Mental Health at Risk: Private Practice Lessons Made Clear by Coronavirus . . . and free resources.

Covid19/Coronavirus . . . demanded immediate operational changes for mental health practices!

Security and Eggs

“Don’t put all your eggs in one basket.” Maybe it’s a quaint old saying that has “lost it’s meaning” for most since the chicken coop has long been relegated to a historical oddity (But not for our family! See picture below . . . . So the risk of gathering and storing all our eggs in one basket is reality for us!)

However, I suspect the wisdom of the adage is not lost . . . but simply ignored in the daily complacency of life that hides the threat of imminent risk . . . until something make that risk visible. Like the Coronavirus. Very quickly, mental health practices recognized the risks of “practice as usual.” Quarantines, community acquired infections, work-from-home, state-wide lockdowns . . . so many rapid changes. Many now regret not being prepared to have Telehealth as an optional backup plan.

My kitchen counter this morning . . . Chicken, duck, goose . . . and turkey. Gathered daily then transferred to bowls, cartons, refrigerator, frying pan . . . our eggs are never all in one place.

Few prepare ahead for potential anomalies like the Coronavirus. The failure to be prepared comes from the idea that things will always operate as they have in the past. That the variables won’t change. Or changes will be brief and only moderately disruptive. When a true disruptive event occurs, as inevitably do—either slowly or in dramatic rapidity—-then the risks become profoundly obvious. We “bank on” having time to adjust.

Risk in Mental Health Services

Mental Health Practice has been no exception. Unfortunately, not many ask the question of “what if it all changes overnight?” Internally, we may ask what happens—”What if I am hit by a bus? type questions—but rarely do we contemplate shifts in our business sector. (Again, many are not prepared to ask what mathematicians ask, “What if that variable goes to zero?”)

Here are some questions that ask the “zero question.” These target “variables” that we have commonly assumed would not change

• What if insurance companies shut down for several months?

• What if clients will not come to the office?

• What if interest in mental health services stop?

• What if gatekeepers—teachers, doctors, etc.—no longer refer to mental health?

• What if the government mandates closing our doors?

Some of our hens (with rooster on guard!) waiting to fill up more baskets.

Finding More Baskets

As I listen to the professional chatter about the changes being made due to the Coronavirus, I think the biggest shift is a flight into a different modality. Telehealth. I get it. I am doing it myself. In the short-term, it is the easiest “fix” and probably a necessary “stop-gap” for most private practices. But, this transition still leaves most operating in the same “basket” of healthcare dependent upon insurance and private pay.

Some, no doubt, are in the short term, relying on retained profit in the business, personal savings, or their partner’s income. Uncomfortable. It is a short-term fix that will hopefully get everyone through the current crisis . . . but not a long-term successful business strategy. Most businesses start with one product but they don’t grow by continuing to offer only one product. To do so, increases the risk to the business. What if no one needs an MP3 player anymore, for example?

This leads me to encourage you to consider finding another basket.

Business Contracting, Consulting & Coaching

In my world, contracting and coaching with businesses and leader provides some “down side protection” from the risks of health care. (Ahhh! It’s a different basket! Yes!) While business has a basket also can be effected by seismic shifts like the coronavirus . . . like has happened in the entertainment sector . . . but business is not uniformly impacted in all sectors. Therefore, it lowers risk by spreading that risk over sectors impacted in to different degrees.

For example, in a recent coaching session, I asked a business owner how the coronavirus was effecting their market and business. “it’s not. At least yet,” he answered. It seems that this particular business sector is one deemed critical to the response to the pandemic. Unlike other business sectors, it remains open for business and operating as close to normal as any in our country at present.

Someone remarked to me just this week that in the times we are in business and leaders more than ever could use the guidance of professionals who understand people. No doubt. I only wish more were available.

Learn more!

Get started with a Free Video on Private Practice through Contracting on You Tube

or download a Free eBook; Private Practice through Contracting.

Coronovirus (Covid19) Flu, Profit Margins, and Survival

This sign, I think, depicts what I am saying . . . . Closed—but thanks to good practices—not gone. Photo by Tim Mossholder on Unsplash

Coronavirus (Covid19)

So the world is facing a new pandemic. It’s all over the news and everyone I know is assessing the risks to the people they love that may be particularly vulnerable. Universities are closing. Healthcare providers are taking employee’s temperatures before allowing them into work. Sports events are taking place with few or no fans in attendance. Some are avoiding going to restaurants, changing vacation plans, or working from home.

Globally, I recently read that in Italy all businesses are shut down with the exception of grocery stores and pharmacies. Imaging that! In my local context, there is a lot of fear, many people working to try and contain and lower the risk, and speculation about the actual size of the threat (here I speak in global terms not individual outcomes which obviously can be catastrophic) which remains unknown—and possible unknowable—as I write..

Local . . . and Global . . . Impact

Even in my small arena and in the smallest businesses that I work with, consideration of the risks and substantial departures from normal operations are taking place in order to cope with this emerging threat. People are asking a lot of questions they did not have to consider only a few weeks ago. What do you do if customers will no longer come to your “brick and mortar” for services? What actions do we need to take to protect employees? What do we do when our sales stop for a time . . . due to the changed behaviors of customers due to this threat?

A Terrible Event . . . and a Business Lesson

However, while trying not to minimize the terribleness of this pandemic, this very public crisis demonstrates the very real need for business to plan for such events. You can’t, for example, provide free services (vaccines for example) if your employees quit because you can’t pay them. Businesses who regularly create a “rainy day fund”—by collecting a profit—are able to continue to provide services even if their revenue stops temporarily. Businesses that don’t do this have to find someone else’s cash (banks, private loans, grants) to survive.

The grim reality—the coronavirus and it’s threat to businesses—frankly reminded me of conversations I regularly had with graduate students in the behavioral health programs. I hope those conversations helped them to be prepared to ride out the turbulence of a crisis like we are facing now.

Business Survival and Profit

Talking to those students about the “business side” of being a health care provider . . . and the role of accounting for the three traditional components of business—operating costs, labor expenses and a profit margin in establishing a fee structure . . . I would ask students, “What exactly is profit?" I could often see these good-hearted students squirm as they struggled with their answer. Every semester these students—most of whom had never had a business class in their academic careers—would answer with some variation of the following . . . “It is adding an amount to your fee because you want to make more money.” Or . . . “It’s deciding the market will pay you more so you raise your fees to make more money.” No and No. The first definition, as students described it, should be labelled “greed.” The second, some form of “price fixing or gouging.”* Adding a profit margin to your fee is neither of these . . . and the present crisis illustrates why.

Businesses who only cover their expenses (operating costs and labor) have no insurance policy for a severe crisis like the coronavirus. Thus, when a crisis hits, these businesses are dependent on an outside entity to rescue them . . . a government bailout, bank loan, or private funds.**

In my own private practice, I have had to weather periods of no cash flow. Most notably when the Affordable Care Act was started. Insurance companies were unable to tell us what copays to collect and were not paying in a timely way. Everyone in my practice survived on the savings (profit) that they had collected and we were able to stay open for the three months we had no revenue coming in. Others, albeit lesser disruptions, include changes in the insurance industry, transitions to electronic medical records, billing department personnel changes, etc.

I genuinely worry about some of my colleagues in health care in this current crisis. During the Affordable Care Act transition, I heard colleagues talking about drawing on their own personal savings, getting short term loans to float their practice, drawing on personal lines of credit . . . or other measures to keep operating.

In the present crisis some, especially those who have believed that charging a profit margin is equivalent to being greedy instead of a means to insure agains risks like the coronavirus, may find themselves in a similar crisis. What will they do if insurance payments cease for 30 to 90 days? If their client load drops significantly for a time?

Maybe they can draw on outside support to survive. Perhaps they’ll get a loan. Maybe the government bailout will be accessible to small business owners. Maybe they will draw on their own personal assets to float the business for a while. I assume most will “get by” somehow. Hopefully not, but it’s likely a few may simply close their practice.

Still, as the old business adage goes, “you can’t operate even one day without cash” so it is my sincere wish that my students and the professionals I have trained and coached have planned ahead . . . building profit margins into their fees, retaining these earnings in their business, and as a result have less fear and angst about the current threat to their livelihood. After all, none of us need more to worry about at a time like this.

Here’s wishing you all the best!

Resources:

Learn more with Bryan’s free eBook: Private Practice through Contracting.

Got a question? Ask Bryan.

* I am not arguing that no one sets fees in this manner, they most certainly do. In fact, I have no doubt that some have become very wealthy in this manner, it is not, however, in my view an ethical way to establish fees.

**Yes, a business can plan ahead by establishing a “line of credit” to borrow against in a time of crisis but you are driving up your operating costs by not planning ahead and saving money in your business to weather a crisis where there is no cash coming in.

Five of my favorite questions to ask therapists.

If you are a subscriber or a regular reader of our posts, you know that I was trained as a mental health professional turned consultant. You may also know that as well as consulting with organizations . . . I continue the tradition of “giving back” to the profession by training a few helping professionals each year to add contracting and consulting to their product line through our Leading Edge* Coaching.

I each case, the professional and I start by tightly defining what they want their contracting and consulting work to look like. Most have only been practicing for a few years and are just getting started in contracting, so I ask them to respond to five of my favorite questions. These five, listed below, attempt to help them focus on a few critical issues that need to be addressed to make their planning complete and their plan to be rigorous enough to succeed.

Your planning needs to answer these 5 critical questions:

1. What problem am I solving?

2. What resources do I already have?

3. What funds do I need to get started?

4. Who else is doing this?

5. What will I do to "surprise and delight?"

Bryan

A screen shot of one of our Leading Edge Trello boards. We use Trello not only to facilitate our training but to help professionals learn it as a means to maximize their ability to work with organizations using this very robust platform!

A Reminder . . . 

If you are ready to get started now, we can help through our Leading Edge* Coaching. We work one-on-one with you to develop contracting and consulting work. In on-line sessions we guide you through the development of your contracting and consulting business, developing your first contract or to make contracting a more substantial product line for your future. 

Coffee and Talk about Private Practice through Contracting . . . Coming soon!

Coffee & Talk: A free conversation about contracting that will jump start your practice in 2020!

An Opportunity . . .

Professionals who subscribe to our email list have received notice of an opportunity for “Coffee & Talk” we will be starting in January. They are helping pick the optimal dates and times for these 60-90 minute, on-line, chats.

The goal? To help them shorten the learning curve to getting contracts. The talks help to motivate and energize professionals and provide advice that will reduce the effort it takes to get started with contracting and consulting.

Typical Results

For example, the feedback I got from my most recent talk with professionals in the Atlanta area yielded the following results:

"I felt motivated and more focused. I'm encouraged to get started."
"I need to rethink how to use the Services Chart to fine tune my products."
"I just sent a follow up email to a potential customer who took a survey for me."

Joining the Conversation

These specialized talks are only for professionals in the behavioral health sciences. Numbers will be limited, as needed, to insure the ability to actively participate in the Q&A session. Subscribers will have preference, of course, but others may attend if space allows.

Interested parties can get updates through joining our email list (receiving our free eBook Private Practice through Contracting) or through contacting us and indicating your interest in being invited to a Coffee & Talk event.

Our Free eBook.

It's Halloween . . . and time to face the fears of 2020!

The locus of this fall’s fears . . . working with metal saws to build our new “hoop house.” (See below)

Halloween! So let’s talk about fear.

It’s Halloween. Or All-Hallows’-Eve if you prefer. Time for cute costumes, “haunted” houses, tricks, and a little good ‘ole fright. Public radio is playing spooky music (from Psycho) and reviewing the scariest movies. Parents are talking about their kid’s costume choices. All is abnormally normal. Maybe not exactly normal, after all, the Nationals won the World Series, but I digress.

I was on a video chat earlier this week with some professionals talking about contracting and consulting. I mentioned that I assumed when I started that other professionals were more comfortable than I was in acting as an entrepreneur and “putting themselves out there” doing marketing and sales, since I had no background in this area. But, it turns out, I was not that different from most professionals. Once again I was reminded of this as we talked as one prevalent theme I heard in the questions I was asked was . . . fear.

I told them that one of my biggest challenges when I started more than 20 years ago was getting through my own fears. Fear that I didn’t know enough yet, that I wouldn’t be able to find customers, that I would somehow fail. Building confidence, isn’t some big secret. But, somehow we believe the route to success is a lack of fear. No. Success isn’t convincing yourself that the fear is irrational—first, it’s not entirely irrational; and second, the part that is irrational—“catastrophic thinking”—can’t be fixed by reasoning. The person typically already knows that what they are facing is just fear and they themselves, and others as well, have already told them that their fear is irrational. What works is finding ways to successfully take reasonable “leaps of faith” and succeedi

Learning to Use the Saw

I use examples (like the metal chop saw above) to ask professionals I coach, what will make my fear of using this new, and potentially dangerous, tool diminish. Will it being reminding myself that I have used lots of other power tools? Being reassured that “it’s not that hard” and “I can do it?” Maybe watching You Tube videos of how to use the tool? Reading the manual?

All of these help, minimally. (Actually, reading the manual introduced new fears . . . like the blade cracking and flying apart) But these steps don’t drive away the fear. What does? Using the saw.

So, on this day of Goblins, Witches, and Fright, and as you prepare for 2020—embrace fear. Press forward. Focus on what comes after the fear (like the hoop house, see below) that will provide service and joy—not to mention revenue for my wife’s business—for many years.

Use what ever resources you need to help bolster your courage to take the next reasonable risk. In the end, it is highly likely that the benefits of your success will outweigh the terror of the moment.

Success! Here is one of the framed ends I built with the new saw. Kind of look forward to using it . . . now.

Disney or Pixar? Believing and Investing in You . . . (r) Career

Photo by Ross Findon on Unsplash

Chasing Past Success . . . Leads to Failure

Do you want to be Disney or Pixar? (Yes, I know that Pixar is, now, once again, Disney. But hang on and you’ll I think you’ll see my point.) What am I implying in this comparison? Simply, that everyone makes a choice to either let the “industry” or the “dream” determine their professional path. There was a time where my view of these two companies was like this:

Disney was, in my view, playing it safe. They tightly controlled access to their products (still do), not allowing them to be readily available, and using “new” releases of their content to resell their most successful products, or they remake the popular products (over and over) to create new revenues—and for a time, created little new and interesting products. From a business viewpoint, leveraging their past successes was working—to some degree. But they seemed unaware of the losses they were experiencing through this operational stagnation—the “opportunity costs” of not growing and not capturing new markets. They were stagnant.These costs were exposed when employees left and created Pixar.

Pixar, comprised of employees who left Disney, on the other hand, believed in telling a great new story. They believed that creating a strong story and allowing their team the creative freedom to design the telling of that story would be compelling to their customers. The leaders wanted to create a more dynamic, supportive, team that would engage in finding new stories worth telling. They left Disney because of the constraints on their vision or creating a new process and new products. They found a new niche that exploded with customers for their products—and Disney, eventually, recognizing their missed opportunity—eventual bought them and brought them back into their company.

Fear. The longer I have been a professional, the more I recognize fear as being a primary roadblock for people in many areas of life. From the “narcissist” who will not admit to making mistakes, doesn’t apologize, and who dominates conversations to avoid feeling vulnerable or out of control to the “codependent” who will not stand up for their own best interests, accommodates to everyone else’s wishes and who may enable destructive behavior around them—fear is often one of the causal factors of this behavior.

I have no doubt that there was fear at Disney. What if we go to the expense of creating a new product and it fails? Better to “play it safe” with what we know works. Too often, leaders cling to the successes of the past and forget that the successes came from forging new paths. Disney, once the vanguard of something new, let the past—their own history within their industry—determine their orientation for the future. In a sense, the industry standard was now defining Disney. Not Pixar. Pixar wanted to reshape the industry. They wanted to return to a time when new stories, well told, and creative presentation would become the standard.

Fear and Change

In this blog, we’ve written about fear regularly, we’ve focused on the problems of management by fear. We’ve talked about the lies that people tell themselves to protect themselves and avoid unwanted fears, We’ve detailed the problems expressed by ego, trust, mistakes, or control. Finally, we talked about fear in transitions in family businesses. Fear is a powerful enemy. For many it promotes the prey mentality . . . “don’t move and maybe you’ll survive” . . . for other’s it promotes action . . . “keep moving or you might become lunch.” The best approach to fear is to recognize it but not let it “drive the bus.” Analyzing when it is an indicator of real threats or when it is just a conditioned response.

Professionals are no different than the leadership at Disney. The average professional is content to let the profession shape their practice. Right now, the losses due to “opportunity costs” are not particularly painful. Professionals can make a good living. Many over the course of their career dream about changes they would like to see in their professional practices (like no weekend or evening work, less paperwork, providingnmore educational groups, going entirely private pay, or offering a new type of service) but lack an understanding of the steps to reach their goals, do not have the proper supports, or are fearful of the perceived risks.

At one time in my career I joined a group of professionals whose goal was to support the work of private practitioners. I didn’t attend long. Why? Because, in my estimation, the group primarily focused on the fears the group members had of making a transition into private pay. I heard a lot of support for members but few “solutions” or guidance on how to get to a private pay model. Frankly, if I would have lived in that community it might have been worth while to continue but I decided the value wa not worth a commitment of half a day to attend (travel, meeting, and return trip). Hopefully, those who stayed got something they needed out of it.

Most professionals, in my experience, “go it alone” or with the support of a small set of colleagues, the support of a practice they join, or a mentor. They are limited by the experience, vision, and yes, even fears, of their circle of supporters. Many would benefit from getting outside their parochial environs and find support from coaches that have successfully traversed the path they want to take. Few will.

Approaching . . . cautiously . . . Changes to your practice

Taking risks by investing in one’s own career is often taken tentatively, if at all, by most professionals. They fearfully stop working weekends or cut back on their evenings. They drop an insurance provider with poor fees. The average practicianer will also, of course, attend trainings that they can see will directly help them in their career—a new technique (EMDR training), method of service delivery (Neurofeedback), or product (coaching)— but exploring the cutting edge of practice, new modalities of practice and the changing landscape of engaging professional services are paths chosen rarely, and only by the few.

So, as an example, the enterprising few have created on-line venues for providing counseling and coaching on-line (see, for example, PSYPACT). An increasing number fo professionals over time follow these explorers by joining and providing the services once the framework has been created. More, perhaps most, may take a “watch and wait” stance to see how new approaches “shake out” in the industry. Still others, wary of the ethical challenges, professional licensing limitations, and potential legal risks will not—unless compelled—engage in any way this new frontier of practice and may even question the motives, ethics, and professionalism of those who do. Yet, at it’s very core, it is a change, either good or bad, that is happening and that is unlikely to be stopped, in my opinion, unless it is addressed through regulation on a national level.

No, a professional should never practice in a way they deem to be unethical, of dubious benefit to clients, or out of their scope of expertise. But . . . that doesn’t mean that professionals have to limit themselves to the constraints of the past either. The profession has always changed and grown. From it’s roots in neurology, to the application of psychological principles in industry, to the application to artificial intelligence, the field will continue to evolve. Professional vision and the opportunities they cease will lead the movement. Will you be in your career? Part of the vanguard, scouting out new territory? Perhaps, preferring the safety of journeying among peers positioning yourself firmly in the group? Or, perhaps, the trailing the pack and holding on to the past territory?

This week, I got an email from a professional who is taking part in our Leading Edge Coaching**. We had to delay our meeting but she noted that she has a new contract and couldn’t wait to tell me about it. Good for her! She is courageously moving toward her preferred future and finding that it is possible.

**Leading Edge Coaching (LEC) is our process to provide specially-tailored coaching to a limited number of professionals who want to add contracting and consulting to their “toolbox” of services. Coaching is a monthly one-on-one with Bryan G. Miller, Ph.D.—with most of the work carried out between coaching sessions to keep the cost minimal. The goal of LEC is to help professionals to get their first contract within 6-9 months or expand their current contracts. Space is limited to protect the quality of the service. For further information or to request a spot in our 2020—or beyond—coaching cohort contact us. We promise that there will never be any pressure and all services are provided on an unconditional money back guarantee.

Simply . . . Like Jobs. Steve Jobs . . . and Redesigning Apple

Apple logo: Wikipedia

Simplification . . . Yes, KISS** is still good advice!

In his book, Boundaries for Leaders, Dr. Henry Cloud tells the story of Steve Jobs, who—having returned to Apple as CEO, brought clarity to the struggling organization—eventually driving success by eliminating 70% of their models and products. How did he do this? By having a clear vision of what Apple was and was not. Jobs, while sitting in a product strategy session, shouted, “Stop! This is Crazy!” and going to the whiteboard, drew a four-cell chart. “Here’s what we need,” he said—then he wrote “Consumer” and “Pro” across the top of the two columns and followed this by labeling the rows “Desktop” and “Portable.” “Their job,” he said, “was to make four great products, one for each quadrant.

Simple. Elegant. Apple. Great at what it does. Different.

Often times in business we over-think ourselves. We move, naturally, toward more complexity—believing that “more is better,” that complexity or more choices creates more value, right? But experts remind us that focus, clarity, and quality are often driven by parsimony . . . simplicity if you will . . . and may be more important than complexity. (Think of your T.V. remote. Do you really want more options?)

How about your business? Have you driven your strategic planning to parsimony? Have you achieved Job’s level of clarity? If you quizzed your board, employees, vendors, customers, would they all describe what you do in the same terms? Are you clear what and whom you are and what you are not?

One Example

At HSC, we have focused on developing this clarity and created four core products—one for each market segment and product level. This clarification of our vision has driven us to focus on continual development of these products and prevented being “distracted” by pouring energy into new ancillary products that take the focus off what we do best.

For example, a recent conversation with a business owner lead to the discussion of an “opportunity” to develop a product to help private pilots deal with the anxiety of flying—particularly the additive stresses of landing. An interesting, and tempting, thought given our background in mental health, mindfulness, and training. Should we do it? Should we invest energy in developing expertise in this “problem” and create a training to meet this need? Well, focusing on our core model helps get to an answer . . . does it focus on our customers? Not clearly. Is it a service we offer? No. So, unless we change our strategic plan, this is not an opportunity that we would pursue.

Maybe it will help you to do the same.

Like Steve Job’s example, we divided our table into two segments: our market segments and our product lines. Here’s a representation of our model for comparison:

Keynote slide on our four core products.

Notice that we have two primary markets: Organizations (including family business) and Professionals. We also have two distinct product lines: Services and Training. Our four core products then are located in the yellow cells. cross-referenced by these four variables.

What issues are each of our core products focused on improving"?

Organizations:

Human Systems Consulting: There are many ways to implement a successful business plan. In almost all cases, the plans depend on people to carry them out. Our core consulting service is designed to help resolve issues related to the human element. Challenges with culture, motivation, conflict, performance . . . all the human variables that interfere with high functioning.

Team Player Skill Development: People behave as they have been conditioned to behave. Reach out your hand toward someone raised in the USA and they, involuntarily and instinctively, extend their hand toward yours. But that rationale “act” of shaking hands is not universal—it is a conditioned response. villagers in asian countries may not respond in the same way. Employees need training that does not simply “tell them” how to do something different they need to practice. Our training is to start the process of practicing new, functional behaviors that create good team functioning.

Professionals:

Leading Edge* Coaching: Professionals want new ways to practice and pay their bills. But most are “locked into” a health care model dependent on insurance reimbursement. We help professionals develop private practice contracts and to develop a consulting practice through personalized coaching sessions. our coaching process is designed to help identify opportunities, understand how to apply their skills and knowledge to contracting, create marketing plans, develop their fee structure and generally support professionals developing private practice contracts and consulting work.

IMPACT Model*: For professionals ready to jump into contracting and consulting, provide and introduction to the contracting/consultation process we have developed over 20 plus years, to give them a road map on how to work with organizations. We have trained professionals on our marketing/consulting model in national conferences, on-line trainings, and in person workshops.

Well, that’s it. Our four products, one in each quadrant to serve organizations and professionals.

Special note: Interested parties can check our availability for training/services by contacting us. Please note that due to demand, we typically schedule trainings a year in advance. Other services are on a first come, first served basis, and subject to the availability of a consultant at that time.

**KISS acronym for “Keep It Simple, Stupid!”

A Peek into Our . . . not Google's (sorry!) . . . Consulting Algorithm

I think a map would definitely help in this case! Photo by Victor Garcia on Unsplash

Just finished a post for our email subscribers about the critical need for professionals, turned consultants, to have an “algorithm,” or decision-making process, process or path, to guide them as they engage with human systems. This engagement may be in developing their private practice through contracting or by going “beyond the couch” and becoming a consultant. In plain terms, this algorithm can be boiled down to a series of questions and decision points that creates a path to follow, such as . .

HSC CONSULTING ALGORITHM: (Sample questions to ask yourself.)
1. Do I have contact with a decision maker? YES .....
NO ......

1A. If, YES, go to #2 . . .
1B If, NO, then ask to make contact or move on . . . .

2. Does the decision maker recognize a need? YES ....
NO ....

2A. If, YES, go to #3.
2B. If, NO, go to 1B.

3. Does the recognized need, require a deep understanding of the human system? YES . . .
NO . . .
3A. If, YES, go to #4.
3B. If, NO, Is the need solely training/coaching for the decision maker? YES . . .
NO . . .

3C. If 3B is YES, then seek conceptual agreement to propose training/coaching.
3D. If 3B is NO, explore the issues and how they relate to the system, then seek
further exploratory meetings or a conceptual agreement to propose
consulting.

The Power of an Algorithm

The power of an algorithm like this is comes in . . . confidence. Confidence in knowing where you are in the process, what has been done already, what needs to be done next, and a process that is replicable—and can be used again and again with decision makers. This algorithm, for HSC, has developed through more than two decades of consulting work, reading the consulting literature, teaching graduate students and professionals how to do consulting, and our own publishing.

Developing this process at HSC has evolved to the point that we created our IMPACT Model of consulting and forms the core of our Competitive Edge Coaching process . . . helping mental health professionals who want to develop consulting contracts. We even created a “cheat sheet” of our process in our IMPACT Model Quick Start Guide.

Moving from Healthcare to Contracting/Consulting

For those starting, or wanting to start, this process . . . here is a place to start:

• Recognize that this process—creating an algorithm—is helpful for getting private practice contracts that provide “health care” . . . as well as consulting with organizations. At HSC we have done both—private Employee Assistance Programs, for example, and business consulting/coaching. We use the same process for both.

• Read everything you can get your hands on about consulting. Especially, resources coming from those who transitioned from health care to consulting since they will speak the same language and can highlight the similarities and differences.

• Consider getting training as a coach or consultant. Training programs will decrease the time and effort to make the transition and start getting contracts. Organizations such as the International Coaching Foundation, or others, can help you get moving.

• Adopt an “algorithm” process or plan that has worked for other consultants until you develop your own—if you ever need to. Don’t “reinvent the wheel” start by finding a template to follow then you will tweak that, or create your own, as you gain experience.

• Be patient, but aggressive. Remember, it will take time to transition into a new product or service and to transform yourself into a new skill-set. Be realistic about your progress and not overly self-critical. Get support, find mentors, and just keep working . . . and it will be likely to happen.

Sign up for our emails . . . and get a free eBook.

Nine Signs You are a Normal Therapist . . . and encouragement to break the mold.

Image: villagehat.com

In the BBC hit series, Sherlock, the protagonist, Mr. Sherlock Holmes, characteristically known by his unusual double-billed hat called a “deerstalker,” given to him by his faithful Dr. Watson, describes himself as a “consulting detective.” Further, he also describes his nemesis, James Moriarty, in similar fashion, as a “consulting criminal.” This description, of an external expert as consultant, is something we need. In the profession of mental health, we need more “consulting experts” and fewer “normal therapists.” Consulting experts . . . ready to use their knowledge and skills to assist in all kinds of venues. Medical, legal, business, government, education. Here’s why.

I’ve been a professional therapist for over 35 years. I don’t consider my journey within the profession to be that remarkable or different from the “average” or “normal” therapist. Where it has been different, has been in the things I have done outside the “normal” parameters. In working with manufacturing companies, with family-businesses, non-profit organizations, and others.

Being a “normal therapist” myself, I’ve also supervised, administered, trained, and taught hundreds of other normal therapists over the years, and . . .

Let me be blunt . . . there are a lot of things about being “normal” that, over time, will drastically increase the risk—the risk of practicing in a manner that will undermine the therapist’s life and career. Over time, doing significant damage if not understood, addressed, and overcome.

What do I mean? Well, let me tell you. I mean that I have cringed as I have heard too many therapists, often nearing the end of their careers, that don’t have good retirement savings, do not take off quality time from their practices (some skip vacations and have not had a quality vacations for years), are not in a position to financially help their children or families and who are burned out, tired, and, sometimes, defeated by the very career they chose to support and sustain them and their families.

From a business/career stand point, the normal therapist is often their own worst problem. Let me lay it out for you . . .

Nine signs of the normal therapist:

• Believes that working for an organization is safer than working for themselves. Ah the benefits! Salary, insurance, paid time off, training budget . . . there are several aspects of working for an organization that appear to make it the safe choice. But is it? It feels like it until the the layoffs, down-sizing, closings happen. Most businesses, even Fortune 500 firms, don’t last more than about a couple generations. It’s just not as safe as you think.

• Thinks that the most reliable way to get paid is to be dependent upon insurance reimbursements. I hear many talking about wanting to get away from insurance but most, even the experienced, see insurance as a reliable source of revenue. Okay, sure, it is. But, organizations—who provide coverage for your clients— change insurance providers. Reimbursement rates are dropped. Getting paneled becomes more limited. You either spend time chasing the payments or pay someone to chase them for you. Is this really the most reliable form of income? For me, the answer is, “No!” Contracts, several that have laster more tan 12 years in my case are far more reliable. Negotiated rates with organizations that appreciate the value you offer is far different than the insurance panels trying to minimize costs.

• Worries that peers, or others, may think they are driven by a desire for money. Occasionally I wonder if the worst thing you could say to a “helping professional” is that they seem to be “interested in being financially successful.” Most deny this by quickly pointing to other priorities for their work. But, just because it is not their primary goal, does it mean that they don’t want to be financially successful. In most cases, “No.” However, they are uncomfortable acknowledging this. They constantly make sure that peers know, and will not judge them, by downplaying and insisting their focus is not on money.

• Are willing to trade time for vague benefits. They are wooed by vague benefits to their own career and live based on hopes reaping “marketing benefits,” unplanned “giving back” to the community or profession, and “just a good experience. They accepting being on call, providing free phone support, writing letters, and other tasks without much, if any, benefit to their business. I’m not suggesting that none of these things should happen—circumstance dependent, any and all of these may be appropriate or necessary; my point is, that the normal therapist simply does this, and accepts doing it, because it has been the standard practice historically.

• Makes excuses about the unsavory elements of their career rather than working to change them. Long term complaints about hating paperwork, insurance, no shows, without taking assertive steps to remove those things from their business life. Most will simply accept these things as part of the profession rather than re-examining their utility in today’s environment or seek other forms of practice that minimize or eliminate some of these elements.

• Constantly seeks to reassure themselves that they are competent. I hate to say it, but a majority of normal therapists have a lot of self-doubt. Just like the college student taking Psych 101 and wondering if the symptoms described in class men that they have a certain diagnosis, therapists, perhaps due to the personal intensity of their studies or primal interest, often give marquee attention to their weaknesses or deficits rather than their strengths. Few feel confident that they “know enough” or are an “expert” beyond a narrow and specifically trained knowledge base and skill-set. Yet, in truth, their life-experiences, knowledge, and training make their utility much more broad then they imagine.

• Doesn’t take risks, even small ones, that could provide significant improvements in their career. You’ve probably heard the old joke, “How many therapists does it take to change a light bulb?*” How about the correlary, “How many therapists . . . will change.” Therapists tend to play it safe. Leaps of faith for the sake of their career are rare. This includes wisely spending money to increase the likelihood of progressing in their careers. So, they go to mediocre trainings, don’t pay for supervision to gain expertise, do not spend money to learn new processes or products that could make their practice stand out and separate them from other providers.

• Follows the rules. While their are pioneers in our field, out there breaking new ground, as a group, therapists are prone to follow the “tried and true” of that the profession has dictated health care “is.” There are few “disrupters” or “contrarians” as a rule in the group and thus not much innovation. Tendencies run more toward “am I doing it right?” and against, “could it be done better?”

• Feels victimized by outside sources. Let’s face it colleagues. We often “play the victim.” Whether it is society, insurance companies, culture, history, etc. there is often a stain of helplessness norms in our thinking. These professionals, among the highest educated and trained people in the world, feel trapped and powerless by forces outside their control. We may seek to liberate others from the forces that we fear may be in fact constricting our own trajectory.

Professionals that stay trapped in this normative mindset may have an adequate, or even good, careers. Many do. They will, however, be subject to operating within the confines of the health care system and their own perceived limitation of their profession. The tragedy of this is that their are no “consulting therapists” in daycare centers, oncology offices, pediatrician practices, legal firms, or on family business boards—among many other places where they could provide significant benefits. More sadly, most professionals have never even asked themselves the question, “Could they benefit from my consulting?” Thus, the inquiry is never made. No discussions take place. No services are defined or contracts completed . . . and no help is available.

Do you see these signs in our profession? How does it affect the careers of your colleagues? How many of the nine traits influence your thinking?

As a profession, we need to focus on becoming more entreprenurial, taking a broad view of our capabilities, and turning those into non-traditional areas that could use our help. IN as sense, we need to see our selves as “consulting professionals” and not just therapists. Are you ready? If so, grab your “deerstalker” and let’s go. The game is afoot, dear Watson.

Ready to be abnormal? Share our post, make a comment, or more than one, and include in your comments how you shared the post, and you will be entered in a drawing for a digital copy of our book Beyond the Couch: Turning your behavioral health degree into cash without losing your soul and other prizes. To encourage comments, we will give away one copy of the book for every 10 comments. So, even if you already have it, or are not interested in the book for yourself, you can tell us who you’d like to give to or we will give it away for you!

*So, how many therapists does it take to change a light build? “Only one, but the light bulb has to want to change.”

If you practice like no one else, your practice can be like no one else!

Some of our giveaways I got to share with my colleague at coffee. (Graphic Design by Andrew Miller (andhegames.com and andhedrew.com)

If you practice like everyone else, your practice will be like everyone else!

Throughout my almost 30 years working in the health care field I have had great colleagues. These experts provide critical services for individuals, couples, and families. They are specialists—true experts—in their scope of practice and I happily refer to, collaborate with, and respect them for their work.

However . . .

Considering the “State of the Art”

Colleagues in our field as a group, perhaps like most industries, generally talk, month in and month out, about the same repetitive topics . . . referrals, going “fee only” (or dumping insurance), recruiting new professionals, insurance contracts, and procedures or techniques they are learning or implementing. Go to coffee with many in the behavioral health industry and you are sure to wind up talking about these issues.

There’s nothing, at all, wrong with that of course.. These are the daily concerns of the typical practice and the variables that owners/providers need to focus on to be successful. Many are happy to confine their “work life” to these issues but some of us are not.

For the “others” these topics, while necessary to deal with, are often redundant, task-focused, conversations that—like chores—need to be done but rarely result in a “bounce in the step” after the conversation. After almost three decades in the industry, while these continue to be necessary discussions, engaged in regularly, I find myself more interested in conversations about the national melodrama of politics, the latest cool product (currently Darn Tough socks), new technologies, or woodworking projects. Maybe you can relate?

A different practice

I was reflecting on this after a recent coffee meeting with a colleague. No, not because the conversation was a better version of the typical topics, quite the opposite, because it wasn’t—at least not the vast majority of the meeting. A meeting that I left feeling energized, excited, and ready to push my business forward. Why? What was different? What was different is we weren’t just talking about the same-ole-same-ole topics.

My colleage isn’t just practicing like everyone else. He is more entrepreneurial that the average clinician.

Through serendipity and the encouragement of others less risk-aversive, I have learned, despite my natural tendencies toward the opposite, to do the same. So our conversation wasn’t about insurance, referrals, recruitment and all the old repetitive topics. Instead, the conversation was about an upcoming training we are doing out of state, demonstrating for him a game we newly licensed to use in our training, possible opportunities with a local manufacturing enterprise, and discussions about developing our own new software games for training. All factors of my practice not being defined by the typical “private practice” label.

Sustained changes

This week, under this broader umbrella of Human Systems Consulting, we will be billing an engineering firm for coaching. Signing a training contract with a government agency to use games to train leaders on teamwork skills. Continuing our monthly trainings of other professionals on becoming consultants. Talking to a non-profit about the status of a 13 year old contract to determine if it will continue as is, change, or be terminated. Continue discussions about developing a communications/teamwork game with a software developer. None of this directly related to my full time private practice as a mental health professional.

If it sounds like work, it is. Is it But its work, I find, that invigorates. It’s not boring. It’s new. It’s mine. No one else, outside my team is doing what we are doing. It continually challenges me to grow and expand my learning, my skills, and, assumably, my value to systems who need some help. It also protects from some of the inherent risks in healthcare. All factors that makes the private practice less anxious, more sustainable, flexible, and versatile.

Normative vs. transformative

Now, if you tend toward the stable, comfortable, personality that enjoys routing, likes tweaking and improving know systems, and are perfectly happy with continued discussions listed in the first scenario—then good for you! You likely are not looking for something different or more. However, those who crave learning new things, challenging themselves to do more, want new vistas or horizons to explore . . . even if you are good at putting up with the first scenario . . . then this latter scenario is much more invigorating. In my experience, it is an antidote to burnout and makes you more enthused about both.

What would you like your practice to look like if you could choose to do whatever you wanted?

What services or products would you be excited to provide?

What’s stopping you?

Broken shovels and new handles.

The poor old shovel . . . yellow fiber-glass handle finally gave out!

Sometimes you just gotta do it. I was replacing my mailbox post when it happened. The old shovel handle broke. I've been expecting it. This old, yellow, fiberglass handle was never the best. It quickly began to weaken; the digging becoming a maddening-test-of-stubborn-resistance as the handle flexed, twisted, and alternatively held it''s rigidity as a project progressed.

Now it was caput. Finished. Should I "pitch it" in joy of the cessation of the frustration and hold a wake to it's demise? No. I would replace the handle with a good, solid, wooden one. I grew up in that era. Don't through away things that still have value. Even if the time, the replacement parts, and ultimate finished product are less than ideal.

Changing that handle (see the finished product below) reminded me of the process of helping professionals with "old" skills upgrade to "new" ones. Learning to add contracting or consulting to their professional practice. The tools essentially remain unchanged but the experience is transformative.

Check out our no-coast, no obligation, webinar on Private Practice through Contracting!

Almost makes me look forward to digging.

Professional Burnout

Photo by Yaoqi LAI on Unsplash

My private practice, it seems, has recently become an oasis for professionals experiencing burnout in their careers and personal lives. I’m not talking about professionals who just can’t cope or who have personality traits that make them doomed to burnout; I’m talking about successful helping professionals–experts who have been practicing and thriving for 15 to 35 years who suddenly cannot stand the work they once chose and loved.

While I’ve written about ways to prevent burnout in the past I am still learning things as I help these experienced professionals–who are often very insightful and creative in their own right–reinvent their professional and private lives to make their work-life balance manageable and sustainable forms.

I wrote this almost two years ago, and I followed it with some reasons I think successful professionals suffer burnout. (My original follow up post was entitled "Regaining the Joy of Your Career!"

Reasons successful professionals experience burnout:

• There is an emotionally overwhelming triggering event.

• They have an exaggerated personal accountability for their work.

• There is denial of the effect of exposure to traumatic emotional events.

• Self-care is seen as optional (and sometimes selfish!).

• Accountability is universal (I have to do everything well!) and not subject to rank ordering.

• Unrealistic comparisons to others lead to a lack of balance.

• The isolation of the profession diminishes their perspective of life.

• Emotional avoidance of guilt, fear, shame, rejection often underlies unhealthy behaviors. (just like our clients . . .)

• The “supporting cast” of family and/or friends reinforce unhealthy functioning.

• Band-aids are applied when surgery is needed.

At the time since I wrote this list, conditions in the profession seem to be exacerbating the problems. (Faithful readers may remember when I challenged myself to state what our field needs in just 4 words.) Today, some insurance companies are requiring professionals to pay application fees and annual fees just to be on their boards (the customers don't pay the overhead now the service providers do?), cutbacks in public funding is threatening services, demands for "validated" therapies threaten to make healthcare the paper-pushing cousin to education, and professionals in other fields are developing services that challenge the mental health industry.

More and more professionals I talk with are seeking a way to mediate these negative forces, or leave the healthcare industry through adopting private pay or concierge practices, marketing life coaching, contracting directly with organizations, retooling into another industry, or retiring.  (Not all experts are the same Organizations need people-experts to advise them.) Often professionals, unprepared for a shifting healthcare context, burnout under the vicarious trauma of a long career. Seeing more clients that is sustainable in a healthy manner. Today, more than ever professionals often need a backup plan and exit strategy.

What can you do, in the short-term, to prevent burnout? Here's a few ideas:

1. Don't expose yourself to additional trauma through your entertainment choices.
2. Limit your clinical work by mixing in other business ventures.
3. Find and maintain restorative hobbies, activities and friends.
4. Listen to music and turn off the news.
5. Take a break--a long one--from social media.
6. Create a long-term business/career/life plan that includes diminishing the heavy clinical load.
7. Broaden, or narrow, your niche to include activities that are not saturated in traumatic material.
8. Develop a network of social contacts that are not from the healthcare industry.

Good luck!

Read: The greatest leadership lesson I ever learned.

Interested in decreasing your dependence on insurance? Check out Private Practice through Contracting. It will help you "think outside the box," encourage you to seek work you love, guide you into paths that are sustainable . . . and it's free.