Launching During COVID-19

This is a recent coaching call with Michael, a graduate student intern preparing to launch his private practice.  The call occurred just after the COVID-19 outbreak and stay-at-home orders, restricting Michael to video sessions only in his initial months.

Michael and I talked about the associated challenges, as well as defining one’s ideal client, writing as marketing, asking colleagues for referrals, and establishing fees (you can find a more detailed process for establishing your fees here).  Michael also refers to IDAs at the end of the call, which I’ve written more about here.



Michael:  Maybe back to your question about what’s most pertinent on my mind, I think some of the structural stuff was really helpful to get through last time.  Some of that stuff isn’t exactly relevant right now, but I think maybe moving into marketing – like that aspect of developing my own practice.  Especially thinking about: here I am about to graduate, I’ve spent a lot of time building up what I hope will be a referral network in town.  And so how best can I – because that’s something I can prepare and plan for – getting the word out, communicating what I can offer, sharing who I am.  And then making it – being receptive to new clients and new inquiries as quickly as possible.

Ryan: What kinds of things are you doing so far or looking at?

Michael:  I mean, what I keep on coming back to are the two main things of developing a nice website, having an easy-to-find domain name.  I’m doing all the SEO, search engine optimization, getting on Portland Therapy Center, getting on Psychology Today.  All that kind of stuff to put me searchable and findable.  And then there’s that question of: referral network – all these connections I’ve made in the counseling world through trainings, through colleagues, through peers, through supervisors and mentors.  How can I lean a bit into that world – I mean, part of me wants to say, in a way that isn’t greedy – like ‘feed me clients – I need clients.’   But more just this openness to letting folks know, ‘hey, I’m going to be starting a practice.  Here’s the kind of work I do.  Here’s the kind of clients I see.  If you have anybody in your circles that you want to send my way, I’d be very open to that.’

Ryan: It sounds like you’re already sensing this within yourself, but just the importance of reframing – as if you’re taking something from folks, to more just putting yourself out there as having something to offer, having a service that you’re wanting to reach people with – and that it’s a gift, which you’ve been training for and preparing for and that you really want to share with people.  There’s certainly no shortage of need out there in the community.  Right now especially with COVID-19, I think that there’s a level of anxiety, and really trauma for a lot of people, not to mention the impact of social isolation.  So it’s really important that we put ourselves out there and that we let people know that we’re available.

Michael:  Yeah.  I really appreciated that, Ryan.  Just that simple reframing.  Because there is that resistance and this feels vulnerable, right?  I mean, especially as a new developing counselor, it bumps right up against impostor syndrome.  ‘What is it that I can offer?  Am I really ready for this?’  And to be honest, those are familiar voices enough that I’m just like, ‘oh, there you are again.’  But they come in subtle ways.  Like I mentioned, is it too much to ask this network of people that I have – is it too much to ask, ‘hey, I’m open to referrals?  I’d welcome anyone that you’d want to send my way.’  So that’s a more nuanced way of doing that.  But I think – it’s really helpful – something lands and me just to reframe it and also bring it to a bigger perspective.  This is actually a service that’s really needed, especially right now.  That’s helpful.

Ryan:  But it sounds like just being so new in the work, really putting yourself out there in that way is a little bit scary.

Michael:  Oh, yeah.  It is.

Ryan:  And kind of wondering what folks are going to think when they receive that email.

Michael:  Right.

Ryan:  When you said that a moment ago – when you just said, ‘here’s what I have to offer, I’m just letting you know I’m available,’ how did that feel to say it that time?

Michael:  It feels really good because it’s true.  To be honest, I worked my ass off to get here.  So part of me is like, this kind of ownership of that.  Like, ‘yeah, this is what I have to offer.  I’ve wanted to offer this for a long time.’  Now I get to offer it.  How cool is that?

Ryan:  There it is.  Great.  What I found over the years too is that that first private practice announcement is a little bit about us.  But what’s going to happen over time is that clients are going to start asking for help with referrals.  You’re going to help point them in the right direction, and that’s going to be happening with other colleagues as well, and they’re going to want to know, ‘who’s out there that I can send this person to?’  So we need to be informing each other and updating each other – especially in private practice where we’re all kind of working a little bit more in isolation.  I’ve had folks that have asked me, ‘can you send me an update every six months just to let me know what your availability is?’  So I think that desire is out there among colleagues as well.

Michael:  Yeah.  And so maybe that’s another question that comes to mind.  Do you have a spreadsheet of names and contacts and populations they serve and availability?  Is it something as informal as that – organized but informal?

Ryan:  Yeah, I have a little database that I keep.  I do my best to keep it updated.  And typically what happens is I get a request from a client that’s quite specific and I start putting my feelers out there, and then I get feedback about the panels that they’re on currently, their rates, their location, and I just update the database each time I go through that process.  It is hard to keep it current, because folks’ circumstances are changing all the time, in terms of what they want to take on and who they’re willing to take on.  It’s just a first stop for me to look to see if I can find a match.  But after that, a Google search or just going through my other contacts is helpful also.

Michael:  Okay.  I mean, I do imagine once I have an established practice or even before that that the referrals will be mutual, like in the sense of me being able to do that as well.  That’s a helpful reminder to have that information on my own end so I can be most helpful to clients or their connections that are in need of counseling.

Ryan: What do you think the key pieces of the announcement would be in terms of who you’re serving, your ideal client?  That’s going to be important to include, right?

Michael:  Yeah, it is.  It’s one of the challenges of being a bit of a generalist right now.  I don’t have a specialty.  I don’t have a focus.  I don’t have even a wish for that right now.  Right now, my clients range in age from 24 to 74.  They come in with acute trauma.  Some eating disorders are present, some relationship issues.  So it kind of runs the gamut in some senses.  I know in Portland Therapy Center, you list those problems or those areas that you can work on.  And I’m sure I’ll need to do that, but being that the kind of work that I’m finding I’m doing is pretty general – not general – it’s like wide, I guess.   It’s varied.  So I kind of have this ‘I don’t know how I’ll talk about – what kind of population I want to serve.’  Portland!?

Ryan: Have you noticed in your work this year that there are some folks that you just really come alive around or that you’re really feeling jazzed about that relationship?

Michael:  Yeah.  I can feel into three of my clients right now that speak to that.  And that kind of work is that somatically-oriented psychotherapy, that depth work, the ability to bring in mindfulness – clients’ capacity to practice – in-session practice – meaning to use it to study their experience to get more insight.  Their willingness to feel deep emotions and whatever it may be – pain, grief, loss, sadness, joy even.  But that willingness to feel that transformative quality of the kind of work that I can offer.  Yeah, I get very jazzed about that.

Ryan:  So it’s very much oriented around the approach and clients’ appreciation of that approach, so that you have some momentum.

Michael:  I have one client that had a tremendous loss last year – a very traumatic loss in her life.  And that’s what she’s come into counseling for.  But we haven’t really worked on that.  It’s been much more about just the relationship and having someone in her life that she can just talk through her present-day problems in her relationship, her job, whatever it may be.  And every once in a while, I kind of dip into something a bit deeper.  And I also find satisfaction in that, because I see how she responds to it.  So that’s the other side too.  I get alive – I find this aliveness comes up – this excitement – because I see the potential in the work.  I do this because there’s that depth, right.  But there’s also a quiet satisfaction of just being that presence for someone.

Ryan:  So a couple of thoughts here.  One is that you could – I think it’s totally valid at this stage to not have a specialty of any kind or to have to niche very specifically.  I do expect that that’ll come as you just work with more and more folks over time.  You’ll start to get a feel for, like, ‘yeah, there’s a certain quality to the kind of folks that I work with that I leave the session feeling really excited about the work’ – and you may just find that that gets more defined over time.

In the meantime, you could just kind of name those that you have worked with.  So if you were to just sketch out in your email: ‘I’ve worked with folks that have experienced a major loss,’ obviously naming the appreciation for experiential and somatic work, etc.  So kind of just cataloging the folks that you already do have experience with and that you’ve gotten some good mileage out of.

I want to say at the same time, you’ve spent time building these relationships, and what they’re really orienting to when you send out that email is you.  They know you.  They understand who you are and how you show up.  And we all have an understanding that’s it’s the relationship itself in therapy that matters most.  So that’s really what’s going to stick with people when they’re thinking about who to refer to.  Having sent that email and them knowing who you are, you’ll come to mind.  And at the same time, in time, having an issue or a client population that you can say, ‘think of me for that,’ is helpful also.

Michael:  Yeah, that’s really helpful to hear that.  And to be reminded that the referrals will – especially at this stage, especially given who I’m going to be reaching out to – it’s all about that relationship that I have.  And it actually helps relieve any pressure of needing to define, but more describe.  I love that.  That’s really helpful.

There’s this question too about relationships – counseling [couples].  That’s one of the areas that I haven’t had a whole lot of experience with at the clinic yet.  And it’s been interesting – I’ve only had two couples and I haven’t had either of them in a couple of months.  And I’m finding a lot of joy and satisfaction in the individual work.  Sure, I could see couples, but do I want to?  And I think the answer – when I ask myself that, it’s like, ‘yes, I do.’  I want to be able to offer counseling to couples.  But is it going to be a specialty of mine?  Is it going to be a focus?  Probably not.  At least not right now.

Ryan:  So you might list in the email, but not name it as your bread and butter.

Michael:  ‘I’m a relationship therapist’ – yeah, no.

Ryan:  So the broader conversation that we started here was just about marketing, in general.  So we talked about websites, directories, what does it mean to be starting a practice using video counseling.  One thing about directories is that I’m noticing that some of them have places within your profile that you can signal that you do online therapy.  So you want to make sure that you’re doing that right now.  I think a lot of people are looking on those sites for people who have been willing to continue in an online format.  Otherwise – it feels to me like this is just the new norm.  This is what we’re doing now – online therapy.

So you’re kind of, with the exception of your office, launching in the way that you would otherwise.  I mean, you want to just start – I mean, if you’re game to do online therapy, then to really just be taking a lot of the same steps that you would’ve been taking otherwise.  I think it is a lot trickier beginning a relationship with somebody online and not getting that initial rapport that you get from face-to-face.  A lot of the folks that have been in practice and are transitioning now to online therapy, who I’ve talked to, are not taking new clients.  They’re just working with their existing clients.  You may be able to continue with some of your folks from M.E.T.A., right?

Michael:  Yeah, that’s the hope.

Ryan:  You’re also going to be seeking out new clients.  So that process will be a little bit different than continuing on with existing clients.

Michael:  Yeah, exactly.  And this new client that I started with this week, I’m grateful to have that experience to feel what it’s like to have the initial contact, consult and then the sessions – all began virtually.  I can’t imagine – well, I can imagine that’s not sufficient for some clients.  But I’m happy to see that I’m able to feel okay about it and establish that relationship.  And I think one of the differences between in-person and online is if I feel like I need to take more time with that relationship to develop – trust, familiarity, looking for cues from each other.

Ryan:  Right.  I like what you said.  That you’re just being very explicit with one another about –

Michael:  Yeah, isn’t this weird!?

Ryan:  Right.

Michael:  There’s another question that’s come up in our conversations about fees.  But I don’t want to necessarily get onto that until I feel like the whole marketing conversation is complete.  Is there anything else that I should consider or am missing or haven’t thought of?  I’m sure there’s lots of that.

Ryan:  As I sit with you I keep thinking to myself that your greatest resource, besides of course, you as a therapist and your personhood, is that you have really dedicated a lot of time to building this network.  And for myself, the majority of clients have come through colleagues.  The other half comes through current and former clients for the most part.  The website I don’t consider to be actually a place where a lot of new clients stumble upon it and then send me an email and say, ‘hey, I’m really interested in working with you.’ That happens sometimes, but usually it’s just a place for folks to land after they’ve gotten my name from a colleague and they want to read up a little bit more or they’ve gotten my name from a former client.

So I want to really encourage you to kind of push through all of those voices when they crop up that say, ‘I don’t really know if it’s worth sending this out’, and to really be in touch with the folks that you have taken time to meet.  That’s going to be probably the best way to go.  And we’re in this unfortunate circumstance right now where we can’t be doing in-person trainings and meeting new colleagues that way.  So we really have to kind of lean on the people that we’ve already taken time to build relationships with.

I guess another thing that’s been alive for me and that I often wish I’d got started with earlier is just writing.  Because I do feel like it’s one of the ways, before we actually get to know a client in person, that we can give them a feel for who we are and our voice and what we care about.  And just to establish a little bit of an online presence that way I think can be helpful.  Your web copy is one version of that.  But if you feel drawn at all to writing articles or little blog posts…

Michael:  I see.  Yeah.  There’s a lot that happens when you even mention that.  I’ve done quite a bit of writing and blog posts and stuff, especially during my time in the monastery.  I actually kept a blog that talked about my experience and also provided some education around Buddhist history and teaching and doctrine and stuff.  And I really enjoyed it, in part because I felt I had a place of authority to speak from.  So back to what happens in me when I think about that.  It’s like, I’m not sure.  Where is my authority in this?  Do I need that authority?  Or is it more the case of, like you said, giving clients and potential clients and colleagues a sense of both who I am but also how I work.

Ryan:  I mean, you are new as a counselor but you have such a rich history and it’s so unique in our field.  There are certainly lots of folks practicing as therapists who also have meditation backgrounds.  But yours is quite deep and just – it’s you.  So the chance to make that known and express that in a public way, even though you haven’t had a lot of practice experience [as a counselor], could be really special for people to bump into.

Michael:  To be honest, Ryan, I haven’t considered this at all and I’m really intrigued by this idea of writing now.  I mean, just as we’re talking, part of my brain’s kind of wondering, like, ‘what would I be able to write about?’  And all of a sudden, this whole list just shows up.  So I’m like, yeah, interesting.  I don’t know exactly what to say underneath each of those things.  But I think it would be an interesting process especially for me to get better fluent and eloquent with how to describe my own professional identity.  Again, that question: what it is that I offer and to whom I’ll offer it?

Ryan:  Right.  It could be really clarifying.  Another dimension to that is – it’s a way for you to communicate with prospective clients – and it also could provide a way for you – if this is interesting for you – to have some kind of product.  I think a lot of counselors do find as they get further along into the work that their only stream of income is coming from in-person, face-to-face time – which hopefully nourishes us and feels alive throughout our careers – and yet at a time like this, when we actually have to be away from face-to-face work, or like you had to go home a couple of months ago and be away from your clients.  So having some sort of product, whether it’s a course, or an eBook, that potentially you could sell, could be another way of earning income when face-to-face work isn’t possible.  It provides some flexibility.

Michael:  Or even kind of a way to serve and support the community of counselors, as well, in some welcome way.  I think of Roy Huggins who’s like a great therapist already, but then his specialty of offering teletherapy and HIPAA compliant courses and stuff.  It’s huge, and he’s really stepped up.  So that’s kind of like the extreme version, but I also see the role that that offering can really benefit so many counselors.  I’m not saying that I have any aspirations to do anything like that, but it’s for me that would feed something about wanting to serve colleagues.  I have no idea what that would look like, but it’s interesting.  You planted a seed.  So I’ll just occasionally water it and see what happens.

Ryan:  So you had mentioned fees a little while ago.

Michael:  Yeah, it’s one of these unknowns about – because after our first conversation, again, part of this plan that was starting to be formulated – I was feeling pretty good about imagining myself coming out of school, starting a practice in July and starting at a rate at something around $100 an hour.  And feeling like that’s kind of edgy but I think I can do that.  The economy’s strong.  There are a number of clients who are able and willing to be able to pay that much per week.  My existing clients wouldn’t right now.  Some of them might be able to, but right now they’re paying between $45 and $55.  And we talked about how that looks.  So now thinking about starting a teletherapy practice, given where we’re at.  And then also that our economy is really – who knows what it’s going to look like after this?  It’s already in a recession.  What that recession looks like and then the cash economy, I have a lot of questions about that.  So just maybe talking through some of the considerations.

I have this default – okay, I’ll just make it as affordable as possible – $50 an hour, because I won’t possibly have rent.  Overhead will be really low – just me and the computer and the webcam and a few plants and that’s about it.  Is that a realistic thing?  Is that something I should worry about right now?

Ryan:  Like we’ve learned in the M.E.T.A. trainings, we want to just be curious about: who in us is making the decision?  Where is that coming from?  If it’s coming from that place of ‘I don’t know if I’m worth it – I don’t know if I can really justify $100 an hour’ – we want to be really cautious about that.  You’re thinking pretty pragmatically just about the state of the economy and people’s willingness to spend, so I think that makes good sense.  But I don’t notice people lowering their rates right now.  What I hear is that they’re being flexible.

Michael:  Yeah.  Maybe that’s the actual question around this.  How flexible can I be and how do I know how to be flexible?  There’s a big difference between getting $50 an hour versus $100.  So how do I understand where to be flexible, how much to flex, that kind of thing?

Ryan:  Right.  Some of it will be relational, right?  So you’ll have what you consider to be your established full fee.  And then going into a relationship with clients and talking about what their budget is, what they can afford, how possible it is for them to afford your full fee and what kind of adjustments they might need.  And we talked last time about the importance of setting that up well, too, so that you can revisit the conversation and you’re not locked into a $60 fee for the entirety of the relationship.  I think the first thing is how do you establish what you’re actually worth, what your service is worth – in comparison to what other therapists in our community are offering and what the community will respond to.  And that is a bit of a difficult question to answer right now, I think.

Michael:  Right now, yeah.

Ryan:  But most people that I’m talking to aren’t seeing a big drop off.  Maybe 15% to 20% drop, at the most, is what I’m hearing from folks.  And a lot of that is [clients] just taking a little bit of a temporary pause but planning to circle back in the coming weeks.  I would be a little nervous about you adjusting what you anticipate you’ll want your full fee to be, once all of this passes, right away.  I might default instead to starting out what you were planning to have your full fee be and see what happens within that.  You can always make adjustments.  You can always have a note on your website and any marketing that you do, any private practice announcements that say you’re open to sliding scale or negotiating based on circumstances.  But I think you really want to establish a rate that you feel is truly justified based on your training and, again, your personhood.

Michael:  That’s helpful validation.  And it is interesting.  Just to notice that internal process of what motivates … that impulse to drop it from $100 to $50 or something like that.  It’s like, not wanting to burden clients.  I can see adjusting it to like $85 or $80 or something like that.  But given – and depending on what this world looks like in two months – two and a half.  But I’m glad to hear that from you, that encouragement to keep it as close to that full rate that I wanted to have as possible and see how that is and be flexible within that.

Ryan:  The other thing I’d say too is just – we always have to be doing this with respect to our own circumstances.  So really looking at what your expenses are, the kind of life you want to be living and the lifestyle you want to have in the coming years.

Michael:  And I think I need to spend time on that, because I really don’t have a sense – there’s nothing guiding me like quantitatively, financially – I don’t have a sense of that yet.  So this is all kind of coming from the heart and all the stuff that the heart contains, all the strategies I’ve developed and coverings.  That would be really helpful to actually pencil this out.  It seems like that would also allow me to know how flexible I can be with some of the lower rates.  Again, my existing clients, I do want to take as many as possible that want to come.  So that’s going to be potentially six to eight clients at a fairly low rate compared to where I want to be at.  So therefore, what does that mean for the new clients?

Ryan:  Yeah.  I think about it as – again, what you need in order to have the lifestyle that you’re looking for.  So energetically, what you have capacity for.  So, you could lower your rates to $60 or $70 and get 20 to 25 clients a week and that might feel great, or it might feel exhausting.

Michael:  Right.  Exactly.  I don’t know about you, but I’m finding video, my teletherapy to be more exhausting.

Ryan:  Yeah.

Michael:  That’s helpful.  Thank you.  I keep on looking in my email trying to find that list.

Ryan:  You want me to pull it up on the screen?  I have it.

Michael:  Would you mind?  I don’t know why I can’t find it.  And I remember a lot of the things and I’ve just kind of been going through my head to see what else we haven’t really touched on.  And some of this stuff is a little – the whole question I had last time about private practice versus group practice – I felt really clear about it.  It’s private practice.  That’s where I want to go – like solo – after our first meeting.  And it’s come back the last couple of weeks just given the uncertainties.  I’m like, maybe it makes more financial sense to join a group practice.   But it’s still kind of – even just our conversation today as it’s unfolding – it feels much better about – no, actually I really want to do solo.  And I think I see a way to do it.  You’re supporting me and easing some of the anxieties around it but also giving some direction to how to make the most of it, given what I’ve already set up, but also just the current dynamics as well.

Ryan:  What feels better about solo in general?

Michael:  A couple of things come to mind right away.  One, I can do the kind of therapy and counseling I want to do.  I imagine much more flexibility about the clients I take on.  So that choice, that freedom and autonomy really seems important to me.  There’s also something a bit more personal in that I want to build up something that’s just for me. From me and for me.  And wanting to feel that satisfaction of feeling like, ‘yeah, look at this.  Here I am thriving, finding my way, making it work.’  And so there’s that challenge piece that seems really exciting and risky at the same time.

Ryan:  Yeah, there’s an added risk of going at it yourself, but you can imagine it being more gratifying.

Michael:  Exactly.

Ryan:  Okay, I found it.  Let me see if I can pull this up.  Can you see this?

Michael:  Yes, now I can.  That’s right.  I kind of brought that up in part because that first bullet point is a bit moot now.  We talked about renting versus leasing last time.  And my takeaway was: I much prefer the idea of renting my own space for a lot of the similar reasons – to have autonomy and gratification and the most flexibility.  And I kind of had a sense that it was possible financially from our last meeting as well.  So I still feel good about that.

I feel better about location considerations.  I have much more of a picture of what I want in an office, what I want it to feel and look like.  The question of finding a good office space, that’s still an outstanding question.   I have a feeling that – similar to referrals, the network will also be a source of possibilities – just letting me know of offices that they have available.  I mean, this office that I mentioned I was going to go look at in northwest right before the shutdown was in a suite.  Somebody had rented a suite of three or four offices.  Two of them were family mediators, so they work a lot with divorce and such.  So they’re interested in having a counselor in there as well that also did relationship counseling.  So it would be a very interesting dynamic to work in.  But the office itself sounded really pretty ideal.

Ryan:  Nice.

Michael:  That came from a colleague from a training I was in.  It was exciting to have that possibility come up.  I haven’t really even begun to look at office space and I probably won’t until we have a sense of what this economy’s going to look like, especially, to be honest, if this pandemic peaks and then wanes over the summer – there’s certainly the possibility that it’ll have a second wave.  So it may be the case that for the first nine, ten months, we’ll just be doing teletherapy.

A business loan that I’ve looked into a lot – the IDA.  I haven’t circled back around since everything’s been shut down.  But Mercy Corps has these – they’re one of the local providers.  You have to go through one of their classes before you qualify to apply.  And I was planning to do the business planning class.  So I just need to go back to that.  I think that was supposed to begin next weekend.  I can look back into that and see if that’s even happening.

Ryan:  I’m just wondering if they’re getting any funding, because normally this is federally funded.  And I’m just wondering if they have a new capacity to help people with IDAs or maybe even broadening their eligibility criteria, or if it’s completely the wrong time to be approaching them.  I don’t know.

Michael:  I’ll look into that.  Just the idea that that could pay for some of these operational costs of supervision, trainings, that kind of stuff, is very enticing.  The supervisor that I’ve reached out to and have been trying to explore working with charges $170 an hour.  I have been able to build up a little bit of savings since we’ve talked which is helpful.  Again, the idea of starting a teletherapy place without office rent would save a tremendous amount of money.  So it would be interesting to be able to do this for the first few months with really low admin costs and try to build up clients, so that when I do have admin costs, I already have a pretty established practice.  That sounds pretty good to me.