Should You Start a Private Practice as a Therapist?

Lisa Marie Bobby:   Have you been thinking about starting your very own private practice as a therapist? This is an exciting time and, it could be a really great thing for you. And I know from experience that it is a mixed bag, just like everything else. And so on today’s episode of Love, Happiness Success for Therapists, We’re going to be talking about all of the different things that you should know about starting a private therapy practice so that you can make an informed decision about whether or not it’s going to be a positive thing for you and go into this with your eyes open should you decide to go that route.

I really wanted to record an episode on this topic because I think that many people in our shared profession have a dream of having their own private practice someday. And fallibly that was my dream when I went into counseling school, when I did my master’s degree. I knew going in that one of my goals was to have my own private practice.

And part of that was coming from the fact that I had previous business experience before shifting careers and pursuing a master’s degree in counseling. I’d never actually had a job before. I’d always run one business of some kind or another, really my entire life. And so that was a natural part of it.

And what I’ve also learned over the years I did a solo private practice for many years and then growing self counseling and coaching stopped being just about me and started evolving into a group private practice, probably seven or eight years after I first began this as a solopreneur.

And that obviously took it to a different level of business serious and intensity, right? When you’re trying to manage and operate a business that’s more than just you and really support and care for other clinicians and support their success and build a whole business around that, that, that is a different animal.

But that for me has been very rewarding because I really enjoy. business. It’s something that has always just been super interesting to me and I like doing it. So that was actually my first love. And for me, therapy was secondary to that. And for me though, I think the group private practice has been so rewarding because it’s given me the opportunity.

Opportunity to really shift from just assisting clients, which of course I still do. I still maintain my own caseload, but really focus on how do I help clinicians flourish and thrive? How do I help them develop personally and professionally? So I, I do clinical supervision. I’ve served as our clinical director in the past and really that focus on helping support the wellbeing and the ongoing growth, love, happiness, and success of clinicians has been a priority for me and a very satisfying one.

And that’s actually where this podcast comes from, right? I was a long time. I am the longtime host of the Love, Happiness, and Success podcast, which is civilian facing talking about, common growth and relational and career issues, but that’s where the origin of this podcast came from.

It’s like, why am I not doing this for clinicians? And so that’s just a little bit about my background and my mission to set the framework for talking about the question that we’re coming together today to explore. Explore, which is whether or not to start your own private practice as a therapist.

And again, this is a real dilemma for a lot of people in our profession. It’s the dream for many therapists and. Understandably I think there’s this idea, this allure of being your own boss and being able to set your own schedule, especially if you have been in employment situations that have been more difficult externally imposed you need to be there at certain hours or you don’t really have a say over who you work with, or you have to do certain things a certain way in order to comply with the organizational standards or what a way of doing things, even just the idea of the autonomy and being able to operate in the way that you see fit.

fit can feel like the best thing in the world, right? Because as we’ve talked about so many times in past episodes of this show, burnout is such a real occupational hazard for us. And being in the wrong environment, particularly one that doesn’t. Truly nurture our wellbeing and our ability to set healthy boundaries, our ability to have and maintain autonomy, those contribute to burnout.

And so it’s easy when you’re in that kind of place to look to this shining mirage of private practice and think that will make everything better. And it can be better. And is it all it’s cracked up to be? There are things in private practice that are pros and cons, highs and lows, and everything in between.

Particularly if you are seeking to make the transition into private practice because you’re trying to get away from something, right? It’s not just moving towards, we’re moving away, right? Unfavorable working conditions, again, particularly in high agency work, community mental health work, high need populations that have very serious issues and maybe an extremely high caseload.

In some environments you may have dozens and dozens, over a hundred people on your caseload that really need a lot. And just the realities of having so many people on your caseload, only having so many hours in your day, it feels like you’re set up to fail. It’s just overwhelming. But then on top of that, the reality of many of these organizations is that it’s low pay.

And with all of those things combined into And again, particularly if you throw in like a toxic work culture or unsupported professional environment, it can really make private practice seem like the golden ticket, that shining castle on the hill. And I think there’s also a reality in addition to the environments or the workload, there can be.

a desire for a different kind of work altogether. And I think this is especially true if you’ve been working as a therapist in healthcare environments with people who are dealing with very big diagnoses. So trauma, a significant mood disorders, other severely or persistently mentally ill populations.

I think that part of the dream is getting to do more of the work you want to do. Growth oriented therapy, maybe relational therapy, life transitions, getting clarity but I think the, Dream, like working with high functioning people who are going to value and appreciate what it is that you do and be eager to have the kinds of transformational experiences that you can create for them because that’s where your heart is.

That’s what you want to do. And. It’s true. You can do that in private practice. You can do the work that you love with people who are willing to pay you for that and have it be more fun and more enjoyable. It is also true that the financial rewards can, are, could definitely be there in terms of making more money per billable hour especially like moving away from a salary situation where if you break it all down, the hourly wage may be fairly low, but you could also have more flexibility, more autonomy, be able to operate everything the way that you want to be able to.

Work with people the way that you want to using modalities that you feel excited about. And all of those things can be such a beautiful thing when you’re able to build a practice, doing the work you love to do, which again may not be mental health treatment, which is what we’re often tasked to do in many other environments as therapists.

So all good things and lots of potential and as with any major life decision it’s important that you have a clear understanding of these motivations and the reality. Of what private practice entails. And I’ll just say that particularly if you have been in a place and environment, even like a mental and emotional and personal space that’s burned out, that doesn’t feel good.

It can be easy to create a fantasy about what private practice would be like, or this idealized version of what private practice is as. this like some something else to move towards like a hopeful thing to get out of a bad situation and I have personally seen therapists and I’m going to be talking about a couple of things that you can do to jump out of one frying pan into a different kind of frying pan and not have a great experience at private practice either.

So to keep you from doing that, let’s jump right in. the challenges of private practice. And I will tell you that I have lived through all of these challenges and that I can tell you with some clarity about what they involve. So I think the very first thing to be thinking about and knowing is that Operating a business is a totally different thing than being a good therapist.

In fact, you can be the best therapist in the world. Really technically an excellent clinician and that does not mean that you’re going to have any clients coming in the door or that you’re going to make any money doing it because it doesn’t have anything to do with being a successful business owner.

That is. One thing to consider that you’re going to be spending a lot of your time doing things that are not therapy in order to make this go. And those things are going to be unpaid. It’s a lot of work that you will not get paid for because the only thing that you get paid for in private practice is that billable hour.

The other thing that every business owner will tell you is that we think going in, we’re going to be our own boss. I’m going to have this freedom and the reality of any business, particularly in the first stages, like the first 10 years of operating a business. This is true for a therapy practice, for the pizza joint down the street for the hair studio.

You go find any business owner in your community and they will tell you the truth, which is that as a small business owner, it is. It’s easy and honestly, like generally the experience that at least for a while, this business is going to own you, not the other way around because of the amount of work that it takes to get these things going.

And for example, one of the crash course in business 101 in order to have a business, you have to have clients who are. able, willing, prepared, motivated to pay for said services one way or another. You have to have money coming in exchange for the services that you provide, right? So how does that happen?

Attracting a steady stream of clients, particularly if they are self pay, private pay clients, requires a very substantial investment in marketing, whether it’s your time or your money. Yes, in a private practice, you might be able to charge a higher rate per session and have somebody pay that out of pocket.

But in order to make that happen, you have got to factor in the unpaid hours that you’re spending to connect with that client and bring them in the door and manage everything related to that. And so when you factor in all those unpaid hours, consider that it’s the billable hour But how many hours are you spending before that and after that?

Because your actual hourly rate might be very different than that. Now there is another path. Obviously there’s another business model, which many therapists pursue. And that’s the one where instead of you putting a lot of energy into marketing really well, no, I don’t have to do that. I can instead become paneled with an insurance company and they can send me a steady stream of clients and they will pay for it, which seems like a win.

I have clients I’m getting paid. Great. But that can be a mixed bag as well. So a lot of counseling practices opt to depend on third party payers for referrals and for reimbursement. So you’ve solved the marketing problem, but it introduces another problem, which is the administrative work involved with insurance claims, the forms, and then the forms are rejected.

You have to resubmit them and negotiations for payment. And also this is where the original dream can start noting that health insurance only. Pays for behavioral health care, not the broader range of services that you might enjoy providing and really want to do. So if you build your business around having insurance, direct clients towards you and pay for those services, you will by definition be back in the boat of providing behavioral health care for the purpose of diagnosing and treating mental health conditions.

which again may be very different from the work that you really want to do. Growth oriented therapy, couples counseling, helping people with, life transitions, that kind of work. Those are not medically necessary psychiatric issues requiring treatment. And if you’re trying to bill insurance to cover those kinds of things, but many clinicians in order to thread the needle and try to make private practice work and do the work that they want to do are actually misrepresenting the work that they’re doing to insurance companies and committing insurance fraud in the process.

If you are doing relationally focused couples counseling for the purpose of improving a relationship, but then telling the insurance company that this is actually about the treatment of one partner’s mental health condition in order to get paid for that, it’s insurance fraud. And people can get in trouble for doing this.

So it’s important to be really clear about the choices that you’re making and what you’re getting into on either side of the equation. Because again, with the insurance stuff, it might be true. Okay. Now I’m saving time and energy and money and angst. It’s because I don’t have to market stuff, but then there’s this whole thing that you’re wandering into with insurance.

Now you’ve traded that time and energy for another spending insurance claims, a boatload of work, and maybe not. not doing the work that you want to do. So unless you’re pretty clear that you are eager for the time and energy and effort of running a capitalistic endeavor of a business and everything that goes into that in terms of marketing, Or if you are really good at operational systems and good at paperwork and okay in providing the kind of psychotherapy behavioral health care that you’re going to be signing up for to do insurance work, if either of those feel good to you, then private practice could be an extremely good experience for you.

But if neither of those really feels ideal for you. You should consider that and take that into the equation when you’re thinking about what you want to do long term. And then truly, there is yet another variable here that I think needs to be discussed because and I say this as somebody who did a solo private practice for easily seven eight years before it got to the point where there was enough there to turn it into Something that was more than just me I mean you know, have an employee or anything like that is that it can be exceptionally isolating.

And that’s, whether you’re doing insurance, whether you’re doing, going after the self pay model, because without a network of colleagues around, it feels so easy to be stuck or alone. And that is something that I have always valued that I experienced prior to solo private practice through my master’s program, moving through that in a cohort model and developing a strong community there and in my doctoral program.

And luckily for me, the first years of pursuing private practice, I was still in supervision, which really helped. And then later on, I was lucky enough. To be able to build a professional network of people, a consultation group over time, but it took me a number of years before I figured out how much I really needed that.

And I think I, I struggled a lot in the process. If you do a private practice of any kind, just realize that it’s going to be very important to invest time and energy into relationships, either if it’s a clinical supervisor or professional mentor, consultation groups, a consultation partner.

It needs to be baked into this because we all encounter so many challenging. Emotionally difficult, traumatizing, but also even just ambiguous situations where we don’t know if we’re doing the right thing. We don’t know what we don’t know sometimes and to bounce that off other people, to have sounding boards, to help us create clarity around what it is that we’re doing, develop solid case conceptualizations even can often happen through that external processing, but truly.

This profession requires so much growth and development from all of us as people and as professionals. And to do the self of therapist kinds of work that will always come up is vital. It’s vital for our wellbeing, but also for our client’s wellbeing and for our ability to create not just a private practice, but an ethical, beneficial, trustworthy practice.

We have to have that visibility and insight and accountability into ourselves. So that’s another piece of this puzzle that needs to come together when pursuing a private practice. I will also tell you that one of the difficult things that many therapists are not fully prepared for when they decide to go the private practice route is the financial anxiety that can come along with it and also the potential for ethical gray areas that can come up that are oftentimes It’s related to that financial anxiety.

So if you are depending on your private practice and clients that you’re working with is now your entire income, you don’t have a salary that can potentially influence your relationship with your clients and with how you’re operating as a therapist and not in a good way. Bye. For example, some therapists can make questionable ethical decisions about whether or not to take on a client that they, they might need the income, they might need that client.

And so they say yes to a client who’s dealing with something that might not totally be within their scope of competence. It’s, I see this all the time as a marriage and family therapist being a marriage and family therapist, it’s a totally different degree. It’s a different training. It’s a different supervision track, but all the time I see clinicians who have not had that training and experience with anything.

Maybe they’ve had one class in couples and family therapy, happily accepting couples into their practice or with any other kinds of things, saying, yes, I’m going To something that you really do not have experience. It can be hard to say no, I guess is what I’m trying to say. And so in order to say no, there needs to be this sense of financial security that is you know what?

You seem like a great person. I don’t know that I’m the right person to help you though. Let me make a referral for you and have this confidence. The other clients are coming in the door and it’s going to be okay. Similarly, like we were talking previously about the whole insurance question, like if you really want to take a client and they really want to work with you and they want to do work that has nothing to do with a mental health condition, but you both feel like insurance needs to pay for it in order to make it work financially, you can make the payment.

inaccurate claims on that insurance submission paperwork. Yeah, this is an adjustment disorder and I have a treatment plan. We’re treating the adjustment disorder. It’s not an adjustment disorder. It’s somebody who’s trying to figure out if they want to do something else with their career, break up with her boyfriend.

It’s not a psychiatric diagnosis. And so in order to be. Squeaky clean. Ethically, we need to take a hard look at how our even subconscious worries about being financially stable may influence the choices that we make when it comes to clients, particularly around money. So I just wanted to say that out loud.

And then lastly, I have had this experience, I think to a degree I’m still fighting my way out of this experience is that as a business owner, it, you’re chained to your business in a lot of ways. This is true as a solopreneur for sure, because everything falls on your shoulders.

If somebody calls or emails or wants to make an appointment or wants more information or needs something sent or needs a letter, it’s all the things. And also not having support around you if you need to take a break and you really want to disconnect, take time off, take a vacation particularly if you’re doing more of that behavioral health care and you have clients who might not, Be fully stable for two weeks while you’re in Thailand or whatever, you need a backup plan or somebody who can help you help your clients in case of an emergency.

Other than that, even if you’re in Thailand, you’re still going to be checking your phone and checking your messages and corresponding with people and you can never really unplug and that can be very difficult. Those are all things to consider about. Do I want a private practice or not?

And I don’t mean to make it sound negative because again, there could be many positive things here, but it’s a, you’re trading one set of problems for a different set of problems and wanted to make you aware of what those problems can be so that if you do decide to pursue this, you’re going into it saying, I am intentionally understanding and signing up for these.

Things as opposed to, starting to get in there, like quitting your job, take this job and shove it. I don’t want to do this anymore. That’s totally understandable. But then being surprised at, the realities of what you will be getting into in the next chapter, right?

So one middle path that I have become a strong advocate for over the course of my career particularly for people who do not have that natural drive to do like business stuff, if it’s either like sales and marketing approach or the kind of developing the operational systems that, requires, if you’re going to go with an insurance based model or that, that desire for the healthcare approach, a different middle path that can work really well for a lot of clinicians is the best of both worlds through joining a group private practice that does what you want to do, meaning a group private practice that is focusing on Good night.

therapy for growth, couples counseling, career development, the kinds of work that you would really relish and has already built all the systems to make that happen so that you don’t have to do all of that work. You can just show up, do the fun part and then be on your way. And this kind of setup can provide the autonomy.

that you’re looking for, particularly if you’re not an employee. So look for a situation where you can come into it as an independent contractor. That’s the way that growing self is set up. And that’s for a reason. The purpose of our group private practice is to serve clinicians and help them kind of clients.

We’re not like, Client facing primarily, we are here to help clinicians and because of that, they’re not employees, they’re contractors. So they are totally setting their own hours. They are defining their own, choose your own adventure. They are deciding what kinds of clients that they want to work with, benefiting from marketing services, sales funnels, all of this.

stuff, and also to the favorable compensation of the private practice without all of the work with somebody else to, take care of the administrative things and the billing, but also without the isolation of a solo private practice. So it’s all built into the system. And that can be a fantastic thing.

opportunity for people to get the outcome that they really want when they think about private practice, what’s it’s going to be like freedom and fun, self pay high functioning clients and doing the work that I love and being my own boss. The, Having a business is not often the vehicle to creating that, but getting aligned with the right group private practice can actually create that outcome.

I have people on my team all the time and they’re like, I’m going to Thailand for two weeks. Bye. And they’re like, cool. Bye. Go, cause the system handles it and they walk right back in and they do the stuff they love and it’s all good. And they are earning enough money that they can go to Thailand.

Or where else they want to go, right? And so if that feels like it could be an option for you, what I want to just encourage you to do is first of all, look for a group practice that aligns with your values. That’s really important. Are you and they on a shared mission? Because if there is a misalignment in that mission, if the culture Isn’t a good fit that is going to make it not feel like your practice and a good group private practice experience should feel like your practice, your professional home.

So that’s really important. Do a lot of digging. How would you describe your culture? What is the mission and values of your organization and how is that expressed in what you do? Mission and values of my practice is growth, love, happiness, and success. Everything that we do is in alignment with those.

things, whether it’s client facing or for our clinicians or for our employees, for that matter, the people on the back of end of things and make it all run. So think about that. And then I would also strongly encourage you to find a group private practice that works for you. you. So what I mean by that, they are doing the dirty hard work for you, like marketing for you, providing wraparound support for you from everything from insurance billing.

If it’s a practice that has that revenue model and it’s more of the healthcare focus, somebody’s handling that. Somebody’s handling billing. And there’s also support for you to practice your own self care, be it taking time off and having that be okay, taking your own hours, deciding whether or not you want to take specific clients, like a lot of autonomy and support for that.

And also I would encourage you to look for a practice that really invests a lot into you, your professional development. consultation groups baked into the system, opportunities to consult or get support, self care kinds of activities. And there are practices that are all of, I know that because that’s what growing self is.

We do yoga together, we have consultation groups, we do this clinical supervision, on demand consultation, professional trainings. There are. So many different things that we’re doing here, private practice success coaching, even as something that we do to help support clinicians coming in from an agency environment to be successful, because even in a supported private practice like ours, we could fire hose somebody with prospective clients all day, but if they’re still operating in an agency mindset, they won’t be.

Be able to connect with private practice clinicians who are wanting and needing something very different so that professional development is really important. I’ve personally been shocked. I’ve heard stories of some colleagues, they’re like, yeah, it’s a group private practice. I get to use an office space, but I have to bring in my own clients.

They have a front desk person that helps with billing, like I’m on my own with like appointment scheduling. And I’m like what is this doing for you? So again, just, come into it with that, that empowering stance of this practice is here For me to help me achieve my professional and life design goals.

What do I want that to be for me? What is my vision of what I want, how I want to feel and how does this practice serve me in creating that and have those kinds of conversations with anything that you’re considering getting into. So that is a really good middle path for some people to create the outcomes that they want and.

jump over some of the difficulties that can be involved in creating those outcomes in a solo private practice. So to wrap this up should you start a private practice? Again, it could be a really great option for you, especially if you have that, organizational systems mind of okay, we’re going to have these insurance claims and he’s going to do that.

And yeah, like a project management kind of approach. If that administrative ability is strong in you, or if you have that, red meat eating kind of business sales and marketing and yeah, I actually really want to do that. So those two pieces, then green light, because you can do those and then have those contribute to creating the kind of private practice experience that you want as a solopreneur.

It will still take time. Again, for me. It was probably about seven years from the time that I started until it was, it felt stable enough for me to relax a little bit. And it is absolutely achievable. It totally is. As long as you’re going into it with your eyes open and just not running away from something if you’re in a bad situation and jumping into something else that might wind up not disappointing you, but being.

being different than what you thought, right? And consider other alternatives. There are different ways you can go. We talked about a group practice model as being a possible solution for people who don’t want either of the operational business pieces, just want to reap the rewards. Group private practice could be a great way to go.

So I hope this was helpful. I hope it makes you think, do some journaling. If you would like more resources on this topic, I have more for you. You can come to growingself. com forward slash therapist. To access all the things I have we have I’ve put together some other articles and some advice if you’re considering doing private practice, you can find additional podcasts on this topic and others about the life and times of being a therapist.

You can also take my flourish and thrive as a therapist assessment, which will give you some visibility into some of the environmental factors that we were talking about earlier and, give you that insight into, yeah, probably like running away from a bad environment. Helping you slow down and make good choices about what you want to do next.

And additionally I’d love to invite you to be part of our community. You can jump into the comments section on the blog at growingself. com forward slash therapists in any of those posts. I’d love to hear your thoughts or follow up questions if you have them for me and get in touch with me. I would love to hear from you.

I’d love to hear more about what is on your mind and in your heart so that I can Be on your team and support you in it. You can connect with me on Instagram, but track down growing self on Instagram, growing self is on Facebook and growing self is on LinkedIn. Send me a message. Tell me how you’re feeling about things.

If you have reactions to any of what you’re hearing so far on the love, happiness, and success for therapists. podcast. I’d love to hear about it. And of course, if there are other topics or questions or things you’d like to hear discussed on the show, please let me know so I can make it for you.

All right. Thank you so much for spending this time with me today and I’ll talk to you again next week. Take care.