I really enjoyed Amy E. Flaherty’s blog post today about the 7 things she wishes she had known before going in to private practice. It was fun to take a peek inside another therapist’s head!
So . . . I responded to her with the 
7 things I wish I had known before making the leap into private practice (and my list could have been so much longer!) .
Here’s mine ————>
Then, I realized that I want to hear from each of you!
What are the 7 things that you wish you had known before you headed off into private practice? Care to share?
(I think this is important enough that I’ll compile them all into a post to share with you.)
Tamara,
I just wanted to say Thank You for your website and blog. I have worked in a nonprofit agency setting for the past 7 1/2 years and have recently opened my own private practice. I have found so much useful advice and tips on here, I think you and your readers are amazing. Thank you again for all you do!
Elizabeth! Thank you so much for taking time to drop in to let me know that I’m contributing to the success of you and your new practice! That means so much to me! Some of the biggest blogs in existence have recently decided to stop allowing comments are their blogs and I’m so saddened to hear that. Your comment today is enough for me to believe that it’s important to keep the comments open. It’s the primary way whether I know if my blog is useful or just taking up space.
Do tell us more about where you are, Elizabeth and what your practice is focused on so that we can all support you in growing your business! I hope you will drop back in often to share what you are learning, network with us, and learn from us, too!
Blessings to you on your journey!
I am located in Ohio, as for nicheing, I am working on that 🙂 I enjoy working with a variety of people but I am more focused on children, adolescents and families. I do enjoy working with young adults and women, I think as I go and continue to grow it will become more and more clear where my niche is.
Before I opened I took your advice and created a marketing plan, goals, came up with my vision of my “ideal practice and client”, created my policies and documentation.
I am blessed to have a great network of seasoned therapist that have stepped into a mentor mode for me. The biggest hurdle for me at this time is how fast I have grown, it is wonderful and I am not complaining but it can be overwhelming.
I initially was going to begin my practice over the summer, my nonprofit position is at a school so I have the summers off. I am also a subcontractor in a group private practice, I am there one evening a week. So after reading how most practices take awhile to get up and going I decided to open earlier, I was going to see how it went before resigning from the nonprofit over the summer.
In that mindset I set my goals, get a few clients by June(I did have a number), hit marketing hard over the summer and hope to have enough client’s that I will not need to return to school in the fall.
If I didn’t have enough clients by fall my backup plan was to add clients in the group pp. As of yesterday I was 1 client away from my Sept goal, which again is awesome, but it means I am working 3 jobs until the end of the school year(only 3 more weeks so it’s not too bad).
I have been blessed by knowing and working with a psychiatric nurse practitioner, we knew each other from the nonprofit, she left several years ago and joined a practice very close to where my pp is located. Her practice has referred 90% of my client’s thus far, they have 2 locations and I have been getting calls from both.
I am nervous about doing much marketing at this time(I was going to take brochures and cards to schools, dr’s offices, etc) due to almost being full, but on the flip side I am planning with no shows and clients that only come for a few sessions in mind.
Like I said, it is wonderful problem to have 🙂 I also have a very supportive husband that has encouraged me when I was doubting myself and my plans, and 2 supportive little boys who agree this will be great and are excited that I will be able to volunteer at their school some next year instead of working at a different one.
Elizabeth, what a lovely success story! I’m so glad I could be a part of it. Although my first venture 20+ years ago into private practice was quite difficult (because I was clueless), when I started over in Colorado in 2002, I had significantly better results. If you have a good solid plan and hit the ground running, anyone can build a strong and vibrant practice.
That’s harder to do if your time is split between multiple jobs. I really struggled with that at one time, too.
One thing I would suggest, Elizabeth, is to not slack up on your marketing when your practice is full. It’s easy to do, I know, but if you can keep your marketing efforts consistent over time, you will minimize the feast-and-famine cycle that so many therapists experience. I learned that pre-private practice when I was working for a for-profit psychiatric hospital back in the 1980’s. They kept their census fairly stable by doing the same “community outreach” aka marketing day in and day out.
The one cautionary note I would make is that it is very dangerous to rely on getting all of your referrals from 1 or 2 sources. Your favorite referral source might move, die, retire, go out of business, or simply find another provider that she prefers to refer to – especially if you haven’t been around her in the last 4 months. Any practice can thrive with 3-5 great referral sources but the fewer referral sources you have, the more vulnerable your practice is.
Congratulations, Elizabeth, on making great choices for your practice. Wishing you lots of success and hoping you’ll drop back in here often to chat and share your successes and your challenges, too! We’re looking forward to learning from you, networking with you, and sharing what we know, too!
Thank you Tamara for all of your advice and experience. I found out that the nurse pract. is actually moving to a different state at the end of July. I have continued marketing even though I am very close to being full. My question for you and others out there is how do you handle referrals after you are full without losing that referral source? Thank you again!
Hi, Elizabeth! You are so welcome! And, congrats to you for being so busy! That’s the goal, right? Based on criticality and client safety, of course, I start spreading out (and, if appropriate, weaning off) my clients. And, my clients know this from day 1 with me – When I talk about termination of services at intake, I talk about my preference to “wean clients off gradually” and give examples of that.
My thinking about this is both clinical and also a business choice. The clinical piece, of course, is about building a client’s confidence and stamina in his / her new skills and to lessen dependency on me. I want her to get her “sea legs” so to speak. And, the business piece is that I want to always have room for new blood coming into my practice – especially those requiring more immediate support. I have room at all times by design to get a new client in to see me in 5-7 days.
Tamara,
I also just want to say Thank You for your website and blog. The main thing that I wished I had known before I headed off into private practice is a better marketing plan. First year was very lonely. Three years later I am were I wanted to be when I started. Prior I had patients/clients while working with our veterans (15 years) for a group. Private practice to me is the most rewarding work I could have ever projected.
I would like to wish everyone here continued success in their life journey of private practice.
Oh, my goodness, Neal! Isn’t that the truth?! I didn’t even know what a marketing plan was when I opened my first practice. Is it a surprise to anyone that I just about starved to death? And, while I was starving (and twiddling my thumbs) there was no one to commiserate with!
Lessons learned along the way . . . ! Thanks for dropping in to share today. Perhaps if enough of us say the same thing over and over and over again, there will be a handful of therapists new to private practice who will do it differently! That’s the plan at least!
Please do drop back in often to chat. We don’t have nearly enough men’s voices here!
Seven things I wish I had known before I went into private practice?
• I wish I had known that the surest way to build a practice is to become MORE specifically “myself” rather than to try to emulate what I thought a “psychotherapist” should be. My practice began thriving only after I pursued my own passions and interests and geared my practice toward that:(Dream Work, Expressive Art Therapy, Interactive Guided Imagery, Energy Psychology)
• I wish I had known better that while psychobabble theories are important, an awful lot of what people need is education. I have developed a file of handouts for common issues, and continue to develop them as Pinterest pins now. The blog I write now continues that education focus.
• It took me a while to realize that I am not a “one size fits all” psychotherapist and to accept that not every client is a good fit for me, and vice versa. The more I geared my practice to a particular demographic the better I did
• Once I got over my “fear” of losing clients, I learned the importance of referring them out sooner then later for complimentary treatments (massage, acupuncture, fitness trainer, etc.) This only enhanced their confidence in me.
• So, I learned the importance of creating a broad referral list, and using it.
• I wish my training prior to private practice had taught me sooner how rewarding group work can be. The small groups I later led over the years have been some of the most rewarding work I’ve done, and make therapeutic interaction available to more people.
• I wish I had known sooner that the blood, sweat, tears and years it took to become a licensed professional were definitely worth it. Twenty + years later I look back and feel humbled at the privilege of sitting with so many great souls and the autonomy and flexibility it gave me.
Oh, Mary! I can relate to so many of these but the one that resonates loudest with me is “Don’t be the one-size-fits-all therapist” because it’s just WRONG! And, that was so me, I’m embarrassed to say! Thank you for reminding me again of what it took forever for me to learn!
Hi Tamara. I’m not sure I could come up with 7. I have a thriving practice right now. But there are a couple of things I wished I would have know. #1 That having a solo practice can be very isolating. I am in my office all day and only talk to clients. I do have meet and greets with other therapists once a month and am in an online peer group via Google Hangouts every week, but the day to day can be lonely.
#2 I wish I would have known that this isn’t as glamorous as it was in my head when I started out. I think I expected this to be the most fulfilling thing I could do. It can be, but it’s also exhausting at times and for me, dealing with chronic pain and fatigue makes it especially so. I do things to make sure I have rest and relaxation, and fun times too..but it’s just more challenging than I knew.
But…all that said, I wouldn’t change anything about what I do. Hope that makes sense.
oooo. Linda, I totally agree. I learned too how isolating it can be. I spent the day encouraging people to live the life I wasn’t living myself at times because I was “peopled out” by the end of the day. I got fed up with this and started a Creativity Club for myself 5 years ago… that has added more balance and “life” to my life, and created a network of “non-work-related” community. Much needed…..
That’s great Mary. I would love to know what a creativity club is! I do have some outside friends too and it is good to not talk shop sometimes.
Linda, thanks for your interest in learning more about how a Creativity Club works… see my response to Pam on the thread. Let me know what you think!
Mary, could you tell us more about the Creativity Club you started? Thanks!
Sure thing Pam!
When people heard about our Creativity Club, there was so much interest and so many questions about how we structured it that I spent last year writing up a handbook which is now available: The Creativity & Camaraderie Club Handbook: Have More Fun, Live More Wholeheartedly, Encourage Each Other It’s available on Amazon in print and ebook. It gives complete “how-to” instructions, group guidelines, etc.
I often think this would be a GREAT way for clinicians to build their practice and reputation in a community (by following the structure guidelines, offering it in their community… very “positive psychology” focus.) I also think it would be a GREAT thing for therapists to create for themselves with a bunch of other therapists to bring balance into their lives. Let’s all lead the lives we encourage our clients to live! I’d be interested to know what you think….
Hey, gang, Mary has agreed to write up a guest post on the Creativity Club in the next few months! Stay tuned!
Linda, I love that you used the word “glamorous” because that’s what I thought it was to be a therapist in private practice! Didn’t we all? It WAS glamorous . . . from the outside looking in!
I grew up watching Dr. Marlana Evans, the psychiatrist on Days of Our Lives and that’s exactly the word that came to mind. After all, in the soaps, the shrink never has to go buy the toilet paper and clean the bathrooms of her office; nor does she talk to insurance companies and do the paperwork or get called out of a concert to deal with a suicidal client or . . . or . . . or . . . .
I love what I do. I really REALLY LOVE being in private practice for so many reasons! But “glamorous?” I don’t think so! That fantasy image of how I thought it was going to be is long gone! Thanks for another reminder!
And Marlena’s gorgeous suits, right Tamara? LOL. I know…an office in the hospital where you had people stopping by all the time, and you never actually had to do therapy…you just made it a hobby to figure out family members. Ha ha.
Linda, I love that you are talking about the isolation of private practice. It’s so not what extroverts expect and need! I wonder if introverts relish the isolation . . . ?
I wish I’d known that I am valuable, my time is valuable, and that I can charge what I’m worth. Your #3 on your list is really ringing true for me and I will be spending more time contemplating it.
Thank you for this idea and these lists — I relate to SO many of them!
Not only can you charge what you are worth . . . . You can actually get paid what you are worth – and without insurance:)! It’s a matter of choice! And, it’s helpful to remember that in private practice . . . the choice(s) is all yours.
1. How hard it is
2. Not take my clients for granted
3. don’t be afraid to make changes to improve my services
4. How long it takes to grow: It doesn’t happen over night!
5. It;s ok to refer out, I don’t have to be all things to all people
6. Have a clear idea of my ideal clients
7. How much I need a support network, including other therapists and those outside the therapy field
Hey, Jill! I’ve missed your voice here! I didn’t have a clue who my ideal client was when I started and, girl, I wish I had! That’s such a hard one in the beginning, isn’t it? But, it can be a game changer in private practice. Once I got clear and was willing to say it to others, , it was almost like a magnet drawing those ideal clients to me. YES! Figure it out – the sooner . . . the better!
The biggest change was going from an agency setting where I had to take anyone, to having a choice in whether or not to refer out. Then it was actually learning how to communicate it to potential clients.
Hello Tamara,
Thank you for sharing not only your 7 things but Amy’s as well. I can relate to both of them in some areas and it is ALWAYS nice to know that others have been in my footsteps and have felt similar feelings. After being in practice for about a year and a half now, I know there are more than seven things I wish I knew and some of them have been mentioned by others. What I have discovered is that when you do learn new skills in private practice both clinically and business wise, learning is only the first step. It is about practicing these skills continually that creates excellence, confidence, and success. This is something that I struggle with and need constant reminders.
Hi, Erik! Welcome to Private Practice from the Inside Out! You’re making such an important point! I., too, have taken great classes full of really important lessons and then, never practiced them. And, when the time came that the info could have been useful, it wasn’t because I was not prepared. I hadn’t done my part to integrate the new skills into my repertoire. What’s that saying . . . “Use it or lose it?” Thanks for the reminder!
I hope you’ll drop back in often to let us know how we can support you as you grow your practice, share what you know, and network with us, too!
Tamara-
Thanks so much for your blog and willingness to share. There are so many things that I wish I had known prior to going into private practice. My number 1 wish I knew was I should have started building my personal brand prior to private practice.
Hi, Lacrecia! Welcome to Private Practice from the Inside Out! It’s great to have you here!
I wish I had known that, too! I tell those still in graduate school that NOW is the time to build your professional network and your brand, too. It doesn’t take extra work in graduate school to do that. It just takes vision, intention, and a willingness to plan ahead!
Thanks for a great reminder to every therapist-to-be out there! Hopefully they are reading this, too.
Seven Things I Wish I Had Known Before Going Into Private Practice:
1. Building a practice is a process much like therapy. It takes time and commitment.
2. You’ll spend as much time working on your practice as you do in it.
3. Having a niche is crucial.
4. Take risks and put yourself out there via social media and other public platforms.
5. Schedule vacations and days off for self-care.
6. The value of building a networking and referral base.
7. A goal without a timeline is only a dream.
I think a big challenge I struggle with is courage to try new things and not be afraid to take outside the box so you don’t get in a rut
Oh, Pam! I could claim every one of yours! The two that I really really needed to know (and didn’t, of course) are the ones about working in the business vs. working on the business and also “A goal without a timeline is only a dream.”
Can you say “clueless?” I swear I really was! If I hadn’t had some amazing mentors along the way, I would have been one of the many that threw in the towel and gave up the opportunity to change the world one client, one couple, one group at a time. So glad I had a lot of help along the way in figuring it out!
I’m in the process of closing my St. Louis, MO practice as my husband’s employer has transferred him to Dallas, TX. I will be starting the private practice journey all over again. Knowing what I know now will be helpful to me as I begin this second chapter of my therapy career. It feels a little overwhelming but I’m also confident I will be able to do it again.
Oh, my goodness, Pam! I’m so excited for you! And, by the way, I’ll be attending some of your trainings there because the Dallas-Fort Worth area is home for me. I moved from there in 2002 (to Colorado) and still have many connections there. Let me know if I can help you make introductions, get settled, etc. I know we’ll have an opportunity to meet once you get there. When do you move there?
The movers will have our things delivered to our new home by May 24. I would welcome an opportunity to meet you in person and will get in touch with you regarding making connections.
Excellent! Looking forward to it!
I am newbie, but I just want to tell you all how awesome you are for sharing your knowledge and tips! All of this information is super helpful. I took a private practice workshop with Brenda Bomgardner in Denver while I was still in school and it helped me so much. I would say the niche part is the most important because really, how can we encourage others to live authentically when we aren’t doing the same? I’m a musician and was worried I’d somehow have to change and stop performing in rock bands when I became a therapist. Now I know I can be my wacky artsy self while I help other artists! I’m back in my hometown of Baltimore and have started coaching. I take the MFT test this month to get licensed – I can’t wait to start providing even more help to my community!
Thank you so much for your advice, everyone!
Lauren, welcome to Private Practice from the Inside Out! Brenda and I are friends and I’m a fan of hers, too! So glad you found each other!
I so appreciate your talking about having a niche. It’s such an easy way to give a therapist a leg up in growing a practice.
I also can speak to that feeling that there were parts of me that I needed to hide or change. Now I know that those very parts – those very human and sometimes fallable parts of me (and you) – are the very parts that set me (and you) apart and draw our ideal clients to us! The more you lean into your wacky artsy self, Lauren, the more your true tribe will find you.
Good luck on your MFT exam! I look forward to following your career and hope you will drop back in often to chat!
Lauren, it it a pleasure to mingle with you here on Private Practice from the Inside Out. I have been a follower of Tamara since 2008/2009 and have gained a lot of knowledge and friendships here. You found your way yo a fabulous blog. Also, Tamara is a gracious host – thank you for the mututal fan comment Tamara.
I loved having the privedge to work with you, Laruen, as you discovered your authentic voice and unique niche – musician and artist turned coach and therapist. Also, your new and improved website is fabulous!
Thank you for the shout out. With Gratitude.
Such helpful information. I am just starting and like many others, I so appreciate this type of shared information. Clinicians prepare clients with good tools for life’s transformations…I consider this to be an avenue that does that for the helping professionals. THANK YOU so much for your advice.
Thank you, Lisa! That has made my week! I so appreciate the feedback!
Welcome to Private Practice from the Inside Out! How did you find out about my blog? And, where are you and what is it you do?
As a new therapist in private practice, this information is invaluable to me! Tamara, I have said it once (maybe twice) and I will say it again, you are a ninja!!! Your website has been monumental in learning the ropes!
Thanks, Cindy! I can never hear that often enough:) so thank you thank you – for following my blog and for taking the time to let me know that I’ve been helpful. That’s the goal!
Hi Tamara!
I really enjoy reading your blog and this particular post you wrote on some of the things you wish you knew, also helps. I was wondering if it would be possible to address -at some point in time- the issue of legalities in starting a private practice from one’s own residence. I would like to work from my home and have not been able to find much literature on therapy specific home practices.
All the best!
Hi, Raluca, and welcome to Private Practice from the Inside Out! Thank you for asking about best practices for offering psychotherapy in a home office. It’s been a while since I actually addressed this issue and your question is particularly timely with the projected increase in distance counseling.
Here is What the New York Times and Pinterest Say about Your Psychotherapy Office.
And, here are Things to Consider When Working from Home and 7 More Considerations for Working Out of Your Home.
Let me know if I’ve left anything out!
Those are some wonderful and very helpful resources, Tamara. Thank you!
You are so welcome, Raluca! I hope you’ll be back often to join in the conversations here. By the way – where are you and what is it you do?
I’m in Denver, Tamara. I enjoy working with the LGBTQ population and have been niche-ing in early trauma. I sometimes see children, families, and couples but my forte is, really, individual work. In my work with trauma, I combine various analytic and dynamic models and I sometimes use Eriksonian hypnosis, in which I am trained. I’m also getting ready to start a doctoral program in clinical psychology. That about sums it up 🙂
Raluca! You’re in my back door AND our training apparently follows the same vein. Happy to meet you and hope we have an opportunity to meet in person later this year!
Great to meet you too, Tamara. The world is small and getting smaller everyday, I’m sure we’ll meet 🙂
And while we’re at it, would a home based practice need to be registered (llc, etc)? I live in the state of Colorado.
Not necessarily. What form your business should take i.e sole proprietorship, limited liability corporation, etc. is a decision that should be made after consulting with your accountant and attorney. It’s not a one size fits all choice.
Are there any resources you are aware of for, maybe, comparing or helping one decide which form one’s business might take? I realize there are many answers depending on who’s asking and their particular situation, but sometimes it’s helpful narrowing down to just a few prior to seeing a lawyer/accountant, which can be quite costly.
Nope. I’m sorry, but that’s not how that decision needs to be made. You income and assets need to be weighed with the pros and cons of the different business structures. I will say that for most therapists (but not all), starting off as a sole proprietor seems to make sense. However, if you are the exception, you may want to move into a different structure fairly quickly and I’m in no way qualified to even broach that conversation with you.
Fair enough!
Raluca, I am chirping in on the topic. First, I want to make it clear I am not a CPA or attorney so I am not giving advice. I am only going to share that I choose to go with an LLC based on assets as a layer to protect my personal assessts. Hence, it is very important you talk with a qualitifed accountant and lawyer so you can make an informed decision that may have long term consequences.
Hi, Brenda. Thanks for “chirping in.” And, for those very same reasons i.e. “based on assets . . . to protect . . . ,” a different therapist will choose a different business structure.
Thank you for your input, Brenda. I think that’s what I will do!
The book, The Portable Lawyer for Mental Health Professionals, includes a section on practice models. I have recently moved from Missouri to Texas and am investigating what model will work best for me. The book has been helpful in helping me understand legal terminology but, as Tamara has pointed out, consulting an accountant and/or an attorney will be crucial.
Ahhhh, Pam! There you go touting my favorite lawyer’s book again! I’ve got to go pick up a more current copy! Mine is now over a decade old!
Would love an update on how your relocation is going:)
A new edition came out in 2013. It’s a resource I use often.
Regarding my relocation; I have submitted all the required paperwork to the TX board of professional counselors and am hoping they review my application and send me a license by the end of the month.
Then it’s off to find office space, meet with an attorney and an accountant and get all the legals aspects in order.
I will probably also need to do some shopping to pick up some new toys for my play therapy room.
Excellent! And, where are you planning to practice in DFW?
The Plano, Frisco, or Allen area.
I’m buying this book now, Pam. Thank you for weighing in and for the suggestion. What a great helpful community you have created here, Tamara. I’m glad to have found it 🙂