Starting a Successful Practice in Clinical Psychology and Counseling

A Guide for Students in Psychology and New Career Psychologists

Owen J. Bargreen

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135054939
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Clinical psychology is a quickly growing profession, yet it is a challenging one: the preparation is arduous, the training is highly selective, and the results – an established and financially successful practice – are not easy to achieve. This book explains how to prepare for and surmount all of the hurdles presented to those who hope to eventually develop a lucrative and rewarding practice in clinical psychology. It is the first of its kind to focus primarily on financial success, though it does also look at the personal stresses and rewards of the profession. The author provides tips from his own experience and from other financially successful private practice psychologists and offers business techniques and pointers that are not explained in training programs. Undergraduate students contemplating a career in psychology will find advice on preparing for the GRE, applying to graduate schools, and getting involved in research and clinical work. For graduate students, an overview of a graduate clinical psychology program, preparing and completing a dissertation, and gaining experience in psychological testing are provided. Chapters then focus on how to build and manage a private practice, the best ways to manage personal and business finances, and how to practice good self-care. Additionally, the book includes a chapter by an expert on student-loan repayment that examines how to best work through the process of paying back student loans while building a practice.

1
How Can I Help You Make Money?

Why Write This Book?

Many people ask me why I should write a book that helps other psychologists make more money. That is a very complex question. The answer is multi-faceted. I want to help you. When you do better, the profession does better. Ultimately, it is about the advancement of the profession. The more that you make, the more others will make. We all want to earn money, but we want to feel good doing so. With the proper foundation, you can be financially successful and feel good about helping others. There is some natural cognitive dissonance that comes with making money in psychology. I can remember the first person who paid me for therapy. I felt badly about it and my initial thoughts were that I shouldn’t be receiving a good deal of money for a therapy session. An automatic thought I had was “Maybe I should be charging less.” My ensuing epiphany was “I am running a business and I have innumerable expenses including student loans, mortgages, car payments, and business expenses—really too many expenses to name.” My book explains that it is OK to be financially successful in our profession. You can help kids, adolescents, adults, families, and couples and feel good about getting paid to make a difference in the world. It feels good to be paid to make a difference. Really, there is no good reason not to be financially successful. There are some sacrifices that you will need to make, but it will be worth it. By making good money, you will be protecting your future. I promise to explain more about that later.

Psychologists face some grave issues. Reimbursement rates for psychologists are declining. When the Medicare reimbursement goes down for psychologists, so too do the other insurance reimbursements. Then, sooner or later, the private pay reimbursements go down (this is not an acceptable trend). After what we have been through in grad school, and licensing, I am all for psychologists making money. When you make more money, I make more money. That is not a bad deal for me. I was able to be successful in a short period of time and I want you to be successful as well. Grad school was a long, arduous experience, and at times it can seem like a complete nightmare: the coursework, the dissertation, dealing with the administration. It can also be a wonderful time to blossom, because there are many meaningful clinical and research learning opportunities.

I do a substantial amount of psychological testing. With the poor reimbursement rates for psychologists out there, I am careful about what I choose to do. And I am sometimes asked why I do not do psychological testing for a cheap reimbursement rate. The reason is simple . . . doing our work for cheap is not good for the future of the profession. There is a great difference between doing pro-bono work and doing work for a rate more than 20 percent below the standard charge for testing services, which in my state in 2013 is less than $100 an hour. The former is encouraged and should be a part of everyone’s private practice, while the latter is not acceptable. When I do not do the work for substandard rates, I am doing a big favor the rest of the profession. The more work that we do cheaply, the more that people will look down on our profession. And we are already getting plenty of that from other professions, particularly the medical field. It is important for us to stand up for our profession. Whether that means getting involved with your state psychological association or joining APA, we need to do our best to protect the integrity of what we do. Psychology has been challenged for many years and we face tough times, as social programs are getting cut, reimbursement rates have decreased, and master’s level therapists are everywhere. This can create the impression that psychologists aren’t as valuable as they, in fact, truly are. Psychologists are not making money that is consistent with their experience and education. But, there is a method to making more money as a psychologist.

We are taught not to look out for ourselves. Psychologists abide by possibly the toughest ethical code of conduct compared to other professions. We are so worried about being sued, doing the wrong thing, and saying something that we shouldn’t, that we don’t do a better job protecting our rights. Many psychologists are practicing in fear, which sometimes prevents them from making more money. Now I am not saying that everyone should do high-risk work like child-custody evaluations. We need, however, to look out for our profession more closely and not be as fearful. I certainly have been guilty of being fearful quite a few times. And the fear is not unfounded. We hear about these horrible cases where psychologists, as a result of vengeful lawsuits by divorcing spouses, lose their licenses. We go through years of laws and ethics classes so that we understand what is and what is not acceptable conduct in our profession. We are really left with little margin for error, as sometimes even the slightest error can cause major ethical problems. Any breach of confidentiality and we can be sued. We are going to make errors but it is unlikely that we are going to make ethical violations. I shouldn’t have to tell you that you shouldn’t solicit patients—there are better ways to make money. Besides, the APA Ethics Code directly tells us that it is not OK to solicit patients, as we cannot misuse our influence as psychologists.

Did you always know that you wanted to be a psychologist? Chances are, you didn’t know that before attending undergraduate studies. Perhaps you were inspired as an undergrad, just as I was. I will explain to you what you need to do during your undergrad years in order to move forward toward the goal of becoming a clinical psychologist. Not to increase your pressure, but doing well in undergrad courses will be more important than you think, as more and more people apply for clinical psychology programs. So be sure to not blow off your grades, even if you are attending a great school, because many schools will have cutoff GPAs (grade point average) where you simply won’t meet their criteria unless you are above what they are looking for. Brutal, huh?

Maybe you have already completed graduate school. Well, what do you learn in graduate school? You learn about psychology. You learn about theory, research, psychotherapy, and psychological testing. Grad school provides some essential information about the practice of psychology. As I’ll explain later, grad school offers some incredible opportunities to gain experience doing psychological testing (hopefully). And of course there are great opportunities to gain skills as a therapist as well.

But what about the business side of the practice? Maybe you have a class that includes a few lectures regarding the business side of practicing psychology. That’s what my program did. A few lectures weren’t enough. Did you have a class on business? Maybe two classes? Not likely. I had to know more. So I did my research. Fortunately, my father was an MBA with a good deal of business experience, so he mentored me. But what about the people who don’t have a dad who is in business? This book will help you from the business perspective. While I don’t have my business degree, I do know how to make money and I know how to create a profitable business. Bill Gates didn’t have a business degree either. And he’s not exactly panhandling on the street.

I’m not going to pretend that I know everything about business. But I can offer some good advice about creating a financially successful practice in clinical psychology. That’s what I did. I started my practice in Fall 2008. By Fall 2009, I was having $50K quarters. That equates to $200K each year (for those who struggle through the arithmetic section of the WAIS-IV). We are talking about a serious income here. I don’t have a family but that is the kind of income that can easily support a family. And if you want three-plus kids, you will likely need a large income to support the family.

Money makes everything easier. Don’t tell me that you want to come out of grad school and make $60K per year. Now I am sure that there are those who say that they really don’t care about how much they make. I’m not going to believe that for a minute. Most people care, even those with a doctorate in psychology. That doesn’t mean that you don’t want to help people, but everyone who finishes a five- to six-year doctorate wants to make good money when they are done. They want to, because they feel that they have earned their stripes. They feel entitled to making more money than the rest. And they will make more money than others in mental health, excluding psychiatrists.

We live in a capitalistic society. So far, capitalism, compared to other economic systems, seems to be working adequately. But it is a double-edged sword. As psychologists, we have a drive to help, to work through people’s problems and to enhance the lives of others. But trust me, when you start making money in your practice, you are going to want to make more and more. Darwin calls this “survival of the fittest,” in that we want to do the best to ensure our survival. Making a good salary is one way of ensuring our survival. It is also a way to protect and support our offspring, another Darwinian point. I would argue that the need to create financial security is inherent in all humans, whether they have a more altruistic bent or not. Besides, as we know through recent research on altruism, most people are not “perfectly” altruistic. I think our drive to make money is OK, and I would also say that the drive to make money is essential for the future integrity of our profession. If we don’t do well financially, Medicaid rates go down, insurance rates go down, and we get paid less. The reality is that the more we make, the better or more-esteemed our profession appears.

Darwin also taught us about natural selection. Natural selection is about surviving and reproducing in the best possible fashion. For now, we will apply this to economics and leave out the sex talk. If you want to have the nice things, drive the nice car, then read on. Darwin tells us that humans try to carry on the best traits or attributes to subsequent generations. He tells us that some people are going to be more successful (economically, in this case) than others. Those who are successful will continue to strive for success in order to carry those traits that will enhance the advancement of their offspring. What does this have to do with psychology? Well, if you have a financially successful practice, you will be anchoring the future of the profession. We have a natural need to try to do better, and to do better financially because that will enhance our lives, and ultimately our species and our profession. By doing better financially, we will work to maintain the survival of our species (clinical psychology). This is how humans evolve (Darwin) and how our profession evolves (psychology). Now, this is not the ultimate evolution of the practice of psychology. But we are talking about a marked improvement about the quality of life in clinicians. I would argue that when clinicians’ lives are improved, the quality of their practice is likely also improved. That means better quality of service. This benefits society.

The truth is that there can be a huge discrepancy in salaries between psychologists. I mean, we are talking about someone making $50-60K and someone making $200K. That is potentially four times more money, excluding taxes. Can you imagine living in a house that was four times nicer than yours? How about driving a car that was four times nicer? Or being able to afford a house or condo at all? For those psychologists who have been in practice for many years, what about being able to pay for your kids’ college tuition rather than telling them to get a job or a student loan during college? They might get a job and then drop out. They might not get a job and drop out. But I can assure you that most kids who have their college paid for are going to really appreciate what their parents are doing for them. They also will start their professional lives without a tremendous burden of debt. You are giving your kids a valuable opportunity.

For those who are younger psychologists, like myself, I don’t want to burst your bubble here, but you are going to have to pay for a lot of things in your life. It is going to be hard to pay for a $200K house or condo. Eventually, you will want to buy a place and stop throwing money away with rent. With housing markets improving but banks not lending, you might have to save $100K for that, which is a hell of a lot of money. Now, unless you marry someone who is rich, or is a recipient of a fantastic trust fund, you are going to have to come up with some serious cash. It takes a very long time to come up with that kind of cash. But remember that many banks require 20 or 30 percent down for purchasing a house or condo. If you buy a house or condo that is $500K, then you will likely need at least $100K. Saving is tough. Factoring in saving with having children, and it is an even more laborious task.

Let’s say that you have kids when you are 35 and you would like to save roughly $100–150K for a house or condo by the age of 55. Twenty years equals $5–7.5K per year that you will have to save, double that if you want to buy the house or condo by age 45—yep, that’s saving $10–15K per year! That is a ton of money to save each year. And you will likely have to do this in order to pay for a house or condo. This task is going to be considerably easier if you are making $150K per year rather than $70K per year. Even saving for smaller things, such as a trip to Europe, is not easy. Assuming that your trip costs $5K, including airfare and hotels, it might take you an entire year to save for the trip. If you want to travel regularly, that can be a serious expense. But with the right income direction, regular travel and yearly great vacations can be a possibility. Saving is part of being financially successful, and I am going to help you work on this important issue in this book.

Making more money is about thinking about the future. It is about thinking about a better means for your family and upgrading your lifestyle. It is about paying off those student loans sooner, about having less anxiety about getting that car loan, about having (in most cases) a better quality of life. Money isn’t everything, but it sure makes life easier. There has also been a trend in the past 10 to 20 years where some psychologists have been making actually less money than when they began. Some of my older psychologist colleagues complain about this all of the time—how the reimbursement rates continue to decline for insurance companies and Medicare/Medicaid. Despite increases in living and business operating costs, psychologists are actually making less money than in the mid-1990s. However, I have also found that the ones who are making less money are the ones who are only doing psychotherapy and are not doing consulting or psychological testing, which typically offer better reimbursements. Still, my colleagues’ complaints highlight a disconcerting trend for the future of our profession.

While the reimbursement rates continue to decline, my book focuses on making lemonade out of lemons. We face a tough situation as psychologists today and we want to make the most out of it, financially. This book isn’t only for those who have completed grad school, have fought through the EPPP (Examination for the Professional Practice of Psychology) and state licensing exams, or who have set up their private practices. This book is also for those who are considering a grad school, and for those who are still in grad school and don’t know how to set up their careers. I will begin by explaining what you should do in grad school to best position yourself for money-making opportunities once you have completed licensure.

Typing

Typing is a skill that comes naturally to many. For those in my age range as a 30-something, it is very likely that you are a fast typist. I became a seasoned typist when I started my undergrad. At Whitman College, everyone was really into Instant Messaging. My girlfriend at the time was constantly on IM and messaging me. We would chat back and forth for hours, which became really silly because she was one floor down from me in the freshman dorm. Little did I know that the typing skills that I gained from constant IMing would provide a very helpful template for my current work as a psychologist. Yes, I am coming to my point here.

My point is that you need to have good keyboarding skills. If you are in grad school and are not a good typist, this is something that I feel you should address immediately. Not only will you be writing your dissertation on a computer, but you are also going to be doing a ton of work using your computer once you’re in private practice. Typing on the computer is essential in psychology, especially in psychological testing. As I have stated, the best way to make money in starting a private practice is to do a lot of psychological testing. So work on your keyboarding skills if you are not a sound typist. Take a class if you need to. Get on IM and chat with friends. Just make this happen because it will be worth it in the end. My IM recommendation sounds silly, but you would be surprised how important having excellent keyboarding is in your practice. Improving your typing skills could save you hundreds of hours in your clinical practice in the future. I know that focusing on tech skills follows a problem today where the entire world has gone technological and people have lost face-to-face connections with one another. But please do this, because my book is about being financially successful. We don’t live in Cuba, so you will have plenty of opportunities as a psychologist to become financially successful. If you don’t make the money, someone else will. And don’t tell me that you don’t want that Hawaiian vacation this year.

I have colleagues who also do state assistance evaluations, as I do. They are unable to type out their evaluations immediately like I do, so it takes them substantially longer to do the psych evals. What I can get done in 45 minutes, would take some twice as long. Simple math here is that I am going to be making 100 PERCENT MORE MONEY THAN THEY DO IN A DAY DOING THE EVALUATIONS. This equates to big bucks. If I do eight evaluations in a day at $130 a pop, that equals $1,040, whereas they will be making $520. I’ll take the $1,040, please.

Lately there have been major changes made to dictation software. For instance, some of my colleagues use Dragon, a new, more-seamless form of dictation software, where you can dictate into your computer and the software writes down what you say on a word processing document. This might seem easier to you, because you don’t need to type things down. But remember that you will have to spend additional time with the dictation software, once you are done with your interviews and evaluations. Time is money, so it is best to learn how to type as you go during evaluations. You don’t want to spend extra hours after work, whether you are typing things down or whether you are using the finest dictation software available.

Being a good typist is essential, but it is also important for you to be able to process and multitask well while typing. The art of multitasking during an evaluation requires a lot of practice. When you are typing, it is important for you to process what the person is saying. It is imperative that you gain skills that are connected to processing information quickly and being able to synthesize information cogently. Your ability to synthesize information presented to you will improve as you gain clinical experience. For instance, if you are starting graduate school, processing what the person across from you is saying will take a great deal of time. There will be a period of time in your career as a psychologist where your ability to multitask and process/synthesize information will be at its apex. Since processing speed worsens, rather than improves, with age, you also will eventually lose some abilities to process information and multitask as you grow older. Your eventual lowered ability to process information and multitask is further evidence that your most financially successful (biggest volume) years as a clinical psychologist will be when you are younger, but also will be after you have gained some clinical experience.

Making Money

You know that you didn’t get into psychology to get rich, right? You should have become a medical doctor or a lawyer if you wanted to be rich. But the good news is that you have already prepared yourself well for making money by taking the psych testing classes, choosing good and varied clinical internships, etc. You did that, right? If you didn’t do that, you can just take the classes over. Just kidding.

Here are the recent stats on psychologists:

Median annual wages of wage and salary clinical, counseling, and school psychologists were $76,741 in 2013 (http://www.psychologycareercenter.org/salaries.html). Looking at the stats, we are not talking about a whole bunch of money. $70K, espe...

Table of contents

• Cover
• Title
• Copyright
• Contents
• ACKNOWLEDGMENTS
• 1 HOW CAN I HELP YOU MAKE MONEY?
• 2 UNDERGRADUATE AND POST-UNDERGRADUATE EDUCATION
• 3 ON STUDENT LOANS
• 4 GRADUATE SCHOOL
• 5 LIFE AFTER GRADUATE SCHOOL
• 6 STARTING YOUR PRIVATE PRACTICE
• 7 BUILDING YOUR PRIVATE PRACTICE
• 8 MANAGING FINANCES
• 9 SELF CARE
• Index