Category: Starting a Practice

Referrals and Referral Fees

Referrals are probably the most common way that therapists and counsellors get new clients. Many of them come through personal recommendations, from colleagues, friends, existing or former clients, or through other professionals, such as doctors.

photo  (14)Sometimes more formal arrangements are in place, where referrals are made in return for a fee or other consideration. Typically, you find this as part of a room rental agreement in a therapy or mixed discipline centre, or as part of a membership or directory based service.

The fee for the referral can be a once-off contribution, a one-time contribution per client referred, or a regular payment based on the sessions attended by the client (with perhaps a time limit.) The purpose of the fee is usually to recognise that the referrer is giving something of value to the therapist (ie paid work.) The referrer may have invested in the establishment and reputation of the centre or directory, and may continue to promote it through advertising or marketing.

The advantage to the therapist is that she doesn’t have to do all that promotional work herself, although, depending on the flow of referrals, a single source or client referrals may not be sufficient. It’s also wise to continue to generate referrals on a personal basis, in case for whatever reason the flow through that source dries up, or you move on.

Check out what it’s going to cost you for the referrals and what you can reasonably expect to get in return. Here are some ideas to think about:

  • Are you guaranteed a certain number of referrals?
  • If you make a once-off payment per client, how does it work if the client doesn’t stay? Do you get a refund?
  • If there’s no guaranteed number of referrals, check with other existing users to see what their experience has been like
  • Ask what promotion is being done by the centre or directory
  • If you can, get a sense of the quality of referrals. Are the clients assessed before being referred?
  • Can you specify the criteria for referral to you?
  • Check out the situation about “ownership” of the client.  In the event that you decide to move on, are there any restrictions on the client moving with you?
  • In looking at the cost, consider it in terms of the value you will receive. If you get a client that stays for a while, the referral fee will probably be a very small proportion of what you can expect to earn.

Can I Earn More In My Practice Without Working Extra Hours?

The subject of money can be a thorny one for practitioners. With lots of talk about recession and redundancies, therapists can find it hard to charge an economic rate. One way of earning more is to work more hours, but if that’s not possible, here are some tips:

1. Increase your rate per hour. A small increase of even a couple of euro per hour will result in a big change over time. There are several ways to do this:

  • Increase the rate for all clients from a particular date. Give existing clients several weeks’ notice, it makes the transition easier, and lowers the resistance.
  • Introduce an increased rate for new clients. This is an easier option, but also slower in terms of the result it brings.

2. If you allow negotiation about fee levels, create a minimum level below which you are not willing to go, and stick to it.

3. If you have a sliding scale, raise both the minimum and maximum rates, but narrow the gap, by cash registerraising the minimum one more.

4. Always offer your highest rate first. Don’t offer a discount, let your client ask.

5. Be clear about the criteria for reduced rates, for example, for unemployed, students and OAPs.

6. To avoid the possibility of being argued down by guilt about the client’s circumstances, have the contact details of a low cost service close to hand, and be prepared to refer the client on. If you find it hard to justify, try this or similar wording “I’m sorry, my own financial circumstances don’t allow me to charge less than x, but I recommend y, they give a very satisfactory service at low cost. Here’s their number.”

7. And my favourite tip. If you find all of this very difficult, don’t wait until you’ve met the client and heard their story before you introduce the subject of fees. Raise it at the beginning of the session or better still, when the appointment is made. That way you are less likely to succumb to the guilt!

If you’d like to talk about how you can earn more in your practice, I have a couple of coaching spaces available, so contact me here for an appointment.

Where Do I Start?

Being the one who  runs the practice, as well as the one who provides the service, means that sometimes there’s just too much to do in the available time. I’m sure you’ve had the experience, I know I have; the to-do list that just keeps growing no matter how fast or efficiently you clear the items, sometimes it just can’t be done.

There are many time management systems out there, thousands of books, computer packages and apps to help you “manage your time.” They all have in common a process of prioritising – you decide what’s most important, or urgent, and organise your tasks and your time accordingly.

They all work – once you decide what your priorities are. But for some people that’s the difficult piece, that’s the stumbling block, what do I prioritise?

Speaking with a friend this week she identified this problem, the things she should do for her practice, were not the things that were attracting her. Those things that were attracting her were family related and learning something new, both of which are important to her, but neither of which were going to progress her practice.

I’d love to be able to solve the problem for her, to magically slow down time, so that everything she has on her list gets done. But I can’t. I can tell her what I think she should do, but then that would be my priority wouldn’t it, not hers? Because here’s the thing, my friend, and only my friend controls what goes on the list. She and only she decides what to do, what order to do them in, and also what not to do. And while I can help her to be more efficient, I can suggest processes and strategies, I can’t actually decide for her what her priorities should be.

I struggled with this for a long time myself, and some days I still do. The first breakthrough came for me when I realised I never get to the end of the list. There are always more items, more tasks, more ideas to be added to it. And even if I get someone else to do some of it for me, there will still be more on my list than I can possibly clear.

I have to make a choice, and keep making choices, minute by minute, hour by hour, day by day about what I want, about what I’m making important for me, right now. I can decide not to choose, or I can sit here looking at my list waiting for the right choice to emerge, or I can just start somewhere. Which leads me to the second breakthrough.

That came when I realised that the point of my life is not to get things done. The doing is merely the road I’m choosing to walk down in order to have the experience. The experience, what I learn, and who I become in the process, they’re the point. So what I do, or say or think, only has the importance or meaning that I give it. I get to choose that too!

My father told me when I was a teenager, “If you want to live your life, you have to get out of bed in the morning.” I’ve long forgotten the context of his advice, but the principle still applies. So I get out of bed. And photo  (43)then I look at the list. I choose, and go from there.

Choosing is painful at times. It raises all sorts of fears about getting it wrong.  What if I make the wrong choice and regret it?  What if I make the wrong choice and someone else disagrees with me? What about the loss of the things I don’t choose, or the things I never make enough of a priority to do? And so on, I’m sure you could add a few of your own!

Not choosing is also a choice, and a valid one. And it brings up exactly the same fears and feelings. And maybe the most important thing for me to do today is to do nothing, or to do something that isn’t on my list at all, but makes me feel good, like meeting a friend, or playing with a pet, or just sitting on the sofa in my pyjamas. Maybe the most important thing for me today is staying in bed (Sorry, Dad!)

If you struggle to know where to start when it comes to any aspect of growing or running your practice, I’d love to help. Contact me here with your query, or to avail of your free 20 minute consultation.

Need to Attract More Clients? Just Ask

I was in the bank some time ago and a woman who was trying to encourage me to buy a pension gave me a box of mints with “Just Ask” written on it. It reminded me of how complicated we can make the whole looking- for-clients thing.

Earlier this week, a friend who was thinking of starting her own practice, said she was overwhelmed by the thoughts of what she had to do in order to get clients. She was talking about business cards, websites and letters to GPs and all that good stuff. But she hadn’t thought about the most obvious source of potential referrers, among people who already know her.

askI suggested she make a list of everyone she knows, (and yes, I do mean everyone!) and call them to say “I’m setting up in practice. If you hear of anyone who needs a counsellor, would you give them my number?”

Better still, write an elevator pitch and use the calls to friends and family to get familiar with saying exactly what you do and how you help your clients.

Therapists don’t really talk about their work. Well, we can’t, can we? So much of what we do is confidential. Unfortunately, and probably in an effort to make sure that we observe that confidentiality, we can wrap our work in a veil of secrecy, to the extent that those around us, family, friends, and former work colleagues can be afraid to broach it with us, and so, probably never think to mention our name to people they know who might benefit from talking to us.

If you need more work, JUST ASK!

Sometimes when I suggest this, people tell me that asking those closest to them is actually harder than asking a stranger. I am curious about this and if you feel yourself hesitating to take the step of telling those close to you about your work, perhaps you need to reflect a little on what’s behind your hesitation. Our nearest and dearest are more well disposed towards us than a stranger will ever be. Perhaps there’s a concern about observing appropriate boundaries? Look at it this way, every therapist has clients they can’t work with for a variety of reasons, so what do they do with those clients they can’t see? Yes, they refer them on to another therapist. You may not be able to help someone because the connection is too close, but if you refer it on to another therapist, that therapist will probably reciprocate when they have a similar problem. What goes around comes around.

If I can help you with any aspect of setting up or running your therapy, just ask! I’d be glad to offer whatever assistance I can. You can email me here with your query or question, to avail of your free 20 minute consultation, or to make an appointment.


Help! I Need A Room, Fast

The Buck Stops Here

Many therapists setting out in practice for the first time have closed their doors and gone back to working for someone else within three years. Not because they’re not good therapists, not because they aren’t helping their clients, but because they had no idea what it takes to run a business.

I learnt this lesson the hard way.

Portrait of senior owner of pet shop
Stock Unlimited

I was 26 when I became self-employed for the first time. I became a partner in the small accountancy firm in which I had been working for a couple of years. I had been managing for some years before that, and so I’d learned some of the tasks of running a business. The accountancy profession works much the same way as large families do, last year’s intake supervise this year’s, (or the older kids rear the younger ones!) So I knew the form.

I was 28 when I began to learn what it really meant to be self-employed.  After my second child was born, things changed in the practice. We embarked on a business venture that was new and untried, which put significant strain on the resources of the practice. Our practice overdraft started to climb steeply, and I realised for the first time what being a partner and therefore “jointly and severally liable” for the debts of the firm actually meant in practice. The much hackneyed phrase “The Buck Stops Here” means just that. If the practice went bust, I was at risk of losing my family home. I had two small children, one of whom was less than a year old. Now all of that “liable” stuff had been carefully explained to me by my solicitors before I signed the partnership agreement, and I had studied law as part of my training, so it wasn’t as if I didn’t know it. But at another level, I didn’t really know it at all. Up till that time, it had been an elaborate kind of game.

Fast forward two years, and the partnership had dissolved in acrimony and never ending legal battles and I was out of work for the first time since I was 17. I’m not telling you this to scare you, just to illustrate how difficult it is to know what’s involved in something until you’re actually in there. They say experience is something you get just after you need it!

One of the most difficult things to explain to anyone who is expecting a first baby is just how your life changes after the baby is born. No amount of reading books, or going to classes, or talking to other mothers really prepares you for

Baby, Human Hand, Mother.

it. You can imagine the fun and the joy of it. You can read about the sleepless nights, or the symptoms to worry about, but nothing can really teach you about being a parent except the actual experience of it.

It is exactly the same for setting up a therapy practice. You can learn the skills of working with clients. You can learn the management skills, as I did, but the mind-set piece of being self-employed, that realisation that I am responsible for this venture, and just me,  is something you have to do on your own.

It’s a question of taking ownership, of committing, as they say in the marriage vows, for better or for worse.  It doesn’t mean that it’s always going to be hard, or that you’re going to have to struggle. It’s not so much about the doing, as the being. Without the commitment to the business of your practice, you’re going to struggle to find the energy, the interest and motivation to do what you need to do. The beauty of it is, that when you do move into that mind-set, it all becomes easier. It’s like finally accepting something you’ve been denying for ages, there’s a peace and a certainty that descends, and a knowing that it’s going to be okay.

If you’re struggling to take ownership of your practice and need some support, I’d love to help. Please contact me here to make an appointment or to avail of a free 20 minute consultation.