When they asked Michelangelo how he made his statue of David he is reported to have said, “It is easy. You just chip away the stone that doesn’t look like David.”

In our therapy or coaching practices,  in order to say ‘yes’ to the right things, we have to say ‘no’ to other things. Frankly, I never want to say ‘no’ to people or projects. This leads to overwork, fatigue and burnout.

In order to create the space for new opportunities, new ventures, new relationships and even new clients, there needs to be, well, space.

What do you need to say ‘no’
to so there is space for ‘yes’?

Here is a suggestion. Make a list of the activities that you have committed to – personal or professional. Estimate the time it would take to complete them all. Now, after you get over the shock of what you have committed to, begin to flag the ones that bring you love, money or joy. Then look at the ones that trigger anxiety. Do you have to do them? What would really happen if you said ‘no’?

Our profession can lead us easily to compassion fatigue. Please don’t let that happen to you. Stand up and say ‘no’ to the things that don’t serve you. I can almost guarantee that you will see new opportunities that you never saw before.

For me it will be saying no to tweaking the blog and saying yes to completing the writing of my new book, The Entrepreneurial Therapist.

What about you? What will you say no to? Please share in the comments section below.

Have you ever wondered why we cry at certain movies? Sometimes they are happy tears, often they are sad ones. How is it that we can get so involved with characters we don’t know such that within two hours, we are shedding tears for their fate?

I was asked that question by a reporter once. I came up with fancy-pants theories about family of origin issues and general cultural angst. But now I am rethinking it.

Artists use their skill to create responsiveness in their audience.

Art can amplify emotion and create great impact very quickly. But how do the artists create that intensity of feeling?

(Note: These are my notes from my conversation at TLC2010 with Jeff Zeig about his new interest and project, a documentary.)

Jeffrey Zeig, Ph.D. is the Founder and Director of the Milton Erickson Foundation, having studied intermittently with Dr. Erickson for more than six years.

Jeff spoke to us at the 2010 Therapist Leadership Conference about his current area of interest: How art amplifies emotion and creates impact. Currently, he is working on a documentary called: The Art and Science of Impact with Viktor Frankl’s grandson, Alex Vesely.

To get a sneak peek at this new documentary, please play the 3 minute video trailer below. Then let us know what you think!

(If you don’t see the video below, you can watch it at http://www.youtube.com/watch?v=R9zVieFzLd4)

Let me share what I learned from his presentation:

The deepest level of rapport we can have, not only with our clients but with our children, loved ones, and friends, is called attunement. It often is created and enriched by emotional experiences.

Jeff says, “There are moments when you want to amplify emotion — in therapy and in life.” He is examining how we can have greater impact in our work and in our lives by exploring how artists use their art to create greater emotional impact for their audiences.

For example, if you listen to the first 90 seconds of Beethoven’s Fifth Symphony, you hear the first four, very strong notes. These notes are followed by lighter notes – going back and forth and rolling into crescendos. These contrasts (again whether in life or in our sessions) evoke emotion and can have great impact.

Often times, we as therapists sit in the same posture – session after session – and speak with pretty much the same tone of voice. But imagine if you saw a classically trained Shakespearian actor, say Richard Burton, sitting on stage like a therapist saying in a soft voice while looking at the audience, “To be or not to be?” Would that have the same impact as he would have on stage moving around and saying those words in a strong voice with pointed gestures? (Not that I am recommending you do that in session, but it is an interesting thought when thinking about evoking emotion.)

Art is about amplifying emotions so Jeff is looking at art (architecture, interior design, choreography, music composition, painting and especially movie making) and deconstructing those arts into elements of impact to learn how artists amplify emotion.

For example, when you go to the movies, attunement is really important. The director needs to get you attuned with the film to get you interested in the story.  How does he or she do that? What are the auditory or visual cues or sequential techniques that help get you into the characters and feel your way into the story? If we look at how that is done, can we apply some of those techniques to our own work to create more attunement and create deeper emotional impact?

For the documentary, Jeff interviewed James Foley – an A-list Hollywood movie maker – who created 11 feature films including Glengarry Glen Ross. Jeff says, “I spent two hours with him going over the first five minutes of his movie, Perfect Stranger, with Halle Barry and Bruce Willis. The first five minutes are the title sequence. He showed me how he built attunement and created responsiveness with the audience – all in the first five minutes of the film.”

Imagine if we learned how to connect with our clients that quickly!

This documentary won’t be out this year but I have a surprise for you. I have the video trailer for this documentary which I will show you in a moment. I found it really interesting.

This documentary, again, is called: Art and Science of Impact. Jeff told me, “This project is about synergy. If we are to advance in our field, we need to do more than just immerse ourselves further within the field. Let’s look at other fields to see how they create attunement and impact. Then we can deconstruct it and apply it to our own work and relationships.”

Now – your turn …

What do you think?

Do you find that art evokes emotion?

Can you see how we easily attune with characters in a play or movie?

Might it be a good idea to see if we can deepen our level of rapport with our clients by studying how artists create emotional impact?

I look forward to hearing your comments. Please share them below in the comment section below.

In a graduate school business class, years ago, I studied “entrepreneurship.” This was about creating a business and selling products. At the time, I was a computer business consultant in Hartford, Connecticut, USA. I was considering starting my own computer consulting business and took this class to see entrepreneurship in the consulting business might be a good avenue for me.

Our first assignment was to break into groups and (on paper) create a new company and that company’s first product line. We had to come up with a “brand” and figure out how to manufacture, market, sell and distribute our company’s product line.

This was in the 1980s – nearly 30 years ago and a visible part of our culture were young people called “yuppies.” Yuppie was short for “young urban professional” or “young upwardly mobile professional.” Some people called them DINKs for “double income, no kids.” These singles and married couples in their twenties and thirties were bright, on the go people with much disposable income. The “yuppie” lifestyle was about having money, nice things and a lot of time to enjoy their life or career.

What my study group and I knew was that yuppies were a great target market. They had a lot of disposable income and were happy to spend that money on items of convenience.

My group designed a line of disposable, designer-looking, paper products. We called them “Yup-cups, yup-plates and yup-towels.” I lead the product design, branding, and marketing part of the project and loved it. Luckily others loved creating the manufacturing and distribution plans because when it came to those topics, I lost interest.

To this day, I can’t remember what grade I got in the class. Because the next 10 years of my career were shaped and changed by a different class assignment.

We were asked to take an “Are You an Entrepreneur?” assessment quiz. A high score on this test suggested that you will be successful and an entrepreneur. My score was very low and the comment was” Stay working for someone else. You do not have what it takes to be an entrepreneur.”

Whoa, I felt sad. I wanted to work for myself – choose my own hours and have that computer consulting business with clients I wanted to work with.

On the other hand, it somehow felt right. The idea of manufacturing and distribution and managing a hundred or a thousand people didn’t seem like my cup of tea. I took it as a sign that I would not be successful as an entrepreneur. I stopped dreaming of my own consulting business.

It took me about ten years of working for others (and deep soul searching) to understand. Then I got it! I was never going to enjoy owning a business that included a lot of manufacturing with dozens of people working for me. But creating a small business (a micro-business) with 10 or less employees (or even just me!) appealed to me. I wasn’t interested in creating a product driven business. I wanted to provide service to people – to have a service business.

Since then I have started three successful micro-businesses – including the computer consulting business, my therapy practice and my online coaching and training organization.

The moral of the story? Therapists in or who want to be in private practice are entrepreneurial by nature.

They love providing a service to others. They love to work for themselves, set their own schedule and choose their clients. I see this type of therapist as a specific kind of entrepreneur – you a “thera-preneur.” They do work they love with clients they adore and get paid for their service.

The Classic Private Practitioner is one example of thera-preneur.” It is a lovely model and one I have owned for 15 years and taught about for the last seven years. Most therapists start with the Classic Private Practitioner model. Most enjoy serving their clients this way for their entire career. It is wonderful to see how many of you have embraced this model so successfully!

As I have watched this warm, community of therapy-business owners, I notice that some therapists have decided to use their therapy skills and time in other ways to suit their passions and lifestyle. This is what is so nice about the service-driven business model. It is flexible in that you can design your business exactly as you want it. You can work in a way that serves you as well as your clients.

Many therapists added teaching, training, or coaching to their menu of services. Others added more clinicians to their practice and earned more income. Others decided to write books and gain instant credibility. Some decided to take up an important cause or issue and became the go-to person in their area. There are so many ways you can design your therapy-business in ways that support you, your family, your lifestyle, and your clients.

As I look back, I think that entrepreneurial assessment test wasn’t scored right for service-oriented entrepreneurs like therapists. Because therapy-business owners are entrepreneurs and a wonderful type of entrepreneur: “thera-preneurs.” They are very creative professionals. They are able to design how they deliver services and run their businesses to suit their passions, energy, business and lifestyle goals.

Not much has been said or written about all the options for running a therapy-business. I think you should have this information. That is why I am talking and writing about it now.

What do you think? Have you felt like an entrepreneur?

Are you interested in adding other services or products to your menu of services? If so, what would that look like?

Are you curious or have you thoughts about other ways you could use your therapy skills that would leverage your time – meaning make money beyond the “seat in the chair” therapy hours?

I would love to hear your comments, please leave them below. As you know I read and treasure every comment.

Finally, I am happy to be a part of this fabulous community of “thera-preneurs.” Thanks for the joy you bring into my life and into the world.

May you have the life and business you really want!

On the minds of many therapists are these two questions:

How can I increase client commitment to therapy? How can I make sure they don’t drop out of treatment?

At this year’s Therapist Leadership Conference, Bob Bertolino shared some interesting research related to how and why our clients get better. But first, here are some findings that can cause us to pause.

The average therapy client is 80% better off than the untreated (non-client). That is great news! But, look at this:

Since 1977, Bob reports that our therapeutic outcomes have not improved. In fact, the average client dropout rate – those who terminate prematurely – is 45-50%. This could be for a number of reasons, for example, there seems to be a lack of consumer confidence in therapy; they wonder if it really works. Furthermore, we as a profession haven’t taken strong stance in measuring/tracking outcomes.

Where should we be spending our times to improve client retention and outcomes?

Bertolino reports the common facts that influence positive treatment outcomes are as follows:

• 87% of client treatment success is due to the client. The means individual factors such as: his or her strengths, and the resources that the client has to tap into. Also, factors such as persistence and faith, and a sense of membership in a community are important predictors.  How the client uses these resources is a factor as well – as is the client’s personal level of motivation, and resiliency.
• 6-9% of positive outcomes come from the “therapist effect.”  This is the ability for a clinician to go in and connect with a particular client with methods that generate hope. The clinician sees herself (or himself) as an active ingredient to create change with this particular client.
• 5-7% is due to relationship alliance between therapist and client. This surprised me – I was taught this was the single biggest factor and today it is reported to account for only 5 – 7% of successful outcomes. Yes, positive outcomes start with  the therapist’s ability to create the alliance. Clinicians who are good at creating and maintaining therapeutic alliance are flexible and good at making adjustments as needed. Beyond that, most of the potential for outcome relates to the client and the above-mentioned client factors.
• 1-2% of outcome success is related to a specific therapy model and techniques. Bertolino suggests that before we take more classes in theoretical models, we find out how positive our clients see our/their outcomes.

The questions remain: What do we do to help people not leave treatment prematurely and how do we help them reach positive outcomes? In other words, how do we know that are clients are benefiting from our work? Many therapists will say, “I just know I am effective.” In studies, almost all therapists identified themselves as above average or exceptional. Statistically, we can’t all be above or way-above average as compared to our peers. So let’s figure out how to measure our success.

Research is pointing to the idea of clinicians using a “feedback measure” (which can be as simple as a checklist or a rating scale) given to routinely to the client. These type of feedback measures, can help reduce client dropout rate and improved outcomes by as much as 50-65%.

On the feedback measure, the client reports to the therapist how they are doing and how the therapeutic relationship is perceived by the client. You can see if the client’s functioning is going down or up. You can keep track week to week and look for changes that can pave the way for important clinical discussions.

Two such measures are offered by Scott D. Miller. He offers the “Session Rating Scale 3.0 (SRS)” designed to assess key dimensions of effective therapeutic relationships. He also offers the “The Outcome Rating Scale (ORS)” designed to assess areas of life functioning known to change as a result of therapeutic intervention. These feedback measures aren’t complicated – just four questions each.

These are generously offered at no-charge by Dr. Miller and can be downloaded here.

When we put the client at forefront (since 87% if the success is related to the client) and use feedback measures, it provides a plethora of information. We can notice a client’s score is less than last time and ask, “What does the drop mean? What can you do to help yourself this week?”  These measures allow us to connect deeper and be very helpful to the client.

In addition, a feedback measure done regularly can help identify a client with one foot out the door. During or at the end of a session, you can pause and ask, “I’d like to pause here and ask how it is going – are we talking about what you want to talk about?”

If there has been a therapeutic break, we can really hear the client and respectfully tell them we are sorry we missed it and address it with the client. Maybe with simply being asked and heard, enough repair has been done for the client not to leave treatment.

If you are wanting to improve your outcomes and effectiveness, you might want to consider a feedback measurement. There are many measurement scales out there. As I said, two of them are at http://www.scottdmiller.com/?q=node/6 These are very important too as many of you are building private-paying practices. Those clients reaching deep into their own pockets to pay for therapy sometimes tend to spread out their sessions or not come regularly. By using “feedback measures” this might change. (Let me know your results if you start doing this. I’d love to hear how they work for you.)

I can’t wait to hear your thoughts, comments and experiences in the comments box below.

As I close this article, I really want to thank Bob Bertolino for making all this easy to understand. If you’d like to connect with him, please do so at this website.

The bad guys are at it again with an email invading inboxes worldwide claiming that the user must reactivate their AOL online account within the next 24 hours.  I want to encourage you not to click on ANY links in these emails. These users who click on these links are asked to provide their email address and in return, are being sent viruses.

A good rule of thumb to help spot these emails is to check the email message for any mispellings, smaller text size and the email address the email was sent from.

Here is an example of this: in an email I received, the very bottom reads 2010 American Online. The actual name is America Online. Looking for small things like this will help you from these email bad guys.

Ben Saunders is not a therapist. He has a very big dream and plan. He wants to set the new fastest time (on foot and with no support) from the edge of the Arctic Ocean to the geographic North Pole. He is not a newbie to Arctic excursions. He is the youngest to ski solo to the North Pole and is known for completing the longest solo Arctic expedition by a Briton.

To help make the latest excursion possible, Ben recruited sponsors, which in a recession isn’t the easiest to do. He was turned down by many but persevered to get a few companies, including LandRover, who believed in his dream.

As Ben prepared for his excursion, he knew he would face thin ice, polar bears, and temperatures with the windchill as low as -70 degrees C. (-94 degrees F.)

Ben was dropped off at the edge of the Arctic Ocean on March 23, 2010 with the plan of completing the 478 mile distance within thirty-five days. Again on foot and with no support!

Just a few days in, there were catastrophic problems with his equipment. One of his fuel canisters was broken. The leaking Coleman fuel contaminated 70% of his food supplies. He now was low on fuel and food.

What now?

Ben weighed the options and while his desire to complete the distance was strong, his personal safety was more important. On March 30, he reported on his blog:

“For a number of reasons, some outside my control and some entirely down to me, I’ve decided to postpone restarting this expedition until the spring of 2010. Convincing sponsors, the media, the audiences I speak to, my girlfriend and my mum that solo expeditions without support over several weeks in one of the least hospitable places on the planet aren’t inherently reckless has at times been difficult. And while I suspect I have a healthier appetite than most for challenge, solitude, hardship and risk, outright danger is something I’ll go out of my way to steer clear of.”

What a powerful lesson in leadership for us all. Sometimes it is time to simply pack up and go home to regroup.

Over the last 35 years in business, I have acquired some guiding principles. Here is one: Both good and bad things will happen at times – sometimes for reasons you don’t understand. The key is to expect and accept them. Then you want to ask the question “What now?”

Your (and my) business income will fluctuate – perhaps during certain times of the year -  or even from year to year. Sometimes it is because of where we are in our own lives. Sometimes it is something that appears – like Ben’s leaky fuel container – outside of our control.

What does a ‘wealthy therapist’ (or ‘thera-preneur’) do when things aren’t going the way you want?

1. Assess the situation with clear eyes, mind and heart.

It is so easy to over-identify with one’s business. (Trust me, I know.) To make decisions that serve and support your business, it is important to see your business as a separate unit from you. When things are going well, a savvy ‘thera-preneur’ determines what is working and why. She looks at her metrics (income and expenses) and asks, “Right now, which of these expenses are driving income? Which aren’t?” She makes decisions thoughtfully.

2. Look for opport’unities to increase income that are new and fresh.

Pair an old idea with a novel approach. For example, instead of a community lecture, consider offering an interactive discussion night with a theme. If you are love working with singles, you could offer an “Understanding the Opposite Gender” group discussion one evening. The attendees write down questions they have for the opposite gender. You could start with asking one of the “men’s questions” to the women. Facilitate the discussion and then offer your own thoughts. Then switch to a “woman’s” question that you ask the male attendees. You could offer this at church singles groups or anywhere singles meet. Heck, you could even do it on a teleclass!

Or maybe you have thought of opening a training institute. Is now the time to do it? Why yes or why not? What about the book you’ve been thinking about writing? Imagine offering a several-session class where you write the book as you teach it. Find your way of creating more income by looking for or creating new oppor’tunities for yourself.

3. Know when to pack up, let go and move on.

Why do we cringe when we think about ‘failure?’ Each time we try something that didn’t work, we are closer to learning what does work. If you are like me, you have tried many therapy models before finding a favorite. You may have spent time with many supervisors, or clinical populations, or even business models before you felt successful. You are not expected to succeed at everything you try. If you learn when to let go (by assessing well) you are then able to move on to your next “big thing.”  Make sure you make space and time for it.

Earthquakes. Ship wrecks. Dangerous excursions to the North Pole. There is uncertainty all around. But in my heart, there is a flutter of excitement in uncertainty. The unpredictable can invite us to tap into our inner-innovator. We can look for new ideas and creative ways of implementing them. We can refine, repeat and offer fresh approaches to ideas that have worked before.

Above all and in spite of the uncertainty around you, please treat yourself with the utmost respect. You know best what is right for you and what you are called to do.

And now – it is your turn.

What situation would be a good one for you to assess now? If it is working, why do you think that is? If not, what does that mean?

Is there an activity in your business (or personal life) that simply needs to be stopped, shut down, or turned off? If yes, how might doing so help you find more time and energy for a more rewarding activity?

How might you use a fresh or novel approach to increase your income?

I thoroughly look forward to reading your thoughts and comments. Please share them posting in the comments below. I look forward to the dialogue. I read and treasure every comment.

And, for me? What now? Well, there is the new book. And, seriously, I can hardly wait until next spring as I follow the brave and smart Ben Saunders on his Arctic adventures. (He invited me to share this amazing photo with you.)

For some time I have been encouraging therapists and healers to think beyond the dots. How can you take your passion and actually change the world? As we know it starts with one person with creativity and an idea.

And sometimes innovation can seem odd in the beginning. I remember the first time someone showed me “post-its” – those small notes that have self-adhesive on the back. At first I thought no one would want them as they’d stick to the wrong papers and end up a mess. Wrong! Now they are an office supply staple for most of us.

Being a leader with a passion to make things better often requires innovation. It means standing alone at first – waiting for others to join you in the cause. It takes partnership with those first few followers to generate the movement.

Here is a playful yet powerful 3 minute video from Derek Sivers at TED2010  that shows how a “lone, dancing nut” can start a movement. Turn your speakers on and click on the play button below.( And a big thanks to Calgary therapist Christine Korol, for finding and sharing this video with me.)

I am interested in your story for my next book. This book is about therapists who have rejected the notion that therapists need to be poor. These therapists have embraced the entrepreneurial spirt and have businesses that successfully reflect that spirit. (I call you “thera-preneurs”TM)
For some of you, this means acknowledging your worth and contribution -  and charging accordingly. For others, it means embracing new business models such as:

* Creating multiple offices with therapists working for you

* Having a center with many pre-licensed therapists

* Starting a training institute (for therapists or for the general population)

* Opening a treatment center (in-patient or day treatment)

* Founding a non-profit organization

* Offering multiple streams of therapy income

* Creating a membership program

* Or finding other ways of delivering services that leverage your time and energy.

If you have a successful therapy business and want to share your story with my readers and me (and maybe be showcased in my book), please send us an email at Support@InTLI.com with your story. Specifically I am interested in knowing:

* Your business model

* What made you change from the one-to-one model to this model? Were you burned out?

* What has been the most rewarding part of this change for you?

* What has been the hardest?

* Do you think other therapists can do this?

* What have the results been? What does “successful” mean to you?

I am honored and look forward to reading your stories! I hope yours is selected to be in the book!

In 2003, the first Be A Wealthy Therapist website was created and launched. Back then, websites for many of us were big deals and I felt so “in the future” to have mine “on the world wide web.”  Here is our web banner from that first website:

(I still love the old tagline – Private Practice and a Big, Fat Bank Account – Yes You Can! But I can tell you – not everyone loved it!)

Fast forward to today – seven years later. My, how technology has changed. Now a 14 year-old  can get a website or blog up in a couple of hours.

Back then, our Be A Wealthy Therapist exhibit booth was shunned by therapists at conferences. People didn’t even want our no-charge training materials if they said “Be A Wealthy Therapist.”

When I finally sold one product at our exhibit booth, the purchaser asked us not to give her our specially printed Be A Wealthy Therapist plastic bag to carry the product. “I don’t want people to see those words,” she whispered to me as she glanced around to see who might see her at our booth.

Therapists have really grown as business people over these past seven years. While they have always been caring professionals and well-trained in the art and science of their therapy, those in private practice today have a much broader (and more comfortable) idea of the business of psychotherapy.

For example, seven years ago we didn’t talk much about money. Look where we are today.

Money is not ‘bad’ in our thoughts and vocabulary these days. Money is a measure of the value we put on our time and services. We are taking responsibility for our income in new and powerful ways. We set fees we feel good about. We choose reimbursement options that work for us. We see that money is both a clinical issue and an issue of good self care. I love the progress this represents for us as a profession.

And the future is very bright.

I see compelling business possibilities opening up for the ”business-curious” therapist. There are so many new ways to add even more meaning and money to our lives -  along with or beyond one to one sessions in private practice.

If you like, you will be able to create multiple streams of therapy income – everything from online products to opening multiple offices to starting foundations or non-profits to writing books.

These new options can be big or small but will give many therapists opportunities to bring into play more of their creativity, build some new muscles, and have a lot of fun.

Furthermore for some who are experiencing compassion fatigue, burnout or just a bit of boredom with seeing clients all day every day, these new pathways can offer new ways to use their skills and help bring more meaning into their lives and careers.

Now it is your turn. What do you think?

When you look back over the last seven years, have you changed in the way you think about money and earning a living?

Where are you being invited to grow more?

What do you see as the future for your therapy business? What would you love to do if your weren’t afraid and knew how to do it?

Please share your thoughts, comments or questions below or if you are reading this somewhere other than the blog, you can comment  there at http://InTLI.com/blog/2901/#respond. I look forward to the dialogue. I read and treasure every comment.

I am so excited about the upcoming Therapist Leadership Virtual Conference (TLC2010) that I had to make a new video and share with you who will be there and what you can learn. So sit back with a cup of coffee or tea, and spend 3 minutes with me…(Click the play arrow to start the video)

To see more of our presenters and their topics (along with some no-charge previews), please visit http://TLC2010.com