Group Therapy Practice Expands With Virtual Coaching

Group Therapy Practice Expands With Virtual Coaching
Darryl Pure, PhD, CGP, FAGPA

At a recent conference, I found myself in an elevator with a colleague. He asked what I was doing these days. I replied with a simple question, “You know how therapists find that they are struggling with managed care, working harder, making less, and disliking what they do?” “I sure do,” he replied. “Well,” I said, “I help therapists all over the country grow their practices, increase their incomes, and put pleasure back into their lives.” This article will address how I used my existing group skills to reposition my career and find new joy and creativity in my professional life.

The Journey of Pain
Like many practitioners, I initially jumped on the bandwagon of managed care. At first, the ride was smooth; I was reimbursed at decent rates, there was little interference from the reviewers, and my practice remained full.

After a couple of years, I noticed that the paper work was increasing, and my referrals and income were decreasing. I was spending hours on the phone with reviewers who requested confidential information about my clients and even more time in “voice mail Hades.” To add insult to injury, try as I might, I was dropped from panels as “carve-outs” began to appear, and industry mergers eliminated some panels and launched others.

About six years ago, I decided that I was miserable and that the only path to any semblance of an enjoyable career was to drop out of managed care. I also strongly believed that this was ultimately in my clients’ best interests.

I dropped out of every panel I had joined. My secret weapon was group psychotherapy. I reasoned that I could offer people treatment that was so cost-effective and efficacious that I would be able to compete in the ever-shrinking fee-for-service marketplace.

Fee-for-Service Success
My strategy worked! Over time, a few clients left my practice, and many others, refugees from mangled care, came seeking the sort of treatment they knew they needed. They also knew they would not receive that sort of help from an HMO. My practice was not as full as it once was, my income shrank by 20 to 30 percent, but I felt as though I was back in practice. For the first time in a couple of years, I felt like I was doing the job I loved and was trained for.

To succeed, I marketed myself effectively and became more flexible in how I framed my practice. Initially, in order to meet my clients’ financial requirements, I reduced my fees when necessary and went from seeing people twice a week to seeing them less frequently. I also began to stress the utility and cost-effectiveness of group therapy. This created a fairly full practice, but created new stresses.

Before managed care, I was seeing 15 people a week while filling 40 sessions. Additionally I ran three groups with eight members each. My new practice consisted of 30 people filling an average of 25 clinical sessions a week with six groups of 8-10 members. I felt exhausted! More change seemed in order.

A New Plan Emerges
A close friend of mine developed a multi-million dollar business because he had a clear idea of what he wanted in his dream job. I decided to take a page from his play book and developed a list. I wanted to:

have more time at home;
be able to earn more income per hour;
develop a practice that included highly remunerated services;
run more groups;
work less nights (difficult if I wanted more groups);
have a practice that was geographically flexible;
travel for fun, not business;
have free time.

This list became my mantra. Whenever I evaluated new opportunities in the field, I compared them to this list. For example, I thought of getting trained in organizational development. This would allow me to run more groups, have more free time, get paid more, and be geographically flexible. It would not, however, allow me more time at home with my children, or travel for fun.

A Virtual Coach is Born
About a year ago, on a fluke, I attended a conference that allowed me to spend time with a colleague I hadn’t seen in years, and signed-up for a workshop on “Saying Goodbye to Managed Care.” The workshop was on coaching—not only was it about coaching, but it was about virtual coaching, i.e., via the telephone! To make the plot even thicker, the presenter began to talk about virtual coaching groups!

Skeptic that I am, my “quack-meter” went off, and I became very suspicious of the presentation. Coaching? What is coaching? Isn’t that just a word that untrained people use to do therapy without gaining the requisite training? How can anyone work with people they’ve never met? How can you effectively work with anyone over the telephone? Groups over the telephone? Preposterous.

Four things helped me keep a slightly open mind.

Coaching used the same set of skills that I already possessed, but applied them to new populations and to non-clinical problems.
Coaching could be done by telephone and was, therefore, geographically flexible and could easily fit my schedule.
Coaching could be done in virtual groups, which further utilized my unique set of skills.
Finally, people pay for coaching out of pocket, did not use insurance or managed care, traditionally pay in advance of receiving services (no receivables), and pay at a more lucrative rate than is usual in psychotherapy.

The field is a broad one and encompasses sports coaching, executive coaching, personal coaching, sales coaching, business coaching, and even coaching to help people organize their files and their offices. All forms of coaching share in common a powerful relationship that helps people make important life changes. Coaching helps people crystallize and take action toward important personal and professional goals.

There are three main distinctions between coaching and psychotherapy.

The coaching contract specifies that, while the client may receive therapeutic benefit, the relationship is not for the purposes of psychotherapy, but for coaching towards certain, specified goals.
Therapy treats disorders; coaching does not. Coaching establishes a collaborative relationship between coach and client which seeks to empower the client to reach their goals. If the block to achieving these goals is psychopathology, coaching would not be the proper relationship; psychotherapy would be. In this case, the coach, who may not be trained in mental health, would refer the client for psychotherapy. The same would be true if the client had accounting problems. The coach would not try to solve these, but would refer the client to an accountant.
Therapy often focuses on people’s difficulties and the painful life histories that created them. Coaching focuses on peoples strengths, abilities, and goals. It does not overcome deficits as much as it champions clients’ victories.

Clearly a coaching client could benefit greatly from my clinical skills. In fact, a group therapist’s clinical skills are a clear competitive advantage over the skills possessed by non-clinicians. Furthermore, coaching exposes clinicians to populations that would hesitate to seek out psychotherapy. These populations do not perceive themselves as needing psychotherapy, and think it is for sick people. Coaching, which is for well people seeking to maximize what they achieve in life, is seen as trendy and socially acceptable.

The Transformation of a Practice
I was intrigued by what I had learned, but still cautious. I checked with the American Psychological Association about the ethics of coaching and was told that coaching was ethical for psychologists to engage in. In fact, APA was promoting coaching as a method for clinicians to expand their practice opportunities beyond the purview of insurance and managed care. While slightly more cautious about telephonic delivery of services, APA was encouraging. Consultation with legal advisors from the APA Insurance Trust was also reassuring.

Following these consultations, I pursued training as a coach. Today, my practice, while still mainly devoted to traditional psychotherapy, includes several coaching sessions per week. Additionally, I run groups that are able to meet during the day! It is quite easy to have groups convene during the day when people don’t have to leave their offices, to travel to my office, or find parking, and can simply pick up the telephone.

While I coach clients on many issues, I concentrate my coaching on three areas:

Fathering issues—working with individuals and groups from around the country who wish to improve their fathering skills. This includes men in intact families, custodial fathers, and non-custodial dads. I also work with business organizations on ways that they can become “father friendly.”
People in financial services—primarily traders, brokers, and bankers who are seeking to improve their work performance while cultivating their personal lives. Given the perceived value added to their careers, these clients are willing to pay greater fees than psychotherapy clients, whether in individual or group coaching.
Psychotherapy—working with psychotherapists who wish to develop and improve their practices, free of managed care and third-party payers.

A typical day might see me waking up and getting my kids ready for school. After I drive car-pool, I return home, and while sitting on my patio I spend 30 minutes coaching a therapist in Nebraska on expanding his fee-for-service practice. After a short break, I meet with a group of fathers from around the county who are engaged in a group on fathers raising daughters. In the afternoon, I meet with a group of psychotherapists from non-competing markets, helping them develop and achieve their practice goals. Later, I will see four traditional psychotherapy patients face-to-face and then lead a group in the evening.

My eventual goal is to increase the number of psychotherapy groups that I do. I also want to increase my coaching practice because it will allow me to decrease evening work and improve my income. Another benefit to coaching is that it will allow me to summer in other areas of the country while being able to keep my client base.

Coaching has also expanded the techniques I use in clinical practice. My clinical practice has shifted a bit as a result of my coaching. It has freed me to expand some boundaries and measure the response that occurs in the group.

Finally, I find coaching to be an engaging, fun break from clinical work. I find it enjoyable to mix clinical work with non-clinical problems. It is also gratifying to work with clients who are not healing from difficulties in their lives, but instead maximizing their potential. My coaching clients describe me as their “secret weapon”, a role I value.

This article was published in the October/November 2000 issue of The Group Solution.