy

As we move into this time of the year, I think there's a sense of anticipation that occurs for most of us. And that anticipation can be either positive or negative. For some, I know there are some folks that as we moved into the holiday seasons, it's one that they face with dread, and, you know, just brings up a lot of bad memories. But I think for others, there is just a sense of excitement, a sense of, as I said, anticipation about this particular season. But I know for me, one of the things that happen is, I really began to think about the end of the year. And just thinking about making a transition and New Year's resolutions, and, and all of those things and setting new goals and really thinking about those things. But this year, you know, it's really quite different. And that's, you know, the big understatement, and that this is a year that is going to stand out for us. Those of us that are living through this pandemic that we're in, and just the political climate and all of that that we have had this past year, I think it's just created a lot of change. You know, one of the things that has happened for I know for me, in my own practice, and just in my life in general, when the pandemic hit, our priorities begin to change. And the timing of the pandemic also hit for me personally, in a time when my wife was going through major surgery, and just a really big life change for her and for us and our family and being able to take care of her. My wife is disabled at this point, and she just requires a lot of care. So it's caused me to really have to think about what is important for me in my practice, and what is important for me, just in my life in general. You know, one of the things that I think is most important to start with, and you hear this from me over and over again, and for those of you that have been listening to the podcast for a while, have heard this is you got to start with why, and really looking at what are your priorities? Why do you want to be in practice? Why do you want to do the things that you do? You know, this year, we've learned a lot, in particular, just learned a lot about making a transition to a whole different business model for many of us, and that is the switch to telehealth and to doing therapy online. And my prediction is, and this is more my opinion, but you know, and talking with other folks across the country, I think this is going to be very true, I think telehealth is going to become very much the norm over this next year. And one of the things that that causes us to do is to really think about how we have our practices structured, how we have things set up, you know, one of the things about being online is that your office space becomes less important. You know, being able to have the furniture and all of those kinds of things that we think about him, doing therapy with people and having a space that is comfortable for people and therapeutic and has the right colors and the light and all those kinds of things that we think about. That is not quite as important. You know, what becomes important is what is in the background on your screen. When you're doing therapy with people. You know, the other thing that has happened for us is we've really had to think about how we do how we do things clinically. I know, for me, that has been something that I've had to really pay attention to is that doing therapy in the online space is effective if done in the right way. And so that is something that we have to really think about in moving forward and really in our training and what we do around making that experience for our clients something that is inviting and Mormon and that sort of thing. I know one of the things that I've run into with some of my clients is that they have not had a good space on there and to do therapy. And so I have just a small handful of clients that I still see in the office. But for the most part, I've made this total switch to teletherapy. The other thing that that has brought up for me and just thinking ahead in my own practice, is what do I want my practice to look like moving forward, you know, all of a sudden, what One of the big things that is really become quite aware is that the boundaries around who the types of people that you can see, and the geographic limits of, of people that you can see for therapy has now widened a great deal. Since I'm licensed in the state of Tennessee, now my potential client base, particularly if I continue with online therapy, is the whole state of Tennessee. And so that's really caused me to think about how I market my practice, and really thinking about a, a broader reach. One of the things that's coming up yesterday I, as I was, I'm recording this, I've been been working or collaborating with art, my friend, Daniel fava, who has private practice elevation podcast and website. And Daniel is is not a therapist, but his expertise is around building therapy websites. And, you know, there's some other folks that are good, good experts in that and one, in particular, the folks over brighter vision, which they, if you're starting from scratch, they would be a good one to go to. But anyway, one of the things that I started realizing is that my website really was in need of updating. And so one of the things that's coming up in future episodes, after the first of the year, as Daniel is going to walk me through, making upgrades to my website, and being able to make those changes and, and just doing a facelift with the website, making some changes around all of that. And so he walks me through that process. So what My point being is, is that, again, in thinking about the things that we've learned over this past year, our priorities have changed. The way that we approach, private practice, in many ways has changed. And so we have to think about doing things in different ways. You know, now more than ever, is a great time to be in private practice, because there is such a demand for mental health services. I know in my own town, here in you know, I have I would describe where I live is, is a small metropolitan area in northeast Tennessee, live in Kingsport, which is one of what they refer to as the tri cities. And so it's a it's a small Metropolitan metropolitan area surrounded by a large rural area. And really our client base and our practice comes out of three states, we get folks, not only from Tennessee, but also folks that that come to see us from Virginia and also Eastern Kentucky. And so it's a, it's an interesting place to live, I love where I live no more right in the heart of the Appalachian Mountains, as I like to say, but one of the things about switching to telehealth is that it is mentioned earlier it has it has reduced the geographic bounds of what we do. And even if you're thinking about having a group practice, thinking about the therapists that you can hire for a practice that is now broaden given telehealth there, you they no longer have to compete. And one of the things that I say kind of tongue in cheek about about having lived through this pandemic is that it's drastically reduce my commute time and that I've been doing much more working from home. And so I've got my office at home set up to where I can see, see clients from there and work from home just as easily as if I went into the office. Now it's nice to go into the office because it's a it's a good change of scenery. And also I get the least wave to the other people on my staff and, and talk to them from a distance but yeah, it's uh, one of the things about the the pandemic that we're we're in is that we're really thinking about things differently. You know, one of the exercises I did for myself earlier in the year, particularly when my, my wife was in the hospital and recovering from the surgery she had, I sat down and in just spent some time writing down what were my new priorities. And I think one of the things that can happen for us is that we can get really overwhelmed with all that is going on around us particularly in our practices within our families, just in the world. And I think one of the things that happens Isn't that just kind of sits on our brain. And it just creates this sense of anxiety for us. And so one of the things that I do every week, which has been a big help for me is I do what I call a brain dump. And so in my plan or on one of the pages, I just simply make us a list and I just title it brained up, and I just write down everything that is just kind of capturing my attention at the moment, things that, you know, things that tasks that I need to complete are things that I'm thinking about, or things that are maybe causing me to worry or any of that stuff of just simply writing it down in many ways, it's kind of a, it's really just simply a journaling exercise. But one of the things that that has, does when we do that is it really gives us a new perspective on things are really being able to kind of hone in on what really is important. And a lot of times when we write those things down, what we notice is that when we write it down, we think that might not be such a big deal. After all, even though it's something that's just kind of captured our attention, and that sort of thing. The other thing that I would say is to be able to embrace change. One of the things that we that has happened to all of us is that our routine has just been turned on and and particularly for those those folks out there that still have children at home, and just having to navigate this whole thing between working and then homeschooling and all of those kinds of things. Our routines are just been turned on and and so being able to, you know, in many ways, except the fact that that has happened, and to be able to kind of look at the small ways in which we can change our routine to make it work for us. You know, the other thing about and this Sorry, I'm jumping around a bit, but these are just kind of some thoughts that came to me as I was thinking about this episode. The other thing that I think that is become important for us is to really kind of think about how we connect with others. One of the things about this pandemic is it has caused a lot of us to feel kind of isolated, and disconnected from the people that we normally interact with the people that that matter most to us. You know, we just see stories all the time of, particularly this season. As I'm recording this, we're getting ready to move into the Thanksgiving holiday. And so many of us have, have pulled back from our traditions, and that we're not traveling, we're not getting together with family, I know for me, it's just going to be my wife, and my daughter and I for Thanksgiving. And that's okay. And part of it. You know, it was in many ways, when we made the decision to do that it was a hard decision to make, because my family always gets together over in North Carolina and our place at Lake lure. And as I like to say, a whole fam family is there. And we're it's just a fun time in this year in particular, was going to be an important year because this my dad passed away last Thanksgiving on Thanksgiving Day. And so being together as a family, this year was going to be a real important thing for us, but had to embrace that change and had to really think about what is important and what are our priorities, given the pandemic and given all that's going on. And so my point being is I think it's just important to, to really allow ourselves to, to embrace change, to lean into it. And to be able to really kind of take ownership of that of being able to think about how do I reorganize my life? How do I reorganize the things that are important to me, given given the things that we've got going on. I think one of the things, too, just as a side thought to that is that we are creatures of habit. And we get used to doing things in the same way. All the time. And so when we change our routine or change the way that we do things, it just becomes a bit unsettling. And so I think as we know as their post, when we're faced with stress, we need to be able to, to really focus on that self care, and really do those things that we need to do in order to care for ourselves so that we're enabled to care for those that matter most to us. You know the other thing about this, this time that we're in is that the phrase The new normal has kind of become cliche in a way, but we really have created a new normal, and that we just think about our relationships with others differently. We, our interactions with others have changed drastically. And so I think, again, not to repeat myself too much that just some something that we need to embrace. On the positive side, though, I think there's the one thing about it is that has created some really interesting opportunities for those of us in private practice. In particular, in particular, just thinking about doing things in the online space. One of the things I jotted down as I was kind of making some notes for myself around this particular episode was just the the great opportunity to be able to create diversity of income within your practice, you know, one of the things that can happen is that we can get locked into just a one, one particular way of creating income for ourselves. And the primary way, for those of us is mental health providers is that, as I like to call it, it's the the but in chair, income stream, in other words, being able to spend that time with clients one to one, or one, you know, for you see couples, you know, one to two, or whatever that might be. And that is the primary way in which we create an income we get paid a fee for by the people that see us either through them paying us directly or through insurance companies reimbursing the patient for that. But anyway, one of the things that I think is really important to keep in mind is that, and we saw this back, when the pandemic had, at least in my own practice, I had a real dip in my practice, in that, through the month of March and April, when the pandemic really was taking off, and things were starting to shut down, locked down. Which should, personally I think we need to go back to some of that right now. But anyway, When, when, when that occurred, one of the things that happened in my practices is that we just saw a drastic drop in the number of clients that we were saying, and so with, with the lag time as it is for an insurance based business, that really hit me in June and July, and so I saw a real dip in income. Fortunately, I had the the reserve set aside for things exactly like this. And that had money in reserve to make us through to cover expenses to be able to pay my staff and all of those sorts of things, the money was there. So as a side note, just keep that in the back of your minds, particularly those of you that are just getting started in private practice, is to really focus on building a reserve for yourself. But the other thing that I think a lot of folks are thinking about, and this has been something that's just been kind of exciting for me. And one of the things that happens for me with practice of therapy is I've got another stream of income. And it's basically an online income stream. So there are so many great opportunities to be able to create that for yourself in the online space, either through selling digital products, if you've got a work chic sheet, or some sort of activity that you'd like to share with other therapists. You can, you can, you can sell those online and the platform that I use for my my digital products, like paperwork, packets, and the session note helper and all of those kinds of things is, is a platform called gumroad. And we'll have links in the show notes here for how you can find out more about gumroad. So that's what I do have another idea in there just thinking about creating other income streams is, is doing online courses. I know for a lot of us once we got out of graduate school, and this was true for me is a loved learning it's also love teaching other people things. And so there is a great opportunity to create not only this one to one way of creating income, but also one to many way of creating income creating online courses or seminars, that kind of thing. The platform I use for that is teachable, and for anybody that has signed up for any of my courses versus like G Suite for therapists which are doing a revamp of that just just saying that out loud, doing a revamp of that, and also the money matters in private practice. And then also the group practice outfit or that are partnered with David Hall on is all of that housed on teachable, also doing some business consulting for other therapists that are interested in doing like one on one consultation with the I've got the the platform for that for people to access that also on teachable so what My point being with all of that is give yourself permission to think outside the box and to think about creating other income streams for yourself, so that you're not just solely dependent on just that one to one interaction that we all love and enjoy doing. I don't see myself stopping that, given what I do, because I enjoy those interactions. But there are ways to really to really create other streams of income. You know, I think one of the things, one of the limiting mindset things for a lot of people is that we, we kind of grow up with this idea that, okay, I grow up, I go to school, get, get my education, get my degrees, and then I go to work somewhere. And so work at that place, whatever that place is, and that's where I get my income. Well, with the online space, you can get income from several different places. And when you look at folks that are fairly wealthy, that's what happens for them is that they've got income coming from several different sources in several different ways. And so anyway, I just want to get you to kind of think about that. And particularly thinking about priorities and thinking about the changes that we've gone through over this past year. And just being able to think in different ways about how you manage your practice, how you have it structured, how you how you do things. And so hopefully all of this makes sense to you as you think about it. Because these were things that I was thinking about and just what I've learned so far about being in practice and what is important and what my priorities are over, over the last several months, and then just thinking into the next year, you know, how am I going to structure my practice? And what is it going to look like? It's going to change and it will change again and again and again, until I finally retire. But that will be something to, again to embrace to be able to go with. But for me, that's an exciting thing. Just being able to look at new ways of doing what we do in our particular in this particular world. And as I said earlier, now more than ever is a great time to be in private practice, and go into the mental health field. I know. I know, part of the story I was talking about where the where I'm located, is our phones are ringing off the hook and getting ready to add another clinician to my practice and and anticipate having to add more. Just because the demand is there. The stigma around mental health i think is starting to go away because there's a lot of press about how this pandemic has affected people in their mental health and just the anxiety that they feel so Anyway, hopefully this has been this has been some inspiration for you or just some things to think about. I thank you for being with me in this journey. And thank you for listening to me ramble on about what I think is important in just thinking about our practices and, and that sort of thing.