It is hard to believe Within Sight is in its 11th year of business. Celebrating our 10th birthday last year was an important milestone for us personally and as small business owners. It is estimated that 70% of small businesses fail within the first 10 years (Carter, 2021.). Our accomplishment is even more impressive when we factor in surviving during COVID and the great resignation both of which caused us, like many other small business owners, many sleepless nights and worry. At that time, it was a real possibility we might not make it to our 10th year celebration.

Being a successful outpatient mental health practice also underscores how amazing it’s been that we have, in fact not only survived, but thrived during this time. Being a service delivery business versus selling a product is a challenging for any type of business. Add in operating a mental health agency, typically known for being fiscally hard to sustain, and you start to get an idea of the odds that were stacked against us.

The difficult nature of our business is mainly due to having our financial survival tied to accepting insurance. Insurance payors demand we accept their rate of reimbursement. What other types of businesses have to accept what someone else says their rate should be? Then there is the never-ending job of trying to get insurance companies to pay. The time we spend trying to do this is so frustrating on many levels. Our clients deserve to have their insurance pay and we also deserved to get compensated in a timely manner. Why does it have to be so hard and complicated? (We will dive into this topic in another blog.)

We also started out without a medication prescriber, which at the time was unusual and meant it would take more work to get the word out about our practice. Two female, licensed clinical social workers starting a business and employing several clinicians did not exist in Evansville in 2013. Also, there we very few economically feasible electronic platforms out there to do documentation and billing at that time. Now, there are many good and reasonable choices to get started.

Beginning with limited funds and working hard to obtain therapists that were willing to take a chance on our vision might have been naïve then, but our confidence and certainly there was a need for a different type of practice fueled us. We felt both our employees and clients deserved something better. We believed and still do in a collaborative practice. One in which we develop our clinical skills through intensive continuing education, regular supervision and working through our own personal psychological issues so that we can be our healthiest and best selves for our work.

Julie and I still take out our first business retreat notes created those many years ago that laid out our dreams and which was the foundation of our vision and mission. This practice has helped us stay true to our principles and values and has been our North star. It is so easy to lose your way, give up or go low during the difficult times or when others tell you can’t do it. We continue to look back to inform the future, make sure we are staying true to ourselves and focus on the positive.

Today, more than ever, the choices for mental health treatment are great. COVID opened up opportunities for remote service delivery and that was so very much needed. Access for people that could not come into an agency is now available, when prior to COVID telehealth was limited to medical management in remote areas only. Now we can continue to work when there is inclement weather or clients have issues that prevent them from coming into the building allowing us to continue our important therapeutic work.

It also was something our industry was not truly prepared for and has created unforeseen problems and the potential for poor service and even malpractice. The advent of national telehealth companies who appear to be engaging in unethical practices and taking advantage of our current mental health crisis is troubling. Clinicians with little therapy experience setting up shop at home only doing telehealth and without the support of other experienced therapists to consult with is equally troubling. Then there is the shortage of mental health providers due to many therapists not accepting insurance and the great demand that has surged since COVID’s huge mental health challenges finally broke down the stigma about seeking mental health treatment.

It is kind of like the wild, wild west out there. We are reeling like everyone else from the last three years of turmoil as we look to our North star so we stay true to our vision. With this in mind, we are starting a series of blogs making formal our thoughts, observations and experiences since this mess started. We hope to inform and educate people as they navigate this new mental health world so that help can be found more easily whether that is at Within Sight or elsewhere. We also hope to stimulate thought about the world of psychotherapy and mental health as we examine topics such as different service delivery types, how to choose the right therapist, how to know if therapy is working, when to leave therapy and different types of therapy models.

We have finally broken down the stigma that has kept so many from seeking help in the past. COVID isolation has shown everyone the importance of social engagement to our survival and yet our feelings of separation and despair are greater than ever. In my 26 years as a mental health professional, I have not experienced the current level of need, distress, change, and therapeutic advancements that is happening now. We are indeed in a mental health crisis but maybe it’s really an existential one. As Benjamin Franklin said, “Out of adversity, comes opportunity.” So here we at our growing edge as individuals, psychotherapists, business owners, and humans ready to embrace the challenge. Let’s see where we land. What I do know is that it is within sight.

- Caron  

Caron Leader co-owns Within Sight with Julie Bellamy. Both are Licensed Clinical Social Workers and have been practicing since 1996.

Carter, T. (2021, January 3). The True Failure Rate of Small Businesses. Entrepreneur.

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