The Opioid Epidemic: What can you do to help your clients?

No longer can we look the other way and assume that these deaths are confined to a certain type, class, race, or gender of person. Fifty-two people die from overdose every single day. This cause of death now outranks motor vehicle accident deaths.

Know what you can do to help your clients…

Every year in May, the U.S. Department of Health and Human Services celebrates National Women’s Health Week. It may seem like a warm and fuzzy time for us to celebrate the great strides we’ve made in protecting women’s health…

But it’s not.

This year’s commemorative week came on the heels of some staggering news about women’s health. For the first time in many years, the Centers for Disease Control and Prevention (CDC) is documenting a drop in life expectancy for white women.

One of the reasons blamed for this is the stark reality of overdose deaths. Many of these deaths are unintentional overdoses of opioids and heroin. The CDC is calling the issue of opioid misuse and death an “epidemic” and is pushing for substantive change. New guidelines for prescribing these medications are being developed. There’s a heightened awareness of the need for behavioral treatment of pain.

No longer can we look the other way and assume that these deaths are confined to a certain type, class, race, or gender of person. This is hitting all types of people, women included.

Fifty-two people die from overdose every single day. This cause of death now outranks motor vehicle accident deaths.

Often the problem starts innocently enough. Maybe a woman has chronic pain, perhaps she has acute pain. Her doctor or dentist prescribes on opioid (Percocet, Oxycontin, hydrocodone, Vicodin, etc.), and within a very short time the problems can begin.

Changes in her brain structure and chemistry are happening, and of course she doesn’t know it. If she has any underlying depression or anxiety, the pills give her an instant boost. If she tries to stop the pills on her own she may feel miserable and desperate.

…And so the problem continues.

We aren’t talking about an addict on the streets with a needle in her arm. We’re talking about your mother, your daughter, your sister, your friend. It’s really up to us to reverse the devastating impact of this problem.

You’ll be hearing a lot more about this in the weeks and months to come. Educate yourself about how you can help. Good resources include the National Safety Council, the CDC, and the Office of National Drug Control Policy. Many communities are taking matters into their own hands and agitating for change.

In honor of the women in our lives, let’s step up and take action to protect those we love from the impact of opioid misuse and overdose.

Before it’s too late.

What can you do to help your clients?

Know the signs of Opioid Use Disorder as defined by the DSM-5®.

Opioid Use Disorder – A Problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

1. Opioids are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance
11. Withdrawal

Use the one-question screening from the new CDC guidelines on the treatment of chronic pain: “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”

The answer of one or more is positive. It is 100% sensitive and 73.5% specific. You won’t miss anyone who has the disorder, but there could be a few false positives where further investigation is needed.

Learn more:

This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. Martha trains across the U.S. and internationally on such topics as compassion fatigue, DSM-5, and the treatment of trauma. A prolific writer, she has published over 175 articles in newspapers and magazines, and is the coauthor of Overcoming Compassion Fatigue: A Practical Resilience Workbook.


What’s in a Brand? Learning What Campbell’s Soup and Dr. Phil Already Know

For therapists, traditional ways of getting the word out—a discrete ad here, a few hints to colleagues there, even a fancy website—just won’t cut it anymore. In a sound-bite-saturated world of information overload, having a brand that stands out is the only way to attract potential clients.

The following was written by Joe Bavonese, PhD.

Some therapists might recoil in horror at the thought of “branding” their practices. We are, after all, healers and mental health professionals, not hawkers of cosmetics and cornflakes. Indeed, to many of us, the thought of promoting ourselves and our practice seems crass, undignified, and, perhaps, a tad narcissistic. But we can no longer deny: the traditional way of getting the word out—a discrete ad here, a few hints to colleagues there, some folders or business cards sprinkled around town, even a website with your impressive credentials listed in chronological order—won’t remotely cut it.

In a sound-bite-saturated world of massive information overload, frenetic tweeting, continual advertising, and endemic cultural attention deficit disorder, having a brand that stands out is probably the only way you’ll have a chance of capturing the attention of potential clients.

Before we throw our hands up, let’s take a breath and consider what branding really means.

A brand is a marker, often personal, of the specific identity and special attributes that propels something—a product, person, service, organization—out of the vague, undifferentiated backdrop of “somethings” and “somebodies.” Your brand individuates you, conveys a meaning, tells a story, and elicits strong feelings.

You may be surprised to learn that you probably already have a brand; as a therapist, your brand is your invisible identity, based on how people in your community see your business. Your brand may be neutral, positive, or negative.

While that may sound straightforward enough, it took a long time and an impressive number of mistakes for me to understand that I needed a brand, then to figure out what my brand was, and how to hone it, sharpen it, and promote it to the public.

The Naive Beginnings

In 1992, I was the clinical director of an outpatient mental health and substance abuse clinic, supervising 15 therapists, seeing about 25 clients a week myself, and already looking for an escape. While keeping my day job, I found two therapist friends to share a tiny office and start a small practice on the side.

Initially, I didn’t have to do anything to promote my practice: colleagues from my day job sent me referrals. Soon, I was seeing 10 to 12 people a week, in addition to spending my regular 50+ hours per week at the clinic. But that’s when I hit my first snag: I had no free time. I wasn’t sleeping enough. Conflicts with my wife increased. I got no exercise and, worse, began eating fast food regularly.

Realizing this pattern wasn’t sustainable, I dreamed of quitting my day job and doing private practice full time. How hard could it be? If I were in private practice, I thought, I’d have more hours for all those new clients I felt confident would flow my way.

I decided, quite arbitrarily, that getting to 15 clients a week would somehow prove beyond a shadow of a doubt that I could succeed in private practice. Assured of my future as a private practitioner, I’d then confidently quit my job. And it actually came to pass: I finally managed to squeeze in 15 clients two weeks in a row, and I gave my notice.

Within three weeks, however, I’d gone from triumph to terror. I had hours and hours of open time slots to fill, but was unable to get more than 20 clients a week consistently. Without the daily contact with therapists at my old clinic, referrals slowed down substantially, and I had absolutely no idea how to promote my practice.

Eventually, my wife, an MSW, joined my practice. We both loved working to help people find more intimacy in their lives, and we’d always gotten great feedback on our work. To make sure we were concentrating on what potential clients needed in this area, we organized a series of focus groups. We contacted the directors of four local singles’ groups and found two couples’ meetings through a church and a synagogue near our office. We provided dinner for these groups, and asked them what types of services they and their friends might want. We asked questions, took copious notes, and got feedback on different workshop ideas and business names.

Without realizing it, we were taking the steps necessary to create a distinctive and viable brand.

Based on the focus group feedback, we started a drop-in support group for singles, an eight-week psychoeducational workshop for singles called Creating Lifelong Loving Relationships, and two workshops for couples. Also, we offered individual, couples, and group therapy. We chose the name Relationship Institute, with the tagline “Teaching the world to love.” This name emphasized the learning aspect of our approach, and conveyed the idea that singles who were alone and couples who were unhappy were not that way because of intrapsychic deficits, but because they’d never been taught the essential skills for healthy relationships.

We hired a graphic designer to create a logo and a professional brochure that told our story about how we’d spent a great deal of time in individual and couples therapy ourselves, learning how to have a more fulfilling relationship. It stated that we could now help others learn to do the same, but much more rapidly and inexpensively.

As therapists, we had all the elements of a successful brand: a unique visual image, a unique business name, and an emotionally engaging personal story to tie it all together. I was soon seeing about 22 clients a week in addition to running two groups and leading bimonthly workshops. Hey, I thought, maybe this isn’t so hard after all.

Necessity Is the Mother of Invention

We had our first child in 1995, and our second pregnancy the following year resulted in the birth of twins. I panicked as the carefully constructed financial spreadsheet I’d created unraveled before my eyes. My only thought was that I needed more clients – a lot more clients. At this point, I learned that having a good brand was necessary but not sufficient on its own for a successful practice.

In desperation, I searched nationwide for help and discovered a small business-marketing guru named Jay Abraham in Los Angeles. I reluctantly signed up; too embarrassed to tell anyone but my wife that I was paying for something 10 times more expensive than any clinical workshop I’d ever taken.

Soon I was sitting in a large, noisy conference room with 425 people at a hotel. The workshop, a sort of crash course in Small Business Marketing 101, created a sea change in my attitude and mindset. I discovered that I was a small business owner, not just a psychologist, and that I had to work on my business, not just be in it. The workshop led to a powerful call to action when Jay took the branding concept deeper by introducing the idea of a unique service proposition (USP), which encapsulates what problem in the world your product or service addresses and what its specific benefits are.

Jay also taught us the concept of the Lifetime Value of a Referral – every new client, on average, brings in a specific amount of money (your fee times your average number of sessions before termination, which for most therapists is more than $1,200). If you spend half of this amount to get a new client, you’ll get a 100 percent return on your investment. Really? I thought. Spend $600 to get one new client? That’s insane. But the numbers didn’t lie.

Difficult as it was to grasp at first, I found myself increasingly guided by the Lifetime Value of a Referral concept, and began placing expensive display ads – $300 to $500 – in various print publications. The ads used my USP-enhanced brand, along with the four-part advertising formula Jay outlined:

  • Start with specific problem statements in the language of potential clients
  • Follow with the benefits they’ll receive after a successful experience working with you
  • Add unique features of your training or how you work
  • End with a way to contact you.

I wrote articles for local publications, started a public-relations campaign targeting local media, and began tracking my referrals, income, and expenses with extreme precision. Within six months, my caseload was consistently averaging 35 clients a week, and we had plenty of money to support our growing family.

I thought I was doing great. Then my accountant mentioned two things: college education for the kids, and retirement for me and my wife.

Expanding the Brand

I began thinking of ways to generate multiple units of income per unit of time. One of my business coaches repeatedly said to me, “Therapy doesn’t scale,” meaning you always have to provide one office, one therapist, and one client to make one chunk of money. But scalable services can multiply the results of your work. You do the work once and your income multiplies from that point on, as with books, large group workshops, or DVDs.

After reviewing various options, I decided that hiring therapists to work under our brand was the smartest choice. The idea was that I’d generate referrals for the therapists and get a percentage of the fees collected. My income would rise as more clients were seen by more of my contracted therapists.

I’d embarked on a path I’d never have imagined traveling, but everything seemed in place. Thanks to my successful brand and Jay Abraham’s ideas, there were plenty of referrals for everyone. The problem was that since I had no idea how to run a business with staff, at first, I kept messing up.

I hired the wrong people—too young, too inexperienced, too controlling—or I paid them too much. I also wanted them to like me too much, which led me to overlook clinical shortcomings or unresolved personality issues. I didn’t know how to fire people who weren’t performing, and I wanted to do everything myself, which resulted in even more hours at the job and less profit than before.

After several years, however, I began to see the light. I kept studying business and management principles, hired office staff, delegated tasks, learned how to create systems to run the practice more efficiently. Soon my monthly passive income began to grow steadily.

As technology evolved, I took several advanced trainings in Internet marketing and discovered the profound opportunity that the Internet presented to savvy marketers. Instead of me reaching out to potential clients, they were now searching for people like me. It was a startling 180-degree shift. All I had to do was create an online presence optimized for local search, making sure that when someone Googled “marriage counselor” in any of the three cities we had offices in, our website would show up on the first page.

Using this online strategy, I doubled our practice in five years. Currently, at least 70 percent of our monthly referrals come from online sources. Our brand is firmly established in both the local and online worlds.

Creating Your Brand

While branding is central to business success, the best brands are an authentic expression of who you are as a human being. Don’t choose a brand simply because you think there’s a large pool of potential clients out there with a specific issue.

Ask yourself: What do you want people to feel and think about when they hear your practice name or think of working with you? What are you doing to create that in your clients’ minds?

In today’s world, technology makes it to share your brand with thousands of people are a negligible cost. Unfortunately, too many therapists still tend to be uncomfortable around technology – which limits their ability to connect with a vast Internet-based audience of potential clients. But there’s a simple solution: if you aren’t comfortable using technology yourself, hire someone who is.

A website costs less to maintain than the phone in your office, and high-definition video can be created, edited, and uploaded to the web for free using just a smartphone. You can tell your story in your own voice while looking directly at potential clients who are seeking the exact help that you provide.

As therapists, many of us still carry around the idea that our profile in the world is supposed to be discreet and modest. But that old attitude has become a crippling handicap. These days, our brand needs to be highly visible and energizing, offering an authentic picture of who we are and what we can do for people who need our services. It’s an essential form of communication that helps us attract the people whose lives will benefit from contact with us. And the more people we connect with, the greater the good we can do in the world.

Joe Bavonese, PhD, is the director of the Relationship Institute in Michigan and the codirector of Uncommon Practices, a service that helps psychotherapists create their ideal practice.


This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

The full article, “What’s in a Brand?” written by Joe Bavonese, appeared in the Sep/Oct 2013 issue of Psychotherapy Networker magazine.

Are you ready to start a group practice?

You’re a successful therapist, and it’s taken years to build up your practice to this point. But what now? There’s only one of you and only so many hours in a day to see clients. If you have the enviable problem of too many clients, adopting a group-practice model could be a good career move.

In today’s business of therapy, clinicians must approach their work as equal parts therapist, salesperson, and manager. Creating a group practice not only helps you delegate office work such as marketing and administrative work, but it also creates a relatively passive income stream.

Switching from having a solo practice to running a group practice is a major transition. It can be a sustainable strategy to generate referrals, market your practice and increase revenue & reimbursement, but be prepared to ask yourself some serious and practical questions.

Do you have enough office space to support a growing practice?

Generally, you need at least five hours a week of unused office space to start a group practice. Maybe it’s time you aren’t in the office, or would rather not be in the office (such as nights and weekends). Before you upgrade your space, make sure you have the cash flow to support the extra expenses.

Can you be an effective boss and delegate tasks with authority and confidence?

For a group practice to run smoothly, you need to create, test, and revise clear systems for every aspect of the business. This includes clearly outlined policies on dress code, handling money, processing session information, assessing staff performance, handling phone and email inquiries, and assigning new clients to clinical staff. Don’t forget about the new logistical responsibilities you will need to manage, such as tracking referral sources, creating monthly reports on individual and group performance, calculating profit-and-loss statements, and doing payroll.

Getting comfortable determining what tasks can be performed by others and delegating these tasks will help you share the office responsibilities with new staff and save you from being overwhelmed with clerical work.

Are you ready to let go of a certain amount of control when it comes to dealing with clients?

When bringing in new staff you also bring in new personalities. If you heard someone speak to a potential client in a tone different from yours, how would you react?

Are you comfortable hiring and firing employees?

Hiring staff is a lot like dating. A lot of people look good on paper, but you never know how compatible you are until you spend time with them. A therapist that comes highly recommended may also come with an approach that doesn’t mesh with your current therapy culture, or they may underperform. And yes, those who underperform may have to be fired. It’s important to be decisive when it comes to making your goals and expectations clear, even it if means people may not always like you.

If you’ve answered yes to the questions above, it might be time to transition to a group practice. Remember, speed bumps and potholes along the way are normal, and there’s a learning curve here! Bringing a positive long-term attitude will be necessary for success.

Would you consider starting a group practice?
Tell us why or why not in the comments below.


This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

Click to read the full article, “The Challenge of Becoming the Boss: How to Make a Group Practice Work,” written by Joe Bavonese and Casey Truffo.

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