In our last post, we talked about how the smallest inattention can have a bottom-line effect on your thriving practice. Hopefully, you have paid attention to those three line items and you see that taking care of business a little bit everyday truly makes a difference in your weekly return.

These next three may hurt a little more. They speak to your practice of the practice. As a clinical supervisor, I know that once uncovered in the light of day, with a quick shoring up, all is well.


Breaking confidentiality

Imagine this scene: You stop in the hallway to say hello to a colleague and you see the wife of the couple you saw last week. Now, you have referred her out to another clinician in the office. She is in the right place and so are you. However, instead of waiting for her to notice you, you say–”Helene! Are you seeing Michele today?” She nods yes, you collect your next client and say goodbye to your colleague. Yep. You just broke confidentiality. Twice. With your next client and your colleague. It’s a small thing, I know but it speaks to feeling completely safe in your office.

How about this one?

Helene, having felt so much better after seeing you (and now your office mate) refers her colleague at work to you. During intake, the work colleague mentions that she’s so happy that Helene and her husband are satisfied with their marital work and she hopes the best for herself, too. You say, “Yes, I am pleased that they are pleased.” You just broke confidentiality! Do you have a release from Helene to talk about her?


I can feel the eye rolls from here. However, these breaks lead to bigger ones. I recently got a referral from a long-time client. Most of my referrals for marital therapy seem to come from satisfied and terminated clients. The new client had thought about asking her individual therapist–someone from across town–when this happened: He said at the end of a session: “I’d like you to see a clinician in my office that I think does superb work. I think you and your husband will really like her. She recently terminated with a couple who reminds me of you, actually.” And this is where he slipped: “Their kids are the same age as yours and they go to the same school.” Did you catch it? He gave just enough identifying information to have her guessing who it was. These are not huge breaches. However, they are just enough blurring to give the client a sense of unease. In these three examples, it would have been just as easy for the first clinician to wait for the client to say hello, and in the second and third examples, not directly acknowledge their relationships with any other clients. I get that all three were about joining and making the client feel comfortable. However, there is potential for the exact opposite.


Being Irrelevant

This is one is especially painful for those of us who have been in the game a while. If you have been reading the blog, you know I stress the need for continuing consultation as long as you practice. And, when you are in a consultation or supervision group, the added benefit of new information is bound to help the bottom line. How?

There is not a week that goes by that someone in my office doesn’t share an interesting CE experience, a cool, new website or an assessment they found online. And the key? Take them all in. Your clients will know you are up to date and relevant. I will give you a great example. For years, after I had done a meditation with a client I would offer to “tape” one for them. When smartphones first appeared on the scene, it never occurred to me that my taping days were behind me. It took an intern to walk in while I was busy copying a meditation to point out the recorder in my phone. “Make it and send it!”. It became my mantra. Chances are you clients won’t point out the new and improved way you could be doing something. Handouts? Send the link. Meditations? Check out the dozens of meditation websites that offer variety and a different perspective. Assessments? Find the ones that are valid and reliable and have them ready in one document if a someone asks. Better yet, have all of these ideas on your resource page on your website!  I guarantee when a client feels like you are not only still in the game, but leading the charge, they will be impressed by your energy and devotion. Recycle those tired, copied-too-many-times handouts and download!


The Dog

Finally, the curious incident of the dogs in the office. I love my dog. I love your dog! I just don’t want them curled up in a corner of your office while you see clients. This is lately, a conversation I am having more frequently. Now, in case, you think I am a big fan of Freudian technique where the therapist is a blank screen? I am not. In fact, I like a level playing field, a flattened hierarchy and yep, I answer personal questions.  I just think that when someone comes to see you, they see you! Not another living breathing entity. Who, while you may have carefully trained to be quiet and obedient, might not be for the smallest of reasons. And that’s disruptive and what the client remembers from the interaction. Even if you cleared it with the client, do you think they are going to assert themselves and say, please don’t? You have established the ground rules where you get to have a pet taking up attention–from them.

Frankly, a dog in the office is about you and your comfort, not necessarily the clients. Yes, they may love dogs too and we all know that therapy animals have a place in our world but unless that’s your niche? Please, keep your dog at home. And, if that feels harsh, then by all means, include your dog–in a therapeutic capability with a job. And that may be just the niche that promotes your bottom line.