Occam’s Oyster

The oyster has an amazing evolutionary trick.  When a microscopic particle of something or other gets into its soft tissue, it creates over time layer upon layer of nacre, a substance which creates a pearl.  What began as an irritant can go on to become a very valuable object.

You are not an oyster.

If something irritates you, you don’t always need to be stuck with it.  And although I am a big fan of the cognitive reframe, to use it all the time overlooks that you can often resolve whatever is irritating you by removing it.

 

Case in point, for the past several years I have used a billing service.  They’re great, but there has been something about the process of my patient intakes that irritates me.  I have patients fill out an intake form, which they bring in to me.  At the same time the billing office has a face sheet they use as well, but they need some information that is not on the face sheet but is on my intake form.

So for the past several years the patient will download my form off the site, fill it out and bring it in to me.  I then have to scan the form and fax it to my billing office.  To make things more complicated I have several computers and a scanner at home as well as an iPad.  You’d think this would make things easy, but I can not seem to get them all to talk to each other the right way to scan something and email it in under 30 minutes.  One laptop doesn’t get recognized by the wireless network.  The iPad can scan the form but not email it.  This has been going on for years, and I had grown accustomed  to the irritation as I tried putting on layer after layer of “solutions.”  I’d put off scanning the forms until my office asked me for them, which made their work harder, and payments from insurance choppy.

Then it hit me that I am not an oyster.  Whenever this irritation came up I had been so focused on trying to make things go more easily, that I had never really taken a few minutes to think about how to make this problem go away.  The answer in this case was simple.  Instead of having my patients email the form to me, my introductory email to them can instruct them to email or fax it to the office directly.  They need regular access to it, and I don’t.  They have all of my other administrative paperwork which they keep all safe and secure, so it is actually far easier to have them keep it since they are doing all the billing.  I rarely use that initial paperwork, and I’ll always know where it is.

I offer this as a nuts and bolts example of how your therapy practice needs to be evaluated periodically.  The whole craziness above is a vestige of when I was doing all of my billing, and something I now realize I was not ready to let go of.  And so I just got used to the irritant, ignored it, and hoped it would go away or become less irritating.

We therapists take more irritation for granted than is necessary in our business.  We each have a different version of layering on the nacre.  One of mine is constantly adding new gadgets and trying to find ways to make work easier, rather than making it go away entirely.  I used to spend hours learning the intricacies of a billing software and calling insurance companies, and then I realized I wanted to get rid of the irritation.  I researched different services, and finally decided on one which cost a little more, but did a lot more for me.  Now I give them 9% of my fee, and in return they keep me credentialed with the insurances I take, send out statements, answer questions from patients and submit all my claims electronically to insurances.  Not only do they trap more of my revenue because they can focus on it with more expertise than I, they save me valuable time.

I didn’t value my time as much when I started out, and I am glad I changed that, because I know I wouldn’t have had the time or energy to write a regular blog, do speaking engagements, or write my book this year if I had been chewing on all that paperwork.

So why does it often take us so long to fix systemic problems like this in our practices, or our lives for that matter?  I would suggest that the answer is that we don’t value thinking.

I know, sounds crazy on the surface, therapists don’t value thinking?  Thinking and thinking about thinking is a big part of our profession.  But when was the last time you allotted yourself time specifically to think on something.  By that I mean dedicated time where you think through something single-mindedly, not answering emails, talking on the phone, watching television, etc.  Most people I coach can’t remember the last time they did that, in fact our coaching appointments are often the closest they come to it.

You don’t have to schedule a specific “thinking time” in your day, although you can certainly do that if it works for you.  But in the case above I didn’t do that.  Instead I noticed I was getting irritated for the umpteenth time and said to myself, “Ok, stop EVERYTHING, how can I make this irritation go away?”  Within a relatively short time of dedicated thinking I identified what the system was, what the problem was, and what the new system would need to be to make the form nightmare go away.  Not get less irritating, not more tolerable, but gone.

Look, I’m not saying that everything in life that irritates you can be removed, or even that that would be a good thing.  I’m just saying don’t settle for mitigating damage before you’ve tried making the problem disappear.  Ask yourself, “am I layering nacre over and over?  Is that the best I can strive for?”

Then ask yourself, “am I making time to think, and am I thinking about the things I want to think about when I do?”  Sure there are lots of times when you run a business that you’ll need to think about stuff you’d rather not think about; but if that’s how you’re spending the majority of your time then maybe you’re running the wrong business.

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Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined

Every once in a while I receive an email that reminds me that the work I am doing is making a difference.  Today I received this from a new colleague to our field, and with her permission I share it in its entirety.  I hope that you will comment on it and show her that she’s not alone:

Hello Mike,

I am a newbie therapist, having entered the licensed profession less than a year ago. Though despite my newbie status, despite the fact that I currently have no clients, no office, no firm job prospects, with a website and business plan that are both still in the initial stages, I still feel that I am an Epic Therapist. Or, at the very least, I am in training to be one!

Anyway, I just wanted to let you know how truly, truly, refreshing I found your blog. In the past, I have spent many, many, many hours skimming one random psychotherapist website after another. More often than not, I get so bored to tears reading the same drivel. I can’t understand how so many of them stay in business. From their websites, I feel that often there is no real spark or passion for their profession, and that they are all trying so hard to play it so safe, that so many psychotherapists end up sounding so cookie cutter. Not to mention the rather pretentious attitude that comes with, “I specialize, well, in the whole DSM-IV. What is your disorder? How may I help you in your disordered state?” Or my personal favorite, “Are you anxious? Depressed? Do you find yourself worrying a lot? Do you sometimes find yourself feeling lonely?” My thinking after reading that is always, “Yeah, I am depressed and anxious just from reading that!” After exhaustive online research, I felt rather alone in feeling like a therapist could dare to have their personality shine online. And then I found your site, and I was like, “Someone who dares to break the mold!” YAY! 🙂

So I have basically spent my free time the past couple of days reading as many of your blogs as possible. I know that you must get many, many e-mails. And I am trying my very best to have my e-mail be worth your time. I am hoping at the very least that what I have to say might spark a possible interest for a blog response.

When I am in my Secret Headquarters, well, ummm, Head(corner) more like it, I feel like anything is possible. I feel the passion and excitement and knowledge for my blossoming niche, Sandplay/Play Therapy. I feel my passion and excitement for my professional focus on the more non-verbal approaches to psychotherapy, for the times when individuals just can’t seem to find the right words to truly express everything that is going on inside of them. Even right now, I feel myself fumbling around for words, and wish I didn’t have to rely solely on words at this moment in time to captivate my Epic Therapist passion. So when I am in my Secret Head(corner) I feel rather invincible. I feel like I can make it. I feel like I have the ability to design the website I want, and set up shop the way that I want. Though the moment I step out of my Secret Head(corner) I am immediately flooded with all these scripts of why I can’t do this. I feel like there are so many “voices” telling me I can’t succeed on my own terms quite yet because I haven’t paid my dues to the system. The current system that exists between many CMH, Non-Profit establishments and insurance companies, make it near impossible for newbie therapists to get a traditional job. From my own experience, I didn’t even qualify to apply for the clinical position for which I interned. When this happened to me, I acknowledged to myself that the current system is way out of joint, and that deep down inside, I have no real desire to associate with that kind of business structure. Though still I feel so many professionals trying to taint my passion for a private practice with their venom of, “Well, you need to walk, crawl, climb your way through Mordor, in order to finally be able to sever your newbie status ring into the fiery pits.” Though I tend to see another option rather than the traditional route: http://www.youtube.com/watch?v=1yqVD0swvWU  (I love this video, two minutes of LoTR epic-parody goodness.)

In their eyes, I am trying to take a short-cut. Though I am not trying to take a short-cut, merely a different path. I have checked the policies and procedures regarding private practice, and even with my Limited License Professional Counselor (LLPC) status, I am able to set up shop. I have a qualified supervisor and seek out as many mentors as possible; I am constantly researching to gain as much knowledge as possible; I spent much time and effort in receiving professional training in Sandplay/Play Therapy. I feel like I am a blossoming professional in my field. I am determined to have an ethically driven, professional private practice, with a strong niche, and a strong professional voice. Though, every time I think of my “Limited License” status, or I think of all the things I still need to learn, I sometimes feel myself retreat into this defeated status. So I guess my question is this, how does one continue to build up and defend their Epic Therapist status, when so many naysayers want to tear you down because you are forging your own path?

If this sparks a possible blog/e-mail response that would be awesome. If it doesn’t, that is okay too. I know your time is valuable. I am just grateful if you took the time to make it to the end of my letter. Best of luck in all your efforts!

Sincerely,

Esther Dale, MA, LLPC

 

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Why Ursula the Sea-Witch is My Guru

Ok, so first, let’s be honest, there’s a lot to take issue with in terms of Ursula the Sea-Witch.  She definitely carries on Disney’s longstanding history of portraying evil as black, single, independent women, adding to that list women who are considered “overweight” by Western standards of health and beauty.  Oh, and she’s sexually aggressive, in that she flirts with King Triton and likes to move in a way that shows she enjoys her body.  So yes, I get that Ursula embodies a lot of the negative stereotypes that women and people of color have had to put up with in media.

But if we can look beyond that, I think Ursula has a lot to say that will help you with your business plan as a private practice therapist, and maybe beyond.

I also must admit that Ariel annoys me, especially at the beginning of the movie, which is where one of my favorite scenes is when she makes a deal with Ursula in “Poor Unfortunate Souls:

Ariel is reluctant to make a deal, because she’ll risk losing contact with her family forever.  And Ursula acknowledges this, and says, “Life’s full of tough choices, innit?”

The number one thing I hear from people who want to have a full-time private practice is, “where do you find the self-pay patients?”  There are dozens of posts titled that on the Psychology Today forums, and right next to them are the posts saying how much many therapists hate Managed Care and having to take health insurances, with all the rules and restrictions, and low fees.

Yet, when I talk about building your practice to people, I also hear from many people how much they hate promoting their work, and how critical they are of others when they catch a whiff of self-promotion about them.  I can’t tell you how many times my blog posts and book blurbs have been pointed at and I have been “accused” of self-promotion.  Accused, as if somehow promoting your work and your business is a bad thing.

It’s not.

Look Ariels of the therapy world, life is full of tough choices.  You can have a private practice that relies on insurance only, and that isn’t a bad thing.  You’ll get to see a range of people who have worked hard to earn health benefits that they want to use, and you’ll have instant diversity of economic status in your practice, the more plans you accept.  And the insurance company will list you for free, and you’ll probably build up your practice more quickly.  The downside?  You’ll make less money, have more complicated paperwork, and time will be spent doing it.  And your income will be capped.

Or you can have a private practice where you focus on self-pay, and that isn’t a bad thing either.  You’ll have the ability to set and raise your rates, less paperwork and reviews, and have more time to do other things.  You’ll still be able to have a diverse practice, using my PB+5 model, and more independence in many ways.  The downside?  You’ll need to promote your work.  You’ll need to give potential patients and colleagues some good reasons why they should forgo their insurance benefits and pay you more money.

To do this you’ll need to spend time working on networking, generating content for your website, speaking, writing a book or making a DVD.  And you’ll need to keep doing it.  That’s right, you’ll need to consistently promote yourself and your work.  The time I used to spend on billing and reviews I now spend on self-promotion, and I do some of it every single week.  Sometimes I like it, sometimes I don’t, but nevertheless I do it.  Even though I have a wait-list I still do it.  And I have watched as several colleagues, who have been in the field for a long time, have stopped doing it.  And their practices have begun to dry up, because the phone doesn’t ring as much any more.

You can also try mixing and matching the above a bit, taking some insurances, and doing less promo.  Charging more for some patients, and doing more pro bono.  All of that is up to you.

But I’m here to tell you you can’t have it all.  That’s right, I’m not going to pitch to the starry-eyed that everything is possible.  A lot is possible, but everything is not.  That’s right, somebody finally said it, there are limits, and you have to make tough choices.

When people work with me, they end up making those choices, and I don’t judge whichever they choose, because I don’t think there is a right answer to this.  But I also am pretty outspoken that they are going to have to fish or cut bait.  If you don’t like the idea of tooting your own horn, I’m not going to push you to do it, but then don’t complain to me about having to take health insurance.  But if you want a predominantly self-pay practice, don’t get self-righteous about self-promotion.  First off, self-promotion takes many forms: blogs, advertisements, peer-reviewed journals, telling someone what you do at a party.  Everyone in our field does some of that, at least everyone I have ever met.  But you’ll need to get off whatever train trip you’re on about how self-promotion is wrong.

There is absolutely nothing wrong with working in an agency full-time.  There is absolutely nothing wrong with having a self-pay practice.  There is absolutely nothing wrong with taking or not taking health insurance.  There are plenty of therapists who are going to take the options that you don’t.  But you need to choose something or you can’t have a business plan.  And if you don’t have a business plan, don’t try to be self-employed.

Finally, I’d encourage you to get a clock and keep track of how many hours you spend griping about managed care, criticizing your colleagues who market themselves, or asking how to find those self-pay patients online.  Because all of that time is time you could be spending on billing, filling out paperwork, writing a book, promoting a talk, in other words building your practice.  Complaining to peers is not networking.  Worrying about your business is not the same as effort.  Don’t confuse the two.

Life’s full of tough choices, go make one.

 

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Dings & Grats

I am convinced that if more people played video games, in particular massively-multiplayer online games, the human race would become kinder and self-confident.  Here’s one reason why:

In MMOs like Warcraft, you have a social chat text window that is in the lower corner of your screen, constantly streaming messages.  These messages are color coated so you can identify those you want to be reading, and screen out or hide those you don’t.  For example, I usually have my guild chat “on” so I can talk and listen to guildies, but I rarely have the world “Trade” chat on, because I’m not a big shopper.

As you progress through the game, you level up.  And when you level up, that’s an accomplishment.  So you type into guild chat: “Ding!”

Ding, reminscent of the bell on a game show, is a way of calling attention to the fact that you have accomplished something.  It’s tooting your own horn.  But in gaming, dinging is socially acceptable!  So when you announce over chat, “Ding!” You usually get a stream of “Grats!”

Grats, you may have guessed, is short for “Congratulations!”  It is the public acknowledgement in gamer culture of your achievements.  And if you are in a big guild and there are a lot of people online, you will sometimes get a stream of 50 or more “Grats.”  This also means that if you are logging on or only half-paying attention you will catch on that somebody just achieved something.

Since everyone goes through the same levels, everyone recalls what a sense of accomplishment they often had when they dinged, and they pay it back or forward because they know how great it felt to get those grats.  What emerges is a culture where achievements are announced and mirrored, which makes for a heightened sense of community and self-esteem.

When gamer patients announce they’ve hit level 85, or downed a major boss, or rolled and won on a piece of Epic loot, I am often quick to Grats them.  I also encourage some coaching clients to get better at dinging when they have hit an achievement.  “I finally rented my own office, Ding!” “I have 10 new patients, Ding!”  Each of these is worthy of a quick energetic announcement of accomplishment.

By now some of the naysayers are probably thinking, “How corny.”  And who has time to congratulate someone for every little achievement?  We’ll just end up raising a generation of narcisists who overstate every accomplishment.

Obviously I disagree.  First off, you don’t have to Ding on world chat, so to speak.  Who is your guild?  What group of people form your supportive circle that want to know when you’ve accomplished something.  Second, there is always some self-regulation when Dinging.  I don’t ding every time I mine some ore or pick an herb in WoW, but when I hit level 85 you bet I Dinged.

Third, when did we get so miserly with compliments?  Is it some sort of holdover from the Pilgrims and the dour work ethic?  It takes a second to Ding and the same to Grats.  What is lost in that second pales in comparison to the affective shift in our psyche and the change in our neurochemistry.  Think about any day you went into a job you hated, and the number of decision moves you made to do it even though you didn’t want to.  If that didn’t deserve a Ding as you passed a co-worker’s cubicle, I don’t know what does.

Lately I have been trying to increase my Grats as well.  Whenever a colleague posts on Twitter that they published a book, or finished a course, or got their license, I try to retweet with a big “Grats!”  I try to amplify their achievement, not ignore it or dismiss it.  One of the great powers of social media is how it can amplify things.  And one thing many of us need practice with is unlearning a depressive stance, where we only see the negative.  Now I am not a positive thinker, in fact positive thinkers make me feel uncomfortable, because I think they’re a bit deluded.  But that doesn’t mean that I can’t get better at noticing and acknowledging the achievements and positive contributions others make.

I’m sure you can begin to see how this is applicable to therapy.  Help your couples patients practice dinging and gratsing.  Work with school staff to set up a Ding and Grats system in their classroom.  Can you imagine how amazing it would have felt in middle school to finish your presentation with a “Ding!” instead of “The End,” and hearing 25 voices say “Grats!”

Dinging and Gratsing are expressions of enthusiasm, and sometimes it seems to me that there is some silent war being waged on enthusiasm.  We’re supposed to play it cool, be “laid back,” and never indicate we care that strongly about anything.  Is that really the apathetic and guarded culture we want to pass on?  Let’s get off Plymouth Rock for goodness sake, and start calling out with some enthusiasm!

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Fun & Failure

Early in the summer I had the opportunity to give a workshop at the University of Buffalo.  The evening before I gave it I had the opportunity to sit down and have dinner with Nancy Smyth, the Dean of the School for Social Work.  Although we’d never met before in person, the time sped by with good conversation and laughter.  Fortunately I had finished my prep for the workshop, because I was quick to crash that night.

The next day I spoke in front of a group of clinicians, caseworkers, and administrators.  The age ranged from 20s to 60s, and the discussion was so lively that the day sped by, and before I knew it, I was being ushered out of the classroom and into the car to the airport.  The workshop participants did not agree with each other (or me) on all points, but everyone said that they were walking away with me having changed their thinking about technology, video games, social media and healthcare.

Sometimes I take for granted how much fun my work is.  There is enough diversity in who I work with to keep me invigorated most days, and the balance of a portfolio career really suits me.  Being my own boss suits me as well, and this year I mixed it up a little.  I dropped one class I was teaching and took this semester off so I could focus on writing and promoting my new book.

Promoting Reset is not something I enjoy doing.  Although I coach and blog about the importance of self-promotion and what hold us back from doing it, that doesn’t mean that I enjoy doing it all the time.  But one thing I have been learning is that writing the book was the eas(ier) part.  I need to keep getting the word out about it, and sometimes I feel like I am overtaxing the patience of my Twitter followers, Google+ circles and Facebookies.  Some of these people are in multiple groups, and I can imagine that they get irritated with another post about the book.  “Enough already!” I imagine them saying.

Speaking up is not easy, and many of us actually have a much easier time speaking up for others than for ourselves.  We speak up for our clients, our kids at school, our pets when they depend on us for care.  It’s ironic that we get so good at striking blows for freedom, blogging against oppression, picketing, and political advocacy; and yet we cringe at the idea of promoting ourselves.  Perhaps that is because the former makes us feel righteous, and the latter makes us feel guilty.  I definitely enjoy advocating for technology and the people who use it with my colleagues, but I wonder if I would have promoted my book at Buffalo if it had been published then.

I’d better get used to it, because now there are more speaking engagements coming up, and having an eBook means I can’t just lug a pile of them to the the hotel and have them sit on a table.  I need to be speaking up about Reset, because no one else will.  And one thing I have also learned to do at talks is to let people in them know I enjoy speaking engagements and am available to do more.  And each time I have done that, I have gotten a lead.  Hopefully out of all of you reading this I’ll get hired to do another few.

This is such a contrast to my clinical work, where I am required to be more quiet, reflective, and other-focussed.  I am not alone in this, psychotherapy tends to require us to listen more and talk less much of the time.  It is also a safe place to “hide out” if we aren’t careful.

One of the most unfortunate lessons our current educational system teaches us is that we should hurry up and find out what we are good at, what comes easily for us, and then stick with that.  In school settings, not-knowing is considered a bad thing rather than the predecessor to curiosity.  By college we have learned to speed through any unpleasant “requirements,” and major in something that interests us.  The problem with this is that by then we have learned to take an active disinterest in things that we struggle with.  So we arrive in adulthood having learned to play to our strengths, and avoid the rest.  And whereas children are fairly powerless to avoid what they struggle with in school, adults can often construct a life that cocoons them from learning unfamiliar things.

Therapists in particular, have pushed themselves through grad school and internships, licensing tests and boards, and by the time we get licensed to do private practice we feel entitled to close the office door on outside influences.  Several times when I have been hired as a coach or consultant, I still find my clients reluctant to “come clean” about things they aren’t good at.  Some haven’t billed insurers for months because they don’t know how to do the paperwork, or a claim has been denied and they are letting the appeal sit on their desk.  Websites lie around half developed, brochures printed up but not mailed, and all of this is nothing compared to the disarray and avoidance of work/life balance.  Office hours are whenever the patient can make it, their specialty is “anxiety and depression,” and they are running themselves ragged.  And all the time, they suspect that they are really frauds awaiting discovery, and why?  Because they learned that you aren’t supposed to admit you are confused or don’t know something, let alone ask for help.

Fortunately I play video games.

As Jesper Juul points out in Fear of Failing? The Many Meanings of Difficulty in Video Games failure is more than just about not winning.  It forces gamers to readjust their perceptions.  In fact, players prefer games where they feel responsible for failing.  What’s more failure adds content to the game.  Think about what a powerful paradigm shift that is.  Failure adds content that wouldn’t be there.  What might happen if we were able to see failure in our lives as adding content?

Actually, therapists often have a lead in understanding this.  We know that empathic failures are often inevitable, and that when we successfully navigate them with our patients the relationship deepens.  The failure adds content.

So think about your life, your practice, your business or your relationship.  And look straight at where you are failing in it.  I know, it’s tough, but try it for 5 minutes, and then ask yourself, “what content is this failure adding to it?”

This is much easier to do in hindsight, which is why we need to try to practice it in the now.  Because if we don’t avoid seeing the failures, we can readjust our perceptions and progress farther.  Maybe just a small progression, but anyone who works with kids knows the importance of proximal goals.

To go back to the Buffalo speaking engagement, this began as a failure and the setting of a proximal goal.  The failure was this:  I wasn’t getting enough paid speaking engagements.  How did that add content to my life?  Well, it added the mission, should I choose to accept it, of getting more paid speaking engagements.  So I set the proximal goal of starting to let people know I was looking for them.  One night on Twitter Nancy said something complimentary about a blog post, and I quipped that she’d better hire me as a speaker before my rates went up.  A few months later I was invited to speak.  And in addition I deepened a connection, met some really cool students, and saw Niagara Falls for the first time in my life:  How’s that for added content?

So much is possible for you, your business and your life.  None of what I have described above was achieved because I have some special gene.  It took what Pema Chodron calls going to “the places that scare you.”  We are all failures at something–come out of the closet!  Over 6 billion people around you are failing and trying and failing and trying again every day.  Those that aren’t are hiding inside an ever more rigid and constricted life.  That doesn’t have to be you, and it sure as hell isn’t going to be me.

Oh, and I hope you buy my book, and I’m available for speaking engagements, so call me.  😉

 

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Defeating the Boss: Overcoming Your “Big Bad”

 

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Why Therapist Directories Are A Waste Of Time

This post is for all of you who have been considering or actively using listings in therapist directories.  I frequently get asked from consultees which directories they should list in.  I also frequently see colleagues debating on bulletin boards and listservs the merits and demerits of individual directories.  So I figure it’s time to offer you my perspective.  Please bear in mind that I am sharing my experience and opinions here, and if you’ve had a different one, hopefully you’ll mention it on the comments.  If you own a directory service, I hope you’ll disclose that as well.

When I started building my practice, I had a lot of time to spend filling out various online directories.  I literally spent hours filling out profiles that promised to make me visible to potential patients.  To be fair it gave me the opportunity to hone my bio and elevator speech, but other than that I now think that I was wasting my time.  But let’s talk a little about why directories may be a waste of your time, because I think it points to a larger misconception about marketing your practice online.

Billboard in a bottle.

Many therapists still approach the internet as if it was a giant Yellow Pages.  We often create static content, the equivalent of a business card, cover letter and resume, and then slap it up on a website, or a directory.  Then we sit back and wait for the phone to ring.  It’s like we imagine that we created a giant billboard and threw it into the world wide web.  But in reality, it’s more like a message in a bottle, thrown in a vast ocean.  We imagine that that will get us recognized.  It usually doesn’t, and here’s why.

If you google “find a therapist” you will literally find dozens of website directories guaranteed to help patients find the right provider.  If you’re ambitious you could spend hours and days finding all of them and entering your information.  Many of them are free, some charge money, and a few don’t let you know whether they will charge or not until you’ve entered all of your information.  One of the main problems with directories is exactly that there are so many of them.

One thing I’ve learned from starting up social networks for other companies is that you always need a critical mass of members as quickly as possible.  If you launch a site you have a few days to a week to achieve this in most cases.  Otherwise potential members will log in to your site, look around and see little activity, and leave.  So low enrollment of providers in a directory will drive little traffic to it.

On the other hand, if you take a directory like Psychology Today’s you will see that they did achieve a critical mass, and have more traffic.  But the problem here is that this is because every therapist and her maiden aunt is now listed there.  So the problem becomes how to set yourself apart from the rest.  If you are determined to spend time on listing yourself in a directory, I’d suggest that you pay for the PT one and try to distinguish yourself as best you can.  In fact, the Psychology Today site is the only directory I even try to keep current and pay for anymore.

Speaking of keeping current, here’s the other potential pitfall of directories:  The more you participate in, the more you’ll need to update your content, remember more passwords, and check back in.  Some directories require you to log in any time you get a message from a potential client (or spam) in an effort to drive up their traffic.  It’s a lot of hassle for little ROI.

If you are determined to list yourself in directories, please consider the following:

  • If you are planning on practicing online, does the directory have global traffic?
  • If you are planning on practicing in a certain geographic location, does the directory get traffic from your part of the world?
One way to research this a little is to run the site’s address on Alexa, which will often tell you some information about traffic or rankings by country.
But while we’re talking about Alexa, let’s talk about how those numbers can be misleading.  Alexa allows you to download the Alexa toolbar, which allows you to check a site’s alexa traffic rank, but it also allows Alexa to tabulate traffic to any site your browser visits, which is part of how they get those numbers.  So it is very easy to drive traffic numbers up artificially.  How?  Easy, set your homepage to your website, and every time you open up your browser, it opens to your site, and adds to your number of visits.  Not enough?  No problem, have all of your family members do the same on their computers.  Within days, your ranking will rise dramatically, without any real rise in potential referral visits. So keep that slight-of-hand in mind when you look at a therapist directory’s traffic. Maybe they do have 100s of visits a day, or maybe they have 10 people who have that site as their home page to drive up traffic.
So Now You Know.

When I review my practice referrals, I received probably %10 of them from a directory, usually Psychology Today.  The majority of my referrals came from word of mouth, insurance company lists, and increasingly my blog and articles.  By now, many of you will know where I am going with this:  It is content and interaction that convert visits to your website into referrals.  There is not a similar conversion rate from visits to your directory profile and calls to you, or even visits to your website.

Some may disagree with me, but my take on directories is that they are a waste of time, and that they capitalize on therapists’ reluctance to generate interactive and dynamic content.  Put simply, people want to hang up their cybershingle and then go back to passively waiting for the phone to ring.

To spend a lot of time finding and listing yourself in a therapist directory is to confuse worry with effort.  What you should be doing (Oh Nos! A therapist used the word “should” 😉 ) is generating content and creating opportunities for interaction with colleagues and potential patients.  Examples of generating content include:

  • writing brief informative blog posts
  • tweeting links to articles that you find interesting to establish your “brand”
  • offering a free hangout on Google+ on your niche topic
  • creating a meditation podcast that people can download from your site
  • networking in Second Life or attending the Online Therapy Institute’s open office hours
  • doing a five-minute vblog on a CBT technique

I’ve done many of the above, and this blog post is another example.  I guarantee you that this post will generate a new referral for me at some point soon, much sooner than my Psychology Today profile will.

So please take the time you could be playing it safe cutting and pasting your info into yet another directory, and instead take some risks, create some new content, or join in a conversation online.  Web 2.0 is not about being a digital classified ad. Use your time marketing to do what therapists do best: Relate.

Integrity Is Your Brand.


Recently I had two experiences which took me a bit by surprise. The first was when a representative from an online gambling site contacted me and asked me to consider affiliating with their website.  Apparently they had read several of my blogs and found my site and the posts to be in their words “respectable” and “well written.” They wondered how much I’d charge for them to be able to include a link to their site in my next blog.

As many of you can guess, I derive no direct monetary income from this blog.  The revenue I do get comes in requests for consultation, workshops and speaking engagements from people find me through this site, and summer is slower in those areas.  Needless to say the idea of making some money from the blog is always tempting.  And I have nothing against online gambling per se.  But I declined, and at this point I can’t imagine accepting advertising or affiliating.  It might be more tempting if Blizzard or Nintendo were to call, but even then I would have to decline.  Not because I think affiliate marketing is inherently wrong, but because in this case something more valuable is at stake.

The second experience didn’t involve money, but it was actually an even harder decision.  Not long ago I had the privilege of being elected to the board of a professional organization.  I’ve been on several boards, so I was expecting to commit a lot of time and work to this one.  What I wasn’t expecting was to get a call from the chair about my blog.  Seems that someone had forwarded a post where I criticized several organizations for their stance on technology, including this one.  I was told that I’d have to retract the post, and refrain from making any future critical posts about the group.

This is an organization I think highly of, and I can tell that the members of this group are not just in it for the title.  I’m sure I could have done a lot of good serving on it.

But again, I had to decline.

Neither money nor a titular position is more important than my integrity.  In fact, I’d go so far as to say to you that integrity is your brand.

It’s important not to make the mistake of demonizing either of the two parties in the examples.  There is nothing inherently wrong with marketing or in my opinion online gambling.  But I have not built my reputation on being an expert on gambling, and I’m not one.  So even though the website might derive benefit from having a respectable blog link to them, I wouldn’t.  Sure money is great, but as I said, something more valuable, my integrity, might be lost.  I have worked too hard and too long to risk losing that.

I can also understand the board’s point of view: As an ambassador of the organization, whatever I say about it, critical or otherwise could be problematic for them.  I don’t agree with them entirely, but when I understood what was expected my choice was clear.  This blog isn’t Mashable, but many of you have been reading it for as long as it has been up.  And people expect me to tell it like it is, whether it be about technology, gamer-affirmative therapy, or growing your private practice.  If you’ve read the comments you know that everyone doesn’t always agree with my point of view.  But many people have come to find the blog, and me, consistent and honest.  There are other people who can do board work, but without my integrity there is no blog.

At the risk of sounding self-righteous, I know that writing this has made a difference in the lives of therapists and the patients they treat.  It has allowed me to gain access to publications and groups to spread the word that technology is not incompatible with therapy, and that gamers need therapists who are culturally competent in gaming rather than contemptuous prior to investigation.  Seasoned clinicians have told me that they have begun to rethink some of the cherished ideas our field holds about addiction, and fledgling therapists have sought me out for supervision on how to grow and market a profitable and socially just practice.  And of course writing for all of you has helped me feel “powered-up” to continue to do the work even when there’s pushback from colleagues and our field.

I’m not telling you this just for catharsis.  And I don’t have that “Blog With Integrity” badge on the blog just for show.  Here’s what I want to make sure you know:

One day, maybe very soon if it hasn’t already happened, you’re going to realize you’re a success.  You’ll realize that you haven’t been worrying about your practice as much, or that your caseload is full, or that you’re being asked to teach on your expertise.  One day, you’re going to be a success.  And when that happens, you’re going to have opportunities that require you to make tough choices.  Because people will notice you’ve become successful. Whether it be those word of mouth referrals or podcast interviews, you’re going to have become more influential.  Some people will want to harness your influence to help them, others will want to harness it to control it.  And the only person who can decide what choice to make is you.

If you don’t feel comfortable seeing yourself as successful or influential, that’s your problem.  Ignorance is always a vulnerability.  You matter.  The work you do matters.  Your thoughts and opinions matter.  Its when we don’t think we have an impact that we hurt our patients, our families, our business, in fact our world.

Immanuel Kant once said, “Act only according to that maxim whereby you can at the same time will that it should become a universal law.”  I take this to mean act as if anything you were about to do in your life would become a universal law for how to do it.  That’s heavy stuff.  It’s not easy to decide how to act in a way that you’d be willing to have be the way to act for the rest of your life. In this case, blog with integrity.

Integrity is your brand.  Are you willing to do what keeps you whole and constant in your therapy, business and life?  Do you stand up for the things you believe in even when they cost you money, comfort or being liked? And perhaps most difficult, are you willing to notice your success, admit that you matter, and live with the knowledge that you have an impact on the world?

How To Learn About Video Games & Why You Ought To

http://www.youtube.com/watch?&v=JY8h-U7rE6Y

What Google+ Could Mean For Therapy

Every technology reveals the hand that shaped it.  The technology of the 21st Century is no exception:  Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms.  And the explosion of access to information was detonated by our own curiosity.

For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it.  Listservs are a great example:  They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level.  Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.

And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board.  The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them.  The online world expanded exponentially, and in fact that interactivity and information became overwhleming.

Which brings us to Google+.

For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media.  Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds.  If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it.  But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.

So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.

Circles

The Google+ system of circles is as powerful as it is flexible.  Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”

 

 

The interface let’s you drag the name and image of different people located on the top to one or more of the circles below.  When you mouse over the circle it expands to give you an idea of who you have put in it.  And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself.  For example, I have a circle for “Minions.”  I’ve always wanted minions.

This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life.  This can be especially useful with patients on the autistic spectrum.  We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of.  Who goes where?  Is everyone a friend?  Can we put people in more than one circle?  Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”?  What sort of circles might we want to create that Google+ didn’t give us?

People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful.  Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be.  Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further.  Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention.  We could help them explore and decide how to set up their own personal boundaries and affectional investment.

Or imagine for a second you are working on emotional regulation issues with a patient.  You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle.  Do some people go in more than one circle of affect?  Do they notice that they are taking people in and out of circles frequently, or never?

Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to.  They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those.  And all of a sudden they also have a visual list of who they can call when they are trying to socialize.

Last example, working with trauma and/or substance abuse.  Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc.  Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis.  It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one?  What do you think you could do about that?”

So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.

Streams

In Google+ circles go hand in hand with your Stream or Streams.  A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles.  It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back.  And you can set each circle to have different levels of access to your posts.  In other words, circles and streams together allow you to learn and set boundaries.  Here’s what a Stream can look like:

This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes.  Much like Twitter, or like life.  If we had to pay attention to everyone all the time in the same way, we would become very fatigued.  Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times.  Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them.  But it gets even more interesting.

If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc.  Now if you click on any of those circles, the Stream changes.  Specifically, it changes to list only the posts from the people in any given circle clicked.  This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.

Imagine working with an adolescent and reviewing their streams together.  What sorts of media, comments, and concerns are streaming through their lives at any given moment?  And what is the consequence of having 500 “friends” in their friend circle?  Do they feel intimate or able to attend to all of these friends?  Or are there some times that they may be more interested in attending to some friends than others?  If so, why?  Might it be time to start to rethink what it means to be a friend?  Is it ok to select who they attend to at certain times?  Do they really find the content they get from A interesting?  And if it is consistently uninteresting, does that say anything about their relationship?  Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.

For a second example, let’s return to the patient with ADHD.  Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way.  That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor.  If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done.  Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do.  But these types of decisions and focussing techniques may be crucial to staying on task.  (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment.  It’s not always just “playing on the computer” now.)

Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles.  Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?”  Maybe they’d rather tune into a steady Stream from their “Supports” circle instead?  And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways?  Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?

We make these decisions all the time, we just aren’t always conscious or overt about it.  And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves.  We need to have boundaries and filters.  We need to be able to focus and set limits and values.  These needs have begun to be more clearly revealed by the technology of Google+.  Knowing about that technology may improve our ability to treat our patients.