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News In Brief (NIB)

News In Brief 7/6/18

It’s not for the faint of heart……….

The closing of a private practice is a complex process inclusive of ethical, legal, financial, and emotional issues. I found a handy-dandy checklist in the literature discussing the ethical, legal and financial obligations. However, the checklist failed to help me anticipate the intensity of my own resistance to termination. It is my intent now to bring some awareness to that intensity, as well as share some of the “to-do’s” of closing a private practice.

Through the process of termination, I learned so many things at a more poignant and profound level. (My onion lost a few of its proverbial layers!)  As my clients and I sifted through our feelings and made plans for transition, I found I was more attached to them then I realized (and I knew I was attached). The importance of relationship was established in a yet unarticulated, but significantly different depth.

I found that many people with whom I wondered if I was making any progress at all with, had the hardest time separating. They were able to verbalize the significance of our therapy with meaning, that at times prior, I had questioned their capability of experiencing. I realized our work mattered more than I was aware. It re-emphasized the important role that “we” psychologists play in so many lives.

The process of saying goodbye to so many long term relationships (albeit professional in nature)– over and over– day after day –was exhausting and overwhelming. These feelings plopped me right on my rear end. Like, being in bed (asleep) by 7:30 p.m. exhausting. I was emotionally drained, yet needed to continue down the checklist of “other” things to do, all the while trying to prepare for my next phase of life.

I’m a psychologist. I know about feelings. I identify them. I bring awareness to them. I teach them. I share them. However, experiencing loss, sadness and grief with people for whom I care about, hour after hour, for several weeks??? Well that’s just hard. My advise?  Prepare for that. Plan for that. Leave time and emotional reservoir for that.

But who has time for all that self-care (or so I thought) when one has to do the following? Here is my own handy-dandy checklist:

 Give adequate notice

Good ethical behavior suggests we give clients adequate notice. What does that mean? Every client is different. And what if the timing of closure is not within our management, such as in illness, relocation, or the needs of others relating to the purpose of the closure? We need to remember we are only human and only do the best we can.

Notify

A heartfelt letter to both clients and referring colleagues is a good way to start, I found. There may be a few who come to mind that the “in person” approach may be more appropriate, so go through your client list and identify those folks prior to a trip to the USPS. In that letter, an offer to help with transitioning to other providers for continuing care may be presented. Additionally, the letter should include where the clients records will be. Personally, the thought of every client over the last 12 years requesting a copy of their records frightened me! There is just not enough time and ink! Finding a record retention company may be something to consider.

Transition

Ideally, long term clients may need a few months to process and help transition to another provider.  Be aware that the “perfect provider” may not accept the client’s insurance. A suggestion to the client may be to obtain a list of providers from their insurance company, then discuss the “best fit” from that list.  Finding a good fit takes time. A client may need to meet several new therapists, and the provider closing a practice will likely spend time on the phone with the new person(s). This makes the timeline more complicated, and yes, potentially more tiring. Other clients may be “ready for a break” and take the news less seriously. In fact, they may fly out the door with a happy smile. That has its own set of emotions to process. Then there are the folks one may have seen on and off for years and who hold special favor in one’s heart but are currently not in one’s upcoming schedule. Those folks, as well as the provider, would likely benefit from a phone call in addition to a letter. (Yes that means more non-billable hours spent on the phone dealing with yet more emotions).

Record Management

In addition to providing clients with the name and address of where their records will be via letter there are other things to consider. It is recommended that putting notice of closure, instructions on how to obtain records, and/or how to reach the provider on the business website. That means paying for a few years to keep the website and phone/fax lines open. Additionally, a greeting message on the phone should announce the closing to the practice as well as the above mentioned instructions.

Legal and Business

Then there is that legal stuff like contacting the state and federal folks. Make sure your attorney knows what you are doing and ask for information that you may not realize you need to do— what don’t I know to ask about?? Likewise inform your malpractice insurance, and make sure your insurance will cover any incidents that may be reported after you leave. Cancel your “trip and fall” insurance. Then, the most dreaded part– inform the third party reimbursers of your plans. Good luck with that! I suggest not asking them to forward any mail to a different address. Just saying. (Insert heavy sigh here.)

Self Care

Finally, go get a massage. Drink a beverage of choice. Be with your people. Visit a beach or go hike a hill. Relax and appreciate the role of self-care in your life!

Kathleen Albert, Ph.D.

For further information and/or references:

http://www.apa.org/monitor/feb03/howtoclose.aspx

https://nationalpsychologist.com/2015/03/closing-a-practice-practical-ethical-clinical-dimensions/102816.html

https://www.slideshare.net/psychbuilder/closing-a-psychology-practice

https://www.cphins.com/closing-a-practice/