Ryan Thomas Neace

People are returning to school in record numbers. Graduate counselors-in-training are no exception. According to the American Council on Education, 62% of graduate and professional students are enrolled in Master’s programs. This should really come as no surprise. The economy’s in the tank. The phrase “job security” is increasingly an oxymoron. And the advent of online education promises to let you keep your current job and acquire new skills from the comfort of home with just a laptop and a dream.

A client walks into a practice. More specifically, he walks into a session with you. After a brief initial interview, he says to you, “I have problem X.” Now is the moment of truth. That $100,000 education and all those years of clinical experience are called upon for effective goal setting. Your client looks up at you with those dewy, expectant eyes. You give it to him straight. “Do the opposite of X.”

Running a private pay practice sounds so dreamy. People walking in off the street, surrendering cash or credit card numbers. Consenting to paying out of pocket as if money was no object. Oh, how sweet it sounds! With all of the hemming and hawing you hear about insurance these days, you’d think running a private pay practice was the most straightforward, easy step toward easy street. But reality is far more daunting, and it is easy to get discouraged. Here are some implications to being private pay only, and a few suggestions for success.

(This blog is a response to the blog, “SHOULD I EVER PRAY WITH MY CLIENT?” by Ray McKinnis. You may read that blog here – http://my.counseling.org/2011/05/31/should-i-ever-pray-with-my-client/) Recently, Ray McKinnis blogged about prayer with clients, stating that the practice is categorically unethical and worthy of abstinence. I respectfully disagree.

“Bob” and I had some trouble keeping our sessions to an hour. His desire to unpack some historically traumatic events, combined with his clinically significant anxiety and ADD left a pretty tight squeeze. What’s more, Bob agreed that his cannabis use immediately before sessions didn’t give him a full-range of emotional expression, but he was even more scattered without it.