As they become licensed and prepare to open a practice, various list members ask me what I consider the best practice-management and billing software., and each year I circulate links to and info about some of the current programs in this rapidly changing field.

Here are my recommendations:

My basic $.02 is that a program can be terrific for one practice but a disaster for another.It’s crucial to see how well the approach, features, and (sometimes hidden) costs of each program match up with your specific wants and needs.Differences between practices in terms of size, organization,procedures, and preferences can make a huge difference in what program”works” for a given setting.

Below I’m listing 7 widely used programs, along with links to their web sites.I’m listing *only* those programs that will work with *both* macs and Windows-based computers.The web sites for each describe how the program functions, how the it handles electronic claim submission (e.g., whether or not through a clearinghouse), etc.

Some have free trial versions.PLEASE FORWARD THIS MESSAGE to any lists or individuals who might find this resource helpful.

Here are the 7 programs and links to their web addresses:

Founded by a psychologist who began with a grant from the Nationa lInstitutes of Health, PsyQuel has an interesting approach: It’s a web-based practice-management system.

According to their web site: “You are connected directly to our Service Center through the Scheduler. After seeing a patient, all you have to do is mark the appointment as attended, and our Service Center is automatically notified that your appointment is ready for billing. We will submit your claim that day.”

They emphasize simplicity: “Everything is point- and-click simple. After seeing a patient, all you have to do is mark the appointment asattended, and we will handle the rest: tracking authorized sessions remaining, error checking, submitting claims, collecting insurance payments, resolving denied claims, posting insurance payments, reporting results, and analyzing your practice.”

Their site for billing and collection is here:

TherapyAppointment is also a web-based program created by a psychologist. They describe it as “Practice management software for mental health professionals. One solution for online scheduling,electronic claims, EMR charting, appointment reminder calls, encrypted(HIPAA-compliant) email, and more! Patients can schedule online, and enter their own information so you can focus on clinical work. Billing is automatic: you simply chart progress notes.

Designed by a psychologist in private practice to simplify every aspect of clinical practice.” It’’s at: eRecord: Online Behavioral Electronic Medical Record is, as the name suggests, another system that keeps your data on the web. They describe it as “a web-based behavioral EMR and practice management system for psychiatrists, psychologists, social workers and mental health counselors.

The eRecord is online which means it is available 24/7 from anywhere. Clients can access it via a client portal where they can pay online, fill out forms, etc. In fact, the eRecord enables a practice to go completely paperless as paper documents can be scanned to the eRecord and maintained securely.”

The web site is at: ShrinkRapt also uses the Clearinghouse approach: ”

The ShrinkRaptelectronic claim module will prepare a print image file to submit to an electronic claims clearing house.” They use the new CMS form:”ShrinkRapt 6.0 completes the new CMS 1500 form with NPI numbers.”

It’s at:TherapySoft can accept “co-pays and invoice the balance owed for treatment. Submit HCFA’s printed to a black and white faxable form, the traditional red forms, or submit electronically.” They note that you can “Schedule appointments for one or more therapist.

Schedule by room assignment or specific therapist. Print appointments for the day. Usethe Daily Reminders feature to help eliminate no-shows and last minute cancellations. Recurring appointments are easily scheduled with a few clicks of the mouse.”

It’s at:

TheraManager is a flexible software system that they describe as”all-in-one, intuitive, easy-to-use and customizable for any specialty. The software is comprehensive but inexpensively priced by the number of clinicians, solo through very large groups, and the features selected.

These include scheduling, paper and electronic billing, electronic medical records (EMR), documents and electronic prescriptions. It runs on Windows on a PC or a MAC.”

The site is at:

PracticeMagic takes a different approach. “When you run Practice MAGIC for the first time you will notice that, unlike data-base driven software, MAGIC presents you with a weekly calendar of appointments tofill out.

You can use this calendar as your appointment calendar,printing a copy to carry with you or insert into your Daytimer, or youcan simply ignore the time slots and use the calendar as a simplified method of data entry….

Input payment information directly into MAGICand MAGIC will print a deposit slip for your bank deposit. Although your bank provides you with pre-formatted deposit slips, we have foundthat banks happily accept the clearly printed and annotated deposit slips generated by Magic.

With no further keyboard input from you,MAGIC can use that deposit information and the clinical procedural and financial information in its calendar to generate client/patient statements or fill out a variety of insurance forms without any further input from the user.”

Their site is at:Ken Pope

Read the article here.

In a relationship, two people find each other and as long as the sparks are flying, get into a relationship and explore making a greater commitment.

This first stage in relationship development is often referred to as the “honeymoon stage” where everything seems to go great and there is a lot of chemistry, fun and probably a lot of great sex too.

When you get beyond the “honeymoon stage” and enter into a longer term commitment,  eventually some crisis will put your relationship to the test.

The conflicts at this stage can be related to loss issues, death of loved one, work, money, extended family, children, or attractions or affairs with other people.

Whether you are both comfortable with high conflict or not, this stage can determine the ultimate success of your relationship.

In the image below, the amygdala (dark red color) can be seen as part of the limbic system, just below the thalamus (also dark red).

The amygdala has been called the “emotional sentinel” of the human brain because it is primarily responsible for helping us to know when it is safe and unsafe.

The amygdala receives signals from our senses which it quickly evaluates. If the signal is safe, all is good.  However, if the amygdala determines the signal to be a threat, it sends a message to the hypthalamus to produce dopamine, epinephrine and norepenephrine which provide the chemical fuel for us to fight, flee or freeze.

The studies related to the amygdala have demonstrated that damage to the amygdala or negative personal experiences can result in such things as an inability to determine safe or unsafe facial expressions, hyperarousal, exaggerated fear responses or absence of fear responses.

So, if you grew up in an abusive, dangerous household, it is likely your amygdala has processed and stored those memories in a way which may keep you hyperaroused and unsure about the intentions of your partner.

Any tension or conflict with your spouse may easily result in a yelling match leaving you both depleted and demoralized.

Biology mixes with personal history, with disastrous results for personal and intimate relationships.

In a marriage,  we need to be good listeners. We can’t just disagree and blast our partners by telling them their wrong.

This is where the reflective listening process is so important. We show our partner we are listening by reflecting back what they are saying to us, not what we think of what they are saying.

Cognitive restructuring

Unrealistic thoughts are often the cause of misunderstanding and conflict.

This exercise can be especially helpful if you and your spouse engage in escalating conflicts where you blame each other or feel intense feelings of being unloved.

The important concept is any intense feelings we experience have their origins both in the present and in the past. Feelings from the past are stored by the brain in complicated ways, not always easily understood by us in the heat of a conflict.
As I have said previously, our personal history matters. It would be too simplistic to assume otherwise.

Cognitive restructuring helps us create a map of our internal thought process and belief

system and explore our personal life history influencing the development of our faulty thinking and beliefs.

Part of the creative therapy methods of the cognitive behavioral therapy model pioneered by Albert Ellis, Aaron Beck, and others, cognitive restructuring is a useful tool to help change unrealistic beliefs.

What are examples of irrational beliefs?

1. I am worthless.
2. No one loves me.
3. I will always be unhappy.
4. A relationship should not be such hard work.
5. Even though I drink a lot, my partner should not complain.
6. The best way to deal with someone who complains is to tune them out.
7. If people were not so needy, I would be much happier.
8. I will never get what I want.
9. I am right and they are wrong
10. My partner or spouse will never understand me.
11. She hurts my feelings a lot, but doesn’t mean to do it.
12. He drinks alcohol a lot, but he doesn’t have a drinking problem.

In Cognitive restructuring, the therapist helps the client identify and change irrational thinking or beliefs.

Usually, something happens that triggers a strong emotional response. Next, we have automatic negative thoughts or beliefs that cause emotional distress.

The challenge is to become aware enough to identify emotional triggers, automatic thoughts and create new toughts/beliefs that will help us cope more effectively.

In the cognitive therapy model, it is called the ABCDE method. Here it is:

• A = Activating events…we first become aware of situations which lead to strong emotional reactions.
• B = Beliefs or Automatic thoughts… repetitious thoughts/beliefs (positive or negative) we have about ourselves as a result of some activating event
• C = Consequences of these beliefs…our response to our beliefs/automatic thoughts, including self-affirming and self-defeating behaviors
• D = Debate or challenging…more systematic evaluation of our beliefs/automatic thoughts, including looking for scientific, observable data to confirm or refute our beliefs
• E = Effective behavior…developing a more effective response to the activating event based on the systematic research/evaluation of our core beliefs/automatic thoughts.

So, therapeutic use of cognitive restructuring focuses more on negative or irrational beliefs.

The goal is explore and identify more complex ways to understand ourselves, challenging situations, and develop more effective ways of responding.

Let’s try a CR exercise:

Pretend that you just had an argument with a significant other.
The argument left you feeling angry, disappointed, frustrated, and resentful.

The A = Activating Event is the argument with the significant other.

Remember, activating events are situations in daily life that trigger strong feelings in us.

As a result of this activating event, you will begin to have B = Beliefs or Automatic Thoughts. You tend to have these automatic thoughts repeatedly in situations like this.

These automatic thinking process may be referred to as a circular, negative feedback loop.

It occurs over and over again, reinforcing your inability to cope and sense of hopelessness…main ingredients of depression and anxiety problems.
Some examples of negative automatic thoughts you might have include:

1. He will never understand me.
2. He is insensitive to my feelings.
3. He is always like this.
4. He is so frustrating.
5. He is selfish.
6. Winning an argument is more important to him than being right or wrong.
7. He is a bully.
8. He is irrational, I will never get through to him.
9. He is just like his mother.
10. I am helpless.
11. This relationship is hopeless.

Therapeutic work in cognitive restructuring focuses on repetitive negative thoughts (automatic thoughts can also be positive).
As a result of the beliefs or automatic thoughts we experience, there is a C = Consequence. This is the “what we do…how we behave in response to these automatic thoughts.

Often what we do is called the “fight or flight” process. We either fight or run away.

Most of the clients I work with flee, avoid or do anything not to experience the stress related to whatever activating event has triggered them.
Whether it is “flight or fight”, our brain signals the adrenal glands to produce high levels of adrenaline and other stress chemicals.

This intense adrenaline rush is helpful if we have to fight or run from something threatening, but horrible if we are just having an argument with someone we care about.
If we experience higher levels of adrenaline, we likely to be less able to cope effectively with the activating event or stressful situation.

One way we can begin to cope more effectively is to D = Debate or challenge our automatic thoughts which are often based in emotion, rather than realistic data.

Here the steps include the following:

• How accurate are my beliefs?
• Am I distorting any data?
• What do I really know is true?
• What data supports my beliefs?
• What data contradicts my beliefs?
• How much are my beliefs assumptions I am making?
• What can I do to clarify my thinking?
• Who can I talk to help clarify any confusion about this?
• What would happen if I just asked my significant other to answer some questions so I could better understand them?
• Is there any research data or expert opinions I can explore to help me with this dilemma?

Write down your answers to these questions. Use the new data to develop a new, more realistic set of beliefs.

With a more realistic set of beliefs, you are ready to develop an E = Effective plan of action.

This is an exercise best done in writing. Writing will allow you to more fully develop your ideas, remember details, and work with the data you collect.

Using the argument example, you might develop new beliefs such as:

1. He loves me, but gets frustrated easily.
2. He feels criticized by me, so I have to be careful in the way I speak to him.
3. Maybe I get too emotional when I drink wine at night, so I should cut back or not initiate serious discussions when drinking.
4. If I listen better, maybe he will talk to me more.
5. I need to know where my bottom line is. Yelling at him doesn’t do any good. I need to just tell him what I expect and the consequence if he does not comply. Then I need to follow through on what I say. Otherwise, he will not know I am serious.

So, the effective plan for me is to reach out to him when he is able to talk comfortably with me.

I will listen better and just be clear about what I want without criticizing him or raising my voice.

I need to make sure he knows I am serious by stating my expectation and what I will do if he does not comply.

Look next for the Cognitive Restructuring worksheet.