Tithes, Taxes, Tender
Tithes- Maintaining good standing with myself
Taxes- Maintaining good standing with my government
Tender-Maintaining good standing with my creditors
So I’ve come to learn that there are two sides to having your own business and being your own boss.
Side A looks something like making your own hours, no annoying co-workers or helicopter bosses and long lunches.
Side B looks something like having no real days off, sporadic hours, wearing all the hats (accountant, cleaner, scheduler, therapist, cook, etc) and no-one to vent to at the water cooler.
So why do I share all this? Maybe I need someone to vent to or maybe it could bring some insight.
Lately, my conveyor belt sequence seems to be Tithes, Taxes, Tender and repeat.
I’ve been on this private practice journey for over a year now and there has been many teaching moments. I am humble enough to admit that I have still much to learn before I can truly see myself sipping a Mai Tai on a beach with no cares.
I have found that when I find a good rhythm, many things start to fall into place and I am with less worries. So here are a few of my tips for Gratis:
- Find a system that works for you and your business. Remember, it may take a few rough drafts before you find the right fit.
- Taxes are inevitably- so pay them upfront and save yourself end of the year stress.
- Balance might not mean 2-3 full days off but it’s important to take time away from work, physically and mentally. So practice disconnecting and regular self-care.
- Schedule events other than sessions and work into your calendar. For ie. phone catch-up with Liz, online shopping, purchase movie tickets, etc. This will help keep you Balance.
- Start each day with at least 15-30 minutes to yourself. This can look like a mug of coffee, Youtube video, personal playlist, yoga, meditation or a relaxing walk around the neighborhood. Make it a practice and you will be Thankful.
- Find a couple of people you can vent to, gained encouragement, insight and help you remain focus on the plan ahead. They will become Priceless.
- Invest in a mentor. We are never done learning.
- Practice Gratitude regularly and especially when things start to feel overwhelming or stalled.
- Remember, you are needed and people need you.
In our digital revolution, innovation is ever rapidly changing our daily lives. Adapting, whether as digital immigrants or natives, is required to survive anymore. Why then, do we keep revisiting antiquated ways of doing things? As therapists we know that much has changed in the landscape of psychotherapy. What was once therapy sessions generously covered under insurance benefits during the Golden Age of Therapy 25 years ago (Grodzki, 2015), has been hacked away by modern HMO companies requiring endless streams of codes and paperwork. Further, wait times in rural and large cities for therapy services increase as coverage decreases. Online therapy options are the new frontier. One that many may resist, but that ultimately provide major benefits to clients and therapists alike.
Having recently moved to a fully virtual therapy practice using live video (e.g., like FaceTime but using HIPAA-compliant technology), the benefits have been immediate and in many ways unexpected. It is no surprise that telehealth is currently a 6 billion dollar industry with estimates that it will reach close to 20 billion dollars in 2025 (HCInnovation, 2018). While I initially dabbled with teletherapy more by accident than intention (starting with college students in-state living 2-3 hours away from my office), I quickly came to see it benefits for a much larger range of clients. Below, are listed some of the most notable benefits to date.
- Low Barrier to Entry: One of the biggest challenges facing prospective therapy clients is that initial appointment. Statistics indicate the modal number of sessions attended by clients is: one. That’s right, patients will go to one session and never go back again. Theories abound—the experience was awful, there was not a fit with the therapist, or the most self-satisfied of them all- the therapist was so highly effective that they managed to “cure” their client in one majestic session (likely not the case). How does telehealth fit in? An easy way to describe it is this—all those things you hate about your dentist waiting room? They apply in therapy as well. Finding the office, sitting, anxiously counting down the time, waiting for your name to be called. With teletherapy, it’s almost always in the comfort of your own home. You can have your cozy blanket, your special mug, all the things that make you feel at ease. What better start to therapy and opening up than in your safe space?
- Privacy: While this can certainly vary depending on geographical location and the diversity of clients seen by a therapist, teletherapy ensures maximal privacy every time. As one who specializes in teens and young adults, I have found more than once that my clients (even going to different schools and residing in different cities) manage to know one another. I have walked in (and out of my office) on more than one occasion witnessing awkward small talk between these clients who knew each other in kindergarten or who are mortal enemies. With social media anymore, everyone is connected. While I have often managed to help teens find the silver lining of running into acquaintances (we all have issues, therapy is normalized), teletherapy removes this concern altogether.
- Efficiency: Time is perhaps our most precious resource. As such, commutes can be frustrating and stressful for clients already prone to anxiety. Unexpected traffic closures often lead clients to race in, anxious about being late or missing any part of their therapy time. In one scenario I had a patient get into a car accident on the way over to see me. Needless to say, our conversation that session wound up focusing on something entirely different than what we had intended. With enough on their brimming plates, the last thing clients need to worry about is one more place to be. And for that matter, one extra cost if parking tickets or accidents are involved.
- Flexibility: Relatedly, teletherapy allows for maximal flexibility for overworked and overcommitted clients. Having worked with many high achieving populations who are at the verge of mental breakdowns, those who need services the most often have the least time. Being able to reschedule and integrate emergency sessions impacts the therapist and caseload at large minimally. Although of course high severity patients should rarely be seen in outpatient situations without extra staff support, for clients with severe anxiety that is otherwise well managed, the ability to schedule an emergency check-in can be invaluable.
- Safety: Across much of the nation, severe winter weather can put a kink in plans. In Oregon where an inch of snow shuts down the city, snow days can wreak havoc on scheduling. Some clients are stranded on mountain tops, others have four-wheel drive and trek their way to an office that closed down hours ago. Such concerns are eliminated in teletherapy. Further, there is no expectation that clients leave their homes in dangerous weather, there are no late cancellation fees, or consideration of what school districts are opened or closed. With teletherapy, the show can go on, each time.
- Illness: It is not uncommon for teens with heavy workloads and many pressures to repeatedly succumb to illnesses. I have had clients with severe flus and viruses (often actively contagious) come in which puts me and by extension my other patients at risk. Further, illness often can cause additional last minute cancellations while mood plummets. The ability for clients to continue working with their therapist, especially when ill, can be highly impactful. Teletherapy makes it safe for both clients and therapists.
- Patient Timeliness Improved: When sessions begin at the click of a button, timeliness is certainly improved. Without the concern of a traffic jam, getting lost on their way to the office, or running low on gas, it is a no-brainer that timeliness is significantly improved when clients are always in reach of their devices.
- Communications Improved: Like many therapists working independently, prior to moving to a full-time virtual practice, I rented a space in an executive office suite. While there were front desk staff servicing the floor, they also represented dozens of other entities from lawyers to accountants to real estate agents. With high turnover on their staff, messages were often missed, and information was not always clearly articulated (such as the time I was told a patient came in for me on a day I was not scheduled- there was no name, number, nothing leaving me guessing who on my caseload came in for an appointment!). Removing the middleman so to speak eases communication significantly and improves the overall therapeutic experience.
- Streamlined Communication: One of the most integral components of my practice is my online billing, scheduling and charting program which also offers teletherapy directly via secure link. Clients can opt for a reminder text, email, or both and all the information regarding their appointment is at their fingertips. While this unfortunately sounds like advocacy for the takeover of robots, the truth is these programs simply don’t make errors but for exceedingly rare glitches. Having everything in one place is beautifully simple and fits in with the general ethos of teletherapy. In rare times when two patients have shown up for the same session, I have always felt terrible sending them home again when I know they rushed to get there. With teletherapy, when these rare errors occur, there is no harm, no foul.
- Access to Facilities, Food, Drink, etc.: As a therapist to many teens who are often rushing over from school or other activities, I have more than once encountered a ravenous and therefore grouchy teen. I have often supplied my office with healthy snacks and drinks and watched teens polish off bag after bag of snacks while telling me about their day. While I don’t encourage eating for the full duration of therapy, a satiated client whose basic needs are met is certainly important. As such, one of the benefits of teletherapy is access to any of the needs that may come up for a client, down to a bathroom with no line (or worse, risk of running into the therapist in the next stall over!).
- Access for Remote Patients: More times than I can count, I have done a double take when I have reviewed a new client’s file and seen their home address listed in a city about an hour away. In one case, it was a teen living with an elderly grandmother who would drive through wind and rain and on windy dangerous roads to get to my office. It was dangerous for them and frankly unnecessary. When we switched to teletherapy, the therapeutic relationship was maintained, the therapy continued effortlessly and there was no disruption for this family. If anything, our clinic likely saved some harm to the teen and the driving grandmother whose vision had been slowly deteriorating over time.
- Access for College Students: The fact that college counseling centers are more and more swamped is hardly news to those who have worked in such settings. Further, not all colleges are in towns with access to private providers, nor do all college students even have cars. Enter the beauty of access to a wide network of providers without any transportation hassles. As previously discussed, my earliest work in teletherapy came out of necessity for college students who either could not be seen at the college counseling center or who did not feel comfortable walking into the center and being seen by friends.
- Access for Disabled Populations: In many scenarios, those who are bedridden, have chronic illness or otherwise can be major beneficiaries of online treatment options. There are times when clients suffering from IBS, Crohn’s or other diseases may experience shame or embarrassment at their need for leaving to use facilities. In an online context, some of these concerns can be diminished significantly. Further, wheelchair accessibility can be a significant barrier with populations as well; I recall working with one patient and quickly learning we had to make sure to use a room with a door wide enough to let the chair pass, as well as extra room for the wheelchair to maneuver into position. While ideally, more locations will be ADA-accessible, the unfortunate reality is that in older locations, historic buildings, and so forth, making these changes can take time and in other cases be impossible.
- Wait Times Reduced: Finally, perhaps obvious but well worth stating is the benefit of near immediate access. Having worked in large clinics, I have observed insurance teams taking weeks to confirm benefits, process paperwork, and possessing other bureaucratic hassles. For clients able to see private practitioners, access can be near immediate. To be frank, that is one of my favorite parts of solo practice—for too many years I witnessed those in severe need go weeks until they could get an appointment. With virtually all aspects of my practice being paperless and electronic, I can send paperwork to the patient via secure connection, have it filled out, and sent back to me within the day. Most often I can accommodate patients within a week, if not within 24 hours depending on how quickly we can get things going. For clients who are in need to talk to someone urgently, or perhaps finally mustered up the courage to see someone, often waiting weeks can lead to appointment cancellations or clients in dire situations.
While there is no doubt that much more needs to be done before clients and therapists fully embrace and explore online therapy options, the future certainly looks bright. With more and more individuals telecommuting, busier schedules, and the need for greater flexibility in our ever changing world, teletherapy opens up a whole new frontier.
A good resource or a bad influence
As I continue to grow in age and awareness I find myself contemplating more on my presence in the lives of those around me as well as vice versa. I always say, “If you’re not adding to the situation, you’re taking away. I interpret this as meaning; if you cannot add positivity in any form then you should respectfully decline any interference.
This stirred up my thinking of a good resource or a bad influence.
A resource is defined as an element of value in any capacity that can be used by a person or entity to enhance their function (paraphrased). Whereas the meaning of influence is the capacity to affect the character, development or behavior on someone or something (paraphrased).
So I started to review if I was a good resource or a bad influence to those around me. I started to see how powerful my words could be at times but even more so my body language. Something I need to be more mindful of going forward. I also saw how I was able to create calm, clarity and support in times of need. As well as take leave when I didn’t feel I could be useful to a situation.
Then I started to review if people in my life were good resources or bad influences. There are several that always know what to say and for that I am eternally grateful. But then there were a few who created more chaos than calm. It made for an interesting time. In the end, I realized we are very much our environment whether we realize or want to admit it.
So I ask YOU, are you a good resource or a bad influence to people in your life. Also, how are the people in your life to you?
Right around the bend
Lately, this saying has been lingering in my head. At first, I assumed due to my many loving and supportive family/friends/peers. Now I wonder am I still hopeful… that right around the bend could be all I ever imagined.
Have you ever found yourself accepting that certain things will never be?
Or that your heart’s desire is incorrect?
Yet, at the least of moments it all changes.
Because what you couldn’t see was that it was right around the bend.
I’ve come to believe that in life there are no coincidences. Everything happens for a reason. I can’t say I fully understand the theory behind a butterfly flaps it wings in New York and a storm happens in China. Still, there appears to be a purpose to everything, good and bad.
So what are you hoping is right around the bend?