Why create another mental health practice?

Why would one set out to create a mental health practice? My story may shed some useful light.

I did not start out thinking I was going to own a business. It was not a goal of mine as a young person. I was just trying to find my way to a satisfying career. But along the way two factors converged and laid the foundation for my choice: my youthful arrogance and my early work experiences in a poorly run practice. These coalesced into the belief that “I could, if I chose, run a business better than the owners I worked for.”

My bad start was good for me

I now believe that I was fortunate to start my career in a practice that was succeeding . . . and yet was so poorly run. This mixture—success with poor management—showed me that one does not have to be a perfect owner to succeed. I just needed to be good enough. And it gave me the sense that the bar was just low enough for even a novice to succeed. I was thirty years old when I started my own practice. And I was certainly a novice. (For more on my early years see: From nothing to something: The beginnings of my practice.) And those early negative experiences created a desire to do a better job than I had experienced. I had learned how painful a poorly run business could be on employees.

A low bar, a desire to do better, and gobs of youthful confidence—what could go wrong? . . . Right?

From interviewing other practice owners and reading the business literature, I’ve learned that many begin businesses with a similar belief. They also decided that they could do it better than what they experienced as an employee.

This is an important belief and possibly essential to being willing to launch a new venture.

So how should we make the decision to start?

I wish I had a better story about how I began as an owner, one that is closer to what we might call the “best practice” for how to begin. I don’t. Instead I can tell you what I think would have worked better and been less painful than the path I took. I have seen others do it in a far better way than I did and would suggest you do it their way rather than follow the example of my early history. The best practices for how to begin entail at least the following steps. Begin by sorting out these dimensions:

Purpose/ Dream—Why are you creating this business;? What do you think your organization can add to the world of MH?
Branding—What name are you using? What services you rendering? How do your name and services support each other?
Legal/Business—What form and structure are you going to use? Solo practice, partnership, not-for-profit? How does the structure support your purpose and branding? Then register with the state.
Systems—Create a plan for how to do all the key things you need to do. If you do not know what they are, then learn more before starting.
Space—Where are you going set up shop? Does that space communicate the right messages about your brand?
Marketing—How do you get the word out and how do you keep it up once you get busy?
Finances—What is the plan for the start-up? Savings? Borrowing with credit? Self-funded from profits?

Had I considered this list prior to my beginning I would have experienced far less fumbling around. I wish I had spend some hours, days, or weeks thinking through these seven areas. The results would have included faster growth, less pain, more success, and quicker financial stability. (In a sense, much of this website is organized to point you in the right direction. See Building a mental health practice for an overview.)

Purpose and Dream

I wish I had started with a clear purpose and dream for my business. In truth I was so inexperienced that I’m not sure I could even see the range of possible dreams and purposes to weigh against each other. So after 35 years, let me share what my business purposes and dreams turned into. Somewhere along the way I read this quote.

“The mission of most professional firms is: to deliver outstanding client service; to provide fulfilling careers and professional satisfaction for our people; and to achieve financial success so that we can reward ourselves and grow.”
David Maister (1993). Managing the professional service firm. Free Press Paperbacks: New York. pg. 3.

Now I would say that the biggest distinction of our organization is this:

We are a community of therapists providing excellent service to our clients.

The desire to be part of a community of therapists is both unique and central to our identity. But this awareness was not in my consciousness when I began. What I knew in the beginning was that I wanted to work with a small group of therapists who liked working with each other. That was about as far as I could see.

I chose to privilege “fulfilling careers and professional satisfaction for our people” over “financial success” without compromising “outstanding client service.” That became our purpose and my dream.

Writing it down

After about twenty years of leading our organization, I was clearer about what was unique and what drew staff and clients to us. We had become a community of therapists and that was appealing. Those first twenty years were about experimenting with our identity while trying to be excellent clinicians and developing the support systems we needed to meet the needs of our staff and our communities.

The last fifteen plus years have been more about solidifying the methods we discovered in order to stay connected to each other so we can support each other while doing therapy. Structures such as our regular meetings (three or four per month), retreats, social events, etc., have become more central to our identity. I am convinced that these are the reasons we continue to thrive as an organization. There are many organizations that do excellent therapy, but to be surrounded by people you view as friends while doing your work—that is unusual and wonderful. (See my post on “How we use regular meetings to build our culture” for more on this topic.)

I tell this history to say that while we may have an original vision of why we want to start a business, time has an interesting way of reshaping that understanding. I have a memo that I wrote early in my career about what I wanted my business to be about. It mentioned the desire I had to be working with a community of therapists. It took another fifteen or twenty years to actually figure out how to realize that desire. In those years I was trying to find the people and developing my abilities to lead others into that dream.

What we did not choose

You probably noticed that we did chose a purpose that was about making the owners wealthy, as some organizations have. I have always operated with the view that money was best viewed as a means to a greater mission. When money-making becomes the core motivation, people eventually become demoralized. Meaning gets lost in chasing the dollars. I was always determined to avoid that situation.

So why create a mental health practice?

I believe that there are many good reasons to start a business. Expanding on the opening quote, the following seem to me like the best reasons:

Serving in an area or with a population of people who have fewer services available
Providing excellent service to those who come to the organization for help
Providing a supportive, caring work environment for employees
Making enough money to support the above

While not all these are necessary, in my experience the more of these that are built into the DNA of your organization, the more satisfying will be the work and the more success will come your way.