Topic 10: Private Practice {by 4/15}

Based on the reading due this week consider the following two discussion points: (1) Considering the advantages/disadvantages (Table 8.1), personal qualities (Table 8.2), and common mistakes (Table 8.3), what are your current thoughts about pursuing private practice? (2) What are your thoughts about running your private practice as a business?  Will this be easy or difficult for you? (3) How is running your counseling practice different from other helping professions (e.g., physician, dentist, physical therapist), if at all? (4) We have two great guest speakers joining us to talk about private practice!  Zachary Aggott and Jacleen Charbonneau.  Checkout out their private practice websites: https://www.zjacounseling.com/ ;  https://www.jacleen-charbonneaulmhc.com/ .  Please come to class with a few prepared questions.  Simply just share one of those questions here.

 

Your original post should be posted by 4/15.  Post your two replies no later than 4/17.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

45 Comments (+add yours?)

  1. Zacharie Taylor Duvarney
    Apr 09, 2021 @ 08:23:12

    1. Based on the Tables regarding private practice, what are your current thoughts on running as private practice?
    Running a private practice is something I have been mulling over for some time now. I have had the intent of operating a practice once I am licensed. After reviewing the readings, I have been left with much to consider. I will speak to each table individually.

    Regarding the advantages and disadvantages of practice, I ultimately find there to be more benefit in operating a private practice. Concerning advantages, I am particularly attracted to being my own boss, setting my own hours, and being able to conduct therapy in whichever way I choose (obviously while adhering to evidenced based practice). I have always considered myself a leader and someone who operates best when given as much freedom as possible. I have a distaste for corporate bureaucracy, which furthers my drive to be my own boss. Also, as someone who is dedicated to delivering CBT, I believe this would be more realistic if I were running my own practice. I would enjoy having the freedom to conduct therapy on my own terms without having to worry about the pressures of corporate interests.

    There are evidently disadvantages to running a practice. Of those outlined, the ones that concern me the most are the time demands inherent to running a business and the uncertainty in compensation. Speaking to the former, I am someone who enjoys having free time. I find my mental health is much better when I have time to pursue my hobbies and interests. As such, I don’t know if I would be comfortable working more than 45 hours per week. While it would be rewarding in some respects, I am not willing to sacrifice my talents and life for the sake of profit. Regarding the latter, I am someone who believes in a guaranteed salary. I think that I could hustle enough to maintain a caseload and make ends meet, but that would be very stressful and I’m not sure I’m willing to make that investment.

    Moving on to personal qualities, I am confident that I satisfy most of the character traits necessary for running a business. Speaking to the common mistakes inherent to running a practice, I would be most concerned about building a website. Web design is something I have considered doing as a side-hustle, so I suppose the operation of a practice would spur me to become proficient in web design.

    2. What are your thoughts on running private practice as a business? Will it be easy or difficult for you?
    While I consider myself a pragmatist and someone who understands the practices of a free market, I am not sure I could be entirely comfortable as a business owner. I would have to make difficult decisions such as terminating clients who are unable to pay for service. The idea of having to do this makes me feel uneasy as I am someone who entered this field in the interest of being a humanitarian. As such, it would be difficult for me to make the necessary moral sacrifices to preserve my profit margins. As aforementioned, I am also reluctant to sacrifice my personal life for the sake of running a business which also limits my ability to be a business owner.

    3. How is running a counseling practice different from other helping professions?
    I think the essential difference lies in service provision. In other helping professions, clients generally know what to expect when seeking service. Most people know what will happen when they visit a dentist, physical therapist, etc. However, therapeutic modalities are highly variable. Furthermore, two therapists providing the same therapy may differ greatly in their approach or the population they specialize in. Consequently, clients have more options in terms of pursuing therapy relative to other kinds of services. Therefore, as therapists, I believe we are held to a higher level of accountability in operating a practice. Our clients could easily seek a new therapist or disagree with our approach, whereas there is not so much room for disagreement when seeking service from another type of professional (e.g., physician). Thus, in order to run a successful practice, we need to hold ourselves to a higher standard compared to other professionals.

    Reply

    • Melissa Pope
      Apr 10, 2021 @ 16:06:56

      Hello Zach,

      There are so many different aspects to consider when opening up your own practice. I can definitely “feel your pain”, however as I mentioned to Kara, the only things you will regret in life are the chances you did not take. You very well could open up a practice and find that 40 years later you are still at it, or you might find that after 5 or 10 years, it is just too much, and you seek a different route. No matter what happens, at least you tried it. I think that it is hard for “helping professions” especially counselors to run their practice as a business. With that being said, stepping out of your comfort zone, only helps you grow, and how lucky your clients will be to have a humanistic counselor to “break” any negative news to them, instead of one whom is heartless and only in it for profit.
      I have no idea the time sacrifice and energy that is needed for your own practice, but I can speak to the fact that with the business I have now, every moment of my energy is worth it, because I am doing it for me. In its own way, building your own practice could be a form of self-care. Also, if you set your own schedule, you can definitely build in time to spend on your hobbies, or with loved ones. I have full faith in your ability to pursue this and be successful.

      Reply

  2. Kara Rene
    Apr 10, 2021 @ 14:46:34

    (1) I have thought about eventually opening a private practice for several years. Once Adam and I got married, we began dreaming of one day opening a private practice together. I think that the biggest factors that draw me to the idea of opening a private practice are getting to decide what kinds of populations and disorders I want to work with, and (of course) making better wages. However, I recognize that there are myriad risks that come with private practice that I will consider carefully when it comes time to consider whether to get started (ie. once I have my license and more experience): carrying my own liability, waxing and waning of income, and the risks associated with owning your own business.

    (2) I have conflicting thoughts about this. On one hand, I have an associate’s in business, which although isn’t much, provides me with some basic knowledge upon which to build a foundation. On the other hand, I struggle with advocating for myself, being assertive, and asking for what I need or deserve, so I know these things will be difficult for me when it comes to running my own business, and will be traits I will need to actively work on!

    (3) I think that one difference is the mentality so many of us in mental health carry- the “martyr helper” mentality that since we love to help, we will help regardless of the personal cost. Additionally, as counselors we see our clients more often and get to know them much more deeply than many other helping professions, and this comes with a heavier emotional load. We also carry a different kind of liability, as we share responsibility for our client’s mental health as well as physical health and privacy!

    (4) What resources did you find valuable in starting a private practice? How did you know you were ready?

    Reply

    • Melissa Pope
      Apr 10, 2021 @ 15:50:15

      Kara,

      As with anything in life, there are always doubts. I feel the same way you do when thinking of having my own practice. Its a dream, however with all the associated risks, it can be overwhelming. I say, if it something that you want, then go for it and at least try. I believe in Peter Pan, it states “what if I fall?”, and the reply is “oh my darling, but what if you fly?” You will only regret in life the chances you did not take. You may have weaknesses or shortcomings that need to be worked on, but we all do- and “weakness” or mistakes can be positive, if we look at them as an opportunity to grow and be more full. Keep your eye on the prize, and keep plugging along, I am certain you will get there and the view from the top will be marvelous.

      Reply

    • Katrina Piangerelli
      Apr 11, 2021 @ 17:35:02

      Kara,

      I share similar concerns that you do such as the liability, the potential of income fluctuating, and the risks associated with owning a business as well. Also like you, I am really focused on the advantages of having my own private practice. I am excited to choose what populations I would like to work with and the potential to make more money as well. I also like the idea of being my own boss as well and managing things myself.

      I don’t think I knew that you had an associate’s in business, but that’s great! I am sure you learned some useful things about business even if it is just the basics.

      I also thought similarly to you about the differences between mental health professionals and other helping professions such as doctors or dentists. We definitely see our clients more often and typically develop a deeper connection with them because of the nature of this work.

      Reply

    • Jess Costello
      Apr 12, 2021 @ 14:04:25

      Hi Kara,

      I totally agree that many mental health professionals have a martyr helper mentality but continuing to help without concern for our wellbeing can easily become detrimental. This is probably a big barrier for some people considering private practice and the associated financial concerns, as well as something we could probably all work on for our own self-care.

      Though the shift to private practice is definitely challenging for the reasons in Dr. V’s chapter and the ones you mentioned (carrying your own liability, waxing and waning income, etc.) I think your natural compassion and business skills will be assets in this journey!

      Reply

    • Monique Guillory
      Apr 15, 2021 @ 18:33:42

      Kara, I admire your self awareness when considering how private practice might be for you, specifically when advocating for yourself. It seems as clinicians we often focus whole heartedly on meeting our clients needs and can easily overlook what we need. This potential challenge seems even more evident in the scope of running a private practice.

      Reply

  3. Melissa Pope
    Apr 10, 2021 @ 14:52:41

    (1) Considering the advantages/disadvantages (Table 8.1), personal qualities (Table 8.2), and common mistakes what are your current thoughts about pursuing private practice?
    My thoughts are: that private practice has my name written all over it. This is something that I always wanted to do, and I can not wait to have enough professional experience to embark on this journey. If someone were to have shown me both table 8.1 and 8.2 ten years ago I will honestly admit that some of the disadvantages would have intimidated me. However, now that I have successfully started and continued to run my own business since 2014, a good portion of the “scary” things have completely dissipated. The other table, lists personal qualities. My personal thoughts are that you either have the first 5 qualities or you do not. If you do not have them, most likely, you are not one who would even want to pursue having a private practice. All of the other qualities are ones that can be learned, and well groomed, with help and time.

    (2) What are your thoughts about running your private practice as a business?
    a. I believe that it is essential for any person who embarks on opening a private practice to run it as a business from the get-go. Although it may be hard mentally to do this, especially considering that you are in a “helping” profession; running your practice as a business enables you to protect yourself and your clients. It sets good boundaries, rules/regulations/procedures, not to mention allowing others to take you seriously. Personally, running a private practice will relatively easy for me, only because of my existing experiences. I am certain there will be many “bumps” to overcome, but they are good “bumps” because this practice will be mine. The lessons learned will be worth every hardship, and morsel of my energy.

    (3) How is running your counseling practice different from other helping professions (e.g., physician, dentist, physical therapist), if at all?
    a. The major distinguishing factor that I can think of, between private counseling practice and that of a physician or dentist, is the subjective experience of our clientele. With “medical” practice, the client has a issue that can be diagnosed, has a more defined cause and effect, and more likely than not, clearly treated. Counseling on the other hand, cause and effect is not clear.
    (4) Question for Zach: how many websites did you research to design your site?
    (5) Question for Jacleen: are you a board certified Telemental Health provider? What were the steps you took to get tele-therapy up and running for your practice?

    Reply

    • Adam Rene
      Apr 11, 2021 @ 15:16:08

      Melissa, it’s nice to hear your confidence and enthusiasm about private practice! I agree that running it as a business from the start is a great way to set and maintain good standards – it’s like with the therapeutic relationship, starting with a plan and being firm bodes well for future boundaries in treatment.

      Reply

    • Zacharie Taylor Duvarney
      Apr 14, 2021 @ 12:21:32

      Melissa,

      I appreciate you providing the perspective of someone who has already ventured into the world of entrepreneurship. I can identify with the statement you made at the start of your post: I feel intimidated by some of the qualities I will need to exhibit in order to effectively run a business. Thus, I appreciate the encouragement and personal anecdotes you bring to the table.

      All in all, I am hoping to learn skills and build the same kid of confidence you have in terms of running a profitable operation.

      Reply

    • Kara Rene
      Apr 14, 2021 @ 15:56:21

      Melissa,

      I love that you say “private practice has my name written all over it”- because it’s so true! If I have learned anything about you, it’s that if you want it, nothing will stand in your way. Between that determination and passion, your clinical skills, and your business skills, I believe you are well-prepared!

      I appreciated your question for Jacleen about getting up and running for telehealth services!

      Reply

  4. Adam Rene
    Apr 11, 2021 @ 15:09:26

    1. My initial thoughts regarding advantages/disadvantages is that there are more disadvantages than advantages, quantitively. The thought of the overhead costs, the responsibility, and the personal sacrifices like working alone or having to put in too many hours is overwhelming & disheartening. But, the advantages hold more qualitative value. Working private practice allows true autonomy for my therapeutic style, my office space, the clients I take on, and gives me incentive to get really involved in the community I’m working in.
    As the Chapter discusses, I see many of these qualities in myself but also several that I have little experience with or have some increased anxiety/stress around. Particuarly the business-side of the things, like most of us I imagine, is one that seems the most intimidating. But the good news is that learning this side of private practice is something I can learn – I can surround myself with those whom are successful in this venture and learn from them. The internet has a wealth of resources! And as my Dad always says ‘you are no less skilled than an expert in a certain area. The biggest advantage and difference they have is TIME and EXPERIENCE.’
    With regard to common mistakes, one that stood out to me was not diving into private practice full-time. That is not one that had explicitly occurred to me but makes a lot of sense when you think about it. That, to me, is a comfort in that I don’t need to up and quit my paying job to go private practice but rather slowly build the business and the clientele so that I walk into that season of my life with confidence and more assurance than the alternative.

    2. Running my own private practice as a business will definitely come with some difficulties. I am definitely someone who is not as comfortable with the business-side of the things – I am definitely more sensitive, more easy-going, and willing to let things go or slide in favor of saving face or ‘doing right’ by someone. But, through my own experiences and my training at Assumption I feel that I have the skills and the knowledge to admit in the areas where I am lacking and then seek out help or assistance, so that I don’t have to be overwhelmed by the business-side of things.

    3. I would imagine there are much more similiarities than differences. Both businesses need to do marketing, they need to create a base of clients, they need to be involved in their community, they need a steady flow of cash to stay afloat, etc. However, I would imagine the cost of starting up a private counseling practice would be less than a dentist or a physician with regard to access to certain machinery/technology (X-rays, specialized dental procedure chairs, etc.).

    4.
    To Zach, how has the ‘I’m a therapist for people who hate therapy’ worked for you? What about your style fits that statement?
    To Jacleen, my company (CHL) just started taking on Blue Cross clients and I’ve been told it’s a bit of a hassle. Has that been your experience? How does a difficult MCO affect your private practice?

    Reply

    • Katrina Piangerelli
      Apr 11, 2021 @ 17:06:23

      Adam,

      I agree with you that there seems to be more qualitative value in the advantages of private practice. I also really liked this sentence from your post, “Working private practice allows true autonomy for my therapeutic style, my office space, the clients I take on, and gives me incentive to get really involved in the community I’m working in.” This is something I can really relate to because I would like those freedoms private practice has to offer. I also said something very similar about needing to be honest with myself about what I will and will not need help with.

      I didn’t consider the fact that the other professions would need more in start up costs due to the equipment they would need. It makes sense, but I just hadn’t really thought of that.

      I am also curious about insurance and what the process of that would be like.

      Reply

    • Kara Rene
      Apr 14, 2021 @ 16:05:06

      Adam,

      I really like what you said about there being more disadvantages quantitively, but that the advantages carry more weight. It can be easy to become intimated by the number of “cons”, but you are right that it is valuable to focus on the comparative value of the “pros”! You also make a good point, it probably is far less expensive to start a private therapy practice than a medical practice!

      Reply

  5. Katrina Piangerelli
    Apr 11, 2021 @ 16:59:08

    1. Considering the advantages/disadvantages (Table 8.1), personal qualities (Table 8.2), and common mistakes (Table 8.3), what are your current thoughts about pursuing private practice?

    I think there are a lot of advantages to having your own private practice such as being your own boss, working wherever you want, flexibility, and setting your own fees. I also am concerned about a few things that may be disadvantages such as working a lot of overtime, working in an isolated environment, and making sure you have the appropriate insurance to protect your practice. It seems like overall there are a lot more advantages to opening a private practice, but you definitely should do some research and make sure you are prepared. I think if I were to open a private practice I would probably talk to some of my family members who currently have private practices of their own. I would also do a lot of research myself on this topic and make sure I am financially prepared. I would also probably make sure I have a solid amount of referrals and slowly make the transition to private practice.

    2. What are your thoughts about running your private practice as a business? Will this be easy or difficult for you?

    I think there would be some easier parts of having a private practice, but also some more difficult parts. I think that managing all of my records and making sure I am honest with myself about what I can and can’t do on my own. Something that comes to mind is managing taxes and possibly needing to ask someone I know about this. I think it would also be difficult to equate each session to how much income I am making any given week. Possibly having more pressure to do overtime, having evening hours, and having weekend hours. I also think there are some positives to having a private practice such as being my own boss and being able to run the private practice as I would like. I think making some decisions could be difficult on my own, but overall it is nice being able to just manage yourself and your hours.

    3. How is running your counseling practice different from other helping professions (e.g., physician, dentist, physical therapist), if at all?

    One thing that comes to mind is late or no show fees. I think many of us would probably find it kind of difficult to fee our clients if they are late or do not show up for an appointment. With this being our business and source of income it is also hard to not fee them as well. I think that this is a difficult subject for mental health professionals, but the other helping professionals, such as doctors or dentists, usually tend to have some sort of fee for missing an appointment. I also think we tend to build a different type of relationship with our clients as well. Typically, a doctor or dentist you only see once or a couple of times a year. We tend to see our clients weekly, bi-weekly, or maybe even monthly, but still pretty consistently.

    4. We have two great guest speakers joining us to talk about private practice! Zachary Aggott and Jacleen Charbonneau. Checkout out their private practice websites: https://www.zjacounseling.com/ ; https://www.jacleen-charbonneaulmhc.com/ . Please come to class with a few prepared questions. Simply just share one of those questions here.

    How did you decide you wanted to do private practice?
    Who did you consult, if anyone, when thinking about going into private practice?

    Reply

    • Kelsey Finnegan
      Apr 12, 2021 @ 13:31:50

      Hi Katrina,

      You make a good point that we see our clients much more often than other medical professionals, which is another major difference that I hadn’t really considered. Given the more personal nature of our relationship with clients this can make it more uncomfortable to charge for late/cancellation fees, but it is also an important aspect of setting appropriate boundaries with clients and advocating for ourselves.

      Reply

      • Kelsey Finnegan
        Apr 12, 2021 @ 13:32:35

        Hi Katrina,

        You make a good point that we see our clients much more often than other medical professionals, which is another major difference that I hadn’t really considered. Given the more personal nature of our relationship with clients this can make it more uncomfortable to charge for late/cancellation fees, but it is also an important aspect of setting appropriate boundaries with clients and advocating for ourselves.

        Reply

  6. Jess Costello
    Apr 12, 2021 @ 12:21:55

    1. I have definitely considered running my own private practice in the future for the greater autonomy in the ability to specialize, set my own hours and fees, etc. Despite those advantages, I also see the downsides in relative isolation, greater liability, and more responsibility both on the clinical and business levels. Since the idea of setting up and running my own business is a little overwhelming at the moment, I like the idea of potentially partnering with another counselor to share responsibility. Overall, I think going into private practice, despite the work involved, would be a great way to leave a deeper impact on the community and form meaningful relationships both with clients and broader referral networks.

    2. As I hinted at above, I am a little intimidated by the idea of starting a business, especially so early in my career. I have also considered starting several other endeavors on the side and at this point I am unsure if it would be too much to manage. There are considerable challenges to private practice, but the learning curve and adjustment period exist with any big life change and I think I have the skills needed to adjust and overcome the challenges.

    3. Running a counseling practice differs from other helping professions because of the deeply personal information shared in each session, the relative subjectivity (as opposed to a medical doctor who can *usually* diagnose a clear problem) of diagnosing and treating mental health conditions, and the collaborative nature that requires substantial input from the client both in and outside of sessions. Therapy seems more personal than the kinds of interactions between patients and practitioners in any of those other professions, and I could see how this creates conflict in private practice when you’re trying to protect your therapeutic relationship with the client while managing late fees or other business sides of the practice.

    4. What was the biggest challenge going into private practice?

    Reply

    • Kelsey Finnegan
      Apr 12, 2021 @ 13:21:48

      Hi Jess,

      I too have concerns about the isolation and liability aspects of running a private practice, so I also like the idea of partnering with another counselor or two to share the responsibilities.

      Reply

    • Taylor O'Rourke
      Apr 12, 2021 @ 15:25:24

      Hi Jess,

      I think you made a good point that it may be best to partner with another counselor or mental health professional and go in on starting a private practice together or starting a group practice. This way, you have another individual to bounce ideas off of and there is less overall independence. I think first getting involved in an established group private practice may be the best way to go so you can begin to learn some of the business techniques to then eventually go out on your own completely.

      Reply

  7. Kelsey Finnegan
    Apr 12, 2021 @ 13:14:28

    (1) I think the advantages of pursuing private practice far outweigh the disadvantages, and I believe I have many of the personal qualities that are beneficial for working in private practice. For example, I would consider myself generally self-motivated, independent (but also willing to ask for help), organized, and I already have some basic business skills. On the other hand, the personal qualities I would need to work on in order to be successful in private practice are time management and the willingness to be okay with making money for myself. I anticipate it may be difficult for me to charge a full rate/cancellation fees if I know a client is struggling financially, but it will be important to do so. Ideally, I would like to have a sliding scale or do pro bono work with some clients, but I will probably not be able to afford to do so right away.

    (2) Although running a private practice as a business will certainly come with its challenges, I believe the freedom and flexibility it offers will serve as motivation to overcome those challenges. Also, considering the challenges and restrictions mental health professionals face when working in other settings, the difficult aspects of running a private practice do not seem as bad in comparison. Both of my grandparents and parents are self-employed, so I have learned a good amount about what it takes to run your own business from them. I also have a couple of friends who have private practices in my hometown, so I can reach out to them for guidance as well.

    (3) Running a counseling practice is much different from other helping professions because, as stated in the chapter, your fee is oftentimes the only way to make money for your business. Also, it can be considerably more difficult to prove our services as “medically necessary” to managed care organizations than it is for a doctor, dentist, or physical therapist.

    (4) How did you decide what type of health/liability insurance to get? Do you know of any useful resources for exploring what options are out there?

    Reply

    • Jess Costello
      Apr 12, 2021 @ 13:50:55

      Hi Kelsey,

      I agree that the advantages of private practice outweigh the challenges or risks. It would also be hard for me to charge clients with whom I have a good relationship or who I know are struggling, but I think I would have to in order to keep the business running.

      You made a good point that it can be harder for mental health professionals to justify our services as medically necessary for reimbursement. Hopefully this will change as more people seek out therapy and mental health becomes just as important as physical health.

      Reply

    • Taylor O'Rourke
      Apr 12, 2021 @ 15:23:31

      Hi Kelsey,

      I definitely agree with you that the benefits of starting a private practice outweigh the disadvantages. I also think it is great that you already possess some basic business skills, so you definitely have the upper hand over those of us (like me) who have no business experience whatsoever! We share a similar concern; I know it would be difficult for me to keep charging fees to clients who are unemployed or struggling, however this is something that we would need to adjust to and manage how to deal with over time. I also think you asked our guest speakers a great question. I have noticed that many clinicians choose not to accept insurance and will instead offer Superbills if their clients need it. I wonder why this may be the case.

      Reply

  8. Taylor O'Rourke
    Apr 12, 2021 @ 15:20:20

    Considering the advantages and disadvantages of pursuing private practice, I do like that I would be the boss; I can dictate how I want things to be done, what my schedule will be like, and the clientele I choose to take on. There is greater flexibility in this way because my work environment can be what I want it to be and I can work with (or not work with) whatever clients I want. Also, if my practice goes well, I earn all the credit for myself which would be very rewarding. However, with being the boss comes more responsibility, so I would need to take care of scheduling, billing, etc. unless I hire others to take care of these types of things for me. Also, the paycheck would be less stable and unpredictable since income fluctuates with caseload. Considering the personal qualities needed for a successful private practice, I do believe I am highly self-motivated and good at problem-solving which are certainly needed in this business. I work very well independently and have no problem advocating for myself. Considering common mistakes, I do believe it would be difficult at first to treat my private practice as a business because this is nothing that I am familiar with. It may also be difficult to choose appropriate fees and have adequate marketing. Overall, I do hope to end up in private practice someday and believe that for me personally, the pros outweigh the cons.

    I think running my private practice as a business would be the most challenging aspect of it for me. I have no background in business and have never taken any courses in business throughout my time in higher education. I do believe that if this were ever a route I choose to go down, I would benefit from some kind of a business mentor, partner, or at least taking a few business courses to get a general idea of how running a business works. I think I would also higher individuals to help me with billing, for example, so that way I could continue focusing on my actual practice as the priority.

    I think running a counseling practice may be a bit different from other helping professions because the business owner is still so heavily involved in the actual practice. I think in a lot of other businesses, the business owner may be more behind-the-scenes rather than playing a primary role in the practice itself, as a lead clinician for example. However, I think overall every practice is generally run in the same way so I could benefit from speaking with any business owner to get tips and advice on running my own practice.

    My question is for Zachary; where and how did you receive training in cognitive restructuring for PTSD?

    Reply

    • Paul Avolese
      Apr 13, 2021 @ 10:25:43

      Hey Taylor,

      I agree that being the boss of my own business sounds very appealing. I consider myself an independent worker and making my own hours and schedule is something I prefer very much so in my work. I also agree that the fluctuating hours every week seems a little worrisome. Right now, I am wondering if I can specialize and build up my work stamina enough to take on 30-40 clients a week to help boost my minimum pay each week. Any additional pay could be a bonus I’d use for my business or personal life. Like I mentioned in my post, I am glad I have at least a couple of years to establish myself as a counselor before jumping in to private practice!

      Reply

    • Adam Rene
      Apr 13, 2021 @ 17:02:42

      Taylor, I agree with the majority of what you shared here – I had similar thoughts. Interestingly though, I really liked what you said about ‘getting all the credit if it business does well.’ For me that just really stood out to me because it’s true! That, for me, would majorly impact my motivation and confidence in owning the private practice and that I would literally get to reap what I sowed.

      Reply

  9. Paul Avolese
    Apr 13, 2021 @ 10:16:12

    (1) Considering the advantages/disadvantages (Table 8.1), personal qualities (Table 8.2), and common mistakes (Table 8.3), what are your current thoughts about pursuing private practice?

    After reading the chapter and viewing the tables, I am feeling somewhat relieved that I have to work at least a couple of years within an agency before pursuing private practice. I am somewhat confident in my ability to open up my own practice, but recognize there are still some skills and understandings I need to develop first. I consider myself to be very organized, fiscally responsible, and driven. Money management is something I have been practicing since I was little and I always forget that this is a real skill that can be the downfall for some people. Additionally, I have always been good at networking and marketing myself. I will admit, marketing myself is the last thing on my mind right now while I am still establishing my identity as a counselor and I plan on studying areas of private practice I feel less confident about as I develop my identity further. Understanding insurance versus fee for service expectations is another area I still want to become more proficient in as well. After reading the chapter and listening to other people talk about private practice, I think it will be a good career move for me to enter into private practice eventually. I also like the idea of specializing in treating certain populations and immersing myself in literature and communities that have similar specializations.

    In terms of running my private practice as a business, I still need to become more comfortable with having set fees and sticking to them. Making service accessible to individuals is something I am passionate about. My concern is that in having set fees, marginalized populations will not have access to my services. Becoming a therapist for only privileged individuals is something I want to avoid if possible. I am hoping in learning about private practice over the next couple of years, I can create a business model that is accessible for underserved populations.

    Honestly, I do not see much of a difference in the business model for counseling versus other professions. I think the biggest difference would be the work we do with clients. Working with individuals with mental health concerns requires recognition of different dimensions of liability as compared with other healthcare professionals. Additionally, mental health professionals are not regarded as highly as some other healthcare professionals. I think we tend to have more cancellations and that clients take appointments less seriously. This is only a theory, but I cannot imagine someone missing a doctor’s appointment if they are sick whereas some of my clients say they are too busy to make an appointment.

    For our speakers, I would be curious to hear about the populations they serve and if they find they can only serve clients of middle class and up backgrounds with their fees for service. Additionally, I would be curious to hear about caseloads and hours worked per week.

    Reply

    • Zacharie Taylor Duvarney
      Apr 14, 2021 @ 12:24:49

      Paul,

      You and I are similar in that we have been practicing fiscal responsibility from a young age. In our profession, we often don’t talk about things such as economics and investing, but like you, I believe this will be the “make or break” skillset for many of those seeking to run a private practice. While we may not have the experience or skillset for operating a business, we at least have the fiscal intelligence that puts us ahead of the pack.

      In short, as a profession, I think all counselors will benefit from learning how to save and invest money properly, especially within the context of private practice.

      Reply

  10. Paola Gutierrez
    Apr 14, 2021 @ 09:59:34

    1. Weighing the advantages and disadvantages, I’m on the fence about pursuing a private practice. I am a self-starter and work best autonomously (i.e., without a manager/supervisor breathing down my neck) and appreciate the significant pay increase that comes with setting my own fees. However, I might struggle with the uncertainty of income, and the extra pressure of managing the business side of things. I would want to perhaps start in a group practice and then re-consider private practice. As others have mentioned, I’d like to have more experience, knowledge, and skills before going into private practice, so I plan to work in community mental health settings for at least a few years post-licensure. I think this would also make me more competitive in a private practice environment. I do also worry about oversaturation of private practices as this option is more financially appealing than working in community mental health, and what this would mean for attracting a solid client base.

    2. I would first need to strengthen my business skills (perhaps take a basic business class). I think I would also use a service or hire someone to help with billing, taxes, and other business areas that I’m not as comfortable with. One of the reasons that I went into this profession was to help people who may not otherwise be able to afford quality mental healthcare, and my main struggle in establishing a private practice will be working through setting appropriate fees while still finding ways to increase access for those more economically disadvantaged.

    3. I think running a counseling private practice is different than a medical private or other types of private practices in the social perception of mental health. I assume that no-shows or cancellations in this field are more common/accepted than in other types of private practice. I could be wrong, though. I would definitely consider a late cancellation or no-show fee.

    4. How did you decide whether to accept insurance or only do private pay?

    Reply

    • Paul Avolese
      Apr 14, 2021 @ 17:18:56

      Hi Paola,

      It sounds like we have similar concerns in pursuing a private practice. I also want to help provide care for marginalized individuals with low access to care. I am curious if this is even possible with a private practice. I am wondering if more options to do this kind of work will be available once we are fully licensed. I remember when researching jobs for this class, I found some salaried positions that focus on serving the communities we both seem to want to serve. Part of me would rather stick with an agency if I could serve marginalized populations and still make great money.

      Reply

    • Anthony Mastrocola
      Apr 15, 2021 @ 11:30:49

      Hi Paola,

      I think I share a similar expectation in first looking to join a group practice before private practice. I believe this can be a great opportunity to learn the business side of a private practice while also forming connections with colleagues.

      Reply

    • Ashley Foster
      Apr 17, 2021 @ 17:51:50

      Hi Paola,
      I agree that running a risk with private practice can bring some hesitation. I think looking at private practice can bring on more anxiety as many there is more failure reported in “owning a business” than not. When looking at private practice as a supplemental income at first and easy our way into it we are more likely to succeed and build up our case loads.

      Reply

  11. Ashley Foster
    Apr 14, 2021 @ 13:52:30

    1. While looking at private practice and the areas of this week’s reading, there is much to consider. For myself there are many pros and cons I identify when examining private practice. For pros, I like the idea of being my own boss, making my own schedule, and choosing how I want to run the practice. On the other hand, I worry about the uncertain income, no benefits associated with private practice, and the risk of failing by not staying a float. Some of these items I know can be supplemented with additional work and research as well as adjusting to the standard work model we have known. I also know most of these items are anxious thoughts and the success of overcoming some these pros and cons are associated with personal qualities for success. Some key qualities I need to focus on is self-confidence/ self-efficacy, self-motivations, utilizing adaptive coping and advocating for myself when I may need help. I think these qualities are key in dealing with the challenges that are to come with owning my own business. Some mistakes I can avoid in also aiding in my success is to not jump in as fast as I possibly can at full speed. I tend to rush things and get put all my eggs in one basket, this is one trait that could lead to disaster. I also tend to overload myself, so being mindful of time for self-care will be vital.

    2. When it comes to running private practice, you have to look at it as a business. Although we are providing counseling services to individuals, owning and running a practice has the same traits, challenges, and financial concerns that running any other business holds. There are the easy characteristics like how you vision your practice to be and look like but then there are things like how are you going to finance and budget all of it out as well as keeping yourself a float. I think running a private practice is going to be a challenge, but with much preparation, openness and motivation, I also think it can be a great opportunity to grow and be able to provide counseling to clients the way we intend sessions to be.

    3. Running a counseling private practice differs from many other fields of study. An example of this is dentistry or primary care. In both areas, clients/patients come yearly for routine check-ups or when they need to be seen (e.g. when they are sick or in pain). Although in counseling we have different stages of clients such as those who may be in the maintenance phase of therapy, we run more like physical therapist. We have clients/patients that come when something has occurred that has brought on distress or disruption to their lives and receive treatment for a period of time with tools to work on while outside of session. When the client/patient has reach a point of stability, treatment is terminated unlike dentistry or primary care.

    4. For our guest: What has been the must notable challenge and success you have had running a private practice? What are some key tips or advice you would give to us who may want to go into private practice?

    Reply

  12. Olivia L Corfey
    Apr 14, 2021 @ 20:42:12

    1. I intend on entering the private practice field after I receive my license. My current thoughts are that although there are many advantages to private practice, this is an enormous responsibility. Working at an agency, or from my experience a hospital, there are multiple protective layers. If we receive a complaint, we reach out to our crisis manager. When we are in private practice, we are the crisis managers, were are the “head honchos”, we also have everything to lose. This is the most anxiety provoking thought.

    2. Running a private practice as a business will be a difficult task. I did not take business classes and this is not something we typically discuss in school. When I speak to people who have entered private practice I typically get a similar response “It’s trial and error, they don’t teach you this stuff in school.”

    3. The biggest difference I can think of is the subjective nature of private practice. Many people have different opinions about what therapy “should” look like. Working with everyone’s different expectations of what their version of treatment looks like is not something other providers often have to think about (or care about). Another difference is the level of accountability is higher in this field. Individuals as we know are quite complicated. However, if an individual breaks a bone, tooth, or sprains their ankle, there are straight forward ways to go about helping this individual without even knowing their names. No real relationship is needed. In this field, we are responsible for fostering this relationship and working with the individual to help lower their distress and take into account their complexities while doing so.

    4.How do you logistically go about managing your benefits, insurances and protecting yourself from malpractice issues?

    Reply

    • Anthony Mastrocola
      Apr 15, 2021 @ 11:28:51

      Hi Olivia,

      You make a great point about responsibility in the first paragraph. We certainly are the crisis managers in a sense when there is a crisis, and I’m sure it can be challenging to determine the most appropriate form of action during a challenging dilemma.

      Reply

    • Bianca Thomas
      Apr 15, 2021 @ 15:27:15

      Olivia, I absolutely agree with you that it is safer working for another agency, and the thought of opening up your own place provides so many more opportunities to lose; but I also love this fact because it really requires you to work that much harder and smarter in order to make it! The businesses that last are the ones who don’t quit! And this field really primes us for that.

      Reply

    • Mariah Fraser
      Apr 15, 2021 @ 20:19:58

      Hi Olivia,

      I think you make a great point about the weight of responsibility that goes into starting a private practice, especially when it comes to the risk of liability. I think being the person who receives the complaints as well as managing the complaints would be a lot of responsibility in addition to running a business and conducting therapy.

      Reply

  13. Anthony Mastrocola
    Apr 15, 2021 @ 11:27:05

    (1) Considering the advantages/disadvantages (table 8.1), personal qualities (Table 8.2), and common mistakes (Table 8.3), what are your current thoughts about pursuing private practice?

    After reading the book chapter and reviewing the three tables, I’m actually getting really excited about pursuing private practice. I’m getting excited, because I view private practice as a new challenge other than that of conducting therapy. I believe that after I spend years building up a professional reputation, growing a network of clients and colleagues, and mastering this craft, I will benefit from the challenge of starting a business. I would like to learn how to develop a business to function optimally. I believe one of my strongest skills is an ability to remain calm and make rational decisions, which I believe would be invaluable in starting a business.
    Starting at the bottom as a general outpatient clinician is difficult. As I’m preparing to begin, I know that the majority of the hourly reimbursement is going to admin. and I will end up spending more time on paperwork without reimbursement. I am eager to develop enough as a professional to eventually take that next step to benefit from my own ability as a clinician. I am also very much ok with working to make a profit. I agree with the reasoning within the chapter that businesses have expenses and it’s ok to work beyond living comfortably.

    (2) What are your thoughts about running your private practice as a business? Will this be easy or difficult for you?

    I’m excited about the opportunity to run a private practice as a business. I am eager to learn about business practices. I believe I am somewhat of a quick learner, so I would like to challenge myself in developing and sustaining a business. I do not think it will be difficult to work for a profit, because at the end of the day therapy is a service provided. I do think there will be many challenges, but I am looking forward to problem solving and establishing a practice that can be very successful.

    (3) How is running your counseling practice different from other helping professions, if at all?

    I think that running a counseling practice is different in multiple ways. First, there seems to be a systemic notion in this field that the service of counseling is not meant to be profitable. I have trouble with this idea, because oftentimes agencies make a lot of profit, but it stays at the top instead of being spread out proportionately to the counselors. Also, in comparison to physicians and dentists, insurance does not pay enough for therapeutic services. Therefore, running a counseling practice similar to other helping professions may receive pushback, but should not be viewed as controversial.

    (4) Can you describe your experience in defining a specific specialization and how you sought to match your specialty to a market demand.

    Reply

    • Bianca Thomas
      Apr 15, 2021 @ 15:24:10

      Anthony, I think its awesome that after reading the chapter you are excited about pursuing private practice! Learning about business practices, from my experience, really isn’t that hard as long as you have people in your corner who have more knowledge about it than you, and are willing to help you. But there are countless books out there and videos on how to do it! I think our field also really helps up with the problem-solving component of dealing with challenges, which is beneficial and most other professions can’t really say the same.

      Reply

  14. Bianca Thomas
    Apr 15, 2021 @ 15:20:05

    (1) Considering the advantages/disadvantages (Table 8.1), personal qualities (Table 8.2), and common mistakes (Table 8.3), what are your current thoughts about pursuing private practice?

    In all honesty, none of these have changed my thoughts about pursuing private practice; it honestly excited me even ore due to the fact that I truly believe I have many of the skills necessary to do this, as well as so many people in my life who are successful entrepreneurs and business owners who can help me along the way with any mistakes or challenges that come up, and will help me in creating the business I intend to create.

    (2) What are your thoughts about running your private practice as a business? Will this be easy or difficult for you?

    I believe this will be easy for me due to the fact that I have already been studying business for a year and have invested money and time into a business coach who already owns his own successful business. I know there will be difficulties and challenges along the way, but that excites me, it does not scare me.

    (3) How is running your counseling practice different from other helping professions (e.g., physician, dentist, physical therapist), if at all?

    I don’t think owning a private counseling practice is that much different from other helping professions opening their own businesses. The differences would be in WHAT they do but the business aspect of it would be the same.

    Reply

    • Monique Guillory
      Apr 15, 2021 @ 18:27:59

      Bianca,

      I really like how you mentioned the fact that you collaborate with a business coach! it seems essential to have a strong, knowledgeable support network in any business endeavor to be successful. Utilizing resources effectively is an excellent strategy.

      Reply

    • Mariah Fraser
      Apr 15, 2021 @ 20:20:18

      Hi Bianca,

      I think it’s really cool that you have been studying business for a while and actually have a business coach! I would be interested about learning the things that you’ve learned along the way that your business coach has passed along to you!

      Reply

  15. Monique Guillory
    Apr 15, 2021 @ 18:25:17

    I think there is definitely a lot of additional legwork and knowledge to be gained about establishing and running a business that I would need to acquire before venturing off into the private practice world. I have always been interested in private practice, but I definitely plan to gain ample clinical experience within an agency before truly considering private practice. Working in an agency that aligns with my own professional values and procedural practices would provide great insight into the type of private practice I might want to develop. I also know that I am very team-oriented and I would aim to be in partnership with a private practice group of multidisciplinary approaches to human welfare.

    Running a business increases workload, stress, liability, and responsibility, in addition to the stress and workload, and liabilities that come with just being a practicing clinician. I think that establishing a solid foundation of experience, knowledge, and goal-setting is essential to lay out before even considering private practice. Not just in financial literacy, but also business strategies, marketing tools/forums, and strategic planning around work life balance. Knowing what you want to achieve and how to measure those achievements is really important. There seems to be additional risks involved with beginning a private practice, but with the right aptitudes and qualities it can be a very rewarding experience and business career.

    There definitely are different challenges to anticipate that may not be as common among other clinically driven professions such as a dentist, doctor, etc.. Depending on your client base, or the severity of mental health needs of your clients, you might experience greater liability and unexpected crisis’s. You also risk losing money with no shows, taking vacations, or having to cover extensive overhead costs. This goes back to the importance of structuring a well thought out business plan with goals, marketing strategies, clientele, needed support systems, and financial security.

    Reply

  16. Mariah Fraser
    Apr 15, 2021 @ 19:01:15

    I think for me at this point, there seem to be more disadvantages than advantages, in the sense of how scary it is to think of all of the ways I could be sued by my clients! I wouldn’t know how to run a business, so I think not only would consultation be a must, but also some basic business courses because I know nothing about it. It also sounds like opening a private practice could be a money pit if you’re not ready for it financially. I would need to be established in the field with confidence that it wouldn’t be just a failed business attempt. Knowing that if and when anything goes wrong, that it’s on me, is a very unsettling thought. I do like the idea of flexibility in my schedule and being my own boss, but the instability of income is frightening as well. Unpredictable things happen (e.g. COVID) that can really put a business in the ground, especially when we’re not prepared to accommodate (e.g. adjusting to telehealth). I do possess some important qualities such as being motivated and eager to solve problems. But I do at times struggle with self-advocating.

    The lack of a background in running a business would be the most challenging adjustment for me. I would need to educate myself or consult with someone who has the experience of running a business. I also would need to learn to be more assertive if I were to become anyone’s higher-up. I would need to look to hire people to assist me with various aspects of the private practice.

    The differences is the level of vulnerability that we ask of clients; typically you don’t share your demons with your dentist, or look to them for tool to assist in effective emotion regulation. We expect a lot from clients, to get personal with us, to keep an open mind and allow us to be a support that maybe they’ve never had in their lives before. We have a completely different relationship with our clientele than other professionals do.

    How did you know when you were financially ‘ready’ to start a private practice?

    Reply

    • Ashley Foster
      Apr 17, 2021 @ 17:59:04

      Hey Mariah,
      I can agree the lack of exposure to the business world will be one of the biggest hurdles of starting and being successful in private practice. For myself, I am going to start with a group practice to learn the business before I jump in independently.

      Reply

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Adam M. Volungis, PhD, LMHC

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