Recently I was having dinner with some colleagues, who were discussing the state of mental health and managed care. When these conversations start I sometimes begin to sit back, because I anticipate the worst. I expect that there will be some insurance bashing, and then discussion of how their salaries have shrunk, and how unfair the current system is, maybe a smattering of how better things used to be for our profession and concluding with uncertainty about how much longer they can stay in business. I expected this conversation to go the same way, and was preparing to decide whether to try to advocate for another, more empowering perspective.
I was pleasantly surprised.
The conversation did indeed start with the understandable concerns of therapists trying to grapple with the seismic shifts in our careers and businesses. But then one of them began to talk about how he was planning to change the way he did business. Others expressed curiosity about the things he was trying, and I finally offered a couple of ideas. When they found out that I provide consultation on building & maintaining your therapy practice, they were 100% enthusiastic and eager to hear some positive perspectives. They were able to hear my opinions of some tough truths, that we had bought into the managed care model because we were reluctant to market our businesses and have difficult conversations with patients about payment. No one was defensive at all, one even invited me to come talk with a local group of colleagues. At one point they made a joke about my “secrets” for success, and I told them I am not one of those people who holds back secrets to hook people into working with me, and that they could find a lot of free info on my site.
“I was kidding about having a secret,” one told me. “You don’t have a secret, what you have is a strategy.”
The Buddhist teacher Pema Chodron writes in her book of the same title, about going to “The Places That Scare You.” The goal of the Tibetan Buddhist practice of tonglen, or taking and sending, is to reverse the normal cycle of human existence. Rather than seeking out things we desire and avoiding suffering, the meditation practice of tonglen asks us to imagine inhaling and taking in the suffering for all sentient beings and exhaling happiness to send it to all sentient beings. Whether you believe in the mystical qualities of this, the principle is a useful one in that it teaches us to break the instinctual habit of trying to holding on to the things we like and get rid of the things we don’t. A version of this is going to the places that scare you, rather than running away from them.
The clinicians I have mentioned above are well on their way to maintaining and vastly improving their private practices, and its got nothing to do with me. They have realized that fear is real, and that it often is mistaken for the end of the line. They get that it is the opposite.
Fear is the place you start from.
People who deny that things are changing are in my opinion in for a rude awakening. They deny the way our profession is being challenged, the importance of emerging new technologies, and the evolving practice of psychotherapy. They deny the things that would evoke fear in them. This is not unique to therapists of course. Ironically, we often work trying to help patients see the devastating impact on their lives of repressing anxiety-provoking truths. Then we turn around and do the same things to ourselves, hoping that this change in economics or technology is “more of the same.” Folks in this group are in pre-contemplation of fear, they haven’t even gotten that far.
Then there are clinicians who have gotten that things are really changing, and they are terrified! They are paralyzed and miserable, commiserating with others and talking about the way things were in the past and how much better they were then. They see the point of fear and they think of it as the period on a life’s sentence of struggling. This is the end of our careers, we can’t learn to use technology, therapy is a dying art form. They give up, and go out of business in a lingering dwindling sort of way.
Fear is not the endpoint. Fear is where you begin. Fear is where you get going and hire a coach, research and write up a business plan, take a workshop on business development, marketing or integrating new technologies. Fear is the start of renovating your practice. Yes there is a lot of suffering in the world, let’s get going and reduce it.
Epic Therapists know all about fear. They aren’t fearless, there’s a lot to be worried about. Many businesses fail, money needs to be spent to make money later, there are long hours ahead and no structure but the one they give themselves. There is a lot they don’t know, a lot they’ve never learned to do to run a business, known expenses and surprises. But Epic is running toward that dragon, knowing this could be an epic failure, being afraid… and then doing it anyway.
Epic Therapists have learned the concept of “nevertheless.” I am scared that my business will fail, nevertheless I am starting it. I am afraid that I’ll rent an office full-time and not be able to find patients, nevertheless I am going to rent one. I am afraid I’ll sound inauthentic or greedy if I talk about my business to a colleague, nevertheless I am going to talk about my business. I am afraid no one will want to pay my fee, nevertheless I am going to set a firm “bottom line” fee for myself. I am afraid that I won’t be able to keep up with the changes in healthcare or technology, nevertheless I am going to make a strategy.
My last post about having a secret headquarters was fun to make, and it was also serious. We need to have a time and a place for strategizing. We can absolutely have fun doing it, but this is serious business. There really are things to fear in healthcare, building a private practice and starting a business. We need to think carefully and plan, and then we need to begin.
Mike Langlois, LICSW
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