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

My background is originally in Family Practice. When I started off, I wanted to be a primary care provider, and so I started down the Family Practice path. Over time, it became increasingly clear that I showed a special talent for Psychiatry, so I chose to specialize in that area. Flash forward ten years, and now I am serving in a bunch of different roles. Clinically, I split my time between my private practice and my clinic practices. Additionally, I teach and supervise Psychiatrists in training, serve on the Executive Council of the APA in New York City, and serve on clinical advisory boards for two top rehabilitation programs. In my private practice, I get to provide high-end patients with psychiatric care that is nonjudgmental and considers their specific needs. In my clinic practices, I get to provide top-quality care to those who will benefit from it the most. The two clinic practices are a HIV/AIDS community program and a community addiction treatment program. In the HIV/AIDS program, I am the sole psychiatrist in a multidisciplinary medical practice, and in the addiction program I am Medical Director. In both clinic programs, patients have not been able to achieve success in their lives for one reason or another. Through closely coordinated care, my colleagues and I assist the patients to lift themselves up to the next level and, hopefully, start to put their lives together. It’s an incredibly rewarding and satisfying experience. My involvement with the APA and the advisory boards is my attempt to help modernize psychiatry. More and more psychiatry is developing a scientific foundation that is helping to destigmatize the various mental health disorders. I am hoping to help increase awareness, acceptance, and support for the various mental health disorders.

How did you first build your psychiatric practice? What worked? What didn’t?

I have to say that I was very surprised by what worked and what didn’t in the process of building my practice. Following advice from peers and friends, I reached out to the psychiatric community and to therapists in my neighborhood with announcement notes. Additionally, I posted a couple of small ads in hobby journals to which I subscribe. From all of this effort, I may have received maybe one referral. What eventually did work was face-to-face contact: I invited colleagues out to lunch or dinner, I attended every professional function I could find, and I made brief visits to neighborhood treatment centers to introduce myself. Within a few weeks of changing my tactics, the phone started ringing with referrals. Once my roster started to grow, I made a point to meet with patients’ psychotherapists. Thereafter, a network for cross-referral began to grow and business started to boom.

As a psychiatrist, what do you most value in psychotherapists with whom you share patients? Which are the therapists you are most likely to refer to?

That’s a question I’m very happy to answer because I am quite fond of the therapists with whom I share patients. They all have three things in common: collegiality, great communication, and a longitudinal approach for each patient. First off, in private practice, our colleagues are the people in our network with whom we interact; therefore, it really pays off to have good working relationships with one another. This is usually reflected by how easily we ask each other questions and tell each other our ideas. I never hesitate to speak with one of my colleagues because I know that the conversation will be easy and I may even learn something! The next thing I look for is great communication regarding my patients. What makes the therapists in my network stand out above the rest is that they give me updates on how my patients are doing — even if I don’t ask. I refer patients for therapy not because I want to deflect that part of the treatment but because I believe my patients will benefit from the additional modality. Therefore, hearing about how my patients are doing enables me to create more comprehensive formulations and thereby provide better care. Finally, and this may be a personal preference, but I like to work with therapists who take a longitudinal approach to formulation. I like to hear what they think in terms of where the patient has been, where the patient is now, and a few projections as to where they think the patient might be headed. Ideally, I’d also like to hear what approaches they would take given the possible outcomes that they suggested. This comprehensive approach to formulation let’s me know that my patients are in the hands of a therapist who has paid attention, has formed an opinion, and is thinking about the repercussions of their various interventions. This is the type of therapist into whose hands I would like to place the care of my patients.

Do you have any additional wisdom you’d like add for therapists starting out in private practice?

Do what’s right for your patients and the universe will do what’s right for you. I know it’s scary to pass a patient on to a colleague when you’re trying to build up your practice and make a living; but refer when appropriate and you will earn a reputation as a practitioner who puts their patients first. When the recession hit and patients decreased their frequency of visits, I felt the familiar pangs of wanting to fill up my practice. An exercise I found helpful in these situations was to imagine my practice full again and the patient in front of me (or on the phone, or being referred to me) as a patient that I would have to go through some machinations to accommodate. In that situation, would I really be the best provider for this patient? If so, then I would take the patient on. If not, then I would discuss referring the patient to a colleague. You’re here to help so do what’s right for the patient and everything else will fall into place for you.

Find Samuel Sharmat, MD on the web at samuelsharmatmd.com.

Tamarisk Saunders-Davies is a British marketing-professional-turned-psychotherapist. She talked to WCTI via email about her work with female entrepreneurs and the state of therapy in the United Kingdom.

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

I did my first degree in Psychology at the University of Newcastle-upon-Tyne, in the north of England. As a teenager I actually dreamed of being a actor but i started to realise what i loved about acting was getting to understand the character and why they did what they did…fairly quickly I realised what I really wanted to do was study human behaviour so I enrolled in the psychology programme.

On leaving university, I pursued a career in marketing and public relations in London, hoping to put my knowledge of human behaviour to good use. I didn’t, but it was great fun if high pressured and very results driven. Eight years into my marketing career, I got to wondering if I still wanted to be doing it 30 years from now and I couldn’t escape the niggling doubt that no, I really couldn’t see myself doing it for my entire working life. So I took a pay cut, carried on working part time and went back to university to get my post graduate in Counselling and Psychotherapy. It was tough juggling the high pressured job, the blinking Blackberry and essay deadlines but I really felt excited about moving towards my new career as a psychotherapist.

Now I’m running a fantastic London based practice working with ambitious, go-getting women who are struggling with issues around work, relationships or both and who are looking to find some clarity in their lives. I also offer consulting services to other therapists looking to get a better handle on their marketing…so maybe I will be doing a marketing job until I retire!

What’s your approach to working with your “go-getting” clients?  How have you marketed yourself to them?

While my training was integrative, I’ve been continuing my development as a psychotherapist by learning more and more about the existential way of working. I’ve been avidly reading works by the likes of Irvin Yalom, Rollo May, Emmy Van Dursen and Freddie Strasser.

It seems to me that a lot of people have the notion, gleaned from movies, television and glossy magazines that life is perfectable. The idea that other people out there somewhere have achieved the perfect life, when in fact no one has, it’s not possible. So they feel dissatisfied with the life they do have or even cheated out of the life they think they deserve. They yearn for for a life of perfect happiness, while failing to take control of the life they do have.

My role as therapist is to help my clients find their own unique meaning for their life, I assist them in recognising that they are free to create themselves and make something worthwhile of themselves, making it more rewarding by taking decisive, realistic action.

The type of clients I work with–career orientated women who are struggling with issues of self-confidence and self-esteem–respond really well to this approach as it’s quite an active and dynamic questioning process. They feel I’m with them, that I’m curious and that I’m not just sitting there saying “hmmmmm” a lot!

How have I marketed myself to them:  What’s really important for me is to get out there, meet people and tell them about who I help and how. I’m very fortunate in that I really enjoy networking and living in London you’re really not short of opportunities to do that! I’ve also got much more comfortable networking online, connecting with people through social networking sites like Twitter. With a little bit of hunting I’ve found loads of people doing exciting things out there and so wonderful opportunities to collaborate with them have cropped up. I’m contributing to newsletters, websites and all sorts.

The health care system also runs very differently in the UK to how it does in the States, so for me it’s also been key to get on the radar of GP’s. They tend to be the first port of call when people are struggling emotionally. The National Health Service is doing a lot more to create greater access to talking therapies through a programme called IAPT, but demand is still much, much higher than supply.

The clients I work with are used to having a choice of service provider and are prepared to pay to access good therapy quickly rather than wait. In some cases waiting lists to access NHS counselling and therapy runs into years.

Working within the NHS, are you restricted to evidence-based therapy (CBT and the like)?  If so, how do you fit the search for “unique meaning in client’s lives” within that framework?  It seems like the U.S. is slowly heading in a British-ish direction.

The Improving Access to Psychological Therapies (IAPT) has evolved from a paper originally tabled by a very influential health economist called Lord Layard in 2005.

Layard reasoned that funding by the Department of Health (DH) to improve provision of psychological therapies in the treatment of depression and anxiety, would positively impact on the number of people who are ready, willing and able to get back into work. This increase would consequently reduce the cost of Incapacity Benefit (Welfare I think is the US version) for this section of the population, leading to potential savings for the government. By bringing together prevalence statistics for depression and anxiety, costs of training and employing therapists, potential cost savings in reducing the amount of people claiming welfare, and the benefits to individuals and society of improved mental health and wellbeing, Layard was able to make a strong case for investment by central government.

Layard strengthened this economic argument with a moral and clinical one highlighting the inequitable and patchy nature of current psychological therapy provision, long waiting times, and lack of consistency in implementing NICE (National Institute for Clinical Excellence) guidelines for depression and anxiety.

Based on the NICE guidelines (2004), Layard’s proposed solution was for the provision of treatment centres offering evidence based psychological therapies and psychological support. This proposal achieved £3.7million funding to set up demonstration sites in two different areas of the UK, and saw the launch of the Improving Access to Psychological Therapies Programme (IAPT) in England.

The IAPT programme is absolutely about CBT and therapists currently being trained and working within that programme are using that way of working, but there are lots of different types of practitioners who work within the NHS. CBT certainly has a majority share but there are more traditionally trained psychotherapists working within the NHS. The world famous Tavistock Centre for instance, is orientated towards the psychoanalytic tradition.

A full explanation of all the different ways of working within the NHS would take more space than I have here, because provision changes from borough to borough, council to council.

I will say this -  while I believe an increase in access to talking therapies is a good thing, above everything else I believe that a successful therapeutic encounter can only happen if the client has that elusive chemistry with their therapist. I really believe that choosing your therapist, rather being referred to whoever has a free slot for you, is what will lead to that happening. It’s when that happens that good therapy happens.

Find Tamarisk Saunders-Davies on the web at twochairscounselling.co.uk.  For authors mentioned in the interview, go to the Where the Client Is Bookstore.

Will Meek, PhD is a Vancouver, Washington-based therapist who has carved out a niche working with “The Psychology of Men.” He talked to WTCI via email about what that means and what he does.

I am currently employed full time as a psychologist at Washington State University Vancouver, where I run our small counseling center. This essentially means I run the training program, the outreach program, see a full case load of clients, and work on our students of concern committee and am part of the campus Diversity Council. I also teach at Portland State University in the Masters in counseling program. Additionally, I have a private practice in Vancouver, Washington, which I feel quite passionate about. As of this interview the practice is still in its infancy, but I am quite excited about the direction it is going.

Right now I am putting a lot of time into developing my new blog: Vancouver Psychologist. I have written online in some form or another for the past 10 years, and I think this is my best yet. I am also in the process of beginning a research program on psychology of men, which will be centered on another site I have: Psychology of Men. Working with male clients is a specialty of mine, and I think I have some fresh ideas on the subject to share.

What was the biggest surprise in going into private practice?
Insurance! Despite being pretty educated as a consumer of health insurance, being on the provider side was quite a surprise. I heard horror stories from supervisors and mentors during my training, but the reality of dealing with insurance is unbelievable. It takes a very diligent clinician to keep track of all the money he is owed, how the deductibles work for each client, and follow up with session authorizations.

How did you first get interested in the psychology of men?
My first spark of interest came when I realized in my mid-20s that I had never really thought about what it meant to be a “Man.” This was likely the result of some form of privilege, and I soon realized that most of my colleagues, friends, and clients had not considered this aspect of their identities either. So I decided during my post-doc year that I would focus on men’s issues, and I did a lot of reading, personal exploration, and learning about the psychology of men.

The biggest surprise to me was how splintered the literature on this subject was. The were two distinct threads; one from a male empowerment perspective, and another as a compliment to the feminist movement. Not once did I come across something that felt like a balance or integration of both of these perspectives, which is when I decided that I needed to get some of my ideas out there.

You have just started doing research on something you refer to as “Gender Role Advantage”–can you tell us what that is?
Most people studying masculinity have read about Gender Role Conflict (GRC), which is Jim Oneil’s concept about problems that arise when our gender role becomes limiting or harmful to ourselves or others. In working with clients on GRC, I realized that there were major forces keeping men in place with their gender roles and identities, which prevented any change and continued the GRC. These factors amounted to two levels of benefits: (1) acceptance from other men, and success at professions traditionally held by men; (2) increased money/resources, self-esteem, social status, and interest from mates. So gender role advantage is “the benefits from maintaining a particular gender role and identity.” I think that these things must be examined in working with male clients.

Many of my clients feel like they will appear insensitive if they feel good about being a man or explore this aspect of their identity. I think that cautiousness shows some of the awareness of how charged this stuff can be, but once the fear is lifted, it is amazing how powerful and transforming connecting to this part of self can be.

What’s next for you?
I am going to really get some steam behind my research on Gender Role Advantage and hopefully establish that idea in the professional consciousness, since I think that attention to this by clinicians will be very helpful for men going to counseling. I am also going to continue my work in my private practice, writing my blog, working at WSU Vancouver, and teaching at PSU.

Recommended Reading

(All titles available at the WTCI-Amazon Bookstore)

King Warrior Magician Lover
Robert Moore & Douglas Gilette (1991) – HarperOne

The Masculine Self
Christopher Kilmartin (2009) – McGraw Hill

Fire in the Belly: On Being a Man
Sam Keen (1992) – Random House

In the Room With Men
Matt Englar Carlson & Mark Stevens (2006) – APA

Iron John: A Book About Men
Robert Bly (1990) – Da Capo Press

New Psychology of Men
Ron Levant & William Pollack (1995) – Basic Books

Manhood in America: A Cultural History
Michael Kimmel (2005) – Oxford University Press

Under Saturn’s Shadow: The Wounding & Healing of Men
James Hollis (1994) – Inner City Books

Masculinities
RW Connell (2005) – Univ of California Press

Manhood in the Making
David Gilmore (1991) – Yale Univ Press

Castration & Male Rage
Eugene Monick (1991) – Inner City Books

He: Understanding Masculine Psychology
Robert Johnson (1989) – HarperOne

Find Will Meek on the web at willmeekphd.com and psychologyofmen.org.

Frances Sommer Anderson, PhD is a New York-based psychoanalyst and expert on treating chronic pain.  She talked to WTCI via email about what she does and how she does it.  Hear Dr. Anderson speak and learn more about treating chronic pain at the

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

The body–disabled, disfigured, and in pain–has been the focus of my work as a clinical psychologist and psychoanalyst, beginning in 1974 with my clinical psychology internship at Rusk Institute-New York University Langone Medical Center. Learning to help children and adults cope with and surmount congenital, traumatic, and progressive loss of bodily functioning was a daunting challenge in the beginning: I had to confront my own vulnerability to the vicissitudes of life and the fear that we all have when we experience a loss of the capacity to function physically. I soon found this work compelling and was fortunate to become a member of the psychology staff for 12 more years.

In 1979, while still at Rusk Institute, I began working in John E. Sarno, MD’s pain program, under the supervision of Arlene Feinblatt, PhD, the psychologist who collaborated with him in developing treatment of the pain syndrome initially termed, “Tension Myositis Syndrome, (TMS)” which he now refers to as “Tension Myoneural Syndrome.” Treating people in chronic, severely debilitating pain, as a psychosomatic manifestation according to Dr. Sarno, was an exciting opportunity to learn about the mindbody connection, which had fascinated me since my first undergraduate psychology course. After I left Rusk Institute in 1987 for full-time private practice and psychoanalytic training, I continued to collaborate with Dr. Sarno in treating TMS. In 1998, I published “Psychic Elaboration of Musculoskeletal Pain: Ellen’s Story,” a detailed presentation about my work with one of his patients (Relational Perspectives on the Body, The Analytic Press, Lewis Aron & Frances Sommer Anderson, Editors). In this chapter, I illustrated how overwhelming emotions were related to the development of Ellen’s TMS pain and discussed how we worked with these emotions in the psychotherapy process, thereby relieving her pain.

While treating Dr. Sarno’s patients, I developed a TMS symptom-tension headaches. As I delved into the early childhood origins of my own TMS, I refined my skills at identifying sources of TMS and its equivalents. I wrote about my personal journey, “At a Loss for Words and Feelings,” in my edited book, Bodies in Treatment: The Unspoken Dimension (The Analytic Press/Taylor & Francis Group, 2007). I have learned that accessing and experiencing “hidden,” “forbidden,” “repressed/dissociated” emotions is the crucial entry point in recovering from TMS. My colleague, Eric Sherman, PsyD, and I are publishing a book of case studies (late 2010), Pathways to Pain Relief, in which we illustrate how we treat people diagnosed with TMS by Dr. Sarno.

How do you distinguish TMS pain from other pain?

As a psychologist, I am not qualified to make a medical diagnosis, even a psychosomatic diagnosis such as TMS. A physician distinguishes the TMS pain through an interview and examination initially, thereby linking mind and body with a diagnosis of TMS. Teamwork with that physician is a requisite. Let me elaborate by illustrating why the teamwork is necessary. When I’m treating a patient who has been given a TMS pain diagnosis by a physician, I obtain written consent to collaborate with the physician, explaining the “rehabilitation team” approach, learned at Rusk Institute, which I have used effectively with Dr. John E. Sarno for more than 30 years.

As the treatment evolves, I learn about the person’s pain pattern. If the pattern changes for the worse, e.g., the pain intensifies and/or moves to a different location, I refer them to the physician to report these changes. While I may surmise that the intensification and/or change in location are related to emotions that are being evoked and/or warded off as a result of the therapy process, the physician needs to make an assessment before we explore the hypothesized emotional “triggers” further.

When I am working with a patient who was not referred for TMS treatment, I am, nevertheless, attuned to the mindbody connection and alert to “signals” of discord that may come in the form of unpleasant/painful sensations or other medical conditions. I first recommend that the patient consult with their established physician for an evaluation. If there are “no significant findings” or the results sound ambiguous, I raise the possibility of TMS by discussing the mindbody connection and suggesting that they read material about TMS written by physicians [see Recommended Reading, below]. If they “recognize” themselves in what they read, I refer them to a physician qualified to make a TMS diagnosis.

How do you go about treating someone with TMS?

First, I will oversimplify by saying that the treatment is implied in the diagnosis: If hidden/repressed emotions create somatic pain as a distraction or avoidance mechanism to protect the psychological self from intolerable emotional pain, then treatment must aim to identify and help the patient experience and explore those emotions. Now this appears to be very easy for many people–the ones who become pain free after reading a book on TMS. I hear stories about these people from patients and have witnessed this kind of cure among friends and family members. These people didn’t need my help! How they are cured so quickly is a very interesting and important matter that I can’t address further here except to say that I’ve learned a good deal from treating a few of these people over the years after they’ve experienced a recurrence of pain that won’t go away.

The people I treat have usually tried very hard to eliminate the pain and are quite discouraged and critical of themselves because they haven’t been “successful” on their own. They often feel that they’ve “failed” the program, citing statistics in Dr. Sarno’s books about how few people need psychotherapy. As he has described, often TMS sufferers have internalized the value “Americans” place on being independent, self-sufficient, and invulnerable and have been rewarded professionally and financially for these traits. Many of the founders of our country were people in desperate straits who had to work hard to survive. Acknowledging vulnerability and fear could have been more perilous than toughing it out. Thus, it seems to be a part of our national “character.” Another large group of people with TMS have been rewarded for being nice, considerate, peace-makers, for pouring oil on troubled waters, indeed for making sure that there are no troubled waters.

These admirable qualities contribute to building a robust economy and to the smooth working of our social structure. When relied on at the expense of acknowledging one’s own feelings and needs, however, a consequence may be emotional and/or mindbody disorders such as TMS and its equivalents. The disavowal of dependency, vulnerability, and anger/rage contributes to overflowing emotional reservoirs of shame, fear, grief, longing, rage, and even love. The reservoir of rage that Dr. Sarno has brought to our attention, is problematic for many of us in our civilized western culture. Within the last few years, he has increased our awareness of the young child within who needed, and stills needs, unconditional love and acceptance. He has encouraged his patients to get to know that child through journaling and in therapy. In addition, quite a few of my patients have discovered the frustrated, insecure, adolescent who has also been unconsciously disavowed.

So, the treatment begins by exploring the context in which the symptom developed. Often, people do not have an awareness of the emotional impact of the physical/work/family/relationship environment in which they live because they have learned to survive and thrive by disavowing the emotions I described above. I ask for minute details, like a journalist, sometimes annoying with my “picky” questions about “who, what, when, where, and why.” We learn a lot from what they can and cannot answer. My aim is to help them identify “stressors” that can lead to the overflow of an emotional reservoir into a pain symptom. For example, a 36 year-old patient recently told me that, within the past year, his father had died suddenly, he had lost his job, and separated from his life partner. While these life events would cause many of us to have overwhelming feelings, he had scant appreciation of just how stressful these events had been. Thus his therapy began.

While identifying the life events preceding the onset of the pain, I am listening intently to how the person is speaking about the event. How is my patient reacting emotionally to what they are telling me. For example, are they laughing when telling me about what sounds like an enraging/embarrassing/shaming/humiliating situation? Do they seem sad when speaking about sad matters? Can I detect any emotion at all as they speak about a highly volatile interaction or a devastating loss? I often refer to this function of the therapist as the “emotion detector.” In the initial consultation I begin to bring the patient’s attention to this dimension of their participation, carefully probing to assess the extent of their awareness and how they react to my inquiring. We often identify this as an area where they will need to do work both inside and outside of the session.

For people who have great difficulty being aware of what they are feeling about what they are saying, I work intensively on this in each session. I recommend that they take a “feeling inventory” several times during the day and evening: Ask yourself, “What am I feeling about the events that happened during the past hour? How did I feel when my supervisee didn’t meet the deadline and casually brought the work into my office without acknowledging that it was late? How did I feel when our nanny called to say that she had an emergency and had to leave immediately, possibly indefinitely? How did I feel when our 16 year-old son showed up two hours past his curfew, undeniably drunk?” At the beginning of therapy, some people need to take this inventory once every hour.

As we are doing this “emotion detection” work inside and outside the sessions, we are also tracking pain levels as well as presence and absence of pain. This strategy is aimed at making links between emotions and pain symptoms. I offer a few examples to illustrate:

1) A patient had been pain-free all day but noticed that his pain started on the way to the session.  I asked what he was thinking and feeling along the way.  He realized that he had mixed feelings about being in the session.  As we examine these feelings, his pain lessens but is not completely alleviated.

2) A patient is pain-free in the session until she starts to describe an interaction with her husband the previous night.  In our discussion, we discover that she was furious with him and afraid of feeling her anger.  We spend some time helping her tolerate that feeling right there in the session.  As she becomes more comfortable with feeling angry, we talk about some constructive ways to express it to him.  Her pain gradually subsides.

3) A patient is in excruciating pain as he enters the session and has no idea what brought on the pain the day before. We begin our search for the emotional triggers and discover that he had been dreading an upcoming phone call to his mother in which he planned to confront her in a way he had never done.  As we discussed his strategy and what he was afraid would happen, his pain started to subside.

Recommended Reading

For patients and therapists:

John E. Sarno, MD

Healing Back Pain: The Mind-Body Connection

The Mindbody Prescription

The Divided Mind

Howard Schubiner, MD

Unlearn Your Pain

David Clark, MD

They Can’t Find Anything Wrong

David Schechter, MD

The Mindbody Workbook

For therapists:

Lewis Aron and Frances Sommer Anderson (Editors)

Relational Perspectives on the Body

Frances Sommer Anderson (Editor)

Bodies in Treatment:  The Unspoken Dimension

All titles are available at the WTCI-Amazon Bookstore.

For more about Frances Sommer Anderson and TMS, try FrancesSommerAnderson.com and the TMS Wiki.

What’s your background?

I graduated from Boston College with a degree in psychology and received my masters degree in counseling from the George Washington University. I became a licensed professional counselor shortly thereafter. I knew early on that I was going to pursue some kind of career in mental health, but I just didn’t know how or what it would look like.

I remember, quite clearly, that I struggled mightily once I received my masters degree. I had all these grandiose ideas about starting my own private practice but had absolutely no idea what that truly entailed. When I think back to that time I wish someone would have given me a good shake or dumped some cold water over my head…anything to wake me up to reality!

I spent a few years trying to build my career as a clinician and it was quite disheartening. I took jobs hoping to move one step closer to my career goals only to find myself feeling boxed in and stuck in a series of dead end jobs.

But here’s the honest truth about my circumstances at that time. Most of it was my fault. It took me years to realize that the mental health profession, like any other industry, will gladly define you if you let it. And that’s what I did. I didn’t make an honest effort. I spent my days hoping the field would find a place for me. It did, but it was never what I had hoped.

I can look back on things now and laugh, but at the time it was truly a painful process.

The “light bulb”, for me, did not go off until 1999 when a friend of mine shared an amazing story about how he landed his dream job within the profession. I gained a significant amount of insight from his story, and began to move away from the blame game. I took note of all the wonderful marketing and sales concepts he used to find success – ideas like permission marketing, the true definition of value, sales progressions, and the importance of building relevance and credibility. I’ll explain these concepts a bit later. I mention some of them here simply to illustrate that there were a lot of unique approaches to business development I had never thought of at the time. All of them provided motivation for me to change.

Rather than expecting things to come to me, rather than passing up on opportunities or going through the motions, I decided I’d be the initiator. Rather than being average at a lot of things, I chose to become very good at a few things. I set new goals in this direction and have spent the past several years learning, growing, and taking advantage of new opportunities that come my way. It has made all the difference in terms of my personal enjoyment and the general satisfaction I get from doing my work.

What do you do now?

At present, I am a writer, consultant and the Director of Business Development for a large behavioral health care organization. Essentially, I am responsible for ensuring my organization’s treatment facilities are growing. It’s a fun job because I have a say in the services we offer and I am able to partner with people in the community who are doing some incredible things with regards to mental health services.

After 1999, I realized I had interests and passions within the field that could be nurtured elsewhere. So I began getting involved in business consulting. I worked with Industrial/Organizational Psychologists on work culture and social dynamics to help improve business performance. As the years passed I starting learning skills I felt could be successfully integrated into a mental health paradigm. It seemed to me that a lot of valuable business development innovations and techniques were underutilized in our industry.

What excites me about utilizing sales and marketing concepts in the mental health field is the fact that they can be applied to all settings within the profession. They certainly apply to private practice, but also have relevance in organizations, schools and even as part of the job search process.
When I realized this and started using these concepts within my company I saw our outcomes improve considerably. And when others began using them they saw similar results.

How do you apply some of the principles/approaches (e.g., the true definition of value, sales progressions, the importance of building relevance and credibility) when working with clinicians on private practice building?

There are numerous ways to apply these principles within a mental health model. I tend to take a different approach when people ask me how best to grow a private practice. Here are a few ideas I use as a way to begin applying some of these concepts.

Break Away from a Traditional 1-to-1 Financial Model

When I was working as a private practitioner I was stuck in a “this for that” model. I would provide a 50-minute session in exchange for an hourly fee. The problem with this approach is that I tended to reach the limits of my earning potential quickly. There are only so many hours in the day and there is just so much that the market will bear for my services. I see a lot of private practitioners struggle as they try and grow their practices under this framework.

Where do you turn once you reach the boundaries of your service delivery model? I suggest looking for ways to diversify. Expand your service offerings and/or partner with others in an effort to create multiple streams of income. When you hear stories of people who move from slow and steady growth to immeasurable success what you find, more often than not, are people who leverage the power of passive income. They have found a way to generate income with less effort not through smoke and mirrors but by setting up systems to where they can add value in numerous ways.

I understand that the phrase “passive income” elicits all kinds of negative responses. Many people associate it with pyramid like schemes. But passive income has value if used with purpose and principle. Consider this example.

When I lived in Washington, DC I knew a psychologist who had a thriving practice with offices in Washington DC, Maryland and Virginia. She understood the power of systems and built a practice around up and coming therapists in the DC metro region by offering a win-win opportunity. Talented but inexperienced clinicians received mentoring, supervision, counseling experience and a percentage of earnings while my friend received her own percentage from each practitioner.

This is not a new model for any of you I am sure. However, what struck me about this approach was the fact that it had a snowball effect that seemed unstoppable. My friend’s reach within the marketplace was astounding. She had income coming in simultaneously from numerous clinical groups, individual sessions, trainings and workshops without her having to be present for each and every activity.

As a result, she had more time to focus on other business matters such as networking functions, clinical research, strategic development and writing. It made her smarter and more marketable within the field.

Understand that “Markets are Conversations”

A lot of ambitious practitioners choose traditional models of advertising to get the word out that they are open for business. I’m a big believer in marketing one’s services aggressively, however, if you’re not careful you’ll spend a significant amount of money with very little results. I often tell people to be careful not to create marketing materials or to place advertisements that exist in a vacuum. A brochure that you mass mail, business cards you drop off and print ads you place without any kind of follow up will have very limited impact. You need to have a step-by-step process put in place that will take people from point A to Z. I often refer to this practice as a “sales progression”. When creating a marketing plan you should identify strategies that build upon one another. For example, if you give a free talk be sure to have a system in place where you are able to follow up with your audience. Have them sign up to receive a newsletter from you or offer them a free tele-seminar that will take place weeks after the training. You want to put systems in place so people have an opportunity to experience what you have to offer and then they are given an additional opportunity to progress to the next level (e.g., seeking individual counseling, signing up for an intensive paid workshop, joining a new group you are facilitating).

There is a considerable shift taking place across all markets that has implications for how you choose to advertise and market your services. Standard marketing messages often have very little emotional appeal and are easily ignored. In addition, today’s markets offer a plethora of choices. People can easily ignore your message if they perceive no value. So how do they pay attention to your message? People are looking for substance and value. They are finding it more and more online by asking questions and participating in conversations. You need to find ways to be a valued contributor to those conversations. The great news about this shift is that you do not need large amounts of money to market yourself effectively. You don’t need to be on TV or in a magazine to reach your audience.

Your effectiveness as a marketer is not about how slick your brochures are or whether or not you have a compelling name for your practice. It is about your ability to identify communities and to be a valued contributor to the conversations that are taking place. This image should help clarify my point further.

Change Your Definition of “Value”

“Value” is often defined as what one receives in return for some sort of payment. A much better definition of “value” is: the act of offering something beneficial to others without any expectation of receiving something in return.

This is where true growth and opportunity takes place. My friend, who I mentioned earlier, used this model to find his dream job in the field. Initially, he turned down two jobs from one of the largest mental health employers in his area effectively ending any chance of working for them in the future. This would have been true had he not decided to make the decision to help the company find better candidates for the two positions he turned down. And once he filled the two positions for the company his value and credibility went through the roof! He made himself indispensible by thinking of others and helping them achieve their goals. The result: they asked him what he was looking for in a new job and then they created it for him!

A great way to build your network and to increase your relevance in your market is to find unique ways to offer unexpected value for your potential referral sources and clients. They will be impressed by your generosity and you will be nurturing a consumer base that will have powerful long-term effects.

Find David Diana online and order a copy of his free e-book, “Change Therapy,” at www.davidpdiana.com.

Corey Quinn is founder of WTCI affliate MyTherapistMatch.com, a service that matches clients and therapists based upon results of a personality-traits survey. He talked to WTCI via email about why he started the company and how it does what it does.

MyTherapistMatch.com is offering one month free to WTCI readers. Sign up using coupon code 204.

What’s your background?

I was born and raised as an only child in an entrepreneurial family here in Los Angeles. After graduating college, I started up an Internet company in 1999, where we raised $6 million in seed funding. The company streamed live events on the web (webcasting) and unfortunately took a hit in the bubble burst of 2000/2001. After that, I went into financial services and eventually made my way back to school to get my MBA in finance and entrepreneurship from the Marshall School of Business at USC. Just before entering business school, I went back into the internet industry, where I’ve been ever since.

Currently, I am the founder and CEO of MyTherapistMatch.com. MyTherapistMatch.com is a website that matches individuals with therapists based on compatibility.

What made you start MyTherapistMatch.com?

When my parents decided to get a divorce, they put me in therapy. I was 12 years old. My first experiences with being in therapy were positive. My therapist Jackie and I played games, ate candy and just kind of hung out. Her low key approach to therapy worked for me, and as we became friends, I began to open up to her. She was my ally and helped me successfully deal with the range of emotions I was experiencing though the divorce.

Several years later, when I was in high school I wanted to speak with another therapist about typical “growing up” type issues. I began having sessions with Cathy, the school counselor. Cathy was amazing – I felt like she and I were able to talk and relate on a deep level. I felt like she could really understand me – more than anyone else ever could. The work that she and I did fundamentally transformed and improved my life in amazing ways. Looking back, I am so grateful for her and our therapy sessions.

That was the last time that therapy was amazing for me until recently (I am 35 years old). I had a series of mildly disappointing experiences while seeking therapy after high school. Each time, I would go to a website to find a therapist (such as an insurance website, therapist finder directory, etc.) and would find a couple of therapists that seemed to have the right experience, areas of focus, etc., call them and set up initial appointments.

My hope was that I would find another Jackie or Cathy, but what I found were therapists who were not quite what I had previously experienced. All were licensed, competent and well intentioned, but there wasn’t that connection, I didn’t feel that powerful chemistry that was the important ingredient in the transformational process.

Instead of continuing to shop around to find the “right” therapist, I would decide to stay with a good, but not great (for me) therapist – more out of convenience than anything else. I was not in the mood to interview a large number of therapists to find the right one. I was ready to begin the therapeutic process – to start the work. I would come to find that the outcome of these therapy sessions was positive but it was not the transformational experience I was hoping for.

At the end of one not so satisfying therapy session, I thought to myself – “there has got to be a better way to find a ‘good’ therapist.” Good meaning one that I can really feel connected to and trust at a deep level.

I spent some time thinking about different ways to solve this puzzle, and it hit me – take an eHarmony style compatibility approach and apply it to the finding a therapist process. While the client/therapist relationship is not romantic in nature, the requirement for interpersonal trust and rapport does apply. This was the genesis for MyTherapistMatch.com

What do you do now?

As the founder and CEO of MyTherapistMatch.com, I spend much of my time improving the visibility of the MyTherapistMatch.com site to individuals who are actively seeking a therapist. Finding the right therapist is the most important decision in therapy, and by using MyTherapistMatch.com, individuals looking for a therapist can dramatically reduce the amount of time and improve the probability of finding a compatible therapist. In our first month (we launched in November 2009), we had two times the number of people complete our compatibility survey than we had therapists on our site. We are growing in January and look forward to a great 2010.

How’d you come up with the criteria? Why, for instance, “preferred orientation in time”?

My co-founder and I created the matching survey and algorithm. We base the matching criteria found in our survey and algorithm on our understanding of interpersonal rapport. Dr. Robert Dee McDonald, co-founder of MyTherapistMatch.com, is a therapist who has taught interpersonal communication skills in 18 countries to thousands of students. He has been in private practice for over 35 years, has taught psychology as the University of San Francisco, and is a co-author of the best selling NLP book of all time: The New Technology of Achievement.

We know that in general, people like people who are like them. The same is true for therapists and clients. In the therapeutic realm, the client must feel a great deal of trust in the therapist for real change to happen. Without this trust, clients will not open themselves up to the therapist, making the effort futile, extending the therapeutic process for the client, running up the cost of doing therapy and more. The premise of MyTherapistMatch.com is that we help people find the right therapist by getting connected with a therapist who moves through the world in a similar way to the client, thereby increasing the probability of natural rapport and trust.

In the case of “preferred orientation in time,” which is just one of the 23 criteria with which we match therapists and clients, people tend to “live” in either the present, future or past. We match therapists and clients who prefer one of the three orientations similiarly. Contrarily, if we were to match up a client who prefers to be future oriented with a therapist who prefers to be past oriented, there will most likely be a subtle disconnect. Providing support for the preferred orientation in time concept, Dr. Philip Zimbardo, former president of the APA and Professor Emeritus at Stanford University, has recently presented his findings, called Time Perspectives. Please see the following video clip (duration 2:23): http://www.youtube.com/watch?v=DlTphlvB0xs.

Is there evidence that this kind of compatibility helps in a therapeutic relationship?

There is no hard evidence to support our ideas about this particular kind of compatibility. But we do know from clinical evidence that therapists report that when there is deep rapport, there is a higher probability of therapeutic movement. Carl Rogers, PhD., founder of Person Centered Counseling, said that compatibility is absolutely necessary to create a climate for therapeutic change. In addition, Bruce Wampold, from the University of Wisconsin, reported in 2001 that the therapeutic alliance, i.e., rapport, is a key factor in psychotherapy.

In addition, much of the criteria with which we match people are based on the works of well known psychologists, such as Carl Rogers, PhD, Virginia Satir, PhD, Fritz Perls, MD and Milton Erickson, MD.

Has My Therapist Match been working–are clients and therapists matching up and doing good work so far…?

I am grateful to say that MTM is working. We are only in our 3rd month, so the feedback is just starting to come in. The feedback that we have received so far from therapists on our site has been generally positive. In addition, the feedback we collect from our therapist members gets fed back into our matching algorithm, allowing us to better understand the core drivers of a good match for clients and therapists. In that way, our algorithm learns and improves over time.

Corey Quinn’s company is MyTherapistMatch.com. Find more information at the company’s blog, The Compatible Therapist.

Catherine Auman, MFT is a Los Angeles psychotherapist and managed care enthusiast.  She talked to WTCI via email about why.

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

I’ve been working in our field for over 25 years in virtually all aspects of behavioral heath: private practice, psychiatric hospitals, chemical dependency treatment centers, residential treatment, and consulting nationally with mental health facilities. I guess what’s most relevant for this interview is that I worked for two years inside managed care companies, seeing them from the inside out.

I’m now in full time private practice that I built using the managed care strategies that I teach others in my seminars.

All the managed care options can seem overwhelming.  How do you advise people to get started?

The first thing is to learn more about managed care and challenging the misconceptions they’ve heard on the street. Most of these things, like the rumor that managed care companies are hard to work with or that there’s a lot of paperwork, are completely untrue.

What mistakes do people tend to make as they try to get on panels?

People often don’t know how to appear attractive to managed care panels in their applications. It’s not enough to just go to school and get licensed. To make themselves more attractive to panels, it helps to become “managed care friendly.” Neither of the managed care companies I worked for ever mentioned trying to save money or to shorten lengths of stay – both always instructed us to do what was right clinically. They don’t particularly like to work with clinicians who are hostile, or don’t understand how they work. I teach all about this in my workshop.

Some companies have a reputation of being hard to get paid by.  Do you have suggested list of good-to-work-with insurance companies?

It’s really not true that it’s hard to get paid by managed care companies if you do your homework up front. I teach people “how to get paid every time” in my workshops. That said, I’d have to give the “easiest to work with” award to United Behavioral Health (UBH). Most of the time it’s so simple: bill online and a check arrives in the mail.  Love that!

Any final words of wisdom for people trying to get happily to work via panels?

I love managed care – I wouldn’t have a full time practice without it. There’s a steady stream of referrals, an average of two new clients a week, checks keep arriving in the mail from what I bill. Most of what you’ve heard about working with managed care is a lie – there’s very little paperwork, the companies are easy to work with if you know how, and the clients are high functioning. What’s wrong with that?

Find Catherine Auman online at catherineauman.com.

Marina London, LCSW writes about social media at iWebU and helps people with it at emphasisweb.com.  She talked to

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

I started off my career somewhat conventionally. BA in psychology from Yale University, MS in Social Work form Columbia University, psychiatric social worker at New York Hospital, private practice and then a 15 year career as an Employee Assistance Program executive. Started of as Clinical Director for a national EAP ended up as a VP of Operations for another one.

I was an early technology adopter from the get go and was in charge of IT at many of the EAPs I worked for being that rare bird – a clinician who understood computers. Since 2005 I have been the Web Editor for the Employee Assistance Professionals Association. Since 2008 I have been training clinicians on how to understand and use social media to grow their private practices. I have presented at numerous local, national and international conferences on this topic. My next major gig is an all day workshop at the Psychotherapy Networker Symposium in March 2010.

I write an award winning blog http://iwebu.blogspot.com and my Twitter is twitter.com/iwebu. I continue to maintain a rather peculiar skill set (for a social worker) which includes HTML coding, web site design and content writing, as well as other assorted geekery.

What do you see as the most important steps non-tech-savvy clinicians can take to help build their practices?

Step one is to do a ruthless inventory of your skills and your available time, as this will inform your level of involvement. If you don’t have the requisite skills, hire someone to teach you or do it for you. For example, if you only have 15 minutes a week to devote to social media, and find writing to be an excruciating process, don’t blog.

The second step is probably still to have a well designed and well written website. It does not have to be big or full of bells and whistles but it should state clearly:

· Your credentials
· Your areas of specialization
· What is unique about you as a practitioner
· Your publications and presentations if applicable (articles you have authored, speaking engagements)
· How to contact you
· How to find you (e.g. directions to your office)

The third step is to get involved in social media. This can be overwhelming because there are literally dozens upon dozens of social media “channels”, from Ning to Facebook, from LinkedIn to Twitter, from blogging to less known ones like BlogTalkRadio. The important thing to remember is that there are three levels of involvement in social media, from observer, to commentator, to content producer. So let’s say you are a good writer and have something to say and you are thinking about blogging. Step one: read blogs. Step two: read and write comments on other people’s blogs. Step three: write your own blog.

What are the most common tech missteps you see?

On the web site side of things, I still see a lot of poorly written, unprofessional looking sites with bad photography. Clinicians should hire professional photographers – especially for that all important head shot, retain a copywriter if they can’t write web copy, and hire a designer to ensure a professional look. It’s not that expensive and it’s worth it.

On the social media side, I see a lot of clinicians who jump to step three as stated above and then call me in a panic. For example, they launch a Twitter account, tweet once and then have no clue what to do next. Using social media to build a practice is completely different than doing it purely for social purposes. So before setting up a Twitter account, it is important for professionals to follow other clinicians on Twitter, direct message them and articulate a set of goals for the tweets, for example “I want to become recognized as an expert on EMDR for adolescents.” The tweets should be focused around that goal, and you should follow people on Twitter in a purposeful manner. Who can help you further that aim?

If you’ve done all of the above, how will you know it’s working?

Well with respect to the website you may not. Sure you can do (or have someone do for you) some Search Engine Optimization stuff and some Google Analytics to see how many people visit your site. Reality – as one of my favorite new media experts has said – “Having a website is like having a billboard in the desert.”  In other words, unless you actively drive people to your site using other forms of social media, that’s not how you are going to build your practice. You need a website because pretty soon the phone book is going to be totally obsolete and plus, having a website gives you gravitas.

With respect to social media, you have better indicators. How many followers do you have on Twitter? How many people subscribe to your blog? But it is not just about the numbers. It can be about quality. Any day I would prefer to have 10 serious and well connected new followers on Twitter rather than 100 people who absent mindedly clicked “follow.” Clinicians need to remember – you are not Ashton Kutcher trying to hit 1 million followers on Twitter. You are trying to get relevant colleagues to refer to you, new clients for your practice, a booking to speak in front of the local PTA, etc.

Forget about complex analytics, a simple question to new clients, “How did you hear about my practice?” will tell you a lot.

Any other words of wisdom you’d like to add…?

If clinicians are serious about using new media to promote their practice, they might be interested in a concept that I developed called the “Social Media Marketing Triangle.”

I had the idea after I heard my contractor talking about the “kitchen work triangle” as he attempted to remodel my “vintage” kitchen into something more 21st century. He kept harping about the need to have an invisible “work triangle” created by the arrangement of the sink, the stove and the refrigerator. It seems that the placement of these three elements in relation to each other is intrinsically connected to designing an efficient kitchen.

It got me thinking – maybe the key to promoting a professional practice on the web is an invisible “triangle” that you create on the Internet by cross referring between at least three web platforms.

Take, for example, your website, your Facebook page and your Twitter account. What if the strategic placement of any three social media elements in relation to one another is fundamentally connected to successfully marketing your practice on the Internet? So, your website refers to your blog, your blog refers to Twitter, your Twitter account refers back to your website.

In any event, a website and two other social media outlets is about the max that most people can handle and do a good job with. Though I professionally use and lecture about many social media channels, I personally only use two to promote my work.

For more information on how you can use social media and other technologies to grow your practice, read my weekly “web secret” at http://iwebu.blogspot.com. For daily secrets on all matters web for the non-geeky clinician, follow me on Twitter at http://twitter.com/IWEBU.

DeeAnna Merz Nagel is co-founder of the Online Therapy Institute

What is your background?

Educationally, I am trained as a rehabilitation counselor. I received an M.Ed. in Rehabilitation Counseling from the University of Georgia in 1994. Prior to that, I worked in the field of mental health and human services for 5 years. After I completed graduate school I received post-graduate supervision and training working with adult survivors of sexual abuse. For several years following, I worked in many diverse settings- both urban and rural – helping people dealing with poverty, domestic violence, homelessness and developmental disabilities. I spent many years working with child welfare families and foster children offering in-home therapy to families and conducting forensic evaluations to the courts. I am a Licensed Professional Counselor in GA and NJ and a Licensed Mental Health Counselor in NY.

In 1999, I discovered the power of the internet while researching respiratory symptoms. I was sick and a diagnosis eluded my doctors. I turned to the internet for solutions and ultimately, support. I was finally able to talk with my doctor about what I had discovered through support forums and bulletin boards online and I was ultimately diagnosed with Sarcoidosis. From that point on, I realized the inevitable impact the Internet would have in the lives of people all over the world.

Around that time I began offering online counseling through an e-clinic. I joined the International Society for Mental Health Online and had the opportunity to be mentored by pioneers in the field. Eventually, my health improved and I joined the workforce full-time again. For the next 8 years I continued to offer online counseling to clients, maintaining a part-time practice online. In 2005 I was elected ISMHO’s president and I continued to network with my colleagues at conventions and conferences, meeting peer professionals in cyberspace and in person. Regardless of my “day job” online counseling remained my passion. I became a Distance Credentialed Counselor and transitioned from becoming certified to facilitating the DCC trainings. While running an in-home, community based mental health organization, I routinely conducted online field and clinical supervision with employees and contractors.

What do you do now?

Today almost all of my work is related to online therapy and the internet. I am the co-founder of the Online Therapy Institute with my colleague, Kate Anthony. We decided a couple of years ago that we wanted to bring our experience to as many people as possible. To that end, we co-authored a book, Therapy Online: A Practical Guide (just released!) and co-founded the Institute. We offer online training and consultation and promote social networking and the use of Web 2.0 as a way for mental health practitioners across the globe to connect and learn from one another. We offer many avenues for social networking, education and supervision about the impact of technology on mental health. Soon we will be launching a new series of offerings including training and marketing opportunities for OTI members.

I also maintain a small private practice in Atlantic Highlands, NJ and most of my clients deal with issues related to the internet, ranging from cyber affairs and compulsively surfing porn sites to understanding their teenager’s use of social networks like MySpace and Facebook. I spend a lot of time normalizing the internet for some, and teaching appropriate boundaries around the internet for others. Most of my in-person clients also see me online as adjunct to face-to-face sessions. I also conduct e-counseling through a major EAP organization in Canada and I continue to facilitate the Distance Credentialed Counselor training through ReadyMinds (www.readyminds.com).

For a licensed therapist interested in expanding to online services, what are the steps? Is coaching certification necessary? More insurance…?

A therapist or coach who is interested in expanding services to clients online is advised to seek additional training to increase competency. In a “buyer beware” world, it is encouraged that professionals demonstrate to their public that they have the necessary skill and training to conduct services online. At the Online Therapy Institute we offer ethical frameworks for mental health professionals and career and school guidance counselors. In the spring we will release an additional ethical framework for coaches. In January we are launching several online courses for mental health practitioners. For coaches who are also licensed, these courses will offer the necessary training to practice proficiently. Other trainings are becoming available across the globe and professional organizations such as the APA and ACA are offering sessions on topics about online therapy and the use of technology at annual conferences and conventions.

With regard to malpractice insurance, practitioners should check their coverage to ensure that online counseling is not excluded. The practitioner is advised to follow the laws of both the client’s geographic area as well as the laws of the practitioner’s geographic area. While the safest precaution would be to practice within state boundaries, if neither location restricts the practice of online counseling, then it might be presumed that it is safe to proceed. Even so, laws change rapidly and it is difficult to keep up-to-date. Practice due diligence by calling state licensing boards and checking the internet for state laws. OTI offers a Law and Ethics Wiki and we add information as it becomes available. Document efforts of discovery in the client’s file.

In OTI’s ethical framework for mental health, screening for clients who are not appropriate for insight-oriented therapy is advised–makes sense. What happens if an online therapy client emerges as being suicidal, substance abusing, in crisis, or otherwise not appropriate during the course of treatment?

Just as with face-to-face counseling, appropriate client screening is essential. This can occur via an initial consult online or via telephone. In addition, I use the same questionnaire with my face-to-face clients as I do with my online clients. I ask questions related to psychiatric history, medical issues, immediate concerns, medications and I ask about the client’s experience with technology. I state in my informed consent that the client and the therapist utilize the first couple of sessions to assess the client-therapist fit. With regard to crisis, as soon as I receive a new client, I research local resources, and police/fire numbers. Then I follow much the same protocol I have followed when working crisis hotlines. In fact, I encourage practitioners who want to work online to take a crisis hotline training through an agency in their local community, Hotlines have been doing crisis work for decades so handling crisis via distance is not a new concept. Of course, this protocol changes depending on the setting. For instance, the EAP I contract with offers 24/7 support through a crisis call center so the client has access to that number and from the beginning.

Other referrals for services such as substance abuse and psychiatric consults are made as necessary just as in face-to-face work. The key is knowing the client’s geographic area and having a comfort level with researching resources online and developing a peer professional network when such referrals are needed. Networking online is as important to the online therapist as networking within one’s local community for a face-to-face therapist.

Have there been nightmare scenario online therapy legal cases? How are courts weighing in on the subject (if at all)…?

I am not aware of any case law to date that is influencing online practice. But that is always subject to change! In my opinion, following state laws, avoiding dual relationships and maintaining confidentiality online are “hot spots” that could easily lead to legal trouble. All correspondence that would be considered part of the psychotherapy record should be encrypted and practitioners are wise to consider how they manage their online presence with clients given the advent of Web 2.0 and social media.

Any final words of wisdom for therapists interested in offering online services?

If you are interested in conducting online therapy or online coaching, educate yourself. The nuances online and with other forms of technology are real and as with anything we add to our intervention toolkit, we should be skilled and prepared while also working within our scope of practice. And remember, if you are a coach but you are also licensed as a mental health practitioner, your license is the standard of care to which you should adhere. I have spoken with many therapists who think that if they call themselves a coach, then they can avoid any liability that may come with conducting online therapy. That simply is not true.

I hope this is the decade that online therapy is embraced as a viable alternative for those who so choose. Telepsychiatry is already offered in rural communities across the country and now the military is offering online therapy through TriCare. Employee Assistance Programs are offering online interventions and the research is showing efficacy in online methods of delivery. The time is now. We are no longer asking “Should we offer online therapy?” We are now asking, “How do we offer online therapy?”

If you are interested in continuing this dialogue and other similar conversations, join us at www.onlinetherapysocialnetwork.com! We would love to have you!

Find DeeAnna Merz Nagel online at www.deeannamerznagel.com and www.onlinetherapyinstitute.com

If you’ve browsed around for a book about building a private practice, you’ve heard of Lynn Grodzki.  She is the consultant’s consultant, author of several definitive books on practice-building, including Twelve Months to Your Ideal Private Practice, and, more recently, Crisis-Proof Your Practice.  She talked to WTCI via email.

What’s your background?

I have had a checkered career! I worked a lot of odd jobs and got my BA in Art and Design, started and ended a few small businesses and then spent seven years as general manager in the family business. I got a Masters in Social Work in 1988 from the University of Maryland and quickly became a psychotherapist in private practice (LCSW) in Maryland. After a decade of running groups and seeing individual clients, I combined my earlier interest in entrepreneurship with my love of psychotherapy and became a business coach for therapists and healing professionals in 1996. I began teaching my Private Practice Success Program locally in the Washington, DC area to therapists and healers and in 2000, I published my first book: Building Your Ideal Private Practice (WW Norton.) I also took time to formalize my coach training to help me work with professionals. I am a Master Certified Coach through the International Coach Federation, and a faculty member for CoachU, a large coach training organization.

What do you do now?

I work as a psychotherapist in private practice, specializing in counseling for cancer recovery. I also work as a business coach for small business owners. As a business coach, I specialize in working with change-agents: therapists, coaches, healers, and other service-oriented consultants who help others make change in their lives. I write and give workshops. During the past decade, I have worked with thousands of professionals to help them learn how to operate small businesses that offer them a high degree of integrity as well as enhanced financial success.

I am the author of five books about practice-building for therapists, coaches, and consultants, all published by W.W. Norton. I also write articles on practice-building for national magazines and a free monthly email newsletter that goes out from my website, read by over 7000 subscribers.

I am also a breast cancer survivor and volunteer my time as the founder of www.healingwithbasketball.com, an exercise clinic for breast cancer survivors, now sponsored by George Washington University Cancer Institute, Office of Survivorship. I live and work in Silver Spring, Maryland and can be reached by email at: lynn@privatepracticesuccess.com or at my website at: www.privatepracticesuccess.com.

What do you see as the most and least useful first steps toward expanding a private practice?

Building or expanding a practice can feel overwhelming. The first problem most of us have is to start doing things, piecemeal, without a plan. In our clinical work, we try to listen carefully to a new client, identify a series of problems or diagnoses, and then formulate a plan of treatment. Working with a small business is similar. You want to do what I call an “honest inventory” to see where you are starting from, identify the strengths and weaknesses of your existing practice, and then formulate a business plan that can show you what steps to take, when, and how.

Which of your books is the best to start out with?

Two of my books are relevant for those at this stage of practice building: Twelve Months to Your Ideal Private Practice: A Workbook (2003) is a business plan broken down into a year-long process, with exercises, worksheets, and lots of strategies and steps in all areas of practice development. It’s a great book to use alone or with others in a supportive setting. If you want to use this program with others, one way to get support is to join one of my telephone classes (see: www.Strongstartclasses.com) where small groups of therapists from across the country get  facilitated coaching based on the Workbook.

The most current book, Crisis-Proof Your Practice: How to Survive and Thrive in an Uncertain Economy gives you a business plan for today, one that includes the best ways to market, develop an internet presence, and find the viable business models that help therapists and other service professionals stay successful now.

Any words of encouragement for practice-building therapists as we enter 2010?

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. My website has free articles, checklists, ideas, and a monthly newsletter that can show you how to proceed. 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 re-examine your business, shift its direction, and make it more purposeful and more profitable. Let me show you how!

Find Lynn Grodzki on the web at www.privatepracticesuccess.com.  Her books are featured at the WTCI Bookstore.