by Musarat Yusufali LCSW
I remember eons ago (or that’s what it seems like to me now), I was walking and talking to a colleague about being interested in DBT (Dialectical Behavior Therapy) and wanting to specialize in that. Now that I think back to that time, I had no idea what I was talking about or didn’t even know why I wanted to get into DBT. In my young mind, I was attracted by the skills that it aimed to teach and created the change people wanted. I had no idea that it actually had some basis to it.
Fast forward to today, I have done training in DBT through the Behavior Tech organization founded by Marsha Linehan, I have utilized DBT in group settings with adults, adolescents and parents and I use it in my private practice all the time. DBT is a treatment protocol that was created by Marsha Linehan that integrates acceptance and change based therapy models to treat chronic suicidal ideation and self-injurious behaviors.
As you may be familiar, Dialectical Behavior Therapy is very effective for clients with Borderline Personality Disorder (BPD) or traits of BPD. In our clinical jargon, it’s an evidence based protocol for treating patients that have high rates of suicidal ideation, self-injurious behavior and life destroying behaviors. Usually DBT treatment consistents of a treatment team that are all versed in DBT values and may include an individual DBT therapist, a group DBT therapist, a family liason or parent coach, a psychiatrist and other providers as needed.
For me, the biggest research that I found to be fascinating is the research around just adding DBT coping skills into a person’s regular therapy routine and the effectiveness it had on treatment outcomes. The PhD folks, who like numbers and data, conducted 11 research studies where they only added DBT skills component and they found it supported participants in reducing emotional dysregulation, anxiety symptoms, anger outbursts and depression. They even found, DBT skills only helped adults manage their ADHD symptoms, reduce binge eating behaviors, and reduction in drinking to cope among college students.
So imagine, you have a new client come in and they tell you they have been self-injuring for the last few years and they haven’t told anyone. This is usually what happens with several teens I work with, now what are you going to do? They tell you, they don’t know what else to do. Self-injuring makes them feel better. Imagine if you can have the DBT skill set in your knowledge base, you can immediately give this teen one or two coping skills they can start working with. If you later decide this teen would benefit from a DBT skills group in the community, they can attend group while continuing to do individual therapy with you and this treatment protocol will be more effective for them.
This is why I love DBT skills so much. I personally think DBT skills are like the floaters when someone is learning to swim, using a floater can help someone gain their confidence while they are learning to use their muscles of the feet as well as learn how to let go of their fear and learn to float. DBT skills gives the person a structure and method to deal with their external and internal struggles (a float) while they continue to work on deeper strengths (building a secure attachment, self-confidence, self-awareness).
Let me know what questions you have about DBT, reach out with an email: firstname.lastname@example.org
I admit. I'm a little planner obsessed. I'm a fan of the Erin Condren store. I have several May Design planners (buy local! woo hoo!) that I swear by. The thing is, I found myself making lists of the same things and wishing they were in my planner.
Well, if you can't find what you want, make it!
I made a daily and a weekly planner spread to help organize my therapist duties. The weekly sheet includes a places for reflection to help you get clear on what your heart needs, what you are proud of, and what you need.
Connecting with people are right up there with self-care in my books so I also make sure that there are spots on the planner sheet to make plans to reconnect with people who are important to you!
The daily spread helps you track the notes you need to write, the calls and emails you need to make but most importantly, it prioritizes.
My productivity killer is a long to do list. Thirty things on my list might be true, but it means each time I look at my list I have to figure out where to start.
This list has a place for the three things you must do. That means you don't spend time (and energy) making the decision of where to start every time you sit down with your list!
Let me know if it helps! Tag me on IG and use the hashtag #LaunchPlanner so I get to see how it's working for you!
Oh, and just cuz... here are a few of my favorite accessories!!
Erin Condren's Monthly Calendar sticker for 2018
May Design's Sticker Packs
If you're feeling a little uterus power...
Magnetic Bookmarks to keep your page
by Sarah Griesemer, Ph.D.
Originally posted on Session Notes
When I first started a private practice and decided on my fee I looked around at what other people were doing, picked a number, and wrote it on my consent forms.
Little did I know that this was exactly the WRONG thing to do when setting my fee, and it was seriously setting me up for failure. Luckily, I had a fantastic business mentor at the time who helped me figure out how to set my fee for success. Now, I get to pass along that wisdom to you. Here’s how to set yourself up for success in three steps!
1. SET YOUR FEE BASED ON HOW MUCH YOU NEED IN YOUR POCKET.Most therapists set their fee and try to get a bunch of clients in the door. Then, if they aren’t making enough money, they try to get MORE clients in the door.
This ringing any bells?
The problem with this approach is that it assumes that the fee you set is high enough that you CAN see enough clients to make your take-home without going crazy.
Let me float you an example of how this can go south: You set your fee at $75/client and set a goal of seeing 15 clients a week. At $4500 of income you find that after the first few months you are taking home around $1500 each month. Soon after, you realize this isn’t enough. Your daughter is getting braces and you need to bring home $3,000/month.
One problem is that we forget that the fee we set doesn’t cover the hour of work we do with the client. It covers ALL the work we do for our BUSINESS.
At 15 clients, when you’re done making calls and doing other tasks, you’re already working around 34 hours/week and don’t have a lot more time to add more. (I estimate for every client hour you do 1.25 hours outside of session.) Suddenly, you realize that to make the money you need, you’ll have to start working on a Saturday and miss some of your son’s t-ball games.
Unfortunately, since several weeks have already passed with you not making enough, the burden is only greater, and the panic increasing. By postponing looking at your expenses and income, you’ve only delayed the panic and made the whole situation worse…Which leads me to #2…
2. MAKE A BUDGET
It’s boring, I know. I hated doing it, too. But you know what else I hate doing? Dishes and laundry. But I do those. All. The. Time. Why? Because if I don’t I’ll end up with piles of mess everywhere.
I hate to break it to you but if you don’t budget, your practice's finances are gonna be messier than a pile of dirty dishes in the sink. It might lead to debt, financial problems, or the closing of your private practice. The best thing you can do for your practice to see it thriving is to create a budget. It will enable you to figure out your fee based on what you must make instead of what seems like a good idea.
3. FACTOR IN PTO AND SICK DAYS
If you were working for someone else, you’d have vacation days and sick days available for you. Even though you are working for yourself, you still need PTO and sick days. You’ll also need to be out of the office here and there for trainings.
Unfortunately, most people don’t factor these into their fee. Instead, when they take vacation days and their income dips, they hit panic mode and feel worried about money and anxious about taking time off. If you factor time off into your fee, you know that you’ve been able to set aside money for just this occasion! It makes the ebb and flow of private practice feel more manageable, and vacations feel more stress free!
Let me break down the above fee example for you in the real life lens…the above formula doesn’t cover days off, sick days, days your kid is sick, days your client is sick and cancels, or the normal ebb and flow of private practice. Which means, you probably need to aim for more than 20 clients to cover those things. Add in paperwork, phone calls, marketing tasks, and insurance filing (I estimate you spend 1.25 hrs on business tasks for every client) and all of the sudden you are working 50 hours a week.
But if we do the math backwards, you get a recipe for sanity. For example:
My take-home (profit) must be: $3000
My expenses are: $3000
So I need my income to be: $6000
I’ll factor in PTO, vacation days, sick days, cancellations, and general ebb and flow of clients: I’ll estimate 2 full working days a month.
I have the bandwidth to work 40 hours/week which means about 18 client hours (if we assume my admin time from above).
In other words: 18 clients/week x fee – 2 days of income/month = $6000.
This gives us the suggested fee of $150 which is a HUGE departure from what we had guessed.
What a difference knowing your expenses makes!
This doesn’t mean you have to charge $150/client. But, it does mean that something will have to give if you want to charge less. Maybe you will have to work longer hours. Maybe you will have to make less money. Or maybe you will have to find a cheaper office space.
WIth this knowledge you can make planful choices about your practice so that you can enjoy the work you do and help your clients without feeling panic about money.
In the end, that’s usually what we want most of all.
You can find sample budgets online, or you can check out our Fee Setting Video Series HERE complete with sample therapist budget, a fee setting worksheet and three videos to get you going.
Hello again - Natalia here!
As some of you know, my path with private practice has been a bit of a bumpy road. I started my first practice in Portland, OR and did all the things: Got a space, furnished it, and dealt with soundproofing; read the legislation on HIPAA countless times; set up secure phone, email, and practice management systems; built the website, wrote blog posts, engaged with social media; networked like a mother; cultivated relationships with potential referral sources within and outside the mental health field.
There were lots of things I did right but also so many things I f*cked up.
A year after starting, my partner got a job back in my beloved hometown of ATX and I readied myself to do the whole thing all over again.
Yes, starting over can be daunting, but truthfully, I was so thankful for the opportunity to correct course. There were so many aspects of that practice that weren’t working but I wasn’t sure how to fix it.
Through my wellness communities in Austin and Portland, I’ve realized that some of what I struggled with is so common and so avoidable. I’ve also become privy to some of the most common ways that we as helpers dig ourselves into a hole with our businesses.
Here are the top 3 mistakes I’ve either seen or experienced myself and why they can be so problematic:
1. Seeing Clients During _______ Time
Everyone has their own definitions of a weekend, early hours, late hours, ideal work hours, play hours and rest hours. We all have different ideal work times for client-based work and administrative or marketing work.
Yet, time and time again, I see fellow wellness peeps seeing clients at the "wrong" time: during their prime blog writing time, or during a time when they’d really love to finally take that bellydance class, or when they’d rather be at happy hour with some friends, or whenever the client wants to meet despite the fact that they weren’t originally planning to offer client hours on Monday mornings. Because Mondays...
Being flexible is important. And, let’s be honest, when first starting out in private practice figuring out your ideal work times for various tasks may genuinely be an experiment.
However, a lot can suffer if you do not rein this in sooner rather than later. You may end up with too many odd breaks in your day. You may find it hard to get administrative tasks done because you’re trying to accomplish a mental feat at a time that is completely out of sync with your natural rhythm. This can stagnate your marketing efforts and therefore stagnate your business. Your social life or precious me time might evaporate into thin air. You might feel locked into this wonky schedule and not know how to transition out of for fear of losing clients.
Burnout may creep up on you impacting your quality of life as well as your relationships to your clients. Self care is fundamental to ethical practice and, to an extent, is dependent on dedicated time and space that is in sync with the way you work best.
Our September Work + Play will help you devise a schedule that empowers you to balance stability and flexibility to help you grow your practice in a sustainable manner. We will give you scripts to say to clients when they demand a different time slot. We will help you pinpoint when you should be checking facebook and email during the day and when you should be writing notes. We will talk about your monthly cycle and when your "networking" time of the month is. Anastasia McAteer will then lead us in a yoga practice with essential oils to further embody this sense of balance and ease.
2. Setting No Clear Fee
Without a system, our fees may swing among extremes like a pendulum.
One minute we feel strongly that we aren’t being accessible enough on the financial front. Or we feel fear that no one will pay us $125 for our services. So we take on a bunch of clients at the lowest fee spot.
Then we realize how little we can bring home after accounting for overhead and tighten everything up. We turn away a few clients due to their needing a sliding scale fee and insecurity seeps back in.
So, then we pick a number in the middle of those extremes and use that for a minute. In the background, we are working a lot and may not have enough bandwidth to ramp up marketing activities to appropriately attract our ideal niche clients who can also afford a higher fee.
The thing is - this is totally natural. Feeling insecure is natural. Not totally knowing where to land with fees is natural.
But it also can create some problems. For one, when starting in private practice we often come up with our fees by kinda making numbers up. We see someone else charging X and make some assumptions and charge the same thing or something else based on our feelings. But there’s no system or backbone behind it. No wonder our fees can become a moving target.
Additionally, clients can end up staying with us a long, long time. Consenting to see clients at a lower fee can present us with some ethical dilemmas down the road. Raise the fee with current clients or just new ones? Raise the fee with full fee clients, sliding fee clients or both? How?
Honestly, I’d rather avoid as many of those challenges as possible by not falling in that trap in the first place. Luckily, there is a way to sidestep insecurity and create a system that is in alignment with our charitable hearts while keeping us honest about the bottom line. We can teach you a method that will help you stay accountable to the big picture and flex in the here and now without putting you or your business in the financial red zone.
Our October Workshop is all about handling your money... plus we got a little fun thrown in...
3. Not Having A System for Business Money Management
Raise your hand if you feel like managing business money can be SO challenging...yeah, we get it.
There are so many questions. What do we need to do for our taxes? How do we pay ourselves? What kind of limits should we put on overhead costs? Is there a formula for this? F*ck, I didn’t get into this field to do math.
Let’s start with taxes. I’ve seen so many friends not know what can be written off or not come tax time. Not being sure what to do, piles of receipts collect in our work and home spaces. After a while we might not even be sure if those are business or personal receipts. Things get lost or were never accounted for the first place. It becomes a big clean-up project that we avoid while the fear of being audited by the IRS lurks in the background. Lamesies. (Tip: You need to set aside 1/4 to 1/3 of your income for taxes, and you will likely need to pay quarterly taxes.)
Additionally, I’ve seen many friends just take home whatever they made beyond their hard costs. Doing this sets us up for having a lot of financial catch up come tax time and establishes zero business savings.
Without business savings we inevitably end up drawing from personal funds in the future when needing more cash flow for, let’s say, a deposit on a new office space or professional development, let alone an emergency. This further blurs the lines between personal and business moneys making bookkeeping that much more complicated.
Paying ourselves doesn’t have to look like this. In our October Work + Play we will teach you a systematic approach to manage your biz moola so you can avoid headaches like this in the future. During the second half of the workshop, Laurel Kinney will help us discover new ways of looking at our wardrobe so we can stretch our dollar with style.
Registration for our Work + Play workshops are open! Space is limited so sign up today. We are delighted to teach you all our secrets and have a little fun in the process! Join us!