Private Practice Made Simple

4 02 2012

My review of “Private Practice Made Simple” by Randy J. Paterson, PhD:

Private Practice Made Simple front cover

There are plenty of books and websites out there offering advice to mental health professionals who want to know how to establish their own private practice. With this new release Randy J. Paterson, PhD offers his own comprehensive take on this popular topic, promising to provide “everything you need to know to set up and manage a successful mental health practice,” from “getting client referrals and creating a positive and comfortable office atmosphere to building a strong and thriving therapy practice that can serve both you and your clients.”

As the 2008 recipient of the Canadian Psychological Association’s Distinguished Practitioner Award, and the owner of a private multiple-provider outpatient practice in Vancouver, Paterson certainly seems to write with a wealth of personal experience in this area. Indeed, what differentiates this book from so many of the others available on the market is that personal touch, as Paterson shares his own journey into private practice, and the lessons learned along the way, explaining that:

No one really teaches you how to manage a mental health or counseling practice. As clinicians we stumble through our careers, gradually picking up shortcuts and strategies that make our lives (or those of our clients) a lot easier. Many of these useful ideas aren’t rocket science and could have been taught to us in an afternoon if anyone had thought about it. That’s what this book is for: it’s nothing more than a collection of useful basic tips … The emphasis of the book is on quick and easy strategies that can save a lot of headaches.

This light, conversational style typifies Paterson’s everyman approach to the topic, ensuring that the book is easy to read and full of accessible ideas for anyone contemplating the possibility of working in private practice.

While some other books might launch straight into the practical side of running a private practice, Paterson predicates this by starting his book with a chapter focusing on the importance of weighing up the pros and cons of running this kind of business in the first place. Paterson lists his ten most frequently-heard arguments both for and against private practice, and I can guarantee that any mental health professional will be able to relate to at least some of this debate.

The arguments in favor are listed as:

1. No Big-Organization Hassles
2. Getting Away from the Medical Model of Distress
3. Increased Accessibility for Clients
4. You Get to See Whom You Want
5. More Money
6. Supplement Your Salaried Income
7. Flexible Hours and Holidays
8. Work Fewer Hours
9. No Commute!
10. A Service Based on Your Own Vision

Whilst the arguments against are:

1. You’ll Never Get Clients
2. You’re No Good at Networking or Marketing
3. Uncertainty About Income from Month to Month
4. You Hate All the Clerical and Business Demands
5. You Don’t Know Enough to Practice Independently
6. Dealing with Fees will be a Huge Hassle
7. You’ll be Helpless in the Face of Insurers or Funders
8. No Retirement Plan or Benefits
9. You’ll Burn Out and Won’t Have a Safety Net
10. You Won’t have a Sense of Meaning in Your Work

Paterson follows this up with a considered appraisal of what is truly involved in the day-to-day running of a successful private practice, and then allows you to make up your own mind as to whether you’re really suited to this type of business. Assuming that you are, this book then serves as a comprehensive guide to everything involved in setting up and maintaining your practice, from such subtle nuances as the ‘olfactory environment’ and placement of clocks, to website design and finance tips.

As Paterson says, many of the ideas in this book aren’t rocket science, and might initially just seem like common sense, but don’t let this be a deterrent. As you make your way through the book you’ll realize there are also countless suggestions here which will leave you wondering “Why didn’t I ever think of that before?” and feeling enlightened. One such example is the section on ‘The Client’s View,’where Paterson explains the importance of the contents of the therapist’s bookcase:

Look at your own bookshelf from the client’s position. Notice where your eye naturally falls. These are the most salient shelves. Banish books that imply you are having significant problems yourself (Avoiding Burnout, The Wounded Healer), your introductory psychology textbooks, the trashy novels you secretly read at lunch, the books on handling problem clients, the self-help books you wouldn’t recommend to your worst enemy, and all the books on managing the finances of your private practice (including this book). Shift those books upward or downward, and replace them with scholarly books on your specialty areas of practice, books on diversity, a book or two on sexuality (this subtly gives clients to put such issues on the table), the self-help books you most frequently recommend, high-level books on practice and therapy, and other books that communicate your expertise, interests, and breadth of knowledge.

Once you’ve thought about it this seems so obvious, but I have seen plenty of counseling rooms where this advice had clearly been sorely missed, and where business may have suffered as a result.

It is these kinds of subtle tips which can make a huge amount of difference to the way a private practice is run, and which might distinguish an outstanding business from a mediocre one. Having all of these ideas listed in one simple book is truly invaluable, and will surely offer numerous benefits to anyone in the mental health profession. I couldn’t think of anything which Paterson had missed from this book, and he even includes a link to free downloads of practice worksheets and sample forms to help you on your way. If you’ve ever considered setting up a private practice, or you’re running one already, then this book’s for you.

3 out of 5 stars.

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Spent: Sex, Evolution, and Consumer Behaviour

14 06 2011

Here’s another recent book review. “Spent: Sex, Evolution, and Consumer Behaviour” by Geoffrey Miller.

Spent: Sex, Evolution, and Consumer Behaviour

In his new book Spent, leading evolutionary psychologist Geoffrey Miller takes us on a journey through modern consumerism; explaining how and why we choose to buy the things we do, and what these choices say about us, both as individuals and as a society. Approaching the issue from a systemic perspective, Miller looks at the ways in which marketing concepts have permeated mainstream culture, suggesting that we now live in an Age of Marketing which marks a “decisive power shift from institutions to individuals”. Miller explores the numerous ways in which this power shift has impacted human behavior, from the hidden instincts behind our shopping and spending, to the traits we value most in our romantic partners.

“Marketing is not just one of the most important ideas in business. It has become the most dominant force in human culture.”

As a Marriage and Family Therapist, I have to admit I was initially a little reluctant when faced with reviewing this book, which ostensibly seemed to be a study of market forces and economics; but I needn’t have worried. Spent is a fascinating study of human behavior, using consumerism as the starting point from which to explore the evolution of human psychology and the ways in which we have all become consumers, even in our private lives. Miller’s book is written in a style that will appeal to anyone who is interested in these topics, and it doesn’t require any kind of previous knowledge or expertise:

“You don’t need to know much about psychology, beyond what you already know about people. You don’t need to know much about consumerist capitalism, beyond what you already know about shopping. In fact, the less you’ve been taught about traditional marketing and economics, the fewer misconceptions you’ll have to overcome.”

As well as being accessible and easy to understand, Miller’s writing style is engaging and humorous, and he frequently peppers his prose with amusing personal anecdotes and pop culture references. I quickly found myself deeply entranced in the book, eager to keep reading, and fascinated by all of the facts he revealed in each chapter.

In fact, the more I read Spent, the more Miller’s insights into human behavior reminded me of the work therapists do with their clients; trying to identify the driving forces that lead us towards the choices and decisions we make for ourselves, throughout our lives.

“Marketing’s empiricism works like Rogerian psychotherapy, in which the therapist restates and reflects the patient’s concerns. Marketing holds up a mirror to our selves, reflecting our beliefs and desires so we can recognize, remember, evaluate and transform them… It allows us to accept or reject potential ways of displaying our traits through our product choices.”

Miller suggests that there are six main personality traits (known as the “Central Six”) which all of us display as a means of “taste-signaling”, and which we also all assess when evaluating potential partners, as a means of “social screening”. These are: intelligence, openness, conscientiousness, agreeableness, stability, and extraversion. He goes on to analyze each of these traits in detail, explaining how we “market ourselves” to others, primarily as consumers; by supplementing each of these traits with a specific choice of product, brand, or lifestyle choice, according to our own individual tastes. Marketing enables us to establish our preferred identities by aligning ourselves with certain choices, and we make these choices in order to impress others; as a means of establishing our status and attracting potential mates. These choices are known as fitness indicators:

“Fitness indicators are signals of one’s individual traits and qualities that are perceivable by other individuals.”

The irony of this, says Miller, is that we already have these indicators within us, as inherent traits, regardless of consumerist capitalism:

“The most desirable traits are not wealth, status, and taste – these are just vague pseudo-traits… Rather, the most desirable traits are universal, stable, heritable traits closely related to biological fitness – traits like physical attractiveness, physical health, mental health, intelligence, and personality… Consumerism’s dirty little secret is that we do a rather good job of assessing such traits through ordinary human conversation, such that the trait-displaying goods and services we work so hard to buy are largely redundant, and sometimes counterproductive.”

This is the central message of Spent; a timely reminder that the obsessive capitalist demands to which we constantly subject ourselves are not only unnecessary, but also often unhealthy.

“We humans have already spent millions of years evolving awesomely effective ways to display our mental and moral traits to one another through natural social behaviors such as language, art, music, generosity, creativity, and ideology. We can all do so without credentials, careers, credit ratings, or crateloads of product… Runaway consumerism leaves us feeling superficial and empty, because we project ourselves outward to observers too promiscuously and desperately.”

So, having identified this painful cultural phenomenon, how do we eschew these unnecessary values which capitalism has taught us; how do we rid them from our private lives? Far from suggesting that we go back to living like our Cro-Magnon ancestors, Miller concludes his book with several chapters on this topic, with numerous ideas on how we can improve our quality of life, not just as individuals, but on a wider societal level, too. Miller’s suggestions range from simple changes to our consumer habits (such as buying locally or second-hand, or even making things ourselves), to having our personality traits tattooed onto our bodies as clearer fitness indicators for potential partners. He also supports the concept of a consumption tax – whereby every product or service is priced according to its ecological footprint and impact on the environment – and the idea of restructuring the ways in which we build our communities, so that likeminded people can choose to live together, based on shared common interests and ideas, rather than for economic reasons alone.

Sure, some of these ideas may seem a little far-fetched or idealistic, but we have to start somewhere, and Miller’s crusade is a noble one. He concludes by asserting that the best method of implementing any change within society is by changing our informal social norms, one at a time; the unspoken rules which we all take for granted, at a local level. We could all do a lot worse than to live by Miller’s suggestions, and for those who may want to take things even further, Miller provides some exercises for the reader, and a booklist for further reading.

Spent is an entertaining and fascinating read, and I would highly recommend it to anyone with an interest in human behavior or evolutionary psychology. Miller’s explorations of consumer behavior caused me to completely reassess even the most mundane choices I make every day, and the things these all say about me; including my music playlists, the video games I play, my personal fitness, my Facebook page, my choice of friends and partners, and even the bumper stickers I put on my car. Whatever your background, I guarantee that Spent will make you re-evaluate some of the assumptions you had previously taken for granted about your own lifestyle and behavior traits. And you’ll never play The Sims in quite the same way again.

5 out of 5 stars.

Not only did I thoroughly enjoy the book (as you can tell by my review) but I think Miller raises some important issues relating to culture and wellbeing, as well. Many of my clients often come to me saying they feel dissatisfied with their lives – tired of working too many hours, worrying about finances, feeling cut off from family or friends, and like something important is lacking – but not knowing how to escape the cycle. Miller’s book shows us how the cycle is very much one of consumerism and spending, and our culture’s tendency to binge and purge, as a way of making ourselves feel better, or of rewarding ourselves for ‘being good’. I always see products advertised as ‘Treats’ or telling us that we ‘Deserve it’ and I think about the underlying message that this sends: that we cannot be intrinsically Good unless we consume. No wonder so many of us feel lost or worthless! Fortunately, it doesn’t have to be this way. True happiness lies within, and no amount of material goods or wealth can ever change that.

If you or someone you know is struggling with anxiety, depression, or financial worries, and you want to find that inner happiness for yourself, I can help. Don’t wait for that change – make it happen now!





Saying No To Naked Women

28 05 2011

I thought I would share some of my book reviews on this blog, as they do contain some interesting themes.

I’ll start with my review of “Saying No To Naked Women” by David R. Yale:

Saying No To Naked Women

In the summer of 1974, Jack Derritt leaves the city and all of his material possessions behind and heads out to the Arkansas countryside, to live in a shack and take stock of his life. Tired of meaningless flings and constant feelings of misery and self-doubt, Jack wants to figure out why he’s never been able to find a stable, loving relationship, and why he never feels good enough for anyone. He asks himself: “Why is there a throbbing hurt inside me that never leaves?”

This is the opening to David R. Yale’s “Saying No To Naked Women; the story of one man’s struggle to free himself from porn values and sexual addiction”. With Jack’s story as an example, Yale’s novel shows us how our childhood fears can continue to haunt us as adults, manifesting themselves as self-doubt or insecurity, and preventing us from living fulfilling lives or maintaining loving relationships.

As Jack attempts to settle in his new home, he comes to realize that there is no escape from his inner monologue, which is often delivered in his father’s voice, constantly reminding him what a failure and a disappointment he is.

“I’ll never produce anything worthwhile. No woman will ever want me – once she sees my terrible faults. I’ve managed to fool people, but they’ll see: I don’t know what I’m doing. My father is right. I’m a parasite.”

We learn that Jack’s parents were Orthodox Jews and Marxists, and that Jack was raised in a climate of fear and secrecy, and taught to hide his identity. His parents never told him they loved him; instead they made him feel inadequate, and different from the rest of the world. The legacy of the Rosenbergs hung over his head, as a reminder of what might happen to his family if their religious and political beliefs were discovered. It’s these feelings of fear which continue to haunt Jack as an adult, as he remains convinced that he’ll never meet anyone who could possibly understand or value him for the man he is, and that he must always conceal his true self if he wants to be accepted.

Jack seems trapped in a spiral of loneliness, depression and paranoia, and at times this can be frustrating to read. Yale’s story takes a while to get going, and his pace is slow to start with. He focuses closely on setting the scene and building up the characters, but it is not always clear where this is leading, or to what end. Readers who find themselves struggling through the first half of this book should be encouraged to persevere, as the second half rewards us with plenty of valuable lessons and the denouement contains a powerful and important message. Yale’s prose is engaging and easy to read, and I found myself deeply involved in the story, once I had decided to stick with it, past the uncertain beginning. After around 200 pages, the story finally takes an interesting twist, as the solution to Jack’s torment begins to unfold.

One day, divine intervention strikes: he gets stung by a bee in the woods, and the resulting adrenaline shot sends him into a feverish dream world. In this dream world, Jack is visited by a mystical mentor, in the form of a Chassid, who begins to lead Jack through a number of conversations and sessions of immersion therapy which transform his way of thinking about himself and others.

This exposition is somewhat reminiscent of “A Christmas Carol” by Charles Dickens; just as Scrooge meets the Ghosts of Christmas Past, Present, and Yet To Come, so too must Jack accompany the Chassid on a journey through his childhood, a summary of his present life, and an enactment of what the future might be like if he continues along his current path. Yale’s novel is a Dickensian fairytale for the modern age, demonstrating the ways in which childhood fears and insecurities can leave many men struggling with the porn values and sexual addictions that are so prevalent in society today.

Jack comes to realize that he views sex as a form of validation. He tells the Chassid, “I feel like there’s something wrong with me if I’m not having sex on a regular basis.” The Chassid then helps him see how this is connected to his childhood, and he how can end this cycle:

“Some of your anger was at your Dad for not teaching you how to be a man?”
“Yes.”
“And you turned that anger against women – the more frustrated you got the angrier your fantasies got?”
“Damn! What do I do now?”
“Learn how to communicate your feelings to women.”

The Chassid requests that Jack repeat a mantra: “I define myself. I do not let others define me. I do not let my parents define me.” Through this mantra, Jack begins to understand that his parents do not control him any more, and that he is able to live his own life. He begins to let go of the fear and secrecy he learned as a little boy, and to set himself free of the doubt and anger that have controlled him for so long.

“You must affirm yourself… Every time you think a negative thought about yourself, you have to confront it, and contradict it… You can’t deal with yourself the way your parents treated you. I forbid you! When you find you’re making harsh, critical judgments about yourself, stop! And then affirm yourself.”

Through these teachings, Jack is finally able to forgive his parents for their shortcomings, and to uncover the happiness and confidence he has always longed for. He begins to feel accepted by others, and understands what it takes to have a healthy and fulfilling relationship; knowing that the sexual fantasies and flings of his past were just a repeat of the anger and confusion he felt as a child. Finally, by the time he awakes from the dream world of the fever, Jack has learned to integrate the Chassid’s teachings into himself, as an alternative to the voice of his father, which once ruled his thoughts:

“I’m sure not used to thinking strategically like this. It’s a new experience.”
“Do you like it?”
“It makes me finally feel like I have power over my own life.”
“Even without the Chassid?”
“Yes. But maybe the Chassid has become part of me.”

Yale’s novel teaches us that we must understand, forgive, and honor both ourselves and other people in order to find happiness, and that, instead of holding on to our anger, living well is often the best revenge of all. Jack’s story is one that many men will be able to relate to, and the teachings of the Chassid will no doubt resonate with them, too.

One criticism I have, though, is that the book seems unsure of its audience. As a fictional novel about a man setting off into the wilderness to reflect on his life, the book might initially seem to fit alongside classics such as Thoreau’s “Walden”, Kerouac’s “Lonesome Traveler”, Pirsig’s “Zen and the Art Of Motorcycle Maintenance”, and Krakauer’s “Into The Wild”. However, what separates this book from those (including its misleading title) is the suggestion that it is some kind of self-help manual. The back cover suggests that this book “unlocks invisible behavior patterns you must understand to solve personal troubles and identify problem people”, and this certainly seems a little far-fetched.

As a systemic marriage and family therapist, I enjoyed reading about the Chassid’s immersion therapy techniques, and recognized the narrative therapy methods employed to help Jack re-write his own story and take control of his life. I’m sure many readers will benefit from Yale’s suggestions of how to find happiness and overcome the demons of the past. But, while these techniques may work well for some, suggesting that this book could serve as a universal guide to love and happiness seems a little extreme. Those who are simply looking for an engaging fairytale about a man in the wild, on a journey to self-fulfillment, will find that this is a story worth reading. It won’t appeal to everyone, but this is a worthy book, and one that should be recommended to anyone struggling to find love as a consequence of painful childhood experiences.

3 out of 5 stars.

In addition to my review, I’d like to add that I agree with Dr Thaddeus Birchard, an expert in sexual compulsivity and addiction, who states that “sexual addiction, like any addictive substance or process, is a response to the pain and distress of narcissistic damage. All addictions have a common underlying psychobiological process. I think of narcissistic damage as the outcome of a disturbance in attachment. The function of an addiction is therefore to anaesthetize the subjective distress created by the narcissistic damage.”

In other words, sexual addiction often forms as a means by which to avoid dealing with the pain that is caused by attachment injuries from the past. And it is only by identifying and resolving these injuries -through successful therapy sessions – that the addiction can be truly cured.

If you currently suffer from sexual addiction – or are in a relationship with someone who you suspect may be a sex addict – I can help you with these issues. Don’t wait for that change – make it happen now!





The internet, relationships, and the benefits of having a tech-savvy therapist.

15 04 2011

Although researchers continue to constantly explore the myriad of ways in which modern technology impacts our mental health, many mental health professionals still seem uncertain as to how to broach this subject or incorporate it into their clinical practice with clients. Increasingly, it is vital that counsellors stay up to date with the latest technological developments and gadgetry, so that they can be aware of the effects these may have on their clients and their relationships.

As a modern, systemic psychotherapist, I like to think of myself as pretty ‘tech-savvy’ too. I am consistently aware of the possible role technology might play in the lives of my clients. Be it smartphones, Android devices or iPads, technology has significantly changed the ways in which we interact with one another, and also shifted the boundaries of sexuality and intimacy. Explicit sexual materials are easily accessible online, and ‘digital infidelity’ and porn addiction are now problems in many marriages.  ‘Emotional infidelity’ is also becoming more and more common, as people explore intimate secrets which might have, in the past, been reserved for face-to-face time with their partner – or remained undiscovered altogether – through sexts, forums, chatrooms and webcams, with relative strangers. This article in the Huffington Post even goes so far as to suggest that modern couples should change their wedding vows to “until Facebook do us part”.

Similarly, this viral YouTube video suggests that Facebook may contribute to rising levels of depression, as it encourages us to constantly compare ourselves to others, or become competitive with people we barely even know (it’s somewhat ironic that the video spread so well across Facebook itself, though).

Furthermore, this recent story on USA Today suggests that social media websites can be bad for our children, too; exposing them to cyberbullying, depression, and inappropriate content (although Facebook has recently added a ‘suicide-alert’ utility to help identify those who may be at risk).

So, if this is the case, we don’t we all just shut off our computers for good?

Well, the answer is simple: the internet has a lot of advantages, too. It can be an incredibly unifying place for many people, not only as a great networking tool for businesses, but also a hub of infinite connections across the world. More and more of us meet our partners online; either through shared interests, online communities, role-playing games, or the plethora of dating sites which promise to help us find our perfect match if we just answer a few simple questions. Forums, chatrooms, memes and viral videos can help to create a sense of community, particularly for those of us who may not be able to find it elsewhere. If we’re seeking advice, information, or like-minded people, the internet offers us a unique opportunity to feel connected to others, no matter how far away they might be geographically. Social networking ensures that we all feel more connected than ever, to our colleagues, our acquaintances, and even our favourite celebrity Tweeters. And text messages, emails, Facebook and Skype all ensure that we need never lose touch with our friends and loved ones.

A lot of this is often overlooked, as it is easy to just point the finger and blame technology for modern woes, and remember the mythical ‘good old days’ when everything seemed so much simpler.

I believe that we should all keep our computers running,  and that the internet holds a lot of benefits for us all, both as individuals, couples, and families, as long as we remember to invest plenty of time and effort in our real lives and face-to-face relationships, too. Ultimately it is those that are the most rewarding and the most important. I believe that ‘everything in moderation’ is a healthy motto, and that the internet can be a great source of fun, facts, and friendship, as long we don’t let it turn into an addiction or an obsession.

In addition, I’ve had many clients roll their eyes wearily when I suggested they keep a paper journal or write something down, only to see them light up with excitement when I recommend using an online journal or creative writing website instead. It’s just a fact that the keyboard is sometimes easier to fit into our daily lives that the old fashioned pad of paper.

So, if you’re a client looking to see a therapist, don’t overlook the benefits of having a tech-savvy counsellor. I’m not saying it’s a necessity by any means – in fact, it shouldn’t really matter, if your therapist is good at what they do – but it can be nice to have a counsellor who knows the ins and outs of your situation and can really relate to what you’re talking about; particularly if the issue you want to discuss is directly connected with technology or the internet.