A few past and future WCTI contributors weighed in on the question.  Their answers below.  Your answers:  Waiting to be written and posted to comments.

Will Meek, PhD (willmeekphd.com)

Where did your first referrals come from?
My first referrals came from therapist directory websites (Psychology Today and Network Therapy).

Where do most of your referrals come from now?
My referrals continue to come from sources online. Those include online therapist directories and my website, which appears high in search engine rankings. Additionally, I have started getting people from insurance websites as well as from colleagues and friends of previous clients who had positive experiences with me.

Catherine Auman, MFT (catherineauman.com)

I started my private practice by getting on as many managed care panels as I could. This eventually turned into an average of two new referrals a week.During that time I was also building my cash business in any way I could, primarily on the Internet and through advertising. Now my practice is 2/3′s cash patients and 1/3 managed care. I love it!

Buck Black, LCSW (buckblack.com & truckertherapy.com)

Where did your first referrals come from?
In my office:  My first referrals came from people calling the group practice (which I am part of) and the secretary scheduled them with me.
Online/phone:  Google searches that directed them to my website.  I spent a lot of time increasing my Google rankings so this would happen!

Where do most of your referrals come from now?
50% from my website and my online Psychology Today ad.  Approximately 30% from face-to-face networking in my community and the remainder from referrals from the group practice and my ad on the back of the city bus.

Susan Giurleo, PhD (childdevelopmentpartners.com & susangiurleo.com)

First referrals came from colleagues–other psychotherapists, neuropsychologists.

Now: physicians, neuropsychologists, school adminstrators/guidance counselors, current or past client word-of-mouth referrals, my website/blog.

That’s them.  How about you?

• Where did your first referral come from?
• Where do most of your referrals come from now?
• What referral sources are you trying to develop for the future?

Take a second to comment–you’ll likely be helping out a rookie; you may even find yourself inspired to do some extra outreach.

Following his WTCI Interview, Buck Black, LCSW writes about doing therapy with truckers—what’s different, what’s the same, and how it works.

Truckers have their own community.  The average person probably doesn’t think about this community or even know it exists.  However, its important to remember that truckers are responsible for bring us practically everything we own, as well as making our economy move. However, there is little support for truck drivers and their families (see my recent article).

Given the nature of the life of the trucker, I see depression and family problems as the two most common issues truckers address in their coaching sessions with me.  Just think, you sit in isolation all day long (not just 8 hours, but all day long).  Then you repeat this procedure for several consecutive days, if not weeks.  Eventually, you are able to return home and spend just a few days with your family.

There are many disagreements between truckers and their spouses.  This is often caused as a result of the trucker essentially being an absent parent and doing his/her best to help parent from hundred or thousands of miles away.  Also, given that the trucker has contact with friends and family over the phone and occasionally Skype, there are often plenty of instances of miscommunication that result in arguments.  This type of long distance relationship is often prone to miscommunication because the phone and even Skype often does not convey true feelings and body language.

Truckers have a lot of time to think.  If you ask them, most will tell you that they have too much time to think.  If something at home is not going well, they have hours on end to dwell on it while driving.  This is one of the bigger dangers of the job the average person does not recognize.  I often help drivers with simple CBT techniques for thought stopping and distraction.  Given all the opportunity for rumination, there are many drivers that let their thoughts turn into worry and anger.  Again, I often help them use CBT techniques to address these issues.

How it works:  Clients typically find me via facebook, twitter, OOIDA, and word of mouth.  If you search “Therapy for Truckers,” you will find my website.  However, truckers often do not think of doing this.

The screening process is a must given that I work with clients at a distance.  I rely on the assessment form clients initially fill out.  This explains to the client that this service is not for them if they are homicidal or suicidal and that emergency services are not provided.  If there is a need for this service, then face to face therapy is required.  Of course, I will help a client if they happen to have an emergency.  However, I will not enter into a relationship with a client if I feel they will likely have emergencies.  Also, if I have the feeling that I will worry about the person’s wellbeing after I hang up, I will advise them that they need more intensive face-to-face therapy.  Ultimately, the telephone or Skype is the tool I use to screen the client to see if they are appropriate for distant services.

Amazingly, I have found that building rapport on Skype is about the same as in the office.  I think rapport happens so easily because clients come to me wanting to use the technology.  I am not trying to talk someone into using Skype.  If the person were not comfortable with the technology, then there would probably be more difficulty building rapport.  I must point out there are drivers who do not trust that I am a legitimate therapist.  I’ve had a driver call me up and say, “I don’t trust you people,” and continue to tell me his problems.  I listened to him for 20 minutes; he told me that it really helped to get his problems off his chest.  When I asked him to become a client, he said, “No offense, but I don’t believe in your profession.”  I invited him to call back and become a client if he ever felt the need.  So far, I’m still waiting!  There continues to be a great deal of stigma in the mental health field in general and even more specifically with truckers.

The successes that stand out on my mind are couples coaching sessions with a trucker.  I do this via conference call.  Other than using the telephone, it turns into a standard couples session. This is the time that issues can be addressed and I can help the couple with communication skills that will allow them to become much closer and limit their arguing.  This is often an opportunity for the couple to express feelings that they have never shared with one another.  It is this type of work that makes me feel that I really am helping.

Find Buck Black, LCSW online at TruckerTherapy.com and BuckBlack.com.

Have a practice niche you’d like to write about?  Great!  Get started with an email to WTCI.

Buck Black, LCSW is a Lafayette, Indiana based therapist who has found a niche working with truckers remotely, using Skype.  He talked to

What’s your background? What do you do now?

I am a Licensed Clinical Social Worker in the state of Indiana and have a Master of Social Work degree from Indiana University. I also have a Bachelor Degree from Purdue University with a double major in psychology and sociology, as well as a computer technology minor. I have worked in community mental health as a therapist specializing in anger and stress management. I served clients in the addictions, sex offender, PTSD, and Bipolar populations. I also worked crisis intervention shifts at a psychiatric hospital where I would help a client avoid psychiatric hospitalization by hooking them up with services or helping them be admitted to the hospital, depending on need.

Currently, I am in private practice providing face-to-face services in my Lafayette Indiana office. I also provide services via Skype, phone, and email throughout the country and around the world at www.BuckBlack.com.

I specialize in anger management (using an evidenced based model), as well as stress, couples therapy, and various sexuality issues. All of these services are provided in my office or online and over the phone.

I cater to truck drivers at www.TruckerTherapy.com. Here, I provide all of my usual specializations and talk with truckers mainly via phone and Skype. This service is valuable to truck drivers because they can work with a licensed therapist while they are on the road. This service allows many truckers to get help when they ordinarily would not. Since I specialize in working with clients from the trucking industry, I am able to understand and help them with many of the unique nuances stemming from being a trucker and having anger, stress and/or relationship issues.

How did you find your way to Skype therapy and to working with truckers?

I started doing Skype therapy a year ago. I wanted to find ways to expand my private practice, so I attended a private practice workshop. There was a focus of using Skype to help people from all over the world. I liked the idea and then started talking with friends on Skype to test the technology. It was very neat and worked well. Ever since I became hooked on Skype, I have been using the service to talk with more and more clients. Both the clients and I enjoy Skype because it takes the travel out of the equation.

I started working with truckers over the phone and Skype because truckers who came to my office were unable to keep office appointments (due to being on the road for weeks at a time). It seemed natural to specialize in helping truckers because there is a strong need to have the flexibility of using the phone and Skype to allow them access to mental health services.

I find working with truckers while they are on the road to be rather rewarding. I know that I am providing a very specialized service for them because few therapists are willing to talk with them outside of the office. It is challenging to work with truckers because they have their own culture and I am an outsider. However, the more I work with truckers, the more I am accepted into their community. I do have a trucker friend, so that helps greatly.

What difficulties or limitations have you encountered in providing phone and Skype therapy?

My most significant difficulty I have is getting potential clients to recognize that I am a real therapist who is qualified to help them. Many people seem to think that a person who is trying to do therapy at a distance is a fraud. This is why I offer free 15 minute consultations. Other difficulties for me are people who only want to do traditional “face to face” therapy. I’m glad to do therapy in my office, but I hate to see people drive long distances to talk with me when I know there is a much more efficient tool.

How is therapy different over Skype? Do you notice any change to the sense of connection and relationship between you and clients?

Services are different over Skype. I think the biggest challenge is the client’s quality of equipment (mic, camera, computer, and internet connection stability/speed) and the occasional unavoidable technical glitches. So, that is something you usually don’t have to deal with in an office setting. I always give my clients my phone number and keep my phone next to my computer when doing a session. If the connection fails, the phone is a good backup.

I believe there is a good sense of relationship between the client and I when using Skype. Of course, Skype is limited in the amount of body language one can see and it does not replace face-to-face contact. However, I have had client’s turn their cam around so I can see their house. This is helpful in letting me see a bit more about them. However, the client must want to use Skype. If the client does not like the technology, then the relationship would be very difficult to form.

Are there any other limitations—legal or ethical?

As far as liability for distance therapy, it seems no one can give me a good answer. The conservative answer is to do only face-to-face therapy. It has also been stated that it is okay to do distance therapy while practicing within your state. It is generally accepted that using the term “coaching” is a way to protect one’s self from liability, instead of using the term “therapy.” This is because “coaching” is largely unregulated.

It is very important to make sure that you are providing services to a client who is not homicidal/suicidal. If the person has a chronic mental illness, distant services probably are not the best option. I screen each client to ensure his/her goals are attainable over the phone or with Skype. If I feel there may need to be a need for emergency services or a high level of care, then I refer to face-to-face therapy. I urge readers to visit The International Society for Mental Health Online (www.ismho.org) for more details.

Any final words of wisdom for people trying to build a private practice…?

My advice for new therapists building a private practice is to join Linkedin and Facebook (feel free to add me to your contact/friend list). These are great tools for marketing. Also, joining mental health groups on Linkedin can be very helpful way to learn and discuss private practice issues with other colleagues. It takes a lot of work to start a practice, so be sure you are putting at least 20 hours per week into your marketing in the beginning. Remember that you need to keep marketing, even when you are busy! Write articles and be known in the community. When you define a niche, your services will be desired and you will be looked at as an expert. Don’t forget to give back. Keep at least one slot open for pro bono services. This will help you feel good about what you are doing and help the client at the same time. Several times, as an unintended consequence, I have had referrals for (paying) clients as a result of my pro bono services.

Find Buck Black online at buckblack.com, truckertherapy.com (and on facebook and linkedin).

Found a niche or approach you want to share with others?  Write WTCI to suggest an interview.