The Human in the Helper: I felt like my life had been thrown in a blender

Michelle is known in her community for helping colleagues become CE providers because she believes in what they have to share, she recognizes the freedom course creation brings, and she wants colleagues to have additional income streams. She is also known for her fun glasses and for being a breast cancer survivor. “I was diagnosed in January 2020.” Michelle describes a moment in her life that was sheer terror as she waited for official results. She recalls the experience as being told there was something abnormal and that they were pretty sure what it was, but required two weeks to formally confirm. “I would rather go back to chemo than relive those two weeks of hell.”

Michelle wasn’t sleeping. She felt dissociated. Her heart rate stayed high, even when trying to sleep. Her daughter kept waking up in the middle of the night worried and finding reasons to engage her mom to make sure she was okay. Michelle struggled with what to tell her clients. “I feel bad for the clients in that waiting period, I showed up the best I could.” It’s understandable that Michelle had a hard time being present as she waited for the game plan for fighting her cancer, which ended up being a very aggressive type of breast cancer with the worst prognosis. “I notified my clients about needing two weeks off to address my medical care.”

Once she had her plan, which included chemo, surgery, and radiation, Michelle focused on referring out her newest clients and her acute clients to other providers. “It was hard to make those calls while also trying to take care of myself.” Michelle kept clients she’d had longer on her caseload, who also had more rapport for this next season of her life. Then she experienced the pandemic shutdown. “It was sort of a blessing to move to working from home. I had lost my hair, I was wearing a wig.” She moved everyone to online and tried to keep up with her medical appointments.

Another challenge Michelle faced was maintaining boundaries around her cancer treatment with clients who were worried. “I let them know there was going to be a boundary and set the timer for five minutes. They could ask me anything they wanted regarding my cancer and treatment, but once the timer was up, it was back to being focused on them.” Michelle reports this worked well for clients. Some only wanted to know that she was okay, while others had more detailed questions to ask. She navigated this dynamic with her clients through ten months of treatment.

Michelle is in good health now, and has had time to reflect on her process. “I wish there was more support in our community for things like this.” She described wanting a way to notify a trusted colleague when awful things happen, someone who could make the calls and outreach the clients when their therapist has to pause or regroup. Michelle felt this need again when she got the call at the end of a client session that her father had died. “How do we let people know when life things happen? We worry about client abandonment. We worry about liability.” Until a tool that supports this communication is created, Michelle has some other ideas for colleagues. “Be gentle with colleagues online. We don’t know the whole story as to why they didn’t show up, why they didn’t call back. They could be going through something.” She hopes that mental health professionals can support connection and community with one another, two things that feel so important when coming back from crises that happen in our lives. We couldn’t agree more.

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

The Human in the Helper: My clients didn't know

Sharon loves using humor in her therapeutic work, which serves her well considering she works with a variety of clients including children to older adults. It’s also helped her navigate almost four years of medical challenges. “I had three medical issues in a row!” Sharon shared. She reflected on needing serious medical care that felt disruptive to her work-life balance for several years. “It was hard. Sometimes it was great to be with clients because I needed to think of things other than the pain.”

Even as Sharon was attempting to navigate her pain, most of her clients didn’t know she was going through so much. “Clients would be shocked to know what I went through. They had no idea. I had to think about if it would hurt or help clients to know,” she said. This was possible due to her offering telehealth sessions where clients couldn’t see the medical changes or recovery equipment in her life at that time. Sharon went on to describe how she didn’t want to reinforce attachment traumas for certain clients or cause them to worry about her, resulting in clients attempting to caregive her rather than focusing on their own stuff in therapy. “We have to be curious about if honesty is helpful, or if it just makes it about us, “ Sharon warns.  It helps us reflect on the purpose of self-disclosure when things are happening in our personal lives, exploring the impact on our client work from multiple viewpoints.

Sharon isn’t saying that clients come first, however. When it comes to medical care and health and wellness needs, she recommends therapists treat themselves likes CEOs. “Be the CEO of your business where your needs come first, then your client care.” She named how making her health a priority actually helped her get better, and allowed her to serve her clients better when feeling well again.

An important part of Sharon’s recovery in needing medical care was her own support system. She reflects on how embracing vulnerability and sharing her struggles with colleagues helped her reduce her caseload with thoughtful referrals when she was feeling tapped out. She named gratitude for a spouse who encouraged her to do what needed to be done in order to get better.  “There’s a strength in saying there’s no way I can get through this on my own.”

Sharon is celebrating that she’s in a better spot with her health today, and recognizes that the lived experience of multiple medical concerns has made her a better clinician in some ways. “Having to sit in the question of ‘is this it?’ myself allows me to sit in this heaviness with clients.” Whether it’s aging, end of life, or the loss of a loved one, she feels prepared to slow down with clients and feel the big emotions that come with mortality and loss. She continues to hold passion for her client work and gratitude for her experiences, and names a willingness to keep her health a first priority amidst her calling as a clinician. “As long as I can take a break from any surgeries or medical crises in 2024,” Sharon grinned.

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

Seven Steps to Changing Your Business Name as a Therapist

Photo by Kelly Sikkema on Unsplash

It can feel like a stressful process to change your business name, much like it can feel overwhelming to change your last name. What steps do you need to take? What order should you take them? What are you forgetting? Since I’ve experienced both a business name change and last name change, I wanted to share some steps to make the business name change that much easier for everyone else to navigate as private practice therapists and small business owners.

Step 1: File a request to change your business name with the IRS. You will get an updated EIN letter reflecting the same EIN and new business name, which will be used to submit changes to other organizations electronically.

Step 2: Change your business name with your business filing in your state. Here in Colorado, it’s the Secretary of State where you can login and request an update, found in the same portal as your annual business filing requests.

Step 3: Complete forms and/or notify insurance panels of the name change. This could take weeks to months to update, which if they are writing you checks, could become a problem if not tackled just so. Don’t forget to update your CAQH profile at the same time since insurances will cross check that!

Step 4: Update your EHR to reflect the name change in your consent forms, your disclosure, your scheduling tool, and your practice information. Notify your clients of the name change in writing so they don’t get confused.

Step 5: Update your bank information to reflect the new business name. Oftentimes this requires an in-person meeting with a banker at your bank to provide the documentation required to make the change. When you schedule your appointment, confirm what you need to bring to make the meeting as efficient and painless as possible.

Step 6: Notify your professionals of the name change, including your biller (if you have one), your accountant, your financial advisor, your tax person, your practice lawyer etc. Notify your malpractice insurance so they can re-issue your insurance for the updated practice name.

Step 7: Update your marketing materials. This includes:

-Your website

-Your logo

-Your social media accounts

-Your Facebook business page

Now you are ready to announce the change to your community! Even though there is excitement in the change, it can also feel daunting, especially knowing that not all of these steps will go smoothly. Give yourself some grace and a significant runway to implement all the changes before announcing it officially. It can feel like a long process to get everyone up to speed on the new name, however once it’s done, the excitement of pivoting will return, allowing you to look forward to the next meaningful chapter in your business!

Exploring Secondary Income versus Passive Income in Private Practice

Photo by Christina @ wocintechchat.com on Unsplash

Many mental health professionals are exploring additional income streams. Whether it comes from a place of wanting more freedom, supporting burnout prevention, or a desire to have greater flexibility than seeing 20-25 client per week, diversifying income is an important consideration in a successful, balanced private practice.

So let’s talk about passive income versus secondary income. Passive income is something that once launched, makes you money without much effort. Things like:

Book sales

Digital downloads

Online courses

Digital workbooks

An App

Secondary income is a bigger bucket of possibilities, but they also take time to build, effort to maintain, and require time allotted to produce regularly, meaning a more significant shift in your client schedule to avoid feeling overextended. Things like:

Professional training and workshops

Professional speaking

Podcasting

Radio show

Online merchandise or swag*

Retreats

Hosting conferences

Group practice

Video series

Group therapy

Intensives

Supervision

Consultation

Online memberships*

Teaching/Being a Professor

*Depending on how they are built, these could become more passive

Why should we talk about both passive and secondary income streams? As someone with 16 current income streams, the differences and options within private practice matter! For colleagues who connect with me in consultation on this piece, they want to work less so they are seeking passive income streams. Which is great, I’m all about it! And perhaps they are surprised to hear that it can take 4-5 years to see the passive income really flowing well, where additional effort or time isn’t required to maintain them. So then we start to look at secondary income streams together to make a faster, satisfying shift in their money story, with momentum towards a passive income stream in the near future. The ability to bring in additional income is an important skill in business, and thus a skill to master in private practice as well.

Want to know one question (of many) that I ask colleagues in these types of consults?

What’s one pain point for your clients that you already address?

Pain point being defined as an area of hardship, difficulty, or discomfort. Seeking a solution. Is the thing you do (exercise, skill, tool, technique) replicable and scalable to a larger platform for increased reach and income? Let’s talk about it in a consultation!

Both passive and secondary income have a place in the equation of private practice success. Honestly, my favorite type of consultation these days is helping colleagues identify their interests and passions and turn them into possibilities that generate new income. What’s holding you back from dreaming about these possibilities? Maybe you have ideas but aren’t sure how to implement them. With so many colleagues creating amazing things, you are closer than ever to finding your additional income stream(s). Reach out to one of us that speaks to what you are dreaming about. Before you know it, you’ll be one of the professionals showing others that diversified income is possible and maybe even necessary to avoid burnout in our field.

A Caution When Setting Different Rates in Private Practice

Disclaimer: I am not a lawyer. This content does not replace a professional consultation with a legal representative.

What do I need to consider when setting my rates?

It’s a common question I’m asked as a Financial Therapist to therapists. Although there are multiple factors to explore when raising your rates (join us in our upcoming workshop!), there is another piece to the puzzle that’s been on my mind lately.

For therapists in private practice who take insurance, there are parameters they agree to as part of signing a contract and being in-network. One of which is that Balance Billing is illegal in Colorado. Balance Billing describes billing your full rate to insurance, being paid your contracted rate by insurance, and billing the client the difference. This is a no-no in Colorado.

An example:

Your private pay rate is $150

Insurance pays you $121

You invoice your client for the difference, which is $29

Seems pretty straight forward that this won’t fly. But what about in private-pay practices? Are you allowed to charge different clients different rates?

Yes and no.

For different services, it is common and accepted to have different rates. For example, your individual therapy rate may look different than your couples or family therapy rate, EMDR intensive rate, or 60 versus 90 minute session rates. Some folks are charging a higher rate for “premium times” like evenings, which feels a little sticky unless it’s in writing and known to all clients when scheduling for them to make an informed decision regarding their therapy.

What about charging a client a “supply fee” for being in-person? This feels like a gray area in private pay practices.

What feels even more sticky to me is setting different rates for in-person versus telehealth sessions, which has come up more often as professionals explore hybrid practices where they offer both.

For example:

A therapist charges $150 for a 50 minute telehealth individual session.

They charge $175 for a 50 minute in-person individual session.

The cost difference is that they want to charge more for in-person to offset costs like office space or rent, or gas and supplies like coffee and tea that are utilized for in-person services. As a business owner, I understand that thinking. And yet, the bottom line is that those expenses are tax deductions and part of doing business.

Here are two reasons I would caution a therapist against having different rates for telehealth and in-person sessions.

1.     It feels discriminatory

That’s right, this could put you at risk of being accused of discrimination. What if your client has a disability that requires or prevents them from in-person sessions? Does in-person at a higher rate convey a message to an able-bodied person? There are aspects here to think about as a private practice therapist.

2.     It encourages insurance companies to follow suit with wanting to pay providers less

I can tell you how upset the therapist community was when certain insurance companies suggested a lower reimbursement to therapists for telehealth after the pandemic. The argument against this? We are still doing quality work via telehealth and continue to support meaningful client outcomes towards their goals via video. So if we support a different fee structure for in-person vs. telehealth in private practice with private-pay clients, are we not encouraging insurance to reignite this initiative too? As you can imagine, this would have a negative ripple effect on therapists who want to be paid fairly by insurance, and in response, might limit their number of telehealth sessions which reduces access to care for clients.

So what can you do? Rather than charging different rates for telehealth vs. in person, consider raising your rates overall to address the added expenses of in-person services. Not sure what this needs to look like? Join us August 15th from 12pm-130pm MT to engage in a live webinar workshop on raising your rates.

Raising Your Rates Workshop Objectives

1)    Remove money blocks to raising your rates

2)    Identify factors for raising your rates

3)    Explore strategies for implementing new rates

I hope I can convey that my goal in writing this is to support you as a business owner AND therapist. To hold space for multiple views while also owning that I’m risk-adverse. Raising rates is one aspect to consider in response to added expenses in practice, while knowing that things are constantly changing, which means revisiting ideas often to support your business growth.