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Counseling

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Professional Burnout

Photo by  Yaoqi LAI  on  Unsplash

Photo by Yaoqi LAI on Unsplash

My private practice, it seems, has recently become an oasis for professionals experiencing burnout in their careers and personal lives. I’m not talking about professionals who just can’t cope or who have personality traits that make them doomed to burnout; I’m talking about successful helping professionals–experts who have been practicing and thriving for 15 to 35 years who suddenly cannot stand the work they once chose and loved.

While I’ve written about ways to prevent burnout in the past I am still learning things as I help these experienced professionals–who are often very insightful and creative in their own right–reinvent their professional and private lives to make their work-life balance manageable and sustainable forms.

I wrote this almost two years ago, and I followed it with some reasons I think successful professionals suffer burnout. (My original follow up post was entitled "Regaining the Joy of Your Career!"

Reasons successful professionals experience burnout:

  • There is an emotionally overwhelming triggering event.

  • They have an exaggerated personal accountability for their work.

  • There is denial of the effect of exposure to traumatic emotional events.

  • Self-care is seen as optional (and sometimes selfish!).

  • Accountability is universal (I have to do everything well!) and not subject to rank ordering.

  • Unrealistic comparisons to others lead to a lack of balance.

  • The isolation of the profession diminishes their perspective of life.

  • Emotional avoidance of guilt, fear, shame, rejection often underlies unhealthy behaviors. (just like our clients . . .)

  • The “supporting cast” of family and/or friends reinforce unhealthy functioning.

  • Band-aids are applied when surgery is needed.

At the time since I wrote this list, conditions in the profession seem to be exacerbating the problems. (Faithful readers may remember when I challenged myself to state what our field needs in just 4 words.) Today, some insurance companies are requiring professionals to pay application fees and annual fees just to be on their boards (the customers don't pay the overhead now the service providers do?), cutbacks in public funding is threatening services, demands for "validated" therapies threaten to make healthcare the paper-pushing cousin to education, and professionals in other fields are developing services that challenge the mental health industry.

More and more professionals I talk with are seeking a way to mediate these negative forces, or leave the healthcare industry through adopting private pay or concierge practices, marketing life coaching, contracting directly with organizations, retooling into another industry, or retiring.  (Not all experts are the same Organizations need people-experts to advise them.) Often professionals, unprepared for a shifting healthcare context, burnout under the vicarious trauma of a long career. Seeing more clients that is sustainable in a healthy manner. Today, more than ever professionals often need a backup plan and exit strategy.

What can you do, in the short-term, to prevent burnout? Here's a few ideas:

  1. Don't expose yourself to additional trauma through your entertainment choices.
  2. Limit your clinical work by mixing in other business ventures.
  3. Find and maintain restorative hobbies, activities and friends.
  4. Listen to music and turn off the news.
  5. Take a break--a long one--from social media.
  6. Create a long-term business/career/life plan that includes diminishing the heavy clinical load.
  7. Broaden, or narrow, your niche to include activities that are not saturated in traumatic material.
  8. Develop a network of social contacts that are not from the healthcare industry.

Good luck!

Read: The greatest leadership lesson I ever learned.

 

 

Interested in decreasing your dependence on insurance? Check out Private Practice through Contracting. It will help you "think outside the box," encourage you to seek work you love, guide you into paths that are sustainable . . . and it's free.

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A little something for therapists who want to do "more" . . . or do "something else"

 

It was a pleasant surprise. Earlier this month, I got a message from a former student (see below) just to say, "Thanks!" "Thanks for what?" you ask. For introducing her to the idea that a professional, in the "world" of mental health, has developed a skill set that can be used for more than "just doing therapy."

The message came at the perfect time. Why? Because I had just decided--working with my graphic designer/social marketer expert--to offer, for a limited time, the book I wrote on the subject for free. This was the same content that students, like this one, told me I should put into a book. So, I did.

The book was published, used as a textbook for my course, and has been selling bit-by-bit for the last five years. (You can check it out, if you want--but don't buy it! I am going to give it to you free, remember? Here it is on Amazon)

Since publishing the book, a number of students and other professionals who read the book, have recognized the potential and have started contracting and working with organizations and businesses. For some it has been offering therapy services--such as an Employee Assistance Program--for others it has been business coaching or consulting. But "some" is not enough. There are so many organizations and businesses who could benefit from the support of a professional who understands complex human systems and who has "people skills". . . that I continue to doggedly "preach" to my colleagues the benefits of acting as a consultant.

Now, we are offering you this tool--a free tool--to help you jump start your thinking and consider what more you can do. Feel free to share it with other colleagues. (The book has paid for all it's publishing costs!) We want to see more and more organizations and businesses using professional "people experts" to help their work teams and organizations. We can't leave the role of "expert advisor" to business experts, accountants, and lawyers alone. They are very good at what they do--their areas of specialization. But so are we. They know business, we know people. Expertise in both is necessary for leaders and the organizations they lead, to be highly successful.

What is it? The book, Beyond the Couch, is over 200 pages of information, encouragement, and tools to help you begin to think and begin to engage in the role of a human systems consultant. It includes information on:

  • identify potential clients
  • develop proposals and get them funded
  • decide how much to charge
  • conduct and analyze projects
  • utilize the skills you already have
  • manage a consulting practice
  • learn how organizations and leaders think about people

My student, as you will see below, decided to throw herself into full-time consulting work. Others have done the same. But most professionals have continued as therapists while adding contracts to their work. Either way, the book will give you a basic understanding of how to get your first contract and begin to help people Beyond the Couch.

One last thing. I will be hosting a video chat in the next month to tell you more about my experiences and answer questions for those who want a little more advice. When you enter your email to download the book you will be added to our list and we will let you know when the video chat will take place. This will also let you email any questions you would like me to address in the video chat.

Finally, here is the student's note (It is unedited except to protect confidentiality. Used with permission.):

Good evening, Dr. Miller, I was one of your students at _____ in the MA in Counseling program. I wanted to share something with you. By the time I took your class, I had already started my clinical internship and, to my dismay, I didn't like it. I spent most of my time doing paperwork and very little of my time actually helping people. Even when I was helping people, each hour felt like I was doing the same thing over and over. It was challenging, but only because I was so bored. The problems people faced were results of systems larger than themselves - and I wanted to tackle systemic problems. However, I was about to finish a degree in counseling; didn't that mean I should become a counselor? I was frustrated and a bit panicked. Then I took your class. In class, you discussed that you did consulting on the side. After class, you spent a little bit of time with me explaining the consulting work and it piqued my interest. I did a lot more research after speaking with you and tucked the idea in the back of my mind - mostly like wishful thinking. Fast forward. I have been working for a little over 3 years now for ______ with their Organizational Consulting unit. I work with an I/O psychologist and have consulted with NUMEROUS organizations - both public and private. The changing projects, brilliant colleagues, and constant challenge is a much better fit for me. I would even love to start my own consulting group some day. I say all of that to simply say thank you. I knew I wanted to help people and I knew I was skilled in understanding complex relationships, but I wouldn't have thought to use those skills in consulting had you not shared your experience with me. I wish you all the best.

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Fee-for-Service through . . . Contracts

Introductory letter from an old contract

Introductory letter from an old contract

 

Many mental health professionals would like to transition their private practices solely to fee-for-service, also called private pay, clients. Why? Less paperwork, higher fees, lower overhead costs, personal preference . . . there are probably many reasons.  "It's easy. Here's how to do it." to stories of "Tried to do it. It was hard or impossible." My sense is that it may vary depending upon the population and financial demographics of where you work, your years of experience, your reputation, and your entrepreneurial marketing ability . . . and other factors.

The typical "help" on line takes those who through articles and blog posts that advise the reader on how to transition from third-party payment to private-pay practices. This certainly is helpful and may in fact be the path many will pursue. One element that, for me, is almost always missing however is . . .  private contracts. They never seem to be mentioned. Why? I know of therapists who have contracts with pediatricians, chiropractors, non-profits, schools, churches, federal programs . . . and more! Contracts provide stable, non-insurance dependent, revenue. Most of these are for "therapy services" but at times they are for leadership training, coaching, or consulting.

 

Here's why this bugs me . . . For over twelve years, 40% of my business income has come from two customers. Two. I have also spend more than a decade training students how to get these contracts. I mention this now because I can--both of these contracts have been replaced with other consulting work and there is no threat to revealing the amount of business it provided. (Incidentally, I terminated both contracts when it became clear that leaving them behind was best for my business. One contract lasted 12 years and the other 15 years.

 

For those of you who have the entrepreneurial spirit,  contracts can become "the business" independent of a private mental health practice entirely.  (I had a friend in college whose sole business was repairing seats for Pizza Hut . . . he travelled all over the country and made a good living! How's that for specialization?) For the less-entreprenureal, it can be a great supplemental to their clinical practice.   I have primarily done the latter, choosing to operate a limited private practice--where I saw a mix of insurance and private pay clients--and having fee-for-service contracts in addition. It's worked well for over 18 years. 

Although the private practice has been the "main gig" in the last decade,  it was the contracts that provided the most stable source of income, the lowest paperwork to dollar ratio, and that provided a cushion when changes in the insurance world (the implementation of the Affordable Care Act) which dried up all payments for several months.  

While a full discussion of the advantages and risks is beyond the scope of this blog post, here are some comparisons that have made contracting very attractive to me personally. My hope is that this comparison, as crude as it is, will get you to consider your options and make your own choices about what you want your career to be.

 

For comparison purposes, the Fee-for-service model will assume an average of 20 sessions per client with the professional seeing 25 clients on average per week and working 48 weeks in private practice.  Contracts can vary widely depending if they are "one time meetings or workshops" or "on-going services" or somewhere in between thus the number indicated is a minimum  and the upper end of the range is undetermined.

Item                                              Fee-for-service                                         Contract

Clients (annually)                      60 (25 a week for 48 weeks)                    1*

Statements                                 0-720                                                          12*

Referrals (annually)                   up to 60                                                      0*

Fees                                             "health care" schedule                              "health care" or "consultant"

Environs                                      Clinical office                                              Clinical office or "off site"

Marketing                                   Sustain 60 clients                                       Sustain 0 clients*

* Or more depending upon the type of contract and work to be completed.

 

Okay, some of you, skeptics like myself, will say, "Yes, but there is a downside to trying to get fee-for-service contracts and some inherent risks!"  True.  Again, just a reminder, a full discussion is beyond our purpose here and we will not attempt to cover all the points needed to make this decision, but here are a few of the challenges/risks just to get you thinking . . .

If you have only two clients then losing one is a big part of your revenue. Where losing one client out of 60 is less traumatic. I've never had this happen but it has the potential of being very threatening.

I may have to master new processes (depending upon the nature of the contract) to work in a new business environment.  You will.  For me, after more than 26 years as a counselor, this is exciting and part of why I do consulting.

I will have to establish my own fee structure and negotiate with customers. Yes, since you may not be able to just "call other practices" and charge what they are charging there is a need to establish your fee structure.

Establishing a fee-for-service private practice may be the traditional way to move away from third-party payment systems but it is not the only way and, I would argue, it may not even be the best way!

So what is it that you would really like to do?  What connections do you have that might lend themselves to developing a contract for your expertise? What needs can you meet and can you get someone to agree to pay you to help them meet that need?  It is possible . . . .

My dream contract is to get paid to use my Taylor 614ce guitar and use it to teach life-lessons to younger people. It would be fun.  But, sadly, no one is offering. Until then, I will keep practicing and hope I miraculously get blessed with some talent, or at least skill,  before it's too late!  On second thought, maybe a more realistic goal for me would be to focus on the grandchildren--but one can always hope!!

 

 

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Regaining the joy of your career

Photo by  Devin Avery  on  Unsplash

Photo by Devin Avery on Unsplash

In an earlier post (on professional burnout) I told about some of the lessons I am learning about why experienced and successful professionals get burned out. Today, I’m going to share with you some of the solutions. 

Regaining the joy of your career:

  • Only do what no one else can do. (Many professionals can teach basic parenting skills but few can talk from their own experience what it is like to stay married for 35 years.)
  • Rank order your responsibilities. (Your family's needs before additional networking contacts.)
  • Consider a leave of absence . . . with a plan. (Sometimes a break will reinvigorate and help you redirect your energy in the right places.)
  • Avoid unnecessary exposure to traumatic material. (You get enough of that in your work as a professional . . . it should not be your hobby as well!)
  • Set your own goals and stubbornly maintain them. (After all, if you don't who will?)
  • Formalize and prioritize your self-care. ("All work and no play makes Jack a dull boy" they used to say.  It's true.)
  • Consider what it really means to you to be "at work."
  • Use an advisory team to find new ways of providing your services. (Too many professionals go it on their own. They don't value or utilize a professional coach or mentor. This can be a path to burnout.)
  • Do “a little . . . well” or “a lot . . . well enough.” (Don’t be perfect. Don’t be the best . . . right now. Unless you limit your focus to one thing.  Some can do this and be very successful. Some can't and some shouldn't . . . know who you are and what works for you.)
  • Ease back into your career one step at a time. (If you are "toasty" and can't stand what you are doing . . . try to get a break.  But once it is over don't just jump back in! Prioritize and transform what and how you are as a professional.)
  • Consider changing careers. (In the final analysis or some it is just time to make a permanent change.  Better that than decades of dread, inefficiency, boardroom, and failure.)

All the best!

Bryan

P.S.  One way I have avoided burnout is through contracting and consulting.  If you haven't already downloaded our free eBook, Private Practice through Contracting, feel free to check it out.

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Question for do-gooders, part 3

So when do you give away services?

Remember (in previous posts) we asked the question about what my welder should do about fixing my Father-in-law's twenty year old trailer. It is showing signs of deterioration and needs refurbishing. Should he charge full-price, half-price, or not at all.

On the business side, I made the argument that he should charge me the full-price.  Some of you, no . . . most of you seemed to think it should be a half-price job. I know it makes some of you do-good-ers uncomfortable to think that my welder is "due" the full price.  But, the need for the refurbishing, in my mind, is not a matter of negligence or quality on the welder's part.  Yes, maybe his work would be better now . . . but that is what comes with experience. So I stand by my full-price expectation.

 So once again, when do you give away services? 

But everything is not a simple business decision.  Plus sometimes business decisions are not about what is the financial short-term "best" for the health of the business. So, in fact, there may be many reasons why the welder might charge less.  But an over-socialized sense of guilt or fear of conflict should not be the reason.

What would be good reasons? I think there are a number of them. I will loosely divide them into two groups: one, for humanitarian reasons and two, for business reasons.

Humanitarian:

1. First, it should go without saying that if someone really has a critical need and you can provide them what they need to make a qualitative difference then we do it out of a sense of what is right.  We give the hungry food to eat.

2. We also provide to others with critical needs when we can do so without putting others, to whom you owe our primary responsibility (children, employees) in harm's way. Helping out a neighbor with a crisis for example.

3. We give when a gift will help improve the life of others or the community. A social responsibility such as in a time of natural disaster.

4. We give when that gift is a recognition of the another's contributions to others. "I know you serve on the town's volunteer fire department so I am going to give you 20% off."

5. We give when we have abundance and we are thankful for the gift's we have received. This may be a kin to number 3 . . . we give because we have received gifts from others.

Business:

6. On a less humanitarian note, we give when we want to demonstrate our skills to a new referral source. So we may offer something free at first to ease the ability of a "trial" of our new service.

7. We give when a new service is developed and we are unsure of its value. Pilot testing new ideas often is done "at no cost" to the participants. The value the organization or business receives is the learning and development of the service or product.

8. We give them away when charging might put the business at risk.  At times there is a grey area (at least in health care) where charging a client may carry some risk to the business . . . a service may not be covered by insurance for example.  Often the service is provided pro bono rather than engaging in some activity that could cause a legal problem.

9. We give away services at times to help build our market or brand.  Want to develop new connections, highlight your business, or establish your company as a good "citizen" within your community? Giving away your time and services can help with all of these.

Well, I'm only at 9 items so I've probably missed something critical.  What are some other reasons to "give it away?"

Available eBooks:

Private Practice through Contracting: Decreasing dependence on insurance.

Engaging Your Team: A framework for managing difficult people.

Family Legacy: Protecting family in family business.

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Response to "Business question for do-gooders."

Okay, I've teased you long enough.  If you remember I asked in a previous post what the welder who built my father-in-law's trailer should do when I bring it to him for "refurbishing."  I told you it was twenty-plus years old and that it has been a great tool. I asked if he should do the repairs and charge me full-cost, half-price, or repair it for free.

Well, most of you seemed to lean toward the half-price option. Why?  Because it somehow seems fair or just? Perhaps I led you astray (purposely) by mentioning the welds and you assumed that there was some poor workmanship involved?  Far from it in my opinion. It is a quality job that has simply succumbed to the aging process (I can relate!).  

The key, therefore, in my estimation is in the question I asked. What should he do from a business perspective?  From a business perspective I think it is only fair that he charge the full cost of his services. After all if we assume that the job was done well in the building phase and the deterioration is simply due to time and use, then he holds no responsibility to discount his prices.

In fact, he should not discount the work because the cost of his labor and overhead (see my name plate . . . an overhead expense) have not diminished.

Uncomfortable yet Mr. Do-gooder?

I say he should not reduce the price from a business perspective and I believe this to be true.  However, that is not to say that he cannot reduce his price for some other reason. Many times those of us in business do this and for good reasons. We deliver services below our costs or even pro bono.

So, if you feel like the welder could "cut me a break" on the price what would be some valid reasons for deciding to offer a less than full-price option?

I guess on reflection I'm not yet quite done holding you in suspense.  Next, I'll tell you what I think some good reasons to give away services.

Bryan

Available eBooks:

Private Practice through Contracting: Decreasing dependence on insurance.

Engaging Your Team: A framework for managing difficult people.

Family Legacy: Protecting family in family business.

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Business question for do-gooders . . .

I have a trailer . . . or rather my father-in-law has a trailer that he has "left" at our house for the past 15 years. It's not a bad thing. It's a generous thing. Or maybe a pity thing. I dunno. but either way it has been a very helpful tool to our little acreage. 

The trailer is showing its age however.  This summer I rewired it.  It needs a good paint job and to really restore it to its former state it needs to be taken back to the welder that built it for a "touch up" on the welds holding the box together. I've been contemplating how I would handle it if I were the welder so . . .

Here's a thought experiment for fellow do-gooders . . . 

If you were the welder and someone brought back a trailer you built twenty years ago to have the box rewelded, would you:

A. Do it for free.  Hey, the welds should have held.

B. Charge only half.  The welds should have held but its been twenty years.

C. Charge the full price to repair the trailer.

I'd love to hear what you think.  Later, in a separate post (don't want to give away anything!), I'll tell you what I would have done twenty years ago and why I would do something different today. Then we'll explore the ethical decision as a business owner versus being a reasonable, rationale, caring human being.

Bryan

Available eBooks:

Private Practice through Contracting: Decreasing dependence on insurance.

Engaging Your Team: A framework for managing difficult people.

Family Legacy: Protecting family in family business.

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