(cc) photo by khawkins04

Last week’s post How To Get Paid For No Shows prompted some excellent discussions and follow up questions about how to enforce cancellation and payment policies. One comment in particular, posted by “Paul” brought up a valid concern.

Do your policies go both ways? How do you handle the situation when you, the therapist, no show for a session due to a scheduling error, inadvertently double book a session, or cancel a session at the last minute due to illness? Here’s what he wrote:

photo credit: Marcin Wichary

Are you going to work and not getting paid?

Therapists in my consulting practice frequently complain of a high no-show rate, especially with new clients. They often feel powerless to enforce their policies fearing if they’re too strict, clients will drop out of treatment.

I used to have this problem, too, and ended up feeling resentful when I had rushed to get to my scheduled session only to have a client no-show. There were also those days when a handful of clients who didn’t show up or cancelled at the last minute. Since I was paying for child care there were times when I actually lost money by going to work. I knew something had to change.

(c) Can Stock Photo

Several months ago I wrote a post titled, “Why I Broke Up With Managed Care” that stirred up some passionate discussion! While I understand that it’s not the route for every private practitioner, I have continued to build a private practice free of managed care and recently hired my 12th therapist.

While we don’t bill insurance directly, we do give a superbill to clients so they can seek reimbursement from their health insurance so they can still use their benefits. As I’ve continued to write this blog, I’ve come across several therapists who have also “broke up” with managed care and asked them why they decided to build a fee-for-service therapy practice. Here’s what they had to say:

In part 2 of “A Shrink’s Guide To Self-Publishing” Stephanie Adams, LPC walks you through the process of organizing and completing your book and preparing it for publishing. Read part 1 here.

photo credit: Salem (MA) Public Library

Last week, we talked about how self-publishing can be a shrink’s dream second income AND do wonders for their practice by increasing awareness of their expertise. But at the same time many of you who might consider this path worry that no matter how much you like the idea in general, you could never actually write a whole book.

I’m telling you now, don’t sell yourself short! Think about it. What is therapy? A large part of counseling is simply listening to the client’s story and creating together a different, better story of a life they can choose to lead. Probably at least once a session, you will find yourself doing things like attributing meaning to an event in the client’s past, explaining a difficult concept to them, teaching a technique, or painting a verbal picture. That’s storytelling, and you can do it on paper just as easily as you can do it in person!

During my graduate school practicum placements I never had to think about the financial aspect of seeing clients. Billing specialists took care of collections. That was their job. After graduation I worked in a private practice setting where I was required to ask clients directly for…money.

It was awkward at first to have clients share their pain with me, open their hearts, and be so vulnerable, and then ask them to pay me.

Adding to my money anxiety was the fact that I was charging the same rate as my clinical supervisor and I didn’t believe my services were worth it. My supervisor helped me gain confidence by explaining that clients aren’t just paying for my time and skill, but they’re also paying for her years of expertise. I hadn’t thought about it from that perspective before.

Call me a bad therapist. It wouldn’t be the first time. But I write my case notes during sessions. It’s not “writing” really. It’s more like “jotting” a few important things down as I go. I sign and date the note at the end of the session and I’m done. Call me crazy, but I like to complete all work, notes, letter writing on behalf of the client during the session. I have resistance to adding and hour or so at the end of my day for case notes.

If you haven’t been able to tell from past posts, I tend to be an early adopter when it comes to technology. I had a therapy website in the early 2000′s. I’ve been on Facebook and Twitter for 4 years (which is a long time for the over 40 crowd). I love my iPhone and iPad. I developed an app. But, I haven’t yet transition to electronic notes and health records, until now.

Starting today my therapy clinic is finally transitioning to an electronic records and practice management system. After a lot of research we decided to go with Care Paths.

After reading my recent posts on multiple income streams for therapists, Psych Central Associate Editor and blogger, Margarita Tartakovsky asked me how I, and other therapists, juggle so many different aspects of private practice. I’ve been thinking about her question and thought it might be fun to start a series that peeks into “a day in the life” of therapists in private practice. I thought I’d start with me, and start with–today.

Just to give you a little background…I’m a wife and a mother of 4 children ages 5 to 21. I’ve been in clinical practice for 16 years and I serve as director of  Wasatch Family Therapy, a private outpatient clinic that I founded in 2002. Recently, because my clinic has grown significantly, I’ve stopped taking new clients in order to spend more time leading, training, and pursuing other passions, like writing, media contributing, etc.

You’ll notice that my “day in the life” doesn’t include seeing any clients. I am currently on a month-long sabbatical from clinical work, and from as much administrative work as possible, during the month of November to dedicate time and energy to finishing up my first book. After being approached by a publisher a few months ago I decided that it was an opportunity I didn’t want to pass up, but it would require cutting back on a lot of other responsibilities in order to make the deadline. I will resume seeing clients, running staff meetings, and training therapists the first week in December.

Developing multiple income streams is crucial to maintaining income stability in private practice. “Having different income sources allows me to be a bit less stressed when my main funding source, private practice, takes a dip,” shares Jill Kristal, President of Transitional Learning Curves.

Reducing financial anxiety is not the only benefit of developing additional income avenues. Multiple income streams allow therapists to fully express their many talents, gifts, and passions.

Writing and speaking provides former actor Frank J. Sileo, PhD with creative fulfillment as well. “I used to be an actor in a past life so getting up in front of others has helped get that need met, ” Sileo adds. Additionally, multiple income streams allow therapists to make a difference on a larger scale, reaching far beyond the therapy office. “I had a desire to have more impact on troubled eaters than one-to-one sessions or even workshops and talks could provide,” shares therapist and healthy eating expert Karen R. Koenig, LCSW, M.Ed.

If you missed “Multiple Income Streams (part 1)” click here

Relying solely on direct clinical hours may leave private practitioners financially vulnerable to income instability. Since client hours in private practice can vary greatly depending on the time of year, state of the economy, number of new referrals, and several other factors, developing multiple income streams can help you to create a more stable income. “By having the other income streams in place, I have been able to be less susceptible to the ebbs and flows that occur in private practice during difficult economic times,” says The Rev. Christopher L. Smith, LCAC, LMHC, LMFT. In addition to providing income stability, diversifying your professional activities with multiple income streams allows therapists to explore a variety of interests, to express creativity, and to get paid for their passions.

In addition to clinical hours, I own and serve as clinical director of a private therapy clinic where I oversee and supervise 10 therapists, write for PsychCentral and other publications, work as a relationship and emotional health media contributor, do public speaking, provide consultation to therapists building a private practice, and I’m currently writing my first book.  Curious about what other private practitioners are doing to add to income stability I reached out to several successful colleagues to see what additional income streams they’ve developed. Here’s a sampling of what other therapists are doing to diversify their professional life and achieve greater income stability.