When They Hate You.

Many therapists I work with dream of expanding their practice to being a consultant and presenter. In our initial appointments they ask me with a lot of excitement about my experience doing these things. And I am usually very positive and optimistic about it. But although I am “living the dream,” there are many rude awakenings along the way.

One such awakening came this week when I received my evaluations back from a recent talk. Out of the 760 people who attended, 566 of them did evaluations. It isn’t often that I have a chance to get feedback from 566 colleagues at once. What struck me is how I tended to react to them and how I had to fight the urge to focus on the negative. If 535 people rated me as good or excellent, my eye was drawn more often to the 2 “poor” ones. No matter that .35% is a really small percentage, that fraction of a percent that delivered a poor rating was hard to overlook.

The comments were even more challenging, as I noticed that my eyes flew over comment after comment describing me as interesting, great, edgy, fresh, thought-provoking, relevant, a gem, and passionate. But boy did they stop when I read this: “His bias towards media enraged me,” or this: “Seems like he has a chip on his shoulder, perhaps because he was told he had poor social skills.”


Would-be presenters please take heed. When you put yourself out there, people will take shots at you. This will hurt, even when it is a fraction of a percent. Part of what hurts is the asynchronous and anonymous nature of these comments, because you have little recourse to respond, correct an error you may have made, or just plain defend your point of view. But if you want to do public speaking, you’ll need to get a thick skin.

Part of why you need a thick skin is to allow for the accurate appraisal of your work. Here’s how I do it:

I divide the critical comments into one of three categories: Absolutely Useful, Fair Enough, and No ROI.

  1. Absolutely Useful: These comments are ones that don’t make me defensive, where I can imagine myself saying to the person, “absolutely.” An example of this kind is “it was somewhat difficult to follow along in the booklet because he seems to have changed the order of slides.” This comment was extremely useful, as I can put more emphasis in my prep to not change my slides at the last minute. This is an easy fix, and will benefit the audience.
  2. Fair Enough: These comments do make me a little defensive, but there is some benefit in spending time to acknowledge or address them. I can imagine myself saying “your point is well taken, however…” For example the comment “limited research” is fair enough. Your point is well taken, however I was only allowed 45 minutes to present, and needed to choose from my copious slides only 60. Another commentator expressed that they wished I had spoken more about the impact of violent video games and how they are a problem. This is fair enough, however there are plenty of places people can get that information or misinformation, and few places that they can get my take. What I can take from these comments are points to consider weaving in or addressing when there is more time.
  3. No ROI. These are the comments that are clearly ad hominem arguments. A good clue is if they hurt my feelings or make me feel extremely defensive. “Seems like he has a chip on his shoulder, perhaps because he was told he had poor social skills” is an example of this sort. There is little return on investment of time or energy I should expend on this. Who knows why a person would think that comment would help anyone, but more importantly, how would it help make a presentation’s argument more effective? These need to be set aside ASAP to focus on more helpful comments.

The irony is that the most useful comments are usually not the ones that are extremely validating or invalidating, but matter of fact, like the slide order comment. The job of a presenter is to become a better presenter. Whether you like the information and opinions I present is none of my business really, my job is to present it.

In my opinion, part of what makes a person an effective speaker is also bound to make them hated: namely, their passion and conviction. Of course I am biased, of course I think that my point of view is important. Would you really want me up there talking about things I don’t feel or think strongly about? At an old internship of mine a colleague once asked me, “have you ever been hated by somebody?” At the time I thought I hadn’t, and said so. “That’s too bad,” she replied, “It’s very defining.”

Since then I have come to realize that I, like most of us, have in fact been hated. Merriam Webster defines the noun hate as “intense hostility and aversion usually deriving from fear, anger, or sense of injury.” People are hated because they are black, or white; LGBT or straight; rich or poor; Nazi or Jew. In everyday affairs we like to pretend this is not true, and when we do so it is crazy-making. It is often a bittersweet relief to a patient when we say, “you weren’t crazy, you really were experiencing hatred.” Finally, someone told the truth.

When I present about technology and video games, I speak out explicitly or implicitly about adultism. This comes across when I challenge people around the concept of screen time. One very prescient member of my audience stated that my message seemed to be focused on changing adult behavior, not child behavior. Bingo.

When it comes to gaming, technology, and education, we need to take a good hard look at how adultism is implicit in many of our practices. We think we know better than our youth, and we think we know better than they how they should spend their time. Back in grade school, well-meaning adults decided that my time would be better spent memorizing multiplication tables, drilling them into my mind, giving me A’s for knowing them. Yet, now I live in a world where I am never more than few feet away from my phone, laptop, or dedicated calculator, and I have to question whether that time couldn’t have been spent better learning other things. What we are taught as important is bound by the history and culture of the adults in power at the time, and it isn’t always a good thing. In retrospect, I’d have been more prepared for life if I’d learned about the subjugation of indigenous people in school rather than drawing hand turkeys.

So if you are passionate about something, it will give you the passion to devote time and energy to it, go above and beyond the workaday life that we often lead. But it will put you out in front of people who don’t agree with you, see you as a threat to what they believe as good and true. You will be hated. You will get tired and hurt and frustrated. And when that happens I recommend that you take some solace from loved ones and friends, and then get back to work.

Some posts, like this one, are written for me as much as for my colleagues and consultees. We all get discouraged and need to be reminded that we are choosing to strike a blow for freedom in whatever path we choose. But I want to give the last word to one of my commentators, who said exactly what I need to hear when I have moments of flagging confidence and doubt: “Mike’s presentation changed my outlook on technology in my professional and parenting roles. Thank you so much, from a FORMER technophobe!!”

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How To Get An Epic Supervisor

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

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

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

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

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

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

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

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

3. Do your research

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

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

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

4. Know what is important to you

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

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

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

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

No, you may not.

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

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

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

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

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

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

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

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

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

7. Kick the tires

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

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

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


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A Tale of Two Conferences

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

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

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

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

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

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

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

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

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


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.


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Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined

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

Hello Mike,

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

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

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

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

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

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


Esther Dale, MA, LLPC


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Why Ursula the Sea-Witch is My Guru

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

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

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

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

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

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

It’s not.

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

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

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

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

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

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

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

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

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


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Fun & Failure

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

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

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

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

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

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

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

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

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

Fortunately I play video games.

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

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

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

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

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

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

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


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Why Therapist Directories Are A Waste Of Time

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

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

Billboard in a bottle.

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

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

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

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

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

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

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

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

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

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

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

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

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

Integrity Is Your Brand.

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

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

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

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

But again, I had to decline.

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

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

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

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

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

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

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

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

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

Fear Is Where You Start From

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.

Content is King, Quality is Queen

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?