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You Asked, I Answered

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Over the past several years I’ve been asked the same (or similar) questions about my work as well as questions about therapy and private practice in general. I love fielding these questions because it sends me the message that a client (or potential client) is doing his/her due diligence in seeking therapy, which often means a higher level of engagement. It also means that others are paying attention to what is happening within their community, which helps get the word out about resources. I’ve continued to keep track of these questions and decided to put them and my responses together in one place.

What is your background?

I am a licensed clinical social worker, meaning I have a Master’s Degree in Social Work and have completed the schooling and supervision required to be licensed and able practice independently in the state of Illinois. I started my career as a School Social Worker within the field of public education; specifically within special education. I was able to support students, their families, and educators for approximately 15 years before I decided to leave that world completely. I’ve been practicing independently for almost 5 years, specializing in children and adolescents; specifically ADHD, Anxiety, Depression, Trauma, and emotional regulation challenges. I also have extensive experience working with individuals with Autism and other developmental disabilities.

What sets you apart from other providers in your area? 

I’m located in a rural area and those areas are often faced with a lack of resources. We are incredibly lucky; however because there is a pool of other providers to refer to, if needed. I think what sets me apart is my background and experience in education. It has afforded me the ability to be on the other side of the table re: students in need of more intensive support via special education services. Understanding those procedures and processes has allowed me to help parents and caregivers navigate that world in accordance with their rights.

I also work with young children, who need some sort of support not only at school, but also within their home environment. I help parents create plans and interventions that they can carry out at home to help reinforce what the school is trying to accomplish, but also what we’re trying to accomplish, therapeutically. This may mean creating visual supports they can utilize at home, or supplying them with other equipment or materials they may find beneficial to modifying behavior and/or their parental approach.

When working with children, I infuse a great deal of hands on activities that accompany a skill we’re honing or developing. There are more opportunities for important teachable moments and practice while doing a variety of activities or tasks. And, if we run out of ideas, I create new ones. A great deal of the children I work with have executive functioning challenges (as do I), so learning a skill while practicing the skill is the most effective way they can retain the information or concept. It also increases the likelihood that they will practice the skill outside of their sessions in real moments within their lives.

I also structure my days so I can accommodate after school and work schedules. It’s tough to find someone who works past 5p, let alone 6p or 7p.  My other therapist also works a couple Saturdays a month to accommodate her clients, and that has become invaluable to many.

So, it isn’t just you who represents Watson Center for Wellness?

Not at all. I have a wonderful therapist who works part time in addition to her full time job serving students with disabilities at our local community college. She works with children also, but her focus is really with adults.

What services do you provide?

We currently offer traditional therapy for individuals, skill based groups (when developed and running), special education consultations, IEP coaching for parents, professional development for educators and para-educators,  mental health consultations for agencies, and play therapy. We have also been sought out be sub-contractors for DCFS and provide therapy for children who have been placed into foster care. These cases are managed and ran by other state agencies such as Lutheran Social Services and Center for Youth & Family Solutions.

What have you found most people are surprised by, once they start therapy?

Most definitely the work involved. The bulk of the responsibility is on the client when change is in order, and changing behavior is T-O-U-G-H. Because of how difficult it is, it’s a process. There’s unfortunately no instant gratification here. Change will not happen over night; especially if someone isn’t totally engaged and willing to put best efforts forth. A contributor to their surprise is the belief that we know all the answers and will simply tell them what to do and how to do it. If only!

Our job is really to remain present with them, listen for underlying themes, trends, or hidden messages, and look for existing strengths to build on. I also take the approach of educating clients on certain distorted thinking styles and how they can dictate our feelings and behavior as well as how our neurological processes work in specific situations or as a result of certain events. This helps them build a better sense of awareness, which usually leads to them recognizing their role in whatever their presenting issue is. Then some real problem solving and behavioral activation can begin. This is especially helpful with adolescents because at that developmental stage, they’re not really programmed to connect how their thoughts and behaviors affect others or their own outcomes.

I use the same approach with younger children, but it’s certainly more developmentally appropriate and simplified. You also have to get the parents involved to assist in reinforcing the skills within the home environment. This can be a challenge. Parents are so incredibly STRESSED today and most are focused on getting through each day. Asking them to create a new routine or to change their approach feels insurmountable to them. I try to walk them through as much as I can and provide as much as I can, but short of moving in with them for 6-8 weeks…again, changing behavior is tough stuff.

Have clients ever not come back after they learn the onus is really on them?

Oh, for sure. It’s really difficult for many to take the initiative to begin therapy in the first place. While the stigma surrounding mental health has become less pronounced, it is still very much present. It is also hard to come to grips that there are issues we face that are bigger than we can handle alone. So, once some discover that they have to be the ones to do the work…we do lose some after that first or second visit. But, more often than not, they return at a later time because the issue doesn’t go away or get any better.

What do you find is the hardest aspect of private practice?

Oh, that would definitely be the business side of things. I am not a business minded person. At all. And quite frankly there are many principals that seem to directly conflict with the type of business I own. The overhead is rather costly, and as a result, I don’t have any office staff taking care of scheduling, billing, etc. I had an incredibly difficult time navigating fees and taking payment, in the beginning. It’s hard to balance “thanks for trusting me with your overwhelming and dire situation and I’m here to help you, but I’ll need paid now”. It just felt really gross. I just wanted to do what I do, my job, and forget the other stuff. I started researching and getting consultation and quickly realized that almost every private practicing therapist I spoke and connected with, across the country and in the UK, was having or had the same issue. That made a huge difference, and I just had to start thinking about it differently. The fact that we are an insurance provider also helped reshape my thinking about this.

Being able to bill insurance is great for our clients. We are in an area where private paying for services is not always an option. Being able to utilize their benefits is sometimes the only way they would be able to seek out services, and I very much wanted to offer that. But, and what most people don’t know is no matter what your fee is, once you become paneled, or in network with a company, they completely dictate what you charge the client. So, to make things easy, let’s say your fee is $10 for a 60 min session. A client might have XYZ insurance and you are in network, BUT XYZ’s allowable amount is only $6 for a 60 min session. So $6 is what you charge and $6 is what you get, and asking the client for the remaining $4, which is called balanced billing, can get you into A LOT of trouble…violates the contract you have with the insurance company as well as some laws, so you can face a myriad of penalties.

Learning this process, that every single insurance company has a different fee schedule and different levels of covered services is complicated, but you learn very quickly. It might not seem like $4 is a lot to let go of, but if you have 600 appointments per year that are covered by that company, it adds up very quickly and you cannot consider it a loss or use it for taxes in any other capacity. So, being diligent in fee collection and timely billing is definitely something you get better at. Five years later, I find I still have to remind myself that I need to keep the lights at the office on and fuel in my car when I start feeling wishy washy about it.

Are there days you wish you could back to working for someone else because private practice feels too difficult?

YES! All the time, but that thought is very fleeting when it surfaces, and is usually traced back to a stressful situation. For example, I required surgery this fall and needed to take 2 weeks off. There’s no sick days or vacation time to use, so figuring all of that out was terribly stressful. There were moments I thought “ok, so here it is…this has all been a huge mistake”, but everything worked out beautifully, which is usually the case and why I will likely not return to the traditional work force.

I learned very early on that the stress created in trying to control everything was going to be detrimental. You just cannot control every little aspect no matter how much you research, how smart you think you are, or how long you’ve been in the business. Some people might not like you or what you have to say, you might have a medical issue or experience a natural disaster, business aspects like tax laws might change, and on and on forever. I try to concentrate on what I can control and only maintaining that focus. That shift helps me recognize the gratitude I have for being able to do this gig at all.

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