How do you get referrals? How do you get new clients? How do you build your private practice?

Matt Cornell put out this wonderful question on "linkedin," I heard it somewhere (Seah? Mann?) and felt like answering because its something my students are asking me weekly. This is a wonderful question for those aiming to build a private practice when they graduate, or at some point in the future (or present). Basically, people find me because of my research and publications, or by word of mouth. I'm usually not looking for clients, as I am always trying to get more time for my research and writing, which is slightly disconnected from my consulting/psychotherapy practice, (or what I think of as "executive coaching"), i.e., my private practice. People may arrive to see me with an Axis I disorder (for those of you who are not psychologists, Axis I disorders are clinical "diagnoses") and when I do my job right, and the illness is not too severe, they recover from that fairly quickly, and then I am in essense, a coach, mentor, professional supporter and "professional friend." Therefore, the way I think of attracting clients might include principles that apply to any endeavors related to consulting or to providing service.

Our business is highly competitive and what people do is always private, by law. I find referrals often come from other clients, rather than from colleagues who are in essence, in competition for business. I was and still am, very selective. I only see people who have been referred by people I know (in one way or another). I don't accept referrals who are very close to my clients. Each client deserves to have me without sharing me with their family members or close friends. I help my clients find psychotherapists or coaches for their friends and family. I tell them I will be their "psychotherapy broker."

I never take on new clients from the programs in which I formally teach, although my work as a clinician is quite like my work as an academic, a professor, an educator. Students and patients/clients are very vulnerable in terms of ranking and power position, and so their protection from any kind of exploitation is a first consideration (and that would include by me, or any other formal teacher/professor, etc.). My students are always asking "how can I start a private practice?" and my answer is simple.

Find out what theoretical perspective seems best suited to YOU. Join the "groups" following that perspective, go to all of their events, their Case Conferences, classes. Hire a consultant from that theoretical perspective, who seems both collaborative and well-known to the people in that group. Show up at everything, make friends with the psychotherapists there. Present cases at Case Conferences, disguising any identifying details, in order to protect your clients/patients/consultees. Become a person who people know. Have integrity in everything you do. Don't discuss patients without disguising any identifiable details.

Figure out and then define your natural "specialty" meaning, ask yourself: 'What do I love to read about when no one is looking?" Your specialty should be connected to your passion, be it explicit or implicit. Keep up to date with psychological science, bring it to your patients. On an ongoing basis, offer up the results of research findings, that are relevant to their problems or needs. That's why people find it useful to hire a psychologist instead of a counselor. Counselors are excellent, but when someone wants to have their own information worker, someone who keeps up with massive amounts of research coming out all the time (and psychologists are able to do that more easily today, by joining listservs that provide daily abstracts of the latest findings from multiple areas of psychological science, psychiatry). Be known for being kind, and smart. Become a great diagnostician. Be able to spot physical problems that may be confused with psychological problems. Tell clients what you think, or what you think that is relevant to their problems and concerns, and that may help them.

Think frequently about your current clients, be their secret weapon in life, helping them to fight their guilt, helping them to problem solve. Start writing, do research (either empirical studies, or library research, etc.).

"Find out what you patients need and give it to them."
(Hal Sampson said that to me, and it stuck.)

"It takes a person to cure a person" Joe Weiss said. He was right.

"We make the rules" Joe Weiss said, meaning that within every relationship, there are rules established, a frame established. You and your clients make the frame for your relationship, the rules that guide you both as you work together. Never exploit a client, but work with each client to find out what frame is most helpful for them. Sometimes a depressed client needs to talk to me every day, once or twice a week sessions are important, but don't take the place of knowing that I will be checking in with them every day, so they never have too go too long feeling anxious, or down, without sharing it with me. This makes them feel far more secure. While "we make the rules" in general, one rule is universal. Never have sex with your client. This is a rule that must be kept, always. No client really wants to have sex with his or her therapist. Clients do not want to have sex with their parents either. If they think they do, they are "testing" you, to find out if you are going to exploit them. If clients believe that they wanted to have sex with a parent, it is only because they believed that they could make a parent (usually a depressed parent) come alive by having a sexual relationship. It is because they believe (erroneously) that sex is the only way to help a parent feel better. If a client wants to do something you deem "inappropriate" they have to be testing you. Clients want to get better, they do not want to engage in self-destructive behaviors.

Perhaps the most important thing -- be a clinician who "goes the extra mile" and does everything possible to help their patients/clients. Leave no stone unturned, pay close attention to what works with each client, we are each unique, as much as we are all alike. Provide limbic regulation for your clients, hope that they always leave an hour with you feeling stronger than when they arrived. Yes, go the extra mile, whatever that means in each case, go the extra mile. Be a real person, don't try to hide yourself behind a professional facade, and go the extra mile. You will have clients and a successful practice.

Go the extra mile and clients will come to you. Smile and go the extra mile, love your clients, as a parent, mentor, advisor, and healer. Don't take on too many clients, and don't take on too few. Be real, write, study, conduct research, be a true psychologist bringing to your clients the thing that no one else can bring to them, be their researcher, their library, their expert who goes out and finds the information they need. That is our job, be outstanding at this job and you will have as many clients as you want or, as many as you are comfortable with. Establish a real "working alliance" with each client, be "co-scientists" together, working on their problems. Don't be afraid to encourage your clients. Adler once said "Patients aren't sick, they're discouraged." Function as your client's guilt-reducer, teach them to forgive themselves. You are your clients' own, private, knowledge worker, and your job is to share your knowledge with them.