It started with a therapy student.

I was feeling energized while in a mentoring session with a graduate student at my alma mater. She expressed her ambition to eventually find herself as a therapist in private practice. Her questions were insightful, and her energy was infectious.  

I have enjoyed my work as a psychotherapist in solo private practice for over 10 years. In the past year, I have been reconfiguring my simple solo private practice into a complex group practice. I am enjoying the clinical aspect, continuing my own work as a therapist, as well as hiring and supervising early career therapists.  

But learning the accounting and legal aspects of running a business like this has been steep,  and for me, doesn’t come naturally. Truthfully, it has been outright humbling. I’ve been forced to recognize how little I know about family and medical leave insurance, unemployment insurance, employer sponsored health insurance, and payroll taxes. I’ve had to acknowledge the need to educate myself on these things, enough to find and hire professionals to support me in these areas. 

And what about marketing?  

I have barely scratched the surface on this new world. All of these things are running through my head when I was asked this question:  

“How did you set yourself up for success?”  

My mind rewound back to when I was a graduate student, followed by the years working in nonprofits and hospitals while earning my clinical hours towards my license.  

How did I set myself up for success? I’m not even sure what that means. “I suppose,” I said slowly, “I didn’t…”  

When you take any kind of professional or personal risk, there really isn’t an insurance, or “assurance”, that you will be successful. There are plenty of coaches and consultants who can guide you, at least in the professional realm; but, I made a lot of clumsy moves along the way, learning along the way. Some of them were quite costly in terms of time and finances.  

Some of my choices, I realize in hindsight, appeared a bit unpolished. For instance, I  built my own first website before there was Wix or SquareSpace. It was a Yahoo Small Business website, and I called it Yogalena Therapeutics. What even is that??  

I chuckle to myself now when I think about it. But I was PROUD of it then.  

Was that going to set me up for success? Were people googling words like “Yogalena” and “Therapeutics” in their search for a psychotherapist who loves yoga? 

What does it mean to be successful?

In our never-ending quest for success, there really isn’t a recipe. You take a step in the direction in which you are either energetically driven, or even just a little curious. And then make your move. Sometimes you don’t necessarily know what your next move beyond that will be.  

 We refer to this as the proverbial “leap of faith.”  

The thing that often stops us the most from pursuing the thing that we most desire is the fear that we aren’t “set up for success,” so why even bother trying?  

 That is your anxiety talking. Your anxiety wants to keep you stuck, spinning your wheels, wishing you could get past your fears and “level up.” Much of the work of therapy is identifying these fears, and then taking small steps in the direction of your goals.  

 Of course you need to lay a foundation for any professional goals you have. You must do the work, and recognize that learning never stops. But worry less about doing so perfectly, or you will likely never start. 

An evolving concept.

In the end, I told my interviewer that there is no formula for success. There is only continuing education, vision, inspiration, creativity, and energy. There will also be setbacks, anxiety, fears, and yes, some losses. There may even be some failures, which sometimes require time to heal. Then you can reevaluate before determining next steps. 

But please, I implored her, do not let that stop you! If you want to be successful at something, first, decide what type of success you are looking for. What does success mean to you? Is there a financial benchmark, or a professional milestone of accomplishment that means you are successful? Then, not fearlessly, but in spite of your fears, go in that direction.  

Keep in mind, the mark of “success” is always moving. You may reach one milestone and find you already have your next milestone in your sights. Celebrate the victories before moving on to that next level of success. And remember, there is no “there, there.” Few people arrive at their personal pinnacle and think to themselves, “Ok, I did it! I’m successful!” And then stop.

My hope for you is that you will enjoy your wins along the way, and continue setting your sights on the next peak to climb. Rather than setting yourself up for success, set your goals and continue moving towards them. And find some time to enjoy the ride! 

by Connor D. Jackson, JD

Connor D. Jackson is a healthcare attorney based in Chicago who serves independent practices in several states. Visit his firm’s website here.

Business Formation for Therapy Practices

One of the first questions many prospective independent practice owners ask is, “Do I need to establish an LLC or a PLLC before I open?” They also want to know, “Is this something I can do myself? Should I have my trusty accountant set it up for me?”  For a psychotherapist — or any licensed healthcare provider — professional regulations bring even more considerations and constraints.

Let’s discuss those considerations and constraints and talk about how to move forward with a new practice.

Corporate Entities

The first concept to understand is that of a business “entity.”  It’s possible to open a business that is, legally speaking, indistinguishable from you, the owner.  Any expenses or revenues flow to or from you. The business’s debts become your debts. Someone could sue you for the actions you carry out for your practice, such as entering into a contract or taking out a loan. Such a lawsuit would put your personal assets at risk. Legally, this form is called a sole proprietorship. It’s the default structure for any business that doesn’t establish a corporate entity with the state. 

But what if you want to limit your personal liability for the actions or debts of the practice? In this case, creating a corporate entity allows you to separate yourself from the practice and become a “member” or “shareholder.”  Corporate entities give members and shareholders limited liability, which protects personal assets from legal claims against the business in many situations.

When creating a corporate entity, you have the option of two primary structures: a limited liability company (LLC) or a corporation. Corporations are incorporated, and limited liability companies are organized.

Licensed healthcare providers need to be aware of two subtypes of these structures: professional limited liability companies (PLLCs) and professional corporations (PCs). Some states, such as Wisconsin, call professional corporations service corporations (SCs). These companies are organized or incorporated, respectively, to deliver professional services. However, the definition of professional services varies by state. Whether a state mandates that a therapy practice create a PLLC instead of an LLC or a professional corporation instead of a corporation requires a careful reading of that state’s laws and regulations.

Fees and Formalities

For many practice owners, finding the proper structure requires balancing the end goal (liability protections) and the costs in money and effort. The monetary fees, for example, differ for the entity types. But individual states’ fee schedules vary widely, too! An established California LLC, for instance, will pay an annual tax of $800. In contrast, an Illinois LLC will pay an annual report fee of only $75.

Forming a corporate entity also requires creating corporate governance documents, which are legal documents that determine how your entity functions. For example, an LLC should have an operating agreement and a corporation should have bylaws. These documents discuss liability, payment of profits to members or shareholders, and many other factors that have legal consequences and impact your legal rights and obligations. 

Further, to claim the protection of limited liability, you need to maintain corporate formalities. Corporate formalities might include

• issuing stock 
• filing annual reporting to the state 
• segmenting funds of the entity from your personal funds
• consistently entering into agreements in the name of the entity (not your personal capacity)
• recording all the entity’s activity in signed resolutions. 

Typically, small or solo psychotherapy practices find professional limited liability companies more appropriate than corporations because they require fewer corporate formalities. Additionally, the filing fees can be lower than those of corporations. 

An attorney can help you work through the options and understand the best structure for you. You might also launch a practice as a sole proprietorship (sacrificing the liability protections of a corporate entity) and create your entity later, once your practice grows. Just keep in mind that any contracts you enter into as a sole proprietor will not automatically transfer to your corporate entity down the line.

Corporate Entities and Multi-State Practice

When considering the proper corporate structure for a practice, It’s important to remember the rationale for having corporate structures at all. First, the practice owner seeks to separate their personhood from their work. Also, they notify consumers of the entity with which they are doing business or seeking healthcare services. These reasons illustrate how your profession intertwines with your corporate structure.

To operate in multiple states — in person or virtually — you need licenses issued by the appropriate state agencies before you can treat clients in those states. When it comes to telehealth, the client’s location is typically where the care takes place. For example, say that you’re based in Texas and have a Texas license. However, you work with clients who live in Michigan. Thus, you ought to have a Michigan license as well. Failing to do so could invite professional disciplinary action in Michigan as well as Texas. Such activity could also invite claims of misrepresentation or even fraud (depending on your intent). States aim to protect consumers from harmful acts. They do so, in part, by requiring professionals to put consumers on notice of their professional status in its applicable corporate structure.  

Requirements Vary Widely By State

From an organization or incorporation standpoint, requirements for delivering services across state lines vary by state. So if you’re operating a multi-state practice, you need to understand the laws in each state in which you deliver care. 

For instance, in Michigan, a clinical social worker may choose either an LLC or PLLC structure. Meanwhile, Illinois requires licensed clinical social workers to deliver services through PLLCs. Thus, a dual-licensed provider in these states who wanted to enjoy limited liability protection might need two entities to render care in both locales. States may also have specific waivers for delivering care across state lines (e.g., PSYPACT for practicing psychologists). However, these exceptions are few, in our experience. 

Some states, such as New York, require proof of your licensure from the State Department of Education before they will accept your professional entity. In other states, an assertion of the professional purpose of the company suffices. (But if you were to practice a profession outside your scope, this would remain grounds for discipline.)

State laws also vary on which professions can co-operate a single professional entity. For example, what if a licensed clinical social worker wanted to organize a multi-member LLC in New York with a licensed professional counselor?  They would need to research whether the state allows that co-ownership.

And when researching the requirements, keep in mind that each state may not have identical licensure. For example, Texas likely defines a “licensed mental health counselor” differently from New York or California.

Corporate Entity vs. Tax Designation

Many new business owners conflate corporate entity types — the business formation — and tax designations.  You may have heard your accountant discuss the benefits of a particular tax structure, such as an S-corporation or a C-corporation. The tax structure determines how a corporate entity will be taxed. 

Corporate entities are assigned a predetermined taxation method. For instance, a single-member LLC is automatically taxed as a sole proprietorship. As a result, the profits and losses of the LLC are taxed the same way as personal income and losses. However, corporate entities can elect to be taxed in a way that is different from the default taxation method. For example, an LLC that meets specific requirements can elect taxation as an S-Corporation.

Accountants are experts at finding beneficial tax strategies. Meanwhile, attorneys focus on forming corporate entities that meet the rigorous requirements of the state. Healthcare’s strict regulatory environment magnifies the complexity of creating those corporate entities. Thus, a good accountant is a treasure and should serve as a key member of your team of professional advisors. However, accountants seldom have the background and experience to establish a proper healthcare business formation with robust corporate governance documents.

How to Get Started

A healthcare attorney can provide the best guidance on these matters and prepare your business formation with all necessary supporting documents. But perhaps you’re not ready to hire a lawyer or don’t yet have the resources. In this case, contacting the state agency responsible for business entities is a good start. They can direct you to information and answer your basic questions to help you get moving.

This article is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between Jackson LLP Healthcare Attorneys and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

by Connor D. Jackson, JD

Connor D. Jackson is a healthcare attorney based in Chicago who serves independent practices. Visit his firm’s website to learn more.

Telehealth: Insurance & Legal Considerations

When evaluating whether telehealth services are covered by insurance, three concerns should be top of mind. The requirements of individual states, insurance companies, professions, and claims vary widely. Thus, something that might cause one claim to be denied could be irrelevant to another claim’s approval. It’s important to know what questions to ask and what the answers mean for your practice’s procedures.

1. Is it covered, and will I get paid?

First, determine whether your state legislature has enacted telehealth insurance parity laws. These laws typically require parity between the types of services covered or the reimbursement value of the services. For example, coverage parity requires that insurers cover telehealth-based services that they already cover when offered in the office. If a state also requires payment parity, insurers reimburse providers for telehealth services at the same rate as in-person encounters. 

Many states have coverage parity laws, but achieving payment parity has been a tougher battle for providers. CMS has already announced that some payment parity changes will be rolled back once the COVID emergency ends. Legislation is pending in several states to protect temporary payment parity changes, but even if passed, these laws will apply only on a state-by-state basis.

2. Do I need to change how I file claims?

The second insurance-related consideration requires that the provider bill the services using the correct codes, including any modifiers. Most mental health providers are already familiar with the “95” CPT code modifier for telehealth services. 

During COVID, however, CMS reminded providers that claims should include “DR” (disaster-related) and “CR” (catastrophe-related) modifiers as needed to ensure payment.  DR/CR modifiers aren’t generally needed for outpatient mental health services, and they were used more by those whose underlying roles shifted during the pandemic. 

For example, an ambulance company could seek reimbursement for responding to a 911 call and rendering paramedic services, even if they didn’t transport the patient back to the hospital, because COVID requirements didn’t allow them to follow that protocol. When filing their claim with Medicare, the company would add a DR/CR code to identify COVID as the reason they didn’t take the patient to the hospital.

3. Does it matter where I’m licensed?

The provider’s license matters to insurance companies. They use it to determine if the provider is eligible to provide services in the state where the client received them, and they verify it during the paneling or credentialing process before allowing that provider to be in their network. A “place of service” code and office address on a claim form could also reveal that the provider is located out-of-state.

Licensing for Telehealth Care

Traditionally, providers were licensed in the state where they lived and offered care. The client’s state of residence was generally irrelevant because clients saw their clinicians at a physical location. 

The emergence of telehealth in recent years was accompanied by an all-too-common expansion of technology at a faster pace than legal developments. The majority of clients continued seeing their providers in person, and coverage parity laws became the norm only shortly before COVID began. When the pandemic forced providers to suspend in-person care, they faced a new and existential question: whom can I treat?

1. If I’m only using telehealth, am I restrained by my state license?

Under the framework in most states, the law considers a telehealth visit to take place where the client is located during the encounter. This means that the provider must be licensed in the state where the client is actually located — a requirement that theoretically ensures that the provider is regulated by the client’s state and is aware of that state’s practice requirements, such as:

• scope of practice
• standards of care
• informed consent requirements
• state medical privacy rules

In reality, an excellent therapist in Illinois is likely also an excellent therapist in California. Technology now allows them to bridge that geographic divide — if only the law followed suit.

For example, say that you’re licensed in New York, live in New York, and have always seen clients at your New York office. During COVID, some of your clients permanently moved out of the city and into suburbs in New Jersey and Connecticut. Unless New York has a border-state exception, the law prohibits you from treating your NJ and CT clients via telehealth. Some dense geographic areas, like the DC-VA-MD metro area, have recognized the challenges of regulating certain professionals individually and have implemented border-state licenses or waivers, 

Some of these requirements arise from the expectation that providers and clients do reside in the same place. Proximity may even be clinically necessary — if a provider determines that a client’s care necessitates an in-person visit, then they could schedule that appointment promptly. This is particularly a consideration in psychiatry or for therapists working with youth or those with significant mental illness. 

If providers and clients are in different locations, then an in-person visit would be impractical or impossible — even if the standard of care required it. COVID, however, upended some of these norms. Providers were forced to ask themselves whether a client was “safer” receiving teletherapy from home or risking COVID infection by entering their office. Providers also had to consider their own health and how in-person encounters could impact their families, staff, and other clients. Telehealth rapidly became the norm, and emergency orders allowed providers to continue treating their clients even if people had moved around a bit in response to the pandemic. 

2. My profession has an interstate licensure compact. Does that change things?

The Psychology Interjurisdictional Compact (PSYPACT) coordinates the practice of telepsychology across state lines, giving licensed psychologists more flexibility. Currently, over one third of U.S. states have effective PSYPACT legislation, and by the end of 2021, that number will jump to half of states.

Under PSYPACT, psychologists must be located within a compact state in which they are licensed. Meanwhile, the client must also be located within a participating state.  The authorization does not come automatically, however. To practice telepsychology under the authority of PSYPACT, psychologists must obtain an Authority to Practice Interjurisdictional Telepsychology (APIT) and possess an active ASPPB E.Passport. 

The pace of new PSYPACT legislation suggests that lawmakers recognize the value and the demand for teletherapy services that reach across state lines. Nonetheless, the laws still lag behind the technology. Therefore, therapists who wish to set up an interstate practice must understand the laws that apply to their situation.

Figuring out exactly what is required of you and what path makes sense for your practice isn’t something you have to do alone. Law firms like Jackson LLP Healthcare Attorneys specialize in providing counsel to mental health providers to help you get it right in your practice of psychotherapy.

This article is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between Jackson LLP Healthcare Attorneys and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

by Dr. Jocelyn Markowicz, PhD, Psychologist

Help for the Helping Professional: Risk Management Strategies

The success of psychotherapy is correlated with the attachment between client and therapist in the therapeutic relationship (Farber, 2015). According to Dr. Farber, empathy and building the bond of attachment is our stock-in-trade as mental health practitioners. When empathy builds the bond of attachment with someone starved for connection, a therapist may inadvertently set themself up to become a victim of a stalker (Farber, 2015).

Safety Risks Often Discounted

When a therapist embarks on training, they are imbued with ethical principles to guide the delivery of services. One crucial ethical principle is to take reasonable steps to avoid harming their clients and minimize harm where it is foreseeable and unavoidable. However, training programs do not adequately equip mental health providers to take reasonable steps to mitigate the safety risks inherent in working within the mental health field. Unfortunately, therapists often lack support when they talk about the dangers faced in their profession. Therapist safety concerns are often met with the sentiment that “it comes with the territory.” Therefore, they must deal with and manage risks or even active threats alone. People often have the same view when nurses, physicians, firefighters, law enforcement officers, and service members talk about the risk they are managing. The dismissal of the severity of risk that mental health providers take on reduces their access to resources and tools to reduce that risk successfully. An industry designed to help individuals who struggle with the perpetration of harm against others does not negate the provider’s right to be free from harm. Stalking, in particular, has become a major concern for therapists in this technological boom.

Stalking and Therapists

Stalking is a prevalent phenomenon with significant negative psychological, physical, social, and financial consequences (Sheridan, Adrian, & Scott, 2019). According to the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics (2015), a greater percentage of females experience stalking than males. Additionally, 2.2% of females compared to 0.8% of males experienced at least one stalking victimization within a 12-month period. Storey and Hart (2017) correctly documented that prevalence estimates are considerably higher for individuals holding certain professions. Mental health professionals (psychologists, psychiatrists, counselors) have higher rates of stalking than other professionals (Galeazzie & DeFazio, 2006; Store, 2012). Nearly 19.5% of psychologists report being stalked in the context of their professional lives (Lion & Herschler, 1998; Smoyak, 2003; Whyte et al., 2011). Additionally, 32% to 64% of counselors have been victims of some form of harassing behavior from a client (Romans, Hays, & White, 1996; Store, 2016). 

Health care workers and mental health care workers have been stalked by their clients, as documented in several studies from the United States (Romans, Hays, White, 1996; Gentile et al., 2002) and abroad (Galeazzi, Elkins, & Curci, 2005; Abrams & Robinson, 2011). In fact, research has demonstrated that co-workers also stalk service providers, but the percentage of stalking from service users is higher (Ashmore et al., 2006). This means that, although anyone can potentially be stalked within their professional environment, mental health professionals are at a higher risk of being stalked by their clients than others in other work environments.

Reducing the Risk

Specific risk reduction and threat management interventions are needed to ensure that therapists have effective risk management tools and risk reduction policies at their disposal. Why is risk reduction necessary for professionals in mental health? According to Galeazzi, Elkins, & Curci (2005), mental health professionals who have been stalked by their clients have left the field, reported lost time from work, and moved to a different state to escape their stalker. They have also carried weapons to work in response (Pope, & Vasquez, 2011). The impact of stalking on providers is substantial. There is limited training currently available about how to manage stalking in one’s mental health career. The call is to have adequate systems in place to reduce the likelihood of stalking and appropriately respond when it does occur. In the age of technology, stalking risks are increased due to clients having multiple ways to contact their practitioners and access their personal information online. Mental health providers may face online stalking or be stalked by phone or email in addition to unwanted physical presence in the professional or personal environment. Here are six risk management strategies: 

#1 Implement Client Consultations

Harm reduction involves the initial assessment of risk in your professional environment. Therapists are trained to assess risk for client harm to self and others but often do not view harm to themselves as a potential area to consider. Professionals working in a private practice setting, group forensic setting, or within a hospital setting will have different risk factors to consider. For example, a provider working in an independent private practice may wisely implement more stringent policies to reduce risk than a provider who works within a health system and has access to on-site security guards and other professionals that may serve as a risk management team.

When possible, all new clients should participate in an initial consult to determine if this treatment setting will offer the most effective treatment and evaluate any potential risk factors that the provider or system may have to manage. Clinicians are encouraged to refer individuals to a higher level of care and to agencies that can responsibly manage harm potential more effectively as needed. For example, a client with a history of stalking may need to work with a provider in a larger treatment agency versus a solo provider in private practice in order to minimize the risk of intimate attachment that may lead to stalking behavior. The risk assessment process can inform the policies a provider creates for the safety of everyone involved. 

#2 Provider-Client Technological Access

Therapists should use business phones and office email systems versus their personal cell numbers and email addresses to communicate with clients. At the beginning of treatment, therapists should outline communication policies, specifically what content is to be communicated electronically (i.e., scheduling new appointments of cancellations versus crisis intervention) and time parameters for communication with clients (e.g., during business hours only). One’s communication policy should, of course, contain a limits of confidentiality policy and discussion of how the professional will handle violations of the communication policy. A communication policy that outlines limits to professional responsiveness and limitations to the depth of electronic communication can minimize safety risk by establishing clear, professional boundaries.

#3 Maintain Communication Boundaries

Therapists should adhere to the communication policies they set forth for their clients. If a provider establishes that they will not communicate with clients after business hours via email, they must not violate their own policy. If a professional indicates that they will not address clinical issues via email, they must follow through on that commitment. Psychotherapists violating their own communication policy may condition their clients to violate the policy as well. Boundary violations from either party increase safety risks.

#4 Seek Support from Colleagues

Mental health providers have the privilege of helping individuals who struggle with a variety of emotional and behavioral concerns. Given the nature of this work, risk cannot be prevented, but it can be reduced and managed more effectively with support. Not unlike individuals seeking services for distress due to being threatened, clinicians also need support as they implement protocols to reduce their risk or manage active threats. The inherent risk of the mental health profession does not negate the need for support in the face of risk management or active threat reduction. I encourage therapy for therapists to help them manage the distress of working within risky situations or addressing active threats.

#5 Individualized Action

When therapists are managing an active stalking threat, they must take care of themselves the same way they take care of others. They must seek support from other mental health professionals to determine ways to work within the boundaries of ethical mandates while preventing harm to themselves. They may also need to seek the assistance of law enforcement to manage risk and prevent harm. The individual goals and efforts of mental health providers to manage the risk inherent in their position can make a significant difference in the outcomes they experience.

#6 Systemic Action

Training therapists to implement protocols to minimize their safety risks is vitally important to bringing about widespread change in risk management for mental health providers. Psychiatrists and psychologists are the professionals most likely to be stalked, possibly because aspects of the psychotherapeutic relationship can produce misunderstandings about the nature of the intimacy generated and appropriate boundaries in this type of relationship (Galeazzi, Elkins, & Curci, 2005). Mandating risk management continuing education for mental health providers to learn how to minimize their own safety risk should be encouraged. Consultation services for psychologists who are navigating managing active stalking threats should be more accessible. The impact of reduced safety for therapists comes at too great a cost to themselves and their communities. Mental health providers need systemic protection plans so that they can continue working hard to minimize distress and improve life functioning for their clients.

Got something profound or helpful to share with other mental health professionals on the GoodTherapy blog? We welcome content contributions from our members. Not a member yet? Explore GoodTherapy membership opportunities.

References

Abrams, K. M., & Robinson, G. E. (2011). Stalking by patients: Doctors’ experiences in a Canadian urban area. Journal of Nervous and Mental Disease, 199, 738-743. 

Ashmore, R. Jones, J., Jackson, A., & Smoyak, S. (2006). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. 

Farber, S. (2015 ) My Patient, My Stalker Empathy as a Dual-Edged Sword: A Cautionary Tale. American Journal of Psychotherapy | Vol 69, No. 3, 331-355. 

Galeazzi, G.M., Elkins, K., & Curci, P. (2005). The stalking of mental health professionals by patients. Psychiatric Services, 56, 37-138. 

Gentile, S. R. , Asamen, J. K., Harmell, P.H.,, & Weathers, R. (2002). The stalking of psychologist by their clients. Professional Psychology, Research and Practice, 33, 490-494. 

Lion, J.R., & Herschler, J.A. (1998). The stalking of clinicians by their patients. In J.R. Meloy (Ed.), The psychology of stalking: Clinical and forensic perspectives (pp. 163-173). San Diego, CA: Academic Press.

Mark M. A. Bureau of Justice Statistics, January 22, 2015, NCJ 248470.

Pope, K. S., & Vasquez, M. J. T. (2011). Ethics in psychotherapy and counseling: A practical guide (4th ed.). John Wiley & Sons Inc.

Romans, J.S. C., Hays, J.R., & White. T. K. (1996). Stalking and related behaviors experienced by counseling center staff members from current or former clients. Professional Psychology: Research and Practice, 27, 595-599. 

Sheridan, L. North, A. C. & Scott, A. J. (2019). Stalking in the Workplace. Journal of Threat Assessment and Management. Vol. 6, No. 2, 61-75.

Smoyak, S. (2003). Perspectives in mental health clinicians on stalking continue to evolve. Psychiatric Annals, 33, 641-648. 

Storey, J.E., Hart, S.D., & Lim. Y.L. (2017). Journal of Threat Assessment and Management. Vol. 4, No. 3 122-143. 

U.S. Department of Justice Office of Justice Programs. Bureau of Justice Statistics, January 2015. https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5217

Whyte, S., Penny, C., Christopherson, S., Reiss, D., & Petch, E. (2011). The stalking of psychiatrists. International Journal of Forensic Mental Health, 10, 254-26.

Best Practices for Responding to Therapy Referrals

Therapy referrals are an essential part of the success of many behavioral health organizations and practices. Through your referral sources, you can grow your reputation and keep a steady flow of clients coming into your practice. You can generate referrals through networking with other mental health and medical providers, building relationships in the community with professionals like religious leaders, school counselors, and nutritionists who might send clients your way, providing excellent care so your clients want to share you with their friends, and using marketing tools like registry listings. 

Getting new practice referrals is great, but what do you do with them when they come in? What is the best way to handle your referrals so that the people who reach out become new clients?

Responding to Therapy Referrals

Quick Response

Do not leave a potential client waiting. If someone has referred an individual to you for mental health services, a quick response is one of the best ways to bring them in. Prompt replies show potential therapy clients that you are ready and able to help them. When you let too much time pass between the therapy referral and your response, you send a negative message to the client. You are telling them that you are too busy for them. When it comes to mental health services, clients need to know that you are available and care about helping them now rather than later.

Create a Positive First Experience

Your first interaction with a potential client sets the tone for the therapeutic relationship. Whether you or a staff member are responding to a referral, make sure to offer a personable, efficient, caring experience. If you open the door with the royal treatment, they are more likely to feel positive about you and the work you can do together.

Have a Plan

It is wise to have a plan in place for what to discuss on this first contact. A solid plan will help communicate that you are organized and ready to support new clients. Below are four topics to consider bringing up at the first point of contact.

1. Consultation

It is helpful to set expectations about what the first session will look like for your client. If you offer a free or priced initial consultation, that is important to note as part of your introduction. 

2. Scheduling

Talking about your availability will help a potential client figure out whether they can make therapy with you work. 

3. Cost and Insurance

Do you accept insurance? If you are a mental health provider who accepts insurance, make sure you ask the patient if they have coverage that you accept. A lot of people are specifically looking for an in-network therapist, so 1) if you do take insurance, be sure to list that information publicly, like on your registry profiles and website and 2) if you don’t take insurance, but can offer a superbill so clients can file for out-of-network reimbursements, be ready to explain that process. Be prepared to talk about out-of-pocket costs for self-pay sessions.

4. Payment

How do you accept payment? Make sure to let the client know when and how you collect fees. For example, do you collect at the time of the visit? Do you send them a bill once a month? Do you accept credit card payments online or in-person?

Take Care of Your Referral Sources

Refer Clients Outward

You have to give to receive. If you get a potential client whose needs your practice is ill-suited to address, refer them to someone who does offer what they need. The time and thoughtfulness you spend referring clients out will help build relationships with other providers and increase the therapy referrals you receive from these referral sources. 

Personal Touch

If you receive a therapy referral that leads to a consultation or new client, make sure you express your gratitude to the referral source, especially if they’re a professional too. Sending a note of appreciation to the people who are helping new clients find your practice goes a long way. In some cases, it may be appropriate to loop them in on new things you’re learning or new research that is pertinent to the populations they work with. Some practices do this by sending an infrequent (quarterly or annual, for example) newsletter to their referral sources. But showing individual appreciation is really impactful when another professional sends a new client your way—that personal touch demonstrates the kind of care you give to the clients you see, which makes them more likely to send more referrals to your practice.

Registries like GoodTherapy position you to be found by people seeking therapy on their own. To learn more about what a GoodTherapy membership can offer you, click here.