How to Get Taken Seriously as a Mental Health Professional

Many therapists looking to start or grow their private practice often wonder the same question when they are starting out:  How do I get referrals?  If you can tolerate a mild rant, I may have one answer for you.

Let’s look at this concern through a tried and true mental health paradigm.  First, we take a symptom, and then we look at the underlying conflict that the symptom represents.

So what’s the symptom?  That’s easy, head on over to LinkedIn and take a look at several profile pictures of colleagues.  Go ahead, I’ll wait.  What did you see?  When I looked I saw some professional headshots, but more of the following:

  • blank photos
  • top of head/ chin cut off
  • people in front of a car
  • waterfalls
  • tank tops
  • the “I’m holding my phone camera at arm’s length” shot
  • at a party
  • graduation gown
  • flower
  • too dark to see
  • wearing sunglasses
  • skiing

 

If you want to generate referrals, this may be a problem. Some colleagues may have a different opinion or be too diplomatic to say this, but let me not mince words.  If you don’t have a professional headshot it is doubtful I will refer to you.  I don’t send people to waterfalls for psychotherapy.  I suspect people wearing shades of paranoia or vampirism.  I envy people who can ski much too much to ever want to help them grow their business.  Cars in photos are either nicer than mine or too shabby, triggering too much judgment either way.  And party-goers scare me.  😉

My experience as a consultant has been that these headshots are symptomatic of one of two scenarios:

1.  You don’t take social media seriously.  In this day and age, our potential patients want to see us before they see us.  They often do their research by checking out our online presence.  If you go on LinkedIn for example, you may find that several people viewed your profile this week.  A picture is worth a thousand words.  I have seen great head shots in black and white, or even avatars for online therapists, so it doesn’t have to be a standard color shot.  But the way technology works now, whatever picture you choose will most likely attach to your emails, tweets, blog comments, posts, and feeds of all kinds. There are exceptions to this, like my colleague Social Jerk, who needs to maintain a tight hold on her anonymity to allow for her to create such creative and satiric posts about social work.  But if you are not trying to be a satirist, but rather grow a therapy practice, this will not work for you.  And if you’re on Twitter, please don’t be an egg.  When I need to jettison followers to follow additional people, the eggs are often the first to go.  Accept that social media is the point of professional first contact with your colleagues and customers.  Take it seriously.

2.  You don’t take yourself as a therapist and businessperson seriously.  Anyone that has read this blog or chatted with me at a workshop can probably tell you that I am neither dour nor constantly serious.  I certainly think there is a lot of room in our profession for humanity, play and creativity.

That said, we are in the business of providing treatment for serious concerns, working with people who have a range of predicaments.  We assess for suicidality, psychosis and trauma.  Your patients come to you with vulnerability and hope that you will help them create profound change, recovery and healing in their lives, maybe even help them stay alive.  If you think that therapy is just two people in a room chatting, then by all means keep the beach picture.

To get a professional head shot requires investment of your time and money.  It is a business expense.  If you are unwilling to invest in a professional image to represent your business concern I suspect you are not ready to own and run a business.  If you are unwilling to invest the time to look through your existing photographs and select one (if you have it) that presents a professional demeanor online then I suspect you are not ready to own and run a business.

Now I know that the term “professional” photo is vague and subjective.  I am not saying that you need to be in a suit and tie.  You can be a play therapist and have affect like my colleague Charlotte Reznik.  But slapping up a blurry photo of you near a palm tree sends the message that you can’t be bothered to represent yourself or your brand.  And in business we need to be concerned about our brands, even as therapists.

Look, I’m not saying these things to hurt your feelings.  I really want you to succeed, and I know that there are a lot of people out there who need your help.  That’s why I suggest that the photo is the symptom of an underlying issue, which is the difficulty to take either technology or your business seriously.  If you have taken time and consulted with trusted colleagues and have come to the conclusion that “I want potential patients to see me as someone blurry whom they could go skiing with” is your brand, and that the head shot is a conscious and intentional image to brand yourself online than you have my blessing.

If not, get thee to a photographer.

 

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall.  You can find out more about it here.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.
Subscribe to the Epic Newsletter!

Post to a Young Therapist

I’m a big believer in twofers.  When you run your own business, twofers are essential.  So when I get several emails about a topic I try to craft a post in response.  Recently I have been getting emails from many therapists or therapists in training who want advice on how to pursue a career as a gamer therapist.  Many of them grew up playing video games and have a lot more comfort and familiarity with them than their therapists who have been around for a bit.

Take Claire for example, who has graciously allowed me to share an excerpt from her email to me:

For most of my life, both video games and service to others have been passions of mine. I’ve recently been working at a game company in XYZ, and have been immersed in the gaming culture more than ever. The more I see it (and experience it first-hand) the more I see a need for therapists who can address the issues so many gamers face as a result of their passion.

Before today, I had no idea if anyone had pioneered this field of study, of if there was even a place for it. And then I found you. A quick perusal of your website tells me that you and I are very much aligned in our beliefs about how games affect us, and why they matter. Seeing that you have crafted this job for yourself inspires me to look further into the possibility of knitting together these passions of mine.

Note the use of the word “passion” here.  I hear from these younger folks how their interest and curiosity around video games and technology in general is met with skepticism and often hostility.  Supervisors turn into lawyers before their very eyes and begin every conversation about technology with the words “HIPAA” and “liability.”  The only question asked in the exploration of patient’s video game is “how many hours are they on the computer?”

Part of the problem with this disconnect is that many up and coming therapists become inadvertently ashamed of the fact that they are gamers themselves.  The implicit or explicit pathologizing of video games and tech use shapes the behavior and expectations about whether discussing gaming, or even using it as an intervention, stops before it begins.

Those of us who have been in the field for a while can often become set in our ways.  We can act as if education and the workplace haven’t changed much since we started our practice.  Insulated in our office and routine, we stick with the phone, maybe email, and play therapy games that have changed little since the 70s.  With this stance we are not prepared to work with patients in the 21st century, let alone supervise 21st century trainees.

If you are training to be a therapist, here’s what I recommend if you want to be a gamer therapist:

1. Start from Within

Repeat after me, “It is okay to experience excitement and enjoyment when I am working with patients.”  Somewhere along the line our graduate programs have begun to give you the message that you are supposed to be an evidence-based automaton with little emotional investment in treatment.  I have had students who have heard dozens of times in their training ideas like “emotional detachment,” and “inappropriate boundaries;” yet not once has anyone talked to them about feeling excited and enjoyment in their sessions.  Even trainees doing play therapy express guilt or fear about getting “caught up” in the play.  You’d think we were supposed to spend our entire careers with dull, depressing people!  Allowing for a range of emotional experience with patients means the whole range, including excitement and fun.  So if you are going to be a gamer therapist, start building your capacity to enjoy yourself in sessions.

2.  Create A Gamer-Affirmative Environment

Did you know that research has suggested that 1 out of 4 comic book readers are age 65 or older?  Yet how many offices have comic books for their adult patients alongside People and Time?  The same is true for video games.  Geeking up your office and waiting room sends the message that you don’t equate video games or technology with “toys.”  In my waiting room I don’t have comic books currently, but I do have Wired magazine and titles devoted to video games.  Many conversations have begun as a result.  I also have a Deathwing statue and other game-related memorabilia.  Recently someone saw a Post-It I had with the word Katamari on it.  I had made a note of the game to remind myself to check it out.  That Post-It was all it took to begin a very excited and meaningful conversation about the game (which has a free App, by the way.)  The smallest changes to your office can convey that you are interested.

3. Try (and I mean play) lots of different video games

This is the fun part, usually.  I have the major game platforms and am always trying one or two new games a week.  If a patient mentions a game in a session, I make a note to try it ASAP if I haven’t already.  Sometimes this requires discipline, because like most people I don’t like every sort of game.  But each game I test out helps me understand the patient better.

4. Have video games in your office

I have always had handheld video game consoles in my office, but in addition I have an XBox 360 as well.  I don’t think you can be doing contemporary play therapy well without it.

5. Disclose that you play video games

The fact that you have game consoles probably implies this a bit, but let’s be explicit. Regardless of age, 64% of Americans play video games, and the percentage is much higher under 40.  So if you have played video games, disclose that you have.  If you have a supervisor who sees that disclosure as more akin to “I smoked pot as a teen” than “Yes, I saw Star Wars” run away.  Video games are an art form not a controlled substance, and there is a big difference between those two conversations.

6. That said, be on the lookout for countertransference.

Whether you like or hate, play or avoid, video games, you need to be mindful of the reasons why and when you talk about aspects of it.  If your patient is telling you that they managed to fish up the giant sea turtle in WoW, it is an empathic failure to say, “Yeah I got that last week, isn’t it cool,” rather than to reflect to them what that says about their persistence and discipline.  Note any feelings of competition you have (or don’t have) and wonder about it.

7. Get good supervision, even if you have to pay for it privately.

One of the downsides of licensure having a (in MA) 2 year post-graduate supervision requirement before you get your independent license is that it inadvertently sends the message to fledgling clinicians that after two years you don’t need it any more.  That is not true.  I encourage new therapists to consider ongoing supervision of some sort to be a business expense to build right into your practice.  I had the opportunity to have weekly supervision for free at my workplace for 12 years.  That sort of job benefit has gone the way of the milkman in many places today.  This means you’ll need to buy some.

If you buy private supervision, remember that it is a different experience from your earlier or agency experiences with it.  This is not your boss, you are hiring them.  Hiring people means interviewing them, and screening them for fit.  If they are technophobic they are not going to be a good fit for a gamer therapist, so it is important to let them know your pro-technology and gaming stance from the beginning.

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall.  You can find out more about it here.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.
Subscribe to the Epic Newsletter!

When Wallflowers Attack

Back in graduate school, my group therapy professor once said to me, “early risk-takers are often scapegoated by the group.”  This comment came on the heels of yours truly taking a risk in the group, a group of psychotherapists in training.  I learned two things in that group class on that day.  The first was that early risk-takers are often scapegoated.  The second was that we therapists can be just as cruel with our comments as anyone else.

This is something that many of my supervisees encounter when they start to put themselves out there, especially on the interwebs.  They are stunned when the blog post they write elicits comments that are sometimes shocking in their nastiness.  They are confused as to why this happens, and what to do about it.  If you are beginning to use social media to build your psychotherapy practice, write newsletters, prepare a public speaking campaign or just write a blog, this post is for you.

The internet has made it easier to be both impulsive and anonymous, and emboldened some people to hurl invectives.  I call these people the wallflowers.  These are the people in any given group who are afraid to take risks or stand out, and resent those who are brave enough to do so.  They are quietly resentful, and more often than not envious of people who are not quiet.  I’m not talking about introverts here, but rather a particular group who stand on the sidelines seething.

These are the people who send you a nasty email at 2:00 AM criticizing your post for a spelling error, or the folks who text really ugly comments to you after you post something on a listserv they don’t like.  They’re the people who make personal attacks on your workshop evaluation in the guise of constructive criticism, or bait you in discussion groups by deliberately misconstruing your words.  Yes, I’m not making this stuff up, all of these things and worse have come at me by email, Twitter, Facebook, blog comment, and text message.  The majority of the time it will be behind the scenes of whatever arena you’re in, so that you can see it and the larger group can’t.  Consciously or unconsciously, wallflowers are counting on you not passing these barbs on to the larger group.  Nobody likes a tattletale.

So what do you do about them?

First, take a second and calm down, and note that the intensity of your response is probably an indicator that this is out of the ordinary.  Next, try to find a trusted friend or family member that you feel comfortable sharing it with, and ask them what they make of it.  Supervisors are often really helpful here.  Often they will react more strongly then you did, which gives you another clue its a wallflower attack.  Your inclination may be to try to learn something from the comment.  I’m going to say something that may go against the therapist grain here–Dismiss the comment and the wallflower.  Don’t bother trying to make this into a growth opportunity, there are plenty of other growth opportunities out there for you.  Don’t give this your energy.

In my experience this is very hard to do, because therapist wallflowers have a lot of skills to hook you.  They bring their therapeutic arsenal and try to come at you as a therapist, by analyzing or interpreting you.  Don’t fall for it.  Just because you both speak the same language doesn’t mean you have to have a conversation with them.  Therapy is a specialized and voluntary form of conversation, and anyone who tries to inflict this on you unasked is using their Jedi therapy powers for ill.

This is your reminder.

This is the price you will have to pay for being an innovator and a risk taker.  Early risk takers are often scapegoated.  You didn’t do anything wrong, you were just putting yourself out there.  And every time you do that, you will run the risk of a wallflower attack.  Don’t overprocess it, move on.  And definitely don’t let it stop you.  Remind yourself that the reason they had anything to attack you about is because you’re doing something they wish they could, creating.  Anyone can ping off a blog post, or fire off a Tweet in reaction, but it will only be a reaction, not a standalone.

Remind yourself that your ideas are precious.  I’m not trying to sound New Agey here.  What I mean is that the fact that you had something to put out there is not to be taken for granted or underestimated.  You could have not had the inspiration for that workshop or podcast, but you had it.  All over the world there are people who have not given awareness to ideas, throughout history millions of good ideas have never been expressed or seen the light of day.  Not you.  You did it!  And if you stop taking risks the wallflowers win, and the prize is one less idea in the world.  Yippee.

I know this can be hard to do, trust me.  And the technology we have today has made it even easier for wallflowers to attack.  It’s sort of like that sense of invincibility drivers get when they are encased in the protection of their cars.  Shake it off.  Share it with someone you trust for perspective.  Dismiss it.  Stay focused.  You can take time to smell the roses, but don’t get distracted by the wallflowers.

 

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.
Subscribe to the Epic Newsletter!

 

 

The Perilous Price of a Good Living

Recently I had the opportunity to talk with a group of young clinicians, and very bright young clinicians at that.  We were discussing the role of class in psychotherapy, and how to understand it psychodynamically.  I was demonstrating to them how difficult it was for therapists to talk about money, by asking each of them what they would set their fee at.  The majority of them were extremely reluctant to give a dollar amount, and it was striking to me that the dollar amount was almost to a penny what a leading insurance company set their allowed fee at.  But the most troubling response to me was “enough to make a good living.”

I imagine you’ve heard this phrase frequently–like me, maybe you’ve said it yourself from time to time.  It is a throwaway statement, which tells you nothing really about what kind of living a person wants or how much money they need in a capitalist society to make it.  Amongst professionals it is the “Whatever” of salary statements.

Pushing folks, I usually get a comment about “having a good home,” “enough to comfortably support my family,” etc.  These are similarly throwaway statements, but they indicate to me what continues to be considered socially acceptable when talking about money in mental health.  It is ok to want to make money if you only use it to support and shelter your family.  Maybe a vacation, but let’s not push it.  In her 1994 article “Money , Love, and Hate:  Contradiction and Paradox in Countertransference,” Muriel Dimen refers to “Puritanism’s conflict, in which hard work and thrift are valued, but their material rewards may not be enjoyed.”  In other words, what most psychotherapists consider a good living.

Often when working with consultees who are giving everyone a sliding scale fee and often acting out in their countertransference as a result of it, I work with this Puritanism, rather than combat it head on.  I’ll ask them to take a photo of their children, partner, any loved one who depends on them, and keep it visible to them in their office from where they usually set their fees.  These are the people, I tell them, who will go without because you have issues about your fee.  You may think you are being noble by sliding down all the time, but these people are bearing the burden of your nobility.

Am I saying you shouldn’t have a sliding scale fee?  Well yes and no, actually.  I certainly have 2 slots where I slide my fee.  Exactly two, because that is what I have determined in my business plan I can afford.  And if someone is going to be offered one, I always go over with them their financials.  So if you have a business plan, and if you can have a concrete conversation with your patients about how much money they make and expend in their life, you have my blessing, you can have a sliding scale.  But if you have not taken a good look at how much YOU need to make, what your plan is to earn money and have pro bono, and if you can’t bring yourself to talk about a patient’s finances, I don’t think you should have a sliding scale.  In fact, I’d suggest you should really only work in an agency and/or cap your fee at what Insurance Company A tells you are worth.

Because that in fact is how this got started in many ways.  We lament how exploitative insurance and public agencies are, but the reality is they provide us with a buffer from the conflict of having to talk with our patients about money.  Many of us make the third party the “bad guy,” because we don’t want to sully our therapeutic conversations with the topic of money.  Sex, sure.  Incestuous fantasies or homicidal impulses, no problem.  But cash? Forget it, that’s too tough to talk about.

Like many of you, I am very pleased that we have passed the Affordable Care Act this year, but I am equally happy that I don’t have to be limited to seeing patients via insurance.  This is the difficult paradox many of us try to keep secret:  We want everyone to have access to health care, but we don’t want our incomes capped by those rates.  Not everything our patients come to see us for is medically necessary treatment.  Some of it is quality of life and personal insight, and maybe our patients should pay for that themselves.  This may sound like a two-tiered system, and that’s because it is, and in my opinion you will see this two-tiered system get acted out as soon as we switch to a medical home, global payment model.

For me a good living is not having a home and enough to support my family.  I want an XBox, and an iPad, and someone to help me clean my house, and vacations and my Starbucks as well as some other things that even I am reluctant to admit.  I want things that exceed a comfortable lifestyle.  Maybe you want these things as well, or a yoga retreat, a summer home or a pony, I dunno.  Take a look at cable TV sometime, and ask yourself why there is such a proliferation of reality TV surrounding making/winning/wheeling/dealing so much money.  Our voyeurism betrays our fantasies.  But Priscilla or Myles, our inner Pilgrim, still trips us up, and we are afraid to admit exactly what we want as a good life.

In case you think that I have exorcised Myles from my psyche, let me assure you I still struggle with wanting, having and making money.  In a way, my evangelizing on this could be a reaction formation.  But it is a feeling, and I can’t let a feeling get in the way of understanding myself and being ethical.

You see, I’m with Plato and Socrates on this one. Socrates defined the good life.  The good life is the examined one, the life lived in pursuit of knowledge and consciousness.  Socrates doesn’t really talk about money when he talks about the good life, but he does make some interesting points about virtue and how knowledge leads our virtuous behavior.  Not what you feel, but what you know.

Sounds simple, but it isn’t.  In Meno Socrates describes how important perplexity is in the process of attaining knowledge, and hence ethics.  Perplexity is struggling with the contradictions to try to make sense of them, like “I want to help people,” and “I want the iPad 3.”

Periodically I re-evaluate what I want in my life, because my wants, my needs and my financials change.  My financial limits are clear to me, and not always in accordance with those of others.  For example, my billing company thinks that I shouldn’t allow balances higher than $200 to be carried.  I consider $400 to be my limit.  It is up to me to struggle with and get clarity on these things if I want to own and run a business.  And money runs through and beneath my business.  If I want to take a day off, my boss is pretty stingy.  I rarely take sick days.  I have a 48 hour cancellation policy that is much more rigid than many colleagues, but not as rigid as the week cancellation policy of some.  I can live with all of that, I’ve thought it through.  I don’t hide behind the vague salve of “making a good living,” I struggle with the perplexity of my needs and wants, the moral implications of them, and how to live ethically in the context of that struggle.

In many ways, that’s what I call a good life.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.
Subscribe to the Epic Newsletter!

Optimism

This week I had the opportunity to meet with a group of college students who are on academic probation.  There were supposed to be over 20 in the class, and 10 showed up, 5 late.  One of the the things I was struck by initially was how subdued they were, and I suppose I can’t blame them.  The class they are in, on how to succeed in school, meets twice a week in different locations at the college, half the time in a basement computer lab even though they won’t be using the computers.  If they don’t pass this class they are out of the school altogether.  There was something discouraging about the whole setup.

When I asked them how many of them played video games, they all did.  Most of them had played their favorite game as recently as this past week.  And when I went through the room and asked each what they liked playing, I was taken by how for a moment their face would brighten and they’d smile, even make eye contact.  Probably the most memorable moment for me came after I shared with them the statistic that 80% of the time we play a video game we are failing at it, and asked them to think with me about why we can tolerate failure so much in video games yet have so little tolerance of failure in other parts of our lives such as school.  What was different with a video game?

One student, I’ll call him John, raised his hand and said, “I might win.”

What a sad commentary on what education can do to students who don’t fit a certain mold.  Somewhere along the line, John and thousands like him have lost a sense of optimism, a sense that they even have a chance to win at life.  And yet, throughout the one and a half hours I was with these students, every one of them participated, had really interesting comments, argued and engaged with me.  The last holdout was a guy in the back row.  I asked him what he had learned so far today about video games and our discussion.

He sunk a little into his seat, and said, “I’m drawing a blank.”

“Let’s take a minute,” I said, “and let’s assume optimism.  Because you can add something to this discussion.  I know you can.  What have you learned in here today?”

Long pause.

And then he said, “self confidence.”

I should add, and did say to the class then, that we hadn’t even brought up that key concept to academic success yet.  If he hadn’t have added it, we might not have ever gotten it into our discussion.  Each of them had unique ideas, worthwhile ideas, not all of which we agreed with, but ideas nonetheless.

It takes optimism to risk answering a question in class, start a business, go to therapy, or play a video game.  Without optimism we won’t risk trying and failing, and without trying and failing there can be no innovation.

Take a second and think about the world around us.  Is it perfect in every way, or would you like some things to change?  If you think it is perfect we’re done here.

But if you think that the world can be a better place, for people and all sentient beings, then you’re thinking something needs to change.  Maybe you think racism needs to change.  Maybe you think poverty and starvation needs to change.  Maybe you need to be a better parent or partner, or learn more about something in school.  Maybe you want a better job, or want to create a work of art.  Maybe you want to better understand what it all means and how to fit in?  Maybe you want your daughter to have a better life with more respect, maybe you want your son to have a better future.  Maybe you want a war, all war, to stop.

Nothing gets better without change, and risk of failure.  But to risk failure we need to think we can win.  To fail and try again we need to think we could win this time.  Optimism improves resilience and changes our body, according to dozens of studies done by Seligman and other positive psychologists.  And optimism can create a more conducive learning environment.

Optimism, in my opinion is not simple delusion, or a brain defect, as some would say.  Yes, we might fail, but let’s not let that get in the way of making an effort.  Yes there is a lot of suffering and injustice in the world.  We’d better get busy.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

Thinking, and Just Thinking

Originally I was going to title this post, “How to Make A Million Dollars as a Therapist Without Ever Having to Talk About Money.”  And if I was just concerned about driving traffic to my blog and business, that would be the title.  Because there are a lot of our colleagues out there who  want to have a very successful business without having to deal with the sordid matter of coin.  I used to think this was the number one reason that psychotherapists have a hard time being successful as entrepreneurs.  I used to read, and agree with, several psychodynamic articles that have been written by colleagues which talk about how we feel shame around money, project our devaluation of ourselves by refusing to spend money on coaching or supervision, and have difficulty set fees and enforcing missed appointment charges with our patients because we feel that we don’t deserve to make money for our work.

I still think those are big hangups a lot of us have, but recently I’ve started to suspect that an even bigger one is our fuzzy thinking about thinking.

Therapists as a whole love to think.  We like thinking deeply about our patients.  Many of us love working with emergent adults in a large part because their neurology has finally blossomed and they are starting to reflect on their thinking.  We often enjoy studying and debating the thoughts of major theorists.  We even see the value of self-reflection in our work with patients.  We like to think about others, the thoughts of others, our thoughts about the thoughts of others, and what great thinkers have thought about the thoughts of others and our thoughts about them.  Boy, do we like to think about thinking.

Now I am no exception to this.  I see an immense value to thinking, in fact I schedule time during my daily work week where I walk around the Charles and think.  During this time I don’t take calls, I don’t check email, I don’t make appointments.  I think.  I intentionally schedule it during the day to remind myself that thinking has a critical place in my work, and has as much if not more value than a billable hour.  And I will often lament to colleagues in academic settings about the need for more critical thinking skills.  I’ve had colleagues critique my wanting more theory classes at BC by saying, “these students want classes that give them practical tools that they can use,” to which I respond, “how about thinking?  That seems like a pretty good tool to me, when did we stop considering it practical?”

So I am not intending to come across as anti-thinking here.  But I have noticed over the past several years who succeeds in getting their private practices off the ground and thriving, and who doesn’t.  And the ones who fail are usually the ones who come to consult with me, or then need to “think about it.”  I’m very concrete when I talk with consultees, and if they are in job crisis I call it that.  I’ve worked with people whose incomes have shrunk by halves over the past several years.  I tell them what has worked for me, and offer suggestions, and the suggestions require things like calling people to network or EAPs or insurance providers every day or write a business plan, or any number of other things.

They listen and say they’ll think about it.

Some people will make a lot of money off of those folks.  There are dozens of people out there who can tell you how to “visualize” your ideal client, “ideate” abundance, or give you a 5 point plan to success.  I’m not one of those people, and so sooner rather than later the conversation peeters out.  Because they have a hard time moving into doing something other than thinking and talking.  Maybe they’ll write a blog post or tweet a few times, but they get discouraged, because I’m not going to waste their time.  This isn’t therapy.  I’ll tell you what I think you ought to do.  You don’t have to do it, but I don’t have a second set of things I think you ought to succeed in your business.  So if you don’t want to do them, we really don’t have a lot more to talk about.

A lot of therapists, myself included, like to try to think and talk our way out of everything.  And many things can be significantly impacted by strategic thinking, and thoughtful process.  But eventually you have to do some other form of work if you want to be in private practice.  We have more autonomy as sole proprietors, but we also can’t just sit in an office hour after hour “just helping people.”  This is actually the fantasy I often hear expressed by colleagues, “I just want to help people,” as if the nobility of that entitles one to not have to exert any other effort.

One of my friends has a mentor who frequently says, “don’t confuse worry with effort.”  Much of the time I think we confuse worrying with deep thinking, and even more so with taking other forms of action.  We think if we worry about a problem either alone or with another that somehow that “counts” as having done something.  The idea of sustained effort truly alarms us.  I’m talking about me too here.  One of the reasons I have a set time in my week to think about things is so that I contain that urge to think fretfully and know that there is a time and a place for me to think about stuff.  And then I go on to other activities that are required of me during the day.

Another reason the Charles river is such an important place for me around this is that it is where I run.  During the week I walk along it and think, and on the weekends at least once I run along it.  But, and this is key, I don’t go to the Charles and think about running.

I can really only tell you what works for me, and incessant and indiscriminate thinking does not work for me, or my business.  If someone tells you that there is an easy, simple way to succeed in creating and growing your practice, I encourage you to be skeptical.  Creating and growing your business involves taking risks, trial and error, and most importantly sustained effort that is not entirely cerebral.  My experience has taught me that you won’t think your way into a successful practice, but you may succeed in thinking yourself into a bankrupt one.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

Protect Your Online Privacy: Start Blogging!

Many therapists have lamented about the lack of privacy the internet has created.  More to the point in my view, the internet has taken away the veil of secrecy psychotherapy has frequently sought refuge behind.  It used to be that the anonymity of large urban areas, or the possibility of a commute to the suburbs insulated therapists from their patients after the analytic hour came to a close.  I friend of mine once went for years before discovering that Therapist A, who had referred him to Therapist B when treatment was stymied, was actually married to Therapist B.  They did not share last names, but my friend in a moment of high curiosity and low impulse control drove over to Therapist A’s home address and discovered Therapist B’s name there as well.  He terminated therapy thereafter.

For myself, I learned that privacy is to a large extent illusory, not from the internet, but from my first job.  I worked in a community mental health center on a 13 mile long by 7 mile wide island which was 2 1/2 hours by boat from the mainland.  You get used to a diminished sort of privacy on an island.  I couldn’t avoid my patients if I wanted to, unless I wanted to avoid the library, most restaraunts, coffeeshops, the beach, or the one movie theater we had in the winter.  Nor could I find privacy in limiting the type of work I did there.  The Community Mental Health Center was the only one on the island.  We were responsible for, and I did, school counseling, Psychiatric hospitalizations (which involved flying with often psychotic people in a Cesna six-seater airplane,) outpatient therapy, Alcohol counseling and DUI classes, drug testing, and court-ordered counseling for domestic violence perpetrators.  I can still remember how when a colleague and I went out to dinner at a local pub one night one-third of the people at the bar left.  It wasn’t just my privacy that was affected here.

You have a choice in situations like that.  You can hide out in your house with a cat and television (which I did at first) or you can start living your life in the community and negotiate boundary crossings on a case by case basis (which I settled upon as my strategy.)  I learned to cultivate a sense of never-too-uptight-never-too-relaxed when I was in public.  It became second nature in many ways.

When I moved to Cambridge, MA, it felt very anonymous by comparison.  But as many practitioners in “The most opinionated zipcode in the US” will tell you, Cambridge is really a village in many ways.  I still ran into people, and by this time, technology was becoming more of a factor.

As Thomas Friedman has observed, “The World Is Flat” in the 21st century.  Globalization and technology have removed many of the barriers to, and some would say protections from, knowing each other.  Our patients can Google us, Yelp hangs up a business page of us whether we like it or not, and are often only one Facebook friend away from connecting with us.

Even if you want to make the poor business decision of staying off the internet in terms of a website, eventually your contributions to the Democratic Party, your address, and notes about you in your alumni magazine are still going to find their way out to the world.  We’re all on an island today.

So what can you do?  Well, my advice is to start blogging.  I know sounds counterintuitive, but it makes sense on a number of levels:

1.  Buddhism tells us to move into the places that scare you.  We exert so much energy trying to avoid things, find a spot where we can stay safe and stop the awkward and uncomfortable learning process.  And yet we ask our patients to do the exact opposite so often: to look underneath those rocks, descend into the depths of the psyche, face their fears.  Our obsessive quest for privacy is perhaps not that different.

2.  Make the internet work for you.  One of the best ways to protect your privacy is to generate a lot of content that you consciously know is public-facing.  Google “Mike Langlois, LICSW” for example.  Go ahead, I’ll wait.  What came up probably is pages of my website, professional picture, Youtube videos, and blog posts.  Dig a little deeper and you’ll see me commenting on a few blogs.  This is the practice of radical transparency.  All of that content was written with all of you in mind, my patients, colleagues, friends, family members, potential coaching clients, high school classmates, potential employers, my future children and grandchildren and the FBI.  The way Google and other search engines work, the more content I put out there that is public, the further back any unintentional pieces about me will be.  By embracing that the world is flat I have learned to cultivate a style that I can negotiate in my work life while still feeling authentic.  And it is great advertising, or fair warning, if you are considering working with me.

3.  Radical transparency protects your patient’s privacy as well.  Whether we like it or not, therapists are finding themselves on review sites like Yelp.  Yes, anyone can post a review, and no, Yelp will not taking it down if you ask.  More importantly, your patients might not understand the ramifications for their privacy or PHI if they post a review.  Keeley Kolmes has great resources on this, and you are welcome to use my version of her version as well.  Take a look:

Notice that half of my allotted space is not advertising, but a direct message to any potential commenters.  Rather than hide out and try to get Yelp to take my name down, I have used it as a platform to market my business, model what I feel is ethical professional standards, and provide some information to patients in the spirit of informed consent.  Do I want to get bad reviews?  Of course not, who does?  But that is not an excuse to hide my head in the cybersand.

4. Last, but not least, get over your bad self.  Sometimes listening to our colleagues you would get the feeling that they are dealing with the paparazzi, not the public.  Sure patients and others may be curious about your life, but really most people in the blogosphere just aren’t that interested.  On a good day, my blog gets 200 views, on an amazing day last August I got 689 views.  There are 7 billion people on the planet.  Feel free to correct my math here but according to my calculations that means on a busy day 0.000009842857142857142% of the people on the planet are checking out my most visible presence on the internet.

Am I saying you should blog for the sake of blogging? No.  I am saying that there is a Copernican revolution going on in the 21st century, and therapists need to join it.  Rather than avoiding technology and the internet we need to start understanding it and harnessing it.  You can be googled whether you like it or not.  Yelp doesn’t care about contaminating your transference.

Being professional is about how we rise to the occasion of Web 2.0, not deciding to skip out on the party.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

How To Get An Epic Supervisor

Education shapes our expectations of life and work, and education as it stands currently always involves giving up some degree of personal power.  When we’re in elementary school we need to ask permission to leave to use the bathroom.  In high school we need to show up at times diametrically opposed to our circadian rhythms.  At college we have required course to complete our degree.  And in graduate programs for clinical psychotherapy we often have limited to no control over who our supervisor is going to be.

And then when we graduate, we take our cue from licensure boards to a large extent.  Sadly, license requirements shape our expectations of supervision.  We see it as something we have to have in order to get our license in X number of years.  I have noticed that there is a sharp decline in people buying supervision after they get their independent licensure, which does not mean that there is a correlative decline in our people needing it.

So today I want to talk about how to pick a good supervisor for you to have ongoing clinical supervision.  If you are still in pre-independent licensure this can be an especially daunting experience, but also an incredibly freeing one.  To be clear, you don’t have to purchase private supervision from anyone you don’t want to work with!  Read on for some tips:

1. You often get (or don’t get) what you pay for (or don’t pay for.)

If your agency offers you a good supervisory package for free that is great.  One place I supervise at provides employees and interns with a free secondary supervisor.  Secondary supervisors are the ones who can usually help you most with integrating theory and practice and discussing difficult cases.  Most primary supervisors I know may have good skills and an interest in doing the same, but they don’t have the time.  Their role has become reduced in the age of managed care to helping you learn the ropes about paperwork, facilitating your first emergency room or child protective referrals, and being held responsible for holding you responsible for productivity.  So although these hours count towards your licensure they don’t necessarily deepen your practice for lack of time, not skill.

So now you have some choices.  You can take a fellowship or position at an agency that provides secondary supervision, or you can buy it privately.  Don’t get caught in thinking it is an entitlement, because those days are gone.  Yes, we’re underpaid as a profession, but I suggest you think of good supervision as a benefit valued at between $7200-$9600.  If Agency A offers that, but pays less $5,000 less than Agency B, which doesn’t, you are getting a better deal at Agency A.

2. You may already have met your supervisor, but don’t know it yet

If you are one of the many folks who decides to buy supervision privately, take some time to think about the people you’ve worked with already.  Did you enjoyworking with your first year placement’s supervisor?  Call and ask her if she offers private supervision.  Did you love a certain course in grad school?  Call and ask him if he does supervision.  If they don’t, ask if there are any people they can suggest.  Think back to guest lecturers, colleagues you enjoyed working with, that alum you met at an event.

3. Do your research

In this day and age, everyone should have a LinkedIn profile (more on that in a bit.)  Mine includes several recommendations from past or present supervisees.  Make sure you Google your potential supervisor prior to making an appointment.  Yes, Ms. Jones may have her licensure, but if you are interested in providing LGBT-affirmative therapy and she works at the local conversion treatment center, wouldn’t you like to know that before wasting both of your time?

When you contact a potential supervisor, hopefully they will offer to provide you with a reference of another past or present supervisee.  If they don’t, ask.

Some of the old guard psychodynamic folks may object, saying that that contaminates your supervisory experience.  To which I say, there will be plenty of transference that comes up regardless, and that the focus of supervisors should be on practicing radical transparency, not generating a absolutely blank screen.  Supervision often resonates with therapy, but it is NOT therapy.  If a supervisor comes off as seeming like a Freudbot, this may indicate a difficulty shifting cognitive frame sets from supervisor to therapist.

4. Know what is important to you

You can learn something from everyone, I truly believe that.  However, when I look for a supervisor, I look for someone who provides psychodynamic-oriented supervision.  That’s what I do, what I like, and why I became a therapist.  If you are a solution-focused or CBT practitioner, get someone who is expert and experienced in that.

If someone says they are “eclectic,” run away.  Far far away.  If they can’t describe some of the several areas of their interest or competence to you, chances are they are being either vague or seductive.  Yes, I said seductive.  Supervision is a business prospect, and many people focus on landing a new supervisee to the detriment of both of them.

5. Beware of freebies, private supervision starts with the fee

I’m going out on a limb here, but I strongly discourage freebies.  My Contact page warns away the brainpickers.  These are the people who want to get something for nothing, and say, can “I just pick your brain for a second?”

No, you may not.

There is a lot of free content I’ve put out there that people have access to, but this is also my work and I need to be paid for it.  So if you have done your research, hopefully potential supervisors will have papers published, posts online, lectures, recommendations.  If not, please see item 6.

I have strong opinions about this, because I think it shows potential supervisees how to have professional boundaries and value their work.  If you are doing supervision to “give back” at a reduced fee, that’s fine, as long as you let the supervisee know that you are reducing your fee and let them know the full fee.  But be honest with yourself about this, are you doing it to gratify your self-ideal of social justice, or because you secretly believe that you aren’t worth the full fee, or some other reason?

If you are a potential supervisee, consider this:  Do you need someone to help you learn to be a more noble person, a better clinician, and/or a more savvy businessperson?  Will having a reduced fee lower your expectations of yourself and the supervisor?  And would you like to charge no higher than the reduced fee you are being offered?

If the answer to the last is no, be careful, because this may be a set-up for resentment on your supervisor’s part, and you may both suffer from unconscious false pretenses.

Speaking of fee, I walk this walk, and when I negotiated my fee with my supervisor I negotiated to pay more, because I knew that I would have a harder time later if I didn’t.  We then had a great conversation about the limits of this, because obviously she gets to set her fee not I.  But it caused her to re-evaluate and raise her fee somewhat, and modeled for me her integrity, flexibility, and willingness to listen and learn.  And each time I raise my fee, I bring this up again, and each time the supervision is the richer for it.

6. If you want supervision around private practice, stay away from technophobes.

I strongly maintain that to have a practice in the 21st century you will need to have an online presence, some technological savvy and the willingness to learn about it to work with people from the 21st century.  This is even more true in a private practice, where marketing is moving more online every day.

I once had a couple of sessions with a supervisor I was considering starting work with.  This was a world reknowned clinician, whose work I respect immensely.  In the time between our first and second appointment I included her on my newsletter.  Our next appointment she expressed how “astonished” she was that I would contact her that way, and wondered if I was sabotaging the supervision.  Fortunately I have been in many supervisions and have a strong ego.  That was our last appointment.

I suppose I could have chosen to stay and explore this, but that seems more her issue than mine.  I want to have a practice that focuses on Web 2.0 and psychodynamic therapy, i.e. integrating, not pathologizing them.  And if those were her boundaries, fair enough.  But I’m paying for a service, and I’ll take my business to my current supervisor, who is very professional, very grounded in psychodynamic theory, and subscribes to my newsletter, remarking on every issue.

7. Kick the tires

Having read this, you may be thinking, “I don’t agree,” or “that’s not what I want,” or “what a pill he is!”  If so, that’s great!  Because that means you have some idea what you are or aren’t looking for.   Or you may be thinking, “right on!”  One thing my supervisees can probably tell you is that what you read here and what you get in supervision with me are pretty much the same thing.  And it seems to be working well for all concerned.  You aren’t in grad school anymore, you get to pick and choose your supervisor.

It is okay to try out a few supervisors before deciding.  Pay attention to those first few appointments, when you and your supervisor “relax” into the supervision a bit.  Do you notice drastic changes from the first week(s)?  Do you look forward to supervision, dread it, or find yourself not caring either way?  Ask yourself, and your supervisor, how the supervision is starting off.  If your supervisor does not bring up how to get the most value out of your supervision in the first few months, bring it up yourself.

If you are having mixed feelings about a supervisor, don’t be afraid to bring that up.  But if you can’t bring it up, or choose not to, don’t feel obliged to stay.   Supervision is a long, intense and valuable process.  No less than your professional development is at stake.  Choosing wisely begins with remembering that you have a choice.

 

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

A Tale of Two Conferences

Many consultees ask me how to get speaking engagements, and certainly that’s an important question.  But this is also not the most important question.  It is akin in many ways to the conversations around the question, “How do I get a job?”  The focus is often too much on how to make a good impression on the interviewer, how to present as a good fit for the workplace in question.  If you are only asking those questions and wanting to be a successful entrepreneur, I suggest you are barking up the wrong tree.

Because the questions that are equally important, if not more important, are the on the surface the less humble and self-effacing ones:  Do I want to work for this person interviewing me?  Would I enjoy this work environment?  Are these people making a good impression on me?  These are the questions which come from the perspective that you are a valuable commodity, and that perspective to a large extent needs to come from within.  And let me be clear, not all workplaces, even those who purport to be empowering, want you to approach them from that perspective, because it lowers their bargaining potential when money (there he goes again with the money!) questions arise.

So too with public speaking engagements.  There needs to be at least a sense of mutual value, mutual ROI that has to come from the speaker and the speaking engagement.  Let me give you an example:

I am doing in the next year an engagement with conference A and conference B.  Conference A approached me with a request, because they had had a personal referral to me.  I will be speaking to a group of several hundred people at an event where I am one of several presenters.

Conference B sent out a general call for presenters and ideas.  Several years running I have been nudged by some of the folks in charge to apply to present, so this year I did.  Again, the conference will have an attendance of several hundred people and I will be one of several presenters.

Neither conference A nor conference B have an honorarium, but that is acceptable to me for a couple of reasons at this point in my career.  One reason is that I now allot one pro bono presentation per month.  But the other reason is that there is some clear ROI in both conference A and B:  I will get exposure which leads to more paid speaking engagements; I will have a venue to make my book available for sale; and I will get my pro-gaming, pro-tech message out.

So far, so good.  I should add here how both Conference A and B frequently include language in their letters to me about how valuable my contribution is and how much they appreciate me.  But over the past few months I have received communications from both conferences that show how different they are in their attitudinal stance towards speakers.

Conference A sends me a paper letter with the details of registration for the conference.  I am given the name of a specific person who handles presenter registration, told I am welcome to attend the entire conference for free and invited to a special luncheon for presenters on the day.

Conference B sends me a registration form, offers me a discount, and lets me know that they can only “give” me free admission to my presentation.

What?

I am being given free admission to my presentation?  I’m confused.  Is the implication that normally I should be paying for the privilege of presenting my expertise, but as a special gift I get to work for free?  And are they really asking me to pay to attend a conference that I am donating my time and expertise to?

Guess which conference I will continue to work with in upcoming years?

If you guessed Conference A, bingo!  Because they have the right attitude in my opinion.  Their behavior is as valuing as their words.  It costs them virtually nothing to get the group of us presenters in a smaller room for lunch and call it a special lunch, and it costs them virtually nothing for them to give me free attendance to the larger conference.  And by assigning a specific person to handle my registration, they have made things even easier for me.  What’s more they have in a few gestures given me what Chris Brogan calls that VIP Feeling.

Conference B has done none of that for their presenters.  And think of all the value they are losing!  They could have all of us experts in the field adding to the conference beyond our sessions.  Asking questions or making comments at other presentations, networking with others, and being a free resource to other attendees at lunch, breaks and other down times.

Here is where word and deed don’t connect.  What message are you sending when you ask people to work for free and then charge them?  The irony is that Conference B will probably have some organizers who don’t understand why they end up getting a bunch of “hit and run” presenters and resent our not signing up for the conference.  It’s a lose-lose situation for everyone, and it comes from a poverty perspective, not an abundance one.

So if you want to be a presenter, please remember this:  You’re an expert in your field, act like one.  Your time is valuable and limited, and you need to set the tone for that.  Finally, pay attention to how potential presenting clients treat you.  After talking with them, do you feel like a VIP, or do you feel like Oliver Twist?

Some of the old guard have told me that this is the industry standard.  To which I say two things:

1. If that is true, the standard is wrong and needs to be changed.

2. This is one big reason why our profession is consistently undervalued and under-appreciated: Other people take our cue.

Also, someone should tell Conference A that they aren’t keeping lockstep with the industry standard by giving speakers the VIP treatment.

Oh, never mind, I’ll tell Conference A myself: Because they’ve earned my loyalty and I hope to be a presenter and attendee for years to come.

 

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.

Money: The Post You Don’t Want To Read But Should

First off, not only am I not a financial advisor, an economist or an accountant, I have never been the poster-boy for “financial whiz.”  I say this out of neither pride or shame, but for two other reasons.  First, as a caveat to the reader that all of this is based on personal learned experience and therefore as limited as it is true for me.  And second, because if I can do this, I think you can too.

Money is the Achilles heel of many therapists.  We are averse to think about or speak aloud about it, and we come by this aversion honestly.  At least in the US, we are raised and educated without a single class or course in financial planning or money management.  Ask yourself, what subject have I ever learned about in life that I avoided thinking or talking about?  But in the case of finances, many of us emerge into adulthood with huge blind spots about how to function in a capitalist economy and society.

In my coaching and clinical supervision with therapists, and in my talk with colleagues, I have heard some amazing examples of these blind spots.  I once heard a colleague justify not charging a patient for a missed appointment because if she has to miss an appointment the patient doesn’t charge her!  These statements bely an ambivalent and confused statement about money.  Patients are hiring us, we aren’t hiring them.  As uncomfortable as this assymmetry is, the fact is that we don’t pay patients to help us and they do pay us to help them.

I have launched into general diatribes before, but today I want to be really specific and concrete.  I want to share with you one pointer I share with all my coaching clients about how to make more money and how to manage it better.  I’m even going to give you a specific vendor link.

The pointer is this, if you want to make more money, take a look at the bank you’re using.  Making money isn’t just about your fee or caseload, but the fees you may be paying out.  (I know, some of you who’ve made it this far are already getting ready to click away, hang in there.)  One of the things large banks have is large overhead.  They are, for reasons too numerous and obvious, in a lot of distress these days.  For example, Consumer Reports estimates that the government legislature that required them to cap their fee each time you use your debit card at 24 cents a transaction is going to cost banks 6 billion dollars in revenue lost.  So to recoup their losses, they are finding other fees to levy on you that are legal.

What banks are banking on is that we’re afraid of change.  And let’s face it colleagues, most of us want to find a place to “park” when it comes to money management.  We want to find the fee we can set and not look at again rather than adjust it over time.  We want to program our billing into computers or contract it out to services so we can not deal with it.  And we don’t want to compare interest rates and fees, but rather find a bank and stick with it.

And the larger banks don’t just gouge you with fees, they use you in another way.  Maybe you’ve noticed that when you do use your ATM or the bank website advertisements come up that are eerily resonant with what you spend your money on.  This is because banks value your patronage for data mining purposes as well.  Many of them are selling this data to big business.  I am often struck by the irony that a profession which values privacy and confidentiality for our patients turns a blind eye or accepts the violation of their own financial privacy.  So if nothing else, do a little research about whether your bank sells your debit transaction or other data, and if they do, move.

Since 2009 I don’t think I have set foot in a bank to do actual banking.  The last time I went in the building was to have something notarized.  By the same token, my deposits have become much more quick and efficient in my business, and my fees have been minor.  Why is this?

It is because I use an online credit union, Digital Federal Credit Union in fact.  DCU is a completely full-service credit union with the emphasis on online banking.  This is not surprising since it began in 1979 as a charted credit Union for Digital Equipment Corporation.  The eligibility requirements are not at all onerous, in fact your interest in social justice can make you eligible.  I say this because my eligibility came from being a disability rights ally.  I joined the American Association of People with Disabilities.  That was it:  Fifteen bucks to a great cause and I was eligible to join DCU.

As an online credit union, DCU is actually more portable than my licensure!  I can move to any state, bank from any state, online.  Their technology and website are in my opinion excellent.  I can transfer funds easily from my account to other family members’ accounts at DCU, and interbank exchanges are almost as easy.

They have a great bill-paying feature that allows me to schedule payments electronically, either one-time or recurring.  The bill-pay feature has also been a lifesaver for me when I need to dispute something with a vendor or track how much I have spent on utilities for my practice or home in a given amount of time.

And at tax time, house closing, or any other time you need financial documentation quick, DCU allows me to download check images, statements, etc. into PC files.  Or if I am trying to sort my expense deductions for the year I can import the entire tax year into an Excel or other software spreadsheet to sort, locate, and calculate expenses.

But the thing about DCU that makes me go absolutely blissful is their iPad and iPhone app, because it allows me to take photos of checks and deposit them from my office, living room, wherever there is, well, the internet.  No more hoarding checks to make a trip to the bank, no more waiting in lines at the bank.  In fact, I often do my deposits late at night or on weekends, because banking hours aren’t really an issue.

Think about all the time you are spending, which is money you’re spending, on your banking.  Do you spend 30 minutes running to the bank each week?  That’s time you could see a patient.  Is your income stream stuttering because you avoid depositing check until you have to?  And clinically, what message(s) may you be sending your patient that you haven’t cashed their check yet?  If you want to be a better therapist, get better with your money.  And if you want to get better with your money, use an online credit union.

Oh, I have lots of thoughts and opinions on how to use technology to improve your therapy practice clinically and financially, maybe you want to work with me online or in person?