Building a Practice Around a Niche
I first met Lisette Lahana when we were both in graduate school in Western Massachusetts, and we reconnected when she moved out to the Bay Area. She’s got a great entrepreneurial mind and is super committed to paying it forward by sharing her expertise. We spoke by phone the other week about how she started out in practice and how she discovered and developed a successful niche-based practice.
Deb: Can you say a bit about how you started your practice?
Lisette: I went right into my masters program after graduating college as a double major in psychology and women’s studies, so I was a pretty young social worker. Once I became licensed in 1999, I started my practice right away. I started with a few private practice clients, very part time, while I was working at a Latino focused outpatient health center in Springfield, Massachusessets. I developed my practice on the side as I began to slowly lower my hours. I also worked some Saturdays so I could build it up. It was pretty scary to leave initially. I built my practice up to about 14 or 16 by the time I felt I could leave the agency job.
Deb: Like lots of therapists- starting out part time and building from there. Who were the first clients you saw?
Lisette: I was doing a lot of LGBT work at that time, a lot of work with bisexual women, but I was really willing to see anybody at that time who found out about me through my network- mostly therapists I knew from graduate school. My practice was more related to the LGBT community in general because that’s what I was focusing my research on in graduate school- bisexual women’s experiences in lesbian community. I didn’t know what my niche was going to be until I started to work with some transgender people and found that I really loved the work and there was such a need in Western Massachusetts at the time, so I kind of felt into it. It was about a year after starting my practice that I saw my first transgender client.
Deb: It sounds like it organically grew out of your interests, but also matched up with there being a need in your community. That’s so important in finding a niche- that its the place where what you are really excited about and what there’s a need for overlap.
Lisette: Exactly. It fit with my excitement about gender in general, which I’d been interested in for a long time, since undergraduate school.
Deb: Were you on insurance panels when you started out?
Lisette: I did get on a number of insurance panels as I was preparing to leave the clinic job, including the state insurance. I was really worried about not having enough clients to get some full time income. Until about 2006 I was about 90% insurance based, which really cut into my ability to support myself well. It wasn’t that I wasn’t making enough money, I did fine, but because I was taking a number of HMOs my income suffered quite a bit. So when I moved to California in 2006 I decided I would take the risk to see what would happen if I turned away clients wanting to use insurance unless they had a PPO and were willing to submit the claims themselves. I just decided that every time someone came my way with insurance I would just take a breath and say “I don’t take insurance”. Each time I said no and turned someone away I had to remind myself that someone else would call. I waited for the client who was willing to see me because I had the specialization they wanted. By that time I had developed a reputation and a specialization that enough people wanted that they were willing to pay out of pocket to see me.
Deb: I've seen a similar struggle with lots of therapists I've worked with. They got on lots of panels when they started their practice, hoping to fill the practice quickly, and later found themselves working a lot, but not earning what they need to be sustainable. I often talk about making sure that your own needs, including financial, are going to be met in whatever way you set up your practice, so you can do the work over the long term and without resentment. I also talk about building a practice from a place of integrity. How did you reconcile your value of being accessible to people while knowing you needed to change the way you dealt with insurance?
Lisette: Good question. I decided to take about 10-15% of my practice at a lower fee, which for me still means having a limit as to how low I go- in order to take care of myself financially. I have particular groups that I want to serve with my low fee slots, which for me includes clients of color and people in service professions like teachers or social workers. As a social worker, that’s important for me to do. And I can do it in part because I don’t have to spend time fighting with insurance companies for every cent. So that’s how I see it and ethically and how I can offer my services that I trained quite a bit for, to LGBT people who need it.
Deb: Can you tell me a bit about your training and how you were able to build your skills and reputation?
Lisette: Sure. Because I was really aware of how little I knew when I started working with my first transgender client, I started to get supervision and training from a senior gender specialists in Boston and New York, Diane Ellaborn and Katherine Rachin. I attended conferences locally, nationally, and international conferences on clinical work with clients on the gender spectrum including transgender clients, clients who are intersex and their families.. I’ve also done and continue to do a lot of reading including keeping up on current research. I joined WPATH (World Professional Association for Transgender Health) and also went to a lot of conferences created by transgender people. Initially I put in a great deal of effort to attend as many grassroots and professional conferences as I could, which meant a lot of traveling. I developed my skills over the course of 3-5 years. I still attend at least two, if not three, gender related conferences a year. Like any specialization, I’m constantly learning and using peer consultation groups and sometimes paid consultation for help on complex cases.
"I really think that people should know that just because you are developing a niche it doesn't mean you won’t see other types of clients"
Deb: You really invested a lot of time and energy into it. What does your practice look like now?
Lisette: I’d say my practice is about 70% transgender focused and the rest is primarily focused on other people on the LGB community who are trauma survivors. In addition to the clinical work I provide consultation to therapists around the country by video and telephone. I run two consultation groups- one in person in the Bay Area and one by video. I’ve been training therapists to become gender specialists for over 10 years now. I also teach courses and speak at conferences about clinical work with transgender clients, among others who I see on the gender spectrum.
Deb: Is there anything else you think therapists should know about niching and practice?
LIsette: I really think that people should know that just because you are developing a niche it doesn’t mean you won’t see other types of clients day-to-day. I do think it is helpful to have a niche and think about long term practice development that is built around that niche. I think that the reason my practice was successful when I moved to California is that I had already had the niche developed on the East Coast. I was already listed on transgender-focused websites, and people knew me nationally from going to conferences.
Deb: I think that it can be a process of discovering what really excites you but once you discover what it is, it can make all the marketing so much easier, because you know were to go, you know who to connect with. It sounds like when you started your practice in California, you didn’t have to think about insurance, you were already connected to the community and had a reputation. Anything esle?
Lisette: I work hard to have my website address my specialization. A majority of my referrals come to me through my website and email me through my website. When I ask them if there is anything else they would like to know about me, probably 90% of the time they say, “I’ve read your website and I have a sense of who your are”, or “I’ve read your website and can tell that you have the experience that I need” I try as hard as I can on my website to develop resources that are interesting to people. I also use some social networking, like Twitter, to build my reputation related to the niche of consultation with therapists.
Deb: You’ve become a key resource around your niche.
Lisette: And it also hasn’t scared off cisgender (not transgender) patients. So it also hasn’t closed off other parts of my practice just because I have a nice based practice. I was afraid of that, actually, for a brief time. I worried that maybe people wouldn't want to see me because they are transphobic, but if that's the case then that’s ok- I’m probably not the right therapist for them.
Deb: What’s the best way for people to find out more about your services?
Are you ready to discover how to turn your natural interests and gifts into a niche you can develop in your practice? Schedule a consultation and let's talk more about it.
Deb Lyman helps therapists take care of themselves while serving others, by taking them though a process of practice development that is based on the pillars of a sustainable and nourishing practice- mindset, clarity, integrity, sustainability, and community. She works with people in her office in Berkeley, CA, and remotely via phone and videoconferencing.