Kathy Marshack of Vancouver, WA accepted managed care payments until two years ago. "I canceled all of my contracts. It was not cost effective. They cut my fees and the dollars and cents did not work. I run a mostly cash practice with a small amount of indemnity insurance."

Marshack says that half of her practice involves marriage and family therapy. The other half is centered around a growing entrepreneurial couples and family niche. "I have been developing this since 1993 and 1994 when I was doing my doctoral dissertation. I began to see dual career couples and started to market it."

Marshack says that couples who work together in their own businesses will hire financial planners, accountants, management consultants and lawyers but have been hesitant to hire therapists. "A lot of husbands and wives don't calculate how changes in business will affect their lives. When they get in it, they realize they need a relationship specialist. The person they see at home is not the same as the person they see at work. When it comes to dealing with money and contracts, they see they need to redefine their marriage. In business, the partners need to clarify who makes the decisions."

She also sees some spouses who are married to entrepreneurs, father and sons who work together, and other family combinations.

In practice since 1980, the solo practitioner maintains a second office in Portland and share expenses with five marriage and family therapists. Referrals come from Yellow Page advertisements, newsletters, other clinicians, former clients, and brochures. She is also active in the National Writers Union. She writes a column for a local business journal and her book, ENTREPRENEURIAL COUPLES: Making It Work at Work and at Home, has drawn national television and magazine interviews.

"If you set your practice up and market and manage it well, people will come. You will be successful without managed care."

Marshack's tips for a practice success are:

• Offer on-the-job training
• Take classes on business basics
• Learn about organizational development
• Understand what it is like to have employees
• Know the importance of safety issues
• Get involved in the business community