The Business of Therapy - Page 2

Laughing at this, she said, "Well, I always prided myself on being open to change, but you're right! I've shut down. Help me open up!" To do that, I asked her to research things she could do to develop her practice by simply getting curious about what other therapists were up to and what was working for them. At our next coaching call, she'd made a list of ­suggestions about billing practices, office equipment, social marketing approaches via the Internet, and a host of resources and possible help to hire—all from talking to her friends and colleagues. She now felt okay about hiring consultants to help her write copy for the website, start a new filing system, and automate her billing. Step by step, she started updating the business model for her practice.

"The Most Flexible Practice Wins."

Years ago, a presenter at a workshop I attended observed that the most flexible person in a system has the most influence or the widest range of choices. During a negotiation, the person who sees more sides to the argument and adopts multiple strategies can get others to a win-win agreement faster than a person who sees only one point of view. An advantage of having a small business is the flexibility it offers that larger enterprises can't match, with the corresponding ability to adapt to new markets and end an unprofitable program without delay. That means that achieving flexibility in business is similar to mastering ballroom dancing. The key is recognizing that, when your partner is the economy, you have to allow it to lead: don't waltz when it wants to tango! The crucial thing is to learn how to follow and stay light on your feet.

Janice, a social worker specializing in marriage counseling, is one of the few therapists in her city who doesn't rely on managed care. Instead, she operates a fee-for-service practice, but these days, her income is way down: clients who once saw her each week now come once a month.

Our consultation began by assessing Janice's flexibility within three areas of practice: pricing, accessibility, and services. When I asked, "Can you lower your price point in ways that would still protect your profitability?" Janice wasn't sure. We brainstormed together. How about adding low-cost, very small groups to fill in empty hours? What about discounting the times of day that don't fill easily? Would she be willing to offer a discount for prepaying? How about a discount for accepting credit cards? She thought about these options, weighing the pros and cons, and got excited about one: opening a merchant account to accept credit cards, which would give her clients an additional way to pay for sessions.

Then we explored flexibility regarding her accessibility. Janice had a central location for her office in the city and worked a four-day week, Monday through Thursday. Again we brainstormed. Could she add Friday-evening hours, or weekend times? She decided not to shift her hours, because a shorter week was important to her quality of life, but she found an aspect of accessibility that she could offer: she'd return all calls within 24 hours and see new clients within a few days of their initial call. I asked her to note this on her voicemail and her website, so clients would immediately recognize ease of contact as a distinctive feature of her practice.

Then we looked at a third area of flexibility: she could offer a "menu of services" to give her clients a greater sense of choice. Sometimes the reason clients hesitate to sign up for needed services isn't an issue of the price: it's reluctance about how the services are presented. Most of us value having some choice over how we purchase services. In a medical model, a doctor typically tells you what you must have: take it or leave it! In a consumer model, a therapist can offer you a menu and make informed recommendations.

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