Developing a Health Psychology Practice

Suzanne R. Engelman, PHD, BCB, FT

Published in The California Psychologist September/October 2012

As psychologists, we are fortunate to have numerous ways to stretch our professional wings – teaching, research, public policy and practice. This article will highlight six dimensions which have been important in my growing a thriving private practice as a health psychologist.

Background Training and Experience

Throughout my nearly three decades as a clinical psychologist, I have received and provided training, practiced and published in the areas of health psychology and mind/body interactions. These experiences have been acquired as a clinical faculty member with the University of California San Francisco Medical School, working in two other major medical centers, serving as a clinical director in a county contracted agency and in private practice.

As a health psychologist, my clinical work has focused on working with patients coping with serious and life threatening illnesses, mind/body issues, stress management, death, dying and bereavement, and pain, anxiety and depression. My most frequently used “tool box” consists of: mindfulness-based psychotherapy, biofeedback, animal assisted therapy, paced breathing, dream analysis, and most importantly presence, that is, the power of the therapeutic relationship.

I have continually upgraded my skill set by pursuing certifications in biofeedback (www.bcia.org), thanatology (www.adec.org) and animal assisted therapy (www.deltasociety.org).

Getting Started

A progressive, aware, trans-disciplinary internist, whose focus is palliative care and pain management, saw my CV and asked if I would work with some of his patients. To prepare for this opportunity, I joined the medical staff at the local hospital where he worked, rented space in the same suite as this inviting physician, thereby optimizing our collaborative communication about mutual patients, joined several PPO insurance panels, updated my practice forms and learned a web-based billing program to do my own billing.

Practice Marketing  

Despite the frustrations and severely underpaid rates, being an “in-network” provider on a few PPO health insurance panels, (and Medicare) allows for indirect “marketing” through insurance member provider lists. Also, because many patients referred by physicians prefer to use their in-network insurance benefits, being in-network may increase my accessibility to physician referrals. That said, I decide which referrals are appropriate for my practice, and being an in-network provider does not preclude working with patients for whom I am out of network or who prefer to pay out of pocket. Generally, physicians refer patients to me who are management problems, identified as having psycho-physiologic aspects to their medical illness, those near the end of life, suffering intractable pain, anxiety, depression and bereavement.

Time permitting, I network with all members of the treatment team: physicians, nurses, social workers and chaplains – supporting integrated health care for our patients. Sending letters of introduction to physicians, I describe my skills, include contact information and a reference to my website, www.healthpsychologynow.com, another important marketing tool!

I give talks to nursing staff on different floors of the hospital about psychological issues related to their particular medical specialty. As a member of the Psychiatry Department, attending department meetings is a good way to meet the psychiatric community with whom I partner for the many patients with medical issues requiring psychotropic medications.

It’s also an opportunity to get to know the other few psychologists who have staff privileges. In the beginning especially, expect early networking efforts to involve some unpaid “leg work” and pro-bono clinical work.

Contact and Referral Follow-Up

Whenever I receive a referral from a physician, and get a release from a patient, I send a brief report outlining our work thus far, goals for continuing psychotherapy and a thank you for the referral. 

Learn the Different Billing Codes

The Health and Behavior Codes were developed for exactly the kind of work health psychologists do with patients. Regrettably, these codes are still used inconsistently by insurance companies and not completely understood. I found working with the APA Practice Directorate as well as consulting with colleagues, aided my understanding of how to correctly use these codes, rather than CPT codes.

A Note about Self-Care

Compassion fatigue is an occupational hazard in our profession, especially when working with people who are seriously ill, dying, grieving or in intractable pain. I manage my own stress by taking rejuvenating hikes into the wilderness, using a meditative spiritual practice and having a sturdy support system! 

Good luck With Your Practice!

Suzanne R. Engelman, PH.D., BCB, FT (suzyengelm@aol.com) is a licensed psychologist  with a private practice in Laguna Niguel.