8 Steps to Launching or Relaunching a Psychotherapy Practice

In this guest post, Miranda Palmer LMFT and Kelly Higdon share eight ways to thrive in the current private practice climate. The process of building a successful private practice has changed considerably over the last twenty years. Most therapists we speak with who have been in practice for a few decades started by getting their credentials from an insurance companies. Reimbursement rates were relatively high for the cost of living from the 80s into the early 90s. Things flowed. Maybe they had a listing in the phone book, but back then there was no need for websites, Facebook pages, or Twitter accounts!

Fast forward to now: the financial picture for therapists in private practice has drastically changed, as we are in a time of low or stagnate reimbursement rates combined with an increase in cost of doing business and living.

The old model is simply that, old. It doesn’t work for today, and thus we find experienced therapists with a full practice that isn’t profitable enough to prepare for retirement, and new therapists often feel lost when they ask their mentors for direction and get answers that don’t resonate with the current economy.

We want to simplify the steps required for launching and successfully running a private practice in 2014. Whether you are starting out fresh, have moved to a new city, or need to make some significant changes in your business foundation, these steps will help you get things on track!

1) Develop a clear vision of your life

We tell our clients to do this regularly. We help them reassess and ask them to be accountable for the choices they make that lead them toward or away from that vision becoming a reality. This is your road map. When you begin with a plan for your life, your business can be formed to support that plan. So before you come up with an awesome group therapy curriculum or some other great idea, write down a super clear vision for your work AND home life.

2) Take that vision and break it down into pieces

Having a simple vision, with no basis in reality, can be difficult. How much money do you need to make that vision come to life? What would it take for you to go home at that time each day? Are you preparing for quarterly taxes? Are you realistic about how many clients you can see regularly while avoiding burnout? Are you leaving time for networking and marketing your practice? Leaving time for going to trainings? For being sick? Are you leaving enough time to return client phone calls and be available for crisis situations?

This is where people can get stuck in magical math. If I see 20 clients at $100/hr, that is $2,000 per week for 50 weeks – that’s six figures! YET there are expenses, taxes, real life stuff that happens. Be honest with your capabilities and your needs. Also, be open to the idea of reaching your goals in different ways. You might discover that face-to-face sessions is only a part of the plan. Now go crunch numbers, write down the schedule, and look at the specific pieces that are needed to fully form your vision.

3) Develop a business plan based on your vision and those realistic pieces

Every therapist in private practice needs a written business plan. He/she must know exactly how the fee was developed, how many sliding or pro bono slots there are, how much money is put toward retirement, etc. There is also a bit of research to be done here. Surprised? Sure, people need mental health services, but who and where are they, and what are the holes in the market in your area? Have a clear idea of who you want serve and how you plan to serve them. Write it down; be accountable to yourself.

4) Develop a sustainable plan to let your community know who you are

Notice I didn’t say develop a sustainable plan to let people know your business exists. People decide to work with therapists they know, like, and trust. Being authentic in how you present your private practice to the public doesn’t have to mean complete self-disclosure. Maintain professional boundaries, but don’t be afraid to let your personality shine!

The beauty of our current world is that people can advocate for themselves by choosing a provider who they believe is prepared to help them heal. If a potential client doesn’t get a chance to hear your “voice” and how you practice, how can he/she determine if you are a good fit? How hard is it for you to choose a therapist for yourself? Can you imagine how much more difficult it would be without an advanced degree and a deep knowledge of psychological theory?  Make sure to clearly communicate what unique things you can offer as a therapist.

Be aware of your insecurities and how you demonstrate those to the world. Now is the time to believe in yourself and honestly take stock in what you bring to the table. It is not prideful to share your craft with others. It is necessary in order to build relationships and instill hope in members of your community.

5) Develop and maintain clear business boundaries

Your business is your service to your clients. You may think that the things you are doing on a daily basis are serving your clients, but you need to be honest with yourself. If your business is struggling, it will impact your clinical work. What would happen if your clients talked to one another? Do more assertive clients pay a different fee than passive clients? Do clients with poor money management skills pay less than a client who has better budgeting skills?

Stick to your plan. Go back, and if you start to waver, remember #1 – why you are doing this in the first place? What is the life you are seeking to create? Who are the clients you are seeking to transform? When you break those boundaries, you are holding yourself back from the dreams you have for yourself and from helping your community in a profound way.

6) Streamline your business processes

The best way to do great clinical work is to free yourself up to do great clinical work. Whether this means transitioning to a paperless office to reduce late cancellations or no shows and decrease unpaid balances, or outsourcing your insurance billing so you never have to sit on hold with insurance companies again, find a way to make the business process work efficiently. If you feel like you can’t afford to streamline your process, you need to look at return on investment and/or whether you have set a fee that fully integrates business and overhead costs.

7) Streamline your marketing process

It takes more energy to start from a stopped position. The start of launching or re-launching your practice takes a LOT of energy, gusto, and enthusiasm. Know that it won’t always be as hard as it is in the beginning. Watch what works for growing your practice most effortlessly, and make a way to continue the bare minimum even when you are full with clients to keep things flowing. Maybe that is blogging once a month, speaking a few times a year, or monthly lunch dates with new contacts in your area. If you don’t have time to do some minimal tasks to keep things moving, you need to reassess if you are being honest with yourself about the time it takes to run a business.

Your marketing must align with who you are and your core values. If you don’t want to write a blog, don’t. If you don’t want to speak, don’t. BUT, do something and analyze if it works. If it isn’t working, then tweak it until it works, or let it go and move on to other options. Just because your neighbor gets referrals from Psychology Today doesn’t mean that is what YOU should do. You must only do what is best for your business, not necessarily what is best for others.

8) Celebrate your accomplishments!

Be good to yourself; kind to yourself. There is a lot to learn when starting a private practice. Know that everyone has a learning curve, and seek out a supportive community. However, no matter how awesome your community is, you will be struggling to stay energized and enjoy private practice if you are being unkind to you. Start from the inside out! And don’t be afraid to celebrate all the great accomplishments you’ve made in your private practice.

Miranda Palmer is a Licensed Marriage Family Therapists who is passionate about teaching and empowering other clinical counselors to successfully run a private practice. Visit her site www.zynnyme.com to learn more. 

Kelly Higdon wants to make a difference by sharing her expertise to help clients and business owners reach their full potential. Check out her Business School Bootcamp to learn more.   

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Adventures In Private Practice: Trauma Specialist Leticia Reed, LCSW

Less than one year ago Leticia Reed, LCSW opened her private practice in Long Beach, CA. Find out what resources and tools have helped Ms. Reed muster the courage to open her own practice, what she's learned from clients, and how she manages her roles as "therapist" and "business owner".

Tell me about your private practice...

I opened Reed Behavioral Solution in March of 2012. My practice mission is: "Helping individuals, couples and families achieve hope, healing, wellness and freedom. Empowering my clients to leave better than they arrived is what drives me to provide the best and most effective services. I specialize in women's empowerment and trauma, although I provide a wide range of services to other populations in my practice. I also offer Christian counseling for those seeking spiritual connectedness as a means of coping and regaining a sense of purpose and hope.

Why did you decide to open a private practice?

I began my practice after leaving employment with the County of Los Angeles and feeling like individuals were being failed by the system as they were only treated as a number that became lost in a revolving door. I felt like opening my practice provided me with an opportunity to make a significant impact, one with real rehabilitation and healing.

Clients that therapists find to be the most “difficult” are sometimes the ones who can teach them the most. What have you learned from your toughest clients?

I agree that "difficult" clients provide the most meaningful learning experiences. Through my more challenging cases, I have learned the importance of patience, tolerance, unconditional positive regard as well as the real importance of "starting where the client is" to guide them towards healing. The technique- Motivational interviewing has been the principle that I have incorporated to achieve this while increasing motivation.

What’s your biggest pet peeve about private practice?

One of my biggest pet peeve would be the amount of documentation required as it takes away from my time spent in direct contact with my clients. However, it's necessary as it also provides me with a blueprint and framework that guides my treatment and goals.

How did you discover or develop your practice “niche”?

My niche sort of evolved as the majority of my clientele seeking services has been women with self-esteem and trauma related issues.

What resource (book, website, person) helped you the most when setting up your private practice?

The various resources that have aided me in starting my private practice has been the following: Nakeya Fields of Fields Family Counseling who offers a workshop geared towards assisting individuals starts their private practice, while providing lifelong networking and consultation with other group members. I also used and received a wealth of information from Ofer Zur Institute Practice Handbook for HIPAA friendly forms and regulations. My mentor Cynthia G. Langely, my prior clinical supervisor who has many years in the field serving in various positions, including on the CA BBS panel when the Oral examinations were required, has continued to provide me with a wealth of information and support. Lastly, The various Facebook groups I am currently in, including Julie Hanks’s Private Practice Facebook group have also increased my knowledge that has been instrumental in keeping me current in the field.

What has surprised you most about being in private practice?

The things that have surprised me the most about building a private practice has to be the amount of work it takes to stay afloat and monetary resources needed to build and maintain operation. Another surprise has to do with the number of people hurting and in search of HOPE, some of which are fellow colleagues.

Has your private practice helped you grow professionally?

My private has influenced my growth professionally in the sense that it has taught me the importance of being organized, detailed oriented, punctual, and the importance of networking/collaboration.

Has it helped you grow personally, too?

On a personal level it has made me to be more grateful and attuned to the world and my purpose in it, helping me to not take anything for granted.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?  

Self-care is extremely important to me. I love pampering myself, traveling and engaging in church activities, reading my bible and praying. I also make it a point to surround myself with positive people that are encouraging and uplifting.

How do you cope with the inevitable stressors involved with being your own boss?

I cope with the stressors of being my own boss by consulting with colleagues in practice and digging my heels in the sand and "just doing it". My tenacious spirit and optimistic personality as well as my strong Faith in God has assisted me in my success in this short amount of time I have been practice. Colleagues that know when I began have commented on my rapid success. I am a very blessed woman and I am looking forward to even more expansion in 2013 and beyond.

Find out more about Leticia Reed's private practice at www.reedbsolutions.com

10 Things I Accidentally Did Right In Building My Private Practice

As I reflecting back on 10  years in private practice I did a few things right, mostly by chance.

With a business license, professional license, and big dreams, I opened a private practice ten years ago. Having never taken a business, marketing, or management course, I have learned "on the job" how to be a small business owner. Hopefully, you can learn from what I accidentally did right and intentionally apply them as you build your private practice.

1) Start small, think big

At the time I opened the doors I was a solo practitioner. Those of you in solo practice know that means I was the receptionist, the billing manager, the webmaster, the marketing specialist...Being a "one woman show" for a few years not only taught me what it takes to run a practice, but also how to teach others what I had learned as the practice grew. My vision was to grow my practice into a group with several practitioners and over time, that has happened.

2) Grow slowly

I didn't know it then, but one of the main reasons new businesses fail is because they grow too quickly. As a mother of 3 children at the time, I was fine growing slowly so I could manage the multiple demands on my time. Turns out it was good for business too. Growing slowly allowed me to build a business without loans or going into debt.

3) Charge more than you think you're worth

From my first day in private practice I have always charged a higher fee than I felt I was worth. This forced me to deal with my own money issues, and to learn to value my own services and skills more highly. I came to understand the value of the perceived value of my services as clients assumed that I must be very skilled in order to charge at the high end of the scale for my location.

4) Think like a business owner

My family of origin tends to have an entrepreneurial mindset where self-employment, flexibility, and freedom are highly valued. This framework helped me to be able to think like a business owner and a therapist and to find an emotional place where those two roles weren't mutually exclusive. Although they are occasionally in conflict, I've found that that is a rare occasion. Thinking like a small business owner has helped me to set better therapeutic boundaries with clients as well.

5) Trust your gut

In all areas of practice, from office location, to logo design, to who to hire, to which practice software to purchase, after researching the best options I ultimately followed my intuition in making key decisions for my private practice. While the path hasn't been perfect, I can't think of one decision where I trusted my gut and regretted it.

6) Hire qualified people that you trust with your reputation

One of the scariest things in growing from a solo practitioner to a larger practice is hiring people who have the power to impact  your professional and business reputation. In addition to hiring very qualified staff, also hire people that you'd trust and train them how to present themselves in a way that builds your credibility.

7) Set strong boundaries with money

Whether it's following through with your office policies regarding collections, or saving for those dips in client numbers, I have tried to be consistent with money policies. This also applies when hiring employees. My tendency was to give away a little too much at first, because of my inexperience. I soon learned that there is a cost, emotionally and financially, to having employees, and that I deserve to get paid for management time and for holding all of the liability in the practice setting.

8) Create a home away from home

Creating a comfortable yet professional office space has helped me, and my clients, to feel welcomed and safe. I've found self-expression in my private office environment and decor helps foster a sense of safety and nurturing and creates a space where I feel at ease.

9) Integrate your passions into your practice

I have always integrated current interests and passions into my private practice. If there's a film that I really like, I'll use that with clients. More recently I've become a tech geek, so I've integrated technology into my private practice by launching an online therapy division, moving to electronic records, and building a social media following.

10) Take good care of you

Personal self care has always been high on my priority list. I've known that if my own needs were going to get met it was my job to make it happen. Whether it's scheduling exercise, bringing healthy food to work, making time for social events, or attending my own therapy, I am fiercely committed to making sure I am taking care of me. I think those habits have allowed me to energetically continue investing in my clients, my practice, and my employees without feeling burned out.

What things have you accidentally done right in building your practice? Please share so we can learn from each other!

Creating Your Perfect Work Week (part 1)

This guest post is written by Ashley Eder, LPC. Ashley is a counselor and supervisor who believes we each have the potential to create a more satisfying life. Located in Boulder, CO, she works with clients and therapists through curiosity, self-awareness, and acceptance in order to create lasting change.

A successful private practice is not just defined by how many clients you see or how much income you generate. One critical stream of non-monetary compensation is the satisfaction your practice brings you.

That’s right--as a business owner in an inherently flexible field, part of your “payment” is the freedom to create a work week that works for you.

Whether your workload is in its sweet spot or not is a personal measure; what feels nourishing and sustainable for another clinician might be either under-stimulating or exhausting for you given your temperament and the other responsibilities in your life.

Ask yourself the following questions to start creating your own ideal work week:

• Are you excited to go to work?
• Do you enjoy your clients?
• Can you maintain your personal relationships?
• Do you have time for self-care?
• Do you feel satisfied and complete at the end of the day?
• Are you resentment-free?
• Are you intellectually stimulated?
• Have you stopped doing the things you dread?

Yes, you really can expect to have a practice that is that satisfying. If you found yourself shaking your head “no” to some of the questions above, it’s time to re-evaluate how you spend your work week. Take time now to explore these questions in detail. Be honest. Where are you solid in your business satisfaction and where could you use more work? What would your life look like if you were able to answer “yes” to these questions? Can you be specific now, or will it take some soul-searching to figure that out?

Check back for part 2 of Creating Your Perfect Work Week for concrete suggestions on ways to build satisfaction with your business. My suggestions will help you narrow the gap between where you are now and where you would like to be. Expect to revisit these areas throughout your career in private practice, especially as you advance in your career and skills, experience personal life changes in relationships and parenting, and do your own work in personal therapy.

Visit Ashley Eder, LPC's practice website

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Getting 3 'Fs' In Private Practice Is A Good Thing!

My motivation for starting my private practice, Wasatch Family Therapy, was very clear. I wanted to create my ideal work environment and I knew that no one else could do that for me. I felt called to help people heal themselves and their relationships.  I knew that I wanted work with therapy clients who valued my services and time, and who were dedicated to working hard to improve their life. I wanted the flexibility to set my own schedule and take time off to be with my children and attend school and sporting events. I wanted to do paperwork that was relevant and helpful for treatment. I wanted to invite other clinicians into my professional space who were gifted therapists, genuine people, and who I enjoyed spending time with. I wanted to work as a social worker part-time and make a full-time income (a lofty goal in a profession where many work full-time and make a part-time income).

I know why I chose to go into private practice but I was curious if other therapists and counselors around the country had similar motivation opening private practice. I recently asked several therapists about their reasons for taking the leap into the business world of owning their own practices and noticed three common themes emerged. I call them the 3 "F"s of private practice: flexibility, freedom, financial opportunity.

1) Flexibility

Therapists who take the leap into private practice value flexibility in their work schedule to better balance work and family life, and to pursue other interests.  Dr. Mary Sidhwani, a psychotherapist in private practice since 2000 in Ellicott City, Maryland opened her practice so she could have the flexibility to care for her two young children. "I wanted to be able to balance both my professional and family life; to be able to spend as much time with my children as possible while they were young."  Social worker Diane Spear, LCSW-R of New York City said, "I had worked at an agency with wonderful colleagues, but private practice gave me the opportunity to set my own hours and fees."

Of his decision to open his own practice psychologist Dr. John Duffy says, "I wanted to go into private practice as I wanted control over my career: my schedule, niche, fees, client base, whether I accepted insurance, and so on. I also wanted to be able to write, consult, speak, and expand my practice, or take fewer clients, as I went along."

2) Freedom

Freedom to select a particular client population to work with and choose your own approach to treatment has drawn many therapists to open a practice. After agency work left her overworked, underpaid and burned out, Esther Kane, MSW of British Columbia chose to open a private practice because it allowed her to focus on her passion - women's issues. Kane says she loves the "autonomy and flexibility of not having to answer to anyone."

Spear says she appreciated being able to choose who she worked with and how she approached treatment. "I wanted to choose level of pathology I want to treat, choose the theoretical orientation and supervisor I'm most comfortable with, and set the environment as I prefer. In short, autonomy, autonomy, autonomy!"

3) Financial Opportunity

It's a risk to open your own practice, but when it grows, you are the one who benefits most from the financial growth. Private practitioners have the opportunity to grow their income in ways that are unlikely to happen when you work for someone else. New York City therapist Emma K. Viglucci, CFT, LMFT, CIT experienced the growth potential first-hand. Since opening Metropolitan Marriage & Family Therapy, PLLC she says, "I've grown the practice to the point where I had 10 clinicians working with me as part of our clinical team. My practice has become an Internship Placement Site for MFTs in training."

Financial need helped Lisa Gomez MA, PLC of Surprise, AZ transition from part-time to full-time private practice. After being laid off from a full-time staff position due to budget cuts Gomez says it was "the perfect opportunity to take the step of faith into full-time private practice. I love private practice because I can be as successful as I want or as flexible as I want."

What motivated you to start your private practice?

If you're thinking about venturing into private practice, what do you hope to gain?

photo credit: Leo Reynolds