www.BeTreatedWell.com Practice Profile
This is an article that was published in a national psychotherapy newsletter called
Psychotherapy Finances.
This therapist prospers with specialized niches
Developing good niche markets can be the path to reducing dependence on
managed care. Michigan’s Antonia Caretto is focusing on three comparatively
narrow specialties--and as a result does no insurance work.
● Obsessive-Compulsive Disorder. These clients make up about 25% of her
caseload. Since this is a diagnosis that primary care physicians readily recognize--
and know they can’t handle themselves--it’s particularly good for establishing
referral relationships with docs, as well as other mental health professionals. And
Caretto is on the Scientific Advisory Board for the OCD Foundation of Michigan--
another valuable referral source.
● “Girls Who Worry” is the title of a monthly support group Caretto runs for girls
aged 7 to 13 and their parents. At the moment, there are 19 daughters and moms
attending, and she’s planning to split it in two. There is no charge to attend, and
Caretto sees it both as a marketing tool and a service for the community. She says
the market is ripe for this kind of service.
“Last year I picked up a ton of referrals in this area...The girls have worries about
small clusters of things--separation from mom, going to school, getting sick. They
get hung up in family stuff: ‘I can’t go to a friend’s house because what if I get
sick and they (parents) are trying to reach me but they can’t?’ That kind of thing...
I see it as a marketing thing, but it just makes sense to do it because it serves a
need.”
Caretto taps this market in other ways: “Every year before school starts I do a
mailing to my data base of school contacts. I composed a letter saying, ‘This is
what I’ve been doing over the summer. Here’s what I’m going to be doing this fall.
I look forward to working with you.’ I enclose a flier.”
● Trans-gender patients. This is obviously a small niche--but it still constitutes
10% of Caretto’s practice. Trans-gender clients--people who are considering
changing their sexual identity with surgery--aren’t flooding into therapy offices.
But there are only two programs in the Midwest--one at the University of
Minnesota and another at the University of Michigan—and Caretto is an approved
provider for the University of Michigan program.
“Nobody can run a whole practice on this,” Caretto notes. “But if you take into
consideration all of southern Michigan and northern Ohio, the University of
Michigan is the place they call. And there are only a handful of specialists who do
this work. How do you tell your family, your employer—there are a lot of issues to
address?”
Another category of patient Caretto’s seeing more of these days are those
suffering from depression complicated by seasonal affective disorder (SAD). Again,
this is a small, highly specialized niche--but one that resonates for people in the
higher latitudes. In fact, we’ve heard from therapists as far south as Maryland that
SAD is a factor in their practice mix. Caretto says that during the darker, colder
months, she always has at least one active client who falls into this category--she
became interested in the subject when she realized she suffered from it herself.
“People started coming in and I’d listen to their history and hear a similar
pattern,” she recalls. “I started recommending light boxes to some patients. I
have two of them and I loan them out so people can try them. You’ll know in a
couple of weeks whether it’s going to work for you.” Caretto doesn’t sell the
machines herself. “I give them brochures from various companies. It’s expensive
(about $400) but if they can cut out three therapy sessions because the
depression is being treated more effectively, it’s a good investment for them.”
Caretto has been in private practice for about 10 years. Along with her niche
marketing, she says active networking with diverse referral sources is the key to
building and holding onto a cash clientele: “At any given time, I may have three
patients who were referred by psychiatrists, four referred by pediatricians, and six
to eight referred by school personnel.
“I do a good job keeping in contact with referral sources. If someone comes in to
see me and they’re already on medication prescribed by a family doctor, I get a
release signed to talk to the doctor...I have one [physician] who has referred five
patients in the last three months.”
Finally, Caretto signed up with a local newspaper to be on a “panel of experts” the
editors created to answer questions from readers. “They email us the question of
the week and we respond. They pick the responses they want to run in the paper.
That’s great for me.”
Transsexual clients tend to stay in therapy long-term
To undergo gender reassignment, candidates must first convince physicians and
therapists that they qualify. It’s the beginning of a long process, says Antonia
Caretto. These clients come to her in one of two ways. They may hear about her
practice and call her directly, or they might be referred by the program at the
University of Michigan. At any given time, Caretto tells us, she has one or two
patients from each category.
“The guidelines say that before there is any discussion about hormones even, the
person has to be in [therapy] for at least three months. That’s not to say that on
day 91 you get hormones. The idea is you don’t want to take the risk of moving
toward something in error.
"It’s not unusual for there to be co-morbid issues, whether it be depression or
substance abuse. Then there’s a lot of history-taking geared toward their gender
identity as far back as they can remember. What was it like when they were a kid?
Who did they play with? What were their interests? When did sexuality come into
their lives, and what was that like?
“You have to decide, maybe this is cross-dressing and not transsexualism.”
Caretto compares notes with other members of a team at the university—that
includes a social worker, a physician, and herself. If they determine the person is
a candidate for a gender change, then the person undergoes hormone therapy and
lives for a year as the desired sex.
Other issues arise post-hormone therapy and post surgery, notes Caretto. For
example, at what point should the client tell his or her family? How do you handle
dating? “Some people do fade into the woodwork post-op,” Caretto says. More
often, the client stays in therapy for several years.
Nuts & bolts
Antonia Caretto runs what she calls “a one-woman show” in suburban Detroit, with
no receptionist or administrative help. The office is about 500 square feet. She
does all her own billing using QuickBooks, and she built her own Web site, www.
betreatedwell.com, using Yahoo SiteBuilder.
About 30 clients per week pay her full fee of $130 “without blinking.” She reduces
that fee only occasionally, she insists. She has an alert built in to her billing
software that pops a client out if they’ve gone three sessions without paying.
“Most people pay weekly,” she tells us. “But I always print statements out at the
end of the month. If there’s someone who hasn’t paid for a session, it’s a gentle
reminder. I don’t get stiffed very often — I’ve learned from my mistakes.
“If they’re behind, I talk to them about their participation in the treatment. I
explain that I may not be able to treat them if they don’t participate [by paying on
time].”
This is an article that was published in a national psychotherapy newsletter called
Psychotherapy Finances.
This therapist prospers with specialized niches
Developing good niche markets can be the path to reducing dependence on
managed care. Michigan’s Antonia Caretto is focusing on three comparatively
narrow specialties--and as a result does no insurance work.
● Obsessive-Compulsive Disorder. These clients make up about 25% of her
caseload. Since this is a diagnosis that primary care physicians readily recognize--
and know they can’t handle themselves--it’s particularly good for establishing
referral relationships with docs, as well as other mental health professionals. And
Caretto is on the Scientific Advisory Board for the OCD Foundation of Michigan--
another valuable referral source.
● “Girls Who Worry” is the title of a monthly support group Caretto runs for girls
aged 7 to 13 and their parents. At the moment, there are 19 daughters and moms
attending, and she’s planning to split it in two. There is no charge to attend, and
Caretto sees it both as a marketing tool and a service for the community. She says
the market is ripe for this kind of service.
“Last year I picked up a ton of referrals in this area...The girls have worries about
small clusters of things--separation from mom, going to school, getting sick. They
get hung up in family stuff: ‘I can’t go to a friend’s house because what if I get
sick and they (parents) are trying to reach me but they can’t?’ That kind of thing...
I see it as a marketing thing, but it just makes sense to do it because it serves a
need.”
Caretto taps this market in other ways: “Every year before school starts I do a
mailing to my data base of school contacts. I composed a letter saying, ‘This is
what I’ve been doing over the summer. Here’s what I’m going to be doing this fall.
I look forward to working with you.’ I enclose a flier.”
● Trans-gender patients. This is obviously a small niche--but it still constitutes
10% of Caretto’s practice. Trans-gender clients--people who are considering
changing their sexual identity with surgery--aren’t flooding into therapy offices.
But there are only two programs in the Midwest--one at the University of
Minnesota and another at the University of Michigan—and Caretto is an approved
provider for the University of Michigan program.
“Nobody can run a whole practice on this,” Caretto notes. “But if you take into
consideration all of southern Michigan and northern Ohio, the University of
Michigan is the place they call. And there are only a handful of specialists who do
this work. How do you tell your family, your employer—there are a lot of issues to
address?”
Another category of patient Caretto’s seeing more of these days are those
suffering from depression complicated by seasonal affective disorder (SAD). Again,
this is a small, highly specialized niche--but one that resonates for people in the
higher latitudes. In fact, we’ve heard from therapists as far south as Maryland that
SAD is a factor in their practice mix. Caretto says that during the darker, colder
months, she always has at least one active client who falls into this category--she
became interested in the subject when she realized she suffered from it herself.
“People started coming in and I’d listen to their history and hear a similar
pattern,” she recalls. “I started recommending light boxes to some patients. I
have two of them and I loan them out so people can try them. You’ll know in a
couple of weeks whether it’s going to work for you.” Caretto doesn’t sell the
machines herself. “I give them brochures from various companies. It’s expensive
(about $400) but if they can cut out three therapy sessions because the
depression is being treated more effectively, it’s a good investment for them.”
Caretto has been in private practice for about 10 years. Along with her niche
marketing, she says active networking with diverse referral sources is the key to
building and holding onto a cash clientele: “At any given time, I may have three
patients who were referred by psychiatrists, four referred by pediatricians, and six
to eight referred by school personnel.
“I do a good job keeping in contact with referral sources. If someone comes in to
see me and they’re already on medication prescribed by a family doctor, I get a
release signed to talk to the doctor...I have one [physician] who has referred five
patients in the last three months.”
Finally, Caretto signed up with a local newspaper to be on a “panel of experts” the
editors created to answer questions from readers. “They email us the question of
the week and we respond. They pick the responses they want to run in the paper.
That’s great for me.”
Transsexual clients tend to stay in therapy long-term
To undergo gender reassignment, candidates must first convince physicians and
therapists that they qualify. It’s the beginning of a long process, says Antonia
Caretto. These clients come to her in one of two ways. They may hear about her
practice and call her directly, or they might be referred by the program at the
University of Michigan. At any given time, Caretto tells us, she has one or two
patients from each category.
“The guidelines say that before there is any discussion about hormones even, the
person has to be in [therapy] for at least three months. That’s not to say that on
day 91 you get hormones. The idea is you don’t want to take the risk of moving
toward something in error.
"It’s not unusual for there to be co-morbid issues, whether it be depression or
substance abuse. Then there’s a lot of history-taking geared toward their gender
identity as far back as they can remember. What was it like when they were a kid?
Who did they play with? What were their interests? When did sexuality come into
their lives, and what was that like?
“You have to decide, maybe this is cross-dressing and not transsexualism.”
Caretto compares notes with other members of a team at the university—that
includes a social worker, a physician, and herself. If they determine the person is
a candidate for a gender change, then the person undergoes hormone therapy and
lives for a year as the desired sex.
Other issues arise post-hormone therapy and post surgery, notes Caretto. For
example, at what point should the client tell his or her family? How do you handle
dating? “Some people do fade into the woodwork post-op,” Caretto says. More
often, the client stays in therapy for several years.
Nuts & bolts
Antonia Caretto runs what she calls “a one-woman show” in suburban Detroit, with
no receptionist or administrative help. The office is about 500 square feet. She
does all her own billing using QuickBooks, and she built her own Web site, www.
betreatedwell.com, using Yahoo SiteBuilder.
About 30 clients per week pay her full fee of $130 “without blinking.” She reduces
that fee only occasionally, she insists. She has an alert built in to her billing
software that pops a client out if they’ve gone three sessions without paying.
“Most people pay weekly,” she tells us. “But I always print statements out at the
end of the month. If there’s someone who hasn’t paid for a session, it’s a gentle
reminder. I don’t get stiffed very often — I’ve learned from my mistakes.
“If they’re behind, I talk to them about their participation in the treatment. I
explain that I may not be able to treat them if they don’t participate [by paying on
time].”
| Antonia Caretto, Ph.D., PLLC |
| www.BeTreatedWell.com phone: 248.553.9053 |
| Articles of Interest: Business of Therapy Anxiety Why Gender? Asperger's Disorder Adjustment Disorders Self-Injurious Behavior |
