2. Common Practice Mistakes

How do LPC Associates even use their credential? Can you counsel across state lines? Why is so hard to say goodbye to our 'regulars?' Our practice is what we make of it, that’s why it’s vital to have a conscious approach in everything we do. My inbox has been full of questions relating to LPC Associates in private practice and folks struggling with clients who move away (or move on). You want to help as many people as possible, but you also don't want to break any laws while your doing it. In this episode, we talk about the LPC Associate credential and how to officially and correctly present that. We also discuss specifics like the problem with trying to maintain a client census as a KPI, or trying to hang on to regular clients. Many counselors struggle with paperwork too because they don’t have great information. So we get into a fair late cancel/no show policy today as well. 
Show notes and more at katewalkertraining.com.

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Transcript

Today’s training or coaching is all about common practice mistakes. I’m going to try to do this the last Thursday of every month because it’s based on the information I get from my “inbox.” I put that in air quotes because it’s actually I stalk other threads. I go on social media, Instagram feeds, all of the things, and I try to see the hot topics right now. And the struggles folks may be facing or the challenges and how they work it out. And there are ways to work out these things, folks. 

 Now, what I’m going to give you is my opinion based in law. If I don’t have the answer to something, by golly, I will find it because I have a huge network of people that I can ask and I know what I don’t know.

 So today we’re going to talk about three common practice mistakes. And I love the Step It Up membership because it’s so varied; we have supervisors, we have grad students. 

 Let me go ahead and talk about all three. We’re going to talk about the LPC Associate credential, how to officially and correctly present that. We’re going to talk about the problem with trying to maintain a census, or trying to hang on to regular clients. And then we’re going to talk about the problem with not have a fair late cancel/no show policy. So you’re going to get the information about that. 

I’m going to frontload this by saying as a Step It Up member, you have a coupon right now to the Badass Basics course. It’s starting September 1st. I love Step It Up, I love the fact that I can give you so much information, but September 1st I’m starting a six-week deep dive into private practice. It will also have weekly coaching calls with me, but it’s very, very structured. The link is in the Start Here profile in your Kate Walker Training profile. But I’ll try to post the link here because Step It Up members, you get to keep the discount for the entire month of August. Everyone else got it for about 24 hours, you get it for the whole month. Enrollment closes midnight September 1st, sharp, and then you have to wait until next year to try to join it again.

Alright, LPC Associates. Let’s talk about that. First, there is no such thing as an LPC-A. Zero. Zip. Nada. There is no such thing as an LPC-A credential. How do I know this? Because if you look in our rules, you will see a section called “definitions.” In the definitions, there is no definition for the LPC-A, only LPC Associate. And that happens, right? So, in definitions, it’s not like they define bird or airplane and therefore we can’t use those terms. But BHEC goes one step further, and LPC goes one step further, by stating overtly, “You may not use the LPC-A credential. You must say LPC Associate.” Now, I get it, and I’m talking to supervisors right now who might be freaking out because they have an LPC Associate walking around in a hospital that says LPC-A. There are things out of our control. And in our code of ethics, in the LPC code, it does state where you’re able to correct it, do your best. When others make a representation of you that isn’t quite correct, like if I want to Google myself, I could probably find a directory somewhere where I’m listed as an MD, a medical doctor. But in order to correct that, it’s going to cost me $50, and I’m not going to do that. I’m not going to go everywhere on the inter-webs and try to see where my credential is incorrect just so I can pay somebody $50 to correct that. 

So supervisors, if you know you have an LPC Associate walking around right now with a badge that says LPC-A, take a deep breath. Tell your associate to do their best, to see if they can get a longer badge, and if it doesn’t work out, it doesn’t work out. Same thing if I’m talking to a LPC Associate who is freaking out right now because their credential is misrepresented somehow in their agency. Do your due diligence, document that you did your due diligence. 

I’ll give you an extreme case. There was a complaint brought against a Level 3 LPC Associate. So this was somebody who was just hours away from upgrading. This was back when they could not own their own private practice, and so the practice they were joining had misrepresented them on the website by calling them LPC when they were actually still an LPC Associate. A complaint was filed, and of course those wheels grind slowly, so two years later, this LPC Associate shows up with her supervisor, she’s now an LPC, and she explains to the board the steps that she took to correct the information. The board said, yeah, you did everything you were supposed to, next. No bill. Gone. No problem. Now, I know it’s years off of your life when it comes to the stress of having a complaint, but you must do your due diligence the best that you can to correct that credential, document that you did, and then go forth and do good work, knowing that you did the very best that you could. And that’s, of course, part of your decision making model, which everyone should have, whether you’re a grad student, an associate, an LPC, or a supervisor; have a process that you use when you’re making these decisions.

Now Part A, if that was Part A, this is 1B. This “supervised by,” if you’re an LPC Associate and you’re wondering if you should put “supervised by” after your name, the answer is probably yes, you should, unless you’re just writing it on a notepad like we used to do in the sixth grade when we’d try out our boyfriend’s last name. Oh, I’m sorry, am I the only one who did that? 

So, whenever you are writing your name, Kate Walker, LPC Associate, Supervised by Jane Doe. It could be your email signature; it could be in your podcast episode. It could be if you’re a guest on someone else’s podcast and they’re introducing you. Why? Because this is not happening in a vacuum. It’s happening in a space where someone else is going to read it, listen to it, watch it. That person receiving, we’ll call them the public, and the rules are designed to protect the public. And so anytime we present ourselves, represent ourselves, sign our names so that the public will digest it, that’s called advertising. That’s called marketing. And so you must, LPC Associates and supervisors, make sure that you’re putting “supervised by” whenever you represent yourself in public, whether it’s a single email to a single person or a podcast episode to a million subscribers, alright? The mistake there is thinking the exception is…

I try to make things really clear when I teach and I try to base it on the very, very foundation. What are we trying to do here? And this is pretty clear to me, we’re trying to protect the public from thinking that you’re something that you’re not. We call that misrepresentation. So it would be as if I’m saying, Kate Walker, PhD. Oh, you’re a psychologist. Nope, I’m a counselor educator. So Kate Walker, PhD, LPC, LMFT, MNOP, right? We’ve got all of those letters, but the public doesn’t know what that is, so we’re constantly having to clarify who we are, what we are, and the scope of our practice. So that was mistake number one. That was a long one: the LPC Associate credential.

Alright, mistake number two. This is one I might get a little bit of pushback on, so let me present the caveat here. When we talk about keeping long-term clients, I recognize that there are some diagnoses that must be treated weekly, regularly, just that’s the nature of it. I’m a strong Al-Anon believer, I’m a strong believer in support, in a strong mental health network. So let’s put that piece aside, just for a second. Let’s recognize that that is the case sometimes. 

Now, if you have a caseload, or grad students or new associates, if you’re building a caseload based on regulars, now you’re sounding like a bartender, right? These are my five o’clock regulars. I know who they are, I know their names, I know their problems. No, we don’t do that, right? Because number one, maintaining a census as a business model fosters a dependency. And that’s unethical. And it’s weird how it happens. You’ve got to check your countertransference, you’ve got to really consult to see if that’s the case. Remember, I recognize that there are things that must be treated weekly and regularly. But sometimes you’ve got to look inward and say, am I just really afraid of this person leaving because I won’t be able to pay my car note? And I literally, in a complaints hearing, back when they were open in the day, heard someone say, I don’t understand why this person is filing a complaint against me; they’re one of my regulars. Heck, they’re my car payment.

Alright, so looking at your client load as a thing you can count on, basing your business on this census cash flow, on these 20 regulars every week, and then getting surprised when they don’t show up, or getting caught off guard when they quit or terminate, that’s dangerous. It’s dangerous for a cash-based practice, dangerous for an insurance practice, dangerous ethically. There are a lot of problems that come into play when you count on regulars. No medical profession does that, right? Since we are a medical model most of the time. 

So think about your cancer doctor, right? He’s not hoping that these people are regulars. They’re wanting them to get better and get on their way. Of course, there is the case of a chronic condition or a terminal condition and they will treat that person or persons. But they’re not going to build their whole caseload hoping for regulars. So I hope that makes sense. And feel free to post comments down here if you’re feeling uncomfortable with that. 

And of course, if you watched my workshop last night, if you were able to attend it, I talked about that as far as building a cash-based practice. We talk about intakes, having an excellent ten-minute consultation, the way to have a marketing strategy where you’ve got a constant flow of phone calls and people that you’re interacting with, positioning yourself as an expert. So I’m not going to talk a lot about that because as a Step It Up member, you’re going to get that replay in your profile as soon as I get that to the transcriptionist and get it uploaded. When you see that, go into your Start Here course, click there and have a look. It’s called Building Your Cash-Based Business.

So the number three problem: not having a fair late cancel/no show policy. So a late cancel/no show policy is there to inform your client but to protect you. Most of us, especially in our own practice, we don’t have the cash flow to absorb late cancels and no shows. I mean, you can imagine working in a hospital, right? Someone doesn’t show up to their appointment, well, you’re still going to make your $50,000 a year because you’re a salaried employee; you’re getting paid whether the patients show up or not. In a small practice, it’s not like that. Somebody doesn’t show, you can’t fill that spot in less than 24 hours usually. I mean, occasionally – I use an online scheduling system, so when somebody cancels, I will see, oh good, I filled that. It popped up really quickly, I didn’t realize someone was looking for an opening. But that’s pretty rare.

So in order to deter that – you’re trying to make that something that is not desirable for your client, that they’re going to think twice about, you need to make sure that number one, you have one, and number two, that it is fair. So one of the questions that was brought up last night in the workshop was okay, what about that first session? Would you ever take a fee for a no show at a first session? So short answer, I would not. And here’s why. Even though legally, especially with all of the online forms that we have, jot forms, the electronic medical records, where you’re able to get a HIPAA-compliant company like DocuSign to get that potential client’s signature and have them sign on the dotted line that they understand your policy and they understand that if they don’t show up, they’re going to be charged the full fee, there’s no relationship there. A ten-minute consultation doesn’t create a relationship. So when you do that, when you take their money, and say, well, you signed the fine print, two things can happen, and I bet you can guess, right? Number one, a complaint, I don’t think there’s a leg to stand on, but there’s two years of your life stressed out. And two, they can easily dispute it with their credit card company. And yes, you can submit all of the documentation that they signed, but now you’re messing with HIPAA. Now you’re releasing information because you’re trying to get your money. You’re not defending yourself in a lawsuit, you’re submitting information that is protected by HIPAA. It gets really sticky really quickly. So I don’t recommend taking a fee for a no show on the first session. Instead, I encourage folks to build a relationship. An emotional connection is your best insurance against a no show at the first session. 

So a fair late cancel/no show policy is going to simply state – and this is what I think is fair – anything less than 24 hours will be charged at the rate that your session costs. None of this $50, $60 thing unless your session is $50 or $60. The full rate. And those of you that take insurance, that is not the rate that insurance pays you. This is the rate you would charge if the client was not using their insurance. And you make sure that you’re able to charge their credit card. Now, we’re not going to get into the type of software that you can have that allows you to do that. But again, you want to make sure that you have software where you can capture their credit card information, which means the software has to be HIPAA-compliant and sign a business associate agreement.

So a fair late cancel/no show policy, let’s talk about that. Fair to the client, or potential client, means they can read it, they understand it before they sign it. And you tell them – it’s important that you let them know verbally. It’s kind of like that feeling you get when you leave the used car place and you bought the used car and then you get home and it falls apart, and they say, well, you didn’t read the fine print. You should have known. That doesn’t make you feel warm and fuzzy inside, that makes you feel taken advantage of. So a fair late cancel/no show policy isn’t just what you put in writing, it’s telling the client, oh, by the way, I need to remind you that my late cancel/no show policy is…if you don’t show up or if you cancel with less than 24-hour notice, I will charge you the full amount on your credit card.

Now, I did see in some threads that people are worried that folks just show up and they’re mad at you. Okay, well, I don’t know. I mean, for me, I think that’s happened once in 20 years, and that’s back when I used to take those phone calls. I don’t do that anymore; I have a system that takes care of that for me. Remember, we talk about that a lot in the Step It Up membership, we talk about it a lot in the courses that I teach. Your systems must be scalable. So I don’t talk to folks when they late cancel or no show, but my system can send an email that says: so sorry that you had to miss your appointment, just know that we’re charging your credit card for the full amount. We look forward to seeing you at your next appointment. I explained it to them verbally, they got the information in writing, and – here’s the most important part that I think a lot of us struggle with: I follow through with it. If I start doing this yeah, but that’s a good reason, oh, but that’s a good reason, now I’m playing favorites and that’s not fair. How am I basing the decision to allow Joe over here to get away with it, but not Connie over here? Because she’s – and well Johnny is this. Now, the countertransference is running my business. That’s not allowed. I have to be a good business person, but first and foremost, I have to be a clinician and recognize when my bias is showing. 

So a fair late cancel/no show policy, it starts with the writing, it starts with the intake, you verbally explaining, but it absolutely includes your ability to maintain a boundary and follow through consistently. So if that’s something you struggle with, your clients are going to be confused. And don’t even get me started – if your clients are buddies outside of session and they’re like, she never charges me, well share charges me every single time! We’re not even going to go there.