Read an excerpt form Lynn's latest article, published by Psychotherapy Networker Magazine (July/Aug 2003).

One hot summer afternoon, John, a psychotherapist in private practice for 17 years, came into my office looking frustrated, complaining that his practice was going nowhere. Not that he didn't like doing therapy—he still loved it—but he felt stuck and frustrated in the practice itself. His income had barely inched upward over the past few years, he wasn't getting his name and practice out in the world as he wanted, and he felt increasingly overwhelmed by paperwork, as if the business part of his practice was running him, not the other way around. When I asked him to explain what he meant, he sighed and described the chaos of his office: journals, newsletters, papers, insurance forms, notes, bills and whatnot were stacked on the desk, the table, the chairs, the floor, to such an extent it was difficult to get around. "I know I'm really good at what I do, and I have dreams of expanding my practice and developing more of a reputation in my field," he said despondently, "but I can't seem to get organized to do anything about it. I thought I would feel more settled and directed by this age, but I don't."

John wasn't at all unusual among therapists. After all, psychotherapists don't go into clinical practice because they're such great business people. They want to be helpers and healers, not entrepreneurs. Although most therapists value the autonomy and income that a private practice brings, the business world and terms associated with it—such as profit, expansion, competition, even "success" itself—tend to make them uneasy. In short, as a profession, most therapists tend to regard business as alien to their practice.

That's not to say that therapists can't learn to become very smart business people. In fact, far from being a struggle against their own better instincts, or a betrayal of their own best principles, becoming more entrepreneurial can be deeply liberating and actually allow therapists to be more effective and less anxious, less psychically split between their "good" clinical practice and their "bad" business.

After John finished describing his frustrations and the rat's nest of paper that was his office, I asked him to mentally take a step back, so he could better examine not only the state of his practice, but his relationship to it. Therapists tend to over-identify with their practices. As sole proprietors, they frequently do everything and take every role in the business—clinician, CEO, administrator, bookkeeper, secretary, janitor. With so much of themselves wrapped up in their practices, it is not surprising that they tend to think they are their practices. This over-identification is one key reason why therapists often feel unhappy in business. When the business is up, their mood goes up; when the business falls off, they crash too. In their fused state, they often can't recognize the difference between what they want and what the business needs in order to succeed.

One way to help clients differentiate themselves from their practices is to ask them to imagine the practice as a clearly distinct entity from themselves—another person, so to speak. True, they created the business, but it is no more an undifferentiated extension of themselves than their own real-life child. "If your daughter needs braces," I sometimes say, "you don't refuse her orthodontics because your own teeth are perfectly straight." I asked John if he could talk to me about his practice as if it were a separate being with its own individuality, personality, needs and behavior.

He laughed nervously, but agreed to give it a try. "Should I make it a male or a female?" he asked.

"Your call," I replied.

He thought for a moment. "Well, my practice is definitely a she," he said. "She is timid and boring. She's also pretty rigid—she only knows how to do things one way, and she sticks to it, even when it's illogical. We've gotten along okay, so far; she's a familiar, safe presence in my life. But, I've known her for over 20 years and she never changes. I'm bored with her." John paused, looking ruminative. "It wasn't always this way. When we first met, I was thrilled by her—she got all my attention and energy. But, now, my attention is drifting. I want something more.

John suddenly reddened, looked at me, open-eyed, and barked out a laugh. "I sound like the world's biggest cliche! I get it now. I'm having a mid-life crisis," he said. "I want to have an affair, but it's not my wife I want to leave . . . it's my private practice!"

The great thing about working with therapists is that they frequently get the picture very quickly. John looked out the window for a long minute. "This is ironic," he said, a little sheepishly. "I specialize in working with couples, and here you are reminding me that when you are in a relationship for a couple of decades, even a relationship with your business, things change. The question for me, I guess, is what the changes mean and how they will play out. Will I need to leave this timid, messy lady—and all that we have built up together over the years—in order to get what I want now?"

We looked at each other and smiled. "Welcome to business ownership at mid-life," I said.

Finding a Road Map

With the therapists I see struggling with their relationship with their own practices, a broader developmental framework is crucial to helping break up the emotional logjam keeping them stuck. It's extremely useful to recognize the characteristic themes that consistently emerge in the early, mid-life, and mature stages of any small business. In the early stages, owners are consumed by survival, competition, and stabilization. During the mid-life stages, issues including organization, expansion, and achievement take center stage, while during more mature stages, the officially "successful" businessperson focuses on renewing personal values, finding more affiliation with others, and incorporating a greater sense of integrity.

The developmental model I use in my business coaching with practitioners like John is adapted from Spiral Dynamics, Don Beck and Christopher Cowan's book on social and organizational evolution, which, better than any work I know, highlights the specific objectives and tasks that need to accomplished at each of the eight color-coded developmental stages of business development. The Beck and Cowan model can help people recognize the stage their business is in and organize themselves to better meet the distinctive challenges before them.

Any beginning entrepreneur, including a therapist, in the first (beige) developmental stage is primarily concerned with survival. Clients in this stage typically complain of feeling insecure, panicky and clueless about what to do next in order to keep their business viable. Inexperienced and driven by anxiety, they operate mostly on instinct; the best way to help them is by teaching them to replace instinct with clear intention and thoughtful planning. I usually begin by helping them devise a business plan, which leaves as little as possible to random chance. This might mean writing down their short-term goals and long-term vision for the practice, deciding specific networking steps to take and how many hours each week to network, scheduling time to consult a financial advisor or a computer expert if needed, and creating a circle of professional support, such as meeting regularly with other therapists who can be a source of guidance and encouragement.

These suggestions are often met with surprise and resistance—"it will cost too much money," "I don't want to get all these other people involved." "I should be able to do this stuff myself," are the excuses I hear. It always amazes me that clinicians invest freely and generously in their own clinical growth—paying for clinical supervision, taking advanced training courses, attending workshops, buying textbooks—but consider investing in their businesses a kind of unnecessary extravagance.

The second, or purple, stage often reflects a superstitious, even magical way of thinking, and parallels cultural eras when people still feel dependent on rituals and traditions, often without practical or rational basis. At this point, a business may be surviving, but the entrepreneur has no idea of what he or she is actually doing that makes the thing "go." Not knowing how to keep on being successful, they tend to cling to comfortable old rituals and habits, almost from a sense of dread that if they change anything, the success will go away. For example, one therapist told me he had four different bank accounts in three different banks and randomly deposited his client's checks each week into all of them. "Why?" I asked him, and suggested that consolidating them would make better financial sense. He shook his head and repeated doggedly that this system just "worked" for him up until now, and things might not "work," if he changed it. Several therapists have told me that when they lose clients, they believe that if they don't allow themselves to worry and just visualize "abundance," new clients will show up. They insist that if they think about their situation too carefully, it will stop the flow of clients. Many clinicians have no idea how clients discover them, where the referrals come from; the appearance of new clients remains a vast mystery to them—a gift from heaven. Not knowing what they have done to get clients in the first place, they don't know how to keep doing it.

Helping these therapists unravel the myths and mystery of business and implement practical, concrete strategies, while they learn the real-life laws of cause and effect, empowers them. They feel less anxious as they see that can take steps to create their own business destiny. Writing business plans and setting goals, determining how much they want to earn and how to best to set and raise their fees, deciding what their policies (about cancellations, for example) are and what factors determine client retention, knowing how to effectively market, network, and other ways to generate referrals—all this information can help them understand how a therapy business works. Such steps normalize business operation, make it less confusing and help them become savvier entrepreneurs.

Finally, in the early stages of a business's growth, there is the red stage—what is referred to by Beck and Cowan as the egocentric phase, when a strong sense of individualism and selfhood comes to the fore. With survival secure, clinicians begin to have some practical sense of what they need to do to keep their businesses afloat and start concentrating more on staking out their own professional identity in the world. At this stage, a proprietor knows she has developed something substantial, worth protecting and preserving, and begins to look around at all the potential external rivals there are out there—how many others in her area also specialize in addictions, or adolescence, or couples' counseling? How is the clinician going to stand out from the throng?

Therapists often have a hard time with competition. While it seems perfectly normal for a car salesman to be competitive, it feels perverse to therapists, who are not happy to find themselves thinking envious thoughts about colleagues and obsessing about how they can get ahead of the pack—it sounds so narcissistic and unbecoming in a mature, selfless healer!

On the other hand, because clinicians often don't understand the normal mindset of an entrepreneur or how to accept themselves as competitive beings, they may overreact to the presence of perceived rivals. One therapist I saw had identified a colleague in her area, with similar credentials, professional history and specialty, as someone she needed to match and keep up with, step for step, as if her own career somehow depended upon how her colleague did. She found herself trying to second-guess the colleague—angling to present at workshops where she thought the other therapist would also present, for example. What helped her negotiate this particular stage was re-focusing on her own personal vision for her professional life, re-connecting with what it was about the work that she loved, what she wanted for her own career.

Mid-Career Issues

When John described the chaos of his office—journals, papers, insurance forms, and whatnot stacked on the desk and the floor—and showed me his old-fashioned calendar with a jumble of scrawled names and appointments, I knew he was having trouble negotiating the fourth (blue) developmental phase, which focuses on organization. People at this mid-life stage need to create a strong, more functional business structures to support their dreams of enlarging their business and becoming more profitable. John's frustration came about because he wanted to move on to branching out and pursuing greater opportunities, but he hadn't completed the tasks required by the blue phase his business was in. He had ideas and dreams, but didn't have the structures in place to make them happen.

Although people have to learn to realize that their businesses stand alone as separate entities separate from themselves, it is also true that because people's businesses are their own creations. They necessarily reflect key strengths and weaknesses within them. However distinct your children are from you, undoubtedly they also reflect your genes, your values, your capacities as a parent. At times, the easiest way to help a therapist change a problem in his business, is to see if he can make a similar change first, in himself.

I told John that he needed to think of his business as a mirror of himself. What was it in his life, or in his childhood, that might contribute to the mess of his office and the paperwork that was essentially drowning him? John said he had never been a well-organized person. As a young child, his parents had moved many times. Again and again, he had been uprooted from familiar surroundings, friends, schools, leaving him feeling that nothing ever really belonged to him. Nothing, that is, except what he could physically carry with him from house to house, region to region. Rather than teaching him to pare down his belongings and travel light, the constant moves made him ferociously attached to his "stuff." Once John understood the connection between the origins of his pack-rat mentality and their effects on his business, he could begin, with difficulty, to take steps to change the latter. Reluctantly, he admitted that this problem was more entrenched than he thought; he needed to bring in someone to help him fix it and agreed to hire a "clutter consultant," a professional he found in his local paper, who came to his office and completely de-cluttered and re-organized it.

John focused on other "blue" issues of organization, including how to use what I call a "practice upgrade plan"which encourages proprietors to build into their daily schedules time for planning and actions that will strengthen their practices' long-term prospects. For example, this is the stage for a therapist to decide his top five business goals for the next year, and to take one action every day toward these goals.

After several months, John found, to his delight, that his business was easier to operate: his billing was done on time each month, he had collected past due receivables, and his clean office and new, computerized calendar made his weekly administrative tasks a breeze. With his new-found energy, he was ready to move into the fifth (orange) stage and focus on expansion and achievement. John was jumping with at least three new ideas each week for expansion that interested him. Once people acquire a new set of eyes for gazing on a new world of sparkling possibilities, they also need a filter for sorting all those opportunities. I suggested that he develop a set of six questions that would help him evaluate each potential opportunity. His set of filtering questions were:

1. Is it, or will it be, profitable and when?

2. Will this allow me to do better work as a therapist?

3. Will I have fun doing this?

4. What's my gut feeling about this opportunity?

5. What do I gain if I say no?

6. What do I gain if I say yes?

How did these questions help him sort through the onslaught of possible opportunities? One of John's colleagues who had many legal contacts had built a practice of couples therapy with court-referred families. He asked John to join him in setting up a partnership to offer workshops and training for other mental health therapists to the same kind of court-referred counseling. The colleague said the referral rate from the courts and lawyers was substantial, but many therapists didn't know how to do strategic, effective counseling with this population; he and John would show them. Using the six questions above, John thought that it could be very profitable, but not without two years of hard work and marketing. He was expert in couples counseling and enjoyed training others, but decided that this project, while interesting in itself, would not actually help him become a better therapist. As to whether it would be fun or not, John said, "I'm not sure. I like the guy quite a lot, but the 'fun' part of the deal would probably be outweighed by the sheer drudgery of getting it off the ground." What would he gain from saying no? More time to pursue interests that he really knew he liked. What would he gain from saying yes? Possibly a new income stream—training could be a good profit generator down the road. In the end, John decided against it—the negatives seemed clearly to predominate.

Marketing is a daunting word for therapists, who generally loathe any suggestion of self-promotion. To help them conquer this hurdle and begin taking various marketing steps—networking, becoming involved in community activities, teaching courses at local adult ed colleges, writing articles for local newspapers, etc.—I imbue them with the basic principle that should undergird all their business-building efforts. Base your actions on love, not fear. Fear-based marketing, for example, would be a therapist grimly settling down to make phone calls to people he doesn't know well, detesting the whole process and saying, "I loathe doing this, but if I don't, my practice won't survive." We talk about these feelings, and I typically ask, "Is it possible to imagine a way of doing this that might not seem so bad, might even make you like it?" Generally, we get to a discussion of the clinician's love for his own work and pride in his vocation, his deep belief that he does have something good that will truly help people, his realization (beneath the reluctance to make the call) that the person he is calling might be glad to hear about what he is offering and welcome collaboration.

One clinician trying to grow her practice who I worked with called an oncologist she knew. She told the doctor how much she admired him and his reputation for kindliness and patience with patients, and wanted to let him know that one of her own specialties was working with very sick people and their families. This clinician made the call in a spirit of love for her work, for the good she knew she could do, and from a conviction that she and the physician might make a very good team. The doctor felt both flattered and receptive—here was someone to whom he could refer people for the kind of help he did not have the time or expertise to give.

At this heady stage of entering orange territory, feeling an upsurge of personal power and emotional zest, many therapists—but not many conventional businesspeople—become aware of a small, tough little worm gnawing away at their euphoria, signified by the words "ambition" and "profit." These terms, along with "competition," so normal to the business world, are often psychological anathema to therapists. John, for example, would be energetically talking about potential new opportunities when suddenly, looking crestfallen, he would say something like, "Boy, I'm beginning to sound like a real estate developer, not a therapist."

I asked him, just as I had about his messiness, what it might be in his family of origin that made him so uncomfortable with ambition and profit. "My father was in sales and worked for a variety of bosses," he began. "He often complained about his current boss and how owning a company gave a person a swollen head. When I try to stretch too far in the direction of seeing this as a real business and making more money, I can hear my father saying I'm getting too big for my britches and setting myself up for a fall."

I often invite proprietors to "embrace their ambition"—clearly a tough sell for therapists, who think that too much emphasis on ambition and profit signify self-absorption and greed. So, I suggest to clinicians that they think of ambition as a kind of emotional fuel, a motivating force that frees their passion, imagination and creativity. Ambition is really a synonym for desire, emerging from the same impulse to move forward that helped get them through school and into training internships and, finally, into their own private practices in the first place. I suggest they ask themselves what they fear about ambition, and then to allow themselves to do a little daydreaming about their ideal future. What, no matter how apparently improbable, grandiose or Walter Mitty-ish, would they most like to see happen to themselves and their businesses? They don't have to act on every ambitious thought or fancy, but allowing their minds to wander in this way helps detoxify ambition and gets them in touch with their own aspirations.

Evolutionary Stages

After orange, there is another set of latter-life evolutionary stages, with its own phases, beginning with green, which represents a move toward the integration of more humanistic values into one's worklife, the desire for deeper personal and even spiritual connections, a yearning to experience again the soul-deep inspiration that brought them to the work in the first place. People signal they are ready for this stage when they complain that, for all their material and professional success—the practices (perhaps several offices) purring along at full occupancy, the workshops they are asked to conduct, the book chapters they are writing—they feel something lacking. Green is the color of congruence—when any incongruity between professional success and personal identity becomes painfully obvious.

John, who was exuberantly enjoying the world of prospects and achievement after having been in a safe, but confined business situation for a while, would not be ready to shift into the next, green stage. But another client, Clara, is experiencing "symptoms" of green. Clara, a social worker, with many years of experience, no longer sees clients. Instead, she owns and operates a healing center that she built from a one-person business to a prosperous 15-person organization housed in a large commercial property that she owns in a busy Midwestern suburb. She employs mental health professionals, as well as massage and physical therapists. Clara is an excellent businesswoman and a natural marketer, who actually enjoys calling total strangers to talk about her practice—she considers each call a kind of adventure into the unknown.

But, when Clara called me, she said that, in spite of her obvious success, she was feeling dissatisfied and burnt out. She felt tired much of the time, and though she had a heavy workload, she thought this tiredness was from feeling increasingly less personally connected to what she had built. More and more, she felt less like a healer, with a real gift for connecting with people in pain, than like the harried CEO of, say, an expanding widget manufacturing plant. "As each year goes by, I feel less sure about my direction," she said. "I'm always marketing, planning or thinking about some business problem—staffing, expansion, leveraging our space needs or looking for increased areas of profitability. I wanted to create something meaningful with this center, something that would genuinely help people and contribute something to the community. I've done that, I think. But, I have lost the sense of what it means to me."

"And besides, " Clara said forlornly, "I feel lonely. I don't know any nearby therapists in my situation that I can talk to for support. All the professional clinicians I know imagine I couldn't possibly have any complaints or needs. It sounds like a joke, but I am a case example of 'lonely at the top.'"

The objectives of this stage usually include building a deeper community, relaxing old boss-employee hierarchies by sharing more power, taking steps to renew the old passion and exploring the spiritual dimensions of identity. For clinicians in this stage, I have created a check list of 60 evocative words that elicit core values—including, for example, "creativity," "learning," "enlightenment," "sacredness," "compassion," "adventure," "inspiration," "accomplishment," "understanding," "wholeness," "connection," "fairness," and the like. Therapists are to pick their top four, which they feel define them and their work at some fundamental level. Which words, I ask, draw from them an almost automatic sense that "this is really me"? Next, we look at whether these values are now reflected in their practice. What would bring more passion into their work lives? How can they make their professional lives more deeply congruent with their deepest values? Because the hallmark of coaching is to help people take action—not just speculate about personal philosophies—together, we work on concrete steps to bring their practices more in line with their ideals.

Since one of her core values was "healing," Clara began to realize that she missed the 'hands-on' experience of doing therapy. So, she hired a part-time operations manager to take on some administrative tasks, freeing her to see a few clients every week. At the end of the year, she reported feeling exhilarated again about her work, rediscovering her fascination and passion for doing therapy itself. During this time she also created a professional network of ten or twelve business leaders who met regularly to talk about their concerns, and a smaller, more intimate circle of four or five entrepreneurs who became friends, as well as associates. Clara now felt the "connecting" instincts that drew her to the field in the first place had been given new birth.

There are two stages beyond green—yellow and turquoise—which represent, each in its own way, a leap into a different, transcendent kind of thinking and feeling about work and professional identity. The yellow stage—a phase of deep creative regeneration—occurs when a seasoned, mature, successful entrepreneur makes a profound life change and breaks away entirely from his or her old route to explore pioneering territory, just for the sake of newness.

At one workshop, for example, I asked attendees to each simply talk to the group for a few minutes about their practices—where they felt they were in their career trajectory. After several practitioners had spoken about their aspirations and frustrations—most were in the early and middle stages—one woman raised her hand and said that she and her husband had built a very successful group practice. "I feel now that I have achieved every professional goal I set out to achieve—including what many here today are still seeking," she said. "Now, I am ready to do something completely different. Next year at this time, I know I will no longer be associated with this practice. I don't yet know exactly what it is I am going to do—though I've got some ideas—but I know it will be a departure. My husband and the group are not happy about my decision, but I feel very deeply that it is time for me to go off on my own, in an entirely new direction." As she spoke, the room became very quiet—she was clearly at a different crossroads than any of the others. A therapist at this stage is willing to intentionally provoke some chaos, relying on her flexibility and the synchronicity around her. Her knowledge and competency as a therapist and businessperson are retained and integrated as she ventures into this new phase of life and work.

The last stage is denominated the rarefied turquoise stage, an idealized "holistic" domain in which people can experience a serene sense of flow about their professional life.

Marla, a psychologist in private practice for a decade, says that there are months at a time where she feels that her therapy business operates effortlessly. In the early years she did a lot of hard work—making contacts, finding the right office, getting her policies to reflect her values, building her reputation and her skills. She joined associations to get her name out there, spoke at any conference that would have her, and learned how to fill a practice with referrals so that she could side-step managed care and stay independent. "My practice stays as full as I want it to be," she says. "I make good money. I love the clients I work with. I love the work I do. I get to take whatever training appeals to me to stay fresh and motivated. I feel very connected within my community and have a lot of professional support around me. I don't have to hustle or promote myself in any way. Good referrals come in regularly, from all the contacts I so carefully made in the past. I can be very selective and only see clients I want to work with. After a long day of seeing clients I don't feel drained. Instead I feel full, as though I just finished a very satisfying gourmet meal."

Meanwhile, back on planet earth, we therapists are mostly still trying to reconcile the ethics and values of our chosen profession with what we often feel are the unsavory truths of the business world. And yet, it is the business itself, our own business, that—in this world—gives us the most freedom to practice our vocations with the greatest degree of integrity and personal choice. As therapists, we often consider ourselves to be masters of change. If we can begin to see that our businesses are themselves evolving organisms, with their own identities and strengths and weaknesses—just like our clients—we might be better able not only to master the process of their change and development, but to enjoy watching them—and ourselves—grow.

Copyright by Psychotherapy Networker and the author, 2003; all rights reserved.

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