It's not every day you get to talk with someone who has experience going into a therapist's practice and reviewing every aspect to make sure it's legally and ethically prepared for any and everything that might happen. That's why I was so excited to meet Mark Roseman and Dr. Steven Frankel of Practice-Legacy Programs. They focus on helping therapists prepare for transitioning or closing their practice... and everything that needs to happen in between. What an awesome resource!
Thankfully, they're not only a great resource but also two very friendly and generous guys. I reached out to see if they'd let me pick their brains about common things they see and they were happy to answer all my questions... and even give a free presentation download sharing more about setting up a professional will.
So, check out my questions and the answers from Dr. Frankel below... and prepare to take some notes!
Q: What common issues do you see overlooked when you work with therapists?
A: The ethical and legal requirements terminating a mental health practice, and, especially, the awareness that a successful practice is characterized by ethical planning for practice transitions due to death, disability or retirement.
The study of resilience factors: Resilience is important for clinicians to understand and to know how to assess. It is not typically taught in graduate training because of the mistaken beliefs that it is uncommon (and therefore not worth spending academic time pursuing), and that it is about psychological health rather than psychopathology. (Book recommendation, "Resilience and Ordinary Magic." Ann S. Masten)
How much to write in clinical records: We all are well-informed about the categories that must be covered in records, but there is little training about how to decide whether to write more vs. less. This issue is especially important in clinical (write less, I say) vs. forensic (write more, I say) records.
Practice Models: e.g., A group practice, the ethical and legal implications of being in a “formal” group vs. a group of colleagues who share office space, secretarial time, office machines, etc., but are not a “formal” group. There are considerable ethico-legal issues that arise around these issues.
The differences between being a consultant and being a supervisor. They don't teach us the difference between being a "consultant" and being a "supervisor." Under CA law, supervisors are liable for what their supervisees do, but consultants are not. Big issue!
Q: What is a professional will and do I need one as a therapist?
Basically, his answer was yes, you totally need one! Have no clue what it is or how to proceed? No problem. It's a larger topic than can be adequately addressed in a blog so Dr. Frankel provided this free presentation that you can download and share with your colleagues (yup, total permission to share away!).
Presentation download not good enough for you? Well, he also provided this video of him actually presenting all the material! You can hear questions from the audience and everything. It's two hours so bookmark this page if you don't have time now. And make the time to sit down with some coffee or tea and watch it this week!
Q: What are the steps to develop a back-up plan so another therapist has access to everything s/he needs if I am out for an emergency?
A: You would need your clients/patients to sign releases to allow another therapist to access charts. Your informed consent can include an emergency clause addressing this issue. The clause should be initialed by the client/patient.
Q: What things should a therapist consider when planning for an extended absence, like surgery or maternity leave?
A: Understanding the issue of patient/client "loyalty" in terms of potential client shift to temporary clinician, as an issue. The covering therapist must be competent to provide the same care you provide. Also, include language about temporary coverage clinicians in your informed consent (see last question).
Q: What recommendations do you have for a therapist who wants to sell off pieces of their practices?
A: Contact an expert organization, like Practice-Legacy Programs, as the issues that are raised are complicated. They involve practice valuation (which determines the value of the practice), practice brokerage (which brings potential buyers to the table) and transition models, such as: Does the seller retire? …Continue to consult to the buyer? ….Continue to practice as an employee of the buyer, etc? (And lots more questions you and I have probably never thought of!)
Good stuff, right? I can't believe all the helpful tools Dr. Frankel was willing to provide along with all the food for thought.
WARNING: Don't be overwhelmed by it all! It's so easy to feel paralyzed after reading an article like this and thinking about all the aspects you need to consider in private practice. And that's not the intention at all.
Yes, there IS a lot to consider but there's also a TON of resources available to you. So, if you need help making sure your clients are in the right hands after your practice closes (either expectedly or UNexpectedly) then head on over to Practice-Legacy Programs website and learn more.
If you're worried about other things, like marketing your practice or contracting with insurance, then head on over to the QA Prep Resources page and see what other awesome therapists are out there to support you. And post your questions or additional resources in the comments below.