therapy practice

Is Your Counseling Practice Prepared for an Economic Downturn?

Is Your Counseling Practice Prepared for an Economic Downturn?

In a Facebook Therapist group, a person recently asked a question about how people had experienced their practice during past recessions. The answers varied as one would expect for a variety of therapists in a variety of places. As a person who practiced in the SF Bay Area during both recessions in 2001 and 2008, I wanted to add my feedback. The Bay Area was hit very hard by the recession in 2008. Many people lost their jobs. During that time I was seeing insurance clients and I did not struggle at all during the recession. One of my suitemates did not accept insurance and did struggle quite a bit. 

Therapists have their reasons for being on or not being on insurance panels. In some areas of the country (like the Bay Area) most therapists do not accept insurance. They can sustain their practices with private pay clients only. Because of the high incomes of many people that live there, that is a possibility. In many other areas of the country that is not a possibility. It is so dependent on economic situations. However, it is important to remember that economic circumstances can change. 

We have been hearing for several years that a recession is coming. We certainly know that high inflation has made many people reconsider how they are spending their money. Therapy can be considered a luxury item for many. Not just for those paying the full fee but for those with co-payments. 

How do you plan for or try and sustain a counseling practice if there is an economic downturn?

  1. Have a specialty that is recession-proof. What specialties will people pay for even if times are tough? Two easy ones are working with children and couples therapy. People will often find money to help their children or save their marriage. 
  2. Diversify your practice. What can you add? Groups, consultation, coaching, or teaching or creating an online course. Having a diversity of offerings can keep you going during tough times. Having any type of passive income is awesome. I have some online classes. They were a lot of work to develop but once they were done they have become a source of passive income. I don’t have to do anything but collect the fee (and of course check in every so often to make sure the content is up to date). 
  3. Expand your skill set. Learn a technique that is in high demand. During the pandemic, I used the time to become both certified in EMDR and a consultant. This has helped me both be a better therapist and diversify my income by adding consultation to my offerings. 
  4. Stay connected with other therapists. This is different now in these post-COVID times. Many of my therapist relationships have started online. I am in at least ten different therapist Facebook Groups. I have to target where I spend my time. I focus on EMDR groups to allow me to be seen as a knowledgeable resource for people. Most of my consultation groups have been recruited for on Facebook. I understand the real issues about social media and the good and the bad. To have a practice in 2022 and on and not be engaged in some social media is to restrict your marketing. People like to make referrals to therapists that they know and knowing someone on social media counts. 
  5. Start making videos and even better do them and post them on TikTok. Videos are an easy way to get your name out there. You can almost do video blog posts. Give your thoughts on things related to your practice. A YouTube channel helps your SEO and can build your brand. TikTok is the new wave of social media. People like quick bits of information. The attention span of the average person seems to have dropped, so short content is more effective. Make sure you share your content on social media and use a great picture in your post. This is a marketing tip, but it is even more essential to make yourself stand out during tough economic times. People want to feel like they are getting their money’s worth and working with the best person to help them. 


I would love to hear your feedback about how you have handled different economic circumstances in tough economic times. Feel free to post in the comments. 

Nuts and Bolts Starting Your Private Counseling Practice-What You Wish You Learned in Grad School

Starting Your Private Counseling Practice-What You Wish You Learned in Grad School

I have been teaching a workshop on starting your private practice since 2011. Not to toot my own horn but the feedback I have gotten on this workshop has been amazingly positive. People feel so overwhelmed by the idea of everything there is to do to start your private practice. They also recognize that they don’t know what they don’t know! They also feel nervous about asking the many questions that are arising. I have been able to provide a safe and interactive workshop where you can ask any questions. 

Originally I focused the workshop on CA therapists since that is where I was practicing. However, with the move to Zoom workshops and my move across the country I have revamped the workshop to be non-state specific. I have also revised the Ebook that I first wrote reviewing all of these concepts. 

In the last workshop, I ran one of the participants asked for a checklist of things to do to start your practice. I was amazed that I had not created that yet. It is so helpful!

And here it is for you to use. I want you to start and have a successful private practice. I hope you will also buy the book and take the Zoom course. 

But the most important thing is to take the time to be thoughtful in envisioning your practice and what you want it to be. Then just work through the list one item at a time (and they might not all be necessary for your practice).

Private practice is a great job. Building it is work but it will be so rewarding when you have your business. 

Feel free to email me if I missed anything on the checklist. Like everything it is a work in progress. 

Also I have a Facebook Group where you can get tips on starting your practice. Join Here!

Zoom now offers Business Associate Agreements

Zoom now offers Business Associate Agreements

Zoom now has individual telehealth options

Goodness this is now old news. I started this post and then forgot about it. Welcome to new times!

Anyway for those who are still looking for a good Telehealth Program Zoom now has a Healthcare plan for $14.99 here. 

You do have to reach out to the Sales people to get the Business Associate Agreement and when I did it a few months ago it took some time to get it.

That being said if you are not using an electronic health record for your tele-health then Zoom is going to be your best bet. Everyone knows Zoom now that would be willing to do online therapy.

Anyway if you have not moved off of a less secure platform like Skype or Facetime now is the time to do so. While there is a waiver in effect that allows us to use non-compliant platforms it is always best practice to use a HIPAA compliant platform.

Do you need to worry about the “open notes” rule?

Do you need to worry about the “open notes” rule?

Open Notes rule

There has been a bit of panic as therapists have begun to hear about the open note’s rule that was supposed to go into effect in October but got pushed back until April 2021. Is this something that needs action in most therapy practices? The easy and short answer is no. I went to tech guru Roy Huggins’s office hours on this and a few things came up.

  1. If you take only paper notes there is no concern at all.
  2. If you use a practice management system like Simple Practice or Therapy Notes you are currently exempted from this requirement. Because these systems are not electronic health records systems (and many of us have used that language incorrectly) but practice management systems. And if your system does not allow for the quick transfer of these notes you are okay under this rule.

BUT (and there is always a but) you do need to make sure you understand that under HIPAA clients have a clear right to all of their records at any time. This is an requirement that many therapists seem to not understand. There is not a lot of wiggle room here. Psychotherapy notes are excepted but you have to be very careful that you are following all the rules for what makes a psychotherapy note. Roy says he teaches his trainees to always write their notes as if a client would read them at some point. That is a practice I follow myself. These rules emphasize that therapists (and all medical providers) cannot do anything that blocks access to information for a client. In fact, in the workshop, Roy gave they said that they say the Office of Civil Rights (the enforcement arm for HIPAA) is now enforcing those complaints more and more.

For more information please check out Roy’s office hours that are linked to above and here is an official website with further information. 

Starting Tele-Health in CA

Let’s talk about Tele-Health in CA.

Adjusting your practice to tele-health

Adjusting your practice to tele-health

Like most of you I have spent the last few weeks transitioning to a telehealth based practice. I was lucky in the sense that I began making the move before the stay in place orders so most of my clients were able to sign the paperwork in person. I was unlucky in the sense that I had signed up for VSEE clinic and it collapsed the first day under the pressure. I was able to sign up for Simple practice and get a free month and use their video capabilities. I have liked this service and it now has been in the quandary of whether I should move my health records to Simple Practice from Therapy Notes. Because right now I do sessions on one platform and write notes and bill on another. Therapy Notes is working on video capability but there are still months away from it. I am in contact with SP to see about the help they can give me in transitioning.

That being said I know there is a lot of information out there about HIPAA being waived right now. I do want to caution people to not use that as a reason to stop using HIPAA compliant technology. Using other non-secure platforms jeopardizes our client’s information and should only be used if there is no alternative and with informed consent on behalf o the client.

What do you need to do in CA to do tele-health?

  1. Obtain informed consent form the client-this includes informing the client of any risks or limitations of telehealth services.
  2. Provide the client with your license or registration number
  3. Document reasonable efforts to ascertain the contact information of relevant resources in the patient’s geographic area

Thee consent does not need to be written though that is the best way of documenting consent.

Each session the therapist must

Verbally obtain and document the clients name and address at tine of session

Assess whether client is appropriate for tele-health

Utilize industry best practices for tele-health

We are allowed to provide tele-health in any other state only if that is permitted in that state by that states governing board. Some states have waived this so it is best to check in with the state where you client is located. Remember our liability insurance does not cover us if we practice outside our scope of practice or outside of CA if we are not following the laws.

Here are a few additional resources

Here are the BBS regulations on tele-health

CAMFT produced Telehealth FAQs for Therapists during the COVID-19 Coronavirus Pandemic
by Ann Tran-Lien, JD,, Managing Director of Legal Affairs

Check out the resources I developed on my counseling website

Here is a video I made on my transition to Tele-Health

Resources for Tele-Health Platforms

In this time of crisis do not expect any free platforms.

Thanks to Michael and Donna of Counselors Concierge for producing a list which I modified for this post.—Free version no longer available-unable to find pricing on their website.
VSee—Free version no longer available $49 a month for sole proprietors
Zoom Healthcare option ($200 a month) you do get 10 licnesse so you can share the expense. It does take them a while to get back to you to get the BAA.
Spruce video Spruce has a package with many services including video for $24 a month
Google Meet w/ GSuite and BAA (chat and video) they are advertising $6  and $12 plans montly
ReGroup—No pricing information on website and they may be no longer accepting new accounts
Thera-link $45 a month
TheraNest-telehealth option (w/ account) the account pricing is based on active clients and starts at $38 a month for 30 active clients. Free
Simple Practice–telehealth option (w/ account)

2020 Requirements for CA Licensees

stop sign

For 2020 the Board of Behavioral Sciences has added a few new requirements for licensees in CA. The first law AB 630 is a requirement that you let all clients know where they can make complaints. The suggested wording is as follows


The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at, or by calling (916) 574-7830.”

This must be given to clients by July 1, 2020 so I suggest that the New Year is a great time to update your paperwork and add this to your informed consent. All of your existing clients must sign this statement also. The BBS memo on this is found here.

The second requirement is that after January 1, 2021, you must receive 6 hours in suicide risk assessment and intervention. If you are a new licensee you will do that as part of obtaining your license. If you have a license you will have to have proof the first time you renew after January 1, 2010. My renewal will be April 2022 so in the period between 2020 and 2022 I need to take a CEU course on suicide assessment and intervention or I will need to get documentation that I received such training in graduate school or a training program. Remember the BBS is auditing CEU requirements and it is the #1 ethical violation for licensees currently so make sure you have the documentation in your files.

The BBS statement on that requirement is found here.

Negotiating a raise with insurance companies

Negotiating a raise with an insurance company

close up of man with calculator counting money and making notes at home

So can you get a raise with an insurance company you are in network with? The answer is yes. Here are a few tips on how to do it.

1. Check your contract first. Some insurance companies never give raises. A few of them have it in their contracts that they do not negotiate with individual providers. Check that out first.

2. Find where you send the request. This can be the most challenging part of this process. If possible you want to make the request to a provider relations worker and you want a direct name. However, many companies do not give that information out so you have to send it to a general mailbox. I still have had success doing that.

3. In your request be brief and let them know why you deserve a request. Make sure you emphasize something you do that is different. If you have some specialized training or work with a population that not every therapist works with. They don’t care that they haven’t given you a raise in many years. They do care if you offer something that is in limited supply.

4. Be persistent. Seriously. Send the request and then follow up every 2-4 weeks on it. Two of the three times I have negotiated a raise I corresponded with the company at least four times before I got a real response.

5. Ask for a generous increase. I have had an insurance company just give me a larger amount I requested and another one negotiated down some. So ask high and expect them to counter offer.

6. Be creative. Recently I got a response from a person from a general email and then they stopped responding to me. I did some research on how this company formatted their emails. Most companies do that in a standardized fashion with last name and first names. I then emailed them directly and got a response within a day.

7. Once you get the offer you have to usually send in a new W-9. Then it can take a few months for a new contract to be signed and for it to go into effect.

Photo Copyright: jk1991 / 123RF Stock Photo

5 things to do when your therapy business is slow

5 Things to do when your therapy practice is slow

When I teach my Nuts and Bolts of Private Practice one of the things I talk a bit about is managing your practice anxiety. No matter how long you have been in practice there will be ebbs and flows. Sometimes those ebbs will feel really scary and overwhelming and send you messages like “Oh my. I am going to have to go back and get a real job again.” It is important that we practice not from a place of fear but instead a place of peace. If we allow ourselves to get fearful about our practices that will lead to making decisions out of that fear. Those decisions tend to be bad. We accept a client out of desperation rather than because they are one of our ideal clients. Almost always there will be regret later. So here are 5 suggestions to cope.

  1. Put it into perspective. It can be helpful to track weekly client counts and keep that to refer back to over time. We have a way of forgetting that we have been through certain experiences before. Going back and looking at a spreadsheet of income and number can calm that thought and remind us that we have been through it before.
  2. Consider using the time to relax. I know it feels counter intuitive to relax when our practice is struggling. However, fighting the struggle doesn’t help. Using the time to take care of things around the house or increasing self-care can help energize you for the clients that will come.
  3. Up your networking. You should be regularly reaching out to other therapists and care providers and have a coffee date. But most of us don’t do this well. Especially when business is good. When business is slow it is a good time to get it in gear and make a bunch of coffee dates.
  4. Take care of some of the back office tasks. Is your shredding up to date? Does your office need a refresh? All of your forms copied? Blogs written? Take care of all of those tasks. You will feel a sense of accomplishment even if you aren’t getting paid for the tasks.
  5. Do one marketing thing that is out of your comfort zone. If you are an introvert this means doing something that involves contact with other humans. If you are an extrovert perhaps it is writing a blog post. Think about one of those things you have been putting off forever and take care of it. In order to build successful practices, we need to push ourselves sometimes. When things are slow is a good time to do this. 
Photo Copyright: astragal / 123RF Stock Photo

5 Podcasts to help you build your therapy business

5 Podcasts to help you build your therapy practice


Podcasts are the newest addition for those building their practices. Well, new may be a bit of an exaggeration but it feels like right now every other day I see a new podcast by a therapist. I confess to not being much of a podcast person myself. I like to learn by reading. But podcasts are a great way to get information quickly and learn a lot. I created this list from recommendations made by therapists in a variety of Facebook groups including Selling the Couch.

This list focuses on practice building podcasts. In the future, I may add a list of practice related podcasts so feel free to comment and let me know your favorite podcasts for a future post.

  1. Selling the Couch. Melvin Varghese is up to episode 132 of his podcast and that one talks about returning to work after a maternity leave. I was featured in episode 105 on Search Engine Optimization Tips. He touches on a wide range of topics and interviews therapists in the field. Melvin is a great host and super genuine and also offers a Facebook group to more support.
  2. Private Practice Journeys Christopher Quarto interviews 4 different therapists monthly as they start their practices. He also throws in some experts in the field speaking on a variety of business building topics.
  3. Practice of the Practice Joe Sanok is a long time private practice coach. Some of his recent podcast topics include writing an e-book and building a private pay practice.
  4. The Private Practice Startup  Katie Lemieux and Dr. Kate Campbell are two MFT in Florida that have built successful 6 figure practices. Their recent podcast topics include secrets of a badass profile directory and things you need to know before signing your private practice lease.
  5. Abundant Practice Podcast Allison Puryear is a therapist that fought through her own struggles with money to work towards a successful private practice. Her recent topics include 5 reasons private practices fail and how to get consistent referrals.
Photo Copyright: astragal / 123RF Stock Photo


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