David P. Diana (interviewed in WTCI here) has just released a new book,

Preface

When we are no longer able to change a situation, we are challenged to change ourselves.
— Viktor E. Frankl (1984)

A career in mental health is rewarding and challenging, inspiring and at times discouraging, open and yet surprisingly restrictive. These dichotomies define the core of a life spent in service of the psychological and emotional well-being of others.

Since I began my mental health career in 1994 I’ve heard much talk about the sacrifices one makes when choosing the life of a behavioral health care provider. It is a noble endeavor indeed! However, this book is not about burdens and sacrifice. It’s about innovation, opportunity, and abundance. It is also about change and about breaking free in a profession where few see how this can possibly be done.

This book honors the caretaker in you while giving equal importance to your own well-being. A career in the behavioral sciences offers a vast reservoir of opportunity, more so than at any other time in our profession’s history. But those opportunities are sometimes diffi cult to see and hear. This book is about those untapped opportunities.

The history of our profession reveals a discipline that, since its inception, has challenged the status quo in pursuit of truth and understanding. Innovation, curiosity, a sense of wonder and growth were all bedrock principles.

But what are we to make of the mental health profession today? Are we living those bedrock principles? Are they available to us?

The material presented here will teach you how to combine your understanding of human behavior with innovative business ideas, thereby giving you the best of both worlds: fi nancial success and the ability to do what you love.

Learn from the disciplines of sales, marketing, and business development, and you will bring about new levels of success no matter what your interests or what role you choose to play in the field.

The new rules in today ’ s economy are important not only for big business but for professionals in all walks of life including behavioral health care.

In a dynamic world, we know all too well that change is a constant. The question is never about deciding whether to change. The question is about what kind of change is needed.

I am taking you on a journey into new opportunity within the profession. It’s a story about you. It ’ s a story about the possibilities available to you.

And it is well worth the effort.

Purchase Marketing for the Mental Health Professional at the WTCI Bookstore.  Find David P. Diana online at davidpdiana.com.

Dr. Siegel is author of an impossible-seeming number of books,  including Parenting from the Inside Out, The Mindful Brain, and, coming later this year, The Mindful Therapist. His most recent release is Mindsight: The New Science of Personal Transformation, which explores the interplay of brain science, psychology, and mindfulness. Take a look:  here, reprinted with permission, is an generous excerpt:  Chapter 7, “Cut Off from the Neck Down.” Enjoy.

Mindsight: The New Science of Personal Transformation

Chapter 7

Cut Off from the Neck Down - Reconnecting the Mind and the Body

Anne’s first visit was on a rare rainy day in Los Angeles. She must not have brought an umbrella, because her long black hair was soaked. It was bundled into a loose knot at the side of her head, and a stream of moisture was quickly darkening the shoulder and neckline of her jacket. I couldn’t help watching the dark spot spread, but Anne didn’t seem to be bothered. I’d soon learn that this lack of interest in her body was more than just a passing state of being caught off guard in the rain.

Anne looked around the room, slouched back into the couch, and said, “Well, here I am, but I’m not sure why.” Anne was a forty-seven- year- old physician and the mother of eleven- year- old twin girls. She told me that she had been putting off going to her internist for a follow- up exam for more than a year. Her slightly raised blood pressure and some findings during a routine heart exam had concerned him, and he’d asked her to return a few weeks later, but she just hadn’t gotten around to it. Yes, Anne told me, she knew that doctors made the worst patients. But she felt that there was nothing wrong with her heart and she didn’t need to waste her time. Her blood pressure was fine now; she just had a few palpitations that she was pretty much able to ignore.

So, I asked myself, if her heart was really of no concern, why was she talking about it? “I don’t have time to see any doctors,” Anne continued, the words tumbling out. Her life was stuffed to the brim with work, she said, her long days spilling over into weekends spent at the office where she was in charge of a group of radiologists. I wondered, too, how she had made time to see me– and why she’d really come. Anne looked lost, and behind her eyes seemed to be a distant sadness, a kind of longing for something she couldn’t find. My own right mode was filled with a vague sense of pain, but at this point I couldn’t place it, couldn’t name it, so I just noted these internal sensations and filed them away in my mind.

Anne then told me that even with her professional success, she didn’t feel very accomplished, and that her life was empty. There wasn’t much else besides work. She had divorced her husband six years ago because “they just didn’t have much in common.” She hadn’t been interested in dating when the twins were younger (besides, she was too busy), and she wasn’t in a current relationship. Her daughters divided their time between her house and her exhusband’s in a nearby neighborhood. When I asked her about her relationship with the girls, she told me that they were “miniteens” who ” didn’t really want to bother with their parents.” They were “very independent,” she added proudly. Anne paused for nearly a minute, and I waited to see what else she would say. Then she looked at me with a puzzled expression and said, “Well, I’m here anyway . . . and I guess there has to be something more to life than just this.” I took that to be a request for therapy.

When I asked Anne to tell me something about her upbringing, this is the story she told me:

When she was three years old, Anne’s mother died of lung cancer and her father became very depressed. She was sent to live with her mother’s parents in a nearby town, and she didn’t see her father again for almost a year. During that time her father had been hospitalized, and when he was released he returned to live with Anne and her grandparents. When I asked Anne about that year, she said, “They were caring people, warm and loving,” and then she paused for a few moments. “But it didn’t last long,” she added. “I was young, and my father came back, and, well, it all changed after that.”

Anne’s father remarried when she was five years old, and the new family moved across the country to settle in the Pacific Northwest, near Seattle. She didn’t see her grandparents again until she was in college. Anne’s father and stepmother had two more children, active boys born a year and a half apart, whom they doted on. Anne said she loved her brothers but felt ignored by her father. As for her stepmother, Louisa, she was “a robot of a woman” and a harsh disciplinarian who criticized Anne relentlessly. Anne’s father never intervened.

One day when she was eleven years old, Anne had a particularly painful dressing- down from Louisa. Later, as she told me, she went for a long walk in the apple orchard in back of their house. She remembered making a decision: She promised herself that she would “never feel anything again.” As she told me this, her face grew even more vacant, and she drew her index finger straight across the front of her throat. It was the gesture most people would recognize as “it’s over” or “off with his head.” But I wasn’t at all sure Anne even knew she had made it.

“It worked. They could never touch me again. I mean, they didn’t hurt me physically or sexually abuse me, but I never let them make me feel bad, no matter what they came up with. He and my step-mom just became nonpeople in my life. I ignored them from then on. I worked like crazy in school. My teachers loved me, and that was that. After college and medical school, I knew I would be okay. I think in many ways it all helped me become the successful physician I am today. I suppose I should thank them…all of them… but I don’t speak with them anymore. They wouldn’t know what to do even if I did, I mean, to say I’m sorry, if they could. That’s it. That’s my story.”

The session was over. Anne agreed to return, and then she went out into the rain.

KEEPING THE BODY OUT OF MIND

Halfway through Anne’s second visit, a quotation from James Joyce that I’d heard somewhere popped into my head: Mr. Duffy “lived at a little distance from his body.” It was in the way she moved, the stiffness of her gait, the way she held her hands motionless in her lap. (Her throat- cutting gesture stood out even more in retrospect.) It was also emerging from her account of a limited, rigid inner life lived only above the shoulders.

Anne told me she’d been quite artistic as a child– she’d excelled at drawing and loved to paint– although she’d had “no time for such things” in years. Unlike my patient Stuart, she did not seem to have a deficit in right- mode development; this was suggested by her artistic abilities and the fact that during her recounting of her personal history it was clear that she was aware of and able to articulate autobiographical memories in great detail, a specialty of the right brain. Moreover, sitting with me in the office, she expressed herself well nonverbally, making good eye contact and varying her facial expressions and tone of voice as different issues came up, which are other signs of right- mode development. Her left mode had also shown early strength; she’d been at ease with science and loved to solve math problems when she was in school. Her success as a radiologist supported my impression of at least some degree of horizontal integration; her profession required combining the spatial pattern recognition of the right mode with the analytic clinical mode of the left.

In our initial interview, Anne had spoken only briefly about her reaction to her mother’s death: “She died, I was young, and I don’t know what I would do without her.” This confusion of past–”I was”–and present tense–”I don’t”–is a window into possible issues of unresolved grief. I thought about how her mother’s illness must have affected their relationship even before she died– how confused and frightened a toddler would be by her mother’s inability to care for her. She had also experienced the sudden loss of her father, who disappeared and later returned, only to remain distant; and then she was taken away from the grandparents who’d cared for her lovingly for two years.

Next there was Anne’s “decision” as an eleven- year- old “never to feel anything again.” Anne spoke of this as a turning point in her young life. As I asked questions about her current experiences, the cutoff from her body became clearer. Anne “ate to live” and took little pleasure from food. She said matter-of- factly that she’d “never been a particularly sexual person.” She’d never been involved in sports, and she had no physical fitness program.

The disconnect from her body wasn’t complete, however. There was the matter of her palpitations. I asked Anne about their quality, frequency, and intensity, and she was able to tell me that they happened a couple of times a week, were “only mild” but– in contrast– “unnerving” enough to make her stop whatever she was doing. She couldn’t pinpoint anything that caused them. When I asked if she could sense her heart when it was beating normally, she said that she could not. But these sudden onsets of rapid, sometimes pounding, and irregular heartbeats “bothered” her. I urged her to go back to her internist to be sure there was nothing to be concerned about. She said that she’d “think about it.” Anne was an expert observer of interior anatomy in all its subtleties, but she refused to pay attention to her own body.

ESCAPE FROM PAIN

Anne had adapted to a painful situation by shutting off awareness of her feelings. What’s wrong with that, you might ask? If our adaptations allow us to survive, why challenge them? Here’s the basic problem: The conditions Anne experienced as a child– the painful loss of her mother and grandparents, her new family’s neglect and harshness– no longer existed. She had adapted as best she could, but she’d had no support to help her resolve her losses– then or now. So her adaptation, which initially gave her strength and enabled her to move forward in her life, actually had come to imprison her. It kept her from being able to thrive.

Anne’s decision to “never feel anything again” had effectively shut off the body proper from the neck down. It was as if she were trying to take refuge in her cortex, to cut herself off from the ongoing pain of criticism and isolation and unfairness. This adaptation may also have helped her leave behind– out of her awareness– her unresolved grief over her first great loss, her mother’s death, which preceded all the others. Like all emotions, such overwhelming feelings are created throughout the extended nervous system, in the body, brainstem, and limbic areas; they directly involve our cortical regions as well. But if we can find a way to block subcortical input, if we can keep it from traveling upward into our consciousness-creating cortex, voilà!–we’ve “eliminated” our feelings.

No one knows exactly how our mind uses the brain to defend us from pain, but two things we do know from repeated clinical experience. One is that people do this quite often. As you’ll see throughout this book, these adaptations can take many forms, from avoiding our feelings momentarily when we are overwhelmed, to long- term shutoffs, or to shutdowns like Anne’s. The second thing we know is that somehow we– that is, our minds– can modify neural firing patterns to create what we need. For example, when we need to place something in the front of our mind, to focus our attention, we activate aspects of the prefrontal cortex on either side of the brain. So we can propose that one possible way the mind uses the brain to block something from awareness is by literally dampening the neural passage of energy and information from the subcortical regions upward to the cortex, especially to the parts of the prefrontal region that mediate awareness.

Here’s another thing we know for sure: When we block our awareness of feelings, they continue to affect us anyway. Research has shown repeatedly that even without conscious awareness, neural input from the internal world of body and emotion influences our reasoning and our decision making. Even facial expressions we’re not aware of, even changes in heart rhythm we may not notice, directly affect how we feel and so how we perceive the world. In other words, you can run but you cannot hide.

Colleagues of mine at UCLA have recently demonstrated that the pain of social rejection is mediated in an area of the middle pre-frontal cortex that also registers physical pain from a bodily injury. This area is called the anterior cingulate cortex (ACC) and it straddles the boundary between our thinking cortex and our feeling limbic regions. In addition to registering physical sensations from the body and feelings from our social interactions, it regulates the focus of our attention. Because it links body, emotion, attention, and social awareness, the ACC plays a key role in the resonance circuitry that lets us feel connected to others and to ourselves. (In fact, the more we can sense our own internal world, utilizing the ACC and related areas such as the insula discussed in the Minding the Brain section “Riding the Resonance Circuits,” the more we can feel the internal world of someone else.)

These research findings give us a new way to think about Anne: Her young mind would have been as driven to obliterate the chronic pain of loss and rejection as she would have been to escape physical pain. If she could shut down the activation of her ACC, perhaps she could “eliminate” the awareness of her pain. Standing in the apple orchard, Anne had found a way to exclude that pain from her conscious experience. The problem is, you can’t eliminate bad feelings and keep the good. If you block lower input from reaching the ACC and the insula, you’ve blocked the source of emotion from reaching awareness. The result was a deadened emotional life and a cutoff from the wisdom of the body. The insula and ACC also appear to work together to create an overall self- awareness–something that seemed to be impaired in Anne as well.

BRAINSTEM SIGNALS: PAY ATTENTION! FIGHT, FLEE, OR FREEZE?

We gain access to the body’s wisdom through interoception, which literally means “perceiving within.” Try pausing for a moment right now and just become aware of the beating of your heart and the in-and- out of your breath. These basic physiological processes are regulated by the brainstem; the brainstem also helps regulate our cortex by influencing our alertness and directly shaping our states of mind. You can pick up brainstem signals at any time by becoming aware of shifts in your breathing and heart rate– and also by paying attention to arousal itself.

Think of times when you realize you’re feeling drowsy. You are focusing on the brain’s alertness, noticing your capacity to attend to information– a teacher’s lecture, for example, or this book you are reading. Perhaps you’ve returned to the same paragraph several times without taking it in and you’re ready to admit that you are not in a state of mind to continue reading. You then choose how to respond: Should you have a cup of coffee or splash cold water on your face to try to wake up, or should you just take a nap? This is one way you regulate your internal world– by being able to monitor and then modify energy and information flow, in this case, levels of brainstem arousal.

The brainstem also works with the limbic area and cortex to assess safety or danger. When our threat- assessment system tells us we’re safe, we let go of tension in our bodies and our facial muscles relax: we become receptive, and the mind feels clear and calm. But with an assessment of danger, the brainstem (along with the limbic and middle prefrontal areas) activates a decision tree: If we think we can handle the situation, we enter the fight- or- flight state of alert. This in turn activates the sympathetic branch of the autonomic nervous system (ANS). Our heart begins to pound as the body readies for action. Adrenaline pours into our bloodstream and the stress hormone cortisol is released; our metabolism is prepared for the energy demands ahead.

On the other hand, if we believe we’re helpless, that there’s nothing we can do to save ourselves, we freeze or collapse. Researchers call this the “dorsal dive,” referring to the portion of the parasympathetic branch of the ANS that has been activated. This response goes back to our earliest evolutionary ancestors, and it’s thought to have real benefits for an animal that is cornered by a predator. Collapse simulates death, so an attacker that eats only live prey may lose interest. Blood pressure drops precipitously in a freeze state, which could also reduce blood loss from wounds. In any case, it makes the animal or person fall limply to the ground as they faint, which maintains precious blood flow to the head.

If you are vertically integrated, you can read what your body is telling you about your safety or danger, including signs far more subtle than running away or fainting. You may feel a certain tension when you’re walking down the street and only then realize that someone is following you. Or you get a feeling that you just can’t trust the person you’re talking with. In everyday life, having access to subcortical energy and information is also essential to thinking. Being aware of these subcortical impulses enables you to know how you feel, alerts you to your needs, helps you prioritize your choices, and then moves you to make a decision. This is how “gut sensations” or “heartfelt feelings” help us live our lives fully.

Since Anne had little interoceptive awareness, these subtle signs of safety, danger, or threat were probably muted or missing from her awareness as well. But even without awareness, these threat states, these brainstem- mediated neural shifts, can directly influence our thinking, our reasoning, and our sense of vitality. Someone can be ready to fight, vigilant for danger, or depleted by a sense of helplessness without knowing why. I thought Anne’s palpitations might be in some way related to internal stress states. If a subtle internal or external threat led to adrenaline and cortisol release, her heart would pound, which would capture her attention– but since she had little consciousness of her internal state, or of its causes, she wouldn’t know why it was pounding.

LIMBIC LANGUAGE: “PRIMARY” VERSUS “CATEGORICAL”

I’d been struck repeatedly by how confused Anne seemed when I asked her basic questions about how she felt in a particular situation. The cutoff seemed to extend to her relationships. She’d told me outright that she had few friends and no connection with her family. Staying away from her family as a child– and now as an adult– seemed self- protective, but I was concerned about the rather distant way she talked about her own daughters. They were the same age she’d been when she banished feelings from her life, and I knew that however “independent” children that age sometimes act, they do indeed need their parents.

In her first session, Anne had told me that her life was empty. Yet her refrain of “too busy” also conveyed that it was full to the brim in some ways. What seemed to be missing was the sense of energy and engagement that can give even ordinary experience richness, depth, and meaning.

To open the channels of vertical integration in Anne, to bring the signals of her body, brainstem, and limbic areas up into her cortical awareness, I first needed to open the doors of “emotional communication” between us. But when we talk about emotional communication, what do we actually mean?

If we focus only on the easily named and universally recognized emotions– such as anger, fear, sadness, disgust, excitement, happiness, or shame– we can miss the real richness of our minds: the realm of what I call “primary emotion.” Primary emotion is the subtle music of the mind, the ebb and flow of energy and information that we sense during the moment- to- moment shifts in our internal state throughout the day. Sometimes, against this constantly shifting, changing background, an event occurs that orients our attention and activates our arousal, and the intensity of our arousal creates within us an emotion such as anger or fear. Even though these universal (or “categorical”) emotions are recognized worldwide, in every known human culture, they do not emerge as often as you might think. Consider the course of a day. How often do you experience clear, unambiguous anger or fear? For most, it is rare. Yet your inner world is filled with subtly textured, constantly changing states– what I am calling “primary emotions”–that continually color your subjective sense of being alive.

Thinking about these primary and categorical emotional experiences opens a new window on how we connect with others– and with ourselves. Young children need attunement with caregivers to feel seen and safe in the world. As parents, we can attune not only to our child’s outbursts of categorical emotion– such as sadness or fear– but also to primary emotional states such as being energized, alert, focused, sleepy, or subdued. Parents who wait for a categorical emotion to arise before they “connect emotionally” with a child are missing the majority of important opportunities to attune. Attunement with a child’s primary emotions is available moment by moment, as we pay attention to whatever has captured her attention. We can also tune in to our child’s internal world by noting her levels of arousal. Is she engaged or depleted, lively or subdued? Having this primary emotional attunement to our children helps them feel deeply connected to others; as we resonate with them, they feel part of a larger “we.”

Learning to track internal states– to become aware of our primary emotions– is a refined skill that begins when we’re children and continues throughout our lives. Sensing this internal flow of energy and information is the essence of mindsight. As we first learn to pay attention to this flow through the attention our caregivers pay to us, we enter the world of knowing the mind. But Anne was not given the opportunity to learn how to sense her internal world from a safe, secure place after losing her mother and her grandparents. She, like so many of us, had to find a way to cloud her mindsight lens so as not to see her inner world. She learned to live a life devoid of meaning.

THE FEELING OF MEANING

Meaning is literally shaped by the limbic regions’ appraisal process– the continual and immediate sorting of experience into “relevant or irrelevant,” “good or bad,” “approach or avoid.” This, along with input from our middle prefrontal cortex, helps create the meaning of events in the brain. Meaning has a feeling to it, and establishing vertical integration for Anne would allow her to become receptive to this textured sense of significance coming from her inner world.

The cortex, especially in the frontal areas, can create abstract representations without input from the direct experiences mediated by the subcortical areas of the extended nervous system. We can think of the word flower but never sense the flower’s aroma. We can paint that flower on canvas, but never lose ourselves in its textures and colors. Even right- mode visuospatial images can be sterile when devoid of access to subcortical input. There are musical virtuosos who leave audiences cold, literary scholars who are unmoved by the poetry they write about, physicians who diagnose but cannot connect with their patients. Integration requires openness to allow the many layers of our inner world to enter our awareness without rigid restrictions.

Words themselves are abstract representations that emerge like islands from a sea of associated meanings. Take, for example, the word daughter. If I say “daughter” to a young woman who’s just heard the news that she is pregnant, that word will initiate a cascade of associations and responses. All sorts of beliefs may emerge: Daughters are fun. Daughters fight with their mothers. Men prefer sons. Will the pregnancy bring all the joys of her own relationship with her mother– or the pains of disappointment and confusion? Washes of sensation may fill her mind until she feels overwhelmed, unclear, cloudy. Maybe having a daughter would not be so good; maybe she’d be a better mother to a son.

With the word daughter, all of the young woman’s own developmental history may be activated and revisited, with a mixture of old and new emotions. Was she close to her mother? Did she find her own voice, or did her mother overpower her? Taking on her mother’s perspective, she might wonder how her mother felt about having a girl. How did she respond to her daughter’s adolescence? Were her responses supportive or hostile or perplexing as she as a young girl matured physically, transformed from teen to adult, became sexually active, left home? And now that she is joining this passage of women from one generation to the next, how will her mother respond to the news of her pregnancy?

The meaning of daughter includes all of this and more, including the emotional associations that might arise if the young woman were to happen upon a mother- daughter pair at the park who appeared to be in rapt connection, exhilarated by each other, their laughter contagious yet private.

Now think of what mother meant to Anne. How could she stay open to her cascading associations, beliefs, concepts, developmental issues, and emotions? These elements of meaning, the architecture beneath our wash of feelings, would naturally flood her mind, intrude into her relationships, dis- integrate her brain. What choice did Anne actually have? Could she say, “Oh, no problem– let me be aware of this pain of loss of my mother. Let me be aware of this intolerable humiliation from my stepmother.” Not possible. And so Anne discovered a survival mechanism: She cut herself off from meaning in her life. But while this was useful as a defensive maneuver in her childhood, it had become a fence that imprisoned her, cutting her off not only from herself but from her own daughters. Anne felt nothing and she was stuck. She had “a meaningless life.”

THE FENCE OF DEFENSE

When strong primary feelings emerge or a particular categorical emotion arises, we may respond with an ingrained, learned reaction that is rooted in our past. If you grew up in a family in which anger was expressed as destructive rage, for example, you might get incredibly anxious whenever anger is expressed. In response to that anxiety, you may have learned to feel helpless and confused, causing you to freeze; or you may have learned to be fearful of rage, causing you to burst into tears and flee the scene; or perhaps you learned an aggressive “fight” response, causing you to meet anger with your own anger. Fight, flight, freeze– these are all emotional reactions to, yes, your own emotional responses.

Beyond our learned reactions to ordinary emotional threats, we also have patterns of adaptation that help us cope with overwhelming situations and with our reactions to them. These patterns of adaptation are sometimes called “defenses” and they shape the matrix of our personality: how we experience our inner world and interact with others. Here is the outline of the common pathway of defenses that is now accepted by many psychologists: An emotional response arises ➔ creating a reaction of anxiety/fear ➔ which initiates a defense. This defensive reaction shuts down the emotion, or at least the awareness of it, which then lowers the anxiety/fear and allows us to continue to function. This is why defenses are not only useful– they are often essential.

Defenses come in many forms. We can rationalize intellectually about a situation, minimizing awareness of our feelings by moving away from the more feeling right- brain mode into the logical left. This was Stuart’s strategy. We can attempt to ignore a situation, skewing our perception to see just the positive side of an experience, a kind of “selective neglect.” Some simply call this optimism, and it is a time- honored, and sometimes even healthy, strategy. When you are surrounded by lemons, make lemonade. Some people deal with a painful feeling by “projecting” it onto others and then hating them for it. This primitive and destructive adaptation is called “projective identification,” the strategy that says the best defense is a good offense.

Whatever the defense, the idea is the same: We build a fence around our awareness so that we don’t feel the anxiety or fear associated with feeling our feelings. These are usually automatic strategies, patterns of reactivity adopted without conscious intention or even recognition, and certainly without free will or choice. Anne’s orchard “decision” was in fact an unusually conscious, perceptive moment of self- reflection. It was only later that her intentional suppression was transformed into automatic repression. During her childhood, Anne had no way to soothe her profound internal distress and interpersonal pain and so she could not remain open to their meaning, and her adaptation was to just “go cortical.” Once she had blocked vertical integration, the primary function of Anne’s body was to transport her head.

ATTENDING TO THE BODY

Anne and I were now at our fourth session, and I was able to pre sent to her a plan for therapy based on our initial period of assessment. As a physician, she was intrigued by the notion that her adaptation at age eleven might have persisted as a neurological pattern in her brain. I also told her that I thought she had been through a lot in her early years, and that I thought I could help her deal with whatever that time meant for her.

Anne and I needed to go on a journey together to help her feel receptive, to be attuned to herself, so that she could open up her awareness in new ways. She was up for the task, not certain what any of this would involve but willing to commit to a few months of therapy to find out. That was a good place to start. I told her, as I’d told Jonathon, that we’d need time to alter her synapses so that she could unlearn her old patterns and create new ones. Awareness, I went on, was the “scalpel” we would use to resculpt her neural pathways. Anne was intrigued by that image and wanted to know more. Now I knew I had captured her attention– the first step in changing her mind, and her brain.

I didn’t want to distract her with the details of how awareness might enhance neuroplasticity, but I had some recent research in mind. The nucleus basalis, part of a region adjacent to the brainstem, has neural projections that secrete the chemical acetylcholine throughout the cortex. Acetylcholine is a neuromodulator, and its presence enables any neurons that are activated at the same time to strengthen their connections to one another. One theory suggests that we can use focused awareness to stimulate the nucleus basalis to secrete acetylcholine, thus enhancing neuroplasticity and learning. If this is so, it helps to explain why paying close attention gives our minds the power to change our brains.

All I told Anne was that through the work we would do she’d discover for herself the power of attention. We went over the basic mindfulness- of- the- breath exercise and we practiced some walking meditation.As we’ve seen with Jonathon’s experience, learning mindfulness techniques can strengthen the hub of the mind so that internal sensations, such as bodily signals or waves of emotion, can be experienced with more clarity and calmness. My hope for Anne was the same, that with practice she’d strengthen the very parts of her brain that could not yet permit her to feel her feelings. She was game for taking on these forms of practice, not only in the office but as a daily “mental training” regimen at home. A weekly therapy session, an hour at a time, wasn’t enough to focus her attention in an intense way. She would need regular synaptic exercise between her sessions with me. Reinforcing new synaptic linkages requires repeated neural firing to stimulate neuronal activation and growth– to SNAG her brain.As with Stuart, we could use the focus of attention to stimulate the activity and growth of areas that had been underdeveloped in childhood. In Anne’s case, these regions would be the important circuits of interoception and self- regulation– of sensing the inner world and regulating that world– that had not been given the opportunity to grow well in her youth.

At her next session, I suggested we do a body scan, like the one I did with Stuart, thinking it would help her to gently become aware of her body in a nonthreatening way. I asked her to close her eyes and to look inward. Anne was fine as the focus of awareness moved up from her feet to her legs and then to her hips. I felt cautious as we progressed to the pelvic area. Anne had told me she hadn’t been abused sexually, but this is one point at which anxiety sometimes emerges strongly during a scan. Anne focused with no problems. We then moved to the abdomen and the back, and she was still fine.

But when we focused on the chest, she started to breathe rapidly. Her hands started to shake. She made fists and pushed down with her forearms on the arms of the chair as if she were trying to hold down some feeling. Then she opened her eyes wide and said that she had to stop– she was hyperventilating and looked terrified. Anne had jumped from rigidity straight into chaos.

I was concerned that Anne was having a panic attack. We stopped the exercise and continued our session with her eyes open, and her agitation gradually subsided. She said she didn’t want to discuss the experience. She was “fine” now; she simply ” didn’t like the body scan.” We’d wait till later, when she’d developed more of an internal reserve to deal with upsetting sensations, to come back to that important source of bodily information. While research suggests that focusing attention on the heart can trigger both physiological reactions and an awareness of intense emotions, the specific nature of the feelings it had awakened in Anne was not yet clear. As our work continued, I hoped we’d learn more.

BUILDING INNER RESOURCES

The direct body- scan approach had triggered so much anxiety that Anne panicked, so I needed to choose more gradual ways to introduce her to body awareness. I started our next session by asking her simply to notice the movement of her fingers as she slowly opened and closed her palms. “Just noticing that,” I said, “let yourself be filled with how the hand appears, and how it feels.” We repeated the walking meditation, too, letting her feel the sensations of her feet with her eyes open.

Next I suggested that we develop a “safe place” into which she could always retreat– an image in her mind that she could draw upon to soothe herself whenever uncomfortable feelings arose. At first Anne had trouble coming up with an image. I told her this could be something from memory– a special vacation spot, her favorite room at home– or it could be entirely imaginary, a place where she could imagine herself being peaceful and contented, or at least safe and secure. Anne finally recalled a cove at the beach near her medical school. “I used to go there just to be with the waves,” she said. “The sound of the waves, how they moved in and out, the curve of the beach, the sunny skies– everything gave me a feeling of things being okay.” I asked her to sit with the image of the cove for a while, soaking in the sights and sounds and sensations. Then I told her to just notice her body and asked how that felt. When she said, “It feels good,” I went on. “Being aware of the body, just sense whatever arises in your experience.” I wanted her to create a neural association between her mental image of a place of safety and her awareness of bodily sensation.

This technique is used in several schools of body- focused therapy, and it had an entirely different purpose than the imagery work I’d done with Stuart. By creating that connection, Anne was able to experience and articulate what her body was feeling. She told me her abdomen felt soft, her face relaxed. Then she said her breathing was easy. She could feel her heart and it was “calm and steady.” In contrast to her reactive panic during the body scan, Anne was now experiencing a state of receptivity. We were harnessing her regulatory prefrontal areas to help monitor and manage her internal states.

Another receptivity- enhancing technique I use involves systematically tensing and releasing the individual muscle groups of the body, from feet to head, which helps create a state of relaxation. Still others involve bilateral stimulation, whether by listening to alternating sounds or gently tapping on the left and right sides of the body. Some researchers believe that this creates not only relaxation but also increased sensitivity to mental imagery. But Anne felt most comfortable with her image of the cove and with the breath-awareness exercise I’d taught her first. We continued to practice them to give her confidence that she could go from reactivity to receptivity by her own mental efforts.

I wanted to keep her experience in the body on the positive side, so next I suggested that we try an exercise with color that evokes different feeling states. I do this work with a set of eyeglasses that have lenses made in various colors. Color is a powerful emotional cue for many people, but in Anne’s case I asked her to focus on sensations in the body itself. Again, this seemed like a safe way– for some patients it’s even a playful one– to awaken her awareness of shifts in physical sensation. With the first pair of glasses– green– nothing happened. “I don’t feel a thing …just the usual…just blank.” But when she put on the second pair– these happened to be purple– she exclaimed, “Whoa– this is weird!” Anne said she had a “tingling feeling right up here,” pointing to her upper chest.

After that, Anne felt her body change with each new color. Red evoked energy in her limbs “like ants running up my arms”; blue a deflated feeling in her abdomen “like a hole”; yellow a sense of constriction in her throat. This was not a test– each person has a unique response. The point was simply to create contrasting sensations, so that Anne could begin to recognize internal shifts.

Anne’s initial response was excitement at her newfound ability, and we spent a good part of the session with the glasses, just letting her experiment with this neutral approach and find words to describe her body’s sensations. But when I suggested that we might return to the body scan next time, she became frightened and hesitant. “I don’t want to get into a panic again,” she said, bringing her hand protectively to her heart. “Those feelings are not right…I can’t handle them.”

I reminded her that she now had her safe place as a resource at any time, and I assured her that we would move slowly. The internal world of Anne’s childhood had been beyond what she could tolerate– at that time. Now she might be surprised to find that she could learn to tolerate what had once been intolerable.

WIDENING THE WINDOW OF TOLERANCE

Personal change, both in therapy and in life, often depends on widening what I call a “window of tolerance.” When that window is widened, we can maintain equilibrium in the face of stresses that would once have thrown us off kilter.

Think of the window as the band of arousal (of any kind) within which an individual can function well. This band can be narrow or wide. If an experience pushes us outside our window of tolerance, we may fall into rigidity and depression on the one hand, or into chaos on the other. A narrow window of tolerance can constrict our lives.

In our day- to- day experience, we have multiple windows of tolerance. And for each of us those windows are different, often specific to certain topics or certain emotional states. I may have a high tolerance for sadness, continuing to function fairly well even when I or those around me are in deep distress. But even a lesser degree of sadness– whether your own or others’–may cause you to fall apart. In contrast, anger may be relatively intolerable for me; a raised voice may be enough to send me right out my narrow window. But for you, anger may not be such a big deal; you see a blowup as a way to “clear the air” and move on. In general, our windows of tolerance determine how comfortable we feel with specific memories, issues, emotions, and bodily sensations. Within our window of tolerance we remain receptive; outside of it we become reactive.

By now you’ve probably noticed that the window of tolerance matches the river of integration, which I introduced in chapter 4. The more freely that river can flow and the farther apart its banks are, the better we can attain and maintain integration and coherence. But if that flow is constricted, we’re constantly in danger of hitting the banks. In many cases our well- being depends on widening the window of tolerance so that we can hold the elements of our internal world in awareness– without being thrown into rigidity (depression, cutoffs, avoidance) or chaos (agitation, anxiety, rage). As we develop mindsight, our windows of tolerance widen and we can experience the fullness of our lives with more acceptance and clarity.

If we move through life without mindsight, we may keep narrowing our window of tolerance around a specific emotion or issue. Then we may find ourselves either bursting the boundaries of that window and jumping into the chaos of reactivity, or avoiding situations that trigger such ruptures, restricting our lives without knowing why, not giving ourselves the freedom to escape our rigidity and empowering ourselves to grow. To widen our window, to make ourselves more adaptive and at ease with a particular feeling or situation, we need to change the associations that are embedded in the neural networks themselves.

“STAY WITH THAT”: THE HEALING POWER OF PRESENCE

The presence of a caring, trusted other person, one who is attuned to our internal world, is often the initial key to widening our windows of tolerance. Because Anne did not have such relationships in her later childhood, her tolerance for awareness of bodily sensations and primary emotions had narrowed. Cutting off access to her sub-cortical input was once a means to survive– but now it was restricting her life. If I could be present fully with Anne, if I could let my own internal world resonate with hers and remain open myself, I could help her track her sensations and uncover their meaning, widening her windows of tolerance.

Recall that the resonance circuits include mirror neurons that would enable Anne to resonate with my own reactions to her. My being present fully with Anne at moments of distress could help her mirror my own inner feelings of safety. Here is a key fact about relationships: The resonance circuitry not only allows us to “feel felt” and to connect with one another, but it also helps to regulate our internal state. (It is the middle prefrontal area at the top of the resonance circuitry that shapes our subcortical states.) In other words, the interpersonal resonance between Anne and me could help widen her window of tolerance, so she’d feel safe enough to feel her own feelings. This is how in the moment, face- to- face, we help one another grow, and initiate the long- term synaptic changes that help us even when we’re apart. And by continuing with her internal reflection practices at home– the mindfulness- of- the- breath and the walking meditations– Anne could further reinforce these synaptic changes, transforming the way she communicated with her own body.

At the beginning of our next session, I once again invited Anne to return to the body scan that had triggered her panic. It had now been ten weeks since our first session; during this time she had been doing her home practices regularly, and she and I had developed a trusting and collaborative relationship. Exercises such as the safe-place imagery and the colored glasses had helped her observe her inner world in a more objective and accepting way. She had also received a clean bill of health from her internist, who had rechecked her heart and found nothing of concern physiologically. Still, I moved into the body scan slowly, giving her plenty of time to immerse her awareness in the subtle sensations from her lower limbs, her hips, her abdomen.

When we came to her chest, her panic began to emerge. She grimaced and her left hand went to her chest. She opened her eyes and said we had to stop. I reminded her that whatever that sensation was, she always had her breath awareness and her internal safe place to return to. If she felt herself getting too close to the edge, she could shift into a focus on her safe- place imagery of the cove and watch the waves go in and out for a while. She closed her eyes, focused on her breathing, and her face slowly relaxed. She opened her eyes again, looking right into mine, and said, “Thanks.”

I suggested she might take a few moments and just let this new sense of openness fill her. As her body seemed to settle into the chair, and I saw her hands relax and her face become more supple, I said that she might just notice how she could use the focus of her attention to calm her body, and her mind.

Anne said she was “ready to dive in” and we went back to the body scan. When she focused on her chest region, the panic again began to emerge, but this time she said she could now sense it from a “more distant place.” She had learned that she could just stay with her sensations, and that not only could she be “okay,” the sensations themselves would change and become less overwhelming.

That’s the strange thing about panic– when we lean into it, it loosens its grip on us. The power of reflection allows us to approach, rather than withdraw, from whatever life brings us. And when we learn to “stay with” a feeling, to give it its time in awareness, then we discover that feelings– even very strong and threatening feelings– first arise and then dissipate, like waves breaking on the shore. Panic is just another feeling, a set of neural firings in our brain. Learning to stay open and present to it, or to any other distressing feeling, is not easy, but it is an essential step in moving through the fences of defense.

THE WISDOM OF THE BODY

What was revealed as Anne learned to confront and regulate her anxiety, as she widened her window of tolerance? What sensations, images, feelings, and thoughts were now free to emerge? As we returned to the body scan during that session, Anne felt a wave of coldness in her chest and tightness in her limbs. Again she said it was hard to breathe. She spent a few moments at the cove, following her breaths as if they were waves on the shore, she later told me, and then said that she could continue.

As she stayed with her inner experience, images of her father and stepmother appeared in her mind’s eye. She felt frightened of their faces and wondered if this panic was a fear of their meanness, of how they had mistreated her. She again focused on her breath to ground her in the hub of her mind, that open and receptive state of her regulating and self- soothing prefrontal cortex.

Now Anne began to tremble, her face looked tense, and tears began to flow down her cheeks. “I see a picture, but it’s not something I remember…it’s something I’ve seen, something I have. It’s the only picture I have, the only thing I have left. It’s a picture of me and my mother.” Anne opened her eyes and looked at me. “I have that picture buried in my closet somewhere– I haven’t looked at it in years.” She seemed relieved but exhausted. It was near the end of our time, and I asked Anne if she’d like to just take a few moments to sense her breath, to let her body relax and her mind appreciate all that she’d been through during this session.

To make sure we had thoroughly explored her heart- mediated feelings of distress, we returned to the body scan during our next session. Anne’s initial sensations of panic shifted gradually during the scan. She now began to feel a heaviness in her chest and a tightening in her throat. Then tears filled her eyes. As her panic was allowed to take its natural course, unhindered by defensive reactions, it moved toward completion, dissipated, and revealed an emotion that had been far more hidden in Anne, a profound sense of sadness. Now the essence of staying present for Anne was to allow these sensations of loss and grief to unfold in their own time.

In a subsequent session we simply sat together as she let the image of her mother holding her– the one in the photograph she’d remembered– fill her awareness. At first her tears were slow, a few drops she didn’t seem to notice and did not wipe away. But as we stayed together with whatever she was feeling, she began to sob uncontrollably, her body bent over as she moaned in pain. I let her sense our connection with my own nonverbal signals– a sigh, a quiet “ummmm,” the rhythm of our breathing in synch. When she opened her eyes and we looked at each other, I noticed my own tears.

“I know this sounds strange,” she said, looking at me now with softer eyes than I’d ever seen in her, “but I can feel my mother’s presence; I know she is here somehow with me.”

Then Anne told me she had had a dream the night before our session. “I haven’t had a dream in decades,” she said, “and this was a strange one.” Dreams are the work of sleep, one of the important ways we integrate memory and emotion. They occur when cortical inhibition is released enough to allow our subcortical limbic and brainstem regions to have a heyday with imagination and feeling. The dream itself is an amalgam of memories in search of resolution, leftover elements of the day’s events, sensory inputs while we’re asleep, and simply random images generated by our brain’s wild activity during the rapid- eye- movement (REM) stages of sleep.

I thought it was a great sign that now, finally, Anne’s subcortical regions were sending their input into her dreaming brain– enough for her to remember these internal images when she awoke. I listened closely.

“In the dream I am swimming to shore but the tide is going out and I can’t fight it. Then my legs are tied to a boat that is headed out to sea, but I keep trying to get back. I’m pulling frantically with my arms, but I’m getting more and more exhausted. The boat just keeps moving and I can’t see the shore anymore. I woke up this morning and felt panicky. It was awful.”

I asked her to tell me more about what she’d felt when she awoke, and what came to mind now as she recounted the dream to me.

“I don’t know. I think it’s weird. Maybe I’m just too tired.”

But a week later she described a second dream, and also the notes from the therapy journal she’d begun to keep. “I’m back in the water. Now I can see the shore. But the boat is moving again– I’m going quickly out to sea. I feel like I’m going to drown for sure. But then I reach down to my leg– I think I really did, it felt warm– and I pulled off the ropes. I freed my legs and started kicking like mad. Finally I got to the shore and collapsed in the warm sand. I remember just looking up at the sky, seeing the sun, and feeling safe. Then I woke up and knew it was all a dream, but I felt relieved.”

This time she was more ready to talk about what these images might mean for her, and we explored her feeling of helplessness as she was pulled away from everything that was warm and solid in her life, and then her relief as she finally reached the shore again.

IMAGES OF HEALING

At the beginning of our next session, Anne handed me a large envelope. She had found the picture of her with her mother, which had been taken when Anne was about two years old. She told me that after her father remarried, he had destroyed anything that reminded him of her mother, and had never spoken about her. It was only after she’d left for college that she was finally able to visit her mother’s parents, who gave her this photograph.

But in the envelope there were two pictures, an old snapshot and a larger print of the same image. Anne had scanned the old photo into her computer and then deleted the figure of her father, who had been “lurking” in the background. “I want to hold on to the part of memory that gives me warmth,” she said. “I don’t need to be tied to my father’s mean wife, or to his grief.”

The enlargement centered on little Anne and her mother, nestling together in an old- fashioned wing chair. Anne was in her mother’s lap, pointing excitedly toward the camera with her right hand, while her left hand held on to her mother’s encircling arms. Her mother was gazing down at her and smiling. It was a moment suspended in time, the child secure in her mother’s embrace yet eager to reach out, the mother delighting in her daughter.

As I handed the photos back to her, Anne said, “I can see a certain sadness in her eyes.” Her mother’s cancer had been discovered when Anne was about a year and a half old. “I can only imagine how horrible that was for her, knowing she wouldn’t be able to care for me, or see me grow up.” We sat together, just staying with that feeling of clarity.

In the weeks ahead, Anne would also come to reflect on how difficult it must have been for her father– her grandparents had told her how much he had loved her mother, and how he’d fallen apart when she died. “I guess he did the best he could after she was gone,” she said to me one day. “He was so young himself, only twenty- six. But I still can’t understand why he just disappeared– and why he chose such a monster for his new wife. When my mom died, in many ways so did my dad.”

Anne’s grief was finally taking its natural course as she opened to all of her feelings– love, loss, confusion, anger, and even forgiveness.

Anne decided to stay in therapy beyond the few months she had committed to originally. As her work continued, Anne’s life began to have a sense of vitality that had been missing for decades. She began to take time to exercise regularly. Her palpitations gradually reduced in frequency, then ceased altogether. She started to see some of her colleagues socially, outside the office. She also found the time to “just be with” her daughters, and she discovered that there were things they enjoyed doing together (it turned out that the girls liked art projects, too). Instead of catching up at the office every weekend, she made it a point to plan outings with them. “I know they won’t be around much longer,” she told me.

Anne feels more present in the room now. She holds herself differently; she seems at home in her body, her movements more fluid and relaxed. She has started to wear her hair down, flowing over her shoulders. And she has told me that she no longer feels empty inside.

Purchase Mindsight at the new, all-Daniel Siegel section of the WTCI Bookstore.  Find Dr. Daniel Siegal online at drdansiegel.com.

For your reading/sampling/learning pleasure, an excerpt from The Blueprint for a Successful Practice: Methods of Marketing Your Business & Increasing Your Bottom Line by Illinois-based therapist and consultant Gina L. Spielman, LCSW, C.H.

Chapter Five:  Attracting Your Ideal Client

Maybe you would like to attract a certain type of clientele to fill your caseload and have been unable to do so? Of course, working diligently on many of the previous methods and suggestions mentioned should help you meet this goal. This chapter gives some additional words of advice on how to attract your ideal client.

DETERMINE WHO YOUR “IDEAL CLIENT” IS
You might not be quite sure what your “ideal client” looks like. If this is the case, I suggest doing some soul-searching to figure this out. There is a good chance there are certain types of cases you enjoy working with more than others. This is important to identify for yourself and your contentment with your practice. What types of cases seem to fill you up, and which ones seem to deplete you? Which cases tend to make you look forward to sessions, and which seem to make you dread them? Many of you will have a clear feeling or picture here, however there will be some of you that may need to take a bit of time to figure this out for yourself. Once you do, it can benefit you in many ways. The most important way is that it will contribute to your happiness in your work. It will also assist you in writing a professional profile on yourself that will portray your specialties and interests, which will attract your ideal client. Clients may also be able to sense whether you are truly excited to work with them or not, so it is a win-win situation if you know what your ideal clients look like and then they are attracted to you.

GETTING “QUALITY” REFERRALS
Perhaps you would like to learn how to receive more of a certain type of referral, such as non-managed care or higher fee? There are plenty of self-pay clients out there and making yourself stand out will definitely help attract them, many times at your full fee. In my practice, at this point all of us are certified hypnotists in addition to our primary licenses. This has done very well for us in our area, because it is difficult to find a mental health professional who is also a hypnotist. There certainly are not many on managed care lists. So in that way, we certainly stand out in the crowd for clients looking for some hypnosis with their psychotherapy. Therefore these clients are more likely to bypass some or all of their insurance coverage to see us. So think about what additional training you might find interesting and would enjoy doing. Some interesting certifications that I have come across are in the following list. The good news is that none of them seem to be extremely difficult to achieve, yet they serve the purpose of conveying a niche or communicating a specialty:

• Certified Hypnotist (C.H.)
• Emotional Freedom Techniques Certification (EFT-CC)
• Distance Credentialed Counselor (DCC)
• Certified 12-step Consultant (CTC)
• Substance Abuse Subtle Screening Inventory (SASSI) Certification
• Certified Anger Resolution Therapist (CART)
• Stress Management Counselor-Certified (SMC-C)
• Certified Bereavement Facilitator

Whatever your interest is, fully research any possibilities and choose the training that you feel the best about and are able to do. This will make you stand out in the crowd to your ideal clients and their referral sources. Make sure you place this on all your marketing materials and word it such as “Certified Anger Resolution Therapist”, and if you can place the certification letters behind your name that will work well (just make sure to explain all of your credentials so that potential clients can see them clearly and quickly, and understand what they are). So, if someone needs anger management, and you are a CART, they will likely call you first.

On your marketing materials, you can also list major trainings you have attended. Include wordings such as “ICASA/ICADV Certificate: Trained by the Illinois Coalition Against Sexual Assault & the Illinois Coalition Against Domestic Violence”. It does not have to be a formal certification to include it as something important. Doing this increases your credentials and also gives a clearer picture of your professional interests.

You may also choose to join various associations, such as one for Cognitive Behavioral Therapists, to show that it is one of your methods and you keep up on all the recent news about it. CBT is one method or theory that is frequently sought out by potential clients as well as referral sources. So taking something a step further by joining an association, or showing you have had additional related training, will make you stand out.

Having some unique specialties or interests will help. For example our “Holistic Approaches to Well-being” has generated many referrals. I am simply a practitioner member of a holistic health association and have taken an interest in learning new research along with natural remedies. It is my approach to look at the whole person as well as their life and everything around them, in addition to spirituality and energy. This is how I see all cases and it has done well for me and the counselors in my practice. It also draws the clients in. It is certainly not the usual approach clients will likely get from someone perhaps in their managed care provider network.

So, being aware of trends, filling current needs, and making yourself look different than the average counselor will be important. One of the frustrations we hear from clients is that they cannot find a specialized therapist in their managed-care network. So, set yourself apart and demonstrate your true value in the marketplace through specialization. Many people that are in the market for healthcare value specialization.

WHAT IS YOUR IDEAL CLIENT LOOKING FOR?
Ask yourself what your ideal client might be seeking. Know the answers to this question, and make sure all of your marketing materials will be attractive to your potential ideal clients. What are they looking for and what would they like to see? If you want to work with grief/loss, perhaps your ideal client would like to see that you belong to a professional association of grief counselors, and that you have written an article on grief that you have posted on your site. This will be quite attractive to this type of clientele, and none of it terribly time-consuming or expensive.

Another example situation might be where the potential client is looking for someone who has been through a similar problem, and she feels it would be necessary for the counselor to have that type of personal insight and understanding. For example, a client who needs assistance coping with physical illness might search for a counselor who has been through a severe illness herself. So on this counselor’s marketing materials, she may want to mention that her approach to helping clients cope with physical illness comes from dealing with her own past illness. This counselor will definitely stand out in this client’s eyes with this information on her marketing materials. There is a unique understanding here that only someone with these types of experiences can provide, and this can be extremely important for a client like this.

WHERE WOULD YOUR IDEAL CLIENT COME FROM?
Ask yourself where your ideal clients may come from. Might it be from the phone book? Might they come from an EAP plan (an employee or family member of an employee)? Maybe they will come from a certain type of internet website? Or maybe your ideal client attends divorce support groups in the suburbs? Perhaps they will be referred by a specific insurance company? Wherever your ideal client may be, or may be looking, you are going to want to have a presence there somehow, and make sure everything there is complete and looks professional. For example, if they might come from a specific insurance company, make sure that company’s list is completely accurate as far as how and where you are listed. As I mentioned earlier, it would surprise you to know how many times I found my provider information to be incomplete or inaccurate. These lists are what potential clients, as well as referral sources, are viewing.

BE AWARE OF TRENDS
Watch the news and read your local papers to look for trends! This can spark ideas on current needs in your area and how to fill them. For example, after watching and reading my news, I see opportunities for professionals trained in career-oriented counseling, grief/loss, marital therapy, financial counseling, suicide prevention, insomnia relief, and more.

WORK WITH EAPS
Contracting or working with some EAPs can also give you a referral base of clients who can eventually be self-pay or have insurance coverage for ongoing services. (See Chapter One for more on EAPs).

Keep in mind that if you are not the right therapy provider for a client, which may be determined after her EAP assessment, it is usually fine to refer out to another more suitable provider for the treatment piece. So, do not feel like you have to take every EAP case as a long-term therapy case. Just explain to the client that you feel that another therapist would be a better fit for her actual treatment, include the reason(s), and then make the linkage to the treatment provider.

ANOTHER WORD ON SELF-PAY CLIENTS
Often we get clients that are not sure they want their insurance billed for psychological treatment. This could be a legitimate concern as we really do not know what the insurance will do with their confidential information. There may also be a treatment plan or reviews necessary, so there may be additional concern with that. Clients also need to be told that, in the very least, a psychiatric diagnosis will have to be submitted to their insurance for any coverage to be released. This diagnosis could remain in their permanent record. So, if the client is teetering back and forth about whether or not to use insurance, explain all of this clearly and then he may choose not to use insurance. Then you have a self-pay client, at least initially (note: he may change his mind later).

If you have a client that is looking for something specific only, such as hypnosis, life coaching, or career counseling, it is probable that his insurance will not cover it anyway, so there you go! If you are offering services such as sports psychology, career-oriented counseling, or anger management (for courts), the insurance will only pay if there is a covered psychiatric diagnosis that needs treatment. So you will have to explain that to these clients and also that a psych diagnosis will be submitted and will then be on their insurance record. Some will chose not to have it submitted and will rather self-pay.

I also know that marital and family treatment is not always covered by insurance (particularly HMOs). So, if someone calls asking for couples counseling and she has a very limited HMO that you are not in-network for, let her know that she might not have the coverage anyway. Have her call you back if it is determined that her insurance does not cover this, because they might as well see you for their couples counseling then, right?
Some are predicting that if universal coverage gets passed (or if government gets more involved), marriage and family therapy will not be covered. They are also saying that mental health, if it even gets covered at all, will be even more scrutinized for “medical necessity” and “evidence-based treatment” than ever before. They think that people are not going to want to pay taxes on something that is for “personal growth” only. This all may be true, but it might turn out just fine for everyone reading this book, because now you all have the ability to exist without relying on insurance cases alone!

DON’T FRET IF YOU’RE NOT IN-NET!
If you are not in-network for a potential client’s health insurance, try not to let that be the end of the call. Ask if he has a PPO plan or another type of plan with possible out-of-network benefits. Because if he does, there will likely be some coverage for him to see you (and sometimes it is not much different than the in-network benefits, especially when you factor in contracted rates compared to Usual and Customary out-of-network rates, which can be much higher). So, you can offer to give him a receipt for services that he can submit to insurance for re-imbursement. This is usually called a superbill receipt. (See Chapter Three for more information under the section “Use the Superbill Receipt”). In my practice, we like using these, as opposed to submitting to out-of-network plans, because we get paid upfront this way and we do not usually have to deal directly with all the insurance issues that seem to frequently arise. This does not mean you will not get pulled in to help in some situations, but it is usually much easier and more lucrative this way. There are some therapists who continue to bill out-of-network plans because there are some benefits to doing so, such as Usual and Customary PPO rates being quite nice, and clients also usually appreciate the billing service. We have found, though, that many clients will go the superbill or self-pay route just because they want to see a specific person, either because they have the specialty or technique that is needed, they have a desired office location, they came highly recommended, or simply because they felt a connection with the counselor and therefore put that before any payment issues.

There are some clients or patients, however, that simply are not going to be able afford to go the out-of-network route even if they really want to see you and you have negotiated down to your very lowest amount, or even offered to bill insurance for them. Unfortunately, those sometimes have to be referred on to someone else, but always say “call us again if your situation changes”, because you never know what can happen in the future, or who they might refer later on. Always keep a good reputation within the community by being helpful, courteous, competent, and open to new referrals.

Some clients will choose to bypass their insurance altogether. You will find that some people will forgo managed-care, or HMO, reimbursement. So they will self pay for services that are of high value because they can be of higher quality, offer real privacy, offer more control in decision-making (such as length, frequency, location and amount of sessions, or methods used), and are truly customized for their individual needs. You can tell callers exactly this, and still show respect for their insurance carrier at the same time. Leave the client to make the decision, and hopefully it will be an educated one. Remember not to jump straight into offering sliding scale to these folks. Wait to see what their financial situation is first, and then you may decide to offer it if absolutely necessary. You can always try contacting them again in the future to follow-up and further discuss, if you have not heard from them in a while.

MAKE SURE THEY KNOW YOU TAKE CASH!
It is important that you make sure you include statements such as “private pay” or “cash/checks accepted”, as well as “sliding scale fees available (if necessary)”, on your marketing materials. You will want to make sure that non-covered clients know they can see you. As I said previously, we have had clients ask us if we take cash! Ummm, YES we take cash! We have also had clients feeling reluctant to speak to us because they did not have insurance. Well, we had to explain that it is just fine as we do take cash, checks, and credit/debit cards. In addition, we have told clients that we can be very creative with setting up their treatment and payments depending on various circumstances when needed. Some of these have turned out to be exceptional long term clients for us.

SEEK ORGANIZATIONS AND GUILDS THAT LINK PEOPLE TO MENTAL HEALTH AND WELLNESS PRACTITIONERS
As mentioned earlier, there are some new and unique organizations that are creating ways for people to access providers and services that may not be covered by (or involve) their insurance. This avenue can therefore be a way to obtain more self-pay clientele. A few of these organizations are contacting employers to provide a membership card for employees. This card would entitle them to discounted services from provider members. There is no insurance to deal with, and no one to approve or deny sessions. Instead, providers agree to offer their services at a discount to members, and the clients pay upfront. From what I have seen, there is sometimes a fee to become a provider member, however this usually includes a listing in their directories which is an added bonus. So, asking around and searching for “guilds”, as well as topics such as “alternative health care provider lists” and “health savings cards”, may bring you to these types of opportunities.

DRESS TO ATTRACT THE TYPE OF CLIENT YOU WANT
Think about the type of clients you want to attract and how they might dress while coming to sessions. If you want to attract adults that are upper class or business professionals, you might usually want to wear business suits, dress pants or dresses while conducting sessions. These types of clients might be slightly uncomfortable if you are always wearing jeans or something more casual. On the other hand, if you want to attract children, adolescents or more casual (or perhaps blue collar) adults, then wearing a business suit or dress may make it difficult for your ideal clients to connect with you. But if you are usually in jeans, casual pants, or a very casual dress, then it may help you to connect with these clients. If your caseload is a mixture of all types of clients and you want to keep it like that, then I suggest you wear casual pants or casual dresses/skirts during most of your sessions, so you fall somewhere in between and will be able to connect well with all clients.

OFFICE SPACE THAT ATTRACTS YOUR IDEAL CLIENT
Your office space can attract your ideal client and keep them coming back. Therefore, make sure your office always looks inviting because you never know who could be looking in. You will want them to get a positive feeling of what it might feel like having a counseling session in your office. If you want to attract children, then make the office inviting to them. Having toys, small scale furniture for them, colorful décor, and children’s activities all will help. If you want to attract more adult upscale or business-type clientele, then you might want to make the office look more upscale or business–like, and you may want your offices to be located near upscale residential or corporate areas. If you would like to attract the teenage client, then having “cool” things in the office will help, such as certain games, décor or magazines, because if it is fun or “cool” for them there, then teens are more likely to return for services. If you want more hypnosis clients, then make sure you have the appropriate furniture for them to be the most comfortable. If your desire is to work with more handicapped clients, then of course you will have to make certain your space is 100% handicapped accessible. Working with larger-sized clients will require you to have various sizes and shapes of furniture. If your office is small, there are ways to create optical illusions to make it seem more spacious. Get some help in making it feel more cozy if it seems too big. Just make sure the office, and the contents, accommodates and makes comfortable the type of clientele you want to attract and keep.

MAKE SURE YOUR AVAILABLE TIMES AND DAYS MEET THE NEEDS OF YOUR IDEAL CLIENT
Having days and times available that will be convenient for you and your clients is crucial. I have found that a mixture of some daytime, evening and weekend hours works quite well when building a practice. Also make sure the times are tolerable for you because you will not last long if the times you can use the office are not the times you want to work or have a lot of energy. It just will not work in the long run and clients may sense this as well.

TAKE CREDIT CARDS
Accepting major credit cards will most likely attract more self-pay and superbill clients and it might be easier for them to pay for additional services as well. It will also help for any bulk payment situations. (See Chapter One under the “Accept Major Credit Cards” section for more on credit cards).

A WORD ON SPECIALTIES
If you have a specialty where you are highly trained and skilled, but you do not particularly like doing the work, shift the training and knowledge a bit to something you do like. For example, a therapist might be trained in alcohol abuse counseling but may not like doing that specific type of work. She could leverage that skill by working with related topics or populations. For example, she could add to her marketing materials that she works with family members of alcoholics, or codependency, or that she does evaluations only. She could also make a shift to a general “addictions” specialty, which may include issues such as smoking and habit cessation, internet addiction, and so forth. So you can use what you have learned from having previous specialties, and shift it a bit towards the particular issues or populations you would like working with. It will be better for your practice in the long run if you enjoy the work you are doing.

OFFER SPECIAL SERVICES FOR THOSE WHO LIVE FAR
Reaching out to populations that live far can add to your income as you can gain more “ideal” clients as well as increase your “income streams” this way. For example, a beginning hypnotherapist may want to offer longer sessions to those who live far away from her office. Also, someone who specializes in grief counseling may want to market to farther away areas and offer telephone sessions to attract more grief/loss cases. These far-away places might be rural, underserved areas within your state. The possibilities are endless if you think about it.

Find the rest of the book at the WTCI Bookstore.  Gina Spielman is online at www.ginaspielman.com.

Unconditional Positive Regard

from Therapy Online: A Practical Guide

Conveying the potential for the therapist to have unconditional positive regard for the client is a process that can often start before any communication actually takes place when working online, through the use of the website to explain what this means and what regard the therapist already feels for the website visitor without having met them. This sounds facile, but it is the tone that is taken via the text while writing the website content that can convey this. Many people make the mistake of writing website content for themselves and how they would like to be, rather than being congruent (which we shall come on to) and writing for their potential client, considering the likely state of mind of the potential client. One can convey to the client that one expects to hear issues and problems that the client may feel embarrassed or ashamed of, and that as their therapist, one will think no less of them for having shared those issues. The website can state up front that the visitor is held in the utmost regard, that they are accepted and that there is a space for them to explore themselves and grow from the experience while being safe from being judged or ridiculed.

It is important to remember that the client can carry the therapist’s input, literally, at all times, and therefore the text must be carefully constructed to avoid any ambiguous meaning that the client can use to fuel any self-fulfilling prophesies that she or he may have. Conveying unconditional positive regard throughout the email or IRC session can aid the interpretation of the text around it, which is often misread, unconsciously, to suit the client’s agenda (Goss and Anthony, 2003). Acknowledging the client’s worth and one’s respect for them often renders misinterpreted text as incongruent and so the client will go back and re-read the text to better understand the meaning, as the misinterpreted text does not seem to ‘fit’with their experience of the therapist thus far. In this way, the regard the practitioner holds for the client and the ability to ensure she or he understands this, underpins the whole tone of the text.

The online disinhibition effect (Suler, 2004), further defined in Chapter 2 often means that the more distressing or uncomfortable issues come up much earlier than they would in face-to-face sessions, and the practitioner may find that they are struggling with this information before they really ‘know’ the client and are able to feel that the unconditional positive regard is inherently in place.This process is crucial to the effectiveness of the therapeutic process – if one is not able to keep the reassurance of understanding and regard in place, the client will feel that they have ‘gone too far’ and they can be lost, since ‘disappearance’ on the Internet is facilitated so easily. It is important to indicate that, in the case of emails and forums, although a word count or length limit is appropriate, it does not mean that the content of the work is limited. Having unconditional positive regard for them means that you can trust that the pertinence of the work will emerge as the relationship grows, and that even where there is uncomfortable work going on at an early stage, this is not only expected, but welcomed.

Many humanistic or person-centred therapists will convey warmth and regard in a variety of physical ways, including smiling, appropriate touching, or leaning towards the client. Chapter 3 will focus on how this is done when working with text, but it is important to point out now that most of the physical tools that the person-centred therapist employs are entirely possible when working without a physical presence in cyberspace, even appropriate hugging (in fact, particularly the hugging (Anthony, 2000)). It should be noted that representation of physical contact or movement should be encouraged when online to assist the development of the relationship and convey the core conditions of humanism. The consistency of this warmth and regard will be important as the work continues, and any withdrawal of it will rebound negatively on the work. It is therefore essential that all representation of being a physical being is natural and personal, so that it occurs without thought or specific intention, unforced.

From Therapy Online: A Practical Guide by Kate Anthony and DeeAnna Merz Nagel.

Are you happy? Do we need galoshes? Are bluebirds perfect? Do you know the distinctions, empirical or theoretical, between moss and lichen? Is it clear to you why I am asking you all these questions? Should I go away? Leave you alone?

Therapists spend most of their time asking questions and only rarely get asked anything themselves.  So here, for a debut Mental Health Break, suggesting the preview of the Powell book posted by the publisher.

Read some out loud with someone–makes for a lively parlor game-type activity.  Some questions good for laughs, others for a little discussion.  “Do you consider yourself dangerous?” might get you talking about fear of expressed anger–how we sometime imagine our rage unleashed is more than others, or the world, could possibly survive…which may lead to talk about early terror of parents’ survival-threatening anger…and to how this is dealt with in object relations theory and …so much for that Mental Health Break.

Enjoy.

Loved it?  Gonna buy it?  Here is it is at the WTCI Bookstore.

Building Your Ideal Private Practice

Twelve Months to Your Ideal Private Practice

Following up on WTCI’s interview with private-practice guru, Lynn Grodzki, an excerpt from her latest book,

Chapter 1: From Surviving to Thriving

Economist Paul Romer once said that a crisis is a terrible thing to waste. Any crisis, global or personal, becomes a defining moment in time. It is fraught with difficult challenges but also filled with a remarkable opportunity for making major, important changes. As I write this book, much of the world is facing a deep economic recession. My clients — therapists of all types, healers, coaches, consultants, and many other service-oriented professionals in private practice – are justifiably worried. They ask: How can I manage the problems that this crisis is causing within my small business? With so much to do, what should I attend to first? I may be OK today, but what about tomorrow? And the most determined wonder: Is it possible to not just survive a crisis, but to thrive?

This economic crisis is global, but during the course of your business ownership you may also face a crisis of a more micro or personal nature. Illness, an unexpected need to relocate, a professional setback, the break-up of a partnership, or a change in the need for your specific services can bring your practice to the brink and leave you feeling scared. In times of fear, we tend to contract our awareness and develop a kind of tunnel vision, seeing just a small slice of the big picture. Flooded with our own feelings, overwhelmed by the needs of our small business, and trying to work with the ongoing needs of our clients, it’s hard to regard a crisis as any kind of gift.

But buried within every crisis, often veiled by the multiple daily worries and tasks, is a hidden jewel: the rare opportunity to stop and see your private practice and yourself with new eyes. With the proper framework you can use a crisis, any crisis, as a jumping off point to reexamine your business, shift its direction, and make it more purposeful and more profitable. Many small businesses get better at what they do only during bad times. Many business owners only take action when their back is against the wall, and their old way of working stops working.

Therapists I coach find that the challenges created by the current recession, while anxiety-producing, are also highly illuminating. (For purposes of brevity, I will often use the generic term of therapist in this book to refer to readers, although I know that many of you are working in other helping or service-oriented professions. Please adapt or adjust this term and any references to one profession versus another in the case examples I offer, so that the information fits your professional situation.) In a crisis, everything good, bad, or indifferent about your private practice and yourself as a business owner is exposed for evaluation.

A crisis is like a low tide at the ocean. When the ocean recedes you can walk far out on the sand and see all manner of debris littering the ocean floor; but you also spot the occasional treasure – a pristine, glimmering shell buried in the sand. Today’s crisis, the recession, has stripped away the surface gleam of business and society. We now see all the weak links and vulnerabilities. But if you know where and how to look, you can also see potential. There are countless prospects for new business within all healing and helping professions.

You can approach a crisis with trepidation, standing on the shore and nervously looking out, horrified at the debris and confusion. Or you can learn to be a beachcomber, walking amongst the litter, scouring the sand for shells, scanning the horizon so that you don’t overlook prospects for business development. Through the pages of this book, I will help you to unearth the business opportunities right in front of you. Dig deep enough, and you may discover your own latent entrepreneurial capacity to increase your profitability, resilience, and leadership. All of these half-buried treasures are laid bare by a crisis; they are yours for the taking. Ignoring them is, as Romer says, a waste.

Time is a factor in a crisis. You need to move quickly. I know that some believe, as Nietzsche said, that which does not kill us makes us stronger, but I am a realist: Everyone has a breaking point, as does every small business. In this book I will work with you in two ways, to show you what to do, effectively and quickly, to save your practice, but also to suggest how to be, so you can stay resourceful and calm. As with my earlier books, I will be speaking to you as though we were in a private conversation, with me as your personal business coach. I will offer examples and ideas gleaned from years of coaching thousands of your colleagues. I will combine a healthy dose of tough love with compassion and optimism. My hope is that this will be the right book for you at a critical time, but also a book to keep on your bookshelf and refer to when needed.

For those readers who have picked up this book but are not faced with a current crisis, reading this for prevention is a wise move. Knowing how to avoid risk and act more strategically helps you stay successful over time. Think of this book as a fire drill – without the danger of smoke and heat at your back, I will show you how to take steps and make changes that can reduce concerns about your future. Regardless of your current situation, I offer you what I believe every small business owner needs: a crisis-proofing plan that can light your way in times of darkness or help you to avert disaster altogether.

Triage

I am a psychotherapist in a solo private practice that I have operated successfully, free of managed care, for over 20 years. Before that I worked for 7 years in the family business, as General Manager of a multi-million dollar scrap metal business and also started a few small businesses of my own. In a move to marry my fascination about business with my love of helping people change, a decade ago I began working as a business coach and consultant with an international clientele.

From this combined experience in my own private practice, my experience spent coaching others, and understanding the world of small business ownership, I know that in a crisis your job, as the owner of the practice, is similar to a surgeon on a battlefield: you must do triage. You need to do assess the damage, stop the bleeding, stem the worst of the pain, and start treatment where it will help the most. Any crisis is destabilizing; trying to figure out the first steps to take can be bewildering. In other crisis-oriented situations, such as a war-torn battlefield, medics have a method of prioritization called triage. They quickly assess the damage and determine a preliminary plan for those who have been hurt. If your practice is hurting, you need triage in the form of a crisis-proofing business plan.

Being without a business plan is common. During good times, a plan is helpful but not critical. But in a crisis, having some kind of plan is essential, not just to keep the practice afloat but also to keep you, the practice owner, calm. You may be flooded with fear or anxiety. Fear causes a strong fight/flight impulse and it’s a dangerous impulse for a business owner. Instead, you want to slow down, think clearly, conserve your energy, and take well considered steps. Having a plan, a way to formulate your thoughts and actions and a way to put the situation in perspective, can make the difference between your practice success or collapse.

This book comprises a business plan that works well in a time of crisis or can be used as a resource to protect you against crisis. It is comprehensive and addresses the major areas of a business plan: overall direction, finances, marketing, administration, and business positioning within the marketplace. It is easy to understand and implement. But it is different from a traditional business plan in that it has four sequential stages that help you navigate a crisis. Each stage of the plan corresponds to a section of the book. The early stages and chapters of the plan focus on immediate steps to help your practice get on a solid footing quickly; the later stages and chapters consider longer-term ideas and strategies that can help you maintain and sustain an ideal practice over time. You can read the book progressively, stage by stage, to have the complete plan or customize the plan as needed by jumping ahead to the sections that seem most relevant.

Here is an overview of the crisis-proofing plan, stage-by-stage:

• Review: In the first section of the book, we quickly determine your starting place and assess any damage. I will lead you through a streamlined evaluation of your situation, so that you can analyze your assets and liabilities, set and then prioritize your goals. You will read a long case example of the crisis-proofing plan in action to see exactly what is possible to correct and improve in a small business with guidance. In each chapter, I give you exercises to help you take next steps but also to clarify your situation, so that you can see the big picture of your practice within the context of a crisis. Step by step, you will learn to regain control of your situation and feel supported.

• Recommit: Next we focus on strategies to help you re-craft your practice. I explain the ways to minimize risk in a small business, and how to break free from unhealthy dependencies that are obstructing profitability. Instead, I will show you specific ways to affiliate and collaborate, pursue better opportunities and options, so that over time your practice becomes healthier. We look at your financial situation, and how you handle money. I will walk you through the ins and outs of cutting expenses to trim unnecessary fat from your budget, but not starve your practice. Using a crisis-proofing marketing plan, you will see how to generate referrals even in a down market and attract quality clients. We will retool your systems and operations so that your practice management improves and you operate a more efficient business — one that reflects the best of who you are today.

• Rebrand: With your practice moving towards a healthier position, its time to rebrand – to make it more visible. People who need your services have to be able to find you. You will see how to make best use of the Internet to generate clients and develop multiple streams of income. We will refine your future practice direction by analyzing the top four 4 business models for a private practice during a tough economic market. Then you will integrate all the earlier sections and formalize your turnaround plan, setting specific goals to help you move forward and stay motivated.

• Reinvest: The final section of the book looks beyond surviving to thriving. I will show you how to build a practice you can sell, not just own, so you can consider retirement options. You will also see how to invest more in yourself, since you (the owner) are the most valuable asset of your practice. We will look at the emotions and beliefs that can sabotage your success; your mindset is often the difference between going the distance or giving up. With exercises and case examples, I will help you shift from feeling victimized by a crisis to claiming a sense of leadership, empowerment, and choice.

Crisis-proofing Mantras

Starting right now, I want you to think about your practice the way a successful entrepreneur thinks: with a balanced combination of optimism and pragmatism. You need some business mantras, short phrases, repeated often, that keep you focused and on track. I have six mantras that my clients hear me say again and again. Each one addresses an important crisisproofing perspective that I want you to consider before you act.

1. “Focus on profit, not growth.”

Profit and growth are not the same. In a crisis, the smart way to operate is to keep your eye on your profit (your income minus your expenses.) Stop daydreaming about new ideas and services for new or different markets; come down to earth and think about ways to make your existing practice and services as profitable as possible. Even though you may be bored or yearning for newness, this is not the time to expand impulsively. In a weak market, don’t overburden your small business with unnecessary expenses. Adopt a tough love approach to your business spending. The best ways to focus on profit include the following:

Lower input costs: Negotiate to cut expenses on office rent, advertising, supervision or mentoring, printing, mailing, website hosting, office equipment, phone lines, and outsourcing billing. Leverage these same expenses by sharing them with colleagues or affiliates.

Increase productivity: What work do you do that is not billed? Begin to examine billing in these areas that involve your time and effort. Set boundaries on your unbilled activity. Increase productivity. What will help you do more with less?

Systemize: Organization is key in being more profitable. Match your business efforts to your business needs. What can you clean out, fix up, delegate, or automate? Start with small steps and make inroads into clutter and filing. See chapter 7 for ideas and software that can help you run a leaner, more efficient practice.

2.  “Small steps count.”

You are a small business, so the loss of one or two clients can be a hard hit. But the opposite holds true as well – one or two new clients can keep your practice humming. A small increase in savings or a small reduction of spending can make a real difference. Let your small business help you to think in small steps. Consider short term goals and small action steps. Avoid losing yourself in daydreams of big visions; keep your objectives specific and doable so that you don’t get discouraged. Small is beautiful in a crisis. One way to think small is “chunking down.” Chunking down is a process-oriented term that means going into detail to find smaller and more specific elements of a system. It’s a useful strategy to combat feelings of overwhelm, when a task seems too large to comprehend, or a goal is too complex to implement.

For example, rock climbers facing a daunting mountain climb will chunk down the difficult climb to ease both their psychological and physical ordeal. They will mentally divide the huge mountain climb into a series of shorter climbs; its similar to driving a long distance in your car and instead of trying to do the drive in one long haul, stopping every few hours to stay refreshed and see the drive as a series of destinations. Try this with your goals. As your mind learns to see a task in smaller elements, you will feel calmer and in better control. You can use a back and forth mental process of “chunking up” — seeing the big picture — and then chunking down to manage change and create more understanding and focus for developing an action plan. For example, David Straker (2008) suggests this process:

• Define the problem in one all-encompassing sentence (chunking up.)

• Chunk down to find possible project goals.

• Chunk up to review the strategy as a whole.

• Chunk down to build an even better understanding of the relationship of the problem and the steps.

• Chunk up to look for problems in the overall system.

• Chunk down to find specific actions to address.

Here is how this works: A therapist complains of feeling paralyzed. She complains (chunking up): “There is a huge amount of tasks that I need to do for my practice right now. I am overwhelmed.” Time to chunk down to make it manageable. To get her started, I ask her what, specifically, needs doing first. We look at a series of steps and ten goals for the next 3 months. She gets clearer about the details and begins to feel calmer.

Now we need to review her goals by chunking up, so I can make sure that she is fully on board with this plan. I review by reading her list of goals out loud, for us both to hear, and then ask: Will this list of goals take care of the problems? She sits quietly and then says that it seems complete, but she is not sure. Time to chunk down again to make sure it more precise. I go over each goal in detail with her and we discuss her steps. After each goal, she says “I get it. I am clear.”

But we are not done yet with this back and forth thinking. Time to chunk up one more time. I ask her to get up from her chair, walk around the room, and then come back and look at the plan. “How does it make you feel? I ask.

“Tired,” she says. Uh-oh, a problem with the system: The plan to fix her overwhelm is overwhelming her! We stay chunked up, discussing the big picture of her goals and look for ways to revise it. First, I reverse the order of all the goals, so that number 1 is now number 10 and vice versa. Her take on this? She is somewhat less tired. Then I ask her to order the goals by putting the easiest goals first, hardest last. Her take now? She says she feels energy. Easiest to hardest shifts her motivation from exhaustion to “I can do this.”

With the big picture feeling better, we chunk down one more time to finalize her now revised to-do list for just the coming week and to set up the time for the next coaching appointment. This process of chunking down and up, going from big picture to small steps, back and forth, helps her to feel in control and reduce the initial overwhelming feelings and exhaustion.

3. “Don’t resist, assist.”

Change always occurs fastest in a tough environment. History shows that the most difficult survival conditions (think the ice age) sped the fastest evolution. In the same way, a crisis will force your business (and you) to change faster, just in order to survive. As a result, today’s recession is causing a lot of small business owners to play catch up, as their practices change faster than they are emotionally and psychologically prepared to deal with.

How to cope? Stop fighting it. Instead, grease the wheels of your own evolution. As the owner and operator of your practice, help the necessary, inevitable change to take place without the friction of added resistance such as fear, doubt, or anxiety. Of the many therapists and other service providers I coach each month, the ones that are doing the best right now are those who are willing to allow themselves and their practices to change quickly — with their blessing. Darwin said, “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.”

Stop resisting and start getting curious. Look around you to see examples of new, better, easier, smarter ways to operate your practice. What is working for others? Borrow solutions and adapt them to make them fit for your situation. Who are your models for success today? Learn from what others are doing. Business consultant Barry Moltz (2009) writes that a recession is the time to challenge all of your dearly held business assumptions. “If your business can be done in another more efficient way, then adapt – or die,” he says, adding that cockroaches (who are very flexible insects in that they eat almost anything and live almost anywhere – including in the North Pole!) do extremely well in bad times. Darwin would agree.

4. “The most flexible practice wins.”

When I was at a NLP (Neuro Linguistic Programming) workshop about twenty five years ago, the trainer, John Grinder, explained that the most flexible element in a system will have the most influence or choice in that system. For example, during a negotiation, the person who can see more sides to the argument and adopt multiple strategies can get others to a “win-win” agreement faster than a person who can only see one point of view. Flexibility has always been a bonus of being a small business. A private practice can quickly change course, adapt to a new market, stop an unprofitable program, or start up a needed program.

In a recession, flexibility is a key survival strategy. The more choices you have in the way you operate, the greater the chances that you will be viable and profitable. That’s why I see, over and over, that the most flexible practice wins. Can you dance with the current changes in the market? Flexibility in business is similar to ballroom dancing. Your partner is the economy. You are dancing the tango — but right now the market has the lead. Can you follow, light on your feet, and find ways to stay in the flow? Just because you have operated your practice one way your entire career, doesn’t mean you have to continue down that same path if it no longer serves a purpose.

Exercise: Flexibility

Pick one area and to enhance your practice’s flexibility now.

• Pricing: Can you lower your price point? How about adding low-cost, very small groups to fill in empty hours? Can you discount those times that don’t fill easily? Could you partner with another practitioner to run ads, sharing the expense? Perhaps you can offer a discount for prepaying, or take credit cards to help with the price issue. If pricing is not an area of flexibility for you, how about…

• Accessibility: Can you add Friday evening hours or weekend times to capture more clients? Agree to see clients less frequently and still help them make progress? Turnaround new clients to see them within 48 hours of contact? Find additional ways (internet, social marketing, audio tapes, video tapes) to reach clients from an educational position? If you can’t be more accessible, how about…

• Services: Can you add a new service, see a different population, expand your normal session times from 50 minutes to 75 minutes, offer a menu of services to give your clients more choices, become an independent contractor for a busier office in your off hours, move into a corporate setting with your programs?

Here’s how this works: A life coach complains that her practice needs more clients, and I ask about her degree of flexibility. Because her expenses are low (she does not maintain a formal office space and instead works from a home office) she could consider lowering her fee. She does accept credit cards, but decides that she could also offer a discount for those clients who prepay two month’s worth of coaching sessions. She can also be more accessible: Although she works primarily by phone with clients, she has had some recent requests for meeting in person, at a very busy client’s office. This would require her to commute about 30 minutes to get to the client. In terms of services, the life coach is already offering the coaching services for which she feels best trained, so that is an area which will not change; but now she has two other ways (pricing and accessibility) to reach out to clients who may be interested, but not completely sold, on working with her.

A counselor is also considering flexibility for his addictions clinic. He can’t budge on prices (“I have done my budget and if I lower or discount my fees I will not be able to make the profit I need”), and he can’t relocate, but he can be flexible when it comes to services. “I am going to offer couples counseling, family sessions and even play therapy for children.” This will become a helpful additional income source.

5. “Stretch, not stress.”

You are just one small business owner. You are carrying multiple roles and need to have a full life. Although I will recommend many strategies and ideas, no one does all of these at once. This program is not intended to cause more stress—the last thing you need in a crisis. But it may ask you to stretch some, to tolerate a little discomfort as you learn a new way of operating, thinking, or even feeling about your practice in a crisis. For most of us, the opportunities that can help us transform our practices exist just outside our traditional comfort zone. Think about stretching more into new actions. My personal trainer reminds me that when I stretch, I feel a few seconds of discomfort, maybe even pain. But quickly my body adjusts and I can soften into the stretch. When I stress my body, the pain persists and worsens. I have asked too much of my body and caused harm. Don’t try to do everything I suggest in this book. Slow down, stay curious, consider all your options, then select just one or two changes to start with. Don’t go far outside your comfort zone. Select those changes that require a comfortable stretch, not damaging stress.

6. “Detach from results.”

How your business responds to a crisis is not a referendum on who you are as a person, a clinician, or even a business owner. You need to detach from the results of your practice building and stay focused on the process of practice building. With a small practice, results can take time. You still need to stay in process, work your plan, take action, move forward. Tapping into your internal resources can help you stay in process. Attend to the process of change. Note your starting place today and your goal. But focus on the space between the two points (present and future) that I call the gap. Observe the qualities of the gap. If the gap is too big, you will get discouraged. If the gap is too small, you won’t move enough. If the gap is vague, you will feel confused. If it’s too narrow, you will feel constrained. Just like Goldilocks, you will know when the gap between where you are today and where you want to be feels “just right.” I find that the perfect-sized gap can become its own motivating force. Try this exercise adapted from my earlier book with co-author Wendy Allen, The Business and Practice of Coaching (2005.)

Exercise: Close the Gap

Complete the following exercise to help yourself take initial steps.

• What change is needed now in your practice? Think of a general statement that defines it. (Example: “My practice needs more clients.”)

• What is the smallest goal you could set to resolve this? Pay attention to the size of the gap. Does the goal excite you or bore you? (Example of small goal: “I will call one colleague to see if she has any ideas for me.”)

• What is the largest goal you could set to resolve this? Pay attention to the size of the gap. Does the goal seem compelling or impossible? (Example of large goal: “I will contact every physician, attorney, and human resource director in my city within the next 15 days.”)

• What’s the right-sized goal and gap for you at this time? Evolve by stretching just beyond your normal comfort level, but not so far as to put yourself into a state of stuckness or terror. (Example: “I can send letters of introduction plus a follow-up call to all the family law attorneys within 5 miles of my practice. I actually feel excited about this plan. I can do this without too much anxiety. I have been wanting to meet more attorneys for a while.”)

• Anticipate: What will change as you close the gap? Do you see a benefit to evolving this way? (Example: “To make those calls, I will have to verbalize what I do better. I will learn to be less shy when talking about my practice to strangers. That will benefit me as a person, and probably be good for my practice.”) If so, close the gap quickly. Write an action plan with next steps. Get moving. Celebrate each win. Get support for every setback. Assist your evolution and change things now.

To read more of Chapter One and the rest of the book, please order from the WTCI Bookstore or www.privatepracticesuccess.com.

From Therapist as Life Coach, by Patrick Williams, Chapter 13:  “The Future of Coaching.”  Read WTCI’s interview with Patrick Williams here.

The Future of Coaching

“You cannot discover new oceans unless you have the
courage to lose sight of the shore.”

Unknown

Is coaching a passing fancy or is it the true evolution of a new profession? Several indicators point to coaching being a new profession that is establishing itself within the framework of existing helping professions. First, the establishment of a professional organization—the International Coach Federation—and associated ethical standards and minimal competencies, predict the continuation of this profession. Second, the number of practicing coaches (which the ICF estimates at 10,000) is growing rapidly and responding clearly to the needs and demands of our fast-paced, disconnected society. Third, there is evidence of an increasing number of recognized coach-training organizations and a growing number of college courses on coaching, which further establishes the profession within the mainstream of continuing education for professionals.

Perhaps coaching would be just a passing fad if not for its widespread appeal to the general population, which provides a powerful motivation for continued growth and success for individuals and organizations. The growth of the life coaching profession specifically, as we indicated earlier, had many of its roots in the corporate world of mentoring and executive coaching. However, in the early 1990s, personal coaching burst upon the scene with the creative vision of Thomas Leonard (founder of Coach University) and some of the other coach-training schools (the Resources section). The coaching movement has been fueled by the concept and attractiveness of personal coaching. It is a very palatable concept for the self-employed entrepreneur, or corporate refugee who wants to design a life and career that blends with their larger life’s purpose. Coaching continues to grow and evolve in the corporate setting and is a powerful technology for retaining employees, developing leaders, and even transforming the corporate culture of a company. However, we believe that if coaching had only been seen as a corporate phenomenon, it would have rapidly disappeared just like Total Quality Management (TQM), Quality circles, T-groups, Theory X, Theory Y, and other associated “quick fix” strategies. Instead, the quality of a well-trained, personally hired coach, coupled with the internal coaches in corporations, makes it increasingly likely this popular profession will continue to grow in scope and recognition.

Another powerful attraction of life coaching is that having a personal life coach provides a partner who really cares about helping you develop and implement your ideal life. Life coaching also gives a sense of connection, of belonging, of significance in a world that can sometimes seem isolating, overwhelming, or both. Coaches also keep us focused, challenged, and motivated for living our lives (personally and professionally) on purpose. We both have our own coaches for those very reasons.

It is our hope that life coaching, in all its various forms, will begin to permeate society at all levels. We want to see coaches in schools, probation departments, churches, nonprofit corporations, and other community agencies. In reality, this has already begun to happen. Coaching is a combination of communication and empowerment that should become ingrained into our entire cultural fabric so that relationships at all levels can implement the coaching paradigm as a new and effective way to bring out the best in people and create solutions to complex problems.

We do believe psychotherapy has played an important role in those who are lives of many clients and that psychotherapy will still be needed in our society, especially for the seriously mentally ill. However, it has also pathologized a significant number of individuals with sometimes meaningless and unnecessary labels. We believe coaching will become the prevailing way to get help or to learn how to bring out your strengths and overcome obstacles and challenges while pursuing possibilities. We believed this is what the human potential movement of the 1970s intended. Psychological research and theory of the last several decades have contributed much to our understanding of how people change, how they adjust to life’s struggles, and how they develop into self-actualized human beings. That knowledge now lends itself to this new field of life coaching, without the stigma and labeling that comes with psychological counseling or therapy. Being able to receive coaching and have a personal coach, whether privately hired or provided by your company or community agency, is a service we hope becomes ubiquitous and transformational to individuals and our culture as a whole.

Another important factor in any new profession to be accepted widely is publicity and public awareness. The media over the last several years have overwhelmingly said positive things about coaching. There have been many articles about coaching, its impact and value to clients, and the level of professionalism in the field. In fact, after Pat was interviewed for a magazine article on two different occasions, the reporters asked to set up coaching appointments for themselves. Even though anybody can call him- or herself a coach, the quality of people with this title is very high. Many have come from other professions such as law, ministry, or psychology; others are corporate refugees, human resource professionals, or experienced consultants.

Although there are many coach-training programs and certification is available through the ICF and other programs, certification is not necessary. However, professional training and strong ethics are important. After all, consultants have never been certified nor licensed; they only get continued work through their reputations and previous work histories.

We can assume that, as the profession grows, coaching will attract its share of charlatans or unscrupulous business people. But these coaches without ethics and experience will not last long and will fade away quickly. The marketplace for coaches is expanding to the point where anyone who is currently a consultant, trainer, minister, manager, or helping professional is either now learning specific coaching skills or expanding the scope of what they offer to include coaching. Coaching has become an umbrella under which many forms of personal services fit.

Emerging Trends in Coaching

Looking into our crystal ball, we do see some emerging trends that may be on the cutting edge of coaching or may become innovative ways for the public to access the benefits of coaching.

1. Coach on call. Sometimes called “spot coaching,” or “just-in-time coaching,” this is brief coaching available to the client at the moment they need it. A client might have a coach or coaching service on retainer by paying a monthly fee but can call whenever they need support, direction, or motivation. Pat is part of a group of coaches called The Coaching Collective, which provides people with brief conversations by appointment or during set office hours from any one of 12 coaches; clients pay a flat fee of $95 per month to belong to the group. Clients may also participate in classes, book discussions, or a group coaching experience called Collective Wisdom where four or five coaches, led by a conductor, offer coaching to one client at a time for 10-15 minutes. As reported by the clients, these experiences, often lead to breakthroughs. This process is innovative, powerful, and fun.

2. Videoconference coaching. Some coaches now coach via e-mail, but usually as an added service, not as the primary vehicle for coaching. With the increasing availability of video communication by personal computer, however, this will increase as a way to connect with clients. There is even technology available that provides virtual classrooms and chat rooms, allowing the instructor or coach the ability to separate participants with different assignments or conversations. Though this technology is still expensive, it will become more mainstream in the years to come. The ease of real-time visual communication with technologies on the horizon are going to make global coaching an increasingly available opportunity.

3. Agency coaches. We both really see the strong probability of agencies, churches, schools, probation departments, etc., adding staff positions for coaches. What happens in business usually is mirrored in nonprofit agencies and public service agencies.

What the Future Holds

We are on the verge of a fundamental shift in how and why people seek helpers. People today need connection with a mentor, coach, or guide more than ever before, due to the rapid pace of change, the difficulty of sustainable relationships, or the desire to fulfill one’s life purpose.

We believe that the profession of coaching will be bigger than psychotherapy soon. The general public will know the distinction between therapy and coaching and will be clear on when to seek a therapist and when to seek a coach. Coaching will permeate society and be available to everyone … not just executives or high-powered professionals. We expect to see a variety of specialized coaches like relationship coaches, parenting and family coaches, wellness and health coaches, spiritual development coaches, and others.

The entire profession, as we see it, will foster the idea of life coaching as the umbrella under which all coaching rests. Whether a client seeks specific coaching for business or job challenges, coaching for a life transition (such as a career change, relationship loss, or health), or for pure life-design coaching, it is all life coaching. A coach may also serve as a referral source for specialty coaching as needed or requested by their client.

Coaching is a profession that is experiencing dynamic growth and change. It will no doubt continue to interact developmentally with social, economic, and political processes; draw on the knowledge base of diverse disciplines; enhance its intellectual and professional maturity; and proceed to establish itself internationally and in mainstream America. If these actions represent the future of coaching, then the profession will change in ways that support viability and growth. Life coaching exists because it is helpful, and it will prosper because it can be transformational.

From Therapist as Life Coach: An Introduction for Counselors and Other Helping Professionals, by Patrick Williams. Find Patrick Williams on the web at the Institute for Life Coach Training.

Thoughts?  Comment below.

Following on the heels of this week’s interview with William D. Morgan, PsyD, here is the first chapter of his book, Today’s Private Practice, reprinted with permission.  Enjoy.

Chapter 1 — Foundational Concepts

Why Are You Reading This Book?

Maybe you are tired of working in the managed-care system and are thinking about starting a managed-care free practice.

Maybe you have started a private practice, but are struggling to get private-pay clients.

Maybe you have a good private practice, but feel you have not realized your full potential. You want a full practice of well-paying clients.

Maybe you just want a few great ideas to take your practice to the next level. One good idea can sometimes make a big difference.

Private practice has changed drastically from what it was a little over a decade ago and continues to evolve. Much of the change has been related to the expansion of managed-care insurance.

Many practitioners have been able to thrive while others struggle. Many psychologists and other professionals have left private practice, unable to successfully adapt.

Some of the concerns and frustrations I hear expressed include:
• Low fees
• Being undervalued in the managed-care system
• Lower quality of services in the managed-care system
• Discouragement with the lowered income, additional strains
and burdens
• Managed care is too much in the driver’s seat
• Encountered inequities in the managed-care system
• Ethical dilemmas about such things as continuity of care and
terminating therapy too soon
• Having to work too many hours to make ends meet
• Time-consuming authorization, billing and administrative work
• A pervasive current of gloom regarding the future of the profes-
sion

Perhaps you, like many professionals I talk to in the consulting and coaching part of my work, aspire toward a more rewarding and lucrative practice.

That’s where I was several years ago.

As a practicing psychologist, I know what you are likely experiencing. I love being a psychologist in private practice, but also understand how challenging it can be.  I also know how to make a practice grow and stay successful. And, I can show you what it takes to earn a good income completely outside of managed care.

Over the years, I have created a practice that provides me and my clients high levels of satisfaction. And, I can show you how to do that, too.

Some of you, especially Charter Members of the Today’s Private Practice monthly membership, have already begun this journey. You have begun to implement the mindset and practical how-to steps behind the Today’s Private Practice school of thought. Maybe you work with a business coach or are part of a group of practitioners dialoging about practice-building.

I foresee that more and more practitioners will discover financial success in private practice outside of managed care. These practitioners will increase their satisfaction level and sustain it.

Today’s Private Practice is about a model of consistently making a difference in people’s lives, and sustaining success and satisfaction as a professional.

Fee-for-service private practice is not dying, but it is changing.

While many practices are struggling, others are thriving. Successful practitioners have figured out how to promote their services effectively, and you can too.

While many successful therapists learned how to grow their practice by trial and error, you can save months or years by utilizing the Today’s Private Practice approach.

Why I Wrote This Book

I have two purposes in writing this book. First, I want to share that transitioning to a full fee-for-service practice is quite possible. Second, I want to help you create and realize your vision for a satisfying and successful career.

Vision is important, and we deal with it in detail later in this book. Transitioning to a thriving practice will also require determination and follow-through.

I’ve divided the book into several major sections.

In the first section, I talk generally about the philosophy behind the shift to setting up a managed-care free practice. I talk about the general formula for attracting private pay clients and the opportunities it creates.

In the second section, I invite you to explore a different view of marketing. Getting private-pay clients is a stress point for many practitioners, and a topic with which many are not comfortable or skilled. As we look at marketing in a fresh way, I hope you will see that there are simple, effective ways you can build your practice — and enjoy doing it.

In section three, I outline an eight-step approach to implementing the Today’s Private Practice model in your practice.

In the fourth section, I outline practical applications of the approach to developing multiple streams of referrals and income. In every stream, there are opportunities to transfer the science and art we’ve learned.

In section five, I address the transition from where you are now to where you want to be. I share strategies to help ease the transition to a successful practice.

This book is not a textbook or cookbook on building a private practice. Rather, in an informal, down-to-earth, no-fluff approach to the subject, I hope it conveys intriguing, helpful and practical strategies for how therapists can see greater success and satisfaction in their careers and businesses.

Keep reading to find out how to get more out of your profession — personally and financially.

The Current Situation in the Psychotherapy Marketplace

Let’s face it, private practice has changed from what it was 10 to 15 years ago. Managed care has made therapeutic services more accessible to the masses, but also lowered standards of service and diminished the perceived value of therapy. Providers receive less compensation, have more administrative work and feel less in control of the service they provide.

My Own Story

I completed my master’s degree in counseling psychology in 1988 and began practicing as a counselor in a private group practice. Managed care had not yet surfaced in the metropolitan area where I was located. Things went well. I returned to graduate school in 1992 while continuing to practice, with the vision of obtaining my doctorate in clinical psychology and a more lucrative and independent practice as a licensed psychologist. Shortly after beginning my doctoral degree program, managed care was taking over the market in our area and across the nation.

As the impact was becoming plain, I remember the dismay of my fellow classmates who wondered if they were going to be able to earn enough as a psychologist to repay their student loans. I heard stories of practitioners leaving private practice to join groups doing managed-care work because they could not make it work in the traditional private practice model. Some were even leaving the profession.

After completing my training and obtaining my doctorate and license, I worked in a large managed-care driven group. The pay was low; I received about half of the fees collected from managed-care insurance, which was paying about half of the going rate in our area for psychologist fees. There were numerous problems and frustrations dealing with managed-care companies. I had to work long hours and many evenings to support my family.

Finally, after much deliberation and inspiration from practitioners who were successful in managed-care-free practices, I decided to go out on a limb and set up my own private office. From the outset, I established a private-pay-only practice. I did this for several reasons:
• I believe that managed care does not cover high quality services
• Clients want and deserve customized attention
• Many people value real privacy, which they cannot have in managed care
• I believe I deserve to make a good living in the profession, and can design a more satisfying workplace outside of managed care

The question was, would enough people be willing to pay out of pocket for services?

The answer was and is YES.

More and more, people are coming to the realization that insurance no longer covers high-quality therapy. If people desire it, they have to pay out of pocket. If people pay less, they get less.

I researched what it takes to set up a successful private practice. I worked with a business coach to guide me in areas in which I was unfamiliar (what they don’t teach you in graduate school).

And now at the other end of the transition, I can say it was one of the best things I ever did.

The Fundamental Strategy

The thing is, you can make a living helping others. But you have to let go of the idea that the traditional way is the only way.

Psychotherapists can leverage their talents, expertise and abilities in many ways. There are many possible formats for delivering psychological help.

So, how do you, as a therapist, format what you have to offer? To begin, try looking at your services as a solution to a specific problem rather than as treatment for an illness.

In the traditional model, clients must be ill. In order for people to access their health insurance, they must be diagnosed as having a mental illness. This is the medical model.

This creates a barrier for many people to choose to utilize psychological services. They do not want to see themselves as mentally ill and in need of treatment. But, as we shall see, even healthy, high-functioning individuals can benefit from psychological services.

Thus, we tremendously expand our potential market when we reduce the stigma of utilizing our services and focus less on pathology.

Instead, we may adopt a problem-solving/skill-building model, in which clients no longer need to be ill to use our services and receive benefit.

Psychology is not just for the sick.  For example, Martin Seligman’s book “Authentic Happiness” (2002) and Daniel Goleman’s books “Emotional Intelligence” (1995) and “Working with Emotional Intelligence” (1998) provide us with frameworks we can use in a problem-solving/skill-building model. See also Reivich and Shatté’s (2002) “The Resilience Factor.” Rather than focus on illness and therapy, we can talk about increasing personal and career effectiveness, personal growth, increasing life satisfaction and resiliency.

Can you see how this broadens the reach and impact of our services? We can provide solutions to life’s problems and challenges, without the stigma of a diagnosis — keeping in mind that there is certainly a place for traditional services and therapy for mental illness for those that need it.

In this non-traditional approach, we seek to use our services to:
1. Answer a specific problem or challenge
2. Target a service toward a specific group of people
3. Utilize a tangible format.

So, whether you intend to use traditional therapy as 25 percent or 75 percent of your practice pie, it’s a smart move to identify what non-traditional services you could add to the mix of streams of income for yourself. Read on.

N + P + F = SUCCESS

There are three steps to developing a psychology-based, non-traditional service line that will have great value and impact.

The simple three-step formula to creating a new income-producing service is:

Niche + Problem + Format = Service

If your mission is to positively impact other people, this formula will do it. Let’s look more closely.

1. Pick a Niche Market.

It could be divorced parents, ACOA Adults, breast-cancer patients, ADHD executives, children of divorce, attorneys, clergy swamped with congregational people problems or smokers who want to quit.

You can take your services to the workplace and target stressed workers, downsizing companies, businesses in change or troubled employees and departments.
Many more possibilities are listed later in this book.

2. Identify a specific problem or challenge that’s happening in that niche market.

It could be managing stress, self-management, conflict, interpersonal skills, changing culture within a company, work-life balance, co-parenting or dissatisfaction with life, relationships or career.

There’s a multitude of possibilities.

3. Choose the format to deliver your solution.

This is the packaging that your solution will come in.

Example:

Niche: Divorced parents

Problem: Collaboration with ex on parenting; high conflict in communication

Format: 10 co-parenting sessions organized around a five-step process

Equals: A marketable income stream

Ask yourself: For what services will people feel a need and be willing to pay for out of pocket?

Are You Ready to Break Free of Managed Care?

Managed care does not cover high-quality therapy or many psychologically based services for which people feel a need. People will pay for services they perceive as a sufficient value to themselves.

The value of private-pay services over managed-care services are that they are more personalized, remove the stigma of the medical model and clinic setting, offer true privacy and are more effective.

In addition, we have the distinction and opportunity to offer services from a personal growth model in addition to or in place of the traditional medical model.

When you let go of managed care, you:

1. Assume control of your services, income and lifestyle.

There is greater opportunity for financial success and satisfaction in your work.

2. Have greater enjoyment and passion for your work.

You won’t be as bored with your work, and will be less susceptible to burnout. This model encourages you to do more of the work that taps into who you are, what you love to do and unleashes your creativity. You will have greater variety in the work you do, not the same basic work day-in and day-out.

Find Today’s Private Practice author, William D. Morgan, online at WilliamDMorgan.com.

Thoughts?  Feelings?  Sound off in the comment box below.