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"Building Your Ideal
Private Practice:
A Guide for Therapists and Other Healing Professionals" By Lynn Grodzki
Preparation
Chapter 2. . . . . . . . . . .Now You Have a Business Coach
Chapter 3. . . . . . . . . . .Support and Optimism
Chapter 4. . . . . . . . . . .The Aligned Vision Process
Chapter 5. . . . . . . . . . .Entrepreneurial Mindset
Building Blocks
Chapter 7. . . . . . . . . . .Generating Referrals
Chapter 8. . . . . . . . . . .Making a Small Practice Feel Bigger
Chapter 9 . . . . . . . . . . .The Impact of Adding Value
Chapter 10 . . . . . . . . . . .Why Good Therapists Go Broke
Finishing Touches
Chapter 12 . . . . . . . . . . .The Personal-Growth Model
Chapter 13. . . . . . . . . . .Holding Onto Success
Appendix
You're in private practice, or ready to start one. You love the work you do with your clients. But today, loving your work and being a talented professional isn't enough to insure the success of your practice; you also need to be an enthusiastic, talented businessperson as well. As a business coach who specializes in helping therapists and other healing professionals achieve success, I want to show you how to build an ideal practice--one that is both highly profitable and personally satisfying at the same time. The notion of having an ideal practice that is simultaneously profitable and satisfying may seem like a pipe dream when you are wondering whether your practice can withstand yet another slowdown in client referrals, increasing professional competition, or an unpredictable economic marketplace. Overcoming the challenges you currently face in order to build a thriving practice means knowing what to do, but more importantly, it means knowing who to be. By who to be, I mean taking a frank look at yourself and making some necessary shifts in your thoughts, feelings and behaviors so that you become an alert, savvy, skillful businessperson. From this position it is easy and natural to take the steps to create the private practice you desire--your ideal practice. My goal is to help reinforce your business awareness by showing you ways to strengthen your emotional, cognitive, and strategic capacities. During the past four years I have coached over six hundred "therapists" of all persuasions--a diverse range of practitioners including physicians, psychologists, social workers, counselors, personal coaches, nurses, energy healers, chiropractors, massage therapists, physical therapists, acupuncturists, and body workers. (For the sake of simplicity, throughout the book I will use the terms therapist and therapy generically to connote a wide variety of professionals and their professions. When I use these terms, please know that I am speaking to you, regardless of the nature of your professional training.) In the process, I have learned one undeniable fact: How your practice performs is an accurate reflection of you, as the owner. It will be strong where you are strong and weak where you are weak. Taking an honest, careful look at your existing practice will show you precisely where you need to make changes within yourself. My job is to show you how. Throughout the book, I will show you how you can make changes:
If you are like many other therapists I coach, you will notice that the more you change in these directions, becoming a stronger businessperson, the more your practice improves, becoming more profitable, organized, and resilient. You will attract quality clients, retain them longer, and run a smoother operation. Your list of complaints will shrink as you resolve your business problems with less stress. You may find that with your practice in such good shape, you relax and do your best work ever as a therapist. All of this is a natural progression, based on making specific changes within yourself that get reflected in your business and your craft. Along the way, you will probably recognize that you have refined your ability to stay focused and remain optimistic, even when others worry. And these days, in the workshops and classes I teach, I meet too many talented professionals who feel very worried. I hear this worry at the start of every practice-building workshop, when I ask the therapists attending to introduce themselves. "Share the major challenge you face regarding private practice today," I request. Then I hear a lot about what is going wrong: "I've tried everything I can think of and my practice is still not growing". "I need more clients who can pay my full fee". "I hate the idea of having to market my services." "I think I do good work - why can't I maintain a full practice?" "I'm doing okay today, but what about next month" "The competition in my area is fierce. I can't keep up." "I'm brand-new and I feel totally overwhelmed--how do I even get a practice started?" "Managed care has cut my income in half--I'm desperate." "I'm worried that I'll have to compromise who I am and what I value in order to make a living." "I'm not business-minded and I'm not making enough money." As participants continue to speak, I see others in the audience begin to nod their heads in agreement as one by one, they voice their concerns: isolation from peers, the breakdown of traditional referral networks, increased paperwork, and stagnant fees. Some, at the beginning of their careers, wonder how they'll be able to make a living; others with more time in practice refer nostalgically to the "good old days" when private practice seemed so much easier. "I feel frightened. I've been in practice a long time. I do good work and I hate having to change what has worked well for me. It's not much fun to be a therapist today. I'm thinking of leaving the profession." "I'm afraid of losing clients if I increase my fees. My overhead is up, my profits are down. I don't understand how to make money at this business." "At every professional meeting I go to, I hear people talking about how it's only going to get harder to survive in private practice. I'm scared. This is taking a lot more work than I thought. Maybe I'm just not cut out for owning my own business." There is a heaviness in the room, an undercurrent of hopelessness and frustration. "Why do you think you are facing these particular challenges at this particular time?" I ask. Now everyone comes alive, ready to offer opinions. Some lament the public's negative perception of their profession; some berate themselves for not knowing more about how to run a small business. Others cite territorial battles that pit groups of practitioners against each other, the lack of public awareness about their areas of expertise, or too little support from their professional community about practice building. Many point to the destructive effects of managed care. As I listen to the group wrestling for explanations to their dilemma, two themes emerge. The first theme, voiced by therapists who run their business within a medical model, speaks to the dramatic shift in current market forces. If you rely on insurance or managed care to fund your services, you are well aware of this shift. Everything about the way your business operates is changing. I call this the "Oz" syndrome. In the movie The Wizard of Oz, a tornado is bearing down upon Dorothy and her dog Toto. Unable to get to the root cellar for protection, they huddle in the farmhouse. The tornado lifts the house into the air and carries it a long ways, until it crashes down, depositing them in a new land. Dorothy and Toto crawl out of the house and look around. The film, up to this point photographed in black and white, has now turned to Technicolor. The landscape is surreal and fantastic. Dorothy shakes her head and utters that classic phrase: "We're not in Kansas anymore, Toto." Those who operate within a medical model similarly find themselves bewildered by the new, chaotic economic landscape managed care has wrought. Gone are the days when generous insurance adequately subsidized therapy sessions. Today a therapist in private practice faces the choice of working under contract for a profit-minded insurance company and accepting whatever fees and conditions the company decrees, or finding clients who pay out of pocket. You may see this development as either the good news or the bad news for therapy. From my viewpoint, as both a psychotherapist in full-time practice for over a decade and as a business coach, I see the increasing restrictions that managed care puts upon therapists as potentially good news for the profession of therapy, if these restrictions encourage frustrated therapists to step away from the managed-care model of business altogether and eliminate their dependence on insurance payments. I believe that as more therapists in private practice decide to operate outside of managed care, the profession of therapy will shift away from a medical model, and therapy will become primarily a service-oriented business. Over time, therapists will learn to be more fluent within the business landscape; as a result, the profession of therapy may finally emerge from the shadows and come into the light, achieving a greater level of acceptance from the general public. Up until now, therapy has been a misunderstood, mysterious profession. We therapists speak about our work using jargon and citing psychological theories that the general public often finds confusing. But if therapy becomes a fee-for-service business, therapists will be forced to explain, in clear language, what therapy is, how it really works, and all the benefits it produces. More responsibility will shift to each therapist in private practice to become an educator as well as a clinician. If you accept the model of a therapy practice as a service business, you will become more businesslike in your approach. You'll learn to articulate who you are and what you do in words that the average person can understand. You'll connect more with your public, finding out what people really want and what they will gladly pay to receive. You'll need to produce tangible results. If therapy competes in the marketplace as a service business, the mystery, taboo, and vagueness of our work may finally be replaced with a broader public understanding of the value, importance and logic of therapy, including psychotherapy, alternative medicine, and other forms of mind/body/spirit healing. When this happens, therapy will be publicly recognized as a necessary, at times profound, educational method that teaches us how to be more fully human and live an optimum life. For this reason, I believe that the market forces that are shifting therapy out of a medical model into a personal-growth business model are potentially good news for the profession. But you will only see this as good news if you enjoy operating your own business. This brings me to the second theme: Why do therapists face so many challenges in private practice today and why are therapists of two minds when it comes to running their own businesses? Do you believe that working in a helping profession precludes you from combining personal satisfaction with financial success? If so, you are struggling with a split in your psyche in regards to your practice. Let me demonstrate how this split works. Why Therapists Fail in Business Can you remember why you became a therapist? When I interview therapists about their choice of vocation, I am reminded that the root Latin word for vocation is vocare, meaning to call. Many therapists felt called to their profession. Often they had a personal experience with therapy that profoundly changed their lives; they chose the profession in order to pass on their healing experience to others. This was true for me. I left a successful career in the family business to go back to graduate school at some sacrifice, because I really wanted to become a therapist. Therapy had changed my life so dramatically that I wanted to help others in a similar way. In my workshops and classes I often ask therapists how they felt called to become a therapist, and many touching, wonderful stories emerge. As they speak about their calling the room fills with love, their love for their profession. Then I remind therapists that one definition of business is "profit-making," and ask how many felt called to make profit. Usually this request is greeted with startled laughter. No one in the room has a touching story to share about that. They didn't become therapists in order to be in business. Recently when I asked a group of therapists to give me a word that described their feelings about business, one brave soul stood up and said, "Would hate be too strong a word?" Now do you understand the split in your psyche in regards to private practice? You may love working in your profession, but hate working in your business. You may feel that your role as a therapist conflicts with your role as a businessperson. This split makes sense in light of our cultural stereotypes about business; in our society, we hold a stereotype about the kind of person who succeeds in business. This person is ruthless, manipulative, loves power, and places the need to win above the need to relate well to others. Think of the maxim, "It's nothing personal, it's only business," which is often used to justify callous business behavior. This stereotype poses a problem for therapists. We know, first and foremost, that our work is highly personal. A successful outcome in therapy rests on the personal relationships we create with our clients. For this reason, we tend to excel in the skills of insight, listening, and empathy. We want to heal others, not harm them. Anything that threatens building good relationships with our clients threatens our clinical results. So we may believe that paying too much attention to our business makes us cold and hard, i.e., un-therapeutic. The split between therapy and business becomes evident in the way that therapists make peace with their mixed feelings about business, saying, "You have to take the pros with the cons." The "pros" refers to the sense of freedom and self-determination that comes from being your own boss. Having a private practice offers a wonderful degree of autonomy and independence not found as an employee. The "cons" mean the inevitable tasks any practice requires, including organizing, marketing, practice management, setting and keeping business boundaries, networking, budgeting, setting fees, collecting fees, raising fees, and overseeing policy--basically keeping the business growing. This notion of the pros versus the cons illustrates a core problem that many therapists don't understand: Learning to love operating your business ultimately will allow you to be a better therapist and to work at your craft with a higher level of integrity. Unfortunately, I see many wonderful, talented professionals failing in private practice in small and large ways, as they wrestle with this internal conflict. As their practices flounder or stay marginally profitable, therapists wonder where they have gone wrong. A Strong Practice Four years ago I attended a course on marketing for therapists. Over one hundred therapists filed into a hotel conference room on a snowy morning and listened for six hours as the speaker gave lots of ideas and how-to advice. I thought it was comprehensive, uncomplicated business advice, but I noticed how many therapists ended the day looking confused and disheartened. Some left the room early, but I couldn't tell if that was due to the snowy conditions or their difficulties with the content of the class. Months later, each participant received a list of the names and addresses of all those who had attended. I asked two colleagues to help me run a focus group. We invited those paricipants in my local area to come for coffee and bagels and talk about how they were doing in their practices. Thirty therapists came to talk. None could point to substantial change in their practices as a result of the course. Most said they hadn't been able to use the marketing ideas to their satisfaction. They might have tried one or two techniques but they soon gave up when the results weren't as promising as they had hoped. They rejected many ideas as being "not quite right" for themselves, but didn't know what to do instead. They didn't have the necessary skill sets to address their current business problems and found themselves mired in negative thinking. As we listened and probed for more information, I felt concern for these therapists, who desperately wanted to improve their practices, but still didn't have a systematized approach that worked. I decided then and there to design a program targeted to therapists like those sitting in my office--trained, experienced clinicians who were getting nowhere with traditional marketing approaches. As I thought further, I recognized that those thirty therapists were missing three essential elements to running a successful business: 1.They lacked some key personal qualities that help you succeed in business. No matter how much information or advice I might give you about business strategies, if you are lacking in these qualities you will not be able to consistently bring in clients, achieve your financial goals or set good practice policies. I understood that a business coaching program for therapists would have to begin with a focus on personality--shifting who you need to be, not just what you need to do in order to have a successful business. 2.These therapists did not know enough about business. They didn't know basic business concepts, much less the innovative ideas that are shaping the market today. They needed a very adapted form of business coaching--one that would use metaphors and anecdotes they could relate to, those tailored to their specific needs and sensibilities. They also needed to learn a series of step-by-step marketing, financial and administrative strategies that directly enhance a therapy practice. If knowledge is power, their practices were severely underpowered. 3.They didn't recognize how to bring craftsmanship into their businesses, how to polish an ordinary practice and make it shine. Many of them worked too hard without results, spinning their wheels in the wrong direction. They needed to know some tricks of the trade, those finishing touches that experienced, successful therapists use to make the business of therapy easier. I realized I had three categories of coaching to do with therapists, to help them put these elements in place. The first category I called preparation. It represents the key personal qualities and mindset that prepare you, the owner, emotionally, mentally, and conceptually to become a strong business person capable of building an ideal practice. The second I called building blocks. It includes all of the hands-on tools, strategies, plans, and essential information that result in a profitable, well-run business. The third I called finishing touches, those finely honed, craftsman-like touches that add sparkle and distinction to a practice. Unconsciously, I drew on the terms of construction--preparation, building blocks, and finishing touches--to organize my thinking about practice-building. This makes sense when you know that I am married to an architect, and as a result hear a lot about building and design. But I have seen that over time, this metaphor has helped the therapists I coach to recognize the many similarities between building a strong house and building a prosperous, lasting private practice. I am going to expand this metaphor by walking you through the five steps of building a house and then show you how each step contains an important message for you about how to build or re-build your therapy practice. These five steps are your blueprint, and constitute a solid approach to practice-building whether you are starting a new practice from scratch, renovating or diversifying an existing one that needs attention, or simply insuring that a well-functioning practice continues to stay strong over time. A Well-Built Private Practice Here are the five basic steps of building a house: 1. Assess the site 2. Draft the design 3. Lay the foundation 4. Erect the framework 5. Add the finish Now let me show you how each of the five steps relates to building your ideal practice. 1. Assess the site. Building a house requires preparation. Long before the builder ever picks up a hammer and nails, the owner and architect have a number of steps to take. They visit the property where the house will stand and look at the lay of the land, seeing how to position the house. A house can sit many ways on one site. Some ways will offer maximum support for the building; some will cause it to slide and shift. The architect and owner walk over every inch of the site, measuring carefully and looking at site plans to make sure that the ground is strong. They don't want to encounter any unfortunate surprises that will undermine the finished house. The earth needs to be level, with weak areas shored up in order to have a solid surface that can hold the weight of the building. To build a strong practice, you need sufficient support underneath you, as the business owner, to keep you emotionally level, thinking straight, and feeling capable. We will assess how well prepared you are to withstand the emotional stresses and strains of running a business. Without enough positive support you may shift and tilt, lose your commitment to your business plan, or find that an underlying weakness in your resolve erodes your best efforts. Chapter Two begins the preparation, showing you how to get ready to make some changes--in this case becoming a better business person--by becoming an "ideal business coaching client". (In Chapter Two I also show you how to use this same preparation technique with your clients, helping them to become "ideal therapy clients" so that they can get the most out of their therapy with you.) Chapter Three explains in detail how you can create a powerful internal and external emotional support system to manage the sometimes bumpy nature of private practice. I will teach you two effective techniques to help you ride out the inevitable ups and downs, including how to lessen negative beliefs that block you from following through on your business goals. Message for the therapist: To build a lasting business, put sufficient emotional and professional support in place. 2. Draft the design. The design for a house is both a vision and a working plan. As a vision, it incorporates the dreams and needs of the owner. A poor design means the owner will feel unsatisfied living in his own home. A good design will enhance the owner's well-being and let him function well. A great design inspires the owner, bringing an element of spirit into the dwelling. As a working plan, it instructs the builder on specifically what to do and how to do it. The best design for your private practice is a business vision. Properly drafted, your business vision is much more than a daydream--it's a living, breathing picture of your future. In Chapter Four I will take you through the aligned vision process, a unique method of creating a vision that I developed specifically for therapy business owners. This will help you to align the direction of your future practice with your core values. You will learn how to identify trends affecting your practice and to pinpoint your strengths as a therapist. Having an aligned business vision will help you to know what decisions to make to have an ideal practice and give you a detailed plan for moving forward. Message for the therapist: Design an aligned business vision that gives your practice direction and purpose. 3. Lay the foundation. The larger the building project and the more difficult the site, the deeper the foundation needs to be. The foundation provides the reinforcement that the house needs to stand straight and last over time. Even if you are not building a new home but renovating an existing one, the first place to check before starting to build is the foundation. A poor foundation will cause a house to sink; walls may crack. A strong foundation means the house will endure, with few problems, for a long time. You need a strong, underlying foundation to help you firmly establish your practice. Your foundation is your ability to think like a businessperson--staying focused, optimistic and resolute. With this thinking in place, your practice will stand straight. In Chapter Five, I will show you how to develop an entrepreneurial mindset--to see opportunity instead of problems and to stay focused on the future of your business, instead of the past. We will look at what you can do to overcome the barriers the public faces in using your services and how to tap into a powerful resource, your "inner entrepreneur." Message for the therapist: Develop a strong foundation for your practice by adopting an entrepreneurial mindset. 4. Erect the framework. With the site prepared, the design in hand and the foundation in place, the builder begins to erect the framework of the house. Each board is measured, cut and nailed into place. The steps of construction are logical and methodical. The builder looks for the most efficient ways to carry out the architect's design. As each room in the house gets constructed, it represents a series of thoughtful choices about the allocation of materials, money, space, and resources. As you may know, there are many frameworks you can use to build a private practice. There is no one "right" way to set up a practice; it's only a question of finding your ideal way. To help you make your own thoughtful choices about the construction of your practice, I have given you over fifty proven, practical strategies and action steps showing you how to custom-design a business plan, generate an abundance of referrals, expand, diversify, add value, set good policies, make more money, and even build a practice you can sell when you decide to retire. Each strategy is based on a logical, methodical process, adapted for a therapy business. Chapters Six through Ten include all the practical "how-to" ideas, illustrated by case examples, so that you understand how to implement each strategy. I have given you ideas that you can use to improve your business immediately or as part of your long-term plan for sustained growth over several years. And unlike others who write about marketing a business, I include only those marketing techniques that preserve the relational qualities between you and potential clients. I avoid all "push marketing" ideas that are too promotional and hard-sell for the business of therapy; instead, I suggest ways to use "pull marketing," techniques that allow you to naturally attract great clients and opportunities. Message for the therapist: Build your practice your way--erect a framework that results in your ideal practice by choosing from dozens of practical, effective strategies. 5. Add the finishing touches. The finishing touches, called "finish" in the building trade, highlight the craftsmanship of the builder--reflected in the finer choices and detailing that makes a house shine. When you enter a well-built house, the finish is often the first thing you notice. It's important to give time and attention to the small, subtle touches that can have a big impact. The finish you incorporate into your practice will be the details that set you apart from the crowd and let your practice shine. In times of competition, having a polished practice is one of the easiest ways to insure your success. Chapters Eleven through Thirteen show you how to work smarter, not harder, by shifting your mindset from effort to ease; eliminate the fear-based aspect of your work and stay profitable by doing primarily what you love; become more attractive by modeling the services you offer, as a way to attract better clients; and regard the practice you have built with affection, instead of impatience. You will learn how to move beyond the traditional medical model of therapy toward an innovative personal-growth business model, one of the most important trends you can follow for the future. I will also show you how to hold onto your success by becoming highly self-motivated, so that you maintain your ideal practice over time. Message for the therapist: Take your practice from ordinary to extraordinary by implementing the finishing touches that make a big impact on clients. Throughout this book you will find case examples, anecdotes, exercises, guided imagery, and practical advice. I have also provided a pre- and post-test for you to take, so that you can track your progress and see measurable results as you learn how to:
This last point is very important to remember. In times of great anxiety, we tend to feel isolated and cut off from our peers. In the midst of our fears about surviving financially, we jealously guard information and referral sources. We forget that these are the moments when we most need energy and support from our colleagues, so we can all come through the tough times together. Paradoxically, many of the easiest ways to build a practice (or any other small business) in today's competitive marketplace involve strategies of collaboration. During each practice-building workshop I lead, I show therapists how to share constructive ideas with the colleagues sitting next to them, so that they can think about their concerns from a broader perspective. Two heads really are better than one. With so much creative energy in a workshop, the emotional atmosphere in the room gets lighter and more energized as the day progresses. As a workshop breaks up, I overhear people making plans for actions they can take immediately, talking about vision and strategies, exchanging phone numbers, forming support groups. Instead of picturing others in the room as competitors, they are eager to work together as colleagues. I see a group of therapists who feel empowered and in control. Some are thoughtful, still integrating all the new information. Others are talking excitedly, "I can do this. I came in feeling like giving up, but now I'm inspired. I know exactly what to do next." I want you to feel this collegiality too. I will share many stories with you about your colleagues, who are also working to build their practices, so that you will realize that you are part of a larger community of therapists who are learning a new way to function in private practice. You can learn to operate your practice based on a concept of abundance, where there is plenty to go around, instead of deprivation, where you need to defend your few dwindling resources. Do you feel ready to get started? Let me begin by showing you how to best use me as your business coach.
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