Not like sexy-controversial or appalling-controversial, don’t get your hopes up. This is going to be nerdy, business-divisive because I’m going to say the opposite of what a lot of practice-builders encourage you to do.
I’m going to start off with: Maybe I’m wrong. Maybe I need to get with the times and maybe I’m a little old fashioned. I’m still mulling all of this over and am not quite ready to soapbox this but am ready to ask questions to get you thinking and tell you where I stand 95% of the time I’m thinking about this.
I got a request to write a blog post from a clinician building her practice. She’s a clinician who has done her homework. She follows a number of practice-builders and is not interested in reinventing wheels. I love people who have a voracious appetite for learning. And now I’m going to punish her by confusing her, and probably you if you’re one of those info-hungry people.
The question she very innocently asked was what content would be most helpful for her 5 email auto-responder series. Auto-huh? An auto-responder series is a sequence of emails that goes out to anyone who signs up for your email list. For instance, you signed up for my email list when you gave your email for either the Tasky, Confidence-Building Checklist, the video series available exclusively during the launch of this round of groups, or for the networking infographic I shared with folks who listened to the Practice of the Practice podcast I was interviewed on. When you gave me your email address my auto-responder sent you an email with the checklist, video link, or infographic you requested. Then, depending on when and what you signed up for, you got the second of the autoresponder series which basically just asked if you received your checklist. I then personally respond to those that hit reply and say they did or didn’t. Then you may have gotten an email (autoresponder #3) about what your biggest concerns are with practice-building. I broke “business rules” and got rid of that one because a lot of people unsubscribed at that point, probably annoyed with this woman they didn’t know sending them emails all the damn time.
So this clinician sent this really reasonable question which is based on the encouragement folks get from some other practice-builders about how to build their practice. Email lists are considered gold in the marketing world (so you’re a sweet, sweet nugget). An auto-responder series is a good way to build a rapport with the person who signed up. The idea is that the more great content the people on your list get from you, the more engaged they’ll be and possibly buy your product or service. Maybe they’ll also forward something good on to a friend who will like you and also join your list. This is BIG TIME in the business world, think about the coupons you can only access through your clothing store’s site if you provide an email, or the subscription-only shopping available with Zulily or Dot & Bo.
Dude, how much lead up does one allegedly controversial opinion need before it’s actually stated. So, this clinician asked what quality content she could provide to potential clients in a 5 email series and I wanted to say, “None. Don’t do an email list with potential therapy clients.” This is a very rare opinion. I have clinical and work/life balance reasons for this.
Clinical
I imagine my ideal client here. Do it with yours too, to see if my opinion fits for you. My ideal client is miserable. She hates herself. She hates her body. She’s a perfectionist and despite her many, many accomplishments and the admiration of others, she never feels good enough. She can fake being okay like an Oscar winning actress. Everyone thinks she has her shit together. Meanwhile she’s secretly restricting her food intake and purging and overexercising when the feelings become too much. She has constant reminders of her short-comings in her perceived physical flaws. She has a hard time asking for help.
Let’s walk through it: She hates her body and she comes across my (now former) email opt-in “10 Steps to Loving Your Body.” It has great content. It provides some immediately actionable steps for quick wins. It gives a realistic look at what it might take to change her mindset and hints at what life could look like if she could maintain body acceptance and possibly even love her body. It’s a much better life. There isn’t a hard sell, but therapy is encouraged. This is good information and she appreciates it.
Now, she may not be an email list savvy person. Her eyes may have skipped over the part about how she’ll get more emails from me. She probably thinks this is just some good advice, like a Huffington Post article or something.
Problem #1: Do you really have informed consent? Yes, you mentioned somewhere that she’ll hear from you again, she gave her email, so legally the onus is on her, but will it be a surprise to her when she hears from you again? Maybe she’s on a date and Autoresponder #2, “How to Avoid a Binge,” pops into her email and lights up her phone.
Problem #2: Are you selling or focusing on helping? If the purpose of the email list is to remind more potential clients that you’re there, how do you walk the line of just helping by providing info and selling sessions? Personally, I don’t want to have to keep telling my therapy clients that I’m here. I want my therapy clients to be motivated and interested in doing their own therapist research to find me with the other marketing tools I put out there. I want former clients/therapy graduates to want to come back if they need it because we did awesome work together and they trust me. Not because I slowly nagged them into it.
Problem #3: I want to protect the safety of our space. There’s something sacred about the work we do. There’s an intimacy and a rawness and a partnership that’s formed in our therapy offices. It feels somehow tainted by “7 Ways to Set Boundaries (and Maintain Them!)” intruding into her inbox. It’s our job to protect that sacred space, clients giving us permission to violate that doesn’t give us leave to shirk that.
Problem #4: What are we communicating about boundaries? If I email her a couple times a week with the autoresponder + newsletter/blog post, is she going to magically understand that it’s not clinically appropriate for her to email me all the time?
Problem #5: This feels more like a coaching approach than clinical work. This is NOT dogging coaching, I’ve certainly appreciated coaches I have hired. Coaching and therapy are really different. They have overlaps, but the evidence-based, peer-reviewed, clinically-licensed, board-sanctioned nature of therapy, especially with someone with impairment in daily living (i.e. anyone diagnosable) holds more responsibility. If you are a coach, yes, build an email list! It’s a really smart move. I get auto-responder series from coaches and consultants all the time and, like a vampire, drain all the good info and then toss the email aside. It’s great! The content isn’t meant for someone crying a few hours a day and contemplating suicide. Ironically, it’s often about how to build my email list.
Work/Life
Did you guys love Natalie’s guest post last week? There are a million ways to market your practice. Like Natalie says, it’s really best to choose what feels right for you. The whole email list/auto-responder thing just didn’t feel right to me clinically, so I’m not going to force it. I took it down several months ago after it being up for quite a while. It was ONE MORE THING I had to manage. I want private practice to be like a vacation compared to agency work. I don’t want it to involve any more busy work than it has to.
Rebuttal #1: But this content is valuable and helpful! Good! Blog about it! Keep your blog rolling if writing fits for you. Remember, I dig a good therapy blog and encourage you to find good ways to fill it. That allows your potential clients to get all that great info on their terms.
Rebuttal #2: You’re kind of a huge hypocrite. I got this in my inbox. And the likelihood of you being my therapy client is infinitesimal. The boundaries are different for consulting and therapy. I’ll grab a beer with my consulting clients. I’ve had people I was already friends with join my group. My group members have seen me disclose some heavy stuff that I’d never share with therapy clients. While my consulting clients are in some vulnerable spaces throughout our work together, I’m not responsible for their emotional lives in the way we take on some clinical responsibility for our therapy clients.
Rebuttal #3: I’m hoping to launch an information product like an ebook or an ecourse, don’t I need an email list? Yep! You do! And I think having a clear indication of what the sign up is for and only emailing updates about that thing is the most responsible way to deal with that. You can scroll to the bottom of my book page for an example.
Lastly, like anything, do what works for you. If you have an email list and autoresponder right now, read this and disagreed, know that I don’t judge. This is what works for me. These are my concerns. And I’m aware that I can sometimes veer towards the clinically conservative sometimes. Email lists may indeed be the wave of the future and I don’t want to slow you down. If email lists don’t sit well with you for reasons similar to mine, know that you aren’t doing anything “wrong” in your business if you don’t have one.
Let’s talk about it! What’s your perspective? Let me know in the comments. (And as an FYI, any comments that are rude or snippy towards anyone else will be deleted.)
Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.
I’m so relieved to see this post. I’m slow in building my clients and keep thinking things like “if only you did 20 million other things you don’t have time for you would have more clients” (or if I was a less ethical and willing to take on folks I don’t have enough training to serve well, I have referred more clients than I have taken on). I felt like an email list would turn me off as a client so I didn’t do one and have been questioning that whenever I see the advice printed pretty much everywhere.
I’m a firm believer in doing what works for you! Stretching yourself and being aware of options and choosing from them. Glad it was helpful, Ruth!
Allison, you articulated what I couldn’t quite put my finger on as i struggled w/ the next “to do” on my list/: building an email list. I had not really thought abt how I get new clients, and your article made me do that: referrals from colleagues and former clients, then google/website/and most recently my promo video. Thanks for the wake up call and reminder to be more discerning and intentional in the choices I make w/ my practice.
Happy to help, Lourdes! Glad what I wrote resonated!
Popping in To say i wholeheartedly agree. Nothing else to add–you said it all! Thanks again.
Thanks, Abigail! Nice to be in good company!
I totally agree- thank you so much for clarifying the difference between professional/ ethical marketing and borderline boundary crossing or Confidentiality breaking emails (phone notifications can pop up when you dont want them to). This is very helpful to me as a psychologist just starting to enter the world of private practice
Glad it was helpful! It’s just my opinion. I thought it was an unpopular opinion, but I guess you guys are proving that wrong! 😉
I personally get overwhelmed by advise emails and just trash them after while. I know my PP is a business, i dont want to increase the image that i am after people with the idea of making money.
I’ve definitely seen some salesy vibes out there. And luckily there are a million different ways to do business and build your practice.
Allison,
Thanks much for this thoughtful post. I have been in independent practice for about a month now. I have been haphazardly posting a blog (I’m up to 2 posts), I have no email list, and I have been doing things “old school” (I’m in my early 40’s) by taking my peers to lunch and talking with them about my services as a means of building my referral sources. I live in a community that “word of mouth” is worth more than the “e” Commerce route. I like social media, however I am about to quit at least one platform all together because it serves no purpose to me. I am in a business that deals with relationships, why would I abandon the path I know. I can write, i can speak, however, i have been getting the participants I am working from the people that know me, and say “Try this, he could help”.
There is nothing wrong with embracing technology in order to spread the word about you. I would simply suggest know the market where you live. If it’s a community that relies more on Word of Mouth referrals, talk to at least 5 people that you want to get referrals from. Go to coffee and talk, have a lunch, and write it off as a business expense.
now, I will go work on that next haphazard blog post that I am not certain will get me anything. Maybe I should build another CANVA Facebook post and put that on my Practice’s Page. It’s more fun to build an image for me these days than write.
Thanks much.
Jed
Networking is king in my humble opinion. An internet presence is important based on the population you serve (likely more for 20-something clients than those who love working with octogenarians) just so they can check you out before calling. I’m glad you’re adding a blog, haphazard or not, just because it gives potential clients a feel for you as a clinician and potential fit. Congrats on your practice! These first few months can feel like you’re holding your breath but all that networking you’re doing is planting some awesome seeds!
You are so wicked smart allison. After reading this, i immed asked web designer who is amazing BTW to take email lists off – they were haunting me, and for the reasons you mentioned, stIll want the blog post page
Thanks, Renee! 🙂
tHANK YOU FOR speaking an unpopular truth and inviting a deeper dialogue around this issue, Allison. I love your distinction between how we nurture and honor the uniqueness of our therapeutic relationships versus our coaching ones. Both are special in their own way and I believe require us to remain mindful about what resonates with us and with the energy we are intending on contributing and attracting into our practices.
Thanks so much, Keri! I appreciate the support, especially from another consultant. I love that there’s no “right” way so we can all see what fits for us.
Yes-i can only imagine tHe complexity of clarifying w/in oneself and ones many media representations, oneS role as therapist vs coach. You ladies are rockin in in terms of authenticity, inviting discussions, n putting professionalism out there
I despise email lists. I will never do a newsletter or anything like that and I have a thriving practice. I post articles to my blog once per week. I have a plugin on my WP site that allows people to get notifications of my new posts, but I never send anyone anything. I get annoyed when I am arbitrarily added to someone’s email list. Thanks for the article!
That sounds like a great way of doing it, Michelle. That way, people know that they are signing up for updates each time you write a post and so it’s “informed consent,” in a way. I also love what you said about clients being able to access the information “on their own terms.” That’s a beautiful parallel process with psychotherapy work.
I’m totally with you on this one, Allison. I know that email marketing is a valuable resource that can be utilized well in many settings, but I haven’t quite figured out how to make it work to help me build my practice while still feeling true to my values and the image I want to set forth about how I approach my work. I have been testing out the waters a bit to see what works and what doesn’t. I’ve focused on using email to stay connecting with potential referral sources, instead of connected with potential clients. This way, I’m still using email to help “stay on the edge of people’s memory,” yet not crossing boundaries with the therapist-client relationship. I’ve used it to send other therapists and helping professionals resources they might find useful or articles they might enjoy. This tends to spark up conversations and then more in-person hang outs to build those relationships further. However, I still haven’t figured out a way to do this in a mass-email kind of way without feeling like I’m “bugging people.” Recently I sent out Holiday E-cards (I know you got mine!) and sent everyone an individual message. So far that’s the only mass emailing I’ve done that has felt right to be because I personalized each one. But that took me days! I hope I land on a good balance for me soon. I’ll keep you posted when I do.
-Nat
Having a list for referral sources is really wise, if it works for you. My formula for getting over that bugging people feeling is to do my best to offer quality content. I wonder if it’ll ease if you reminded yourself that you’re not spamming people with “refer to me” emails and providing something they want.
That’s a great tip to keep in mind. Thanks!
I totally agree. I also think when someone finds our site either through a search or recommendation they are ready, or close to it, to get help. If they need couples counseling why wouLd I suggest that downloading “10 tips to a great relationship” is the desirable action step or “enough”. People are in pain. Why keep them in a passive state or confuse them to the purpose of yOur role, site, and bridge to setting an appointment with distracting pop ups and ploys to have them join your list as if thats the purpose of your work.
Our ” product” is us and the hope and EXPERIENCE we bring to the work so i’d much rather have my site follow that CONFIDENT EXPECTATION that I’m here and ready than SUGGEST they are being targeted for me to sell an eBook down the road.
Great point, Deb!
Allison,
Thanks for giving voice to your thoughts, very valuable insight. I wholeheartedly agree that theres a huge diFfernece between therapy, coaching and consulting clients. InterestinGly i find that After 6years in private practice, most of my therapy clients are word of mouth And have either nEver visIted my site or never opted in for anything. I privately send them links yo what continues our theraputic discussionS. That said i also have a handful of clients that signed up for and followed my series (which is less sell and more DIscussion) and then called months later for couples counseling — that also aligns with reseach thou, in that couples take years to reach out for help.
Makes total sense, Rebecca!
Allison,
Thanks for this thought-provoking post. I do have an e-mail newsletter which I send out every so often – usually months apart. some of the people who have signed up for the newsletter may be clients and most are not. i fill my newsletter with information about upcoming events like workshops and retreats as well as blog posts on a theme and recent podcast episodes. the clients who have signed up for this have shared that it’s helpful to have information about certain topics relevant to them covered in more depth in the podcasts and blog posts. in sessions they tend to bring up how much they enjoy reading the newsletter when a new one is sent out. i try to use my authentic voice and There is no auto-responder. it’s specific information sent infrequently, usually with a focus on something that has come up for several clients recently and i have expounded upon it more than i’m able to do in a therapy session. so for me, there is a place for it, but i don’t mean this to negate your points because i agree with you. also, to deb’s point, i think pop ups on websites are annoying (i’m old school in that way too) yet many, if not most websites – regardless of the service provided by the site owner – have them. i was ambivalent about adding one to my site but i took the advice of a respected colleague and added it. one point you highlight in your post is that practice building is confusing and it can be overwhelming to receive so much competing advice about the best ways to help people find you without turning people off. thanks again for posting this.
It IS confusing to hear such conflicting info. And I’m so glad there’s no one way to build. Your podcast is awesome, BTW!
Hey Allison, I’ll take the bait to present a counter argument! But first, thanks for posting this because I think it’s a great thing for clinicians to really think through for themselves. It’s also an opportunity for folks to think about their entire marketing approach and not to focus on one small aspect of a bigger picture. (and, I love your site!)
Here goes. This is going to be long. brace yourself! (Also — as I type in your comment box, it’s all caps. I sure hope it translates to upper/lower in the end so that it doesn’t look like I’m yelling the whole way! 🙂 )
One last comment before Is start (yes, dude, I have a long lead-up, too!) — I’m addressing not only your post but also several of the comments.
First and most importantly, the ethics argument: People should always tune into what feels right to them. If a marketing coach or friend is suggesting something that doesn’t sit right with your ethics, you should not do it. Note, however, that an argument that is “a relief” to people because they feel overwhelmed and can’t find time to implement something can easily be accepted based on an ethical argument. (Example: if someone told me that I really don’t have to save for retirement because my spiritual growth will be enhanced by me fully living in the now, I would LOVE them and would sing their praises! Thanks for letting me off the hook because I’m not paying attention and saving enough as I know I should.) Most of us make decisions based on emotions and then justify them by logic. So, we should all think about where the “releif” is coming from when we feel it. If it’s truly ethical, then listen closely to that. If it’s not, then figure out what it really is for you.
second, and second in importance to thinking about ethics is thinking about the whole system. Most of us extract shiny objects from complete strategies, implement that one piece, and expect miracles. I don’t know what other coaches teach, but we teach and implement an entire website marketing system. The site architecture is important. The SEO is important. the way the specialty pages are written is important. Ongoing blogging is important. List-building is important. Adwords (if chosen) works only because it sends visitors to the well-built system with specific pages, etc. all of these pieces work together. But in a specific webinar, I may be diving deeper into one aspect of the system. A therapist could easily think, “Oh, I need a free report and I’ll be home free!” It won’t work that way. You need the entire system.
third, the “make-them-download-rather-than-call argument: People are smart. If your site is set up correctly and the person is “ready to do therapy” there is nothing preventing them from calling you, contacting you, etc. They do not have to download your report, first. Your phone number is right there. That is ideal for the “ready to do therapy” client. To imply that the free report will dissuade them from immediate action is a bit weak, I think 🙂 Free reports/quizzes/email courses, etc. do not prevent potential clients from calling you. especially those who are ready.
fourth, the People-who-come-to-therapist-websites-are-ready-for-therapy argument: Really? One comment claimed this to be true. Rebecca told of couples that came to her months later after being on her list for awhile. I think the readiness of your site visitors will depend on how well your website is built. I don’t know how others coach, but I recommend engagement and list building as a call to action because I believe that people come to your site in all different phases of “readiness to act on the therapy decision”. For your own example, allison, if I were to type into google, “how do i know if i have an eating disorder?” — or something like that… and you have a good blog or site set up that is optimized, I will hopefully land on some of your content As is evident by my search term, I am in the research/wondering stage. I am not in the “ready to go to therapy” stage. While you may have a good blog post on that topic that makes me think, if you do not give me an option to get more info from you, then I will probably forget about you. I’m in the early stages. I’m touching in on this question in the moment, but I’m soon headed back to my life, and I may not visit this question again in months. Not everyone is ready for therapy.
Fifth, another point about the potential client who is just starting to look at their issues, but not ready to start therapy: We design our marketing systems to make therapists visible early in the searching process. If created correctly, the therapist’s website should appear for all sorts of searches having to do with the issues they work with. Most therapists do not have good websites, so most don’t get many relevant organic visits. If most visitors are coming to a therapist’s site because of a referral, the site is being used as a convenient online brochure, not as a search resource for folks online. If you have a brochure site rather than a site that is ranked highly for many terms, then yes, no one will find you until they get a referral to you. But I see that as a weakness in your entire online approach. You’ve missed the strategy of being online in the first place.
sixth, the free download and what it should be: Allison, you did a great job of talking about what your potential client was feeling. she’s miserable, hates her body, etc. as you obviously know (you have an agency background, while most therapists don’t), tuning into your potential client’s current emotional state is uber important. however, why would you take someone who is miserable like that and present them with “10 ways to feel good about your body”?
If someone came into your practice and sat on your couch talking about how miserable they were, would you ever in a million years say, “Okay, let’s talk about 10 ways to feel better!” no. I don’t think you would. I think you’d empathize. I think you’d talk more with them about what might really be going on for them, etc. So, why not a free report (or quiz or email course) titled, “do you hate your body? You’re not alone. free email course shares how other women have worked with this issue and come out on the other side” or something like that?
that could be very helpful for this person. and would establish your credibility. and give them hope that even if they can’t get there, themselves. it’s possible with your help. Win-Win.
seventh, the informed-consent and boundary arguments: If I tell folks that optin to my eating disorders list that I’ll send them a free report (or email course or quiz results) and monthly blog posts, they know that I’m sending them those things and not emailing them personally. The body of the blog post emails can start with: “In this month’s blog post on eating disorders, I discuss xyz.” They should never feel that I’m personally emailing them and violating a boundary. Again, I think the boundary argument is a strange one, if the system is set up and used correctly. Emails are given to folks who have requested to get information from us, period, not for personal emails to them. That is creepy. for informed consent, how is providing good information you write any different than someone buying a therapists book in a bookstore? just make it clear that you are not in a therapeutic relationship.
eighth, the phone-pop-up argument: This one is interesting. If someone has their life configured to have emails popping up on their phone, then they will get lots of popups on their date (to go with your example). they could get an email from another guy they’re talking to on Match.com. they could get an email from their bank that they just bounced a check. It could be anything. This is the nature of our invasive online world, not a comment on a therapist’s inappropriate boundaries. all of us can configure the amount of connectedness we desire, and hopefully, we think about this and make conscious decisions. But, to not give information to potential clients who want to learn about something because they might see an email pop up on their phone at a less-than-ideal time? I don’t want to sacrifice my ability to be helpful for the possibility that my potential client might be reminded of their issue at a time they may not want to be reminded. They CAN opt out. or reconfigure. or turn off their phone on a date (hopefully). We have to trust that potential clients are adults and can make decisions in their best interest.
nineth, the internet-is-for-young-people argument: Really? the data on this shows plenty of older users. we market online, almost exclusively, and Our best clients — the ones that spend a good deal with us on a complete website strategy — are between 50-70 years old. Yes, we coach rather than do therapy, however, the age argument is just not substantiated by all the research out there re who is searching for solutions online. see the age chart here: http://www.pewinternet.org/2015/06/26/americans-internet-access-2000-2015/
Hope that was helpful as food for thought for some, and I welcome any feedback.
Again, thanks for the post. These are important conversations for our community to have!
Becky, AWESOME response! Thank you for offering a contrasting opinion! Very good points!