Private Practice Do You Consider Yourself a Business?

So when did marketing become a dirty word?TMCprofile5

I have been consulting with private practice practitioners for over 7 years and what I find most common is the struggle to think of a healthcare practice as also a business.  We are in the helping service and feel we must help others before we help ourselves. Most of us came into the world of therapy because we had been helped by it and wanted to help others. We all went through long and costly years of school, but most of us never had a class or internship that taught the business of psychotherapy. We struggle with networking, knowing our value, how to set our fee and whether or not to be on managed care or insurance panels. I think most of us just followed the mentors we trusted. Our caseloads can be enough to handle without having to try and do the paperwork, insurance billing, collecting and marketing.

Major first step start to think of yourself as a small business owner and that means thinking about how much you make, how much you want to make and what it costs to run your practice. Running a practice includes your office, phones, etc. but also your marketing budget, which frightens many of us. Your investment in your therapy practice is an investment in yourself. I have made it my business to learn how to do things with as small an investment as possible. The initial outlay may seem overwhelming but there are ways to do things on the less expensive side and remember this is an investment that over the years will keep giving you a return on your dollar. I work with people with all kinds of budgets but what I have found is if I have to spend money to make something look professional it is worth the investment because it represents me in the world. You can have a designer create a website from $500 – $15,000. You can use wordpress and get templates but I have always found even with templates it helps to have a professional do some final tweaking so it looks professional. You can manage the costs by doing as much of the work as you can.

Some of the people I talk with seem afraid of marketing. Most often you are marketing and don’t even know it. When I opened my first office, I shared space with a friend of mine, neither one of us had any clients but we had a lovely office all ready to go. It was a risk and we knew we needed to take the risks to get started. There are lots of ways to get going that minimize the costs and risks, like renting space part-time. I think many of us have a hard time networking and feel uncomfortable attending group events. Think about your school or training programs and start networking with the people you met there. Wherever you are in your career start networking, start developing a referral network. Let people know where you are, what you specialize in and how you can help people. I’ve spent time, money and energy going to school, interned for next to nothing, studied for my license and now I have to go out and sell myself?

Well, the brief answer is yes

The longer answer – You are not selling goods. You are investing in yourself and I will not hide the unpleasant truth you are selling your expertise, skills and experience. The good news is it can be done with creativity, beauty, grace and a tremendous amount of professionalism and ethics.

Licia Ginne, MFT
www.TherapyMarketingCoach.com

Kelly McGonigal – Making Stress your friend

I loved this talk and felt inspired by her and wanted to share it with you. I was hoping I could place it directly on my site, but it’s too big a file for my website. What I love about this is her thinking about how we need to embrace our experience and not it see it as something we need to get rid of but more that our body is giving us information. Kelly McGonigal – How to make stress your friend

Does Avoiding Conflict Really Work?

Man must evolve for all human conflict a method which rejects revenge, aggression and retaliation. The foundation of such a method is love.

Martin Luther King, Jr.

Read more at http://www.brainyquote.com/quotes/quotes/m/martinluth133296.html#5iwHB6QgoQSEZZVQ.99

Man must evolve for all human conflict a method which rejects revenge, aggression and retaliation. The foundation of such a method is love.

Martin Luther King, Jr.

Read more at http://www.brainyquote.com/quotes/quotes/m/martinluth133296.html#5iwHB6QgoQSEZZVQ.99

carlyungDoes avoiding conflict really work. I don’t like conflict, it makes me uncomfortable. I can nervous, sweaty and start to shake if I have to speak up about something uncomfortable. Though I have also found that people that try the hardest to avoid conflict are the ones that create the most. These are the people pleasers who have a hard time setting boundaries and letting you know what they really want. In relationships I find that feeling that your friend, partner, spouse or family is there for you to lean on and provide input is one of the most important elements to a successful relationship. You want to feel that those people closest to you are going to tell you the truth without harm or meanness. You know when you are trying to make a decision and you feel the other person is just trying to please and doesn’t take a stand, it doesn’t feel like you have a separate person with you, they have blended into you. We need to feel that people can be kind and have their own opinion and this is someone that you feel is separate from you that you can lean on and you feel that you can sink your weight on them and they won’t collapse. Those that try to avoid conflict seem to be the ones that you never know where you stand with. They don’t often tell you to your face what is going on, you might hear it by accident, you may never hear it or  it may come from someone else they complained to you about you. I am not saying that you should take on every fight or upset and that fighting is OK,  It is as Carl Jung says that what comes from conflict is growth. Learning how to resolve issues, fight fairly and state your thoughts and emotions is what brings intimacy. Whether it is in your personal relationships, work relationships or being in the world. It is important to stand up for yourself but just as important as to learn how and when to get the best results. Conflict resolution, learning to listen and communicate is what improves any relationship and not every fight can be won but when we feel that we have been heard than it is easier to find the compromise.
Licia Ginne, MFT
www.psychotherapysantacruz.com

What is Codependency?

What is Codependency and does it matter

Codependency is a word that has lost some of its original meaning from overuse. Codependency originated in the recovery movement and was used to describe the behaviors of people who were in a relationship with an alcoholic or substance abuser. Codependency has come to mean addiction to relationships, relationships that do not have healthy boundaries and relationships where the codependent has not been able to protect themselves.

Over the years, however, codependency has expanded into a definition that describes a dysfunctional pattern of living and problem solving, developed during childhood by dysfunctional family rules. These families suffer from poor boundaries (to understand these boundaries and definitions of abuse) and produce adults who have been abused as children. This abuse may come in the form of neglect, physical abuse, sexual abuse, verbal abuse and/or emotional abuse. Abuse will be have found in families who suffer from mental health issues, problems with addictions and compulsivity, in families where for whatever reason parents don’t have time for children, and in families where the parents were abused as children.

Pia Melody in her book, Facing Codependency, defines the Five Core Symptoms of Codependence:

• Having low self-esteem
• Difficulty setting boundaries
• Knowing yourself, knowing what you want
• Taking care of adult needs and wants
• Difficulty experiencing and expressing reality moderately.

In any family there are elements of accommodation that we have to make, for some these accommodations are little for others it can be a form of abuse. We adapt so we can survive. You couldn’t wake up each day and say “This is hell”; you have to go into some type of denial to survive. Those tools we used to adapt were the tools available to children and as adults we may find that we still rely upon them and they don’t work as well as they did before. Remember: as a child your choices are limited. They are pretty much limited to your thoughts and fantasy, these are the tools of children. “How can I think about what is happening to me in a way that I don’t feel like a victim?” Children blame themselves for the problem: “If I were better, maybe my parents wouldn’t fight or I wouldn’t be hurt.” “If I brought more joy to my family than they wouldn’t be so unhappy.” As children we don’t even usually think things this clearly its not until we are far removed from the situation that we can really allow ourselves to think about it. As a child to feel the problem might be in  our parents often makes us feel helpless and hopeless — we do not have the power to change how others respond and as children we don’t have the power to leave or protect ourselves.  So to feel a sense of mastery in the world, we become the problem. “This is something I can work on and fix. I can change me and I can’t change them.” But we constantly fail because we are not the problem.

Psychotherapy has been a good setting for learning that you are not the problem. It can be a good environment for learning how you accommodated and how to put yourself first. How to grow, develop insight and understanding so you will have more options and choices in your life.

As we grow our tools for protecting ourselves should grow, but remember we must be taught coping and problem solving skills. Without this education we still use the tools our child’s mind came up with and often continue to blame ourselves for other peoples behaviors. As adults we need to expand our resources, we have not been taught good problem solving skills or good self care.

Recovery from codependency is learning how to meet and identify our own needs, to learn that putting ourselves first is not always selfish. When we set boundaries and factor in our needs we become a better friend, spouse/partner in any type of relationship. I always use the example when you are on an airplane and the flight crew is giving you the instructions most of us ignore they always tell you if the oxygen mask comes down first place it over your mouth and then if someone needs assistance help them. If you can’t breath you are little help to the next person. This isn’t a hall pass to always have it your way it is an opportunity to start looking at your relationships and consider how they can become collaborative. It is an opportunity to challenge some of the beliefs you have learned about yourself and find that some of them may not be accurate or maybe were but no longer fit.  We learn ways of communicating,we learn to honor and respect our needs and wants and the needs and wants of others. We learn what a reciprocal relationship is and how we deserve to be in them. We learn how to problem-solve and look for the win-win solutions. How to set health boundaries, how to compromise and accept others limitations and not take it personally. We learn to tolerate differences and know there is not always one way to do something. We learn we are not damaged and doomed to repeat the same mistakes. We discover our self-worth and self-esteem. We learn that we are loveable.

By Licia Ginne, MFT
www.psychotherapysantacruz.com
licia@psychotherapysantacruz.com

What is Addiction?

WARNING:
If you are taking medications, street drugs or alcohol and you want to stop using them you must first check with your medical doctor. It may not be safe for you to stop immediately.Addiction-Cycle

How can I tell if I have addiction problems?
By Licia Ginne, LMFT
www.psychotherapysantacruz.com

I met Rod Allison when we both worked at the Recovery Center of Monterey. I asked him once how he defined addiction as an “enslavement to habit”. A medical definition of addiction is a state where the body relies on a substance to maintain normal function and when removed will experience a physical withdrawal.

In more common usage addiction has come to mean and include psychological and physical dependence and abuse. It has come to include more then alcohol and drugs, but gambling, sexual activity, food and eating disorders, computer activity, relationships, and many other substances and processes.

Addiction is doing something over and over to the point where you have regrets (shame), or until it causes harm in your life. It’s a good chance it is addiction or abuse if your behavior includes any of the following: shame, remorse, denial, minimizing and / or secretive behavior. The problem drinker will claim to have had fewer drinks than actually consumed or claim not to have even been drinking. The drug abuser will downplay the amount or type of drugs taken. The gambler will lower the amount lost and increase the amount won. Shame is such a crucial part of the addictive pattern that you can assume the person is underestimating or overestimating their story.

After more than 30 years working in the mental health and recovery field I do tend to view addiction differently than I have in the past. I can’t explain why some people can have one drink and others one drink is never enough. I know there are many physical and psychological elements at work. What I have come to learn is that living with an addiction, abuse or without the use or abuse of substances or processes requires a change in how you view the world. How you view yourself in the world and how you conduct yourself in the world. For many people learning how to cope and relate starts when they are able to stop the addictive behavior and tolerate their own emotions. As I have stated many times on this website addiction has many components and needs to be addressed from a whole person perspective.

It is important to ask yourself does your indulgence affect your work, play, relationships, emotional or physical health?

Compulsivity is the behavior underlying addiction and we can become compulsive about most anything. In the early days of treatment this was referred to as cross-addiction. Current research on brain activity supports the theory of compulsivity as brain patterns are similar whether it is from cocaine use, alcohol or even eating disorders, it seems to be the pattern of any addiction in the brain. It is important when addressing addiction to consider the addictive nature and how it can move across the board from substances into processes and back again.

Substances can include:

  • Alcohol
  • Drugs: amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opiates (street drugs or prescription drugs)
  • Food

Processes can be:

  • Food; restrictive eating, compulsive eating, binging and purging.
  • Gambling
  • Internet use
  • Money & Finances
  • Sexual activity; anonymous sex, pornography, strip clubs, compulsive masturbation, multiple partners, prostitutes
  • Love addiction; infidelity, obsession with partner (stalking type behavior), relationship after relationship, being in love with love
  • Work
  • Exercise
  • Religion

Relationships can be:

  • Co-dependency
  • Co-sex addict
  • Traumatic bonding relationships
  • Love
  • Romance

What may start out as casual use or activity soon becomes compulsive and a demand. You tend to schedule your activities around the behavior or the planning for the behavior. Many report the preoccupation with planning is more stimulating and exciting than actually completing the event. You may become so preoccupied with your desire that it is hard to focus on anything else; you find your mind wandering back to the compulsive behavior. You attempt to control your behavior with rules; limiting use or abstaining without a support group.

Once you remove yourself from the self-defeating addiction pattern you can reassess your life and see what really needs to change; maybe you are lonely, insecure or feel you lack confidence and alcohol helps you feel confident and makes it easier to meet people. Addictions will always have a major downside; hangovers, health issues, financial problems,legal problems, loss of relationships, loss of employment or careers just to name a few.

If you are not certain if you have an addiction stop the behavior for 6 months (or even 3 months) and see how you feel, see if there is a difference in the quality of your life. If you cannot stop the alcohol, drugs, gambling or whatever your compulsive behavior than it’s a good guess it is at least a problem if not an addiction. People who don’t have issues with compulsivity can stop the behaviors for 6 months, they may have cravings at times but do not struggle with urges.

If you want to know more about your behaviors: contact me, contact an expert in addiction in your area, talk with a psychotherapist, M.D., social worker or psychologist who specializes in addiction or attend a 12-step meeting and see if you find people talking about situations and experiences that you have had.

12-step programs offer support and assistance for free or a small donation.

Support for Friends & Family Members

  • Al anon –support for family members and friends of problem drinkers.
  • Adult Children of Alcoholics (ACA) – support for those who grew up in alcoholic or dysfunctional homes.
  • Codependents Anonymous - 12-step program for women and men seeking support to learn how to have healthy relationships.

New Year, New Private Practice

psychoanalysisHappy New Year to everyone. It’s a New Year and soon it will be a new private practice. I gave myself a deadline of the new year before putting a lot of  focus on rebuilding a private practice. Here I am in a new town and realize how little I know about the world of psychotherapy in this area. I spent over 25 years building a private practice in Los Angeles and now need to start building here in Santa Cruz. I laugh to myself when I find a trail to follow and find out its not what I thought it was. Thinking I found a center of therapists that work from an attachment theory model only to find they are using the word literally to describe the service of helping people to make attachments in their world. So as with any business you need to find your market and need to know your resources. At least I have a community in Los Angeles that once practiced here or is practicing now, so I get leads and thoughts about the community. Every community is different in the same way that we as humans have different needs and wants. Forming relationships is about understanding the expectations, needs and wants of individuals. I may want to have a friendship with you where we meet weekly and it may turn out that you have more commitments than I do and can only offer me a monthly get together. It is up to me at that point to see if that works for me or how that fits in my world view. I might be disappointed but trying to get you to free up time and meet my needs won’t work in the long run nor is it fair to the other person. It’s the same with marketing my private practice I may want my practice to look a particular way but it doesn’t mean it will, I do have to understand the environment I am working in. It would be like living in the desert and wanting to grow orchids outside, they would not survive the desert environment. I can keep trying but the chances are high I will not succeed. Now if I want to build a greenhouse that regulates moisture and temperature, it increases my odds of successfully growing orchids. Yet this is a self contained environment and does not rely upon others. Growing a private practice I need to know the desires of the community and how they mesh with my ways of working.

From years of working and teaching marketing I do have a business and marketing plan from which I work. I remind myself it is a slow process and take one step at a time. I am now looking for office space to rent. So if anyone out there knows of any therapy space for rent I would be grateful for any referral. I also know that having a community is an important part of a private practice. I keep my community in Los Angeles and my membership in the Institute of Contemporary Psychoanalysis helps me connect with other local members as well as have a support system as I make this transition. For anyone interested many of the CE programs offered by ICP are done live online so you can learn about contemporary psychoanalysis and gain continuing education units all in the privacy of your own home.  I also look to local groups for membership and involvement to build on my community here in Santa Cruz. These are the first steps of my journey and if I don’t declare them it’s easy to let them slip by and it has always been my plan to have a small private practice. Another commitment is to bring this blog back to life and focus time on writing on it. So I will keep you posted as my journey takes form.
Warmly,
Licia Ginne, MFT
www.psychotherapysantacruz.com
licia@psychotherapysantacruz.com

Relationship Adjustment

As I said in my last post I did move for love and a change in my life. This relationship started as a long distance relationship and we certainly had our bumps in the road. This morning as we tried to get our cats to really meet for the first time it was an interesting experience (I know everyone keeps reminding me that anthropomorphizing the cat is not a good idea but I can’t help but see the similarities). Bob’s cat a 10 year old male seems laid catsback and interested but if nothing happens walks away to find something else of interest. My cat, a 3 year old female who has gone through several major adjustments, seems scared but also curious about this other cat. This morning I thought was a good time to see how they did without a door between them. Curious, circling and sniffing about, the female more cautious and frightened eventually ran for her hiding space. I know this is the beginning and adjustments need to be made. It is the same in my relationship, it was different when the option to return home was there but now we share this home. Like the cats our default is to circle around and see how the other might respond instead of making statements we have been making more comments like “what do you want”. We are almost recreating the academy award winner movie “Marty” staring Ernest Borgnine. As I tell most of my couples communication is key to a successful relationship and yes at times it makes me uncomfortable but I know in the long run it will strengthen our relationship.  Mornings drinking coffee and reading the paper seems to be a good time to have a brief chat unless it is a bigger issue which I try and save for the weekend. We are finding our way as we go from long distance to the same home and I try to keep these relationship rules in place:

  1. Communication – don’t let issues store up and I try to come from how I felt not what is wrong.
  2. Keeping to one topic at a time, it is easy to store stuff up and start to express every grip that you have. I want to empower my partner to feel like they are wanted and valued even though we have some disagreements and I can’t do that if I am reminding them of what I feel they are at fault about.
  3. Fault & Blame – looking for the solution will get you a lot farther then trying to find and identify fault and blame. Each person as a part of the problem they should be accountable for and it’s important that in any kind of relationship we take responsibility for our role. There are exceptions to this and sometimes we find ourselves in relationships with people that hurt us and our role is to find help for the relationship or to realize when it is time to get out.
  4. Finding the strengths in relationships. It is the nature of people that they will disappointment us all in some way, not with intent but just the nature of being human. I want to be able to respect the person I am in relationship with and when I look for the positives that I get they usually fall along the lines of their strengths which helps me understand and tolerate the disappointments and or hurts.
  5. Tolerance – the truth of it no one lives life how I think they should not even me. Practicing tolerance of those things that annoy us, understanding what can and cannot be changed (the serenity prayer that I heard in 12 step meetings always plays in the background when I think of this) and understanding we all have imperfections and it is that humanness that we actually love about one another.

These guides I teach to my clients and try to practice in my life and my relationships and let me highlight the key word here is practice, I don’t always succeed and that’s why we have apologies, though it takes a good sincere one to work.

Licia Ginne, MFT
licia@psychotherapysantacruz.com
www.PsychotherapySantaCruz.com
www.LATherapists.com
www.TherapyMarketingCoach.com

Moving Isn’t As Easy As I Thought – Emotional Aspects

by Licia Ginne, MFTmoving boxes

I have found that when you ask most people questions about moving the common reference is it’s hateful. I moved, have moved and am still in the process of moving. Not only have I moved myself out of Los Angeles but have closed a successful private practice of over 25 years to start up a new chapter in my life in Santa Cruz, CA. In other words my whole life has been turned upside down, it has certainly been my choice but I falsely (or desired) believed it could be more seamless. I thought I was prepared for the emotional aspects of moving but when I woke up last week and felt like I wanted to go home it was the first time I really realized this was harder than I thought. In my own anxiety I find comfort when my external world is in order and now to make such a big change and realize all doesn’t fly into order immediately. As I sit here at my desk, stacked high with papers, lost bills and of course a pile of things stuck together by the bottle of cough syrup that opened in my desk drawer during my move, I can only think of an episode of the Kardashian’s I watched of them moving from Miami back to Los Angeles.  Of course the example I use has become a baseline of expectation, which intellectually I know I can’t reach but emotionally I ask myself why not?  In the show they are returning to Los Angeles, they  offer direction to their assistants who seemed to be doing all the packing and I am assuming all the unpacking and the girls leave for the plane with a couple of suitcases. Now they certainly are in a different financial strata (would Kris Jenner manage my practice and practice development consultations?)  but the emotional pull is there to keep asking myself “why aren’t you done yet?” and sometimes an added criticism of you saw how easy it was for them.  The reality has been learning patience that all is not in order, that I must prioritize what area I need to focus on and there is a great sense of accomplishment when one area is done and to accept it will take much longer than I imagined. I hope I never have to move again but I realized that the move in my head was doomed from the start in Los Angeles when it seemed there wasn’t all that much to pack. As my time frame started to shorten my organization went out the window, certain boxes contained computer equipment as well as dishes and then I threw in a couple of personal items (my system failed at the end in Los Angeles and greatly affected my unpacking in Santa Cruz). I was frantic looking for the keyboard to my desktop which has always been the center of my work world. There are still a couple of files missing that I just can’t figure out what happened. I will keep looking and know it has to be somewhere since when I walked through my empty home in Los Angeles there was nothing left (well that’s not completely true I forgot about the deli drawer in the refrigerator where I keep batteries and ink cartridges), the fridge wasn’t mine and my neighbor was kind enough to go in and get them for me and they are waiting for me in Los Angeles.

I don’t want to leave you with the thought that I am not excited about the move, I have made this move before, I moved to Santa Cruz to attend UCSC as an undergraduate and stayed here for a couple of years after graduating. I moved back to Los Angeles and later on found an opportunity to moved back to Monterey, CA trying to find myself as a therapist and person in life. I ended up moving back to Los Angeles where I stayed for the last 25+ years, developing my private practice, developing my skills as a therapist and business owner, returning to school to become a psychoanalyst and finding self love. When most people ask about my move they say you moved for love, which is partially true I also moved to find a different life for myself outside of work. I will keep you posted as settle in and keep growing.

Relationships Come with Disappointments

I have been seeing couples in therapy for over 25 years and it seems to me we all come to a relationship believing it will be like the ones we see on TV or in the movies. Usually the story line goes something like couple meet, maybe have some problems but then live happily ever after. As I write this I can think of other movies that show the exact opposite but often even those are over the top, what keeps coming to mind is Jennifer Aniston and Vince Vaughn in the “The Break-up”. I know it sounds silly to base our relationships on tv or movies but we do. I always thought once you met someone, fell in love it would all be great. I didn’t think about how do we make decisions. I always ask couples how do you make decisions? This relationship is suppose to meet your needs. So I ask couples to independently start writing what is their ideal relationship or marriage. Then they can come back in and we can start to understand the expectations that everyone brings to any kind of relationship.
stk23562sisWhat is always most startling is I think most of go into a relationship with the idea that our ideas are universal. I think we often get surprised and how our partner can have a different world view. I believe that couples therapy is an opportunity for couples to share the views they have and to try to understand the history that went into not only their partners view but theirs as well. We may think we are fighting about who took out the trash or how much one does or doesn’t help around the house. We are really fighting about different understandings or our emotional reactions to uncertainty. The goal is about being able to understand our partner, to understand that maybe when they are angry they are scared and lash out. The goal is for each person to work to understand themselves and be able to express their real fear, anger or anxiety and not lash out. We will never resolve all problems but we can learn tolerance and understanding.

by Licia Ginne, LMFT 21421
www.psychotherapysantacruz.com
www.LATherapists.com