Friends, I think I’m getting my sea legs. Not surprisingly, it has taken a while to not only feel that inner glow of confidence from a clinical standpoint, but also to thoroughly adopt and embrace a small business owner mindset.

What convinced me recently about the latter was a post by our own Frank Froman on the Division 42 e-list (by the way, if you don’t subscribe to the list, you’re missing a lot; contact our administrator, Jeannie Beeaff, to join the list: div42apa@cox.net). Frank’s post and the ensuing thread explored a concept that Frank calls “Delightful Marketing” (DM). DM isn’t advertising or glad-handing or networking or giving talks in public. Nope, it’s the little, everyday things all of us can and should be doing to communicate the message that we view our patients and clients as special. In Frank’s words, these are things that “make clients go, ‘Oh, that’s really neat.’”

For Frank, that may be something as simple as the dish of fortune cookies on his secretary’s desk or having plenty of current issues of magazines, addressed to the office so it’s clear that they were specifically ordered for clients’ perusal. But it also includes behaviors, like staying around to chat and participate in the rest of the meeting after giving a speech to a Huntington’s support group, instead of leaving once his part had been played.

This got me thinking about what I was doing in my practice to add value beyond what’s merely expected. Some things are just little touches that I hope bespeak thoughtfulness: great-smelling foaming hand wash (not tested on animals), luxurious moisturizing lotion, and a lavender-scented soy candle in the restroom; Puffs tissues, rather than the el cheapo stuff that either feels like sandpaper or shreds immediately into tiny balls onto a patient’s clothing, the telltale detritus of a crying jag; a pad of paper and a pen on a side table next to where folks usually sit, so they can jot down notes and reminders.

Colleagues on the e-list posted their own Delightful Marketing moves. In his office in lovely Nanaimo, British Columbia, Raymond Shred offers single-serving bites of Swiss chocolate. Dave Gruendel keeps a bulletin board featuring cartoons related to therapy and invites clients to contribute. This not only serves as an ice-breaker, but also acts as a reminder, Dave says, “of the importance of humor and of being able to laugh at ourselves.” Micki Levin also uses this bulletin board technique to post articles, poems, or stories and even offers to make copies on request. Arlene Giordano hopes to help her clients take a broader perspective on their problems and lives: she has mounted a world map in her waiting room to invite reflection on “how we are just a small part of it all.”

Regardless of whether you agree with these and similar small touches – such as serving beverages or snacks – the Big Lesson we can all take away is that we are communicating with our patients and clients from the moment they walk through our door. So it’s mighty important to assess what messages we’re sending and ensure that all of them are positive. Although you may be thinking “cost control” when you stock up on toilet paper at the Dollar Store, what you’re saying to patients is, “I don’t care if you get a splinter in your tushy. I ain’t springin’ for Charmin.”

Okay, so maybe I’m exaggerating the importance of these small gestures. But not by much! Think about it. What are you thinking and how do you feel when you go into a professional office and find two-year-old reading material with covers so worn you can’t even read the titles? What’s your impression when the mismatched, battered waiting room furniture looks like it came from the yard sale down the street, or the restroom looks and smells as if it hasn’t been cleaned in recent memory?

Right. The little things really do matter. Now I want you to take a few minutes and go outside your building, then come back into your suite and look around slowly. What do you see, hear, and smell? Is your space welcoming and inviting? Is it pleasing to the eye and a refuge for the soul? Sit down in your waiting area. Comfy? Could you entertain yourself with magazines or newspapers of interest to you if you were 15 minutes early for an appointment? Okay, you get my point.

So far, we’ve only discussed a few of the seemingly modest things that speak volumes about you and your practice. Now we need to get into meatier stuff. In response to Frank’s post on Delightful Marketing, Steve Walfish cites business gurus who teach us that “customers expect a quality product and therefore do not become delighted [my emphasis] unless there is something that they believe goes above and beyond the delivery of this quality product.” Hmm. Now that’s food for thought.

In a snippet from his new book, Finanacial Success in Mental Health Practice, co-authored with our own Jeff Barnett and due out this summer, Steve goes on to emphasize a crucial difference between customer satisfaction and customer delight: “Satisfaction is cognitive and based on perceptions; delight is affective and more emotional; satisfaction is based on meeting or exceeding expectations; delight requires out-of-the-ordinary experience. Satisfaction has a weak memory trace; delight experiences are more memorable.”
I’m willing to wager that most of us, even we newbies, feel pretty competent most of the time in our professional work. And I’m pretty sure that our patients and clients expect us to be competent at what we do. They expect us to have the knowledge, skills, and expertise to provide our services. They probably expect us to adhere to ethical and legal standards in our work and behavior. So what might they not expect? What might we do – what kinds of “out-of-the-ordinary” benefits might we provide – that will add value and invoke delight?

I can hear your wheels turning! That’s terrific! Frank and Steve have opened our eyes and minds to all sorts of new possibilities for achieving “customer delight.” Here are a few things that I’ve been doing since Day One in my practice.

I always greet patients warmly in the waiting room, and I escort them to the outside door to say goodbye when their appointment is over. Of course I modify this routine appropriately if my suitemate has clients waiting. More than one person has commented that they appreciated my walking to the door with them. I do it because my mother raised a polite child, and because I genuinely have warm feelings toward my patients. I think they view those few extra steps as a caring sendoff until the next week.

I also do my best to commit names to memory. Not my patients’ names, silly! Of course I know those. I’m referring to the names of family members and friends, coworkers and neighbors. So instead of saying, “Didn’t you mention that you had a similar problem with your ex-boyfriend,” I can say, “I think I recall your describing your behavior with Brett in a similar way. Am I remembering correctly?” Again, it’s not a huge deal, but this conveys to patients that I’m not only listening, but I’m trying to build a full picture of their lives and histories.

I’m a big reader. I read all the time. (Those of you who have met me are likely thinking I should read a little less and exercise a lot more. Ouch! You’re right. But hear me out on this.) Quite a bit of my daytime reading stems from my curiosity about my patients’ problems and situations, so I read research articles and parts of books and surf the Net for information. I read professional e-lists and subscribe to various newsletters. One of those sources is Medscape. I find all kinds of useful, easily digestible articles and news items that often prove helpful. In addition to mental health issues, I might get updated information about hypothyroidism or diabetes or chronic obstructive pulmonary disease.

I use Medscape’s Drug Interaction Checker to review my patients’ medication regimens (especially in the case of older folks, who frequently are taking multiple medications prescribed by multiple physicians, and sometimes suffer unnecessary consequences). And when I find something that I believe is important for a patient to know, rather than to simply apply in my work, I share it. For example, a very recent study has determined that all anticonvulsants carry a significant risk of eliciting suicidal ideation and/or behavior. So for a patient newly diagnosed with bipolar illness and whose psychiatrist has prescribed Depakote, I underscored that both she and her husband should be alert for any signs of suicidal thinking. This came as news to her and I was glad I hadn’t just assumed that the MD had discussed this issue with her.

Occasionally, too, I print articles, or write brief summaries to share with patients. For one person whose late husband had been a skilled and long-time practitioner of martial arts and Qi Gong, I copied a piece on preparing for sleep by using three simple Qi Gong movements. The reference to something her husband had devoted himself to made this aspect of my approach to sleep hygiene special and meaningful to her.
Perhaps the greatest value-added extra I bring to my practice is creating handouts. I confess, in fact, that I’m the Queen of Handouts. I’ve made handouts on too many subjects to enumerate here, so I’ll tell you about just two of them. One that I give to everyone is on diaphragmatic breathing. Another is a multi-page document that I developed for an older patient who was “graduating” from therapy. I wanted her to have a reminder of the many new skills she had worked on that would prompt her to continue using them. More than that, I wanted her to be able to have something concrete to refer to when things got tough for her again.

So I wrote this handout and titled it “Recipe for Success.” She liked the cooking allusion, having described a few of her culinary specialties over the course of our meetings. My piece addressed all the basics – lots of self-care and healthy living tips – but went beyond those to make the “recipe” more personalized. Using examples from our work together, I included reminders about how to set effective boundaries, being okay with saying No, and accepting physical limitations. It won’t win a Pulitzer, but I put a lot of thought into it and she knows that I did so, solely for her benefit

Recently, I had a visit from this patient. It was maybe 9 or 10 months since I’d last seen her, and she wanted to thank me for having helped her. Toward the end of our chat, she told me that she still keeps the “Recipe for Success” on her bedside table and consults it from time to time. She got a twinkle in her eye then and admitted that some of the things we’d dealt with during therapy quite frankly hadn’t sunk in until much later. So she was grateful that I’d given her that special “recipe” to read and reread and ponder. Id’ say she’s putting it to very good use.

It seems to me that it may well be the little things, and the times when we go the extra mile – when we do the unexpected – that not only instill satisfaction, but evoke a sense of delight in our patients. We all can build more Delightful Marketing and Customer Delight strategies into our practices. Whether it’s Frank’s extraordinary creativity in using metaphors that clients really “get,” or it’s special handouts and exercises that you tailor to each patient, when you go beyond what’s expected and provide the exceptional, you’re engaging in promoting Customer Delight. And that is the most important marketing of all, because it will make you memorable.

Debbie Klingender, PhD, is building her small-town general psychotherapy practice in North Carolina. Please send your comments and suggestions to drdeb@wellspringpsych.com.