Saying No In Your Private Practice

There are a million ways we can talk about boundaries in your practice, and I’m sure I’ll hit most of them at some point, but today I want to talk to what happens when we fall into scheduling and fear-based victimhood. Oh yeah, I used the V-word. Let’s own it.

Time

Here’s what happens: someone calls and seems like a really great fit. You have space available since you’re still building. You want to see this client. They insist that they can’t make the times you offer, so you stretch a little and make that evening appointment you didn’t want to make. It’ll be worth it, you think. Good client, good money, what’s not to love.

Then a few weeks in your partner does that sigh he does, “You’re doing another late day? I thought your late day was Tuesdays.” Or your friends say, “I thought you were free for dinner Thursday nights! We finally all got our schedules aligned.” Or you’re just tired and don’t like working at that time.

Maybe it’s your lunch break you give up. Maybe it’s coming in really early so you’re a weird mix of half-asleep & harried. Maybe it’s squeezing one more person into a day that was already at max client capacity or coming in on your off day.

Hear me now: There are people who will make your schedule work for them. There are people who will not or cannot. You can (and should, IMO) work with the people who will make your schedule work. There are other therapists who prefer to work evenings or weekends or at 7 AM. Allow them to have the clients that need those times.

Money

Taking on another sliding scale when your sliding scale slots were already full, being wishy washy with your no show and late cancellation policies, not collecting past due fees, not verbalizing your new fee increase when a new client calls, giving refunds, putting in unpaid direct service time like long phone conversations between sessions.

Hear me now: The money is a clinical issue. Pretending like it doesn’t matter to you at all is inauthentic and can cause resentment. There is a time and a place for flexibility, but that flexibility needs to be analyzed before it’s offered. Give yourself time to consider unintended consequences. Don’t let your money stuff negatively impact your clients via poor boundaries.

Niche

You treat angry men in recovery. You get a call to see a 13 year old girl with anxiety. You take her on because you have spots to fill, she needs a therapist, and her mom heard good things about you from a friend. And plus all the child & adolescent therapists are full.

You work with grieving older adults. You get a call from a woman who self-identifies as having BPD. She can afford your full fee and wants to meet twice a week. You take her on.

Hear me now: Chances are, you are going to be miserable and feel totally ineffective. These aren’t your people! It’s like a snobby debutante trying to make a relationship with a dumpster-diving hippie work. Don’t force it! Let these clients work with the people who love working with them. Referring them means you will do better work, they will get their needs met more effectively, the world will be a happier place.

Impact

If you have these little kernels of resentment, how do you create a safe therapeutic space for them to be real?

If you aren’t honest with them, how can they be honest with you?

If you aren’t setting boundaries in your own life and business, your clients don’t have a model.

If you aren’t doing your best work, how are you feeling as a clinician?

If you aren’t doing your best work, what does that do to your clinical reputation?

If you’re taking whoever calls, how do people know who to refer to you?

Where it Comes From

On the surface, this is about money and ego. It is. It’s ok to admit it to yourself and it doesn’t make you a bad person. It’s a good thing to make a good living It’s a human thing to let your ego lead sometimes.

I find that when I’ve taken on someone that isn’t a fit because of time/money/niche it’s because I’m stuck in a scarcity mindset. I’m afraid the phone will stop ringing one day or other clinicians won’t do as good a job as I will or I really want to put more money into savings or the client flatters me and I want to please them. Try that on and see if that fits. 99% of the time money (aka security) and ego (aka being good enough) are what I see in others so I don’t think it’s just me.

What to do Instead

Remember that you are not the fixer of everything. You are not the therapist for everybody. You are not the best that ever lived (though I trust that you’re damn good). You are not responsible for the wellbeing of everyone who wants to work with you. In fact, in many circumstances a referral is what’s best for them and you and the therapist you send them to (wins all around!).

Remind yourself that you will be full someday. You’re on your way. If you’re not on your way or you’ve plateaued, get some help with building.

You set up your practice the way you did for a reason. It was so you can have what you want out of life and work. Honor that.

I’ll leave you with two of my favorite Brene Brown quotes about boundaries:  

“I am not as sweet as I used to be but I’m far more loving.”

“Choose discomfort over resentment”

Any tips or hacks to manage boundaries you’d like to share? For instance, I rent my office out during the times I’m not working because I sometimes need an external boundary to keep me in integrity with my time. Let us know 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.