Karen R. Koenig: “Your heart needs to be in it”

Your heart needs to be in it. I love doing therapy. I’ve seen people who think they want to be a therapist stick with it though they don’t feel great enjoyment or satisfaction in the work. I supervised a woman decades ago who I’m still friends with. She finally decided that she’d rather be a […]

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Your heart needs to be in it. I love doing therapy. I’ve seen people who think they want to be a therapist stick with it though they don’t feel great enjoyment or satisfaction in the work. I supervised a woman decades ago who I’m still friends with. She finally decided that she’d rather be a consultant on how to organize your house and your life and became a popular speaker and later an author on the subject. It’s important to know what you want out of the experience. If you only want to brag as a therapist, “Oh, I’m in private practice,” I doubt you’ll last very long. Ditto being a writer.

As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Karen R. Koenig.

Karen R. Koenig, LCSW, M.Ed., is an expert in eating psychology and has been in practice for more than 30 years. She is a popular blogger and an international, award-winning author of eight books on eating, weight and body image. Her virtual and in-person practice is in Sarasota, Florida.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?

I had an eating disorder for the first half of my life: bingeing, emotional eating, chronic dieting, and, for a while, bulimia. When I finally learned to make peace with food and my body, I began thinking about making other life changes, including returning to graduate school to become a social worker. My first post-grad job was in addictions and I stayed in it for six years until I decided to open my own practice.

My practice was general, but my mission to help people with eating disorders grew stronger and stronger. Concurrently, I had begun writing novels, short stories and screenplays. When nothing panned out, my agent suggested I write about what I know — which was how to recover from eating problems. My first book was published in 2005 and my eighth one came out in January 2021.

Due to my books, I’ve done scores of radio, TV and print interviews. I’ve also written dozens of articles on eating, weight and body image and other aspects of psychotherapy and my books have been translated into several languages. I’m where I want to be in terms of being an author and a practicing therapist.

I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?

My best mentor was my literary agent, Janice M. Pieroni, Esq. of Story Arts Management. She encouraged me to write about what I know and to find my own voice. We became and are still good friends. The best lesson she taught me is to not feel pressured to respond to anything in life immediately (not only in trying to get a book published), but to give myself time to consider what’s best for me and decide on an appropriate response. I’ve brought that idea into my therapy and my books which are all about learning effective self-management to live our best lives.

Other mentors include one or two of my colleagues. Although I’m no longer in a formal supervision group, I never hesitate to seek out colleagues when I have thorny clinical issues to deal with. I also have a peer mentoring relationship with a couple of my author friends. We network, share ideas and pass on useful information. I can’t stress how important this is in being both a therapist and an author. We need to freely give advice and be open to receiving it. Both writing and therapy are lonely professions unless you step outside yourself to connect to others. You can’t pretend to know it all.

What made you want to start your own practice? Can you tell us the story of how you started it?

The short answer is that I’m an only child who is very comfortable working on her own. The long answer is that after receiving my MSW, I worked in a methadone clinic for 6 years. I loved the job, but management issues made it more and more difficult to treat clients well. Many of the staff eventually organized to push out our boss and after that effort of several years, I was simply emotionally exhausted.

I thought, “Why not start my own practice?” as I wanted to downhill ski more often and take writing more seriously. My husband was supportive, we moved to a house whose layout was perfect for a home office, I signed up to be a provider for health insurance panels, and I was off and running. Well, actually, walking, because it took quite a while to build my practice.

Can you share the most interesting story that happened to you since you began your career?

That story would have to be how being mistreated by a boss and fighting back empowered me. It gave meaning to the saying, “speak truth to power.” Many of my co-workers were scared of our boss (for good reason), but many were tired of being mistreated and seeing clients suffer. We banded together, had clandestine meetings, lobbied board members, and hired a lawyer. I was fearful of the consequences but received tremendous support from friends and family to stay with the fight. Eventually, we forced our boss to resign and my co-workers who had wanted him out and I heaved a collective sigh of relief.

The work environment was never the same among the staff after he left. There were his supporters who were angry and resentful and those of us who felt vindicated. I learned so much about groups and myself during that time. And what the abuse of power can do to people — paralyzing them so that they can’t take action and how people come to identify with an aggressor. I’ve used those lessons ever since and passed them on to my clients, many of whom have been abused.

Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?

I am very fortunate that my parents gave me a sensible view of money. They encouraged me to support myself, but not to chase after fame or fortune. I’m also fortunate that, because I was married to someone with a comfortable income, I could make less than I would have needed had I been alone or in a different financial marital situation.

I was on many insurance panels in my first practice and when I opened my second one I decided to forgo them and work on a self-pay basis. Since then I’ve had a sliding scale. I’ve even treated clients who lost their jobs for nothing. Believe me, I know my financial situation makes me privileged and fortunate. Most people can’t do this, but since I can, I do.

Many of my clients pay full fee, some pay half fee, and some even less. I do this in part because I’m enraged that people who are willing to seek help have to say no to therapy because they can’t pay for it. I’m a Healthcare for All person. It’s a myth that people must pay a lot in order to feel committed to therapy. It’s pure nonsense. Here’s how I know that: I do volunteer therapy for a few organizations and there is no correlation between those who pay my full fee and those who pay nothing for a session.

I’m very clear about what I’m good at and what I’m not. I don’t have a math mind nor do I enjoy working with numbers. I do my own record-keeping, but have a great accountant, hire consultants for social media, public relations, and my website, as well as pay a literary attorney when I need a contract for a new book.

Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?

It’s especially hard to strike a balance when you have two businesses: being in private practice as a psychotherapist and being a writer. At 74, I rarely have enough time to do all the things I want for both jobs. I’m fortunate that I’m a self-starter, can set and keep boundaries, and am well organized. I also have a honed sense of what’s too much or little. I work Monday-Thursday and often weekends (I’m writing this on a Sunday). But I can and do take time off during the week when necessary or if I simply feel like it.

From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?

I remember starting my practice here in Sarasota and being so excited when I finally had four clients that I sent out an announcement to all my friends and family. Drumming up business if you don’t take health insurance is the biggest job for someone who owns a therapy business.

I did a great many talks back then (libraries, schools, any organizations that wanted a speaker) on eating disorders and that helped me get clients. I also found ways to get interviewed or write stories for local publications. One of my favorite stories is about a client, middle-aged and never before in therapy, who read one of my letters to the editor in our local newspaper and called to make an appointment because she thought I sounded kind and compassionate. I had a woman last month tell me she’d had my card on her refrigerator for years and finally decided to call me about her overeating problems.

The biggest obstacle to overcome is that most business owners want to do what they love, not marketing, but without marketing, you don’t get to do what you love.

Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)

  1. Your heart needs to be in it. I love doing therapy. I’ve seen people who think they want to be a therapist stick with it though they don’t feel great enjoyment or satisfaction in the work. I supervised a woman decades ago who I’m still friends with. She finally decided that she’d rather be a consultant on how to organize your house and your life and became a popular speaker and later an author on the subject. It’s important to know what you want out of the experience. If you only want to brag as a therapist, “Oh, I’m in private practice,” I doubt you’ll last very long. Ditto being a writer.
  2. You need to be realistic and know your strengths and weaknesses. I knew when I started out that I was poor in math and that wasn’t going to improve. I don’t expect myself to be good at everything. I subscribe to the basket approach of living: have things in your life that go into baskets for wanting to be excellent, good enough, fair or poor. You don’t need to be good at everything to be successful as a business owner and, often, if you try, it ruins the experience of what you love to do and do well. If you hate doing public speaking, you’ll need to find another way to reach out to your community. If you need to make money right away to support a family, you’ll likely need a plan B to generate more income.
  3. You need to have a personality that connects with people. I’m fine on my own and enjoy spending time by myself, but I also love to connect with people — clients, strangers, colleagues. If you’re shy or insecure about connecting, you’ll have a harder time with clients and growing your business. For example, I went to two doctors this week. One showed no empathy or interest in me, while the other made it his business to listen and show me he cared. One seemed only to want to lecture and the other one was a people person. Guess which one I’ll never return to. It’s no crime if you don’t enjoy people or are a pure introvert, but unless you’re exceptionally talented and unique, it’s not going to bring you business success.
  4. You need to be able to maintain ongoing self-care. I know many health practitioners who don’t take care of themselves. Some tell me they awaken in the middle of the night thinking about patients and can’t fall back to sleep. Or they have no restricted business hours and take non-emergency calls from clients during off hours then feel resentful of having no “me” time. They encourage clients to exercise and plan meals, but allow themselves to put off exercise and eat unhealthfully. I’m not sure if it’s because they don’t care enough about themselves or are so stressed out they have no energy for self-care. My motto is that I take care of me and others, not me or others. Self-care isn’t haphazard and needs to be scheduled in. I have a client recovering from substance abuse and in graduate school to become a therapist who’s just learning that she can’t eat dinner in front of the TV every night and nourish herself mindfully. She also understands that she’ll be in a better position to counsel others if she develops positive habits.
  5. Don’t define yourself by your business success or failure. We are all less than our best success and more than our worst mistake. You might enjoy great success — have a burst of new clients, win awards, get mentioned in the local paper, and some years make more than you ever dreamed of. And you will likely have down times that seem endless. Unless you can tolerate frustration, go with the flow, and keep your hopes up when the business isn’t going well, it will bring you down. When the business is doing poorly, you’ll want other paths to joy and happiness. When it’s booming, you’ll want to remember that the boom likely won’t last. The only reason I was able to start a second practice when I moved to Sarasota was because I knew I could weather the ups and downs of having one.

As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?

The amount of time spent on each depends on your energy level, financial needs, other commitments and where you are in your career. At 74, I’m not looking to grow my practice. I spend far less time now marketing than I did when I opened my first practice in the late 1990s. Also, I’ve found dependable, smart people to assist me in marketing, social media, and web development. Having them (and I went through many people to find them) allows me to spend more time on what I enjoy: working with clients and writing.

I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?

When I opened my practice in Florida, I signed up as a Medicare provider, but I had many problems with them. I might have been smarter to hire someone to do my insurance billing, but that’s not the direction I took. Finally, after a conversation with Medicare which ended in my hanging up the phone in tears, I said, “I’m done. Medicare doesn’t pay me enough to be this frustrated.” Instead, I decided to go the self-pay route having clients pay what Medicare would have paid me.

I recommend that people new to developing healthcare practices know that they will have many stresses from insurance companies. Either hire someone or prepare to spend a good deal of time and energy dealing with them. Know yourself. Some practitioners manage this stress better than others.

I keep sane by having a schedule. I don’t see clients until 12:30 pm and generally only Monday-Thursday. I use mornings to blog, answer emails and do some sort of exercise daily. When I was younger, I could see 5–7 clients in a row. No more. My limit is 3 and I prefer 2. I don’t mind working until 7:30 most nights. I’m definitely more of an evening than a morning person. Again, you need to know yourself. I take time off for a 30-minute walk up and down our street with my husband most evenings. We don’t eat dinner together, so that’s our special, routine connection time.

I’m very social, so I try to see/Zoom/email friends as often as possible. Sometimes we’ll talk about work, but I endeavor to limit my end of discussing work problems. When I’m not with clients, I try not to think much about their issues. I take 2 dance classes a week (now on Zoom, but previously in studio) and am part of a dinner group that discusses current events twice a month. Also, I attend monthly lectures with another group which feeds my social and intellectual needs.

Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?

My favorite quote, hands down, is by the late Scottish psychiatrist, R.D. Laing: “There is a great deal of pain in life and perhaps the only pain that can be avoided is the pain of trying to avoid pain.” The lesson is clear: choose your pain because you can’t escape having it in one form or another, either as emotional distress or discomfort. I advise clients, “You can have comfort now and pain later or pain now and comfort later. Your choice.” This is as true in building a healthcare business as it is in eating past full or getting exercise.

Once I recognized the truth in Laing’s statement, life became easier for me. I became less of a procrastinator and did what I needed to do in order to get done with it and feel proud and relaxed. I felt more empowered that I had choices and even somehow found tasks I used to think of as odious (such as doing end-of-year recording keeping) as more of a challenge than a chore.

How can our readers further follow your work online?

Thank you for these great insights! We wish you continued success and good health!

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