When You Need to Think Like an Agency

Most counselors in private practice are accidental small business owners. They love the idea of having a private practice- the flexibility with scheduling, choosing their own clients, and the ability to have their own private office space.

However, they typically don't enjoy many of the business-related tasks with owning a private practice. They rarely think of their practice as a business but rather see themselves as a simple service professional. 

Regardless of the size of your practice, there are times to think like a business, and more specifically, to think like an agency. That's right- sometimes you actually need to think like an agency in order to protect your practice and also improve the work you provide your clients. 

You may be thinking "but I left an agency so I could actually do what I think is better work for my clients!" This is often true and the two ideas are not mutually exclusive. Let me explain...

Agencies have a lot of liability due to the fact that they employ people who are often dealing with complex clinical issues and safety risks. For that reason, they need to create policies and procedures, train employees on these P & P's, and regularly evaluate the effectiveness of the work they're doing. 

Now let's be honest. Some agencies do a really poor job of this. I'm not disputing that fact. However, the principles are excellent. They create a safety net when working in high risk situations and seek to provide guidance for dilemmas before they arise. 

Maybe you're sold on the idea but the thought of implementing sounds like a monumental task. Not so! Here are four things you can do to improve your psychotherapy practice that you can implement in an hour or less:

  1. Write out your sliding scale policy. This is an area that presents a lot of resentment and confusion for counselors in private practice. Many therapists decide on a sliding scale on a whim and few ever outline criteria for determining their scale or a timeline for reevaluating the client's need. Consider the clients who are currently on a sliding scale. Consider your ideal client population. How many sliding scale slots can you reasonably maintain and at what rate? Will you require proof of income/need? For how long will you provide the sliding rate? Answer these questions and bam! You've got a policy. 
  2. Write our your consultation procedure. Ethical dilemmas arise (and usually at the worst possible time). Client needs change and become more complex. In these circumstances it's important to remember you are not an island. There are many other professionals with whom you can consult. Documenting these consultations is important (read more about that here) so write out how you'll do that. Will your consultations be over the phone? Do you have criteria you feel is important to meet before you consult? Do you have certain people with whom you frequently consult? Are you part of an ongoing group for support on clinical issues? Answer these questions and bam! You've got another policy!
  3. Do a review of your client records. I frequently recommend this because it is so valuable. Choose 1-2 records and read through them in entirety. Do you get a good sense of the treatment you're providing? Do you get a good sense of the client's needs? The client's progress? Are there clinically significant things you notice you may be overlooking? This is a great exercise to do when you feel stuck with a client and this is something agencies do on a regular basis to ensure staff are providing good care... as well as keeping up with notes on a regular basis! Which leads me to the last recommendation... 
  4. Decide on a reasonable expectation for getting notes done. In private practice you are your own boss. For some people, that's not always a great thing. I find that one area many counselors behind in is writing notes. It's so easy to decide to just go home and make dinner instead of staying to finish notes. Then you enjoy some family time and go to bed (because you need your rest to write good notes). Then the next day something important comes up and then it's the weekend and your kids have activities planned, and so on and so on. One way to avoid becoming backed up is to create what your business would see as a reasonable expectation for getting notes done (hint: this should be within at least one week of providing the service). Write it down as a policy and stick to it like you're an employee. The key here is that you have the flexibility to make the policy work for you. So consider how that works for you individually and stick to it.

There you have it! Each of those tasks will take less than hour but will greatly improve your business status. They'll also help you to avoid a lot of anxiety-provoking situations and create stability for your practice. 

If you feel like this is still a bit overwhelming, consider booking an individual consultation with me. We can walk through the whole process together and get your documentation handled in no time! 

Leave a comment below if you've tried any of these techniques. What impact did it have on your practice? What lessons did you learn about yourself as a business owner?