Yesterday I got an urgent email from a coaching client regarding a situation she encountered many times when working in agencies, but for the first time now in private practice. This question almost immediately triggers my “supervision” mode, so I really had to pull back and grab my coaching hat to respond.
My client (new to private practice, but an experienced, strong clinician) had just met with a new client with whom she spent an extra half hour in their first session (first red flag). This client presented with very complicated issues; most specifically, issues of addiction. My client could not be sure if he was high in their session or if his pressured presentation was typical or mood-related. Sometimes it’s tough to tell when you have no other point of reference. In addition, this client reported a long-standing history of addiction and that he had been clean for less than 2 weeks. He refused to sign a release for collateral information (second red flag). Clearly she was meeting with a very high-risk client.
So what do private practitioners do when faced with the high-risk client? No matter how much you try to screen your clients (i.e. asking just the right questions in an intake phone call; having the client submit screening tools/forms in advance of the first session), inevitably most private practitioners will face this frightening situation at some time in their careers.
My client told me that this type of situation was not uncommon when she worked in agencies; that there she felt safer and better able to respond because she was not alone and the support options were in place. But here, in her safe haven, she didn’t feel so safe – for her or for her client.
There are so many clinical issues that rush through your mind – lethality, medical complications, the need for a higher level of care, and so much more. Those go without saying and they were of primary concern to my client, the clinician.
The “other” issues are not so easy to talk out loud about, and are of primary concern to me, the coach.
•How can I feel and be safe working with this person?
•What do I do if something goes wrong and I end up in a legal situation?
•How can I turn away this person who I’m sure I can help?
•Can I really afford to turn away a new client when I’m trying to build my practice?
These questions are natural – and, they are a very real part of being a private practitioner.
My gut reaction to the call for guidance was to swoop in and pull my client out of the “muck”. As a clinician, I shared her clinical concerns regarding her client. As her coach, I was most concerned about her safety, her license, and her business.
Here are a few tips for protecting you and your practice when faced with difficult situations:
#1 Protect You!
I know I shouldn’t have to say this, but I do. I don’t know of a clinician (including me) who can say that they have never been in an unsafe situation (even for a few minutes) with a client. Most people in private practice work alone (or even if they are sharing space with others, they are alone behind closed doors with clients). Think about who you are seeing, when. Think about your safety leaving your office late at night.
•Consider a panic button that you can use in your office, and you can carry with you to the car
•Let people know when you are working and get them in the habit of you “calling in” from time to time in your day
•Above all else, your safety must be of primary concern to you – if you have a client with whom you do not feel safe either put in adequate safety measures or refer that client to the appropriate setting
#2 Protect Your License
How hard and long did you work to get your license? Are you really going to put it on the line to fill your book or accommodate an unstable client or business partner?
•Go online and read about how/why some professionals have lost their licenses in the past. I think you will be surprised. It is an eye-opening experience, and it will make you think twice about your record-keeping, the way you manage your personal life, and the decisions you make with clients
•Realize that at any point in time things can go south quickly and you could end up having to defend yourself in a malpractice situation. This could happen with any client at any time. Even if the legal action is unfounded, you’ll have to check off that little box on all of the insurance applications (the one about having been involved in a malpractice situation) for the rest of your career! Hopefully this realization will keep you vigilant to do whatever you can to reduce your risk
•Whether it is a business partner with a tendency toward insurance fraud, or a temptation to treat a client out of your scope of practice (i.e. the client requires a higher/different level of care) – ask yourself if that person is worth the risk of losing your license and your career
#3 Protect Your Business
No matter how new or small your private practice, it is your “family business”. You’ve taken on huge risks to have and run this business. It is probably a big chunk of your heart and soul. Protect it as such.
•Recognize that it takes a lot of time to build trust with your customers (referral sources) and the community, but it takes one ugly moment to destroy everything you have built
•People tend to remember the negative things they read and hear. Bad press can stick with you for a long time. Don’t do anything that might put you in a bad light
•Don’t forget that when you lie down with dogs you wake up with fleas. If you have a business or life partner that is involved in risky business, you can be taken down right along with them. You may not have the presence of mind to protect your heart, but for heaven’s sake, protect your business!
Clients or situations that put you or your business at risk (no matter how ill they may be) might elicit your concern and empathy, but it is up to you to protect you and yours. Don’t let one questionable situation or client keep you away from doing what you love and from helping hundreds or thousands of others.
Deborah Legge is a counselor, an assistant professor, specializes in coaching counselors in private practice, and is the founder of InfluentialTherapist.com