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These are your future clients. How do you think they are going to find you?

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Case in point – success with Google AdWords – or any pay per click service – depends on potential clients being able to find your ad. And that depends on your having the correct keywords in your keyword list. It used to be – way back in 2008 – that you had to pay $300 a year or more to get accurate data on which keywords people were searching for in your area of specialization. Now the same data can be found for no charge online.

I wanted to share with you the top 2 free keyword tools:

Google Keyword Tool

SEO Book Keyword Tool

With each of these, you can just type in a keyword such as anxiety, or couple counseling, or teen problems, and get the exact number of times that keyword was searched for in the past month. But even better, you get the related keywords.

For example, if you research the keyword phrase ‘couple counseling’, you learn that it was searched for 18,100 times last month in the US. That’s a pretty high search count. But you also learn that simple added an s to couples – for ‘couples counseling’ – increases the number of searches to 49,500, over twice as much! Then you find that ‘marriage counseling’ was searched for 368,000 times, way higher than any form of ‘couples counseling’.

This data is invaluable for creating a successful pay per click campaign (and for search engine optimization on your website as well). And it’s also why you should be wary of the services now being promoted to sell you just one keyword for a flat rate per month. It’s very difficult to succeed in pay per click adverting with only one keyword (most people get 1 new client in their office for every 70-80 clicks, and you typically won’t get that many using only 1 keyword).

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The reasons for this are fourfold:

• blogs work best when posting strong opinions, and many health care providers (especially psychotherapists) don’t want to reveal too much about their personal positions on issues that may affect treatment
• unlike politics, news and technology blogs, healthcare blogs don’t tend to have enough ongoing, compelling information to get lots of people to subscribe to RSS feeds
• most healthcare providers don’t have the time, money or expertise to promote their blog enough to drive significant traffic
• blogs (and micro-blogging superstar Twitter) work best as a B to B (Business to Business) medium, not B to C (Business to Consumer).

Obviously there have been some healthcare blogs that have been very successful (see Dr. Joseph Merkola’s blog for example), but this type of blog is not focused on one provider’s practice, but rather on a range of related products, services and information.

Healthcare needs – especially those that can be treat outpatient – tend to be focused in time, and once the presenting problem or issue is resolved or treated, people are unlikely to revisit a blog or website unless there is a related range of services that continue to appeal to the person. People’s time and attention spans are just too limited to stay interested in a provider’s thoughts once a problem has receded into their past.

Better strategy? Build a list (SEO, PPC ads, Social Media) so you can, with permission, contact your list consistently over time with useful information that they care about.

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1) I don’t know enough/I should know more about the techniques/theories that are hot in my field now

and

2) If I just did one more training within one of these hot specialty areas, then I would get all the clients I need.

This is a fallacy for several reasons. First of all, most people who have been in any field for at least five years know a lot more than they think. While you should always update your technical skills, competency is rarely the biggest problem in creating a successful practice. Secondly, if you don’t know how to market your services, the greatest training in the world still won’t get you more clients.

Ten years ago I took a terrific training on how to deliver a certain type of psycho-educational workshop. There were 18 people in my training. I kept in touch with the trainers and the people who were trained. After six months, I had done 2 workshops that brought in a profit after expenses of $4400. Not a great result, but one that more than paid for the training almost immediately (since then the same workshop has brought in over $75,000 in profit, as well as leading to numerous referrals for other services). Of the 18 people in my training, 16 had not put on one workshop in six months, and probably never will. 1 person did put on a workshop that brought in 3 clients for a total of $630.

Now the training was excellent, and we were put on a national website that we thought would get us a lot of referrals. It didn’t. When everyone got back home, they were excited but didn’t have the first clue where to start. Where do I get participants for the workshop? Where do I hold it? How much do I charge? How do I know how big a room to reserve if I don’t know how many will show up?

So don’t fall for this trap. Yes there are many superb clinical trainings available today, and your skill as a practitioner would definitely improve if you took some of the trainings (and unfortunately, some trainings are setup more to pad the trainers’ bank account than add to your skill base). But don’t confuse an increase in technical skill with an increase in referrals. Technical expertise is a necessary but not sufficient condition for success.


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I paused for effect, knowing what I was about to reveal. “What’s your average fee per session?” I asked. “$135″ he said. “What is the average length of treatment before termination?” I asked. He said 8 to 12 sessions. I said, “Ok, let’s be REAL conservative and say it was only six. Multiply 6 x $135 and the average value of every referral you get is $810. Mutiply that by 13 and let’s see if that $600 was worth it.”

There was a long silence at the other end of the line. 13 x $810 = $10,530.  So for every dollar he spent on AdWords, he made over $17! That’s a phenomenal result, better than most people get with pay per click ads.

“Gee, Joe, I was about to cancel the account!” he sheepishly recounted.  I couldn’t resist and told him my recommendation: Increase your monthly budget!!! He said he couldn’t do that yet, but would keep tracking the results.

* * * * *

This illustrates a fundamental problem for many healthcare providers. Any amount of money seems like too much to spend. So calculate your Lifetime Value of a Referral, and carefully track the results of  your marketing efforts. You just might be very surprised…

1. Specialize – having a specialty always works better than trying to be a generalist. You need to create a “brand”, a perception in the eyes of the community that you are an expert in one area. We’d be very suspicious of a medical doctor who claimed to be an expert in surgery, internal medicine, urology and neurology. Yet we see advertisements for counselors who claim to treat 10-15 different presenting problems. The fear is that if you specialize, you’ll lose other referrals, but the reality is just the opposite: the most successful clinicians are the ones with a specialty.

2. Study Business and Marketing – being a great clinician is a necessary but not sufficient condition for private practice success. In fact, a mediocre clinician with great marketing skills will always outperform a great clinician with poor marketing skills. Whether we like it or not, we are small business owners, and subject to the same market forces as any other small business in our community. Why do 80% of small businesses fail within five years? Michael Gerber, author of the E-Myth says it’s because being good at delivering a technical service doesn’t mean you know anything about running a business. They are entirely different skill sets, and we’re not born knowing how to do either one. By studying Business and Marketing, I was able to grow my half-time practice to a group practice with nine therapists.

3. Set Specific, Measureable Practice Goals – many therapists say “I want more clients”, rather than setting specific goals. Specific, measureable goals enable you to develop specific plans to reach your goals, and to track how you’re doing. “I want 5 new clients a month, and 25 per week on my caseload” is an example of a specific, measureable practice goal.

4. Create an Online Presence – in the 21^st century, it’s very difficult to succeed without having an online presence that can be found in a local search. Over 80% of people seeking professional services start looking online, and if you do not have an online presence, you will miss out on all of these referrals. Many successful practices are now getting 50-80% of their referrals from online sources. A website is the cornerstone of creating a successful online presence (my article in the March/April 2009 Psychotherapy Networker outlines the most essential steps for creating a successful website).

5. Create a Plan to Generate Referrals – it’s mere wishful thinking to set a goal if you have no plan to reach it. The use of Business and Marketing Plans can serve as a valuable guide in delineating the specific steps necessary to reach your practice goals. If you want 5 new referrals a month, you need to make a plan to specify exactly what you are doing to generate those referrals. Advertisements? Online profiles? Past clients? Other clinicians? How exactly do you plan to promote your practice, and how many referrals will come from each source?

6. Take Small, Calculated Risks – every successful private practitioner is someone who has tried something new, and failed numerous times! The only insurance in private practice is to generate referrals from a diverse set of sources, and it’s only by trying new things that you discover which ones will work in your community and your area of specialization. So do small, inexpensive tests of different referral-generation strategies; expand the ones that work and discard the rest.

7. Carefully Track Your Results – it’s only when you know exactly how your efforts are working – or not working – that you can continuously revise and improve your plans for your business. If you spend money on an advertisement, for example, record exactly how much you spent and how much income the ad generated. Keep track of every referral – where they came from and how they heard about you.

8. Get Support – private practice can be a lonely endeavor if you don’t make the effort to reach out and connect with others. In addition to professional organizations locally, you can also have regular lunch meetings with other colleagues in private practice. There are also numerous online groups and forums that offer the opportunity to share private practice success strategies.

Private practice can be an extremely rewarding career choice if one learns how to do it successfully. I know many clinicians all over the US will full practices who have utilized these eight steps to success.

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Many self-help gurus like to say we are unconsciously blocking manifestation with our negative, limiting beliefs. This may be so, but it’s very hard to prove other than in cases of extreme whininess, crabbiness and general all-around negative disposition. For the rest of us, our visualizations and affirmations may need help from the material world.

I suggested to my friend who wanted to sublet her office that she might place a classified ad in the state social work newsletter or on Craig’s List. She did and got someone in 2 days. While this may seem like an obvious example, the same principle applies to more subtle aspects of manifesting clients, money, or other goals.

It would be nice if all we had to do was think about something, and it would come to pass. But for most things, that’s just a childlike fantasy.  No harm in trying it first – but if it doesn’t manifest after a certain amount of time, you may want to try a formal Business Plan. As long as we are living in the physical, material world, there will always be an element of time and space required for manifestation. Planning the steps, one by one, that lead from your vision to the manifestation of your goal will greatly increase the odds that your vision will indeed show up in your life exactly as you wish.

But I realize that not everyone is in that situation, so I wanted to offer some suggestions for strategies to apply when your clients express concerns about fees, copays or therapy in general:

1 – you don’t have to see people every week! Consider less frequent sessions, since most people have a monthly amount in mind that they are comfortable with

2 – start a group – groups require lower fees and yet your fee as the therapist is usually greater per hour vs. therapy sessions

3 – help your clients get reimbursement when possible – go the extra mile and let them know you understand they are concerned about money right now. Call their insurance company for them and ask about in or out of network benefits, since they may not know the right questions to ask to get reimbursed

4 – expand your referral sources – this is the time to expand your reach, both in the local community as well as online. Recessions are often times when new relationships are forged – your new referral sources are experiencing the same thing you are and may be eager to expand their network of influence as well

5 – generate new therapy prospects by offering free or low-cost lectures – the most expensive, time-consuming thing is to get someone in your office the first time. Make it easy for that to happen by offering quality information at a low price, and overcome people’s initial resistance to working with you. Let them see how much you know and how approachable you are. Make an easy bridge to therapy from that lecture.

These strategies can help you maintain your numbers even when the mass psychology of the country has people tightening their belts.

This is an example of shabby business practices. The message to the potential client is that you don’t care and/or you’re not important. So before you say “But Joe, they were busy!”, realize what it’s like on the other end. It feels like you don’t care, like it’s not important, like you could take it or leave it. None of these may be true, but that’s what I found myself thinking.

More importantly, recognize what it’s like on the other end when you respond the same day: Wow! This person is efficient. This person cares. Surprise is the typical response, which is always a good thing. You have exceeded their expectations before you even make contact.

Also, when you respond promptly, you benefit from the well-documented social psychology ‘primacy effect’. You’re in the lead, way ahead. You only get one chance to make a good first impression. Don’t blow it. Create systems that allow you to respond very quickly, despite a busy schedule. You’ll never know how many clients you lose if you don’t do this consistently.