12/01/2006

Private Practice: Issues, Realities & Ideas

by Wilma Fellman

There was never any doubt in my mind about which aspect of counseling was for me. I was drawn to career development like a laid-off worker is drawn to hiding under the covers. Yet the question was: in what work environment would I best serve the profession?

Twenty four years ago, I began as a Job Club Instructor, working with severely disabled, yet deemed "job-ready" individuals. I loved it instantly! To be a part of someone's life-altering moment of hire was more positive feedback than the paycheck. My next experience was that of a Rehabilitation Counselor, assisting injured workers in assessing their readiness to return to work, or modify their job-goals for a better fit. A need arose for a Career Development Counselor in a Rehabilitation Agency, and it was there that I really fell in love with the process! One day I did an activity related to long-term, strategic, career goal planning and discovered that I had an additional passion for working with specific populations, with respect to Career Development.

Thus, roughly 11 years ago, I embarked on the challenge of my life: Private Practice, specializing in working with adults with AD/HD, LD and other challenges, with respect to making good career choices. First, I became engrossed in organizations that addressed these specific issues, and participated in state and local groups that furthered my depth of understanding.

I have never regretted this decision, and believe that my career is still unfolding in new ways nearly every day. I'm grateful for having tried this avenue and encourage others to do the same - provided they really know and understand the issues, realities and ideas behind the broad, and somewhat alluring title of "Private Practice!"

Private Practice looks like a nearly perfect profession from the outside: One is able to make his/her own hours, be one's own boss, create one's own agendas, and get paid more per hour than anywhere else! Who could ask for anything more? Yet, there are certain issues that need to be understood to make it work for others as it has for me.

Issues and Realities of Private Practice

• In Private Practice, constant marketing that must be done. Oftentimes, counselors are not as strong in this area, and some find they cannot do it at all.
  
• Private Practice can sometimes feel lonely - lacking the camaraderie of co-workers.
  
• In Career Counseling, clients are goal-oriented to leave this short-term relationship as soon as decisions are made or issues are under control. The need to constantly replenish clients is an issue that some Private Practitioners find exhausting, with inconsistent cash-flow income.
  
• If clients pay out-of-pocket (most insurance companies do NOT pay for "wellness" and thus Career Counseling is most often not covered.) then they want it to "be over" as soon as possible. I have found that therapists, who are already billing the insurance company under a diagnostic code of "anxiety" or "depression", refer most of my clients to me. IF two service providers vie for the same fees, the insurance companies will pay neither. So, most career clients are private pay.
  
• Private Practitioners do make more per hour than those who work for someone else. However, when a client doesn't show for an appointment, 20 expected clients per week for short-term counseling might turn into 10 clients who actually show up, resulting in unexpected loss of income.
  
• Overhead costs (rent, insurance, phone, supplies, secretarial if appropriate) result in a fixed monthly expenditure regardless of vacations, cancelled clients or time away to attend conferences.

Suggestions to Offset The Negative Issues

1. Offer free workshops to clinics, therapists, schools and other potential referral sources. Teach them how the career development process works and how their clients/patients/students could benefit, and leave your cards and printed materials for them to pass along.
   
2. Join professional groups that stimulate your profession and result in the exchange of ideas to keep you sharp, growing and part of a larger "family."
   
3. To offset the need for constant marketing, build PR contacts into your week, making sure to assist and inform how you can be of help to referral sources. Don't think about it as "negative cash-flow time," but necessary outreach. You could also hire a student to do some of the administrative work.
   
4. To offset clients' financial hardships, streamline your practice to get right to the specific services they are requesting, so they aren't impatient with the process. Once you show clients progress towards their specific goals, they often request additional services with more trust and faith.
   
5. To help offset the unexpected loss of income produced by clients who do not show, it is wise to send a reminder email or phone message the day before an appointment. In addition, always be ready to use the hour to plan and market your services for that week. It takes the sting out of dwelling on the losses.
   
6. Some private practitioners offset the net cost of no-show clients or last minute cancellations by declaring up front that a fee will be charged in this event. It can often be an incentive for some clients to follow-through, depending on the individual situation.
   
7. Finally - a great way to offset negative issues and realities is to diversify. Once you feel comfortable as a Private Practitioner, you might want to branch out into providing in-depth classes or workshops, on site, online, or even as a teleclass. Staying within the ACA Code of Ethics can still enable you to teach much of the career development process, which leaves the counseling piece to be a smaller unit of service.

Private Practice can be a most rewarding environment in which to serve others in career development. As we suggest to our clients, it is essential to check out the positives and negatives of any job before launching into it with both feet. If we understand the issues and realities, we can plan for them, offset them as challenges, and enjoy the fruits of our endless possibilities!

Wilma Fellman, M.Ed., LPC has been a Career Counselor, for over 24 years, specializing in individuals with AD/HD, LD, and other challenges. She is the Founder/Coordinator of a Michigan organization for professionals who specialize in AD/HD. She is the author of: The Other me: Poetic Thoughts on ADD for Adults, Kids and Parents, and contributing author of Understanding Women with AD/HD. The Second Edition of her career development book, Finding A Career That Works For You (with the Foreword by Richard Nelson Bolles, author of What Color is Your Parachute) was recently published and is now available online at addwarehouse.com, amazon.com and other bookstores. Wilma is Past President of Michigan Career Development Association, served on the ADD Association (ADDA) Board for 8 years, and teaches online classes at ADDConsults.com.
She can be reached via email at WRZF@aol.com.