The National Council of Psychotherapists
How I started a group practice
I am often asked how I built an individual practice for more than 40 years, and how I have maintained 6 groups for almost that long.
My early experience may or may not be relevant in this present day of managed care, heavy competition, and impatience, but here it is.
I started out working in clinics and in the founding of the Los Angeles Suicide Prevention Center, gradually building a reputation among my colleagues. From time to time I would get a call offering me a referral if I had a private practice. Each time, I would have to turn the offer down because I couldn't afford to lease an office and furnish it just to wait for patients. I was approached by several colleagues to form a partnership, but we couldn't get started for the same reason.
What made it possible was finding a physician who had an office he wasn't using in the evenings and was willing to rent to us by the hour. (Since then, whenever one of us sets up an office, we always include an extra room that we can rent out by the hour to young therapists just getting started.)
In those days, the only method of publicity considered ethical was public speaking. I would offer myself to singles and other community groups as a speaker on mental health, suicide, etc. The first year I did this I got no patients from the speaking engagements. The second year, I seemed to reach a kind of critical mass where things started to happen. For example, one day after speaking, a woman came up to me and said that she and her husband had been looking for marital counseling and she would like them to see me. When she went home, her husband said he had heard about a great therapist and had already made an appointment. She discovered he was talking about me.
To the extent that the change from year 1 to year 2 came from me, it might have had to do with an insight that I received after one engagement. A crowd had gathered around me asking questions after I spoke, and suddenly someone said: "I want to see you, could I have your card?" Immediately, many people in the group asked for my cards, also. I reached in my wallet and found I had no cards with me. Someone said: "You may be a great therapist, but you're a lousy business man". I realized at that point how ambivalent I was about asking for business.
Since that time, the principal source of my referrals has been satisfied patients. This source grew slowly at first, but has become a tidal wave over the years. I find that I get chains of referrals from a particular company or industry which makes a problem. Even with six groups, I have many people I would like to place in a group, but know someone in each of my groups.
Referrals also come from colleagues who know me by reputation or have attended my presentations, and from collaborations with colleagues who have patients that need group while continuing with their individual therapist.
My organization, the Group Psychotherapy Association of Southern California, gives members great opportunities to make presentations to the mental health community and has developed an E-mail service that has produced a great deal of sharing of referrals. This Forum seems to be doing some of that, too.
My groups are all open-ended heterogeneous psychodynamic groups. They are filled almost exclusively with my own patients, after I have worked with them individually for quite a while. The principal exceptions are other therapist's shared patients. The fact that I know the patients so well and that they are already psychologically sophisticated and well oriented when they enter the groups may account for their wonderful use of the groups and the lack of some of the problems that have shown up in other groups.
I hope this long-winded rambling is of some benefit to those of you starting on your careers.
The best of luck,
Marvin Kaphan, Past President
Marvin N. Kaphan, LCSW, CGP