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Social Justice & Technology Revisited

March 15, 2014 by langloimsw 1 Comment

I have written before about how technology often makes life easier for a large number of the population while simultaneously disenfranchising others. The good news is that this does not have to be the case.

The example I used in the past was the Starbucks App which allows customers to use, gain rewards for, and reload their account on their smartphone, while making it more cumbersome and difficult to tip baristas. This again does not have to be an inevitability, but requires Starbucks to enhance the functionality of its App.

So I was pleased to discover (special thanks to my student Marissa for bringing this to my attention) this week that come Wednesday March 19th, Starbucks will be rolling out an update to their smartphone App which allows just that. You can read more about it at Forbes here. You will be able to download the update from places like iTunes, and include your tip easily.

While some may dismiss this as a first-world problem, I cannot emphasize how powerful a shift I consider this to be in terms of workers’ rights in the service sector. I am convinced it comes in part as a result of advocacy by and for workers, and sets the bar higher and yet attainable for corporations to maximize their value to customers while not disenfranchising their employees.

How can you help advocate for social justice in the technology you use? First, simply by mindful usage. Take a few minutes today to open your smartphone and make note of the Apps you use most frequently. Next, ask yourself, who, if anyone is disadvantaged by my using this App? Just thinking about the connections can be a powerful mental exercise. Notice how complicated it can get fairly quickly: If I use Evernote frequently, I am less likely to write things down on paper, which may be good for the environment but may also disenfranchise industrial workers in paper mills. Hold on, did I say that you had to stop using Evernote or lobby for paper mills? No, I’m asking us to sit with the complexity of a problem here for a minute to see the larger systems at play. Technology has always resulted in job loss for some even as it may provide workplace improvements or quality of life for others. It’s when we don’t think about these things in a more complex way that we stop innovating social justice itself.

Part of what I’m trying to encourage us to see is that social justice, workers’ rights, unions, and any person or group committed to social justice needs to keep pace with innovation and in fact keep innovating themselves. Technology always runs the risk of disenfranchising people, especially workers. If the McCormick reaper in a few hours does the day’s job of three workers, what happens to those three workers? We are still living in a capitalist society in the US, and it is unlikely that as technology improves and reduces the need for human workers that all of these people will be able to afford to turn their minds and lives to the pursuit of art and culture. Everything isn’t always getting better for everyone in the current system, and we are seeing overcrowding in occupations ranging from factory to legal work.

If social justice advocates, and social workers are to continue to help the disenfranchised, they are going to need to keep pace with technological developments and continue to think innovatively about 21st century equity in complex and sustained ways. And by the way, thinking, “the gap is just going to get wider, the social fabric is unraveling,” is not an example of innovative thinking, but defeatism that exempts us from the work of innovation.

This brings me back to my social work colleagues, and my continued urging for them to keep pace with emerging technologies, especially if you are touting the concept of social innovation. Social innovation without leveraging emerging technology will ultimately lead to future disenfranchisement. If you have a social innovation department in your social work program that doesn’t leverage technology you are not being socially innovative. I certainly don’t have all the answers, but I know that the answer to social injustice will inevitably need to integrate emerging technology into it.

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Filed Under: Gamer Therapy Tagged With: activism, behavior change, building your business, digital literacy, education, marketing, ROI, social justice, social media, technology, twitter, video games, Web 2.0

The Changing Landscape of Social Work

November 17, 2013 by langloimsw Leave a Comment

Recently I had the great opportunity to be a scholar-in-residence at The University at Buffalo’s School of Social Work. For three days I met with students, faculty and staff to speak about emerging technologies ranging from Twitter to video games. During one morning, Dean Nancy Smyth and I sat down for a series of informal discussions around various topics, and the University was kind enough to let me share these videos with you. If you want to learn more about how I can come to your institution to do the same thing, please contact me.

How to Use Social Media and Technology to Develop a Personal Learning Network:

http://www.youtube.com/watch?v=zb74jYN0k5Y&feature=share&list=UUQG8usDJjq8OjMgtNDQC6fg

If I Don’t Use Social Media and Technology in Social Work Practice What Am I Missing?

Social Work is Changing: Integrating Social Media and Technology Into Social Work Practice

http://youtu.be/FQWUMTxXVus

Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, buddhism, building your business, digital literacy, education, facebook, gamers, marketing, mental health parity, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, twitter, video games, Web 2.0

Mental Health: Yes, There’s an App for That..

October 6, 2013 by langloimsw 2 Comments

Nobody wants to be irrelevant, and many mental health practitioners want to try out new technologies like Apps, but how to choose? Currently the App Store in iTunes makes available 835,440 different Apps, of which approximately 100,000 are categorized as lifestyle, medical or healthcare & fitness. And Android users have just about as many to choose from according to AppBrain, which says there are a whopping 858870 as of today. With so many to look at, how can a clinician keep current? Hopefully we can help each other.

Instead of writing the occasional “Top 10 Post,” I’m setting up a site for you to visit and review different Apps. I’ll review some too, and hopefully by crowd sourcing we can get a sense of what are some of the best. I’ll need Android users to weigh in heavy, as I will be test-driving Apple products alone.

Why have I decided to do this? Several reasons, the complicated one first:

1. Web 2.0 is interactive. We forget that, even those of us who are trying to stay innovative. We keep thinking we need to get on the podium and deliver lectures, information, content. And to a degree that is true, but we can easily slide back to the old model of doing things. That’s what you see in a lot of our well-intentioned “Top 10 App” posts and articles. Recently I found myself trying to explain on several occasions why doing a lecture or post on the best Apps for Mental Health didn’t sit right with me. Part of it was because Apps are put out there so fast, and then surpassed by other apps, that it becomes a bit like Project Runway: “One day you’re in, the next day you’re out.”

I was getting trapped behind that podium again, until I realized that we don’t need another post about the top 10 mental health apps, we need an interactive platform. I need to stop acting as if I’m the only one responsible for delivering content, and you need to break out of the mold of passive recipient of information. I’m sure that many of my colleagues have some suggestions for apps that are great for their practice, and I’m hoping that you all share. Go to the new site, check out some of the ones I mentioned, and then add your own reviews. Email me some apps and I’ll try ’em and add them to the site. Let’s create something much better than a top 10 post with an expiration date, let’s collaborate on a review site together. Which brings me to:

2. I want to change the world. That is the reason I became a social worker, a therapist, and a public speaker. I think ideas motivate actions, and actions can change the world. The more access people have to products that can improve their mental health, the better. By creating a site dedicated solely to reviewing mental health applications, we can raise awareness about using emerging technologies for mental health, and help other people improve their lives. Technology can help us, which brings me to:

3. Technology can improve our mental health. Yes, you heard it here. Not, “we need to be concerned about the ethical problems with technology X,Y or Z.” “Not, the internet is making us stupid,” or “video games are making people violent,” but rather an alternate vision: Namely, that emerging technologies can allow more people more access to better mental health. Let’s start sharing examples of the way technology does that. There are Apps and other emerging technologies that can help people with Autism, Bipolar, Eating Disorders, Social Phobias, Anxiety, PTSD and many more mental health issues. I can’t possibly catalog all those alone, so I’m hoping you’ll weigh in and let me know which Apps or tech have helped you with your own struggles.

Is this the new site, Mental Health App Reviews, a finished product? Absolutely not. What it will be depends largely on all of us. This is how crowd sourcing can work. This is how Web 2.0 can work.

If you want to contribute, just email me at mike@mikelanglois.com with the following:

App name
Screenshot if possible
Price
Link to App

and I’ll take it from there. Please let me know if you are a mental health provider and or the product owner in the email as well.

You can also contribute by reviewing the Apps below that you use. Be as detailed as possible, we’re counting on you! And while you’re at it, follow us on Twitter @MHAppReviews

Filed Under: Gamer Therapy Tagged With: activism, Apps, behavior change, digital literacy, education, gamers, gaming, iPhone App, marketing, mental health, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social justice, social media, technology, video games, Web 2.0

Saving Ideas

July 9, 2013 by langloimsw 2 Comments

Sometime, over 40,000 years ago, someone decided to put images of human hands on the cave pictured above. It turned out to be a good idea. This painting has given scientists information on life in the Upper Paleolithic, raised questions about the capacity of Neandrathal man to create art, and sparked debate about which species in the homo genus created it. Other later cave paintings depict other ideas: Bulls, horses, rhinoceros, people.

I wasn’t there in the Paleotlithic but I doubt that the images we are seeing in caves were the first ones ever drawn. I imagine that drawing images in sand and other less permanent media happened. I suspect that the only reason we have cave paintings is because at some point somebody decided they wanted to be able to save their idea, to keep it longer or perhaps forever.

Every day, 7 billion of us have untold numbers of ideas. So what makes a person decide that an idea is worth saving? What makes us pause and make a note in our Evernote App or Moleskine journal? What inspires us to make a video of our idea on YouTube or write a book? We can’t always be sure that an idea is a “good” one or even what the criteria for a good idea is. It usually comes down to belief.

In the past several centuries, the ability to save ideas was relegated to the few who were deemed skillful or divinely inspired. Books were written in monasteries, then disseminated by printing presses, and as ideas became easier to save, more people saved them. But, and this is very important, saving an idea doesn’t make it a good idea, just a saved one. Somewhere along the line we began to get the notion that only a few select people were capable of having a good idea, because only a few select people were capable of saving them. Even in the 21st century, many mental health professionals and educators cling to the notion that peer-reviewed work published in journals is the apex of quality. If it is written, if it was saved by a select few it must be a good idea. If you have any doubt of what I’m talking about just Google “DSM V.”

With each leap in human technology comes the power to save more ideas and then spread them. People who talk about things going viral often forget that an idea has to be saved first, and that in essence something going viral is really a form of society saving an idea. If anything, technology has improved the democratization of education and ideas.

This makes many of us who grew up in an earlier era nervous and frustrated. We call the younger generation self-absorbed rather than democratizing. We grumble, “what makes you think you should blog about your day, take photos of your food, post links to cute kitten videos?” We may even take smug self-satisfaction that we aren’t contributing to the static. I think that’s a bad idea, although it clearly has been saved from earlier times.

40,000 years from now, our ideas may take on meanings we never anticipated, like cave drawings. Why were kittens so important to them? In the long view I think we remember that people have to believe they have an good idea before they take the leap of faith to save it. The citizens of the future may debate who saved kitten videos and why, but it will be taken as given that they must have been important to many of us.

What if everyone had the confidence to believe that they had an idea worth saving? What if everyone had the willingness to believe that it just might be possible that their idea was brilliant? Each semester I ask the students in my class to raise their hand if they think they can get an A- or higher in the class, and most do. Then I ask them to raise their hand if they think they can come up with in an idea in this class that could change the world. I’ve never had more than 3 hands go up. That’s sad.

This is why I admire the millennials and older groups who take advantage of social media and put their ideas out there. I doubt that they are all good ideas, but I celebrate the implicit faith it takes to save them. Anyone, absolutely anyone at all, can have a good idea. It may not get recognized or appreciated, but now more than ever it can get saved. Saving an idea is an act of agency. It is a political act. Saving an idea is choosing to become just a bit more visible. On the most basic level saving an idea is a celebration and affirmation of the self. Think about that, and dare to jot down, draw, record or otherwise save one of your ideas today. I just did and it feels great. Then maybe you can even share it with someone else.

What makes a person decide an idea is worth saving?

You do.

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Filed Under: Gamer Therapy Tagged With: activism, adolescents, behavior change, buddhism, building your business, cave paintings, children, digital literacy, education, facebook, gamers, gaming, ideas, LGBT, marketing, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, saving, self-promotion, social justice, social media, technology, twitter, video games, Web 2.0

You’re The Reason Building Your Business Is So Hard

May 31, 2013 by langloimsw 22 Comments

Recently I was asked by a student to take some time and talk with her about her career options. She was trying to plan for her career post-graduate school, and struggling some with the vicissitudes of a graduate program in mental health. Such vicissitudes, once you commit to studying in the field of your choice, are out of your control. Students are often told what to learn, how to learn it, where to intern, and what kind of internship they can have. Want to learn psychodynamic theory? Sorry, school X doesn’t believe in it, so if you go there there may be one or no mention of it in your foundation work. Want to work at a leading hospital? Sure, you and 100 other students from the schools in your area; so apply, but don’t count on it. So, in graduate school, students like my student often have to like it or leave it.

This disempowers the budding therapist in many ways, not the least of which is that it conditions her to take her cues from others even beyond graduate school. It is hard to learn that you have the power to build your career and business after having been taught that the schools, placements and agencies are the ones who make the rules.

If you are out of school, you have more power than you think, and therefore more responsibility than you may want.

Many therapists want to avoid taking responsibility for their businesses. No sooner do we get out of a school or agency then we start to recreate an agency of our own devising. We create our own set of disempowering expectations, and there are usually plenty of people around to collude with us in this. I call them disempowermentors.

Disempowermentors in the mental health field are the ones that tell you all sorts of rules about how things work. They’ll tell you you can’t build a practice without being on insurance panels. They’ll tell you you need to work in our field for 10 years to build up a reputation before you can open a practice. They’ll tell you you should sublet a few hours and not jump in to a full-time practice. None of these things are true, but most of them are usually fear-based. They are usually the way the disempowermentors did things, either because they recreated their own inner agency and/or because they listened to disempowermentors themselves. If my student isn’t careful, she’ll end up listening to one of these folks, and set herself and her future business back a few years. She’ll have a structure, but it will be one that restricts her choices rather than increases them.

Take a look at who you are listening to: Are they disempowermentors? (One sure clue is that disempowermentors almost always look more tired than happy, more miserable than inspirational.)

One example of someone whom the disempowermentors would say is doing everything wrong is my consultee Lindsey Walker. Lindsey is going right into private practice after finishing graduate school. Lindsey is working on building a full-time practice. Lindsey isn’t in any insurance networks. And things are starting to happen for her. This is largely because Lindsey is very creative and responsible. She has started a blog, Waking The Image, which combines photography and essays on psychodynamic theory. She also just finished writing her first e-book Love Over Trauma: Healing With Your Partner on helping couples recover when one or both of them has trauma in their past.

None of these projects occur in a separate pocket universe: Lindsey works daily on these projects and other tasks that we come up with in the course of our work together. I send her a list of things she’s committed to, and within the next several days she does them. That is why her work is slowly but surely getting noticed and her practice growing. She isn’t waiting passively in her office sublet for the phone to ring. She isn’t waiting passively for insurance panels to accept her, or accepting the fee they want to pay her. Lindsey knows that she is responsible for the success of her business. She is investing time and money into building it, not subletting 2 hours somewhere cheap and hoping she’ll get a client or two after her “day job.” Lindsey made the decision to make building her business her day job. I should also mention that she is not independently wealthy, and that this venture has been a risky and courageous one.

So take a look at your career. Are you happy with it? Is being safe worth it? Are you investing time and money into building your business? Are you taking risks?

If you answered no to those questions, then you are the reason building your business is so hard. You aren’t in grad school any more. You choose to apply for a job, accept it, or strike out on your own. You choose whether to make building your business your day job and make whatever sacrifices you need to make to do that. You decide whether or not to invest in an office, a consultant, or other business expenses. You decide to wait passively for someone to pay you a fraction of your fee, or actively market and network for hours and days and weeks. You decide whether to contribute a blog, book, talk or idea to the world like Lindsey; or not to contribute anything without permission from somebody else. You decide whether to confuse worry with effort and wishing with doing.

Lots of things are possible for you. Owning your own business is neither easy or safe, but it is possible. It takes lots of effort and doing. It’s risky, but no one is making you do it or holding you back. It’s up to you to decide.

Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!
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Filed Under: Gamer Therapy Tagged With: behavior change, building your business, digital literacy, disempowermentors, education, HMOs, insurance, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, therapy

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by langloimsw 29 Comments

Mobile applications have a lot to offer therapists. Whether you are looking for games to play with patients, productivity or billing tools, or something to help you research, there’s an app for that. Many supervisees, students and consultees have asked me lately what apps I recommend, so I thought it was about time I gave you a list sampling those I find most helpful and fun. Many are cheap or free, and available for the iPad, iPhone and Android:

1. GoToMeeting

Planning on doing online therapy? Gotomeeting has desktop and app versions of videoconferencing software, which is HIPAA-compliant. The app version allows you to attend meetings, but the meeting needs to be initiated from the desktop version. I use this program for the majority of my online sessions with patients and supervisees.

2. IbisMail

If you are juggling multiple roles or a portfolio career, or simply want better therapeutic boundaries, this is the email program for you. Installed on your iPad or iPhone, this program allows you to set up automatic filters, so you can sort through junk mail. But it also allows you to set up folders for patient emails, so that you can have them all in one place. Then it is up to you to decide when you review your patient communications, rather than have everything coming through one inbox. Supports multiple email accounts.

3. Flipboard

If you are wanting to add value to your twitter followers or consultees, this is a great app. It provides a slick intuitive interface on your mobile device that pulls in stories from feeds you set, from you Facebook account to the Harvard Business Review blog. When you find something you want to share, the app allows seamless sharing on a variety of social media platforms. In a few minutes you can browse and share selected readings and keep up to date on current interests.

4. Bamboo Paper

This app allows you to write notes on your iPad. It is great for note-taking during evaluations, and allows you to send these notes to Evernote as a .pdf or email yourself a copy. NOTE: Doing this is not HIPAA-compliant if you have distinguishing identifying information in the note, so I recommend you refrain from using the cloud-based features if you have any concerns about patient privacy. If you are using it for workshops or other personal uses, however, no worries. And if you keep the notes local to your password-protected device, it can be a great tool.

5. Evernote

I was hesitant to add Evernote due to the recent hack they experienced, but their quick and effective response to this have actually made me more confident that this cloud-based note-taking device is still useful. It is NOT HIPAA-compliant, so I don’t use it for patient notes ever. That said, it is great for dictating notes about workshops, blog ideas, snapping pictures of things for study aids, and a myriad of other useful tasks. The notes synch up between every device you have them on, so you’re always up to date.

6. iAnnotate

One of my favorites. iAnnotate allows you to mark up .pdf files on your mobile device. If you need to sign off on a document someone emails or faxes you, no more scanning, printing, scanning again stuff. And if you are a student or researcher this is a must-have, as it supports highlighting and annotating research articles. Synchs with Mendeley and Dropbox so you can store your research library with notes online.

7. 1Password

How can you make your mobile device more secure and use your web-browser more safely? This may be the answer for you. 1Password installs on your mobile or desktop, and allows you to save and generate extremely long and secure passwords. The level of encryption can be adjusted for the most cautious of password protectors. This program also synchs over the cloud so that you always have the up-to-date passwords on all of your devices. Even more convenient, it can bookmark your sign-in pages. All of this is secured by double-password protection on your iPhone. Stop using the same lame password for everything and start generating unique hard-to-crack ones for true HIPAA-compliance.

8. Mendeley

One part social network, one part research library, Mendeley allows you to store research articles and annotations online and on your device. It allows you to network with other colleagues to see what they are researching, share articles, and store all of your articles in one place. Often it can even pull up the bibliographic entry from the web just by reading the .pdf metatag. Geeky research goodness!

9. PayPal

This is one option for billing patients and paying vendors that is good to have. You can invoice by email, transfer money to your bank account, and keep track of online payments on the website. The app works well in a pinch if you aren’t ready to swipe cradit cards in your office. NOTE, each transaction has a small fee.

10. Prezi

I’d love to see more therapists using this one. This presentation software allows you to create dynamic visual presentations on your computer or mobile device. You could use it to convert boring DBT worksheets to a dynamic online presentation. Prezi supports importation from powerpoint, and provides free online hosting of your prezis as well as tons of templates and tutorials. If you do public speaking, upload some of your prezis on your LinkedIn profile to give potential clients a vivid sense of your work. You can see a sample here, but bear in mind that it would make more sense if I was there giving the talk. 🙂

11. DCU

I haven’t been to a bank in over 2 years, and this app is the reason why. Digital Credit Union’s Mobile Branch PC, allows me to deposit checks from patients via my iphone. Just login, scan the checks, and in 10 minutes you’ve done your deposits for the week. Meanwhile, the online interface allows you to keep track of your spending easily and export to Excel or accounting software if you need to. Great for tax season!

12. Dropbox

Dropbox is a great and free way to store non-private information on the cloud. The app allows you to email items easily, so I use it to email intake instructions to patients, press kits to people inquiring about keynotes, and a number of other items. I also keep all my DBT worksheets on it so that they can be sent quickly and easily to patients should they be feeling in need of extra support between sessions but not acute enough to warrant hospitalization.

13. TED

This app allows you to stay inspired and experience innovation daily, by beaming TED talks to your mobile device from the offical TED site. You can favorite, search, and share your favorite ones, or hit “Inspire me” for random ideas. As I wrote this, I was listening to Amanda Palmer speak on “The art of asking.” This app can allow you access to ideas outside of the filtered professional bubble with therapists often get ourselves stuck in.

14. Line2

Want a second phone line on your iPhone? This app allows you to have one. You can port your practice number to it, and stop carrying two cell phones. At $9.95 a month you can have unlimited US/Canada calling, at $14.95 a month you get a toll-free number and virtual fax.

15. CardMunch

Tired of keeping all those business cards from a shoebox? CardMunch allows you to snap photos of a colleague’s business card and convert it to a digital one which it stores in your contacts. Synchs with LinkedIn.

16. Micromedex

Keeping up-to-date on medications is pretty daunting, but this app, with frequent updates, helps you keep track od a medication, its Black Box warnings, contraindications, drug interactions, adverse effects, alternate names, standard dosages and more.

And now for some games!

17. Plants Vs. Zombies

This game is great for helping patients who want to learn about strategy and pacing. Choose a certain number of plant types to plant in order to stop the zombies from overrunning your backyard.

18. Zombies, Run!

Continuing my zombie kick, this game is better than any pedometer I’ve ever used. The more you walk or run, the further you progress in this game of fleeing zombies. Go on multiple missions, play with friends, and even train for a 5K.

19. Kingdom Rush

This game is a classic tower defense game, which helps patients learn to make choices, control impulse spending as part of a winning strategy, and work on pacing, problem-solving and a host of other cognitive abilities.

20. Minecraft Pocket Edition

This mobile app version of Minecraft is a great way to connect with a patient’s gaming, and the app allows you to play together on a wireless LAN, so you can fight for survival or create an amazing construction right from your office together.

21. Flower Chain

This is a completely nonviolent game that focuses on setting up a chain reaction of flower blooms in order to complete each level. Great eye candy, and a fun game for clearing the mind after a difficult session.

22. Trainyard

This puzzle game requires you to plan out and design multiple railroad tracks. The trick is to set them up and pace them so that they all meet their goals without running into each other. Great prompt for talking with adolescents about how they can learn to negotiate peer relationships in the same way, or learn to compromise with adults in order to get along with them.

23. Lavalanche

This puzzle game is reminiscent of Jenga, in that you have to dismantle a tower without letting the Tiki Idol fall into lava. Another great one for executive function capacity-building around sequencing, planning and problem-solving.

So there you go, give some of these a try and let me know what you think. Have a favorite app that you want to share? Please feel free to comment and include the link.

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: #sworcery, 1Password, adolescents, Apps, Bamboo Paper, behavior change, building your business, CardMunch, children, DCU, Dropbox, education, evernote, Flipboard, Flower Chain, gamers, games, gaming, GoToMeeting, iAnnotate, IbisMail, kingdom rush, Lavalanche, Line2, marketing, Mendeley, Micromedex, Minecraft Pocket Edition, PayPal, plants vs. zombies, prezi, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, TED, therapy, Trainyard, twitter, video games, Web 2.0

What It Means To Make A Referral

January 7, 2013 by langloimsw 4 Comments

To speak with a relative stranger about the most intimate details of one’s life is an incredibly daunting prospect for many psychotherapy patients. No matter how guarded a patient may be, she or he is daring to be incredibly vulnerable as well. Often the only thing that can make this beginning possible is an appropriate therapy referral. And yet never before has it been so easy for us to make a horrible or thoughtless referral to these brave souls.

It was hard enough when managed care began to shape the behavior of therapists to focus on insurance as being the number one or only criteria to make a referral. But now technology has made it even worse. Readers of this blog know that I am a great fan of technology in general and social networking in particular, so it may come as a surprise to hear me say this; an explanation is in order.

Recently I began to get emails from various therapists with the subject heading “Are you accepting new referrals?” or “Referral for you.” In the past I have found those questions a nice compliment. But these emails were actually invitations to join something called Referral Key, a small business referral network. The message went like this:

If you’re taking on new clients, I’d like to include you in my private referral network to send you business leads.

Please accept my invitation below. Thanks!

Here’s the problem, none of the people who sent me these emails knew me in a professional capacity as far as I can tell. We had never shared a patient, attended a fellowship together, worked at the same agency or supervised trainees at the same place. The only qualification these people would know I had if I accepted their invite was that I wanted more business.

That’s not how you make a good referral.

Look, referring a patient to someone is risky enough when you do know the therapist or the patient. Risky because we have never experienced what it is like to sit with the colleague as a patient. But at least we have some other information to go on. The nature of therapy requires that we be as thoughtful about referrals as possible.

In my experience with trainees and consulting to therapists I have come across a lot of marketing information on how to get referrals, but not a lot of clinical info on how to make them. So here are my suggestions on when and how to make a good referral. Keep in mind that these tips are a combination of my experience, opinions and pet peeves. Between emails, listservs, social networks, etc., I see a lot of different ways therapists do it.

1. Don’t treat a referral as a consolation prize. If you get a call from a patient who says they were referred to you by their insurance, and you are not accepting new patients, don’t feel pressured to offer them another name. Ideally, if you have time to offer them an initial consult you may get enough information to make a suitable referral. If they can come in, you can discuss their presenting problems, therapist preferences in terms of gender, experience, etc. If you offer free phone consultations (which I discourage in general,) you can speak with them over the phone at enough length to get a sense of the patient’s needs. For a thoughtful referral, my experience is that this takes 30-45 minutes. looking online and saying, “Jane Doe appears to be in your network and I’ve heard good things about her” may be sufficient to assuage your conscience but is not sufficient to be a solid referral. Jane may be a whiz at adult ADHD, but if the patient was referred to you for your expertise in PSTD you may have no idea whether Jane has interest or expertise in both.

2. Avoid referring to therapists who “do it all.” I never refer to a therapist who treats ages 3-80 for issues ranging the breadth of the DSM-V. The USDA deals with chunks of meat on a conveyor belt, we don’t.

3. Disclose the extent or limitation of your knowledge of the referral to the patient. If you trained with the person and think highly of them from the way they discussed their work, say that. If they are someone who responded to a listserv request you made and you know nothing about them or their work, say that. Patients trust us to give them expert opinions, and if your expertise is limited the burden of disclosing that is on you.

4. When soliciting a referral, keep it brief and salient. Don’t pepper the listserv or discussion boards with identifying information or your subjective impressions. Age, presenting problem and therapist preferences (gender, takes X insurance, CBT) are enough. So often I see referrals for someone seeking a therapist for a patient who is “a lovely, very insightful young man who would be a delight to work with.” This is more of a sales pitch than salient data. None of your colleagues are probably hoping to work with horrid, clueless people who are a misery to work with, now are they? Nor do we really need to know that the referral is for the daughter of a good friend of yours. If this is a referral that will involve collaboration (such as one member of a couple you are seeing) by all means offer to share more information if the referral works out. But in the meantime, just the facts.

5. When possible, get feedback and use it to inform your future referrals. If you referred to a colleague to treat one of your individual patients for couples therapy, ask them how it is going or went. Please take this information seriously and do not dismiss it as transference. It may be transference, but remember your alliance is with the patient and erring on the side of caution. In my time I have had folks give me feedback that the people I referred to didn’t listen, feel asleep during a session, took their spouse’s side, smelled of alcohol, and a myriad of other concerning statements. Do I know for a fact that any of these stories were true? No. Do I plan on risking referring a patient to one of those people again, absolutely not. If the person you refer to is difficult to reach or collaborate with, bear that in mind for future referrals.

6. Talk to your colleagues. Ask them whether they are taking referrals, or what kind of patients they see. Ask them what their expertise is if you are unsure. Send them an email with brief and salient information asking if this sounds like someone they’d enjoy working with. And absolutely send them a note if you give their name as a possible referral.

7. If you don’t have or want to take the time to make a solid referral, then don’t make one at all. Too often our colleagues try to come up with a name rather than say, “I’m sorry I can’t help you.” Our graduate programs rarely train us to say that. But better you say that than misunderstand what a referral truly is. A referral is a thoughtful recommendation to a patient for a clinical treatment of serious concerns. If you don’t have time to give it sustained thought, understand the concerns or help needed, don’t give a referral.

Above all, please keep in mind that social networks are great for many things, and referring patients is not one of them. If the only thing you know about a therapist and their work is that they are in your “network,” what kind of qualification is that? Don’t confuse networking, marketing, or chatting with referring someone to therapy. If you were looking for a therapist and someone said, “I got an email the other day from someone saying they are taking on new patients,” would that be sufficient for you to make an appointment? Just because I’m in your Contacts or LinkedIn group doesn’t mean I am any good at therapy in general or for a patient in particular. I could be a complete wingnut.

Do you really want to take that chance with someone’s mental health care?

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: building your business, digital literacy, insurance, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, social media, technology, therapy

Happy New Year!

January 1, 2013 by langloimsw 1 Comment

As we start the New Year I wanted to share a quote I think applies to you:

“Talent hits a target no one else can hit; Genius hits a target no one else can see.”

— Arthur Schopenhauer

Going into the New Year, entertain the possibility that you are a genius. Whether you are a gamer playing first-person shooters, a therapist trying to build your private practice, an educator trying to reach students, or someone trying to live a good life, ask yourself: What are the targets you can see that other people can’t?

Don’t expect praise, people will think you are crazy for shooting into thin air. You may be bullied, insulted or ignored, but remember you are not alone. Find that person or group who believes in you even though they can’t see your target. Those are true people of faith in your life.

Does this mean you’ll be coasting? Nope. It takes practice allowing yourself to look for things invisible to most. It takes constant effort to hone your talent.

If you play Minecraft, think of 2013 as your new sandbox. 2013 is loaded with things you’ve not discovered yet. Any rock could conceal diamonds or ore. You will encounter creepers when you least expect them, lose things and have setbacks. But you can opt for multiplayer, and build in community. All of the materials are there for you. You may think you are starting with nothing, but you always have the tools to build tools.

If you keep at it you can change the world.

Whether you are a regular visitor or a loyal follower of this blog, thank you. In case you missed them, below are the 5 most popular posts from this year:

Dopey About Dopamine: Video Games, Drugs, & Addiction

Epic Mickey and Frittering

Gamer Therapy

How to Get Taken Seriously as a Mental Health Professional

Skyrim, Stealing & Sadism

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, education, gamers, games, gaming, marketing, mindfulness, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, video games, Web 2.0

Should Therapists & Social Workers Post Videos of Themselves on YouTube?

November 16, 2012 by langloimsw 2 Comments

http://youtu.be/pWQIbIkOVtY

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!

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, children, education, Liz lasky, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social justice, social work, social workers, technology, therapy, video, Web 2.0, youtube

Contributing

September 27, 2012 by langloimsw Leave a Comment

You can sign up for Extra-Life here.

Filed Under: Gamer Therapy Tagged With: building your business, extra-life, gamers, gaming, marketing, private practice, social justice, social media, technology, video games

How to Get Taken Seriously as a Mental Health Professional

August 8, 2012 by langloimsw 8 Comments

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.

Filed Under: Gamer Therapy Tagged With: building your business, education, linkedin, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, technology, therapy, twitter, Web 2.0

Post to a Young Therapist

August 1, 2012 by langloimsw 3 Comments

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!

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, children, education, gamers, games, gaming, katamari, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, video games, Web 2.0

The Perilous Price of a Good Living

June 30, 2012 by langloimsw 6 Comments

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, HMOs, insurance, managed care, marketing, mental health parity, private practice, psychodynamic, ROI, social justice

Thinking, and Just Thinking

March 20, 2012 by langloimsw 5 Comments

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, business, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, therapy

How To Get An Epic Supervisor

January 25, 2012 by langloimsw 6 Comments

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.

Filed Under: Gamer Therapy Tagged With: building your business, education, licensure, managed care, marketing, oliver twist, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, self-promotion, supervision, therapy, Web 2.0

A Tale of Two Conferences

January 21, 2012 by langloimsw 3 Comments

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, chris brogan, education, marketing, mindfulness, psychotherapy, referrals, ROI, self-esteem, self-promotion

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

January 7, 2012 by langloimsw 8 Comments

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?

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, DCU, marketing, money, private practice, psychology, psychotherapy, ROI, social justice, Web 2.0

Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined

November 3, 2011 by langloimsw 7 Comments

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

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

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, marketing, newbie, private practice, psychodynamic, psychotherapy, ROI, self-promotion, Web 2.0

Why Ursula the Sea-Witch is My Guru

October 29, 2011 by langloimsw 8 Comments

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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Filed Under: Gamer Therapy Tagged With: building your business, HMOs, insurance, managed care, marketing, private practice, psychotherapy, referrals, ROI, self-promotion, ursula sea witch, Web 2.0

Fun & Failure

September 24, 2011 by langloimsw 4 Comments

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. 😉

Like this post? There’s more where that came from, for only $2.99 you can buy my book.

Filed Under: Gamer Therapy Tagged With: buddhism, building your business, failure, gamers, marketing, private practice, self-promotion, Web 2.0

Why Therapist Directories Are A Waste Of Time

August 11, 2011 by langloimsw 56 Comments

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.

Filed Under: Business Tagged With: building your business, HMOs, insurance, marketing, private practice, psychology today, psychotherapy, ROI, self-promotion, social justice, social media, therapist directories, Web 2.0

Integrity Is Your Brand.

August 2, 2011 by langloimsw 7 Comments

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?

Filed Under: Business Tagged With: branding, building your business, gamers, integrity, kant, marketing, private practice, ROI, self-promotion, social justice, social media, Web 2.0

Five Tips For Your Practice This Summer

July 15, 2011 by langloimsw 10 Comments

Filed Under: Business Tagged With: building your business, marketing, private practice, psychotherapy, ROI, social media, Web 2.0

Don’t Run Your Practice Like An HMO

June 18, 2011 by langloimsw 9 Comments

I was surprised today to get a letter from a local insurance company, authorizing payment to me for a session I’d done in September of last year. I wasn’t sure whether to be annoyed or laugh (I decided to laugh) and as I was grumbling about insurance companies I realized that they have taught me what to do and not do with my own billing.

Let’s face it, most therapists don’t like billing and most therapists don’t like insurance. (If you’re not a therapist, read on anyway, you might find it interesting.) Insurance companies are as a rule very difficult to deal with. They make us go through elaborate credentialing processes to join a network that pays us a fraction of our fee. And when we submit claims they often hold on to them for months, delaying our payment. Or they reject the claim because of some technicality, or request a half hour conversation with us to review the treatment so that they can find a reason to stop paying for it. Insurance companies are insulated by layers of administration and bureaucracy, and finding the person to answer the question or authorize treatment can take forever. In fact, the whole premise of insurance has been to have a large enough risk pool of paying clients that they can offset the damages they incur and still make a profit. In short, insurance companies are avoidant, outdated, and hostile to claims.

So why are we just like them?

Therapists groan about insurance companies, and yet we often act just like them when it comes to running our business. We avoid filing claims as long as we can, so that we’ll get reimbursement checks that are bigger and “worth the effort.” We avoid streamlining our billing processes. And we are extremely hostile when it comes to having to file claims to get paid.

Don’t run your practice like an insurance company. Instead, here are some suggestions for you:

1. Don’t delay your billing by unnecessary process. Take a few minutes to look at the way you process bills. Are you writing them down in a ledger, maybe more than one? Do you try to sort things by insurance company rotating different companies at different times of the month? Do you have elaborate formulas for payment plans for your patients’ co-pays? (That’s insurance fraud by the way.) Do you have a calendar that you transfer to your ledger? Or if you have a software program do you enter the same data in several different places? If you are doing any of these things, you’re wasting your time. Come up with one strategy and stick with it, and cut down the number of steps that any strategy you come up with has.

2. Don’t avoid by storing up your accounts receivable. You hate it when an insurance company sits on your claims, don’t do the same thing when it comes to your own accounts receivable. Don’t store up and hoard your accounts receivable to bill “later.” Your patients and you both deserve for you to bill promptly even if it is a $15 co-pay. Don’t drag out your co-pay billing for more than a month at most. Aside from sending a devaluing message to your patients, (“I don’t need that tiny amount of money”) it adds up and can become a source of anxiety to them. Bill out in smaller amounts on a regular basis, and if you don’t, ask yourself what your behavior is expressing about billing. Storing up your accounts receivable may present you with bigger checks later, but irregular ones. For people who know the value of consistent structure, we certainly drop the ball on this one, and then what happens? You see your bank account is low and you say, “I’ve got to do my billing.” And even if you send it out that day, you’ve just set yourself up for a few weeks of anxious trips to the mailbox to see if the money has finally arrived.

3. Don’t treat patient payments like a risk pool. When it comes to billing, don’t rely on a few consistently paying patients to help you avoid billing the rest. If you allow patients to carry a balance set a dollar figure that is consistent across all of them. Mine is $400, because I know that if a patient carries a higher balance than that I may start to get annoyed and that will create static in the treatment. My billing office thinks my limit is too high, but it is what has worked for me and allowed me to be consistent. By all means set your own limit, but don’t have 30 different billing schedules and expectations for 30 different patients! It isn’t fair to the ones who pay regularly, and it also isn’t fair to the ones who don’t. And it also isn’t fair to you. This may work for the insurance companies, but it definitely won’t work for your business.

4. Do your billing every 1-5 days. You heard me, every 1-5 days. None of this once a month or every few weeks or “when I have to” stuff. You’re in business and businesses bill their customers promptly and regularly. And here’s what’s really cool, if you bill every 1-5 days after a while you’ll begin to get paid every 5-7 days. That’s it for this one, 1-5 days, no excuses.

5. Do lose the paper. Not as in misplace it, but as in get rid of it! Many of you are probably saying to yourselves, “he’s crazy. I don’t have time to do all that paperwork every few days!” There’s the problem, you’re still using paper! Start billing electronically, most insurance companies have that capability, and there are plenty of software programs out there that can help. When I used software I would send out that days appointments at 5:30, took 15 minutes. The first few times you will need to spend more time on it by typing in things to the program’s database, but after that it goes pretty quickly. And if you can get in the habit of typing in the first part of the intake the day of the intake, that’s even better.

6. Do use a billing service. I saved the best for last. If you don’t want to do billing yourself, fess up to it. It’s a reasonable business expense to have. I haven’t missed the money I pay to my billing service CMS Billing one bit. The amount of money they have captured for me (including the check from last September) has probably offset what I pay them. In addition, they do all my billing intakes, insurance authorizations, credentialing and customer service for billing questions. The time they have freed up has allowed me to develop workshops, write this blog, and engage in other creative and lucrative aspects of my business. Remember that when it comes to owning a business you need to spend money to make money. Don’t be a tightwad, hire a billing service. Then you won’t have to worry as much about the technology part. But bear in mind that they can only bill as quickly as you report accounts receivable to them, so you still need to do that every few days.

As I write this, 97% of my accounts receivable are under 30 days. I get my money with regularity, and my patients know what to expect when they reach the $400 mark. This is possible for you as well! As this fiscal year draws to a close, take some time to take stock of your billing practices. If you’re acting more like a lending company or an HMO it may be time to change.

Filed Under: Business Tagged With: building your business, HMOs, insurance, managed care, marketing, money, private practice, psychology, psychotherapy, ROI

Being A Noob

June 11, 2011 by langloimsw 1 Comment

Over the past few months I have taken some time off from playing World of Warcraft to try a new MMO called Rift. Rift takes place in a different world from WoW, the world of Telara. It has a different storyline and although the user interface is pretty much a duplicate of WoW’s, there are many many other differences as well. I have been playing WoW for several years, and had progressed my character to level 85, the highest you can get as of now. In those several years I have been a member of three guilds, leveled 6 professions, and spent countless hours researching the internet on strategies, spell rotations, and boss strategies. I’ve traveled the length and breadth of Azeroth and Outland, and completed hundreds of quests and achievements.

And now I’m a noob again.

In Telara I’m just out of the training zone, and level 13. I have no idea where I am, and most of the map is still an undiscovered blank screen. I don’t have more then 20 points in any profession and I’m not in a guild. I’m reading new material and trying to figure out what sort of place Telara is, why the sky is constantly ripping apart as rifts from some other dimension open up and rain down monsters on me and any other players in the area at the time. I keep running the wrong way into mobs of villains many levels higher than me and dying. Lots and lots of dying. And lots and lots of running back from graveyards as a ghost trying to find my body.

Good times.

For those of you who don’t know this, being a “noob” is a term for being a newbie, a newcomer unfamiliar with game mechanics and the lay of the land. It can be a very frustrating experience. The first time I was a noob, in WoW, I had no idea how much I was learning as I was learning it. There was such a steady progression that I didn’t realize how much experience and skill I had amassed with the game until I switched over to a new game. Now it is like I have lost all of that experience and skill, and I can feel overwhelmed. I am nowhere near Rift’s “endgame,” and everything is new and weird. So why not just go back to playing WoW?

First off, I have a little faith. As I stumble through being a noob in Rift, I can remember feeling similarly clueless at the beginning of my time playing WoW. I know that I am learning a great deal, more than I can even tell, and that this sense of being overwhelmed will pass. Also, I am enjoying the heightened sense of discovery, stumbling into the city of Meridian for the first time, having chats with other noobs as we form public groups and down elites.

The last time I was on, my mage was teamed with a warlock and a warrior, and we took on an elite without a healer. We gave it all we got, and then the warrior was down and the warlock was getting attacked. As the warlock fell, and the boss approached me with only 5% of its health left I kept spamming shadow bolts at it until it got to me. Just as it killed me I set off one more bolt that killed it. We closed the Rift, resurrected ourselves, collected the loot, and I felt the same level of thrill and achievement as when I first started playing WoW.

Every gamer was once a noob. Every gamer you see in your therapy practice was once thrown into a strange unfamiliar world knowing no one, with only the clothes on her or his back and a few silver in their satchel. Those men and women in your office who have been deemed failures at school or work by parents or coworkers has tried and failed and tried again hundreds of times. They have wandered around lost in a dangerous world knowing no one, and struck up conversations with other wanderers. They’ve banded together with others to defeat powerful adversaries, worked diligently to perfect professions and skills, and you’ve known nothing about it, because you didn’t ask. Instead therapists often focus on how many hours a person plays, pathologizes gaming as an addiction, or dismisses it as a silly hobby with no clinical or real-life value.

(How many of us approach our patients’ dreams that way? How many of us ask, “how many hours a night do you dream?” or consider them to have a dreaming addiction? When was the last time you dismissed dreaming as a valueless, silly hobby.)

Being a noob takes courage, and stamina. We therapists know this deep down. Most of us gravitated to our profession because we wanted to help the vulnerable, the bewildered and the confused grow into the strong, wise and whole people our patients become. We help them map out their inner world, strengthen their coping skills through trial and error and retrial. We encourage them as they level their professions at work or school, build guilds of peers and loved ones to raid life with, and face whatever monsters they have to to heal from trauma. Let’s recognize the game mechanics in what we do, and learn from the game mechanics in what they do.

Last but not least, let’s talk business.

In the 21st century, many therapists are seeing a game change in our profession. The way we practice therapy and help our patients is changing in many ways. We can use Google to help them find the closest AA meeting, Skype with them when they are away on business in Hong Kong, email them DBT worksheets or set up mindfulness reminders for our groups on Twitter. Even if we avoid using these technologies with our patients, they are trying to talk to us about bullying via Facebook, sexting on their iPhones, or falling in love in Second Life or World of Warcraft. In the 21st century, technology is no longer negotiable, it is embedded in virtually all treatment issues one way or another. And so therapists are noobs once more. This doesn’t mean that we can’t still practice psychotherapy the way we always have. But do you think that that should be our prime goal, to do things the way we always have?

When I first advertised on Google, I paid .10 a click. Nowadays colleagues in my area are paying upwards of 6$ a click to be visible. Having a Google ad or website is now pretty common. Between changes in social media and healthcare, many of my colleagues and the therapists I consult with are finding that the game has changed again, and they feel frustrated and bewildered like they haven’t in years. They’ve become noobs again.

Being a noob isn’t bad, although it can be uncomfortable. But what I’ve learned from fellow gamers is that being a noob can be fun as well. The key is to keep your sense of humor, and not take having to learn new things as an insult. I sometimes hear colleagues express outrage at having to do things differently to grow their business, and heaven forbid they spend money on coaching or business planning or consulting with someone who has more expertise than they do! The subtext is “How dare I be treated this way?!”

Change isn’t meant to single out and insult you, lighten up. Of course you should be learning new things, and leveling up. Have a little faith that you are learning even though it feels clumsy. We keep trying to get to this “secure” place where we’ll never need to stretch or do something different, and it just doesn’t exist. We need to cultivate what my colleague Chris Willard refers to in his book of the same title as our “Child’s Mind.”

In other words, we need to embrace being a noob.

Filed Under: Gamer Therapy Tagged With: building your business, chris willard, gamers, gaming, marketing, noob, private practice, psychotherapy, rift, therapy, video games, Web 2.0, World of Warcraft, wow

Therapist Websites Are Not Enough

May 22, 2011 by langloimsw 25 Comments

Last March a friend and former graduate student I supervised was visiting me from out of town. He was telling me about a call he got that went something like this: “Hi Bob, great website! Would you like to do a workshop on creating a online presence for our chapter of NASW? You won’t be paid for this, but you’ll get exposure, what do you think?”

This sort of exchange contains every element you need to have to teach a lesson on how not to do things as a Web 2.0 therapist. Let’s break this down:

1. What you are doing is so valuable we’d rather not pay you for it. Anything that you would go to a workshop to learn is something you should be willing to pay for. Even if it was only $20, a small amount or honorarium is something you should offer when you recruit someone to help you. Offering a rationalization is not the same thing; if my former student needed exposure the last place to look for it would be from this cheapo crowd! I know we have had a longstanding tradition in the psychotherapy disciplines to expect that we will present papers or talks at big yearly conferences for free, and that kind of thing seems a little different in my mind, because they are national conferences or Symposia and have many presenters. But to recruit someone specific for a specific workshop and not pay them any honorarium seems both cheap and arrogant to me.

2. Online Presence=Having a web site. Wrong! A website is just one small (important, but small) part of having an online presence. Having a website is something you should have prior to trying to launch your online presence. Now opinions vary on how to get one. I have some colleagues who know this space who believe that Therapists need to hire someone to build a website for them, and I can see the merit of this. My own opinion is that WordPress and our current technology have made it possible to have a very professional website for a fraction of that price if you are willing to spend some time and a little extra money to get a framework like Genesis. That is the one I use, and this site is one that I was able to design and launch pretty quickly. I have an older site that is still out there, but doesn’t get anywhere near as many hits now. That being said, I do think that whether you build one or have a professional do that, you definitely ought to have a professional critique it. My colleague Juliet Austin has a expertise doing this, and having been in the market for a while, she has a great eye for dos and don’ts.

But having a website is not an online presence in 2011, it is a colorful classified ad. Yes it is necessary now that potential patients want to see and meet you before they see and meet you, but now that there are thousands of Therapists with websites it will not distinguish you much more than a Psychology Today profile. Having an online presence requires you have a vibrant combination of interactive dialogue, recommendations that establish your “brand” as a therapist, multiple forms of media to see, hear and read you, and some amount of change over time.

I’m not trying to discourage any of you from getting started online with a website, I just want to make sure you see it is only one component of having an successful online presence.

3. Professional Organizations need to become more professional when it comes to business and social media. Asking your constituents to take the lead without compensating them is just lame. But even more concerning are the attitudes I see many organization taking towards social media. One example recently was a workshop NASW was promoting on HIPAA and Social Media. The flyer began with the bold red words “Protect Yourself!” The workshop like many others I have seen approaches the Internet and Web 2.0 from the point of view of fear-mongering, if the advertisement is accurate. Be scared of social media. Don’t learn how to use it for marketing your business, let alone your clinical work. This is not the message we need from our leadership. Include a component on social media in a general ethics course, sure. But please stop fostering the association of technology with ethical risk, social media with liability.

Our professional organizations also need to put the same thought and care in finding expertise when it comes to Web 2.0 as they would other workshop topics. Would we ever email a colleague and say, “Hey, want to do a workshop for NASW on EMDR?” based on information as limited as a website? I doubt it. As leaders of our profession, our professional organizations need to treat the topic of social media and health care with the same care as other topics. Their endorsement gives an imprimatur. If they say, the only thing you need to know about social media is to avoid it or you’ll be sued, we learn nothing but fear. If they say, social media requires no expertise or experience, we underestimate the skills we all need to learn to use it.

Bob is a great guy and an excellent clinician, but his having a website doesn’t make one an expert. Being on Facebook or Twitter doesn’t make one an expert. Having 5-15 years of experience working in the space of Web 2.0 like Juliet, Susan Giurleo, or myself does. These are peer-vetted experts, experts vetted by peers in both the clinical and Internet fields. I used to be hesitant to say this, because even though I teach people how to self-promote as part of their business I still feel uncomfortable with it myself. But I feel it is important to make a distinction between people who have spent years and thousands of dollars learning how to integrate clinical practice and Web 2.0, and your colleague who has a nice website.

Look, we need to start taking social media seriously, 97% of our patients and other human beings use it. I applaud our professional organizations for trying to offer something. But the above approach reminds me of having your grandson hook up your DVD player when he comes home from college. It is shortsighted and underestimates the complexity of the matters at hand. At some point Therapists need to strike a balance between a healthy respect for the growing importance of social media and avoidant fear. And at some point we’re going to need to invest time, money, and serious thought into how, not if, we use it in our practice.

Filed Under: Business Tagged With: behavior change, building your business, marketing, private practice, psychotherapy, ROI, social justice, social media, twitter, Web 2.0

Fear Is Where You Start From

May 9, 2011 by langloimsw 14 Comments

Recently I was having dinner with some colleagues, who were discussing the state of mental health and managed care. When these conversations start I sometimes begin to sit back, because I anticipate the worst. I expect that there will be some insurance bashing, and then discussion of how their salaries have shrunk, and how unfair the current system is, maybe a smattering of how better things used to be for our profession and concluding with uncertainty about how much longer they can stay in business. I expected this conversation to go the same way, and was preparing to decide whether to try to advocate for another, more empowering perspective.

I was pleasantly surprised.

The conversation did indeed start with the understandable concerns of therapists trying to grapple with the seismic shifts in our careers and businesses. But then one of them began to talk about how he was planning to change the way he did business. Others expressed curiosity about the things he was trying, and I finally offered a couple of ideas. When they found out that I provide consultation on building & maintaining your therapy practice, they were 100% enthusiastic and eager to hear some positive perspectives. They were able to hear my opinions of some tough truths, that we had bought into the managed care model because we were reluctant to market our businesses and have difficult conversations with patients about payment. No one was defensive at all, one even invited me to come talk with a local group of colleagues. At one point they made a joke about my “secrets” for success, and I told them I am not one of those people who holds back secrets to hook people into working with me, and that they could find a lot of free info on my site.

“I was kidding about having a secret,” one told me. “You don’t have a secret, what you have is a strategy.”

The Buddhist teacher Pema Chodron writes in her book of the same title, about going to “The Places That Scare You.” The goal of the Tibetan Buddhist practice of tonglen, or taking and sending, is to reverse the normal cycle of human existence. Rather than seeking out things we desire and avoiding suffering, the meditation practice of tonglen asks us to imagine inhaling and taking in the suffering for all sentient beings and exhaling happiness to send it to all sentient beings. Whether you believe in the mystical qualities of this, the principle is a useful one in that it teaches us to break the instinctual habit of trying to holding on to the things we like and get rid of the things we don’t. A version of this is going to the places that scare you, rather than running away from them.

The clinicians I have mentioned above are well on their way to maintaining and vastly improving their private practices, and its got nothing to do with me. They have realized that fear is real, and that it often is mistaken for the end of the line. They get that it is the opposite.

Fear is the place you start from.

People who deny that things are changing are in my opinion in for a rude awakening. They deny the way our profession is being challenged, the importance of emerging new technologies, and the evolving practice of psychotherapy. They deny the things that would evoke fear in them. This is not unique to therapists of course. Ironically, we often work trying to help patients see the devastating impact on their lives of repressing anxiety-provoking truths. Then we turn around and do the same things to ourselves, hoping that this change in economics or technology is “more of the same.” Folks in this group are in pre-contemplation of fear, they haven’t even gotten that far.

Then there are clinicians who have gotten that things are really changing, and they are terrified! They are paralyzed and miserable, commiserating with others and talking about the way things were in the past and how much better they were then. They see the point of fear and they think of it as the period on a life’s sentence of struggling. This is the end of our careers, we can’t learn to use technology, therapy is a dying art form. They give up, and go out of business in a lingering dwindling sort of way.

Fear is not the endpoint. Fear is where you begin. Fear is where you get going and hire a coach, research and write up a business plan, take a workshop on business development, marketing or integrating new technologies. Fear is the start of renovating your practice. Yes there is a lot of suffering in the world, let’s get going and reduce it.

Epic Therapists know all about fear. They aren’t fearless, there’s a lot to be worried about. Many businesses fail, money needs to be spent to make money later, there are long hours ahead and no structure but the one they give themselves. There is a lot they don’t know, a lot they’ve never learned to do to run a business, known expenses and surprises. But Epic is running toward that dragon, knowing this could be an epic failure, being afraid… and then doing it anyway.

Epic Therapists have learned the concept of “nevertheless.” I am scared that my business will fail, nevertheless I am starting it. I am afraid that I’ll rent an office full-time and not be able to find patients, nevertheless I am going to rent one. I am afraid I’ll sound inauthentic or greedy if I talk about my business to a colleague, nevertheless I am going to talk about my business. I am afraid no one will want to pay my fee, nevertheless I am going to set a firm “bottom line” fee for myself. I am afraid that I won’t be able to keep up with the changes in healthcare or technology, nevertheless I am going to make a strategy.

My last post about having a secret headquarters was fun to make, and it was also serious. We need to have a time and a place for strategizing. We can absolutely have fun doing it, but this is serious business. There really are things to fear in healthcare, building a private practice and starting a business. We need to think carefully and plan, and then we need to begin.

Filed Under: Business Tagged With: behavior change, buddhism, building your business, epic therapist, fear, insurance, managed care, marketing, pema chodron, private practice, psychotherapy, self-promotion, social media, Web 2.0

What I Learned at Pax East.

March 12, 2011 by langloimsw 4 Comments

For those of you who aren’t in the know, Pax East is a 3 day event founded by Penny Arcade a great website for online comics and other fun stuff. Pax East takes place in Boston, and this is it’s 2nd year. It is a huge convention which had approximately 70,000 video, tabletop and PC gamers. Last year I went to Pax East because I had finally decided I needed to take gaming and gamer-affirmative therapy seriously as part of my growing practice. I had always thought video games were fun, but it was only over the past 10 years that I had come to see that they could be life-changing.

I had discovered firsthand how World of Warcraft, Mario, and Zelda had helped me recover from a terrible job loss and re-evaluate what I wanted my work and life to be like. I had met dozens of gamers in-game and out who were recovering from various life struggles through gaming. I met soldiers stationed in Iraq who were gaming to keep their morale up or stay in touch with their families. I met LGBT people who had come out and found community for the first time in a Warcraft guild. I met people who had fought off isolation in other countries by raiding with loved ones at home. Still more had survived a divorce, discovered a way to rebuild confidence when they’d lost the ability to walk, or taken the first steps to socializing when their autism had stigmatized them and all seemed lost.

I also began to meet a growing number of young men and women who were refusing to be labeled as addicted or abnormal by virtue of their gaming experience. And I began to wonder what it would be like if as a therapist I came out as a gamer and helped people begin to take video games seriously.

At the same time I began to realize that I needed to take my career more seriously, because I had decided to start a full-time private practice. I had had a part-time practice for over a decade, but it always felt like a hobby. And so when I began to float the idea to family and colleagues I was amazed by their response.

They took me seriously.

Anyone who has launched a business can probably identify to some extent. You spend a lot of time wishing, and then daring, and when you finally decide to tell others you find that they have a far easier time taking you seriously than you do yourself. It was as if the company I’d helped built, my education and my CV were all fluff in my head.

If I had a hard time imagining myself as a independent businessman and a full-time private practice therapist, you can imagine how hard it was to imagine being a successful therapist who specialized in video games, virtual worlds and social media. Sure I could justify playing video games with children I worked with, but a gamer-affirmative therapist? This was a harder row to hoe. I had people thinking I meant online gambling and referred gamblers to me. I had colleagues who pretended Facebook didn’t exist and glazed over when I told them about the social media company I had helped develop. And most often I had this response.

“Oh, I don’t know anything about video games.”

This from colleagues who were throwing out the term gaming addiction willy-nilly. So I knew that I had a couple of choices, keep quiet or begin working with gamers and educating psychotherapists about what video games actually are, and what they can do for us. And I decided that if I was to really try to educate people on video games and doing therapy with gamers, I’d have to take myself seriously. And that is where Pax East and Blizzcon came in.

Where better to meet gamers than in those places? And what better form of continuing education for me than to see what is happening in the gaming world? This was part of the work I wanted to do, and the only thing holding me back from engaging in it seriously was that I felt guilty for having fun. From graduate school and continuing education I had learned that education was serious and not necessarily fun. But when I took the plunge I found that the money I spent on travel and the conferences was totally worthwhile, and the people I met were really interested in my work. This is something my colleague Susan Giurleo wrote about recently regarding another such convention that she is going to, SXSW.

I’ve learned a lot in the past two years. Last year at Pax East I didn’t have nearly as much fun as I did this year, because I felt like I needed to be there every minute and take everything seriously. This year I went Friday and picked a few things I wanted to do, like attend Jane McGonigal‘s keynote speech. And I took fun more seriously and learned more. I got a sneak peek and play of the Nintendo 3DS. I got to watch the amazing new XBox Kinect game Child of Eden. I walked around all day with a Plants Vs. Zombies traffic cone on my head. I participated in the largest massively multiplayer thumb-wrestling match in world history! And all around me I saw happy and energized people playing and socializing with strangers.

I was reminded of the things I tell my supervisees all the time, that if you aren’t enjoying yourself in your work something is wrong. Because enjoying yourself helps you achieve a state of believing that success is possible. And that the people who settle for less in their work get less. Such optimism is crucial, because running your own business takes a lot of time and effort. I have never worked as hard at a job in my life, and I have never loved what I do as much as I do now.

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, marketing, Pax, private practice, psychology, psychotherapy, video games, Web 2.0, World of Warcraft

Tweaking 2011

January 6, 2011 by langloimsw 5 Comments

This is my first blog entry on Evernote. I’m excited about that because learning and trying out Evernote is one of my 2011 goals. More about that in a sec.

One of the reasons I love supervising therapists is that it keeps me honest and focussed on innovation. The other night I was talking with a supervisee about scheduling our time for the upcoming year. Would an evening time on another day work better for me? (Quite a thoughtful supervisee, not an uncommon experience given our field.) I found myself answering that I wasn’t sure yet, because I needed to re-evaluate my evening time. I have been noticing a drop-off in my work with adolescents, and have been coming to the conclusion that if I want to keep working with adolescents I’ll need to give up some of my evening time.

This time of year is an excellent time of year to give your practice and your career the lookover. In the past several years I have gravitated to more traditional hours so I could pursue other projects. For example, my professional development and networking goals for the past year and a half have been fulfilled by my Fellowship appointment at the Massachusetts Institute for Psychoanalysis. In 2009 I identified the need for more collegial contacts and friendships as well as wanting to have CEs for my license. The Fellowship has provided me both in abundance. Like many of my actions to meet my goal, the MIP Fellowship was a “twofer.”

I always try to have as many twofers or threefers as possible, so that I don’t overwhelm myself with actions to meet the multiple goals. Twofers are important to me because I want to consolidate my actions, but not my goals. So I list my current goals and then put the actions under the goal(s) it fulfills. I also rate it hot or backburner. That way if I have a few actions I make myself evaluate the relative strength of my interest to do each. So follow me along for an example:

Professional Development Goal

MIP Fellowship- heading towards backburner. This is my last year of it, and I’m ready to move on to a different structure and get my Monday night back.
Program Exploration – hot. I need to begin planning on what I will do to replace the Fellowship, which means taking a look at workshop or mini-course offerings or webinars that happen during the day. Am I willing to give up my weekends yet? Traditionally I have balked at Saturday workshops, so I am revisiting this.
Continuing Ed on cultural competency working with transgender population- hot. My practice has been trending towards an increase working with this population, so I need to invest time in updating my skills in theory and best practices.

Clinical Therapy Goal

Adolescents- hot. I have noticed that I am trending downward in my work with adolescents, a population I love. Most adolescents require parental transportation and can’t miss school regularly, so I need to revisit my giving an evening up. Saturdays? No. (This is an excellent example by the way, of how there is no one right answer for this. My colleague Susan Giurleo regularly works an evening and Saturday, and there are lots of good reasons for doing this. I have consciously chosen the last 2 years to not have an evening because the evening time was more valuable to me than the money I was choosing not to make. Choosing not to make money is different than saying, “why can’t I fill my practice, whoa is me.” Money is one item of value, time is another, it is up to you to choose what you want to give up.
Gamers- hot. I want to continue to focus on working with more gamers. I need to revisit where and how to get referrals. This year I will try to offer more public speaking opportunities to colleagues to increase awareness of gamer-affirmative therapy. Also will use Twitter to remind my followers of my interest in working with this population.
Couples work- backburner. Even on my best day, this is not my preferred modality. I will maintain my “no more than 3” couple limit, but am tweaking it to focus on private pay, gamer couples or online therapy.

Technology Goal

Twitter-hot. I continue to find Twitter useful, but am tweaking it a lot. I will use it to Tweet blog articles or RTs and hold to my goal of 2RTs and 2 salient tweets (i.e., tweeting something I think is relevant professionally rather than for the sake of Tweeting. Recently I have fallen short of this goal because of the magnitude of tweets that come my way. Will add this to my Epic Win program and scale back on how much time I spend reviewing. Will keep an eye out for Tweet-management software to see if I find any I like more than TwInbox.
Evernote- hot. I have heard about how great Evernote is for too long from too many people I respect to ignore it. I will familiarize myself with this program and try using it for blogging, as well as exploring which other goals it might further.
Game exploration-hot. I have been focussing on WoW and Second Life.
Rockmelt-backburner. Still in beta and having some bugs. Still limiting access so limited as social media. Shut down and I lost a whole blog post! I am continuing to play with it a little but relying on Firefox until it gets a little more stable.

Social Justice Goal

Give an Hour-hot. I still find this a meaningful way of donating clinical time to fulfill the gap for returning vets. There is an increasing number of vets and active duty gaming, and this is a potential twofer with the Clinical goal.
Diversity Class- hot. I continue to find teaching this worth the “pay cut” I take by giving up those clinical hours. This is a twofer a teaching goal and writing goal on rethinking how we teach Diversity.
Masshealth-backburner. I am opting out of taking Masshealth due to the high cancel rate I’ve experienced in the past. This is a twofer with my business Goal below of decreasing my involvement with insurance and diversifying revenue.

Business Goal

Reduce dependence on insurance-hot. The writing is on the wall for decreased revenue and increased hassle as Health Care Reform takes effect. Leave Masshealth and UBH networks.
Increase online therapy-hot. I need to focus on increasing marketing for this modality, it is all private pay and more flexible in time to meet patients and my needs.
Increase consultation and supervision-hot. Supervision and consultation was the biggest growing area of my practice last year. Need to poll current consultees about what they find most valuable so I can emphasize that. Be willing to slide down to my bottom line to attract supervisees in early stage of their career. Make and post more video on supervision and consultancy.
Advertising-backburner. Google Ads not yielding much ROI, decrease ad bids. Stay on Psychology Today for next year but focus marketing/advertising through speaking engagements.

Teaching Goal

Additional psychodynamic class-hot. New syllabus written and course approved. Hopefully this will be offered this summer, will apply to teach it.
One class per semester-hot. This tweak from two classes one semester and one the next was a big improvement. Evaluations better, enjoyed work more. Will consider whether to make up third class by committing to summer course regularly.
Offer visiting lecture or workshops to universities-hot. This year I want to get out to more college health centers and schools for social work to present on gaming. Tufts very successful, will look for opportunities to present at other universities. Put the word out, twofer with business and professional development goals.

Writing and Research Goal

Newsletter-hot. The readership response has been positive and begun to generate revenue. Need to stay focussed on keeping newsletter relevant and yet distinct to my niche. Review of clicks indicates that the psychoanalytic topics are more popular than the gaming ones. How can I increase traffic to those stories?
Blog-hot. Now have over 100 readers subscribed, and growing. Need to continue to make this a focus. 2-3 posts weekly remains doable and will maintain 2 minimum. Again, the practice/business posts are more popular than the gaming ones, need to consider how to increase interest in those articles. This is a threefer with business and clinical goals.
Journal article-backburner. The style and tone of blogging is much more satisfying currently, will revisit later in the year to see if this changes.

So that’s my beginning of 2011 review and tweak. It took me 40 minutes to think and write about this. Don’t you think it would be worth 40 minutes of your time to do the same? What are your goals for this year, feel free to use the blog comment to get started!

Filed Under: Business Tagged With: building your business, gamers, Give An Hour, marketing, mental health parity, private practice, psychotherapy, Web 2.0

How Invested Are You?

January 4, 2011 by langloimsw 6 Comments

photo courtesy of Flickr

When you decided to become a therapist, how much time and money did you spend? Most therapists spend between three and six years (longer if they are MDs) enrolled in graduate programs that cost thousands of dollars. That’s a lot of money! But we do this because we value the profession, the work we do, and the people we help. We also do it because it’s reality. You don’t show up, knock on the door of a graduate program, and say, “hey, can I sit in on a few classes for free?” You want the education and you pay for it, by loan, scholarship or somehow.

It astounds me how this logic seems to go out the window when it comes to growing a therapy practice in a Web 2.0 world. This is probably because technology has become so easy to acquire. You want a blog? WordPress will let you get registered and started in 15 minutes. Twitter, takes 10 minutes and a valid email to enroll. So I see a lot of colleagues decide to “take the plunge,” start a blog, and then..

Nothing.

Nothing happens, or they don’t get traffic. Or they run out of ideas. Maybe they ask me for some advice, offer to buy me a coffee if I can help them with their blog. “Can we just chat?” they’ll say.

Then there are people like my colleague Carolyn, who hire me. That’s right, hire. She wanted some help with her blog, both in terms of the technology and setting it up, as well as market consultation on audience, focus, and sustainability. So she spent the time and money to do this, and even though we’ve just started working together she’s already seeing more of a focus in what she’s doing. We’re backing up and unraveling a few stitches, so that we can get her and her practice ready for the 2011 business year. Carolyn is going to thrive, and not because she hired me: She’s going to thrive because she is investing in her practice and taking technology seriously.

Taking technology seriously means at least two things:

1. Taking technology seriously means you accept that the point in history when using technology was optional is over. You can no longer ignore or opt out of using technology to have a successful practice. Whether you use email, social media, file claims electronically, request authorizations, etc., if you do not start utilizing the resources that technology affords you you will fail. I know that sounds brutal, but your colleagues will pass you buy. Web sites will trump the yellow pages every time.

2. Taking technology seriously means investing time and money in learning about it and how to use it. Just enrolling in a blog service is the equivalent to signing up for a psychology course, and then going out and hanging up your shingle. You’d be insulted if somebody implied that they could duplicate your expertise and services after taking one class or workshop.

Yet, I can’t tell you how many people approach the Web 2.0 practice that way. They’ll email me a question or two, ask for a free consult (which I no longer do) and I think on some level they are expecting that what they will get will be commiseration or something. A friendly “chat.” They really don’t take technology seriously, so they decide they’ll just do it themselves.

Where does he get off saying this?!

Let me give you a breakdown of the work I have done and the expertise that I have:

I have been a psychotherapist for over 15 years.
I co-founded a social media software company; meaning I participated in a startup business in many capacities to grow it. I pitched ideas to clients at meetings, helped orchestrate launches, analyzed client needs, kept an eye on marketing trends; wrote press releases, managed budgets and negotiated CEO contracts. Oh, and I also helped develop the product that several versions and six years later is one of the social media companies to be included in the latest Gartner Group report.
I have spent countless hours researching the changes and developments in the social media industry, and compared to my company’s employees I am behind the curve. This is because I am not involved in the company’s day to day ops, and because I am focusing on doing the other projects you read about. But I know social media, from a user experience and business perspective, and it isn’t from downloading Twitter and playing around with it or making an Excel spreadsheet.
I invested in my own supervision and consulting from top clinicians and coaches.
I have started up and grown a private practice from zero patients to a full practice in 30 weeks. I can tell you it was 30 weeks because that is the amount of unemployment benefits I received to survive on while I built it.

So I know what it is like to take the plunge and how to make it work.

I am saying this to you because you need to take technology and growing your business seriously. Sure if some people read this and want to consult with me, I’ll be very happy. But if not me, please, hire somebody. Susan Giurleo does great work, so do Casey Truffo and Juliet Austin. And Lynn Grodzki is amazing. Heck, check out a couple of people; we all have different styles, experience and foci. But accept that taking your business seriously means asking for help and hiring experts.

So, yes, of course I am marketing for your business, but I am also trying to convey something more: If you do not invest in the time and expertise to build your practice in the 21st century you will fail.

P.S. If you want to get help on generating blog ideas, a great source is Chris Brogan’s service, and yes, you’ll have to pay for it.

Filed Under: Business Tagged With: building your business, casey truffo, chris brogan, consulting, juliet austin, lynn grodzki, marketing, private practice, psychotherapy, susan giurleo, Web 2.0

2010 in review: Some Statistics and Most-Read Posts

January 2, 2011 by langloimsw 2 Comments

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 6,600 times in 2010. That’s about 16 full 747s.

In 2010, there were 35 new posts, growing the total archive of this blog to 47 posts. There were 69 pictures uploaded, taking up a total of 470mb. That’s about 1 pictures per week.

The busiest day of the year was November 5th with 216 views. The most popular post that day was Showing Up for No Shows.

Where did they come from?

The top referring sites in 2010 were linkedin.com, twitter.com, facebook.com, mail.yahoo.com, and mail.live.com.

Some visitors came searching, mostly for venn diagram 2 circles, venn diagrams, venn diagram circles, venn diagrams for kids, and blank venn diagram 2 circles.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

Showing Up for No Shows November 2010
14 comments

Want a Private Practice in the 21st Century? Get a Thick Skin. November 2010
12 comments

The Truth? You Can Handle The Truth. October 2010
10 comments

Referrals, or, Flossing the Gift Horse October 2010
13 comments

About Me July 2010

Filed Under: Gamer Therapy Tagged With: building your business, gamers, marketing, private practice, psychotherapy, Web 2.0

Want a Private Practice in the 21st Century? Get a Thick Skin.

November 23, 2010 by langloimsw 13 Comments

Photo courtesy of http://www.rhinos-irf.org/

Many therapists go into the psychotherapy field because we are sensitive to the feelings and behaviors of others. In the clinical session, this is very important. Even if you aren’t a Self Psychology-oriented treater, empathic attunement is crucial to understanding your patient and meeting them “where they’re at.” People often come to therapy hoping for and expecting a corrective emotional experience, and usually that is an unspoken part of the therapy contract. Patients desire to be understood and heard; therapists strive to understand and listen. In this, sensitivity to what the other is communicating is key.

This is not always recognized by those outside our profession: Many times when we are asked what we do, and when we reply that we are therapists, we hear, “Oh I could never do your job, I’m too sensitive.” Yeah, I can do this job because I’m a really callous asshole. I don’t ever say that in reply, usually I don’t mention I’m a therapist (if someone asks me what I do I usually leave it at, “I do interiors.”)

However, there is a place for insensitivity in owning a private practice, and that is what I want to talk about today. Many of you are excited to begin practicing in a Web 2.0 environment. You have your Twitter account, your professional Facebook presence, etc. But are you psychologically ready for what comes next?

Recently I did a blog on Gamer-Affirmative therapy. It got many positive responses that I don’t remember clearly, but one negative one of course stuck with me. The colleague wrote on a bulletin board, “…it’s just a PR stunt. “Gay affirmative-Transgender affirmative- bla bla bla” Don’t use it…sounds stupid.”

Ouch.

I could get huffy, refer the person to my earlier blog on managing your online presence, but I’m not going to do that.

What’s more, if I have a thick skin, I can look at the comments more objectively, see if they are pointing out something of value to me, something about an idea or plan I hadn’t anticipated. If they do, good deal! If they don’t, can I let it bounce off and move on to the next one without ruminating about it too much?

If you are planning on venturing out here with your practice, are you prepared? Can you take the good with the bad? Can you shake off the hurtful comments? Better yet, can you learn from them? Sure we’d like everyone to communicate on the web in a respectful, polite way. They don’t. Can you deal with this and move on? If you find yourself scrolling down to that comment or email and reading it for the umpteenth time and you haven’t learned anything from it or calmed down, you are not dealing with it and moving on.

Last word, don’t rush this: If you aren’t sure that your idea or practice focus is “ready for prime time,” who can you share it with that you trust will be more compassionate?

Oh, and if you want to donate to the International Rhino Foundation, click on the photo! 🙂

Filed Under: Business Tagged With: building your business, empathy, marketing, private practice, psychotherapy, rhino, self psychology, Web 2.0

Content is King, Quality is Queen

November 13, 2010 by langloimsw Leave a Comment

photo courtesy of Flickr

Colleagues who are connected to me via LinkedIn, Facebook, or this blog have probably noticed by now that you get a lot of communications from me, sometimes daily. I Tweet at you, send you newsletters, advertise upcoming workshops and webinars, and post blog updates. I do this for a couple of reasons; the first and probably obvious one is that I want to stay on your radar. I want you to be talking to someone about their patient who does some gaming thing and be able to say, “Hey, there’s this therapist, Mike Langlois, who does workshops and consults on gaming, let me give you his email.”

The second reason I do all the communication is that it helps keep me honest. Here’s how: I truly don’t believe in putting things in your email or website that is worthless. I really do stand behind everything I send you with the conviction of its value. Because that in my opinion is the major thing that separates the professional from the spammer. Web 2.0 has given us dozens of new ways to throw messages at each other instantly, frequently and from anywhere. What has not kept pace with that is content. So that is why I say content is king, and I am convinced that the next shift we will see in the Web 2.0 world is when people get tired of the bells and whistles and even more discerning about the content. This goes hand in hand with why privacy will never go out of style even on the internet, but that’s a blog for another time. Now I certainly get the occasional “unsubscribe,” and I confess that enthusiasm sometimes has me err on the side of risk, and get a note saying my material is not appropriate for the discussion group in question. But I have never gotten feedback to date that there is no value in the material, that it lacks content. That day may come, but it hasn’t yet.

But if content is King, then the other member of the Royal Family, Quality, is queen. Sure, sending you any article published on the APA website is content, but that isn’t what makes it quality. What makes it quality is that it has been filtered to you through the lens of my discernment. If you look at my blogs and newsletter you will notice some general trends and areas of interest in what I call to your attention. Hopefully my Tweets have that as well. Quality is the flavor of my discernment that filters the content I send you.

This is not to say that other articles are not high-quality, follow Psych Central on Twitter and you’ll see hundreds of quality articles, essays and posts each week. But I don’t want you emailing me to consult with you on couple’s treatment, not my area of expertise. I want you to keep me in mind for a few specific things: Web 2.0 psychotherapy, gamer-affirmative therapy, psychodynamic theory, GLBT, diversity and social justice. Even that is too much for a niche, but those are what I am good at and innovative about, those are my best qualities as a consultant and therapist. What quality do you bring to your patients, your practice, and your business? What will make you stick in our minds, for when we really need you and no one else?

Filed Under: Business Tagged With: blog, building your business, content, marketing, psychotherapy, self-promotion

Showing Up for No Shows

November 4, 2010 by langloimsw 15 Comments

photo courtesy of Ihasahotdog.com

Every therapist I know has to deal with the inevitable missed appointment. This blog is not about how to set up your cancellation policy, explain it to patients, and most importantly adhere to it. If you are interested in my basic thoughts about that you can surf on over to my site for my cancellation policy and download the intake form which has it, as well as email me with questions.

No, today I want us to think about how you show up for your no shows. Most therapists I know use their no shows to play a game of “catch-up.” They catch up with notes, catch up with phone calls, catch up with emails, catch up on the news, catch a few ZZZzzzzs in the chair. Note the progressive nature of the catch-ups: It goes from things you really should have dedicated time in your week/day for and easily degenerates to self-care before you know it.

I never thought I’d use the phrase degenerates into self-care, but there you have it. And I say it because on a meta level it is actually not self-care in the long run. Ok, I have times during the week, a few 90 minute blocks that I have built in to have my “catch-ups.” And if I get all my work stuff finished in the first 30 minutes, which I usually do, I go on to some self-care extras, like a walk on the Charles River near my office, surfing the net, reading on my Kindle or a quick nap. But these are extras, I schedule self-care time in my week regularly, even color-coding it on my Outlook calendar so I have dedicated times for that. So if you have your self-care scheduled, and you have your “catch-ups,” scheduled, that leaves your no shows.

No shows are used for me as additional times to work on my ongoing projects to build my business beyond the office. They include:

Blog posts like this one
Research for my newsletter
Writing a syllabus to propose to teach at the colleges I teach
Writing a workshop application for CEUs
Videotaping a webinar or short web feature to post on my blog or site
Tweeting some of my required Tweeting (I try to Tweet 4 times a day, 2 original tweets, 2 retweets of quality content from others)
Surfing Technorati or Mashable to keep abreast of recent developments in the blogosphere
Designing some Freebies I give away to promote a webinar or workshop
Creating a workshop for helping therapists deal with managed care
Test-driving new (or new to me) online games like Everquest, Aion, or Civilization V
Checking out new apps for the iPhone or iPad

Those are all things I have done in the past month or so when I have a no-show. They allow me to continue to work on the overall business plan I have and get me started on projects that I used to complain I had no time for. I don’t waste time seething that I’m losing money or call a colleague to complain. From the business perspective, the only negative in a no show is the “no” at the beginning of that phrase. As Bettye LaVette would say, I’ve got my own Hell to raise.

How about you? How do you show up for your no shows?

Filed Under: Business Tagged With: building your business, marketing, negativity, no shows, private practice, psychotherapy

Secret Formula PB+5

September 22, 2010 by langloimsw 12 Comments

I have frequent consults with beginning or seasoned practitioners looking to get on Medicaid as private practitioners. Their logic on the surface makes a lot of sense coming from their agency backgrounds. A majority of their patients in agency are on Medicaid, and they may want to keep them as they transition to private practice. And many of us went into this work because we want to help a range of people, including the most impoverished or differently abled. These are laudable goals, and I want to assert that they are not incompatible with private practice. But I do think that Medicaid is, at least in terms of building one.

What happens when your patient misses their appointment? With Medicaid you cannot charge them for a missed appointment. And after they miss two or three, you may have the conversation about “are you really interested in treatment?” They say yes, miss again, and you fire them, or don’t call them back and feel guilty and frustrated; or they drop out of treatment feeling like they’ve failed yet again. And in Massachusetts, the newest vendor of Medicaid, Beacon Health Strategies, is trying to change the provider contract to say that you are not allowed to fire them for no-shows! Outrageous, but hey, you signed the contract, so until NASW or APA fights this statewide that is your agreement.

This is such a lose-lose! Private practitioners are not able to make a living, low-income patients are not able to get consistent treatment, and everyone feels like a failure, except the insurance company which pays nothing. But there is a way to build social justice and healthy treatment into your practice right at the beginning, I call it my Pro Bono + 5 session.

Imagine this, you decide that you want to start out in private practice, and while you are building it you want to be able to take referrals from your old agency, which usually has mostly Medicaid patients. So you call them and let them know that you have 2 immediate openings for your pro bono plus 5$ sessions.

Your what?

You explain that while you don’t take Medicaid, you are offering two sessions in your practice where you contract with the patient that as long as they are on Medicaid you will never charge them more or less than $5. You don’t participate in Medicaid, but you won’t bill Medicaid either. You’ll only ask them for a nominal $5 fee payable each week as part of your committment to building a socially just practice. When you meet the patient, you explain this to them, and explain your no-show policy. They keep their appointment, they pay the $5. They miss the appointment, they pay the $5. If they’re sick or unable to make the session, you’ll gladly offer them a phone session, because they’ll still be paying the $5. This is made clear the first appointment, with whatever your normal policy is. You see, you can’t do phone therapy on Medicaid, but on your PB+5 plan you can. For the patient, they are getting a great discount and affordable treatment. For the beginning private practitioner you are getting great clinical experience, including talking about the fee and your therapeutic contract, and feeling like you are doing some diverse work, which hopefully helps you feel more confident in being circumspect when filling the rest of your week. The referring agency gets to win in that they can refer someone immediately. Win-win.

This is not a new concept. Freud created the Vienna Ambulatorium to provide free psychoanalysis almost 90 years ago. We all know that Freud saw many upperclass patients, but he also allotted some time for low-cost or free treatment. You can do the same. And I suggest that you set a fixed number of sessions right at the start of your practice, which will help you later keep the number of full-pay or insurance appointments fixed as well. So what do you think?

Filed Under: Business Tagged With: Ambulatorium, Freud, low-cost therapy, managed care, marketing, private practice, pro bono, psychotherapy

Thinking, and Just Thinking

How To Get An Epic Supervisor

A Tale of Two Conferences

Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined

Why Ursula the Sea-Witch is My Guru

Fun & Failure

Don’t Run Your Practice Like An HMO

Being A Noob

What I Learned at Pax East.

Tweaking 2011

How Invested Are You?

2010 in review: Some Statistics and Most-Read Posts

Crunchy numbers

Where did they come from?

Attractions in 2010

Want a Private Practice in the 21st Century? Get a Thick Skin.

Content is King, Quality is Queen

Showing Up for No Shows

Secret Formula PB+5

Mouse Over My Pic For A Secret Message..

Epic Tweets

Ye Olde Vault

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Crunchy numbers

Where did they come from?

Attractions in 2010

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Mouse Over My Pic For A Secret Message..

Epic Tweets

Ye Olde Vault