Good To Great Principles for Counseling Therapy Practices

1. Level 5 Executive Leadership

Level Five Leadership is identified by: Personal Humility, Professional Will (at an almost fanatical level), a Workman’s diligence (think plow horse, NOT show horse), and one who is ambitious for the company, not themselves

Good to Great for Counseling Therapy Practices

I hear often the story of when a person buys a counseling practice, only to have the previous owner open a new practice down the street. Having a good reputation in the community, the therapist who sold his or her practice quickly attracts all the clients and referral sources from the business / counseling practice that was sold. This is a prime example of a leader who was building their name, not their practice.

Often I meet counselors who are building their name first, and building their business or counseling practice second.

Also, often I see CEOs / owners of counseling practice who—in addition to minding their business—are seeing lots of patients, writing books, or spending their time giving trainings, etc.
All of these behaviors need to end if one is going to be a level-five leader for their therapy business. As Michael Gerber in “The E-Myth” explains, one cannot work in the business and on the business. A leader has to work on the business.

2. First Who, Then What

Getting the right people on the team comes before vision, strategy, and tactics. Collins words it as getting the right people on the bus, and the wrong people off the bus.

Put your best people on your biggest opportunities, not the biggest problems.

Don’t waste time trying to “motivate people”. The right people are self-motivated but can be de-motivated.

Good to Great for Counseling Therapy Practices

This applies to the therapy practice fairly simply, but it is often overlooked. If you are running a therapy practice you need not only talented clinicians, but great marketers and public relations, great business operations, exceptional billing, extraordinary reception.

Our receptionist / scheduler at Thrive Counseling, Barbara, is a great example of having the right person on the Bus. She does her job with excellence, and it benefits the management, clinicians, and clients alike.

3. Confront the Brutal Facts (But Never Lose Faith in the Potential for Greatness)

• It is impossible to make good decisions without an honest confrontation of the brutal facts
• Create a culture wherein the truth can be heard
• Lead with questions, engage in dialogue not coercion and conduct
• Autopsies of the business without blame
• Remember that Charisma can be as much a liability as an asset because a strong personality often deters people from presenting the brutal facts

Good to Great for Counseling Therapy Practices

Take a long look at the problems your therapy practice is facing and fix them. You will always have issues—if you think you don’t, you’re either missing them, or you’re out of business.

Examples: Billing procedures, payroll, managing time off, managing office space, marketing costs, hiring procedures, client scheduling or rescheduling, etc.

4. The Hedgehog Concept

Organizations should only do what they 1) can be great at, 2) can make money at and
3) have a passion for doing.

The Hedgehog Concept is not a vision or strategy, but an understanding.
Good-to-Great companies set their goals and strategies based on understanding; others set their goals and strategies based on bravado.

Getting the Hedgehog Concept is an iterative process.
Hedgehog companies are simple creatures that know one big thing and stick to it. Other companies are more like foxes that know many things but lack consistency.

Good to Great for Counseling Therapy Practices

I see many therapy practices that provide ancillary services as a way to make ends meet, or because it seems like there is a quick profit to be made. I have been consulted several times by persons who have told me to also provide “Business Consulting” or trainings for corporations. True, there may be money there, but we currently don’t care enough about it to have a lot of passion for it, and I’m not sure we would be GREAT at it, the way we are great at saving marriages and helping people overcome anxiety.

In addition, the Book Focus (al Weis and Jack Trout) also promotes this concept, because a business can only be known in the marketplace for one thing. Sometimes what increases revenue on the short term, hurts the company brand in the long term. For example, if thrive became a place that provided Therapy and Energy Supplements, that might make money immediately, as some of our clients would probably purchase them. However, down the road, why would we want to dilute our brand, our message, and our mission? This would harm any counseling practice in the long run.

5. A Culture of Discipline

Sustained great results depend upon building a culture of disciplined people who take disciplined action within the three circles of the Hedgehog Concept.

A culture of discipline requires disciplined people who engage in disciplined thought and then take disciplined action.

The single most important form of discipline for sustained results is fanatical adherence to the Hedgehog Concept and the willingness to shun opportunities that fall outside the three circles.

The purpose of budgeting in a good-to-great company is not to decide how much each activity gets, but to decide which areas best fit within the Hedgehog Concept and should be fully funded and which should not be funded at all.

“Stop doing” lists are more important than “to do” lists.

Good to Great for Counseling Therapy Practices

Many therapy practice work on a fee-for-service model, where clinicians “come and go” and see a few, or many clients, depending on how much money they want to make.

In many industries this is known as having “hired guns.” The thing about hired guns is that they don’t care a lot (or any) about the company. There are present to do work and make money. They will not be committed, they will not tell others about how great the company is (unless they are telling another hired gun how great the pay is), and eventually they will move on to start a competing practice (this happened ALL THE TIME).

Instead, build a culture in your therapy practice where you invest in your clinicians, and you clinicians invest themselves in the growth and health of the practice. This starts with the hiring practice—I never hire clinicians who say they are “just looking to pick up some hours” or clinicians who eventually want to “end up with my own private practice.”

6. Technology Accelerators

Good-to-great organizations avoid technology fads but become pioneers in applying carefully selected technologies. Good-to-great organizations use technology as an accelerator of momentum, not a creator of it.

The key technology question is does it fit directly your Hedgehog concept? If yes, then becoming a pioneer in the technology makes sense. If no, you can settle for parity or ignore it entirely.

Good to Great for Counseling Therapy Practices

For therapy practices, the issue is rarely one where they are trying to overuse technology. Usually it is the opposite—that they fail to see how EHR (electronic health records), advances billing processes, online scheduling, and other technologies can make their practice run better for management, clinicians, and therapy patients.

7. The Flywheel and the Doom Loop

Good-to-great transformations look dramatic and revolutionary on the outside but actually are organic, cumulative processes on the inside. There is no single defining action, no grand program, no one lucky break or miracle moment.

Sustainable transformations follow a predictable pattern of buildup and breakthrough – like pushing on a giant, heavy flywheel.

Average organizations follow the “doom loop” pattern. They try to skip buildup and jump immediately to breakthrough. Then, with disappointing results, they lurch back and forth, failing to maintain a consistent direction.

Good to Great for Counseling Therapy Practices

In Jims Collins more recent book “How the Mighty Fall” he talk about how once the Flywheel gets going, businesses get bored of it—and begin to start pushing new flywheels. For therapy practices, my advice is to keep pushing the flywheel of providing great therapy to your target market—don’t get sidetracked with trying to start a CEU education company, or a DVD program, or a series of self-help books, or …the list goes on and on.

Turn your flywheel until you company is moving from good to great—then keep turning it some more!

NOTE: This post is a work in progress! If you find it helpful, excellent! If you find grammatical or syntax problems, stay tuned! I hope to refine it in the future. Today I’ll be working on my therapy practice in Cambridge, MA, Thrive Boston Counseling. (www.thriveboston.com).