An Innovative Strategy for Private Practice Survival: A Network of Group Therapists
Mark Sorenson, PhD, CGP

It was 1992, and I was getting pretty nervous. Managed care was increasing its hold in Massachusetts. The town of Newton, where I lived and worked, had recently been reported by the Wall Street Journal to have the greatest number of therapists per capita in the country. I had been leading groups for 10 years and found it to be the most exciting aspect of my clinical work, but it was getting harder to keep my one group filled, not to mention to start new ones. The fact that I was not alone was insufficient to soothe my anxiety.

I shared this dilemma with a colleague during AGPA’s Annual Conference in San Diego. While we felt there was an answer to this problem, we knew finding the answer would involve developing business skills we were never exposed to anywhere in our training. 

What follows is one strategy for generating group referrals in an urban/suburban, private practice setting that works. The genesis of this odyssey was the belief in the power of groups to creatively transform problems into solutions.

A partnership of specialists in group therapy
The first step was to establish an informal group of like-minded therapists. We were looking for experienced Certified Group Psychotherapists (CGPs) who operated independently owned practices and who had energy to devote to significantly expanding the number of groups they were running. It was also important that they be willing to work with managed care as demonstrated by membership on at least a few major provider panels. We made the judgment early on that an undeniable aspect of the business climate was that managed care had crashed the party and installed itself as the gatekeeper for a substantial portion of referrals. We reasoned that since expanding groups meant creating a very large flow of referrals, it made more sense to try and make this new wrinkle in the marketplace work for us rather than against us. 

After many months of brainstorming, we formed a professional corporation called Group Solutions Network, Inc. (GSN), a partnership of specialists in group therapy. Members pay a monthly fee of $100 and help run the organization. GSN has nine independent practitioners and one group practice specializing in groups for substance abusers, and offers more than 60 active groups through its toll-free number and website. We average between eight to 20 group referrals a week (although only a small percentage of these are suitable for our groups). 

Five years after its inception, I have expanded my one group that was barely viable to a five groups that are often full. The problem now is not whether I can begin a new group, but when would I do it. 

The business model we fashioned our venture upon was that of a network, as described by the systems-oriented organizational consultants Jessica Lipnak and Jeffrey Stamps in their business book ??The Age of the Network??. The core principles of a network are: a unifying purpose, independent members, voluntary links, multiple leaders, and integrated levels. Let me describe for you how these principles came to operate in GSN.

Unifying purpose
The unifying purpose in a network is reflected by shared goals, views, and values. It holds the network together. In Group Solutions Network, we not only believe in the unique efficacy of group therapy but also feel quite strongly that what is required in groups is to give to others in order to receive the desired benefit. Lipnack and Stamps refer to this as the development of “social capital.” 

As specialists in group therapy, we give away our energy and expertise in helping people gain easy access to finding the right group. We let referral sources know that they “only need to make one call.” Each member takes turns getting the necessary information over the phone and making sure a suitable group has an opening before passing on the referral. (“Do you have a support group for a 79-year-old battered woman on Medicare in the town of ?) What this often translates into is spending a lot of time directing people towards groups that are not run by network members. What we get in return is tremendous thanks and goodwill, from both patients and referral sources, as well as the group leaders to whom we end up referring. We believe these ultimately lead to referrals that we can place in our own groups.

Another example of social capital at work in GSN is that there are no paid positions. The belief is that those who do more for the group will experience more reward in terms of a greater number of referrals. By and large, this experience has been borne out.

Independent members
All members of Group Solutions Network own their own practices, do their own billing, and are responsible for their own clinical work. For the network, they pay their dues, attend monthly meetings, take turns handling the referral line, and provide good customer service.

“Each member of the network can stand on its own, while benefiting from being part of the whole,” write Lipnack and Stamps. This is the familiar tension in all groups between being a “me” and being part of a “we.” Even though it was hard to find another example out there for us to follow, this principle felt right to us. None of us wanted anyone telling us how to work nor taking a percentage of our fees. This principle also makes it easy to enter and exit the network if it should stop meeting the individual member’s needs.

Voluntary links
One advantage of the network model is that it allows for plentiful and varied links both inside and outside the organization. Network members begin referring more to each other as their practices grow from the goodwill they have sown. Our members also have their own informal links with employee assistance professionals, managed care organizations, and other clinicians. As a result, the GSN was able to get on to several closed provider panels of major managed care organizations, and other referrals have arrived from unexpected places. 

There is also a substantial informal network of clinicians who are on a database that we use when trying to locate groups outside the GSN. These voluntary links lead to the multiplication of relationships and the generation of greater business opportunities.

Multiple leaders
“Networks are leaderful, not leaderless.” Each group therapist in Group Solutions Network is an experienced professional and has unique skills to offer at some point in the process of the organization’s development. I have developed marketing skills that allow us to use direct mail to contact 12,000 clinicians twice a year, as well as through postings on our website. Judy Starr, MSW, CGP, my Co-President, developed a computerized database of more than 400 groups that is shared within the network. Others have taken the lead in developing networking strategies with EAPs and in maintaining good customer service. One clinician has demonstrated leadership by creating a group program for patients with attention deficit disorder. 

Considering the scope of what we do, the GSN is run on a shoestring. We do not outsource as much as encourage the development and employment of new skills within the network.

Integrated levels
This principle refers to the presence of an organizational hierarchy, which consists of an Executive Board elected by the members, as well as the absence of overly restrictive rules and structures so that sub-groups can form and add their unique contributions to the dynamics of the network. The presence of integrated levels also means that GSN has the flexibility to be highly responsive to the needs of the marketplace. If the business climate changes, and only centralized group practices can survive, then we will become that. The network can take advantage of its ability to act quickly and independently.

Most members of GSN have enjoyed concrete economic benefits in terms of expansion of their groups. Yet if you were to ask them what they get out of being part of the network, they would most likely respond that they enjoy the collegiality. 

The GSN has led to the development of group cohesion around shared interests and values, but also around shared excitement and fears. Our is a lonely time to be in private practice, so it should come as no surprise to the readership of this newsletter that the intangible rewards of being part of the group rivals the practical ones. 

Each of us feels stronger and less vulnerable to market forces, allowing us to give more of our attention to the work we love to do. The network has provided an additional experience for us of the power of the group to accomplish more together than we can accomplish on our own.

This article was published in the December/January 2000 issue of The Group Solution.