Mental Health at Risk: Private Practice Lessons Made Clear by Coronavirus . . . and free resources.

Covid19/Coronavirus . . . demanded immediate operational changes for mental health practices!

Security and Eggs

“Don’t put all your eggs in one basket.” Maybe it’s a quaint old saying that has “lost it’s meaning” for most since the chicken coop has long been relegated to a historical oddity (But not for our family! See picture below . . . . So the risk of gathering and storing all our eggs in one basket is reality for us!)

However, I suspect the wisdom of the adage is not lost . . . but simply ignored in the daily complacency of life that hides the threat of imminent risk . . . until something make that risk visible. Like the Coronavirus. Very quickly, mental health practices recognized the risks of “practice as usual.” Quarantines, community acquired infections, work-from-home, state-wide lockdowns . . . so many rapid changes. Many now regret not being prepared to have Telehealth as an optional backup plan.

My kitchen counter this morning . . . Chicken, duck, goose . . . and turkey. Gathered daily then transferred to bowls, cartons, refrigerator, frying pan . . . our eggs are never all in one place.

Few prepare ahead for potential anomalies like the Coronavirus. The failure to be prepared comes from the idea that things will always operate as they have in the past. That the variables won’t change. Or changes will be brief and only moderately disruptive. When a true disruptive event occurs, as inevitably do—either slowly or in dramatic rapidity—-then the risks become profoundly obvious. We “bank on” having time to adjust.

Risk in Mental Health Services

Mental Health Practice has been no exception. Unfortunately, not many ask the question of “what if it all changes overnight?” Internally, we may ask what happens—”What if I am hit by a bus? type questions—but rarely do we contemplate shifts in our business sector. (Again, many are not prepared to ask what mathematicians ask, “What if that variable goes to zero?”)

Here are some questions that ask the “zero question.” These target “variables” that we have commonly assumed would not change

• What if insurance companies shut down for several months?

• What if clients will not come to the office?

• What if interest in mental health services stop?

• What if gatekeepers—teachers, doctors, etc.—no longer refer to mental health?

• What if the government mandates closing our doors?

Some of our hens (with rooster on guard!) waiting to fill up more baskets.

Finding More Baskets

As I listen to the professional chatter about the changes being made due to the Coronavirus, I think the biggest shift is a flight into a different modality. Telehealth. I get it. I am doing it myself. In the short-term, it is the easiest “fix” and probably a necessary “stop-gap” for most private practices. But, this transition still leaves most operating in the same “basket” of healthcare dependent upon insurance and private pay.

Some, no doubt, are in the short term, relying on retained profit in the business, personal savings, or their partner’s income. Uncomfortable. It is a short-term fix that will hopefully get everyone through the current crisis . . . but not a long-term successful business strategy. Most businesses start with one product but they don’t grow by continuing to offer only one product. To do so, increases the risk to the business. What if no one needs an MP3 player anymore, for example?

This leads me to encourage you to consider finding another basket.

Business Contracting, Consulting & Coaching

In my world, contracting and coaching with businesses and leader provides some “down side protection” from the risks of health care. (Ahhh! It’s a different basket! Yes!) While business has a basket also can be effected by seismic shifts like the coronavirus . . . like has happened in the entertainment sector . . . but business is not uniformly impacted in all sectors. Therefore, it lowers risk by spreading that risk over sectors impacted in to different degrees.

For example, in a recent coaching session, I asked a business owner how the coronavirus was effecting their market and business. “it’s not. At least yet,” he answered. It seems that this particular business sector is one deemed critical to the response to the pandemic. Unlike other business sectors, it remains open for business and operating as close to normal as any in our country at present.

Someone remarked to me just this week that in the times we are in business and leaders more than ever could use the guidance of professionals who understand people. No doubt. I only wish more were available.

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Unintended Contracting

Photo by Cytonn Photography on Unsplash

Becoming a Contractor . . . quite by accident!

Since 1994, I have had all or some of my professional work paid for through contracts. This was NOT the plan!  I have mentioned before in this blog that I am not, by nature, an entreprenuer. To wit . . .

• I hate the idea of sales and marketing.

• I am not a "joiner." Involvement is not something I seek.

• I am inherently risk-aversive.

Thus, my first contracts came by "default." That is, through no intention or effort on my part to try and sell my services. Here's how it happened . . .

1993: A colleague offered to guarantee 3 months pay to encourage me to join their private practice. The hospital, whose employ I was leaving, offered to contract with me, part time, for weekend therapy groups.

1994: Citibank, who had bought the hospital chain, closed the hospital. An education consultant, who had a contract with the Department of Education, offered me a contract to do counseling with identified kids in schools. (Realizing this part-time gig paid me better than the full-time job was an eye-opener. But, I had dreams and it was off to grad school.)

1997: A colleague of mine and I dreamed up a consulting gig as part of an assignment for a Qualitative Research class. We proposed, with support from our professors, to help improve employee satisfaction at this 3,000+ plant.

2000: A university offers me a job, but it's not where I want to live. I counter-offer to teach from my preferred location. This leads to a contract to combine trips to campus and distance-learning that continues for 15 years until I decide to retire to pursue other interests.

2003: Interest peaks among students about the consulting work I am doing and I am assigned to teach a Doctoral class on Consulting with Larger Systems.

2010: Students continue to value the class and encourage the writing of Beyond the Couch. As multiple students indicate that the class has been the "most practical" and "best class" in their curriculum, I begin to dream about how to help others benefit from contracting.

2011: I begin coaching mentees about developing contracts. These colleagues develop contracts with schools, churches, medical practices, and non-profits. Personally, I continue with my work with a limited private practice and consulting.

So, that's it.  Let me encourage you to seek colleagues, opportunities, and supports to add contracting and consulting to your "toolkit." It will open up many doors to creative and energizing work!

Ten Reasons "Controllers" Don't Recognize their self-defeating patterns

Photo by Moja Msanii on Unsplash

 

Ten Reasons "Controllers"* Don't Recognize their self-defeating patterns

You've seen it. The person who tries to control a situation when they ought to just leave it alone. The guy or gal who can't see that their actions are causing more harm than good. Why do they do it? Why can't they recognize their own fear? Is it "poor insight?" A lack of psychological sophistication? Poor people skills? A bad childhood? Perhaps. But here are some more pragmatic ways to look at it . . . 

1. It has become a habit. Controlling people control. In their minds, they are helping and often they are. So, the success of "making things happen" creates a Pavlovian-conditioned state (perhaps more Skinnerian) where the behavior is likely to reoccur.

2. Other people respond to it. Face it. A lot of people don't want to be in control. They don't want the responsibility for the outcomes and they are happy to give up that role to someone willing to step in and take it.

3. It masquerades as knowledge and wisdom. Confidence, assertiveness, bold initiatives often give the impression that the person "must know" what they are talking about. Right or wrong the controller often is, defacto, given some credit for knowledge or wisdom by reason of their action.

4. Controlling prevents facing internal pain. Control is a way of avoiding uncertainty, inefficiency, judgement . . . a host of states that may cause the controller to feel ways they do not want to feel. "Taking the reins" for the sake of preventing these bad outcomes is often done "for others" but really is the controllers way to avoid these emotional states themselves.

5. It looks like confidence and leadership. Since controlling is an active process, others have to secumb or fight to take an opposing point of view. Controllers, over time, tend to win by attrition as others "give up the field" and simply choose not to fight. The controller "gains ground" simply be their natural tendency toward being on the offensive.

6. Negative consequences are not immediate. The consequences of the controlling behavior is often accommodated, tolerated, or dismissed . . . in the early stages, especially if the desired outcomes are positive. The organization is growing, the business is making money, or the family is thriving. However, over time the impact of the control implodes. People begin to react to the control. As outcomes diminish people begin to question the controllers behavior, motives, and vision.

7. It is often disguised in humility and openness. Controllers who don't have good people skills are simply bullies. Those who do have these skills often cloak their control in positive ways. "I only want to help." or "You can, of course, do whatever you want to do. But, I think . . ." implying often that their answer is best. One CEO, dealing with a benevolent controlling consultant told me, "She's so nice you almost don't mind the way she pushes you around."

8. Criticism is not allowed. By "criticism" I mean the critical process of examining ideas thoroughly. Many controllers are good at making logically sound, quick decisions. They may under-value the process of allowing others to evaluate the decision-making process. This leads to unilateral decisions. Not fully getting other's on board and committed and when the outcomes turn negative leading to blaming the controller for their decisions and behavior.

9. The motivation is to help. Hard as it may be to believe, one of the reasons controllers don't see themselves clearly is because when they look inwards they know that their motivation is good. They want to help. They clear away the confusion. They prevent inefficiency that is frustrating or hindering others. They get things done.

10. It works. Bottom line. Controllers control because it works. It achieves the short-term needs of the individual, the team, or the organization. The question controllers fail to ask themselves however is, "Yes, it works, but at what cost?" Often it is at the cost of developing the leadership skills of people working for them, developing an achilles heel of a single vision, or in family business, trampling on relationships. Long-term what works maybe be antithetical to what works in the immediate moment.

Leaders, who tend toward control, need to find ways to check their natural instinct. This does not mean downplaying their strengths or abdicating the need for "controls" in their leadership. It means having good "checks and balances" on their natural tendency.  Develop ways to get feedback from other team members, take time to get an outside perspective, create habits to incorporate others into the decision-making process. See yourself as a resource, an encourager, an enabler . . . and less of a director, tactician or decision-maker. Recognize the leadership need others have for inclusion, affection, and their own control as you lead. Long-term the likelihood of success is greater.

Others working with controlling leaders need to firmly assert the need for the leader to develop a more rounded way of leading. This may not be easy for all the reasons cited above.  The controlling leader is not likely to "see" the need for changes. The appeal is often best couched in terms of the needs of the team or the organization. "We know that you have a lot of strengths. We need to you continue to build on those strengths to meet the future demands," is one way to approach this conversation. Don't wait for the crisis, where the deteriorating conditions force this leader to "admit" that something is wrong. Challenge them to grow and demonstrate a willingness to lead in a way that is often uncomfortable for them but of great value to those they are leading.

* "Controllers" in this context means, "minimally well-adjusted, mentally healthy" people who value control. Controllers here does describe sociopath control issues who control out of a need to dominate others, create win-lose scenarios, and/or who are mentally unhealthy.

Get more . . . Download an eBook from HSC!

Engaging Your Team: A framework for leading "difficult" people.

Family Legacy: Protecting family in family business.