Establishing and Maintaining A Private Practice *

James E. Kilgore**

How does a marriage and family counselor go about establishing and main- taining himself in private practice? The essential point is that he must do pro- fessional work when he gets the opportunity to work with clients. If one does not do professional work, he is not going to become established and stay in practice.

Establishing A Practice The traditional way of beginning a practice is to send a professional an-

nouncement of availability to potential referral sources. These include phy- sicians- particularly pediatricians, internists, obstetrians, gynecologists, and plastic surgeons - clergy, attorneys, service agencies, and individuals working in health and other helping professional fields.

An appropriate, ethical listing should be placed in the white and yellow pages of the telephone directory. A good telephone answering service may be helpful at the beginning. Later, a qualified and efficient receptionist-secretary may be the best investment that a private practitioner can make. This person makes an impression of the practitioner’s competence and professionalism on the inquiring public.

The private practitioner’s image and practice are also affected by his own contacts with the public through civic associations and community groups. Availability for consultation with such organizations, including presentations without fee to groups and clubs, result not only in the opportunity to interpret marriage and family counseling to segments of the public but also result very often in a number of indirect or direct referrals.

The physical setting chosen for private practice also is very important. In designing and constructing an office suite, or in selecting one, it may be worthwhile to walk through as a new counselee might, noting one’s own reac- tion to experiencing the place. If it is possible to react warmly and find that the room inspires confidence, one probably has a good setting. The physical location and accessibility of the office including the availability of free parking also affect the client’s reaction toward the counselor and his services, and, therefore, should be taken into consideration.

Not only the way the practitioner deals with the cases that come to him, but also the manner in which he responds to those making referrals to him affect the success of his practice. If one can contact a referrer and indicate that what he says is important and give him time to make suggestions about the needs of the referees, he will tend to believe in one’s desire to work with the persons that he has referred.

‘Revised version of a presentation made at the annual meeting of the American Asso-

**James E. Kilgore, RelD, is in private practice at 204 Northside Medical Center, 275 ciation of Marriage and Family Counselors, November 2, 1973, at Palm Springs, CA.

Carpenter Drive NE, Atlanta, GA 30328.

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It is important for the solo practitioner in particular to obtain the services of good resource persons as consultants. A good gynecologist, urologist, or internist, and perhaps a dermatologist, in whom one feels confidence, can pro- vide immediate, specific information. A physical examination and an early consultation can give needed information in some cases.

Eventually, many private practitioners may wish to increase the flexibility and scope of their practice by adding associates. For example, a therapist with whom one can do conjoint therapy may be a desirable addition. The addition of associates who have expertise that will augment or complement the prac- titioner’s training and expertise-e.g., specialists with children, drug abuse, or other problems-enables him to refer certain cases to an associate in his office rather than to another, outside office.

Private Practice As A Business Private practice is a business. This fact should be understood by the prac-

titioner and clearly communicated to consumers of his services. Efficient, businesslike and professional procedure should be used in dealing with persons who seek one’s services.

One such pattern is as follows: An individual calls and arranges for an appointment through the reception-

ist-secretary. A confirming letter giving the date and time of the appointment and directions to the office is mailed immediately, along with a statement about fees and the services and groups offered.

When the clients come for the initial interview, an explanation of the costs and the anticipated results is given. The initial interviews are designated an evaluation process. The preliminary evaluation, for example, may consist of five sessions, and this fact is communicated to the clients during the first meetings. During the fifth interview, specific recommendations are made, and indications are given as to what is to be expected from that point and what direction therapeutic process will take.

Payment may be by billing; for example, on a monthly basis; or on a session basis. One such explanation of payment, borrowed from a physician and adapted to a marriage and family counselor’s practice, is as follows:

Notice to All Patients As you know, the cost of everything is rising. We would like to help by keeping counseling costs down to a reasonable level when possible. One of the major expenses in this office is bookkeeping and billing. It is taking more and more time and costs more and more with the rising costs of paper, mailing, and salaries. For these reasons we are trying a new policy to help cut our costs and in turn yours.

We would like to ask everyone coming to this office to pay for his visit a t the time, either with cash or check. Most medical offices are doing this, and it seems to please all parties. It would save us a great deal of time and money and would save you the time, trouble, and ex- pense of writing and mailing a check or making another trip here to pay bills.

This is simply an attempt to render more efficient service a t a lower cost. So if it is a t all possible, please pay for your office call a t the time it is made. Thank you.

Some practitioners who follow the payment by the session plan use the major

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bank credit cards. Arrangements to use such cards may be made quite simply through the banks in one’s area that participate in credit card procedures. Use of credit cards for collection and elimination of monthly billing may result in significant savings for the practitioner, thus reducing overhead expenses.

Professional incorporation offers several advantages for the private prac- titioner whose income level has reached sufficient heights. The rule of thumb suggests that when ’one’s gross annual income reaches approximately $50,000 -appropriate legal accounting advice concerning incorporation should be sought.

Whether his practice is incorporated and he is required to have malpractice insurance or whether it is unincorporated and he is not, the private practi- tioner should give serious consideration to obtaining such protection. Mal- practice policies may be obtained through companies providing coverage for members of professional organizations such as the American Psychological Association, by those who are eligible, or through some of the local insurance agents in one’s area. Costs for an annual policy are nominal.

Another kind of insurance is that having to do with counselor reimburse- ment for services to clients. Reimbursement by insurance is becoming an in- creasingly important part of the psychotherapy picture, including marriage and family counseling. Practitioners who possess credentials in other profes- sions such as psychology may be paid under that heading in some cases. CHAMPUS (the Civilian Health and Military Personnel of the United States) has reimbursed marriage and family counselors in recent years.

A private practitioner is in many ways an entrepreneur of the psychological services. He is different from an agency because he has no charity foundation, or grant to support his services. In a sense, he “sells himself” and must be able to “deliver the goods” to persons who purchase services from him or he will go out of practice. He must limit himself to an area that is appropriate to his training and abilities, but must not be so limited that he is unable to help a majority of the persons who seek his services.

Characteristics of the Practitioner In thinking about establishing and maintaining a private practice, one

should consider the kind of person who might do well in such an endeavor. Since the term private practice implies a kind of independence, the person who goes into this field must be willing to some extent to work alone and to accept the success or failure of his own efforts. Undoubtedly, he will be helped by sufficient aggressiveness and organizational compulsiveness to enable him to stay with the difficult tasks of the early days of establishing a practice. Just as the private practitioner must be willing and able to work alone, he must be able to recognize his limitations and be willing to make referrals when- ever he is unable to handle a case.

A private practitioner also must have a degree of accessibility to the com- munity a t large. Any counselor, and the private practitioner in particular, must recognize that the style of his practice reflects his own concepts of family living and significant relationships to the community. How he relates to people in the organization in which he participates and the community lead- ership that he provides will model the openness and freedom that he helps others find in therapy. The therapist who is secure in himself in personal as well as in counseling settings will be likely to help other persons discover security.

The special property of the counselor in private practice, as implied above, is his individuality. He has no agency to protect or mar his image in the com-

April 1975 JOURNAL OF MARRIAGE A N D FAMILY COUNSELING 147

munity. He may suffer from isolation and loneliness a t times, but he does not have the problem of being associated with an agency whose perspective he does not support. He speaks.only in his own name, and there is great free- dom in this situation.

The great risks of establishing and maintaining a private practice are re- warded by an almost unparalleled sense of independent success and personal satisfaction. As in a good marriage some essential ingredients to “success” may be overlooked as the couple habitually experiences them; so in the prac- tice of therapy. The more experienced the therapist and the more established his practice, the less he concentrates on the mechanics of his work. As one begins, however, these guidelines may prove helpful and beneficial if appro- priately adapted to one’s own unique talents and circumstances.

148 JOURNAL OF MARRIAGE A N D FAMILY COUNSELING April 1975