In the time of Covid, Part 6: Return to the Office or Not?

In the Time of Covid, Part 5: Marketing Within Your Comfort Zone

Marketing is probably the most hated word in private practice. For many therapists, counselors and healing professionals, marketing means shameless advertising, promoting, or manipulating—the direct opposite of the relationships they are trying to establish.

If this is why you hate marketing, I agree with you!

I believe that any attempts at “push” marketing—hard sell messaging or publicity that makes a therapist feel aggressive or not genuine—won’t work well in the long run. Our relationships with new clients and referral sources start with the first contact, the first hello. That contact includes our marketing choices.   

Instead, I recommend that you only use methods of “pull” marketing. Pull marketing works like a magnet. Similar to the way a magnet will draw metal filings into its path, therapists can learn how to position themselves, even in a crowded marketplace, to attract good clients and opportunities. Pull marketing, also called marketing by attraction, can help therapists stay well within their comfort zone of normal actions while building needed visibility for their practices, even during a pandemic lockdown.

Overcoming Isolation

In his book The Tipping Point (2002), Malcom Gladwell defines poverty as social isolation. I find that many therapists in private practice—even during normal, non-Covid times—are the most isolated businesspeople I know. Therapists often work in scarcity and deprivation because they have very reduced networks.

The traditional business maxim, “It’s not what you know, it’s who you know” might well be changed to “It’s not who you know, it’s how many you know.” As Gladwell explains, research shows that social and business power is inherent in the quantity, not quality, of relationships. Business owners who know the most people, especially superficially, have a much greater chance to achieve small business success.

In other words, it’s a numbers game.

How can therapists, who are may be introverts or work alone in a private practice, learn to play this numbers game? Here is a challenge: Double the amount of people you know every 2 years. The people in your network can come from any walk of life: friends, family members, professionals, or social groups. It doesn’t matter. Each of these people, over time, has potential to open doors to good referrals and opportunities to enhance a therapist’s practice. Keep growing your community.

Authentic Relating

Therapists tell me that they feel uneasy in their marketing role: “That is just not me,” I hear. It helps if you remember that marketing is a form of relating. You can choose a role for your marketing, one that is within your comfort zone, such as:

  • Educator – helping inform people about the value of therapy and counseling in reducing the effects of the pandemic (anxiety, depression, PTSD and trauma)
  • Advocate – supporting the immediate need for consistent mental health services
  • Resource – becoming a walking rolodex with information and referrals
  • Expert – taking steps to become a leader in your community regarding the needs and welfare of those you serve
  • Model of services – personally and professionally embodying the essence of what you offer to others

Marketing Needs During the Pandemic

Right now, I see that therapy practices are affected in different ways. Some swing like a pendulum between feast and famine. In terms of client count, some practices are full to overfull, with good retention of clients. Others are seeing major client drop-off, with clients wanting to “take a break” or stop services altogether for a variety of reasons.

Regardless of existing client count, many private-pay therapists tell me that they have fewer new requests for services. Some have not had a call from a potential client since the pandemic hit, in March.

If you are seeing a drop-off in new clients, or if you are concerned about your client count in the future, one basic business action is to increase your marketing efforts. Do you have an established marketing plan to fall back on? If not, read on.      

Take the Guesswork Out of Marketing

The surveys I have seen during the past decade show that for most therapists in private practice, their best clients come from two sources: 50% come from online efforts (website, directory listings, social media, podcasts, etc.) and 50% come from old school, tried and true sources (networking, speaking, writing, joining professional groups, etc.)  Your marketing efforts should still reflect this 50/50 split; if you are too heavily weighted in one area and not getting the results you want, try and balance your efforts by doing more in the other arena.

But remember: we are in a new business cycle unlike anything we have been through before. All of your marketing efforts are, in part, also your marketing research. Even in good times, there is no guarantee that anything you do or try to attract new clients will yield immediate results. It’s an experiment. Don’t let this aspect of risk inhibit your outreach.  

Instead, to get more comfortable, make a plan. First, set some practical and realistic goals (see below.) Create a marketing budget of time, energy and money. Try to keep your budget low cost, so that you don’t feel drained by your marketing needs. Track your results and learn from your efforts. What worked, what didn’t? Try it again. Tweak and repeat. The best marketing plan, is one that you observe and modify in small steps. Gather and assess your data.

Marketing Goals

Your marketing plan starts with having some clear, specific goals. Here are a few common goals for a private practitioner looking to attract new clients:

  • Network with known (existing) referral sources
  • Make connections with unknown, but possible (new) referral sources
  • Generate more word-of-mouth “buzz” about your services to the professional community
  • Join a professional community and interact via a list-serve or online meeting
  • Increase the “added value” of services for your existing clients to enhance retention 
  • Improve your website with enriched text, links, articles or videos
  • Re-write your directory (Psychology Today) listings to include more keywords and increase website traffic
  • Grow your email list
  • Reach out with social media, podcasts, articles, webinars, or email newsletters
  • Improve conversion rates of those who find you to those who actually ask for a session
  • Drive more click-throughs on paid ads

See a few goals you like? If not, add your own. (Remember to stay balanced with a 50/50 split.) Then select one or two that feel easiest for you to achieve. Above all, stay within your comfort zone.

Next, make the general goals you selected SMART (specific, measurable, attainable, relevant, and time-based.) For example, instead of “network with existing referral sources,” clarify: Who exactly will you contact? How many calls or emails will you initiate each week? What is the essence of the message you want to deliver? What is your opening script going to be? How will you follow up? When will this happen? Use observable markers and keep track of all your efforts.

In marketing, its not just about the results, it’s about the process. (Sound familiar? It’s akin to many methods of therapy.) To be a happier marketer, detach from the results and stay grounded in the ongoing process. Focusing on the process will help you to keep learning about your private practice and yourself.

For additional low-cost marketing strategies that I recommend for these times of crisis, I invite you to watch a new webinar I just completed, one that has been launched this week.


Join me in a digital seminar I developed: Private Practice in a Pandemic and Beyond: How to Stay Focused, Profitable and Secure. It’s the most complete webinar I have done on this topic to date, and I take you through six modules, each one focused on a different aspect of practice that can help you stay strong and viable right now and in the future. I enriched the webinar with graphic slides, charts, anecdotal examples and explanations, so that it feels like a consultation just between us. Purchase it HERE, thru the Psychotherapy Networker: Just click on the link and then you can take your time, learning at your own pace. In total, a 3-hour webinar, edited into six, 30-minute modules.

In the Time of Covid, Part 4: Your Practice, Exposed

In the time of Covid, Part 3: Triage for Crisis Management

I am getting better acquainted with my anxiety. I thought we were old friends by now and that I knew all of my signature symptoms: chest tightness, unease, jumpy and being on high alert. But this pandemic has upped the ante, and I am finding that my anxiety has more to teach me. Like you, I am sensitive to the anxiety of my clients, colleagues, family, and neighbors. Of course, the world news gets in, too. I get two newspapers a day and listen to NPR…so there is no shortage of worry in my daily experience.  

I find myself working with my own anxiety daily, to manage it and to remember to breathe. In my role as therapist, I have several methods of anxiety reduction I regularly recommend to clients. But in my role as a business coach, I notice that anxiety presents additional problems. It muddles the decision-making process needed to make good decisions about our practices and livelihood.

I have read neurological studies that show why this muddling happens: Anxiety floods the brain and the prefrontal cortex (the part of our brain that often acts as a traffic director, keeping our thoughts, ideas and solutions moving in a rational way) gets very confused; this cognitive area of the brain is easily upset and distracted when anxiety is present.

Normally resolvable business problems–both big and small–tend to collapse without the traffic cop part of our brain being on the job. This is why even simple worries seem so overwhelming to many people right now. Problems due to Covid-19 get combined with those of everyday life. Then our anxious brains deem all these issues equally (heavily) weighted. All demand our immediate attention right now. Its as though they all have a green light to rush in. We get flooded.

This is bad news for a small business owner. You need to consider business problems carefully, to weigh the risks and rewards prior to taking action. You need to think and plan without emotion clouding your judgement.

If you are dealing with worry and a sense of being overwhelmed, its time to have a mental strategy to stay clear and proactive. The mindset I like for dealing with business issues in a crisis is triage.

When Triage is Needed

Triage is a time-honored process that quickly and effectively prioritizes issues and problems during a time of crisis. You may use this process already, but when you are feeling overwhelmed, it helps to be reminded to slow down and be strategic. Here is an example.   

Joel, a therapist in private practice, is normally a cautious small business owner. But now he is overwhelmed and feeling frantic. Working from home using a telehealth platform, he complains that his internet connection is too slow and even cuts out. It’s frustrating. He meant to replace his router but never got around to it, pre-Covid. Now its essential to have a better way to connect with clients, but he is not sure how to proceed. He is having trouble with his billing software, too, a task he had hired someone to do and now tries to do himself. His young daughter is not doing well with the distance learning program the school offers, so he is worried about her. 

Of more concern, Joel says he doesn’t feel well. He still has clients and is using telehealth, but they are starting to worry about him as he coughs and sneezes through the session. Some of his clients have decided to stop therapy. He doesn’t know if he has the virus and has not been tested; he hopes to just tough it out.

“My wife is sneezing now too. She is blaming me for making her sick. So we’re arguing. And one more thing, Lynn, that is really on my mind,” he says. “Even though I have currently moved out of my office into my home to work, my landlord wants to renegotiate my office rent. My annual lease is up for renewal in two months. I am really irritated and upset about this and it keeps me up at night. I think about it constantly. It seems so greedy in this time of crisis that anyone would think about raising the rent. See why I am overwhelmed? What am I supposed to do next?”

I do see why Joel is distressed, and I empathize, but more importantly, I ask Joel if he can start to prioritize all of these concerns. Some are more critical than others. He says an emphatic, “No. All these issues feel immediate and equally important to me right now. They all need to be dealt with, I am just not sure what to do first.”

Joel needs to think clearly if he is going to make good decisions. It’s time for triage.

Using a Triage Process  

Triage is a medical term, used to sort out degrees of seriousness. Imagine a battlefield that is filled with wounded soldiers. You are the medic who walks among the wounded, quickly ranking the level of injury. Traditionally, triage uses 3 levels of prioritizing:

  • Emergent: Think emergency room, 911-quality critical issues that need first attention now.
  • Urgent: Pressing concerns that need care soon, but are not considered life or death right now.
  • Non-urgent: Conditions that are real, but can wait. 

For you, as the business owner of a private practice, triage can present like this:

Emergent issues:

  • I am ill or an immediate family member under my care is ill
  • I need to close the practice immediately
  • I am broke and can’t pay my bills
  • I am losing my license due to an ethical complaint or oversight

Urgent issues:

  • I am overwhelmed with too many clients (or I really need more clients)
  • I don’t know how to do billing or administrative tasks by myself
  • I have lost 50% of my clients due to teletherapy resistance
  • My cash flow is a very real problem

Non-urgent issues:

  • I am OK for now, but worry that my caseload may dry up in the future
  • I would like to add some online classes to my practice to have more to offer
  • I am not sold on telehealth and think more training could help
  • I want more clients in my area of specialty  

Steps to take:

  1. Make a list of all your problems, especially those keeping you awake at night or causing you to feel hopeless & helpless. Sort them into the three levels as best you can. Which are problems that you can impact (do something about) and which are out of your grasp? Stick with those you can achieve.
  2. Focus on resolving only the emergent and urgent issues on your list. This may take days or weeks.
  3. Then turn to the non-urgent issues.

This is what I helped Joel to do; it calmed him in that it gave him a focus of what to address first and what could wait. You can do this, too. Over time, keep updating and adjusting your triage list so you know what needs your first attention versus what can wait. This will provide you with a better sense of control; you can make thoughtful choices and decisions about issues that affect your practice, even during a crisis.

In the next email newsletter, I will look at the non-urgent issues that may be on your list and need resolution, by showing you how to position your business for strength in a time of crisis.

Some readers have asked for resources right now. The source book for much of what I am discussing in my newsletters is my earlier book:

Crisis Proof your Practice: How to Survive and Thrive in an Uncertain Economy (W.W. Norton, 2009)
It’s available on Amazon and at the publisher.
See inside the book at the website.

In the Time of Covid, Part 2: Taking an Honest Inventory

Depending on your background, the concept of taking inventory may be either a business or a moral task.

Those who have worked in business know that taking inventory means the tedious and exacting task of checking on your products. But participants in a 12-step program know the phrase from the internal rigors of the 4th step: taking inventory of one’s flaws to be accountable for one’s current situation in life. 

For our purposes, I want you to take a quick inventory that combines the best of these two concepts: I want you to become part accountant, part accountable. I want you held accountable for the finances, assets, strengths, debt and weaknesses of your business.

I can already hear the groans from some of you. This is not punishment, I promise. Instead, think about this inventory as though it were a camera. You are going to record an unemotional, but accurate snapshot.

It’s time to tell the truth of your practice as it stands today. Only you can do this task. And you need to do this right now, before you make any major changes.

Take a True Snapshot

To complete this first step in your crisis-proofing process, you need to be courageous. Fess up. Take note of the realities about your private practice right now, good and bad.

If we were working together, I would be asking you a series of questions to direct your attention, but the process of looking carefully and closely, without fear or judgment, is always up to you. For example, I would ask you to give me a profit and loss statement and a list of assets and liabilities, and I would want to understand your basic budgeting to know how money moves in and out of your small business. I would ask you to list your obvious and hidden resources, strengths, weaknesses and debt.

Time is of the essence today, so let me show you an easier way to take a snapshot. Take my Strong Start Survey.

Lynn’s Strong Start Survey

I began giving this survey to my business coaching clients and readers of my books, over 30 years ago. Here’s what I know: Reflecting on your practice this way is not a waste of time. It helps with business decisions. It allows you to quickly understand patterns and clues to decipher your practice’s health and well-being today. It suggests a path forward. Here are the 10 questions to answer:

Strong Start Survey

1. Where do you get your energy from?

2. Where are you most personally limited?

3. What do you love about your work — being a therapist, coach, healer, consultant, or other type of service provider? What are your unique strengths and talents?

4. What motivates you to take action?

5. What challenges and problems regarding your practice are you currently facing?

6. What challenges and problems regarding your personal life are you currently facing?

7. Of these challenges, which need attention immediately? Which are lower priority that can be corrected over time?

8. What are the 5 business opportunities that you are currently not making the most or anything of?

9. What are the 10 goals you want to accomplish in the next ninety days?

10. If you have an existing support system (friends, colleagues, mentor, therapist, coach, peer group, etc.) what should they know about you in order to best understand the challenges you face now? How can they best support you (strong feedback, gentle encouragement, listening, direct suggestions, advice, accountability?)

Understanding What Your Survey Reveals

Each survey explains a lot to me about the practitioner and their practice. I group the answers into four major topics: Energy, motivation, direction and action. To see the patterns within your answers, use this guide:

  • Energy level (questions 1, 2, 6)
  • Motivation (questions 3, 4)
  • Direction (questions 5, 7, 8)
  • Action (questions 9, 10)

Now sit back and analyze your own survey: What do you see about your situation right now? Are there opportunities to explore? Next steps to consider? Where are you blocked and where are you full of capacity? I hope it gives you a better sense of what is possible, even now.

In my earlier book written for the economic recession, Crisis-Proof Your Practice (W.W. Norton, 2009), I go into more detail with additional tools to help you take a complete inventory. This book is still in print and can be a resource for you now.

OK, readers and colleagues, this is it for today. In next week’s newsletter issue, we get serious about crisis management. Part 3: Triage– How to prioritize urgent issues that may be keeping you up at night.  

Your 2019 Best Word of the Year (WOTY)

Is there one word, a single word, that sums up all of your hopes, dreams and needs for your practice this year? One word that names your most important mission or purpose?

The Brand Called You

Good branding conveys a factor of trust for a winning combination.

What is your brand — the defining feature that identifies your small business?

Is it your name, specialty, or office location? Do you primarily promote the issues you address, the methods you use or the results you deliver? What sets you apart from the rest of the many professionals with similar credentials, who may be offering similar services in your zip code?

Twenty years ago, Tom Peters wrote an article titled “The Brand Called You” for Fast Company Magazine. It was a remarkable call to action, well ahead of its time. He urged people to think of themselves as being as important and distinct as the brand of clothing they might select, or brand of snack food they sought out in a grocery store.

According to Peters, it was a “new brand world” and branding was an essential strategy for success. With a good brand, people had a chance to stand out, to learn, and improve. “Everyone has a chance to be a brand worthy of remark.” His ideas are still relevant today, maybe even more than twenty years ago.

Why You Need a Brand

To see the importance of branding, look at the profession of therapy. There are over half a million therapists working in the United States. We know that therapists are not generic; not all therapists are the same. That is clear to us as therapists, but not so obvious to the average client.

The average client looking for a therapist does not understand the distinctions between you and another therapist, such as those based on your training, experience or methods. The average client (as well as many of your less sophisticated referral sources) need to know, in plain language, the following: Given the sea of therapists available — what is different or better about you?

A good brand educates potential clients about who you are and what to expect when choosing you. A good brand becomes a mission statement of what you stand for, personally and professionally.

Your brand is both macro and micro, a summing up of your message to the world. As such, it also defines your marketing approach. There is no one, right way to brand yourself or market yourself, but as Peters says, “When you’re promoting brand ‘You,’ everything you do — and everything you choose not to do — communicates the value and character of the brand.”

When I work with therapists, coaches, and healing and helping professionals, I recommend one more thing to consider when defining your brand: don’t overlook the importance of conveying a sense of trust.

Branding and Trust

According to marketing surveys, trust is the #1 most influential factor when people purchase costly services (like therapy and coaching.) Its more important than location, return on investment, or price. When you are in a relational business, your brand must focus on building trust.

Take a moment and think about the essence of trust. Many of us are familiar with the core developmental stages, explained by Erikson. The first challenging stage a child encounters is trust versus mistrust. When trust is present, based on a secure attachment, the child feels hope. Having a brand with trust creates a felt sense of hope.

How is Trust Conveyed?

Trust needs to be a feature of your brand; it reaches beyond the concrete aspects of a practice, such as your technical expertise, training, population you work with, or your specialty. Branding with trust is not reliant on the methods you use, the variety of services you provide, or the fees you charge.

When you are engaged in marketing your practice, trust is communicated primarily in the way you relate. Its more show than tell.

As with any marketing strategy, developing the “Brand Called You” and making sure that trust is communicated requires that you take some steps. Let me show you some of the specific soft skills of trust, 3 questions to ask yourself, to consider how your level of trust is communicated to others, and then a few basic action steps that I recommend.

Soft Skills of Trust

Trust requires softer skills within marketing, including an ability to not just tell others how you work, but shows them your qualities, such as:

  • Empathy
  • Rapport
  • Availability
  • Honesty
  • Careful listening
  • Resourcefulness
  • Willingness to educate
  • Curiosity and caring
  • Professionalism
  • Ethical behavior
  • Follow through
  • Measurable results

I know that these are skills that many of us use when providing services. But for marketing/branding purposes, take this one step further.

Are you communicating your level of trustworthiness to others? The questions to consider are:

1. Would current clients say that I embody these skills?
2. Do potential clients understand my commitment to these skills?
3. Do my referral sources carry this message about me to those they refer?

If you are unsure about the answer to any of these three questions, there is some work you can do on branding yourself with trust.

What You Need to Do

As with any marketing strategy, developing the Brand Called You and making sure that trust in a feature of the brand requires a set of steps. Here are 3 actions to take to move forward:

Craft your basic message—the brand called you: Start by identifying the qualities or characteristics that make you distinctive.

What have you done lately—this month—to make yourself stand out? What would your colleagues or your clients say is your best quality? What are you known for? Who do you help and why? What results do you consistently achieve with clients? (Need more help? Defining your basic message is reviewed in depth, with examples, in my book Building Your Ideal Private Practice, 2nd Edition (W.W. Norton, 2015).

Add elements of trust that you can show, not just tell: Telling someone that you are empathic is not as compelling as showing it.

Use your writing, speaking, and daily interactions with others to express elements of trust (show), and then emphasize what you are doing (tell.) Connect the dots for others.

In your office, with clients, be willing to identify and then claim your varied expressions of trust right in the moment. (Example: “Right now, I am trying to support you by listening carefully and validating what you are saying. How does it feel to have me relate this way with you? What can you learn from this, right now?”)

On your website, in your networking, and in your workshops, explain who you are. Give examples. Show it in action. In this way, start to educate referral sources and existing clients about what you stand for.

For example, in my role as a business coach, I brand myself as a trusted advisor. Over the past 30 years, I have consciously tried to align my words and my actions with this brand. I believe in the values and viability of our profession, so I give freely via writing, speaking, and mentoring. I believe that a rising tide lifts all boats. The more therapists and coaches who succeed–who make a good living while helping others–the more grateful I am that our important work continues to thrive.

Have a deliberate marketing plan: Branding is a marketing strategy. You need to treat it as such, and have a clear plan of action.

Who do you need to communicate with (public, other professionals, specific organizations, etc.) What are the steps you will take? What resources do you need (time, money, access to others, etc.) What are the measures of success you hold yourself accountable to achieve? Accept the amount of follow through and repetition any plan requires in order to produce success. Commit to the long term of your practice. Sow seeds for future growth.

Start Now

There is some urgency to this concept of branding. Peters says that the only critical factor in branding is that you start to do this immediately. I will let him have the last words. “It’s this simple: You are a brand. You are in charge of your brand. There is no single path to success. And there is no one right way to create the brand called You. Except this: Start today.”

Reduce Client Ghosting

We have a hidden crisis in therapy: Clients leave therapy before they can see the results of treatment. They leave too soon, in large numbers, without warning, abruptly. This is both a clinical issue and a business one, because it undermines the efficacy of your services and weakens your business. To learn what you can do to reduce client “ghosting” and improve client satisfaction, read more below.

The Problem of Client Ghosting

Do you have clients who dropout or disappear before finishing treatment and don’t respond to your attempts to connect?

Having a client leave therapy prematurely can be upsetting and unsettling. You wonder: What happened? What might you have done differently? What was wrong with the client?

Like most therapists, you do your best to provide empathy, caring, and solid treatment methods. When a client ends treatment abruptly, without explanation or notice, it can feel like a bad breakup: You were dumped, with no real understanding as to why.

The rate of clients leaving treatment before getting the results they need and want is a bigger and broader problem for our profession then you may know. It’s a serious concern for all of us to consider.

Improving Client Retention

Since improving client retention is both a clinical and a business issue, we need solutions that address both aspects. Here is some data about the scope of the dilemma we face as a profession:

Studies show that from twenty to fifty percent of all therapy and counseling clients leave therapy long before they see results of treatment.

Over fifty percent of clients never come back after the first session; a slightly smaller percentage leave within the first five sessions. We need to change something about our treatment process to stop this pattern. In any industry, this would be cause for alarm.

The Reason Clients Leave Too Soon

What are the reasons for this significant rate of dropout in the therapy profession?

Let’s set the context: Few clients are happy to find themselves in a situation that determines a need for therapy. Clients usually seek therapy at a low point in their mental health and/or their lives. They seek us at their most vulnerable moments. And they often are embarrassed or ashamed about their need for us. In our culture, therapy is often viewed as a sign of personal weakness or failure. The act of coming to therapy can provoke anxiety by itself, given that the nature of therapy can be uncovering difficult feelings and thoughts.

Given this, its essential that we not compound the problem. Having made the significant effort to find a therapist and then come to a session, a client needs to leave feeling that it was absolutely worth the time, money, and effort. Clients need to know that they are making clear and noticeable gains. Even better is if the client feels compelled and motivated to return. Too often, the opposite is true.

Disappointment and Dissatisfaction

Surveys suggest that the number one cited reason clients stop treatment is a lack of satisfaction with the therapy process. Their dissatisfaction is a combination of ambivalence or negativity about their therapist and a lack of tangible results gleaned from one or several sessions.

We know that for most therapy to work, repeat visits are necessary. We have to be more proactive in helping engage clients to stay longer, to see treatment results. We must make an effort to help clients see clear and concrete measures of success.

What can you do to take responsibility to help a client stay in treatment? How can you increase a client’s understanding and sense of value and satisfaction about your services? Can you reduce client disappointment in the therapy process?

I suggest that a strategic model of client retention be part of every therapist’s treatment plan.

A Strategic Model of Retention

I have been interested in resolving the problems of poor client satisfaction and low retention for a long time and written and given workshops on this topic.

I have a chapter on this topic in Building Your Ideal Private Practice: 2nd Edition, titled “Retaining Today’s Clients” that explains why those coming for therapy now are often even more difficult to engage than those clients who sought therapy in earlier times.

My new book, Therapy with a Coaching Edge: Partnership, Action and Possibility in Every Session (W.W. Norton, 2018) takes it one step further. I offer a new model of psychotherapy that embeds a strategic model of retention and client satisfaction into the structure of each session. Its easy to apply and can help clients understand the value of a therapy session more clearly, in the moment. Here is how it starts:

First, stay alert for obvious and hidden signals of client confusion and disappointment, beginning with the first session.

Staying Alert

Have you heard clients say the following during a session? If so, failure to return may be imminent:

  • “I can talk to a friend and get the same kind of help you are giving me”
  • “I am too busy for this”
  • “You therapists charge too much.”
  • “I don’t see what good this is doing.”
  • “How long is this going to take?”

Stay alert to these and other objections. Think of these comments as feedback. Invite direct, consistent client feedback as a way to open a conversation about client satisfaction. I ask clients to share their therapy experience with me, in real time, during a first session and then in subsequent sessions. I listen non-defensively. Keeping this line of communication open during each and every session reduces unexpected dropout.

For many vulnerable clients, therapy is hard to fathom: They wonder “Is it working? Am I getting better? Does this really help?”  If therapy results are couched in psychological jargon and kept vague, clients feel torn about returning. They can’t figure out the process and they don’t know if what you are doing with them even helps.

You won’t know how your clients feel about services and whether they are pro or con about returning unless you ask. You will need to ask often, to stay on track.

How to Ask for Feedback

I like to set up therapy sessions with some structure, so that each session has a beginning, middle and end. On the front end of any session, I ask a client what the session needs to focus on and how we will measure, as the session proceeds, to know if we are making progress together during the session. During the middle phase, as we work through the issues on our agenda, I take time to pause and see if we are progressing in the direction that the client understands. On the back end, I encourage feedback with a few questions that I ask to consolidate gains of the session.

This takes time away from the therapy, many might say, but I suggest that this kind of transparency is essential to the therapeutic process.

Consolidating Gains

The ending process is especially important in the process. I leave the last ten minutes of a therapy session for a time to help my clients articulate the progress and value made in the session. (For more specific examples of this session process, see Chapter 5, “Results in Every Session” in Therapy with a Coaching Edge.)

I take an active role in making this structure work, especially in ending well. I think of this role as a form of therapeutic responsibility and leadership. I watch the time with a purpose in mind: I want to see if our objectives have been met and help my client identify what has been useful and helpful. I want to observe, with the client, what progress has been achieved in this session. I want to anticipate what we can expect for the next time. This is an example of how I combine a coaching approach with therapy, to be very strategic about the goal, progress, and completion of each and every session.

I don’t assume that because I thought a session went well and see its value, that my client agrees or can articulate the same results. I want to hear this in the client’s own words. I don’t presume that a client, even one who seems pleased with our session, will return–unless I can help provide a compelling reason.

If a client can’t identify any value in the session, I am glad to educate them with what I will be putting in my notes.

When I take time to end this way, summarizing gains, it’s not unusual that a client will indicate the she has already forgotten some of what has just been talked about or worked through. This makes sense, because a client is absorbing new ideas, and integrating on both a conscious and unconscious level. Some questions I might use to help this consolidate gains include:

  • What will you take away from our session?
  • Did you get results or make gains you wanted?
  • Do you feel a need or see a reason to return?
  • May I share what I think was valuable from our session?

Finding the right words to sum up may be difficult for a client, so I am willing to collaborate with a client in this task.

Helping Clients to Stay in Treatment

At the start of this article, I said that better retention was both a clinical and business issue. Clinically, helping clients stay longer involves building a better connection with your client and giving them a sense of how and when and why the therapy is moving forward. With this feedback conversation in place, clients have the language to articulate to themselves and others what they are doing in therapy and how it is helpful. It shows clients how and why therapy works and helps them to value a long considered vague and mysterious service.

From a business perspective, helping clients to see a return on their investment, to increase their satisfaction, is always an important factor in terms of increasing referrals and enhancing the chance of returning customers. It strengthens your profit picture.

The time and cost of replacing clients who terminate early means more marketing, advertising, networking, outreach, and continual intakes to get new clients settled in for treatment, clients to replace those who leave too soon. Staff who are ready to see clients may sit with empty hours unfilled. Office space sits empty, adding to a lack of productivity. You need engaged clients, those who appreciate and make good use of your services. You want clients who feel glad that they have taken the time for therapy and are willing to make the effort to complete their treatment, not a revolving door of unsatisfied clients who come and go at will and feel that “therapy just didn’t work for me.”

So my challenge to you is that you consider how you might help to reduce this professional problem and help clients feel more satisfied and invested in their treatment. I look forward to hearing your experience and what works for you in this regard.


Additional resources:

Dr. Bernard Schwartz and John Flowers: How to Fail as a Therapist: 50+ Ways to Lose or Damage Your Patients, 2010.

Joshua Swift and Roger Greenberg: Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes, 2014.

Ryan Howe: “4 Reasons Not to Ghost Your Therapist” Psychology Today.


The Confidence Gap

Sometimes, confidence matters as much, or even more, than competence. Learn how to boost your confidence when it’s needed.

By Lynn Grodzki, LCSW, MCC / copyright Sept 2017

I have been fascinated by a number of studies about the role of confidence and how it affects those in business and leadership. They confirm what I have observed as a business coach over many years. Whether or not you have sufficient confidence can directly impact your level of private practice success, including your bottom line.

The Importance of Confidence

Recent studies suggest that for those in business, confidence acts like a source of fuel, allowing people to go further and faster.

Those with more confidence are able to persist in their goals longer with a higher chance of completion. They find and get more resources. They accrue better information. Because they sound confident, they are listened to and talked to with more respect.

In terms of public perception, those with more confidence rate as more talented when compared to those who are equally trained and talented, but more modest. Higher confidence even equates with more money earned and other financial benefits.

How Confidence Affects Private Practice  

As a business coach, I have seen that confidence affects 3 key areas of private practice;

  • The perception of you and your business by others (think potential clients, referrals sources, colleagues)
  • The energy and drive you have for your projects (accomplishing your goals)
  • The felt sense you carry that can encourage or block your daily tasks (your feelings and emotions about your work)

In light of the studies and my observations, I wondered: How does confidence develop, especially in those who are new to the profession? What is the best timetable between competence and confidence?

Confidence versus Competence

Just to clarify terms:

  • Competence speaks to your ability: this would include your training, methods, certification, results, experience and expertise.
  • Confidence reflects your attitude: this would include your level of belief about yourself, self-assurance, and how you express this to others.

As clinicians and practitioners, we are usually taught that competence comes first and that with time, our level of self-confidence will naturally develop.

But now, based on these studies and my observation, I think we need to build confidence along with, not after, competence. I see it as a skill, as important as any other to develop when building your ideal private practice.

I recommend that you develop both confidence and competence, as early as possible.

Let me show you how to develop more confidence.

Do You Have Sufficient Confidence?

As a business coach, I can often spot what seems to be a confidence gap. For example, do you:

  • Have difficulty talking about your work in a way that generates new business?
  • Worry that if you express your competence, you will be seen as bragging?
  • Set goals that are too small or give up too soon?
  • Default to getting more and more training when you have doubts that you are not good enough?
  • Hope that others will see your value, rather than having to say it yourself?
  • Struggle with the “imposter syndrome”?

If you feel that your level of confidence could use a boost, let me show you some basic steps to close the gap. These simple steps can confer some positive effects for your business in a lasting way.

First, it helps to understand what can block the development of confidence.

Common Blocks to Confidence

 If you experience a confidence gap, here are some common reasons why, according to research I have read:


Hormones further behaviors, some of which seem to help to project confidence. Men, in general, appear more confident than women, according to studies, perhaps because testosterone fuels risk taking and tolerance of conflict. In areas of leadership and business, the ability to invest in a project, experiment, or stand up for an idea connotes assurance and belief in oneself.


Introverts appear less confident than extroverts, especially in a public setting. Many of us who are primarily introverts are empathetic, quiet, and reflective; this makes for a good therapist, but may not translate to looking like we have confidence in business. Extroverts are more expressive and tend to talk and emote more, which is perceived as appearing more confident.


Learning to be overly accommodating as a child, or the need to be seen as “good” or even perfect by parents or others can hinder a sense of ease and experimentation that leads to confidence. Perfectionism is especially difficult to overcome, sowing seeds of self-doubt and making it difficult to assert oneself or act positively. Those who are easy going or appear less anxious seem more secure and trustworthy by the public.


Some in our profession suffer from “imposter’s syndrome.” Its hard to master the craft of psychology and psychotherapy and claim expertise, especially in a public arena or online. Others fear disapproval by their colleagues. They resist speaking up or looking confident due to the “tall poppies” pattern: the tallest flowers tend to get cut down first. They don’t want to appear boastful or egotistical for fear they will be “cut down” or discounted by peers, supervisors or mentors.

How to Build Confidence in Business

The good news is that higher levels of confidence can be taught, learned and applied, like any other skill. I have been helping those in private practice to build confidence, in order to meet their business goals, for many years.

I recommend using any or all of the following six possible strategies for boosting your confidence in business:

  1. Persist: The amount of effort that is needed to build, sustain, and maintain a business is probably more than you consider. Your level of persistence in service of your private practice goals is key to developing confidence. Confident business owners are persistent. They follow through, over and over again. Don’t give up too soon.
  2. Risk: Learn to tolerate some risk. Stretch. To expand your level of confidence, experiment. Go a bit beyond your limits. Remember, small steps count. What can you do, try, or test that might be new behavior? Who can you call, contact or reach out to meet? What event can you attend?
  3. Voice: In my book, Building Your Ideal Private Practice, 2nd Edition, see chapter 8: “The Brand Called You” for ideas to help define your basic message, a way to talk about yourself and your work based on your values, passion, and areas of interest. Can you bring your work into your conversations? Find your voice and assert who you are and what you do in a way that feels true to your nature.
  4. Refute: When you have doubts or anxiety about work, develop more confidence with the technique of refutation, explained in Martin Seligman’s book, Learned Optimism. Use self talk to answer back to any doubts or pessimistic thoughts, especially those that may pull you off course. Use objective statements to counter overly negative thoughts and build self-assurance.
  5. Act as if: A certain degree of projecting confidence is akin to performance. You may need to “act as if” you are confident before you really feel it. As many of us know, this one strategy is a quick fix. Act as if you feel calm, have a voice, can take a calculated risk, and have energy to persist with your desired goal. Acting as if you are confident leads to feeling confident. Practice makes perfect.
  6. Get support: I am a big believer of the value of teamwork. Who do you turn to support you when tackling any or all of these new behaviors? Who can you support in kind? We all need collaborative partnership to succeed. Who is on your team?

Hope this list of strategies spurs you to move forward with new behaviors and an improved level of confidence.


Some links to additional articles and studies on this topic:

Professor Tomas Chamorro-Premuzic explains our inability to differentiate between confidence and competence.

The role of self confidence and career paths.

How lack of confidence holds women back.

Why confidence matters as much as competence.

The secret to career success is not talent, hard work or education, but sheer, unashamed confidence.




Letting Go to Grow

By Lynn Grodzki, LCSW, MCC / copyright August 2016


A well-known business mantra is let go to grow.

This means that at key points in the evolution of a business, you, the owner, need to let go of something so that you and your practice can move forward.

Let go to grow is more than a motto for a savvy business owner: It’s also a challenge for each of us to look at our routines, behaviors, tasks, or long-held ideas.

What needs to change right now or at least be gently retired before the end of the year so that you can advance?

Here are some examples about how you can let go to grow. Commit to find the courage and confidence to take the next steps in your private practice.

Step 1. Decide What Needs to Go

What are you holding onto that no longer makes sense? What slows you down? What stops you from making your small business easier or better?

You may need to let go of:

• Thinking too small about your future.
• A lack of boundaries for your practice policies.
• Routines that sap your energy.
• An insistence to do everything by yourself — denying yourself help and assistance where needed.
• A belief that you can’t raise your fees.
• Sticking with an insurance-only business model.

or maybe you need to stop:

• Letting fear win.
• Operating without a business plan.
• Undercharging and then feeling resentful.
• Hesitating to reach out to those who need to know about your services.
• A reluctance to brand yourself or find your niche.

Step 2. Let Go with Grace

I have been thinking a lot about the process of letting go on a personal level, because I just physically moved my home and office. Although I moved within the same city, I still needed to let go of 30 years of stuff, familiar routines, and a neighborhood I loved. Not easy tasks for me.

To really embrace the change meant I needed to open up. I needed to have the space inside myself to allow in the new. What made it easier was an inspiring contemporary piece of poetry that gave me another framework for letting go. It helps to have the right mind-set when letting go.

You can read it here, with permission of the poet:

She Let Go

by Rev. Safire Rose

She let go.

Without a thought or a word, she let go.

She let go of the fear.  She let go of the judgments.  She let go of the confluence of opinions swarming around her head.  She let go of the committee of indecision within her.  She let go of all the ‘right’ reasons. Wholly and completely, without hesitation or worry, she just let go.

She didn’t ask anyone for advice. She didn’t read a book on how to let go.  She didn’t search the scriptures. She just let go.

She let go of all of the memories that held her back.  She let go of all of the anxiety that kept her from moving forward.  She let go of the planning and all of the calculations about how to do it just right.

She didn’t promise to let go. She didn’t journal about it. She didn’t write the projected date in her Day-Timer. She made no public announcement and put no ad in the paper. She didn’t check the weather report or read her daily horoscope. She just let go.

She didn’t analyze whether she should let go. She didn’t call her friends to discuss the matter. She didn’t do a five-step Spiritual Mind Treatment. She didn’t call the prayer line. She didn’t utter one word. She just let go.

No one was around when it happened. There was no applause or congratulations. No one thanked her or praised her. No one noticed a thing.

Like a leaf falling from a tree, she just let go.

There was no effort. There was no struggle. It wasn’t good and it wasn’t bad. It was what it was, and it is just that.

In the space of letting go, she let it all be.

A small smile came over her face. A light breeze blew through her. And the sun and the moon shone forevermore.

Step 3. Take the Right Steps

Once you identify what to let go, then you need to know what to start doing instead. You will need to have a plan for letting go to grow.

For example, here are 3 goals many small business owners desire:
• More money
• More full fee clients
• More time

And here is a quick strategy I offer for each goal, so you know what to let go of and what to focus on to achieve growth in each area.

More Money

What to let go:

  • Working without a financial plan
  • Negative beliefs about negotiation
  • Resistance to running a business, not a hobby

What to focus on instead:

  • Tracking your income and expenses on paper so you can see the reality of your money at a glance
  • Learning the basics of successful negotiation to handle conversations about money in a confident and therapeutic manner
  • Adopting the mindset and practices of an ethical business owner

More Clients

What to let go:

  • Old ideas of marketing and mistrust of new technology
  • Negative beliefs about your low value
  • Resistance to how much it takes to stay visible with referral sources

What to focus on instead:

  • Make sure that you have a strong and compelling online presence
  • Identify your clinical strengths and the return on investment your clients receive from their work with you
  • Scheduling marketing activities with a new marketing plan you feel is within your comfort zone

More Time

What to let go:

  • Time drains including distractions and procrastination
  • Hopeless and helpless thinking
  • Resistance to delegating, hiring others, or using technology for practice management

What to focus on instead:

  • Protecting and safeguarding your time and energy
  • Countering negative thoughts with positive action steps
  • Exploring strategies for streamlining tasks

Do you need help to take the next steps in this plan? Let’s talk. I can be reached for an Intro session here:

or email: