Innovative or funky private practices?

[gohogwild]

Hi Folks,

I just came across a reddit thread about therapists who offer walk & talk therapy- some clinicians said that they offered the service once or twice by meeting with a client in a public park, but inevitably found there to be a breach of confidentiality (other walkers, etc). I thought this sounded beneficial for certain people or populations (esp, ASD folks/others who may benefit from a way to discharge energy during treatment or are uncomfortable with eye contact) and that this could be theoretically solved by some kind of enclosed court yard or walking loop as a part of a private practice.

And so I am wondering, just for fun, if you've heard of any innovative or interesting private practice-practices like that? Unique structural features or creative integrative practices? Just curious & thanks

---

Members don't see this ad.

 

[Therapist4Chnge]

Years ago I worked at a residential facility and we had multiple outdoor spaces we could use. The residents often liked to be outside on nice days, so we would accommodate when possible. It was a controlled space, so privacy was easier.

I’ve done some performance interventions in rehab gyms, team facilities, and practice fields, but that isn’t traditional therapy. Pre-shot routines, mindfulness exercises, visualization exercises, etc. to improve focus, attention, and overall performance. I don’t do much of it these days, but that was fun work.

I haven’t seen this setup in private practice yet. I def would have concerns about confidentiality, though I can also see some of the benefits, especially for the neurodiverse folks.

 

[gohogwild]

Years ago I worked at a residential facility and we had multiple outdoor spaces we could use. The residents often liked to be outside on nice days, so we would accommodate when possible. It was a controlled space, so privacy was easier.

I’ve done some performance interventions in rehab gyms, team facilities, and field work, but that isn’t traditional therapy. Pre-shot routines, mindfulness exercises, visualization exercises, etc. to improve focus, attention, and overall performance. I don’t don much of it these days, but that was fun work.

I haven’t seen this setup in private practice yet. I def would have concerns about confidentiality, though I can also see some of the benefits, especially for the neurodiverse folks.

Very cool! What’s a performance intervention? Confused about the context, what population would that be with?

 

[PsyDr]

There are multiple neuropsychs that use fMRI in their clinical practice.

Part of the difficulty in innovation: Malpractice requires that you deviated from the standard of care. If you’re doing something “out there”, you’re opening yourself up to liability.

 

[Therapist4Chnge]

Very cool! What’s a performance intervention? Confused about the context, what population would that be with?

I previously worked at two large R1 universities, and I carved out a niche while seeing a lot of collegiate, pro, and Olympic athletes for concussion eval and management. Sometimes athletes would request to continue to work with me, and the work would shift from concussion management to coping with stress and working on the mental side of athletics. Sometimes we’d meet at my office and other times I’d meet the student athletes in the gym/training areas. Most of the athletes I worked with would be in the training rooms during practices bc they weren’t cleared.

Then I started getting one off referrals like an ortho injury (e.g. MCL tear). An assistant or position coach would go thru the team doc to get me involved. It was pretty common for players to come back from ortho injuries and be hesitant to push themselves in PT bc of fear of re-injury. Most teams have sports psych, but some teams/coaches/management preferred me bc I brought a slightly different skill set. It’s not easy to get into, but it’s interesting work.

My pro athlete referrals all started as concussion management, but some turned into performance-based work with some coping/stress management sprinkled in. I use a lot of behavioral interventions, mindfulness, MI, and education (e.g. physiologic response to stress).

 

[BuckeyeLove]

I had a long term therapy patient that i worked with during internship and I kept working with him through fellowship. Serious NPD in the context of some serious legal charges which resulted in long term hospitalization. Dude hated therapists with a passion, viewed them as the reason he was essentially hospitalized for life. Led to some longstanding dysthymia. Working with him was like a chess match though (think Toby doing therapy with Michael Scott in The Office). Anyways...I taught him how to play guitar and we concluded our work by performing at the facility talent show that year. Not exactly evidenced-based, but I think i did help dude out a little. I would never do something like that in private practice though where i was billing for those services haha.

 

[Shiori]

When I was still in grad school, I helped out one of the local private practices that did scavenger hunts for kids with social anxiety. We were all assigned to rooms with different themes. The kids had things on their list to accomplish within each room. It involved activities that made the kids anxious like asking questions or looking silly, so they got to practice their coping skills with friendly adults. I thought it was really cute. We all had fun.

 

[Sanman]

Years ago I worked at a residential facility and we had multiple outdoor spaces we could use. The residents often liked to be outside on nice days, so we would accommodate when possible. It was a controlled space, so privacy was easier.

I’ve done some performance interventions in rehab gyms, team facilities, and practice fields, but that isn’t traditional therapy. Pre-shot routines, mindfulness exercises, visualization exercises, etc. to improve focus, attention, and overall performance. I don’t do much of it these days, but that was fun work.

I haven’t seen this setup in private practice yet. I def would have concerns about confidentiality, though I can also see some of the benefits, especially for the neurodiverse folks.

Did the same in nursing homes. In fact, it usually afforded more privacy than the curtain in their room with a roommate did. I have done some co-interventions with rehab staff in the rehab gym as well and did some exposure interventions outside of the office in PP.

 

[summerbabe]

I wasn’t involved but a VA PRRC that I previously interned at had a standing weekly D&D game group. I don’t know much about D&D but observed once and while the gameplay bored me to tears, that seemed like a really cool way to work on social skills and keep those veterans engaged with VA care.

At another VA polytrauma residential rehab, I went on a few community outings. In particular, I was doing Prolonged Exposure with one patient related to their injury/trauma so getting to see that person interact with the outside world while also chatting on and off during the outing and then bringing some of that stuff into PE was neato.

 

[Therapist4Chnge]

When I was still in grad school, I helped out one of the local private practices that did scavenger hunts for kids with social anxiety. We were all assigned to rooms with different themes. The kids had things on their list to accomplish within each room. It involved activities that made the kids anxious like asking questions or looking silly, so they got to practice their coping skills with friendly adults. I thought it was really cute. We all had fun.

Very cool idea. I was Peds and Adult trained, and I actually sometimes miss working with kids, but the 'real world' logistics of working with kids isn't practical for me. There are so many ways to waste (unbilled) time that happen when working with kids, and I've worked hard on my lifestyle to cut out wasted time/non-billing.

One area of "niche" work I'm curious about are these "wellness retreats" to various tropical locations. I know someone who does these, and they can be very lucrative in some gorgeous settings. It doesn't fit the kind of work I currently do, but if I ever sellout and go Dr. Phil or similar, I wouldn't mind "hosting" exotic wellness retreats.

 

[Sanman]

Very cool idea. I was Peds and Adult trained, and I actually sometimes miss working with kids, but the 'real world' logistics of working with kids isn't practical for me. There are so many ways to waste (unbilled) time that happen when working with kids, and I've worked hard on my lifestyle to cut out wasted time/non-billing.

One area of "niche" work I'm curious about are these "wellness retreats" to various tropical locations. I know someone who does these, and they can be very lucrative in some gorgeous settings. It doesn't fit the kind of work I currently do, but if I ever sellout and go Dr. Phil or similar, I wouldn't mind "hosting" exotic wellness retreats.

I have thought about this as a "retirement" plan. Nice office by the water, offer massage therapy, yoga, etc. and cater to the rich and stressed out.

 

[summerbabe]

One area of "niche" work I'm curious about are these "wellness retreats" to various tropical locations. I know someone who does these, and they can be very lucrative in some gorgeous settings. It doesn't fit the kind of work I currently do, but if I ever sellout and go Dr. Phil or similar, I wouldn't mind "hosting" exotic wellness retreats.

Get some ayahuasca going and the retreat will practically run itself

 

[WisNeuro]

Get some ayahuasca going and the retreat will practically run itself

Only way I'm getting on board with that liability is if we host the retreat in international waters.

 

[PsyDr]

Only way I'm getting on board with that liability is if we host the retreat in international waters.

That's parallel to my retirement plan:

The "SS It's Not Illegal Research If We Are In International Waters"

 

[Therapist4Chnge]

That's parallel to my retirement plan:

The "SS It's Not Illegal Research If We Are In International Waters"

It'll be like Pirate Bay, hanging in international waters, but with better weather and less bandwidth demands.

 

[borne_before]

Hi Folks,

I just came across a reddit thread about therapists who offer walk & talk therapy- some clinicians said that they offered the service once or twice by meeting with a client in a public park, but inevitably found there to be a breach of confidentiality (other walkers, etc). I thought this sounded beneficial for certain people or populations (esp, ASD folks/others who may benefit from a way to discharge energy during treatment or are uncomfortable with eye contact) and that this could be theoretically solved by some kind of enclosed court yard or walking loop as a part of a private practice.

And so I am wondering, just for fun, if you've heard of any innovative or interesting private practice-practices like that? Unique structural features or creative integrative practices? Just curious & thanks

When the weather is nice, I am always outside without my patients! They usually have ADHD. Sometimes we walk some stairs to the top of parking garage and watch stuff

Recently, I was doing exposures with a boy who had selective mutism. The kid was one hell of an athlete. Like a natural, can dig, great form, etc. He was also pretty busy. So before exposures, we did some sprinting while I caught up with dad. He began singing and making verbal noises that day. It was pretty neat. He loved jumping from chair to chair outside.

I don't really think you can treat a hyper boy in your office - (usually trying to target anx/dep, not hyperactivity). I am also always wondering around the clinic doing exposures, practicing social skills, etc. A fun activity is to walk with a patient and verbalize everything your mind says, so they understand that your mind is like theirs - it never shuts up.

It helps me get my wiggles out too.

Personally, I wouldn't worry about a privacy violation as long as the patient understands the risks and the area is reasonably private. Just make sure the pt knows the risks and you documented that convo.

Edit: this wasn’t me being an “amazing”psychologist. I just wanted to get the kids wiggles out and it was a side effect - maybe some endorphins lol.

 

[gohogwild]

When the weather is nice, I am always outside without my patients! They usually have ADHD. Sometimes we walk some stairs to the top of parking garage and watch stuff

Recently, I was doing exposures with a boy who had selective mutism. The kid was one hell of an athlete. Like a natural, can dig, great form, etc. He was also pretty busy. So before exposures, we did some sprinting while I caught up with dad. He began singing and making verbal noises that day. It was pretty neat. He loved jumping from chair to chair outside.

I don't really think you can treat a hyper boy in your office - (usually trying to target anx/dep, not hyperactivity). I am also always wondering around the clinic doing exposures, practicing social skills, etc. A fun activity is to walk with a patient and verbalize everything your mind says, so they understand that your mind is like theirs - it never shuts up.

It helps me get my wiggles out too.

Personally, I wouldn't worry about a privacy violation as long as the patient understands the risks and the area is reasonably private. Just make sure the pt knows the risks and you documented that convo.

I absolutely love your methods! What's your setting, if I may ask? Sounds like you work mainly with kids? Thanks for sharing!

 

[borne_before]

I absolutely love your methods! What's your setting, if I may ask? Sounds like you work mainly with kids? Thanks for sharing!

It’s a pediatric multi speciality center. We see about 3000 kids with chronic health conditions and developmental disabilities per month. Almost all of our patients are on Medicaid. I’m really fortunate to be here and love going to work.

On the med side we have neurology, ENTs/neurootology(sp), gastroenterology, geneticists, pulmonologists, psychiatry, plastic surgery, etc. I’m sure I’m missing many.

On the rehab side we have PT/OT/Speech. Psych is probably more on the rehab side of things.

I used to only work with kids. But now a few of my patients are emerging adults with guardianship (I actually have one emerging adult who is their own guardian, but is very complex medically).

I’d say about 60% of my job is testing kids to help them get state funded developmental services (ie autism and intellectual disability). I do about five hours of parent management training per week (so I guess they count as adults - doesn’t always feel like it). I do another five to ten-ish hours of individual therapy per week.

Honestly, I could make more for fewer hours of work a week If I did what most testing psychologists in my state do - drop insurance and go private pay only and struck out on my own.

I’m literally one of the last people in the state who does GOOD, full, comprehensive evals for insurance.

But my patients, dude, they’re amazing. My colleagues are amazing.

It’s cool to be a place that tries to help the whole human. I get super interesting and complex cases all the time. Like one weird competency has developed where I’m like the only dude in three states who see a deaf/Deaf/hearing impaired kid for an autism eval. Ditto for visual impairment.

I also love collaborating with the geneticists. But like, the emerging adult I mentioned above, wanted me for therapy because I could look at the whole medical chart and help them understand it in accessible ways.

Never a dull day. Occasionally I’ll get a code where I gotta go help a young man who is showing some aggro bxs and do some quick behavior mod (usually with a high value treat) to help them get through their appt.

We had this one dude, who was always getting aggro but couldn’t communicate. Because we are team, we were able to figure out that this dude had CSF leak and was in tremendous pain. A small surgery later, and the dude is coming off some heavy hitting meds, more communicative, etc. gives me chills. And I just basically helped him chill a few times.

Sometimes we’re fighting an uphill battle with very poor parents, low resource knowledge, low self advocacy skills, don’t speak English. But those are super rewarding when you dx a three year old and get them services/aba and I’ve been there long enough that I’m doing some re-evals and get to see these wonderful lil humans grow and develop and it’s cool to be a small part of that.

And we have like four other psychs to always consult with - a huge plus.

But you also have to deal with administrative changes, bean counters, corporate, the latest “targeted health initiativ,” etc. that can temper my enjoyment lol.

 

[borne_before]

I absolutely love your methods! What's your setting, if I may ask? Sounds like you work mainly with kids? Thanks for sharing!

Btw - I added a note above. But the kid w/ exercise wasn’t me being some “amazing masterful psychologist”. It was just the kiddo needed to get some wiggles out and it was nice outside. So while I’m catching up with dad, hes out sprinting around.m and he starts verbalizing. And it generalized.

I also have a kiddo who has started bringing a chess set. We have an interpreter who likes chess too. That’ll be a good exposure I think. Plus it’s kinda fun to play chess with him. We read about the rules and when someone wins we try to figure out ways around that etc. I’m not much of a chess player but can model flexible thinking skills, etc. Last session I used a chess analogy for something having to with compliance with his health condish. We’ll see how it goes lol. It’s also cool to see his self esteem improve. He can’t play soccer bc of injury concerns. And it’s neat to see him get good at something. But most of the effective work (eg behavioral improvement) is with him is parent behavioral consultation.

So I bumble around a lot, and it helps me with other kiddos.

 

[The Cinnabon]

I wasn’t involved but a VA PRRC that I previously interned at had a standing weekly D&D game group. I don’t know much about D&D but observed once and while the gameplay bored me to tears, that seemed like a really cool way to work on social skills and keep those veterans engaged with VA care.

At another VA polytrauma residential rehab, I went on a few community outings. In particular, I was doing Prolonged Exposure with one patient related to their injury/trauma so getting to see that person interact with the outside world while also chatting on and off during the outing and then bringing some of that stuff into PE was neato.

Sort of off handed, but a good DM (the person running the game) can absolutely get paid to do so

I don't really have any interest in doing so myself, it's always been a creative outlet for me, but I have a few friends that are in grad school that have added about 400 a month from doing so.

 

[gohogwild]

It’s a pediatric multi speciality center. We see about 3000 kids with chronic health conditions and developmental disabilities per month. Almost all of our patients are on Medicaid. I’m really fortunate to be here and love going to work.

On the med side we have neurology, ENTs/neurootology(sp), gastroenterology, geneticists, pulmonologists, psychiatry, plastic surgery, etc. I’m sure I’m missing many.

On the rehab side we have PT/OT/Speech. Psych is probably more on the rehab side of things.

I used to only work with kids. But now a few of my patients are emerging adults with guardianship (I actually have one emerging adult who is their own guardian, but is very complex medically).

I’d say about 60% of my job is testing kids to help them get state funded developmental services (ie autism and intellectual disability). I do about five hours of parent management training per week (so I guess they count as adults - doesn’t always feel like it). I do another five to ten-ish hours of individual therapy per week.

Honestly, I could make more for fewer hours of work a week If I did what most testing psychologists in my state do - drop insurance and go private pay only and struck out on my own.

I’m literally one of the last people in the state who does GOOD, full, comprehensive evals for insurance.

But my patients, dude, they’re amazing. My colleagues are amazing.

It’s cool to be a place that tries to help the whole human. I get super interesting and complex cases all the time. Like one weird competency has developed where I’m like the only dude in three states who see a deaf/Deaf/hearing impaired kid for an autism eval. Ditto for visual impairment.

I also love collaborating with the geneticists. But like, the emerging adult I mentioned above, wanted me for therapy because I could look at the whole medical chart and help them understand it in accessible ways.

Never a dull day. Occasionally I’ll get a code where I gotta go help a young man who is showing some aggro bxs and do some quick behavior mod (usually with a high value treat) to help them get through their appt.

We had this one dude, who was always getting aggro but couldn’t communicate. Because we are team, we were able to figure out that this dude had CSF leak and was in tremendous pain. A small surgery later, and the dude is coming off some heavy hitting meds, more communicative, etc. gives me chills. And I just basically helped him chill a few times.

Sometimes we’re fighting an uphill battle with very poor parents, low resource knowledge, low self advocacy skills, don’t speak English. But those are super rewarding when you dx a three year old and get them services/aba and I’ve been there long enough that I’m doing some re-evals and get to see these wonderful lil humans grow and develop and it’s cool to be a small part of that.

And we have like four other psychs to always consult with - a huge plus.

But you also have to deal with administrative changes, bean counters, corporate, the latest “targeted health initiativ,” etc. that can temper my enjoyment lol.

Woah dude, very cool! That's such important work, I'm so glad you enjoy it, it sounds both complex and like it's really rewarding, that story about the CSF leak especially. So with evaluations making up this much of your job, are you more neuropsych? Also, are your individual therapy hours with the same kids/emerging adults or others? Just curious

 

[gohogwild]

Btw - I added a note above. But the kid w/ exercise wasn’t me being some “amazing masterful psychologist”. It was just the kiddo needed to get some wiggles out and it was nice outside. So while I’m catching up with dad, hes out sprinting around.m and he starts verbalizing. And it generalized.

I also have a kiddo who has started bringing a chess set. We have an interpreter who likes chess too. That’ll be a good exposure I think. Plus it’s kinda fun to play chess with him. We read about the rules and when someone wins we try to figure out ways around that etc. I’m not much of a chess player but can model flexible thinking skills, etc. Last session I used a chess analogy for something having to with compliance with his health condish. We’ll see how it goes lol. It’s also cool to see his self esteem improve. He can’t play soccer bc of injury concerns. And it’s neat to see him get good at something. But most of the effective work (eg behavioral improvement) is with him is parent behavioral consultation.

That makes sense, I wasn't really going after the idea of some super special psychologist, moreso regular people who had different ideas and actually decided to carry them out. And that includes being flexible within a cool setting! Chess is a great idea

 

[Sanman]

I wasn’t involved but a VA PRRC that I previously interned at had a standing weekly D&D game group. I don’t know much about D&D but observed once and while the gameplay bored me to tears, that seemed like a really cool way to work on social skills and keep those veterans engaged with VA care.

What are the odds of finding that many nerdy folks in PRRC at one time? One the bright side, it is good practice for imaginal exposure and a better place to channel those military tendencies.

 

[borne_before]

Woah dude, very cool! That's such important work, I'm so glad you enjoy it, it sounds both complex and like it's really rewarding, that story about the CSF leak especially. So with evaluations making up this much of your job, are you more neuropsych? Also, are your individual therapy hours with the same kids/emerging adults or others? Just curious

My doctorate is in school psychology! I jokingly call myself a "neurodevelopental psychologist." Being from the school psych program (aside from my internship) i've never really worked in a school, but we get tremendous assessment experience of the neurodevelopmental disorders, as that's the traditional focus of a school psych. My program had a pediatric psychology research trend and I did my postdoc doing these types of evals. But, no, I am not a neuropsych. I don't really bill the more neuro codes when testing.

I tend to keep people for therapy/interventions after i've evaluated them, as by that point, I've already developed rapport and know a ton about them. But yeah, I keep a small intervention load, but it ebbs and flows. Right now, I am doing a lot of intervention. I think it's important to keep one toe in the intervention pool - just keep you grounded and see if your recommendations are useful.