Last month we profiled a practice that was
prospering as the result of a diverse, something-for-everyone
approach. The two
therapists in that article have several niches, and work in many
different ways--including online.
Joan Unruh’s practice is 180-degrees
away from that.
She serves just two niches in her Boulder, CO, practice:
anxiety and eating disorders, with a sub-niche working with college
students. She’s 75%
self-pay, does little or no telephone work, and doesn’t employ a
Most clinicians probably can’t--or
won’t want to--adopt all of Unruh’s approach.
But almost everyone can pick up one or two good ideas based on
her experience. Below, we
go over the key facets of her practice.
Overall, her practice mix is young,
female, and willing to pay cash.
“About 85% of my clients are women,” she tells us.
(Male clients are generally seeing her for anxiety, she adds.)
“A majority of them are in their 20s, then there are some in
their 30s. My oldest
client is 55--I’m seeing him for social anxiety disorder.
“My out-of-state college students tend
to have parents with money,” Unruh goes on. But in many cases, it’s motivation rather than simply the
ability to pay cash that brings clients to her door.
“I find that most of the people who find me have tried
many other therapists, and are looking for my specialties. So I haven’t had to slide very much.”
She was narrowly focused from the
“It was a conscious choice.
I knew there was a need for eating disorder specialists in the
Boulder area--it’s such a weight and fitness conscious environment.
There are a lot of triathletes, and a lot of people who’ve
moved here specifically for the outdoor, fit lifestyle.
started out in substance abuse. There
wasn’t really any certification for eating disorders, but I felt I
had a lot of good experience in motivational interviewing, and
substance abuse theory. So
I transitioned almost 100% to eating disorders to start.
That was in 2000.” Unruh maintained a part-time practice, keeping her day job
with Kaiser Permenente until 2007, when she entered full-time private
On average, Unruh’s patients stay
in therapy for over six months. “I keep a spreadsheet on that,” she tells us.
Almost all of her patients come in weekly, she goes on, and a
majority are self-pay, paying her full fee of $120.
“I started out 100% self-pay, and it wasn’t until 2007 when
I quit working part-time at Kaiser that I decied to add some
padding...I work with Anthem Blue Cross/Blue Shield. That’s it. (See
details in the box, above.)
Roughly a third of her clients
are college students. “My office is walking distance from the University of
Colorado at Boulder campus--I chose it specifically to accommodate
that population.” Many
of these clients have eating disorders but “anxiety and stress are
huge” in this group.
you have students who are just trying to acclimate, who are away
from their parents for the first time...With other kids, they had
a therapist at home, and they’re continuing their work with
anxieties, OCD, panic, or eating disorders...Very often, I get a call
from parents who say, ‘My kid’s a freshman.
Can we come in for a consult on parent’s weekend?’
And we go from there.”
frequently find her online, through her website, www.joanunruh. com,
or through therapists directories at PsychologyToday.com and Network
sometimes find her on their own, “referred by one of their sorority
sisters...And I go to monthly meetings at the university.
There’s a task force on eating disorders.
So I have a presence there, and I’m on their list as a
referral resource. The
university provides students with a certain number of sessions
in-house and then they refer out.”
She makes it easy to pay her--offering a credit card option
online. “You can go
right on my website and pay there...Parents especially love that.
A lot of the students are from out of state, and it’s the
parents who are paying.”
a steady marketer, making
good use of her website, as well as meeting roughly four times per
month with a colleague or allied professional.
“It’s not a formal thing,” Unruh says.
“I just call around and see who wants to do something--coffee
or lunch.” In addition,
she puts a lot of stock in offering potential clients a free
initial interview, to make sure they’ll be comfortable with her.
(Unruh was featured in our April, 2010, “Marketing” article
on free first sessions.)
I coordinate with registered dietitians, primary care physicians, as
well as psychiatrists...I’m in touch with at least one of those,
once a week. And when
there’s a critical patient situation, we might talk two or three
times a week.”
You can contact Joan Unruh in Boulder,
CO, at (303)668-9024, www. joanunruh.com.
Medicare,” she says. “That’s why for now, Medicare is our main