Have you ever wondered what your therapist does when they aren’t in session with you? Here’s a quick (and general) rundown…
- Open office and get set up.
- Check emails, respond if you have time, or “flag” the emails you need to respond to before you leave.
- Check client portal and make any necessary follow up.
- Check schedule and prepare any documents/activities/etc. that may be needed for the scheduled sessions for the day.
- Coffee!
- Sessions (depending on the day and caseload, average of 6+ sessions per day).
- Session Notes (15-minutes per session at minimum), Intake Notes (30-minutes or more), Contact Notes (for every “not a therapy session” interaction with a client or client’s collateral contacts), Miscellaneous Notes (for staffing), and any other required documentation.
- Complete any other letters or other documentation that we’ve agreed to complete for clients.
- Complete records requests (each records request takes a minimum of 3-hours).
- Treatment planning (preparation).
- Answer phones and return calls.
- Screen new clients (takes at least 15-minutes per screening), create new client charts, and explain Client Portal and paperwork, etc. (takes 5-10 additional minutes).
- Find appropriate referral/resource information if needed (this can take 30-minutes to several hours, even days depending on how quickly other providers get back to you).
- Lunch break!
- Check the mail.
- Process payments as needed.
- Respond to referral sources and other contacts as needed.
- Social media – these days it is basically a requirement.
- Marketing.
- More emails and phone calls.
- Coordinate with Billing Specialist.
- Sanitize between clients.
- Schedule clients’ next sessions, schedule new clients.
- Hours logs (tracking if you are under Supervision, reviewing if you are the Supervisor).
- Continuing Education (CEs).
- Session planning for upcoming sessions (including research, lots of time spent thinking about how we will apply what we’ve learned and how it might benefit each of our clients individually).
- Clinical Supervision and/or Consultation (plus documentation of these interactions).
- Coordinate with your team (group practice or facility, etc.).
- Treatment Coordination with Primary Care Physicians, Psychiatrists, Psychiatric Nurse Practitioners, other providers involved in your clients’ care.
- Answer the half million text messages and other contact attempts from family and friends between sessions.
- Go to the bathroom!
- Eat dinner or a snack if you have time.
- Mentally wrap up your day and shift thinking to what needs to happen tomorrow.
- Clean.
- Shut down office.
- Go home and try to spend time with family.
- Sleep.
Keep in mind that all of the above is what we have planned but because “life happens”, at least 10-things will probably get added to the list, so we don’t get to shut the office down and go home (or we have to go home and do more work) when we’d like to, if something else happens.
Even if we “only” have ___ # of sessions scheduled (otherwise known as ___ # hours of scheduled direct client contact) should not, by any means, be interpreted as a therapist “only working” ___ many hours per day.
It’s too easy to end up working anywhere from 50-60 hours per week.
If you are a Clinical Supervisor, you’ll also be adding these fun tasks:
- Read, review, and give feedback for literally every form of clinical documentation that is drafted to make sure that it meets the requirements of the practice as well as the governing Board for your field.
- Be available any time you are not in session (or in the bathroom) to answer questions, address concerns, and check-in with Supervisees.
- Field/respond to any questions or concerns that get “passed up the chain”.
- Review hours logs of Supervisees.
- Plan Supervision.
- Write Supervision notes.
- Review Supervisees’ client lists to make sure that:
- everyone who needs to have a future appointment, has one scheduled.
- Supervisees are taking payments as needed for sessions.
- Review charts to ensure that all documents and paperwork that should be present, are accounted for and complete.
- Review Supervisees performance.
- Direct Observation.
- Feedback.
- 6-month and annual performance reviews.
It’s easy in this role to work 60+ hours per week.
If you’re also the owner, you can add the following:
- Pay practice bills.
- Payroll.
- All other HR and management tasks.
- General cleaning and maintenance for the Suite.
- Policies & Procedures
- Write
- Enforce
- Revise as needed
- Keep superseded policies & procedures just in case you ever need them.
- Business sustainability plan for the current year and growth plan for the next 2-5 years.
- Keep website and all online listings, marketing, etc. updated.
- Complete cost comparisons for all trainings, insurance policies, supplies, etc. needed.
- Keep statistics on call logs, new client conversions rates, and maintain financial “dashboard”.
In this role, you’ve stopped counting the hours you work because even on “days off” you still have to be available. The last I counted my own hours I am at an average of 70+ hours per week.
Keeping all of the above in mind, if you’ve ever wondered why we set our fees the way we do, here’s more information to consider…
- The typical cost of a graduate degree in professional counseling is 36k (or more).
- NCE (National Counselor Exam) $275 (minimum).
- NCE Preparation materials – you’ll easily spend $150+
- Licensure fees (we pay these fees every two years)
- $40 fingerprint clearance
- $250 licensure application fee (it was more when I was first licensed)
- Continuing Education (CEs) – on average you’ll spend 10k per year (last year I spent 19k just on my own).
- Workbooks, educational books, etc. to help improve the services we are providing and expand our therapeutic “toolbox” – about 1k per year.
- General Liability – $300+ per year
- Professional Liability (ranges based on solo practitioner or group practice) – $300 to $600+ per year.
- Workman’s Compensation coverage
- Sick time and other paid time off for employees
- Electronic Health Records system – $40/month and goes up based on number of users.
- “Work” laptop or computer to keep work separate from “home”/personal use.
- Utilities
- Phone and internet
- Electricity
- Rent
- Payroll processing service
- Professional website and email hosting $59/month and up.
- Billing Specialist
- Small business attorney
- Employment attorney (if small business attorney doesn’t specialize in this area)
- Accountant & bookkeeping services
Medical doctors, psychiatrists, and many other types of providers are able to double or triple book themselves to offset a no-show or late cancellation, they are also able to see 6-8 patients/clients per hour whereas a therapist can only see one client in the same amount of time. A therapist cannot double or triple book themselves either because that won’t work for us in the same way it works for a medical doctor. This means we can see 6-8 clients per day as opposed to another type of provider who can see 20+.
So… when a therapist has a cash pay rate of (average) $150 per session, most of that is not actually going into our pockets. When we charge a late cancellation or no-show fee, it isn’t because we’re greedy, it’s because we can’t fill that time with short (or no) notice and that impacts our ability to continue providing services to our clients.
When we accept insurance, we only actually get paid about 50% of what we billed the insurance per session (almost all of that money goes to overhead costs) and need to take in 2-3 insurance clients to make up for every spot that could be filled by one cash pay client.
If we “slide our scale”, waive fees, we are literally taking money out of the funds for our overhead and out of our own pockets and giving it away.
It’s also pretty common when starting a group practice that the owner will either not pay themselves or not pay themselves consistently for the first two to five years.
With all that in mind… why do we still do it?
Because we genuinely care about the people that we get to help. We love what we get to do and most of us could not imagine ourselves doing anything else. Being able to hold space for our clients during the day and walking with them through some of the most difficult times in their lives is what gets us out of bed in the morning. It’s why we show up even when we’re tired and don’t feel like “people-ing”. It’s why we spend so much money just to be able to learn more about how we can do a better job helping.
If we care so much, why do we still charge late cancellation or no-show fees? Because having time and financial boundaries is actually beneficial to the therapist/client relationship. It helps us prevent professional burn out. It stops financial hemorrhaging through needless write-offs. It helps us help you.
Why do some of us become Supervisors? Because we love to teach and value that we get to have a positive impact on future therapists and newly licensed therapists coming into the field.
Are you thinking about becoming a Therapist? Awesome! I’m not here to tell you “no”. I would, however, strongly suggest interviewing therapists practicing in the setting(s) you think you might want to work in (don’t interview your own therapist, because, boundaries) and ask them for their honest feedback about what their days and weeks look like, ask them about when they’ve struggled with the business end of things.
Have you ever felt like a therapist “is just in it for the money”? Hopefully you’ve read something that has helped you to challenge that thought.
