I remember when the practice opened. Large empty client medical cabinets, vast blank pages on the schedule sheets, things were so unsettled and so open. I had visions of a quite little practice where I would see a few clients, take a break on the hammock outside or perhaps paint. Some days I would do both. I received a great hammock for my birthday, it was quilted and oh, so comfy. I even set up my paints in an unused office. I had every color and brush in my collection and a stack of canvases to go with my rough sketches. Then the phone rang with my first client… Small practices like my small not for profit often have visions of getting away from the rat race of more “business minded” settings like large corporate counseling programs, community programs, hospitals etc. and envision that starting their own program will be a much more sedate affair. Perhaps it can be if you are far more inclined to turn away clients than the average person. If not, even if as I did, you have a number that is not listed by information, not in a phone book and you do not advertise, within a very short period of time you will see that you too have ten hourly sessions per day scheduled and still more calls coming in at a rate faster than you ever anticipated. As far as problems go, this is not a bad one to have because as your practice progresses this will allow for you to either become more selective with clients you serve or to expand your practice. It is imperative however for your health to keep from over working yourself for too long as it can have huge negative effects not only of interpersonal relationships but on your physical health as well (I learned this the hard way). If you are trying to keep a very low client list here is a short list of your enemies (things that tend to pack in the client referrals). • Insurance panels are your enemy as they give you a reduced payment but a large built in referral list. Avoid insurance companies like the plague and charge a great deal to your cash clients. • Word of mouth- this can be killer. Do a good job for a few clients and soon they are telling their friends, coworkers and relatives who may be having similar issues. Soon you learn that one happy client can bring you new clients for years to come. While you can’t spray your clients with water even if you market it as “hydrotherapy,” you can find ways to make their treatment brief and unenjoyable. Perhaps a sign that reads “entertain me,” having a catch phrase such as “you think you’ve got problems, my 10 o’clock thinks they are a Dalmatian, do watch for puddles,” or periodically shouting “boooooorrrrriiiiiinnnnggg” just as your client is getting closer to a break through. • “Being real” – here is what can set you aside from your fellow clinicians. Being friendly, compassionate and anything that makes you seem like a knowledgeable but approachable clinician can lead to many happy clients who will stay with you until they successfully complete treatment but again, they will also refer folks to you which you want to avoid. The solution is simple: do not be “real” nor pleasant. Be aloof, appear to think less of your client and by all means pour on the condescension like warm maple syrup on griddle cakes. • Comfortable office space and furniture- here again, making an office pleasant and approachable to the eye, having comfortable furniture and worst of all a pleasant receptionist can kill your chances at having free time to relax. Consider cold barren walls, cold uncomfortable furniture and perhaps a receptionist trained in pleasantries by Dick Cheney or Judge Judy will do the trick. • Returning calls in a timely manner- self explanatory, MAKE THEM WAIT AS LONG AS YOU CAN. No return calls, no session times. See? Now you are getting it. • Compassion, Caring, Consoling – these traits are the kiss of death for clinicians who want free time. Avoid them at all costs! Maybe hang some anti inspirational posters in the office. Instead of the famous kitty in the tree that says “hang in there” you could instead have one that says “why even bother?” Instead of signals that you care, you could instead say “and I should care why exactly?” maybe a big countdown clock with a buzzer that counts down every second of the client’s session. When it reaches zero a loud buzzer followed by an electronic voice that shouts “GET OUT!!!” will go off… Ok all jokes aside, I my point is that when you start your own practice, LLC, group, not for profit etc. it is good to have a plan and an ideal of how it will go, but realize that it will likely come out differently. When you are new and the file cabinet is bare, ENJOY IT because even if you are just a so so clinician you will likely be full in no time, provided you do the opposite of my short joke list above. Though you may be able to paint and have an office, this will take a great deal of dedication and the ability to firmly say no on your part. I think I did a small painting once when I first opened and had a few minutes on the hammock. Soon it all was packed away to make room for additional file cabinets and office supplies… Do not be afraid to take that first step. Who knows, maybe in a few years I will be able to send my over flow clients to you?
Warren Corson III (Doc Warren) is a counselor and the clinical & executive director of a community counseling agency in central CT (www.docwarren.org).