When Is A Private Practice Like A Pipeline From Rhode Island?

Several times a month I get calls from prospective patients contacting me to provide psychological testing. Problem is, I don’t do psychological testing. Not my training, not my technology, and last but not least not my interest. But nevertheless every month I get calls.

I get these calls from students at a local college, who were referred to me by student support services, and I know exactly who is referring them to me. I know because back when I was building my practice, I marketed heavily to people in the education field, because of my background in providing psychotherapy for people with learning differences. I clearly made a good impression, because the referrals keep coming, and there are lots of other people out there who could be getting them. This is an example of what I call a pipeline from Rhode Island.

Imagine if you will how much oil gets piped from Alaska to refineries, probably a lot. Because Alaska is sitting on a lot of oil resources. Now imagine how much oil would get pumped to an oil refinery from the pipeline if it was from Rhode Island. Not a lot. Little Rhody has a lot of resources if you want music (Newport Folk Festival) or it’s top export, waste and scrap gold but oil doesn’t run strong in the Ocean State.

A pipeline doesn’t do you much good if you don’t have the resources that are being looked for by those coming down the pipeline. This is an example of a mistake I made early on in building my practice that hopefully you won’t make. You see, I just wasn’t clear enough on what I had to offer potential patients. I was more focussed on getting my name and number out there, and rattling off my condensed version of my CV. So through no fault of their own, people heard, “Hi I’m Mike Langlois… Psychotherapy … Experience with Learning Disabilities … ADHD … School functioning…” and filled in the blanks.  I now have this great pipeline from a local college that consistenly feeds me absolutely zero referrals that I can use!

This was reflective of a few problems I’d had back then:

1. Starting a business is not like applying for a job. I was still in the frame of mind that my CV was the touchstone for presenting myself professionally. My soundbite was there a compression of that, rather than focussing in what my ideal patient and expertise is. This was because I was used to applying for a job, having an interview with an agency, and trying to explain how I could do excellent work with every patient in their demographic.  Yet this one-size-fits all approach was exactly why I wanted to run my own practice!  So although I was marketing my practice, I was presenting as a job applicant.  To be fair I was trying to present a niche rather than the generic “I work with people who have anxiety and depression,” but I could have done a better job of conveying what kind of work I do, which brings us to the next problem.

2. Not everyone knows what psychotherapy is! You may have noticed that people think social workers take children from homes, psychologists prescribe medications, psychiatrists ONLY prescribe medications, psychoanalysts do Rorschach tests, or any other number of nuggets of misinformation floating around out there. So even if you are clear on what you like to do or who you enjoy working with, it pays to be specific about what you do. Just a few examples:

“I evaluate children to see if medication can support their learning.”

“I do talk therapy with people who have trouble being happy in relationships.”

“I provide psychological testing to help people identify learning disabilities.”

“I testify as an expert witness about the mental and social functioning of families and their individual members.”

3. Don’t just “say” you have a niche, don’t be afraid to want a niche. Like many people I have consulted with since, I was giving some lip service to having a niche but really was afraid to have one. As a result I would water down my explanation of who I was and what I could do so that I could have a broader “appeal.” Trust me, there are plenty of people out there to help, we can be specific in who we want to work with. And it makes it easier for colleagues to refer to you specifically. We have been conditioned by decades of managed care to think our major qualifications are “I take X insurance,” and “I’m .75 miles from the patient’s work/home.”  Those are not your major selling points. So ask yourself again, who do I want to work with?

Bottom line? Take time figuring out who you really want to work with, and then when you are presenting yourself in the community stick with that. Insurance companies will feed you the people who are looking for a .75 mile away therapist (and many of these will turn out to be great referrals even though not necessarily the best reason,) so with your own marketing be more picky.  One of the great things about reading this blog is that it hopefully gives you a chance to avoid making some of the same misconnected pipelines that I did when I was getting started.  One of the great things about writing it is that I get to research the top export of Little Rhody. Now if someone ever needs scrap gold I won’t send them to Alaska…


  1. Great article!!!

  2. Great post! I don’t really understand why therapists are afraid to “claim” a niche. Actually I kind of do…we are afraid of losing business (or at least that’s our perception) – how do you say no to money? When I started out in my private practice I struggled with eliminating kids from my target population. See, I have worked with kids but I really don’t want to. I don’t like to deal with the parents and that’s the honest truth. It took me a while to realize that the beauty of having your own business is you get to decide who you chose to see and who you chose to refer out. Now I say “I don’t see children. I do see adolescents, 16 or older who are struggling with addiction, depression and sexual orientation”. I’m specific. And It works, it eliminates all the calls I was getting for ADHD assessment or behavioral problems, etc etc. It’s liberating and it saves me time and energy. And the truth is I’m not suffering for clients.

  3. jacqui balloqui says

    Thanks for your wisdom and creativity. It keeps me in touch with what is real!

  4. Mike,

    I enjoyed your article. I teach the, “Building a private practice”, course at Johns Hopkins. I have a number of suggestions on my website regarding how to create a niche.

    Best regards, Lynn Friedman

    • Mike Langlois, LICSW says

      Lynn, Awesome, thanks. I always love it when colleagues give away freebies on their websites. Everybody, run on over to Lynn’s site and get your free info! And while yer there, maybe subscrobe? 😉

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