To Slide or Not to Slide

As mental health professionals, our business model is unique (code word for strange) because our clients know that some therapists are willing to offer a sliding scale. Most healthcare practitioners do not offer to adjust their rates, can you imagine asking your physician if she is willing to slide?

When I started my private practice as an intern, I offered my perspective clients a lower rate while I was building my practice. Now that I’m licensed, I prefer to offer reduced rates to my existing clients. If an existing client is experiencing a financial crisis like unemployment or a medical issue, we discuss it and come up with a lower fee. We explore their feelings about the fee adjustment, and we agree on a future time to revisit the rate; this discussion often reveals valuable clinical material. Several of my clients are freelancers who go through long periods of time between jobs, and they appreciate my willingness to reduce their fees during those times.

If a prospective client calls me requesting a low fee, I refer them to my associate or to a training site. I prefer not to “slide” for new clients with the exception of a referral from a friend or someone who is interested in both individual and group therapy. I choose to volunteer in other ways like offering pro bono Brainspotting sessions to people in my community who have experienced trauma and cannot afford therapy.

Here are some of the questions you might ask yourself prior to deciding whether to adjust your fee:

What are your financial goals for this year? How much do you want to earn? Do you have any student loan or other debt to pay off?

Is this client presenting with symptoms you are comfortable working with, or will this client require extra attention between sessions?

How many low fee clients do you have in your practice?

Do you feel worthy of asking for your full fee?

When was the last time you raised your fees?

If you are interested in learning how to make better financial decisions for your business, join me in June for my 10-week live online class- “The Prosperous Professional.”  This class is appropriate for pre-licensed and licensed therapists, acupuncturists, chiropractors, clinical dietitians, and other healing professionals. To learn more, go to https://mariagray.net/prosperous-professional

Focusing on What's Wildly Important

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I’ve just read Cal Newport’s book entitled Deep Work: Rules for Focused Success in a Distracted World, where he explains how to avoid distraction and focus on your priorities.  Although the book is written for people who have desk jobs, the concepts are applicable to our work as therapists.

Newport describes the idea of “attention residue” which means that every time we shift our attention from one task to another there is a “cost”.  I noticed this recently when I was trying unsuccessfully to solve a bookkeeping issue during my lunch break. When my client arrived and our session began, I noticed that my mind kept returning to the bookkeeping problem, and I had to actively shift my focus back to my client. The skills I’ve learned in my meditation practice helped me return to the present moment and focus on my client.

Newport believes that “To be successful with deep work you must rewire your brain to be comfortable resisting distracting stimuli.” He recommends avoiding using the internet (especially social media) for entertainment. He suggests finding more intentional and less distracting ways to entertain yourself. He’s not anti-Internet, instead he suggests scheduling the time you want to spend using the Internet rather than randomly getting online. I started scheduling three 15-minute social media blocks on my calendar during the week.

I certainly don’t want to be thinking about what I read on Facebook or my accounting problem when I’m beginning a session with a client. I’m not suggesting we avoid doing any of our clerical work between sessions; what I am suggesting is being selective about the type of tasks we work on. 

I’ve recently broken the habit of looking at Facebook during breaks by removing the app from my phone. I need my time between clients to be refreshing and when I look at Facebook, my brain becomes overstimulated, like I’ve eaten a bowl of sugary cereal. Instead of being online, I stretch my neck and shoulders or pick up one of my crystals and hold it while I take a few breaths. After a difficult session, I listen to Brainspotting bilateral music for a few minutes. I still enjoy using Facebook, but I only access it from my computer and at designated times during the week.

The place where Newport’s suggestions have been most helpful is with my writing. Newport believes in “Focusing on what’s wildly important.” This means cutting out the busywork and scheduling time for the things you’d really like to accomplish. I schedule 3-4 hours of writing time (about an hour from Thursday through Sunday) every week and I don’t check email or work on “busywork” during that time; I treasure and protect that time.

What’s wildly important to you?

What's so great about group therapy?

Here are some of the ways group will benefit your clients-

  • When your clients participate in a group they realize that their problems are not unique and that they are not alone.

  • Groups are comprised of members with different levels of recovery. Seeing other people who are coping well provides hope to those who are just beginning the process.

  • Therapy groups are just like families. Members get to explore the way childhood experiences are impacting their relationships in the present.

Here are some ways group will benefit your practice-

  • Witnessing an individual client interact in a group setting will offer you some insight into the way that client interacts with people in his/her personal life.

  • Groups are exciting and dynamic, and the experience will provide you with an opportunity to use clinical skills you don’t get to practice with individual clients.

  • If the client is not in individual therapy, they might decide to see you for concurrent group and individual therapy.

I am currently offering a women’s process group in my practice on Monday evenings. If you are interested in learning more about group therapy, check out www.gpala.org.

Thyroid Blues

Hypothyroidism is sometimes referred to as “low thyroid”. This means that your body is not getting enough thyroid hormone to function well. It’s often an unrecognized cause of depression. One of the challenges to treating low thyroid is that many doctors will consider thyroid test results alone and won’t consider the fact that each person’s body is different. These doctors go strictly by the thyroid ranges and will not adjust the dose if your results fall within the normal range. In her book, The Menopause Thyroid Solution, Mary J. Shomon (2009) explains how different doctors use different ranges for the thyroid test, and even within those ranges we are all different. The issue of blood testing is complex and it is compounded by the fact that many people don’t feel comfortable questioning their doctors. 

In our work as psychotherapists, it’s important that we understand the relationship between thyroid disease and mental health. Below is a list of the symptoms of hypothyroidism (slow thyroid) and hyperthyroidism (fast thyroid). These symptoms often show up for clients who may have undiagnosed thyroid disease and/or entering perimenopause. I encourage all my clients to get annual physicals and regular blood work. I am not suggesting you work outside of your scope of practice, just be aware that these physical issues can seriously affect your client’s mental health.

Symptoms of Hypothyroidism- Low (Slow)Thyroid
Constant fatigue or feeling of exhaustion
Puffiness in the face
Trouble getting started in the morning
Low body temperature
Sensitivity to cold weather
Menstrual irregularity
Depression
Hair Loss
Low sex drive
Poor memory or concentration
Sluggish thinking or thought patterns
Infertility, repeated miscarriages
Unexplained weight gain or difficulty losing weight despite efforts at dieting

Symptoms of Hyperthyroidism- High (Fast) Thyroid
Anxiety
Insomnia
Rapid Weight Loss
Diarrhea
High heart rate
High blood pressure
Eye Sensitivity
Bulging
Vision disturbances

This is not a complete list, these are some examples of the symptoms you might hear about in sessions with your clients. Sources- Depression and Your Thyroid by Gary Ross. M.D and Peter Beiling, PH.D (2006) & The Menopause Thyroid Solution by Mary Shomon.