Re-Starting Your Practice When You Move

Adventure! Necessity! Exploration! Education! There are a million great reasons to move some exciting, some heart-breaking. Maybe your practice is in that beautiful, easy place where referrals roll in effortlessly and it pains you to leave it. Maybe you are still in the building stages and are tired at the thought of investing all over again. Fair enough. Here are some things I’ve learned as I’ve ping-ponged across the United States as private practitioner: You are in transition. You know all those therapists who love to work with “people in transition,” that’s you sweetheart. And if there’s a market for therapists working with this population, you may want to consider that it’s just plain hard to transition. Don’t hold on to the brave face all the time. Don’t pull the BS of “I’m a therapist with a million tools so transition shouldn’t be hard for me.” Transition is hard for everyone. Consider therapy in your new town as you build your local social support. Call or Skype with your friends a lot. My phone bill when we first moved to Seattle? Ridiculous. My mood? Improved. Take some time grieve what you left but be careful about comparisons. When we moved from Seattle to Asheville I couldn’t even look at pictures from our years there. It was like a break-up. Over a year later I still deeply miss Seattle and I also absolutely love Asheville and feel like it’s Home. I can compare little things (the Seattle drivers are SO polite! The hikes in Asheville are so much closer!) without getting bogged down in better than/worse than. Online counseling is not awkward or weird like you might think. It’s an awesome option for the clients you currently have who are stable, have low risk behaviors, and are private pay. There are very important legal and ethical considerations and ignorance isn’t an excuse to do what you want. A few VERY important standouts from the trainings I’ve taken:

• Legally, you need to be licensed in the state your client is in. So I’ve maintained my Washington licensure in order to continue to see some of my awesome clients there.
• Ethically, I only offered this to people who were in a stable place and since I work with folks with eating disorders, I also stipulated that they maintain their relationship with either their dietitian or physician so I would have “boots on the ground” in case the head I was seeing on my screen was atop a quickly shrinking or expanding body.
• Legally and ethically, please please please do not justify using Skype for therapy. It’s not HIPAA compliant and it’s really spotty. I use VSee and have been pleased with their video clarity and reliability. Their HIPAA compliant option costs money but you can make that up in 1-2 sessions. Thera-link has gotten some good press lately and is significantly less expensive.

Rob Reinhardt at Tame Your Practice wrote about other considerations about online counseling on his blog. Get clear about the licensing requirements in your new state. Get used to the idea that reciprocity doesn’t exist. You will probably have to apply like the newly licensed including a new sign off from that supervisor you had years ago.  A good LCSW friend in Georgia moved to Washington right after getting licensed. In Georgia at that time you could have to 50% of your hours be supervised by a psychologist or an LPC. In Washington at that time, you had to have all supervision done by a fellow social worker. She couldn’t get licensed in Washington until she redid (and paid for) however many hours of supervision she needed. Apply for licensure in your new state ASAP. In North Carolina one of the licensing boards only meets to review applications quarterly and if they don’t have a quorum, will cancel the meeting. I hear horror stories of license-eligible folks waiting 6 months to get licensed. Start that process as soon as you know what state you’re moving to. If you plan to get on insurance panels do it as soon as you’re licensed and have an address to give them. Skype-network or email-network (or be old fashioned and use a telephone) with folks in your soon-to-be town and ask which are the most common & highest reimbursing. Look at map to see where you want your practice. I’m on a street that was obviously full of therapists (thanks for the info, Google Maps). Look at proximity to highways and make sure you’re in a part of town that isn’t stressful to park in if that’s important to you. See which cities or towns are likely to commute in. Don’t pay attention to anyone who says anything about a saturated market. As my friend Allison says, it’s like finding your spot at the beach. There’s room for everyone, you just may be close to your neighbors. Need some convincing that saturated markets don't exist, I got you covered here. Find folks to network with and people you’ll refer to. Does your client population often need psychotropic meds, a great medical provider, a specialized dietitian? Google the psych prescribers, medical practices and RD’s in your new area. Check out Psychology Today, Good Therapy, and Google for other therapists in the area. Make a list or spreadsheet so you can jump on networking when you get there. Google business lists you on Google Maps. Once you have an office, hop on! It’s free! Learn about your new community and culture. Attend local events, read the local paper, drive around, get to know what cities and attractions are around you. It’ll be great for getting settled in and for knowing that when a client says “I went to Clingman’s Dome this weekend” that they were hiking, not watching a sporting event. If your practice was smooth sailing for years, you may need to revisit the practice-building information you used to build in the first place. Also check out some of the newer practice-building resources that have popped up since. It’s a new world with a larger emphasis on having an online presence. Have you moved your private practice before? What tips can you share in the comments? Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.