Episode #114

Going into private practice is a big deal. There are a lot of things to consider. One of the biggest decisions that has to be made is if a therapist will take insurance or not. Some people might wonder why that’s even a question, of course private practice people would take insurance. How else would they get paid? However, there are a lot of reasons a therapist might choose to stay off of insurance panels. This heavily limits the types of clients they can see by the very nature of people having to pay out of pocket. This can be a controversial move and I wanted to help shed some light on why some therapists make this choice.

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

 Welcome back to the All Things Substance Podcast. This is episode 114. In the last several weeks, we’ve been talking about issues related to private practice. Since this is the All Things Substance podcast, that might feel a little confusing. If you haven’t had a chance to listen to the previous episodes in the series, I would encourage you to do that, but here’s the too-long-didn’t-listen summarization. 

I believe that our field is headed for a shift. Agency work is getting more difficult because budgets are getting tighter. Cost of living is rising, and wages aren’t keeping up. Lots of therapists are being underpaid and are struggling to make ends meet. We see online places where therapists are asking about other careers, possibly things that they can do since they don’t feel like they’re gonna be able to make enough money to live.

Not to mention the fact that the actual work we do is challenging in a way that non therapists don’t often understand. So I believe that the shift that we’ll be making is that many more people will be heading into private practice. And because of that, people who need help with their substance use are going to need to be able to find help in the private practice sphere.

Now, more than ever, I believe that we as therapists need to know about substance use and need to be able to feel competent and confident to address it. I’m not suggesting that every one of us needs to be a specialist. I don’t think that that’s necessary. I also think that many of the folks that need help with their substance use don’t need full-blown treatment. They may not be in the addiction stage yet, but their use is becoming problematic. Because of that there are these issues that are facing private practice people. This is why I felt it necessary to talk about private practice. 

I am a private practice owner. I’m a single practitioner llc and have no desire to be a group practice owner. I’m not saying I’ll never do it, because I have learned in my life to not say never, but at this moment, I don’t see a need for that. As a private practice owner, there are a number of things that go into what I have to think about.

Today we’re gonna be talking about the idea of taking insurance in private practice or private pay. Of course, there are some folks who do both. I have a couple of private pay clients because they don’t have insurance that I can bill and they still wanna see me. But generally, I take most insurances. In fact, about 60% of my clients are on Medicaid. This is feasible for me in Wisconsin because of a number of factors that could shift in the future depending on how the state defines the codes that I use and the reimbursement rates. It could also depend on how the insurance companies choose to do things, and if they become such a pain in the ass that I don’t wanna deal with them anymore.

When I first started in private practice, it never occurred to me that I would ever be private pay. In fact, being totally honest, I think I had opinions capital O about therapists who were private pay. However, in the last few years, I’ve gotten to know a number of therapists who are totally private pay and take no insurance at all. I’ve had the chance to hear directly from them what made them go that route, and how they manage that. 

The first thing we need to talk about though, is an hourly rate. For those of you who aren’t in private practice yet, you may not know the importance of what the rate is. When an insurance company assigns you a rate, it’s pretty much what you’re gonna get from them, and negotiating is largely not an option. I have known some people that have successfully negotiated a rate, but it’s extremely few and far between. Insurance is really weird. They assign a rate to different contracts and it seems arbitrary.

Now when it’s Medicaid, everybody gets the same amount, with a few exceptions, but in general, everybody gets the same rate for a given service, you can either choose to take Medicaid or not. The hourly rate though is incredibly important because there are a number of things to think about that you have to pay for yourself.

So an extremely low reimbursement rate for a session of therapy would be $65 an hour. There are probably lower amounts, but that’s about the bottom that I’ve seen. To give you context, I won’t take anything that’s less than a hundred an hour and that’s actually not a lot. It seems like a lot, but it’s really not. And let me tell you why. 

One of the biggest things about private practice is your own insurance, health insurance. I mean. For me, my health insurance for me alone is $700 a month, adding my husband to that, and you can double it. That is getting insurance on the marketplace. Now, I could probably lower that premium to maybe 450 or 500 a month if I went with a higher deductible plan, but that’s not something I’m willing to do. Now, I could spend more than that. There were plans that were like $900 a month, and from last year to this year, my premium went up by probably 20%.

Health insurance in an agency is something that the agency covers the bulk of the cost, at least half, if not more, and you pay what’s left over. Another thing you have to think about is sick time and vacation time. So, how many weeks a year can you work? What happens if you get covid? What happens if somebody passes away? What happens if you decide that you want to take a break, go on vacation, have a baby, any of those life things that come up? 

You have a finite amount of money because all of that is tied to an hourly rate. If we take the lowest rate, let’s say $65 an hour, and we assume that somebody works 48 weeks a year, that’s out of 52, right? And so that is two weeks vacation, two weeks of sick time, which is really low and usually for entry level clinicians or people that are starting at a new agency. You have to decide how many clients a week you are going to see. We’re gonna pick the number 25.

That is that 25 clients show up each week. If that is the case and you collect a hundred percent of what you bill, you would get $78,000 a year. For some of you, that sounds like a dream because you’re getting paid way below market rate. However, there are a number of factors here.

First of all, that doesn’t include taxes. The taxes that you pay as a business owner are higher than the taxes you pay off of your individual salaried job. You need to put away about 30% of your money for taxes. 

So if we take a third of your income off of 78,000, We’re at 54,000 take home, remind yourself that in this place you’re not paying into anything like unemployment. You’re not putting anything in savings at this point. You’re not contributing to a 401K or a health savings account. That’s where you’re at after taxes, potentially.

Now you can lower your tax bill by  spending money on things like rent, electronic health records, computers, things like that. So that 54,000 is assuming you don’t have to spend any money on anything else. You don’t have an office space. You don’t have to pay for the internet, you don’t pay for marketing or a biller or anything like that. You can see how quickly that $65 an hour isn’t gonna cut it for you. 

The other thing we have to remember from our discussion two weeks ago, is what’s called a realization rate. A realization rate is the amount of money that you collect off of what you bill.  If you have a bag of cookies, and when the cookies are all gone, there’s going to be crumbs left in the bag. The amount of crumbs is the realization rate. If it’s just a few crumbs, then you realized most of the money you billed. But if there’s a larger amount of crumbs, it means you lost more money. 

So you can’t assume that you’re gonna collect every single dollar that you bill because shit happens. Insurance can be really difficult, even for private pay folks. It can be difficult. So you can’t count on a solid $54,000.

Okay? So you won’t accept anything under, let’s say, $85 an hour. At $85 an hour, at 25 a week for 48 weeks. Then we’re at 102,000. That sounds doable, right? Well, let’s take 30% off of that, and now we’re gonna be at 72,000. Remember, there’s rent, there’s insurance, there’s malpractice,  there’s electronic health records, and internet and marketing and all of the other things that go into running a business.  

This is also assuming that every week for 48 weeks a year, you have at least 25 clients showing up. If there’s a snowstorm and you can’t get to your office, or if you get sick, or if your clients are sick or your kids are sick, then those are weeks you don’t have that amount of money, and so $85 doesn’t give you a lot of room. Remember that all of these numbers are based on an individual practice, not a group practice.

You need to get to the place where there’s enough left over that the hourly rate is at a place where you can survive if unexpected things happen.  The main reason that people go into private practice is to have more freedom, to not have productivity expectations, to not feel like they never have time for themselves. To feel like they have time to do their paperwork. 

If the hourly rate that you’re willing to accept is too low, you’re gonna be trading one for the other. And this time there’s no safety net of health insurance and 401K benefits and short-term disability and life insurance and paid time off, it is a hundred percent on you.

So when someone goes into private practice, they have to start getting really clear about what they’re willing to accept and what they’re not. $85 an hour in private practice can be doable, but it doesn’t leave very much room for and you have to make sure that you are able to keep your client base, such that they show up and that they get there on time and that they stay for the session and that they aren’t late canceling and no showing. So that hourly rate really is the bottom line. You have to decide what you can accept and what you can afford. 

There are places in the United States where a hundred dollars an hour isn’t going to be enough.  because the cost of living is incredibly high. I happen to live in a part of the country where the cost of living is relatively low.  My beautiful home on 10 acres was $160,000. Property taxes are like two and a half grand a year. That can work up here, but in other places, like my friends in California, there’s no way they could survive on that. All of that has to come into play when therapists make the choice to go into private practice.

Wanna talk about the choices that exist when you think about going into private practice, and this has to do with money, dollars per hour, number of clients, and how that money is coming to you. 

So let’s go back to our discussion about insurance. Insurance is going to pay you whatever they’re going to pay you. You can either choose to be a provider with that insurance or not.

Therapists  Have to look at the insurance rates around them and determine whether or not they can afford to take those clients. One of the biggest things is the payment reimbursement rate is between a 45 to 50 minute session and a 60 minute session. 

Every one of my sessions is an hour. It just is. I don’t do well with time management anyway, and so taking something that’s less than an hour isn’t gonna work for me. So every session’s an hour. But there are insurance companies in different parts of the country that will give you shit if you bill too many 60 minute sessions. They wanna know why, because the standard is gonna be the 45 to 50 minute session. 

Well, the difference is this. In the state of Wisconsin, a 45 minute session for Medicaid gets reimbursed at $72 an hour. A 60 minute session gets reimbursed at 113 an hour. That math doesn’t work at all. But that’s how it is, and it’s very similar in other states. 

I see that a 45 minute session is $62 in one state and a 60 minute session at 98. And so you could decide that you’re only going to do 60 minute sessions, and that means that your client has to show up on time because you technically can only bill for the time that you are face to face with the client, not the scheduled time.

There are insurance companies that require prior authorizations. I’m lucky in that I don’t have any of those, and the few that did  I decided not to do. Because frankly I don’t wanna put up with that. First of all, I think it’s invasive and specifically, I had one insurance company that wanted to spend 15 to 20 minutes on the phone with me asking me, deeply personal questions about my clients, about the nature of their trauma and other things, and I thought that was inappropriate.

It’s also time consuming and nobody’s paying for that time. It’s just part of doing the job. If the majority of the insurance companies in your area do prior auths, you’re stuck and you have to do them. And if you forget and run outta sessions, most of them aren’t gonna backdate. 

Besides looking at the rate and prior authorizations, you have to learn how to bill. Or you can hire it out. I had planned on doing it myself because I have experience knowing about billing and I’m pretty tech savvy, and the electronic health record I use has that built in. I did one day of sessions, came home, looked at how to bill it, and was like, fuck this. I’m out. And hired it out. 

Because it was completely worth it to me to pay a certain percentage of the money that I get back to a biller so that I don’t have to deal with it again. If you’re getting a certain amount an hour, you take out your taxes and then you take whatever percent say 7% to a biller, which is pretty moderate to low end. You see that even more the hourly rate is something you have to pay attention to. Insurance companies have other issues that come up, like the fact that they can come back to you and tell you that your person’s insurance had been terminated but you didn’t know.

And so they’re gonna take back money from all of the visits. They can do that for however long they say in the contract. For many of them, it’s up to a year. 18 months could be more that they can come back to you and say, oh, that person wasn’t covered here. We’re taking that money back or, oh, that person had a different insurance you need to bill them first. But if it’s over a certain time period, the other insurance is gonna say, too bad. So sad you didn’t file in a timely manner. And so we’re denying it. And if they deny it, the secondary insurance is gonna deny it also. 

So now that’s 72,000 or whatever you thought you were getting, minus the 7% for a biller minus the clawbacks, which is what it’s called when they take money back and you need to see more clients in order to make up the difference. 

There are people who have incredibly high deductibles, and so even though they have insurance, they have to pay you out of pocket and they have to pay you whatever the insurance company would’ve paid you.

So if the insurance company is saying that they would reimburse $124, then the client has to pay you $124. You cannot lower your rate for them while they’re trying to meet their deductible. It’s illegal.  and if you don’t collect the fee at the time that you do the service, there’s a chance that people can run up a bill and there’s a chance that they won’t pay you.

The other issue comes along with late cancels or no-shows, people miss appoints. It is just part of having a practice. A low no-show cancel rate would be in the teens. Anything over 25% to me is high. So in order to make 25 clients a week, let’s say you have a 15% no-show rate means that you are gonna have to book  28 to 30 clients a week to account for a no-show rate. That’s actually pretty moderate. That means that only three people miss or cancel their appointments. That’s not a lot. 

Those of you in agency work right now or have done agency work. Know that 25 a week is pretty low as productivity expectations are right now. At 48 weeks a year, that’s 1200 therapy sessions. That was the productivity expectation I came into in 2008. We’re now 14 years later, and those productivity expectations keep going up and they’re going to keep going up. This is the crunch that I’ve been talking about that I believe is here, that I believe has been there, is growing and is going to get worse, which is going to push therapists to consider private practice.

So it may seem like a simple answer. Private pay or take insurance. And for many people, taking insurance is the way to go. You have a built-in referral network. People just look at their insurance and figure out who’s in the network, and they will come to you. And that’s true. There’s a guaranteed rate, there’s a way to get paid. There’s direct deposit. You’re not even waiting for checks anymore; it’s easier to build a practice. Those are all pluses of taking insurance.

The downside, of course, being clawbacks  when they do take back money because a client didn’t tell you they got new insurance or they didn’t tell you that they had a backup insurance or they didn’t pay their bill, or there were prior offs that you didn’t know about.

There could be delays in payment.  It could take two months, three months to get paid for a session. Now, in some cases, the insurance companies are better and it’s pretty quick. There are always issues that pop up with an insurance company and there is nothing that calling them and harassing them is gonna do to get you paid any faster. And so you’re doing work knowing that you have to wait for payment. 

All of the insurance companies have different paperwork that you have to file to become credentialed with them, and that all requires being updated on a regular basis. It can take three to four months to get on a panel with insurance. You will submit your paperwork and it might be three months before somebody looks at it.

The fastest turnaround I think I saw was like 90 days. Eventually I was able to get on the insurance panels I wanted. However, I know that there are places in the country where there are a lot of therapists in an area and insurance companies have just said, Nope, we’re not taking any more people.  Starting to sound a little impossible, right?

Hearing all of this, there are going to be people who are listening who are like, oh my God, I can’t go into private practice.

I’m stuck. The truth is you’re not. You’re not stuck. You just have to do some analysis. 

You have to know what your expenses are. You have to know what you can afford. You have to decide if you’re gonna have a physical office or not. You have to decide how you wanna run your business, because as a business owner, it’s a hundred percent on you to set it up the way you want it.

Don’t trade one for the other. Set it up in a way that is sustainable and that you have the ability to do the work you wanna do and live the life you wanna live. If you’re able to do that by taking insurance, then do that. For some people, they don’t take all insurances. They only take a few because those insurances are easier to deal with. Their reimbursement rates are higher and they’re willing to put up with whatever kind of bullshit goes along with it. 

For other folks, they’ve decided they’re gonna go private pay. So when we think about private pay, it means that Whoever’s private paying has  disposable income, meaning that they don’t need it for food, shelter, heat, clothing, that kind of thing, to be able to afford private pay or pay out of pocket for therapy. Remembering that a private pay rate is going to be over a hundred dollars, probably closer to 150, maybe 200, just depending.

Anyone who’s charging underneath a hundred dollars an hour isn’t gonna be able to sustain their own cost of living for very long if that’s their whole caseload. Having a sliding scale fee might seem like an easy prospect, but that requires that you get financial information from people and that you are then negotiating what that rate is gonna be, and you have to be okay with that.

And most of us aren’t good at talking about money anyway. A sliding fee scale is extremely difficult to administer, and it’s difficult to change when someone’s been seeing you at a certain rate and then They get a new job or their money situation changes and then you want them to pay more. People have feelings about that because you’ve been seeing ’em at this rate. Why would they pay more now? 

So private pay tends to be stated rates, no sliding fee scale, and the people have to be able to afford it. If we assume $150 an hour,  private fee, and we assume therapy weekly, that’s $600 a month.

Now that used to be a rent payment, but it’s no longer able to find places for that cheap. But $600 a month is a lot of money that means that the services the therapist is providing are going to be with people who can afford to spend that kind of money.

For many of us who have spent time in community mental health, there’s something about that feels off. It means that people who have lower income and aren’t even necessarily in poverty, but certainly, but lower income, aren’t going to be able to afford those services. People paying for our services isn’t really something that we talk about a lot, and certainly we didn’t talk about in school.

I remember having this conversation with a supervising psychologist and the team that I was running at the time, and he said, why do we feel like people shouldn’t pay for our services? Do we not think that our services are valuable? And the truth is, I do think we should get paid for our services. I just want someone else to pay for it.

I want therapy to not be a burden. I want people to be able to afford to get the healthcare that they need, but we don’t live in that system. We don’t have universal healthcare with a single payer system. We have what we have. While I would love for mental health care to be free for people, somebody has to pay for that and I have to pay my bills just like you do. And so we have to find a way to resolve this conflict.

Most of the therapists I know, it’s a reality that they’ve had to come to terms with.  because the alternative is that they can’t pay their bills and that they have to bust their ass and see 35 clients a week in order to make it work.

And to what end? To burn out, to not be able to do this work. It can be a huge challenge. Private pay is also really scary because when things are tight financially, people look for places to cut it down, and therapy can often be seen as one of those things that needs to go.  Sometimes when people feel like they can’t afford it, they’ll stop showing up to therapy.

Well, you have to decide if you’re gonna charge a late fee, and if so, how much Are you gonna charge the whole fee?  What happens when they argue about it?  I’ve seen often where people will dispute charges on their credit card even though they signed something, knowing there would be a late cancel fee, but they feel it’s unjust anyway because they needed to cancel because of whatever the thing was, and maybe it was a hundred percent legit, but you still weren’t able to fill that spot and you still have to eat the cost. 

You also have to be really on top of taking payments. Most people will take payments when the service is rendered. There are some people who charge before the session even happens. I’ve seen people talk about wanting to charge as much a week in advance in case somebody cancels.

When doing private pay, one of the hard things is finding people who will pay you the rate that you are asking and having enough of those clients to make ends meet. It is definitely a slower process than building with insurance. It can also feel really scary.

There are a number of people who work with therapists to help them find and attract clients that are private pay. Because there are people for whom financial issues are not the main problem and they are able to afford to pay it

The upside of private pay, of course, is that you set your own rate.  Nobody gets to tell you how much you can charge. You can charge whatever you want. You have to state what those rates are.  And they can’t be arbitrary because you have to have them listed. But you can set your rates the way you want them.

You don’t have to file insurance, you don’t have to deal with that kind of paperwork. . There are some people who don’t do notes when they’re doing private pay, which I would not recommend, but you get to decide  what you do for documentation, you get to decide what clients you take and don’t take when you’re signed on with an insurance panel.

If you are refusing their clients often they’re gonna contact you because, well, you don’t have to take every client that they send you. If they think you’re being super choosy, then they’re gonna wonder why you’re on their panel altogether. So private pay means you can really niche down and that nobody’s gonna call you on that.

I have friends who are in very specific niches like infertility or working with kids with autism and they are able to see a very specific type of client. Private pay means that you don’t have insurance companies coming back to you later and taking money away. There is a ton of freedom in it. 

Before I went into private practice, I didn’t understand the hourly rate from an individual perspective. I knew about the hourly rate  from an agency perspective because I had those budgets in front of me and I knew what we needed to make in order to make ends meet. I didn’t understand what it would mean as an individual practitioner.

Once I went into private practice. I got that really quickly. Trying to figure out what I needed in order to make sure we could pay our bills and how much I had to work. I still didn’t understand the private pay thing though. 

It was confusing, and I wondered what about the people who can’t afford that, and are there really people who are gonna private pay? Why wouldn’t you use your insurance? 

Well, there are some people who don’t wanna use their insurance for lots of reasons. They don’t want a paper trail. They don’t want the hassle, they don’t want their information being shared with an insurance company. There are other folks who feel like anyone who takes insurance is willing to work for cheap, and they see that someone who’s charging more can afford to charge that because they’re better. Whether that’s true or not, I don’t know. I do know that those of us with really niche specialties can charge more because there aren’t a lot of other choices. 

As therapists, I think a lot of the struggle for us is internal. Why do we do what we do? What’s the point? Many of us went into this field because we wanna help people, we wanna serve people, and the question is, who? Who do we wanna serve? 

I’ve said many times that some of my favorite clients are teenagers that use drugs and hate people. While being wealthy doesn’t mean you’re not gonna have a kid using drugs. It means that typically they’re not gonna wind up in the kind of trouble that I see. Whether that’s because they’re not doing it is a different matter. It could be that they have lawyers and that’s why they’re not getting in that kind of trouble. But we know that substance use and trauma  are highly correlated with poverty. 

It would be heartbreaking for me if I got to the place where I couldn’t see Medicaid clients. The reason that would happen would be because the state would decide that they’re not gonna reimburse for certain things or that they’re gonna scrutinize my hour long sessions because I can’t afford $62 a session for and do 45, 50 minute sessions.

I think there are opinions out there that therapists who go to private pay are greedy. That they just wanna make money. They don’t care about helping the underserved and they don’t wanna work with people who have real problems. Those are the things that I’ve heard. 

What I can tell you is that that isn’t the case. There are therapists that I have seen online whose values around money are not my values and that I’m not a fan. That I feel like they have potentially lost touch with why we do what we do. And that’s a judgment call on my part. Whether I’m right or wrong, 

But here’s the thing, the people I know who are friends of mine who are in practice and they are private pay, they are not greedy. They have not forgotten why we do what we do. They do hard work with people all the time. They work with people who have horrific histories.  They care deeply about their clients and their clients do need them. 

Money doesn’t mean that people don’t have difficulties. We know that mental illness doesn’t discriminate,  I had one of my colleagues say that she has to separate her charitable giving from her business. The things that she chooses to support are her personal things, things that she chooses to give money to or volunteer for. That is the way that she engages in that world and she has her business where she has to make ends meet as well.

I had another colleague talk with me about  the volunteer work that she does in the community as a way to give back to an underserved population of people. 

It is easy to sit where I sit in a place where the insurance companies are not giving me trouble, where I have a really excellent biller, in fact, the best biller on the planet. Where my expenses are low.

Where the reimbursement rates are decent, where my children are grown, and I don’t have the same pressures that some other folks have, and it would be easy for me to sit here and judge others for being in private prey practice or charging high fees when the truth of the matter is it could very easily shift for me. 

If my major payers started pulling money back from me and started challenging my hour-long sessions. I would make whatever hard choices I had to make to protect my family period. Even though I want to serve people who are in underserved populations. My priority is to my family first and . I can’t give to others if I don’t have what I need. And there’s something in the way that we are constructed as therapists that I think makes it hard to say that out loud.And it’s the truth. 

As I’ve heard from my colleagues and friends that are in private pay practices, I have heard each of them tell me why they made the decision to go private practice and it makes sense for every single one of ’em. These are good people with solid connection to their clients and to their communities who care about helping others.

So my conclusion in all of it  is that private practice, Is still going to be the future of our field and that each person who goes into private practice has to decide for themselves whether they’re going to take insurance, whether they’re going to do a hybrid, or whether they’re gonna go private pay, and that it is not my job to judge or criticize them in any way for whatever choices they make.

I am lucky to be able to make the choice that I’ve made thus far because private pay sounds kind of scary to me. I know people who do it successfully, so I know it happens, but I am grateful I haven’t had to do that yet because I’ve figured out how to do the insurance thing in a way that works for me. That isn’t too much of a pain in the ass and private feels easy to me. 

Now, it wasn’t easy to start, of course, but it is freeing in a way that I never thought it would be, and I can’t imagine going back to agency work after having an individual practice.

Yeah, it’s hard having to pay for my own insurance and not having  sick time and all sorts of other benefits. However, what I’m not having to deal with with agency stuff and the kind of bullshit that goes on, it’s so fucking worth it. We need therapists, we need more of them. There’s a huge need. 

What I encourage you to do is that if you are considering going out on your own, whether you’re doing agency work or you’re in a group practice and thinking about going out on your own, is to get some advice. There are a number of really solid coaches who help people start private practices who have done this work and are breaking it down for others to help them get started.

This is called private practice building. Some people do private practice startup. And they coach therapists how to do that. Some people are private practice builders in the sense that they help people scale up their practices. There are also folks who help people build group practices. 

If you are looking at hiring a coach, I would encourage you to pay attention to your gut  as you’re reading their websites, as you’re looking at testimonials, as you’re kind of feeling out who might be a good fit for you, if something doesn’t feel right, move along.

You don’t have to do this yourself. You really can get help to get the practice started and to build the practice that you want. That is going to be sustainable and that is going to serve you well in your career. 

I have an ulterior motive for talking about this stuff. It’s not hidden necessarily, cuz I think I’ve been pretty upfront, but it’s there all the same.

I want you to take people who need substance use help. I want you to expand your scope and the lens that you use to include people’s use of substances and I wanna help you do that. I wanna help you see what it would be like to have those folks in your practice because I believe that you have the skills you need to do this work. You just need a little information and perhaps some guidance. 

There are a lot of folks who need help with their substance use and there is no one to see them.  I get calls all the time because substance use is listed as something I work with, but I am one person and I can’t see any more people. In your area if you have spots, there are people who need you. 

I can teach you how to do this work. I can teach you how to fold it into what you already do to make it feel natural for who you are and how you practice. Remember, we’re not talking about full-blown addiction, and we’re not talking about people who need higher intensity treatment. That’s not what I’m suggesting. 

So it’s kind of the long game here for me that those of you who are in private practice would consider this. And those of you who may consider private practice someday would already be thinking about what it would be like to serve folks who struggle with substance use. 

In service to that  part of my goal is to break down substance use information in a way that is helpful and will give you the information that you need in order to feel comfortable talking with people about their substance use. Last month I did a webinar called Considering Cannabis.

I loved being able to talk with people and share information about marijuana from a neutral standpoint  to help therapists wade through all of the propaganda, frankly, on both sides, so the anti-marijuana folks and the pro-marijuana folks, to what the real truth is and what the impact is on therapy.

This month I’m gonna be talking about alcohol. On January 24th, which is a Tuesday, I’m doing a two hour webinar called Analyzing Alcohol. We’re gonna be talking about how much is too much, gray area drinking, and how to support sober curious clients. There are a lot of people who are starting to take a look at their relationship with alcohol.

This has given rise to things like dry January or sober October.  Alcohol is the most popular substance that people use and it makes sense then that it’s the most popular one that people can overuse.

Many of our people are overusing alcohol. We might just not know it yet.  I would love for you to join me for the webinar. It is again on January 24th at 7:00 PM Eastern Time, and  you can check out the Analyzing Alcohol webinar at betsy byler.com/analyzing 

Next week. We’re gonna be talking about what it would look like  in private practice, outpatient mental health to work with substance use. We’re gonna talk about what kind of clients they would be and how you can determine whether or not their level of substance use is in the middle ground where you can work or they need a specialist. I hope you’ll join me for that podcast. And until then, have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

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