All You Need to Do to Close Your Practice Is to Stop Seeing Clients and Lock the Door

At some point in time most mental health clinicians in private practice will make a decision to close their practice. This chapter focuses on each private practitioner’s many ethical and clinical obligations to clients. Guidance is provided regarding potential pitfalls and legal and financial consequences to avoid in closing one’s private practice. Issues such as preparing clients for the impending closure, making arrangements for referrals and the transfer of records, knowing when to no longer accept new clients, terminating business contracts, and making required public notices of the practice’s closure are all addressed. Further, specific recommendations are made for preparing for unanticipated practice closures and the development and implementation of a professional will.

Continuing Education Requirements Are Unnecessary and Are Not Relevant to My Professional Competence

Even the best trained and most highly skilled mental health clinicians must take active steps to maintain, update, and expand their knowledge and skills. Failure to do so on an ongoing basis places one’s professional competence at risk. This chapter explains the fragile nature of competence and the steps to take to help ensure the maintenance of ongoing clinical effectiveness. Enhancing one’s competence to add new skills and to expand one’s clinical practice into new areas also is addressed. Continuing requirements for license renewal are described and placed within the broader context of each mental health practitioner’s overarching ethical obligation to provide the highest quality professional services possible. Specific recommendations for achieving this goal are provided in the hope that mental health clinicians will incorporate them into their ongoing professional activities.

If I Treat My Staff Well, They Will Take Care of Me and Look Out for My Best Interests

It may be easy to believe that if one treats one’s employees well, the employees will look out for the practice owner’s best interests. After all, they each should have the success of the practice as their primary motivation for decisions made and actions taken. Yet, as this chapter illustrates, this frequently is not the case. Employees, while often responding more favorably to positive employment practices, nevertheless may not share the practice owner’s interests. Each mental health practitioner who hires employees and staff members should create policies and procedures relevant to the effective running of the practice and then provide sufficient oversight to ensure that all employees follow them. This chapter emphasizes how the business owner is responsible for the success of the business. Specific strategies and steps to take to help ensure the effective running of one’s practice are provided. Common staff challenges are highlighted and specific recommendations for addressing them are provided.

A Fee-for-Service Practice Cannot Survive

During fiscally challenging times and given the prevalence of managed care, it is easy to think that a fee-for-service private mental health practice is no longer possible. This chapter clearly demonstrates how wrong this myth is. Many individuals use their disposable income to purchase goods and services that are of value to them. How to develop and maintain a financially successful fee-for-service private practice is explained. Specific strategies are provided to determine community needs, to develop clinical skills that meet these needs, and to demonstrate the value of these services to prospective clients. Recommendations are made for structuring one’s practice so that clients will be more likely to pay for needed services out-of-pocket and for developing a successful fee-for-service private mental health practice.

Being Known as a Generalist Will Position My Practice Well in the Community

Although mental health clinicians share a range of general clinical skills, and although each of these skills is important to providing excellent clinical care, such skills are not sufficient for success in the business of private practice. This chapter addresses this myth and shares how mental health clinicians must position themselves in their local market in order to be successful. Specific guidance is provided on how to develop specialty areas and niche areas of practice. It is made clear how these will assist private practitioners to differentiate themselves from local competitors and to better meet the treatment needs of their local community. Concrete steps for developing and building a successful niche practice are provided along with useful resources that may be consulted and utilized to help ensure success in developing and running a niche or specialty practice.

Becoming Licensed Means That I Am Now Competent

Mental health clinicians invest in many years of hard work to develop their clinical competence through graduate coursework and through supervised clinical experiences. All this is done with the ultimate goal of becoming independently licensed to practice in one’s profession. Because licensure is such an important event, signifying the culmination of so much education and training, it may be natural to believe that becoming licensed means that one is now clinically competent. This chapter addresses how clinical competence and licensure should be viewed and understood. Licensure assesses one’s competence to enter the profession, but it cannot guarantee competence in all areas of clinical practice at the time of licensure or in the future. How to maintain, update, and expand one’s competence over time is addressed. Risks and threats to competence are discussed, and recommendations are provided for ensuring one’s ongoing competence over time.

In Graduate School, I Learned What I Need to Know About Running a Successful Practice

Although most mental health professionals receive excellent education and training that helps them to become competent and highly effective clinicians, graduate school tends not to provide training in the business side of practice that is needed for success in private practice. Many trainees and early-career clinicians may think they learned in graduate school all they need to know to be successful in the business of practice. Unfortunately, this is generally not true and many of those who enter private practice are poorly prepared for planning, establishing, and running a successful private practice. This chapter addresses the key issues every mental health clinician should know about when contemplating opening a private practice. Business and financial issues are addressed, including developing a business plan and utilizing various consultants. This chapter addresses the myth that excellent clinical skills are sufficient for success in the business of private mental health practice.

Documentation and Record Keeping Are Burdens to Be Completed as Quickly as Possible

Documentation and record keeping are not known as the most enjoyable aspects of being a mental health clinician. Yet, as this chapter explains, they play a vital and important role in meeting one’s ethical and legal obligations. Further, it is explained how timely, thorough, effective documentation can help mental health practitioners to fulfill their obligation to provide the highest possible quality of care. Information is also provided on how clinical records may be needed in the future, and the risks associated with minimal or absent documentation. The role of documentation as a risk management strategy, to meet legal requirements, and to assist in providing high-quality care are each addressed. Specific guidance is provided on the needed components of effective documentation.

I’m the Boss. Who Needs Policies and Procedures?

This chapter illustrates how every mental health practice needs a number of key policies and procedures in place from the outset. Risks to the success of the practice financially as well as ethically and legally are highlighted. Specific policies to create and use are described, and their role for promoting the provision of effective clinical services is explained. Policies relevant to business aspects of running a private mental health practice, setting clear expectations of staff and employee relations and responsibilities, and for responding to or addressing client needs and expectations are provided. Key policies explained in detail include payment, participation in insurance and managed care, fees, requests for records and release of information, and others. How to incorporate such policies into the informed consent process with clients is described.

At This Stage of My Career Paying for Supervision or Consultation Is Just Ridiculous

It is easy to assume that being licensed to practice a mental health profession independently renders one competent to manage effectively every clinical challenge that comes one’s way. Whether novice or experienced senior clinician, all mental health practitioners face clinically challenging situations, ethical dilemmas, and legally perplexing situations in the course of assessing and treating clients. This chapter explains the role of expert consultants in these situations and how they may save one significant money, time, and stress in the long run. Further, this chapter highlights the types of situations during which consultation and supervision may be especially helpful. Guidance is provided on how to know when this type of support and assistance is needed or may be beneficial, both to the client and to the mental health clinician, and how best to utilize it.