Cognitive Biblical
Therapy Coursework
Counseling Through God’s
Transformative Word!
Course 6 Chapter 4
Chapter 4 Setting up the Office
a. Physical Space
b. Insurance Protection
c. Marketing Image and Equipment
d. Setting Your Counseling Fee.
Essay Questions: Answering the section questions (red buttons) is a great way to prepare for the end of the Chapter Quiz. Chapter 4 questions will help you review the text material and apply to your present or future counseling setting. The section questions will provide Dr. Wilkinson’s feedback to your answers.
Quiz Requirement: At the end of the Chapter, a score of 75% is necessary on the Chapter Quiz in order to access the next chapter.
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Chapter 4
Setting up Your Office Space
Sound Proofing
These guidelines will exist for any office space regardless of its location: the entrance to use, waiting area, restrooms, and office sound proofing. There's nothing more destructive to your practice than the ability of somebody to hear what you or the client is saying with the office door closed, even if it is muffled or faint. If the client in the waiting area realizes this, they will assume others can hear them which reduces comfort, confidence and credibility in your counseling. There has to be absolute confidentiality. So soundproofing is going to mean additional insulation for walls, special doors, or isolation from anyone able to listen. Isolation can mean a separate building, isolated from other offices or rooms. Often in a facility other than your home, isolation is the best option. It would be difficult to ask a host facility to modify an office to be soundproof by adding material to the walls and ceiling. In a rented office space, soundproofing should be in place or make it part of the agreement. A hollow core door will act like a magnifier of sound, so a solid door is required to reduce the ability to hear the conversations. Consider the common practice of using a “sound machine” outside of the office door.
Access to restrooms is required, preferably two of them, that are not shared with your family. It's just an issue of professionalism and appearance that has to be seen as important to you. Both the office and restrooms will need to be cleaned and maintained because they reflect on your commitment to your clients. You need to know how it's maintained, because that'll be a reflection to some degree of you and your practice. Other issues are the waiting area, entrance and a separate exit. The waiting area should obviously have an entrance. But there then should be a second exit, so that the people do not have to walk past other clients that are waiting in the entrance. If you can have chairs and a small table for their use, it doesn't have to be big or fancy. The real issue with a waiting room is just that there's a place that's isolated to some degree or gives a person privacy and gives them a sense that it's a professional office. Even a hallway can have nice chairs, some potted plants, and a table. There has to be designated, adequate space for parking that is not an area of gravel or dirt. You don’t want clients to have difficulty getting to your office, which may require some signage to direct them. People seeking help do not need additional problems to navigate through.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
In establishing a counseling office there are some general concerns that have to be understood in order to have an effective office. List and describe some of these considerations.
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Dr. Dan's Answer:
Some of these concerns are soundproofing, location and adequacy of the office bathrooms, an appropriate waiting area for clients, the amount of parking, and entrances and exits into the office area that allow clients to come for counseling without passing by each other or other heavily trafficked areas of the office space.
Malpractice Insurance
One of the most crucial aspects of the establishment of your counseling practice involves malpractice insurance (see attached example). Malpractice insurance is basically protection against a lawsuit by a client that says you mishandled their case and they suffered emotional, financial, mental, or spiritual harm. They may claim that you were not professional, and you actually botched up their case and made the whole thing worse. You will need to be prepared to deal with the potential threat for lawsuits. In eight years of practice, I've been threatened with lawsuits three times. Once was from a person who was mentally ill, and contacted local newspapers, radio and TV stations in an attempt to discredit me. They checked my credentials and found no credible evidence, so it went nowhere. The threat tends to rattle and scare you when it comes. I've been subpoenaed many times for a divorce or a custody case, and a child molestation case. Subpoenas aren't the same as a malpractice or lawsuit, but they can lead to it if the person tries to discredit your testimony to prove their point is correct.
In general, what most professionals recommend is that you carry $1 million per case for every client that you have. If your office is in a church, they will ask for coverage, which you can obtain as a rider (additional insured) as a part of your malpractice policy, for about another million dollars per case. This way, your practice and your office provider (church, parachurch organization, agency, etc.) are adequately covered which is typically a part of your contract or agreement. Some companies will go up to $3 million per case in coverage, which is realistic, if you are dealing with several high-risk cases, a lot of court testimony, or frequently serve as a professional witness. I found that the American Counseling Association, through HPSO, offers reasonable rates.
I advise you not to counsel until you have this insurance. If you don't collect your own fees, you are less liable to be sued, because taking a fee is an indication on your part that you see yourself as a professional, but you're still liable somewhat. If you are in a church setting, they have insurance policies that will extend to you and cover you, but find out. Don't counsel on the assumption that you're covered. A lawsuit can drag into 1000s of dollars, even a million dollars which will ruin you financially for years or even the rest of your life. Work with the Lord to get the money to pay for the insurance.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
One of the most crucial aspects of the establishment of the counseling practice involves malpractice insurance. Discuss why this is crucial, what the minimum amount of insurance is that a person should carry, and where this insurance can be most reasonably obtained.
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Dr. Dan's Answer:
Malpractice insurance is essential in that if the counselor does not procure it before an actual lawsuit, there is literally no protection against large financial liabilities. Even if the counselor is proven innocent, there will still be a substantial cost in regard to the lawyer's fees required to respond to the suit.
Also, a rider on the insurance policy that covers the counselor is required so that a host facility -- such as a church -- will not suffer any financial difficulties due to the lawsuit, since the church could be named as part of the original suit.
Marketing Image
The Marketing Image is really your self-perception, your perception of the professional person you are marketing through all of the ways you present yourselves, such as your business card, brochure, letterhead or social media. See examples of promotional materials attached to this course. A professional image requires a balance between what you can afford and what you need to present yourself well. There is no need for over sophistication, but should communicate well to those in your market area. A small town versus a metropolitan area will require different levels of professionalism. You need to assess your marketing area to determine the level of sophistication, in order to accurately state your commitment to excellence in meeting the needs of the client. Anything less creates an insecurity or doubt because of the lack of care given to providing for the client’s needs for comfort and confidence in your ability to help them. Look at the quality level in each of the course outlined guidelines. A subtle sign of professionalism is what I mentioned that client chairs need to be padded and comfortable with padded arm rests. The comfort also increases attention on session engagement, instead of the distraction of discomfort.
Your office equipment should function well and provide for all of your communication needs. Digital technology is complex, yet be aware of what other therapists are doing to market and promote their practice. Find a reasonable website developer for your own website, content designs for other marketing sites, social media and email campaigns. You may need to have printing of brochures and business cards done outside of your office to reach the level of marketing professionalism needed. Some of your printing can be adequate on your office printer such as letters to pastors and other professionals. God will guide you to find the right quality that provides an overall sense that the image that you present is going to be appropriate and generate trust and confidence in your clients and other professionals. Any help you have with your practice should also be of a quality level for your targeted market of clients. Volunteers are great, but you must train them on professional standards for your communication and interaction with clients. This may mean a certain dress code, conversation topics and office procedures. If you use an answering service or scheduling agency, they will need to meet the level of quality you desire. All of these things combine to make up your marketing image, which will make or break your practice, because that first impression often encourages the client to connect positively with you.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
The marketing image that you project will be discerned through such things as the condition of your office equipment, whether or not you utilize computers, the condition of your waiting room, the contact that you or your secretary has with the client, and even the style and type of message that you have on your answering machine. Please discuss your thoughts on this issue and whether you agree or disagree with the emphasis on your marketing image.
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Dr. Dan's Answer:
The marketing image is actually the evidence of the counselor's own professional and personal self-image. It requires a balance between what the counselor can afford and what is needed to present a professional image to the public. There is no need for over-sophistication, but whatever the counselor utilizes for everyday needs -- office furniture, computer, letterhead, printer, business brochure or cards, etc. -- needs to make a statement that the counselor is committed to excellence and to meeting the needs of the clients.
Anything less will create a spirit of insecurity and doubt within the client, and will not enable the client to have a sense of protection and trust with the counselor.
Setting Fees for Counseling
There are three options for setting fees: flat fee per session, sliding scale based on income, and what insurance will pay. See examples of counseling fee handouts in the Required Written Materials. Setting a flat fee is most often used when there are plenty of clients needing your services. You can learn about the most common rate from other counseling and mental health professionals in your area. Second, you can research the “Usual, Customary, and Reasonable” rate for your practice at the Fair Health portal (put in your zip code & go to Behavioral Health tab). Even though the session rate is for insurance companies, it is the nation’s standard for setting the maximum fee you will charge for your services. Legally, you must set a session fee for counseling as your standard rate, not higher than the UCR, but the same or lower. So first, set your standard rate for a 50-55 minute session.
Second, if you desire, you can use a sliding scale based on the client’s income. The larger the income, the larger the fee. You can make a range for your scale based on three levels: below the area’s average wage, the average wage, and above the average wage.
For example, if your standard session fee is $100, and the average wage in your area for a household was $60,000 per year, the fee would be $70 per session. A wage above $60,000 would be set at $90 per session, and below $60,000 the fee would be $50 per session. This will allow more clients to use your services than if you have a flat fee that is your highest fee. If an organization like a church is paying for the clients, you can reduce the fee for them. See the “Explain Fee and Counseling Services” form as another option to consider when setting cost per session.
Another consideration in all this will be the balance of receivables and disbursements for your accounting system. In other words, when you receive your income, you have to think about how much you collect after the session from churches or insurance payments and how much is in cash. Your major consideration in setting your fees is the need to have the fees generate a reasonable income, support your overhead expenses of the practice, and reach your marketing goals. The quality of your counseling and marketing will provide a steady flow of referrals, if your services are affordable. The idea of a reasonable income depends on where your practice is located.
When I moved from a small city to a large metropolitan area, the cost of living increased about 25%. In general, that meant that my counseling fees had to be adjusted to maintain a successful practice. Gathering information from the area where you are, learning the fees charged by other professionals and the cost of living there, will all help you find a fee level that will be reasonable for your clients and also provides your income and office expenses so that practice flourishes. If you are in a host church, your expenses will not include overhead of rent or utilities. That will reduce the expenses you will have to earn money to pay for. I suggest that when you begin, you charge slightly less than the counselors in your area. You will find more than enough people who want counseling, but can't afford the higher price. Your referrals will keep you busy, and after you gain some experience, you may want to raise your fee slightly.
The second issue is earning enough to meet your overhead expenses. You have to keep track of the cost of office supplies, equipment, salaries, taxes, marketing (time and materials), time off for illness or vacations. To do this I recommend purchasing an accounting system and form a habit of keeping track each week to be aware of your income and expenses to help you make decisions about future purchases, marketing and your salary. If you send bills to clients, churches or insurance companies, you will need an accounting system that will assist you in keeping track of what has been billed, and what has been collected. Because of the time lag in payment, you will need to limit the percentage of your weekly fees to a percentage of your weekly income. I suggest that it is not more than 25%. For example, one week you had a total potential income of $2,000, but of that total amount of money, you collected only 75% in cash, charges or checks which reduces your available money to $1,500. If your needed income for each week is $1,400, you are okay, but any more than the 25% would result in you not making your goal for income. That would mean that you would need to collect more the next week to make up the shortfall. You will need to keep track of the number of reduced fee clients that you schedule to keep your income acceptable. When you have a waiting list, that is much easier to control.
You will have fluctuations in income, so you will need to keep an average in mind of the minimum so that you will be able to handle this, and not feel insecure with it. There are so many variables with clients keeping sessions: cars that break down, kids that are sick, lag in billing, and knowing when payments are due. You need to control how many people pay in any given week.
If you have 25 sessions each week, then you can only charge (bill) six sessions that week. If someone calls to schedule a session, and they are not a cash payment, then you put them on the waiting list. You don't put them in that four o'clock session on Friday, you put them on the waiting list. Agreeing to begin counseling another lag payment person requires that you have them the next week or the week after that which increases your percentage of charging payers. You or whoever does your scheduling has to keep track of that. If you get too many clients in delayed payments, your actual in hand receivables don't meet your expenses. You come up short, and something will not get paid. It may be your salary or another bill. Once you get a predictable flow of payments from churches and insurances, you may be able to adjust this somewhat.
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
Part of the marketing issue also deals with the level at which the counselor sets his or her counseling fees. Discuss your criterion for this decision and some options that exist for how the counseling fees will be established.
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Dr. Dan's Answer:
The major consideration in setting fees is the need to generate a reasonable income and to meet the overhead expenses of the practice. The most reasonable way to do this is to eliminate overhead by having the practice in a church facility where the church absorbs the cost of rent, utilities, and other expenses. This allows the counselor to provide counseling for between $35 and $50 -- affordable for most people and below the $60 to $80 range typical at the secular level.
Fees can be set by a flat fee (such as $50 per hour), by a sliding scale (with an income level serving as a dividing line between lower and higher rates), or as a reduced fee to certain individuals or organizations. Some income will be deferred through billing or insurance reimbursements, which can take at least three weeks or longer. This means regular receivables must be high enough to sustain the initial income gap that billing creates.
Miscellaneous Insurance Options:
The last issue in this chapter deals with insurance protection other than the liability I mentioned earlier. Insurance coverage for bodily injury to a client, renters coverage, equipment coverage, or the counselor’s workman's compensation or income protection. The bodily injury is something that you can pick up just as an extra policy, which is inexpensive, but basically covers your client against any unforeseen accidents. The renters insurance coverage, either you purchase or it may be part of the insurance that covers the facility where your office is located that covers things like damage due to thunderstorms to your computer or other equipment. Workman’s compensation depends somewhat on the size of your practice. The income protection is a disability plan, such as supplemental insurance to cover out-of-pocket expenses due to injuries, illnesses and hospital stays, which you can purchase as a sole proprietor or through your corporation. Probably the income protection is the most important, simply because you need something that's going to allow you to receive income if you're disabled for any length of time.
Copyright 1987, 1990, 1993 by Daniel D. Wilkinson. All rights reserved. For more information concerning this material, write to:
The Biblical Christian Counseling Ministries, Inc., 2730 Radcliffe Dr., Florissant, MO 63031.
Any reproduction of this material without the express written consent of the author is prohibited. Printed in the U.S.A..
Fully answer the following question from the content you just read and submit your answer to find your score and Dr. Dan's answer to the question.
What other types of insurance protection besides malpractice insurance should the counselor consider as part of his or her insurance protection package within the practice?
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Dr. Dan's Answer:
Other types of insurance that should be acquired include bodily injury liability insurance, renters insurance, equipment coverage, worker's compensation, and disability insurance.
You are ready to take Course 6, Chapter 4 Quiz.
Quiz Requirement: A score of 75% is necessary to continue to the next chapter. Remember, it may be necessary to retake the quiz to score 75%, as a part of your learning experience. If so, no worries, give yourself grace and time to absorb the detailed text.
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