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Here’s a great little summary of one therapist’s approach to growing her practice. She’s got an organized approach, and she clearly has a handle on psychotherapy finances. It speaks to the question of whether or not to create a narrow focus in one’s practice.

A narrow focus on special populations keeps a therapist busy

Last month we profiled a practice that was prospering as the result of a diverse, something-for-everyone approach. The two therapists in that article have several niches, and work in many different ways–including online.

Joan Unruh’s practice is 180-degrees away from that. She serves just two niches in her Boulder, CO, practice: anxiety and eating disorders, with a sub-niche working with college students. She’s 75% self-pay, does little or no telephone work, and doesn’t employ a sliding scale.

Most clinicians probably can’t–or won’t want to–adopt all of Unruh’s approach. But almost everyone can pick up one or two good ideas based on her experience. Below, we go over the key facets of her practice.

l Overall, her practice mix is young, female, and willing to pay cash. “About 85% of my clients are women,” she tells us. (Male clients are generally seeing her for anxiety, she adds.) “A majority of them are in their 20s, then there are some in their 30s. My oldest client is 55–I’m seeing him for social anxiety disorder.

“My out-of-state college students tend to have parents with money,” Unruh goes on. But in many cases, it’s motivation rather than simply the ability to pay cash that brings clients to her door. “I find that most of the people who find me have tried many other therapists, and are looking for my specialties. So I haven’t had to slide very much.”

l She was narrowly focused from the start. “It was a conscious choice. I knew there was a need for eating disorder specialists in the Boulder area–it’s such a weight and fitness conscious environment. There are a lot of triathletes, and a lot of people who’ve moved here specifically for the outdoor, fit lifestyle.

“I’d started out in substance abuse. There wasn’t really any certification for eating disorders, but I felt I had a lot of good experience in motivational interviewing, and substance abuse theory. So I transitioned almost 100% to eating disorders to start. That was in 2000.” Unruh maintained a part-time practice, keeping her day job with Kaiser Permenente until 2007, when she entered full-time private practice.

l On average, Unruh’s patients stay in therapy for over six months. “I keep a spreadsheet on that,” she tells us. Almost all of her patients come in weekly, she goes on, and a majority are self-pay, paying her full fee of $120. “I started out 100% self-pay, and it wasn’t until 2007 when I quit working part-time at Kaiser that I decied to add some padding…I work with Anthem Blue Cross/Blue Shield. That’s it. (See details in the box, above.)

l Roughly a third of her clients are college students. “My office is walking distance from the University of Colorado at Boulder campus–I chose it specifically to accommodate that population.” Many of these clients have eating disorders but “anxiety and stress are huge” in this group.

“Sometimes you have students who are just trying to acclimate, who are away from their parents for the first time…With other kids, they had a therapist at home, and they’re continuing their work with anxieties, OCD, panic, or eating disorders…Very often, I get a call from parents who say, ‘My kid’s a freshman. Can we come in for a consult on parent’s weekend?’ And we go from there.”

Parents frequently find her online, through her website, www.joanunruh. com, or through therapists directories at PsychologyToday.com and Network Therapy.com.

Students sometimes find her on their own, “referred by one of their sorority sisters…And I go to monthly meetings at the university. There’s a task force on eating disorders. So I have a presence there, and I’m on their list as a referral resource. The university provides students with a certain number of sessions in-house and then they refer out.”

l She makes it easy to pay her–offering a credit card option online. “You can go right on my website and pay there…Parents especially love that. A lot of the students are from out of state, and it’s the parents who are paying.”

l She’s a steady marketer, making good use of her website, as well as meeting roughly four times per month with a colleague or allied professional. “It’s not a formal thing,” Unruh says. “I just call around and see who wants to do something–coffee or lunch.” In addition, she puts a lot of stock in offering potential clients a free initial interview, to make sure they’ll be comfortable with her. (Unruh was featured in our April, 2010, “Marketing” article on free first sessions.)

“And I coordinate with registered dietitians, primary care physicians, as well as psychiatrists…I’m in touch with at least one of those, once a week. And when there’s a critical patient situation, we might talk two or three times a week.”

You can contact Joan Unruh in Boulder, CO, at (303)668-9024, www. joanunruh.com. Medicare,” she says. “That’s why for now, Medicare is our main concern.”

Nuts & bolts: Seasonal concerns

Joan Unruh is in solo practice, sharing an office suite with four other unaffiliated professionals. Two of her suite-mates are therapists, another is a career counselor, and the fourth is a psychodramatist. She pays $925 per month for her own 350-square-foot office.

Which of her two niches is more important? “It depends on the time of year. When school starts in the fall, I see a lot of anxiety, and stressed-out students. Then in the summer, you see people who are getting concerned about weight issues with all the summer activities.”

Her typical caseload is 30-35 sessions per week. “It got as low as 20 over the summer,”she tells us. But since school started, it’s back up again.”

Patient sessions are grouped into three long days: Tuesday through Thursday, with some spillover onto Saturday. But she plans to spread that out a bit when her son enters kindergarten

The only insurance she works with is Anthem Blue Cross. They pay $76 for a 90806 and “about $100” for a 90801. Unruh’s out-of-pocket rate (paid by 75% of her clients, she says) is $120.

About half her clients pay with a credit card. She processes through PayPal, paying them about 2.9%. She uses a small local billing service to chase insurance payments, “and I maintain an Excel spreadsheet to keep track of the folks who are full fee.”

All client calls go to her iPhone. “I encourage patients to text. Most calls involve scheduling conflicts, anyway, and it’s easier to deal with it that way than by phone…And when I get home I turn it off.”


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