Take Action: The Most Important Hour of the Year


Benjamin E. Caldwell, PsyD

Some of the most critical work we do, both in our practices and in life, isn’t done that often. Depending on your work setting, you may only see a handful of actively suicidal clients through your career. The beginning and end of Daylight Savings Time are good times to change the batteries in your smoke detectors. And an annual review of your practice can be the most important and influential hour of the year for your own career progress.

If you’re a HIPAA covered entity, you may already be familiar with the requirement to review your privacy policies and practices at least once per year. Since you have to do that piece anyway, take the time to do a larger-scale review that can have a major impact on your professional success and happiness in the year ahead.

The review itself doesn’t need to take more than an hour. Here’s one way to structure it.

First 15 minutes: Review of clinical outcomes. What were you trying to accomplish last year? I’m a big believer in using data to measure outcomes, so I start the review by looking back on the clinical data I have for the year just passed. Did most of my clients reach their treatment goals? What can I conclude about myself and my work from my outcome data? What changes do I need to be making in my practice to help more clients succeed?

If you don’t have the data to answer this question, it’s time you started collecting it. Use the rest of this 15 minutes to gather and review possible outcome measures that would be a good fit for your practice. I’m a fan of the WHODAS, the Level 1 Cross-Cutting Measure for DSM-5, the OQ45, and the SRS and ORS for individuals; the MSI-R for couples; and the FES for families. Of course, you have plenty of other options, so find what works best for your practice.

Second 15 minutes. Review of professional outcomes. Other than helping clients succeed in therapy, what were you hoping to accomplish in your work last year? Separate from clinical outcome data, I also look at data on my professional outcomes, which simply means those things I was trying to achieve in my work separate from client success. Your goals for professional outcomes might include a certain income level, getting your work published, getting a promotion, and so forth. (This is also a good time to review where you are in the process of getting CE hours for your next license renewal.) Does the data show that you reached those goals? Perhaps more importantly, why or why not?

If your immediate response about what you wanted to accomplish last year was something along the lines of “keep my job,” then it’s true that this portion of your annual review will be done quickly. But you may also want to spend time reconnecting with why you became a therapist in the first place. Most of us, at some point, experienced this work not as a job but as a calling. What were you hoping to achieve when you started? If circumstances have held you back last year, what will you do this year that will bring you closer to those goals?

Third 15 minutes: Review of privacy practices. This is the part that you have to do anyway as a HIPAA-covered entity. It is important to document that you engaged in a meaningful process of examining your current policies to see whether they are still adequate and consistent with the law and with how you actually handle client information.

Final 15 minutes: Goal setting. Here is your opportunity to revisit the bigger picture of your career, and the reasons you love this work. Have your hopes and dreams for your practice changed? If so, what do you need to change to keep up with them? If not, what specific steps can you take in the next year to bring them closer to reality? I have found it most helpful to set a small number of very concrete goals each year that reflect the progression I hope to make in my own career. Sometimes I have reached those goals, and sometimes not, but simply having them written down in a place where I regularly see them helps me remain focused and aspirational in my work.

To that end, one of the things I’m doing in 2017 is reducing my workload a bit, so I can have more time to be with my family. Part of that workload reduction means leaving behind some writing opportunities, including this column. I have greatly appreciated the opportunity to share with you, over the past year, small steps you can take that will make a big difference. I hope you’ve found them useful.

We’re all in this together. Thanks for all you do.

– Benjamin E. Caldwell is a Licensed Marriage and Family Therapist (#42723) in Los Angeles. He is the author of Saving Psychotherapy and Basics of California Law for LMFTs, LPCCs, and LCSWs.