The Practice of Therapy

On last week's episode, we talked about being able to embrace change. And just thinking about all the huge changes we've gone through this past year, you know, primarily with the, you know, this little thing that's going on called the pandemic, and then just all the political change that's happened. And just really thinking about being able to embrace some of those changes that are happening in our not only in our world, but I think it's affected our practices. immensely. I know, just that whole shift to telehealth has just created a huge change for a lot of us in private practice. So in this episode, I'd really like to kind of delve into thinking about if you were to restructure your practice, if you were to give it a facelift, so to speak, how would you go about doing that and, and talk about some of the things that I've thought about as I'm doing that, in my own practice. So the first place to start, of course, and again, this is something you hear from me all the time is to start with why. And one of the things that I think is important to remember when we think about our Why is maybe even going back to, to thinking about why we wanted to go into private practice to begin with, why not just work for somebody else? And what is it? What is it that motivates us to have our own practice. And I think for a lot of people, that could be any number of reasons, reasons. But I think the number one reason that most of us go into private practice is because we want the autonomy that it brings, and also the potential for grading, great greater earning potential for ourselves, and being able to bring in more money, more income. So one of the things that I think is important to do is to begin with just thinking about why you would want to restructure your practice, it might be that you just got some systems and processes that have just gotten overly complicated. It might be that you are noticing that your own stress level is continuing to rise because of things within the practice that just cause you a lot of headaches. You know, one thing that can happen is that I think, particularly as practice owners, we can let our case loads get pretty high. And that just creates a lot of stress. And that we've got to attend to those things around our case loads in terms of our getting our documentation done, being able to follow up with clients being able to do all those things necessary for just doing the clinical side of the practice. And so particularly for those of us that are group practice owners, one of the things that happens that we realize is that we need to decrease our caseload and we need to be able to spend more time on those administrative tasks that are involved in a practice. So that's just one example of maybe thinking about a change or a way to restructure your time and what you're doing within your practice. So one of the things I think that is important to do is just like if you are going to remodel a house, or you are going to build a new house, or whatever, is to really map out what you want to change and how you want to change it. One thing I think is important to look at is just your workflow, just thinking about from the time that a new client contacts, your practice, and how you onboard them how you bring in, take them on all the way through to discharge and then also being able to think about that workflow in terms of, you know, continuing to get clients because one client is easy. But if you start getting 5678 910, hopefully, what however many you want in a particular week, what's the workflow around that? And, and who's in charge of that? And so, being able to think about that of being able to map it out, you know, one of the things that I'm looking at as just our intake procedure for my practice, and really thinking about what would make it simpler for the client, what would make it simpler for them in onboarding with us. And one thing in particular, particularly now that we're, we're focusing more on telehealth and the fact that we're doing everything online is to make that process as user friendly as possible. In terms of online forums and online processes. Fortunately for, yeah, for me, and for our practice, in that we're using therapy notes, which is an Electronic Health Record system, and they've got a patient portal that is just really very superior. So part of our intake process is, is for our intake coordinator, Deborah to kind of guide people to go to that portal to be able to complete their paperwork, to be able to do all the intake things that we all need in terms of signing consents, there's a way for them to sign it electronically, and all of that within therapy notes. So that's, that's one process that has become much more streamlined. And it's really created a paperless environment for us. So as you think about restructuring your practice, are the tools, for example, if you're using an Electronic Health Record system, are those tools making it easy for not only for you, but also for the client, and being able to think about how you want to restructure things. Again, as I mentioned earlier, I think it's a good idea to just map out your workflow process or processes, and thinking about not only the clinical side, but the business side of things. And the way that I have done that is just create flowcharts of things. You don't have to make it complicated, it can just be on a just take a legal pad and be able to just jot those things down, of just being able to show what it looks like when you go from point A to point B, within your practice on on the clinical side, which I think of the clinical side as anything that we do with clients from the intake, to discharge all of those different processes, being able to map that out. And then on the business side, being able to map those things out as well. And there of course, in in private practice, there is some overlap between the clinical and business sides. But again, not to get too far off on a tangent, I really am a true believer in keeping those processes separated from each other. And that, again, as I mentioned, the, you know, having elect good Electronic Health Record system helps you do that to some degree in terms of all of your patient payment information and all their personal health information is housed in the Electronic Health Record system. Whereas the business side of things as far as just, you know, the payments, you get the expenses, you have all of that sort of thing. In my practice, I use therapy notes for the clinical side of things. And then I use QuickBooks, in tracking the money and all of that sort of thing. on the business side. Also, I use Google workspace, which again, Google workspace, aka G Suite is just a wonderful tool and being able to set up set up some platforms and systems of being able to track things of being able to create a flow, get it, you're going to be hearing more about that from the working on updating the course that I put out G Suite for therapists. But that information is still relevant, even if you go ahead and purchase the course now. And just a little secret is that when I do update, update that course, if you've already purchased it, you'll get the updates that I'll insert into the course. So didn't mean to get off on that sidetrack. But again, be able to just map out your flows your workflows in the different areas of your practice. And again, it doesn't have to be complicated or are or that sort of thing. One of the things when you do that is you'll be able to look at maybe some roadblocks or maybe some places where the flow of things get slowed, slowed down. Or what happened to me when I started doing that is I realized I had a lot of things that I had duplicated. In other words, I was I think back when I was first getting started, I had an Electronic Health Record system not it was a different one besides therapy notes I switched over. But I was I was not only putting stuff in therapy notes, but I was creating double work for myself by putting it in QuickBooks, I mean, different different types of things. So like I had, you know, individual client invoices in QuickBooks, which was just crazy because it just doubled my work. I didn't need to do that. And so what I switched over to is when I collected a payment and recorded it in therapy notes, I would just enter that in my QuickBooks is just a patient Just receiving money from a client didn't identify the client. The other thing too, just another side note about using QuickBooks or any sort of accounting software, most of those are not HIPAA compliant, or HIPAA secure. So you got to be careful they all and that was a mistake I was making is that I was had client information in QuickBooks. I've corrected all of that now and gotten all of that out of there. But that was a mistake I made and not recognizing early on that that, that particular those, those platforms are not necessarily HIPAA secure. So again, looking at your systems and processes, in terms of HIPAA is something that might require some restructuring, as you think about your practice and how your workflow go. The other thing too, about your workflows, not only looking at duplicate things, in other words, or you're, you're entering stuff down more than once, is looking at stuff that's just Deadwood, stuff that you really don't need. You can make, you can make things really complicated for yourself. But a lot of times the sample is just better, particularly when I think think about, you know, writing session notes, for example, one of the things that I think what is particularly a run into this with newer therapists is that they go into so much detail in their, in their session notes they go, they write down just kind of a whole narrative of everything that took place in the session, that is probably something that you can cut back on. really one of the things that I think about when I think about my systems and processes, the therapy notes, the the session notes, therapy, notes, progress notes, or whatever, are really there to as a reminder for you, as a clinician of what you did in that session. So if you have just things that kind of give you the theme of the session, you certainly there is the medical record part where you need to kind of document things that are important for, you know, following that particular patient or that particular client, you know, there are those standards that are important to follow. But one mistake that a lot of new therapists make is that they put too much detail into their progress notes. Your progress notes should only take you about five or 10 minutes to complete. And it was taking you longer than that. Again, that would be maybe some Deadwood or a process, you might want to look at how you can streamline that more, because that is a place where people get backed up, and you can get into some log jams just on client documentation. And I've not met too many people that just love doing documentation. But again, that's a system and a process of looking at how you can streamline and you how you can cut out a lot of Deadwood with that. Again, in looking at your clinical processes, I think it's a good idea to to remember that they should be working for you and not you for them. So again, if there is any part of your processes, or your systems that are just drudgery for you. Think about ways that you can make those things easier for you, and even automate more as you as you move forward. Again, that's a huge part in restructuring and making things easier. I love using Google Forms. And with Google Forms, you can create something, it takes a little while to set them up. But once you set them up, you can streamline your process processes using Google Forms or Google Sheets, those types of tools to be able to track things to be able to do things quickly. For the lot of folks are aware that I created something called the session note helper, which is just really a system that works within the the Google platform, the Google workspace platform, and it's a set set of templates that I created a Google form. And then it uses a an add on called form publisher, which is is HIPAA secure. And what it does is it's it's it's a Google form that just uses checkboxes. You check off the boxes in your Google Form about what you did in your session. And then when you click Submit, Google, the form publisher creates narrative of what you did in your session based on what you checked off on the Google Form. It's a huge time saver, you do need to make sure that you have a little bit of knowledge about using Google workspace. And you do have to have a Google account, a Google workspace account, which you can make HIPAA secure. But again, you can find out more about that by going to practice of therapy.com, slash session note helper, and learn about that. And again, that was a that was one of those things that I created to make my workflow easier. The thing about the session note helper to is that because it's in a Google Doc format, I can just copy and paste whatever I wrote in there over into therapy notes. Again, therapy notes has got a great template. And I use tell you the truth, I use some of both, depending on the particular case. But anyway, it all ends up in therapy notes. But anyway, I didn't mean to get too far off on that tangent, talking about the session note helper. One of the things too, and just thinking about creating change within your practice, or restructuring your practice, is to really look at your profitability, one of the things that can happen is, we can be so busy doing our sessions and just doing all this going on in our practice that we we failed to go back and look at our numbers and really understand how profitable we are. One mistake that most people will make is they'll look at their bank account and say, Oh, I'm good, there's money there. I don't have anything to worry about. But really, you need to really do a deeper dive into your profitability. And I think it's a good idea to look at that maybe once a quarter, at the very least once a year, look at that, to see that you are being profitable, and that what you are bringing in is creating a profit for yourself for yourself, but also a sustainable, what can happen is you can be digging into your reserves, you can be it particularly in our group practice. And again, this was something that I learned the hard way a few years ago, is I realized that what I was producing as a therapist, another words I was having to pay out of that to pay the the the clinicians that I had hired, they were at that particular time, they were contractors, and I was paying them a very generous, very generous cut, or very generous payment for the work they were doing. But what I did a deep dive into the numbers, I realized that wasn't going to be sustainable. I was losing money. And I was taking money out of my pocket because I was overpaying them. And my friend Julie Harris at Green oak accounting talks about that being one of the number one mistakes that therapists make. So in thinking about restructuring your practice, I think it's a good idea to look at those numbers, and to be able to really think about those. And it might be that you need to restructure that you might need to restructure your pay system. And anytime there's change, it can be painful. I know that I went through that where I restructured my pay system for for my clinicians, unfortunately, I lost a few of my my clinicians, because you know, they weren't going to get paid as much. But once I went through the pulled the band aid off and went through that, that painful time, I was able to rehire people under the new structure. And it has been much more profitable for my practice doing that. And actually, my people are much happier because I'm able to now basically restructured from having contractors to employees, and now that I have employees, I'm able to be able to provide benefits in terms of a health care plan and profit sharing and dental and vision and all of those things that are attractive to people and also makes them much more long term commitment. So what I would say about if you're going to restructure in that way, and that's a pretty big restructure that I went through a few years ago is to set a deadline for yourself and a date that you're going to do that. And usually here we are getting at the end of the year. You know, the first of the year is a good time to restructure, and a good time to set a date to read to change things. It's just kind of a natural thing. Of course you can pick any date obviously, if you're going to restructure things. The other thing too that I think is important to look at is looking at your pricing structure, one of the things that can happen is we just get used to charging the same thing over and over again. But, you know, the first of the year is a good time to look at it, for those of you that are insurance based, like I am looking at those contracts and which ones are going to renew, and being able to negotiate a new fee structure, from insurance companies, I think there's a trend because more and more we're people are becoming much more aware of mental health services. And also, there's a shortage of mental health providers. And so one of the things that's coming out of that naturally, is that I'm just kind of hearing word on the street, so to speak, that a lot of insurance companies are raising their fees of what they pay for our services, which is a good thing. If you're a self pay, or if you're a cash base, the first of the years may be a good time to go up on your fees, and really looking at what would be a reasonable increase and being able to change your fees, if they change your your pay structure. A lot of different ways to go about that. And I know that's a big discussion. I know, in the mastermind groups that I've had in focus groups I've had, we've talked about that's one thing that I really emphasize with people, when they're just thinking about becoming more profitable is going up on your fees, particularly if you're getting full and you are in high demand in your community, absolutely go up on your fees. And one question that gets asked is well, what do I do with my current clients? Well, there's two ways you can do that as you can, obviously, you can go up on their fees, I think you've got to be give them some disclosure around that and give them some communication about that in terms of, okay, on this particular day, your fee will go up to this. That's one way of doing it. And just being able to, you know, let them their fees go up with with any new clients. The other other way to do that is just keep your current clients at their current rate. I know that's what I typically do just keep them at their current rate. But any new clients after the deadline or after the date at which the rates change, they go under the new pay structure. So there's no right or away, right or wrong way of doing that. But I think the main thing is is you should be looking at your fees and making sure that you're going up, in order to keep up with inflation, or to keep up with giving yourself raises all of those kinds of things. It's important to think about when restructuring in your practice. Finally, the thing that is an important thing to look at in terms of restructuring, is looking at your website. Coming up in some in a future episodes here, I'm going to be having a conversation with Daniel fava, and getting his hell his help in helping me restructure my website and redo my website. One of the things that I realized is that my website hadn't been updated in several years. And one of the things that I know is that it has become somewhat confusing for some of some of our clients and, and just being able to navigate it. And it's really just gotten kind of real top heavy with a lot of stuff on the website that is maybe not relevant to the purpose of the website. So the number one reason that you would have a website is to promote your practice and it's really kind of your it's your front door to your practice even more so than if you've got a brick and mortar practice. Your website is where people are going to go. In my own practice. I know for a fact that probably 90% of the referrals we get, we get because they have found us on the on the internet, they've they googled it, and they have found us. Fortunately, my website has been around a while and so I've got a pretty good search engine optimization and ranking on Google. Part of it is the name Kingsport counseling associates. Anytime somebody in the town of Kingsport looks up counseling, guess what comes up first. And so we've got a really good ranking because of that because of the name and just the fact that we've been around a while. But anyway, one of the things that you really want to look at and thinking about restructuring your practice. And if you think about it, if you were to remodel your house, you'd want it to look different. And so I think in restructuring it's a good idea to maybe Look at your website and how you can restructure it as well to really reflect who you are. And just give people a sense of what it means to come to counseling and what it means to come to therapy. And so that your website communicates all of that. So again, thinking about in thinking about restructuring, I think looking at your website and making it more user friendly, and making it more accessible to people, is always a good idea. Again, my friend, Daniel fava, over at private practice elevation, he has a podcast, he's going to walk me through that, and we'll have a future series, I'm going to do a little two part miniseries on the restructuring of my website, but you'll I'll be walking, you will kind of walk you through that process and thinking about how you would want to do that. The other, the other folks that I would mention around websites, that are really, they've got some beautiful websites and do such a great job. And that is brighter vision, and you can find out more about them to going to practice of therapy.com slash brighter vision. You know, the other part of just thinking about restructuring is really being able to look at your own kind of personal work habits. One of the things that I've said before is, I'm not a naturally organized person. But I've had to really teach myself some productivity skills, and being able to kind of learn how to be better at managing my time and managing what I do within my day to day work. workflow. One of the things that I love being able to do is use my planner, and I've mentioned this planner before. And we'll try to have some links in the show notes for this. But I use the Michael hyatts, full focus planner for kind of helping me with my productivity, and being able to kind of map out my day and really think about my weeks and, and all of that. And one of the things that has helped me so much is being able to take some time at the beginning of each week, and really kind of map out and think about what it is I want to accomplish for the week. Also on the on the daily pages of that particular plan, or it's got kind of a place to put down what they call your big three. In other words, the big three things you want to accomplish for that day. So most days, I've got all three in there some days, it's just one or two things. But anyway, being able to think about your focus each day, and being able to kind of plan that out is an important piece, and being able to kind of make yourself more productive. Again, there's so much we could do a whole episode episode on productivity. And there's a few older episodes that are where I talk about this, just being able to be able to keep yourself on track and keep yourself organized. You know, in restructuring things, one of the things I think about, again, using that metaphor of a house, if you've got a house, or room in your house that is just full of clutter, and full of things that are just overwhelming to you, when you go into it. It's probably a good idea to think about reorganizing that and decluttering things. And so when I think about restructuring a practice, I kind of think about it in that, in that mode, particularly those of us that have been in practice a while, we can just go accumulate a lot of stuff, just kind of like we do in our houses. I know I've been living, we've been living in our house close to 30 years. Now, I'm kind of telling my age here by doing that. But we just got a lot of stuff. And one of the things that we've been doing over this past year is decluttering, and kind of get reading the getting rather than rid of the Deadwood and the stuff that is just no longer of use to us. And we're just hanging on to for no reason. And so, again, in restructuring your practice, I think that's a good mindset to think about it. What is it that you need to do to simplify your practice, to make it easier for you to run, make it easier for your clients when they come to see you. And just thinking about the flow of all of that. So, to quickly recap here before my voice goes. First of all start with why really think about why you would want to restructure and the purpose of that. The second thing is to create a flow chart another words, maybe start with the workflow that you have now look at how you're doing it now. Write it off. down on a piece of paper, you can draw it out, make little maps and little drawings and arrows and all those kinds of things if that's how you want to do it. But think about your, your current workflow, write it all down and look at it and figure out what it is that you need to remove or change in some sort of way. Look at what your processes are for your intakes. And is that an easy process for your clients? Because again, they are the ones that are going to drive your practice to some degree. But also just thinking going back to the why thinking about what is it that is going to fit your lifestyle, what is it that is going to make your life easier within your practice, around the structure of your practice, and the time that it requires of you look at the things that you can automate more, particularly making use of things like therapy notes, and being able to use their portal, all of those kinds of things. Also, look at those things that you can cut out. The the Deadwood, as I like to call it are there processes that you really are either duplicating In other words, you're you're having to enter stuff twice, or things that just really are not relevant for you in terms of one, the example I gave was just being able to look at making your your prep your progress notes simpler, not having to put a lot of detail and put a lot of time into that of really getting it down to kind of like a well oiled machine when it comes to doing those, those tasks. Also, looking at your, your, how you've got things structured, if you're a group practice your pay scale, is that something that needs to be restructured? Do you need to make a change of maybe going from having contractors to employees of looking at your profitability, again, taking a deep, deep dive into your profit, profitability, my tongue tied here and looking at, you know, looking at your numbers and having a clear picture of that. And then the finally is looking at your website. Does your website reflect who you are? And is it time for a facelift? Again, I'm going to be doing that process myself. At the beginning of the year, we're going to restructure our website. And we're going to redo that, and I'm going to be sharing that process with you as I go through that process. And then finally looking at your own productivity habits, and what you need to do to change those things. So hopefully this has been helpful for you and just thinking about these things. I know, for me just this past year, just a lot of change and a lot of things that have come down the pike. And I think now that we're towards the end of the year and getting ready to start a new year, this is the perfect time to think about this and really looking at how your practice is structured. And is it time to restructure it and make it work better for you.