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Friday 25 May 2012

Private Practice: Task Balancing

The Friday series based on my book Private Practice Made Simple (available from and continues. We're in the home stretch of this PsychologySalon series, though the book covers many more topics.

In the chapter on burnout - or, more specifically, avoiding burnout - I recommend that once a year every private practitioner should sit down and think about his or her task balance.

Private practice sounds simple enough: you set up an office and start seeing clients. But in fact private practice can mean any of dozens of activities. And even if we just consider seeing clients, there is the question of which clients, to what purpose, referred by whom, and facing which difficulties.

Over time, a practice can drift based on the people who get referred to you and the opportunities that arise. This is a good thing. It means that the business is responsive to the environment - it is finding its niche, like an animal in an ecosystem.

But you got into private work for a reason, remember? It wasn't just about making money, or seeing the most clients you possibly can. Most people start their practice with some idea of what they want to accomplish, or the populations they wish to serve, or the activities that they actually enjoy doing.

A colleague of mine at the hospital I used to work at had a one-day private practice emphasizing medicolegal evaluations. He was fond of pointing out that he made more in that one day than in the four days he spent at the hospital. His claim has been reinforced by others I know. In a sense, this area of practice sounds like a goldmine.

But I don't want to do it. It doesn't interest me, I dislike the oppositional relationship that often develops in these encounters, and providing data points for the legal system to battle over doesn't seem that interesting or fulfilling to me. So although it might well be a good source of revenue, I've chosen not to pursue it. It isn't a part of my task balance.

You Can Have Too Much of Anything
Mmm, chocolate pie. Daily. Hourly. For months.

Think of your all-time favourite food.

Now imagine eating that every day for breakfast, lunch, and dinner.  You can have as much as you want, and you can't eat anything else.

How long will it be before you can't stand it?

If you're in private practice, you probably got into it with a particular idea in mind. You love treating OCD, or helping gay men with the coming out process, or doing CBT for trichotillomania, or doing organizational consulting for nonprofits.

Great. But if all you do is that one thing, your work will soon go stale. You'll become bored, your therapy will become a kind of cookie-cutter factory process, and your clients will suffer. You'll be on the road to burnout.

Like all professionals, you need some kind of balance between the different activities you do. That balance will not remain ideal all by itself, and even if it did, your ideal will shift as you go through your career.

So once a year, it's a good idea to sit down and think about all of the professional activities that you do, and the ones you'd like to do, and decide how to recalibrate your work. Wouldn't it be good to do this on paper, preferably with a structured form in front of you?

A Structured Form

Surprise: Here's the form.

The first category of task is individual psychotherapy. If you don't do this, skip to the next section. If you do, consider breaking this down by population. "Somatoform disorders" for example.

To the right of each item, there are four columns:

  1. Estimate the amount of time you currently spend on this activity in your practice. You can use a percentage of your time, or the number of hours you spend, or any other method that works for you.
  2. Rate the satisfaction that you experience doing this kind of work, using a 0-100 scale.
  3. Estimate the revenue that this activity produces per hour. Although it isn't all about the money, you still have to pay the clinic's lease and you can't spend all of your time on tasks that don't earn any revenue.
  4. Estimate the amount of time you would like to spend on this activity if it was possible to do so. Don't worry too much about the practicality of this. You're investigating your wishes, while fully understanding that not all of them might come true.
  5. If you wish, add another column in the margin that may have significance for you. "Amount this is needed by the community." "How effective I am at this type of work." "Ease of getting more of this work." Anything.
Then do the same ratings for the other main populations you see for individual psychotherapy.

And then continue the process for other private practice activities:
  • Assessment-only. If you see some populations only to come up with an assessment, rate each type you deal with.
  • Group therapy.
  • College or university teaching.
  • Night school / public education. If you offer communication skills classes at the local community centre, write this down - even if you do it for free.
  • Consultation with practicum or internship students.
  • Supervision or consultation with registration candidates in your profession.
  • Consultation for fellow professionals.
  • Organization consulting.
  • Government-related consulting.
  • Committees and boards.
  • Workshop teaching. Break this down by the topic of the workshop, if you have several you teach.
  • Academic writing.
  • Nonacademic writing for the profession. Perhaps your monthly column for the local professional newsletter.
  • Writing for the public.
  • Nonrelated writing. Perhaps you moonlight as a mystery writer.
  • And...all other professional activities, paid or not, satisfying or not.
Once you've finished, you should have a sense of whether or not your practice is currently on track. Maybe you're doing pretty much exactly what you would like. Or perhaps the abundance of depressed clients means that that's all you see any more, and that your passion for writing has been sidelined for too long.

If there are big differences between your current practice and your ideal practice, you can then take the task further and see if there is anything you can do to bring your work closer into line with your vision.

As mentioned above, I suggest doing this once a year. It's a good strategy for reminding yourself why you are in private practice and helping you see where you need to steer the boat.

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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple, available at bookstores and through Amazon here.

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