Topic 10: Private Practice {by 7/14}

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 7/14.  Post your two replies no later than 7/16.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

18 Comments (+add yours?)

  1. Monica Teeven
    Jul 11, 2021 @ 14:21:11

    1. My biggest concern running a private practice is not having a steady income. I would have to do more research as to what would potentially be the low end of the salary range if I did open up a private practice. It causes me some anxiety not knowing how much I will make on a regular basis. If I ever did open up a private practice, I would want to do it with a few other mental health clinicians and split the rental fee for the office space. This is because I know the isolation will not be good for me if I do not have some form of coworkers. What I do love about potentially running a private practice is that I can create my own schedule, choose the location I want to work in, and choose what kind of clients and how many clients I will have on my caseload (to a certain degree). This is important to me because I think I would enjoy working with multiple populations (diversity in age and mental health issues) and not every mental health organization can provide that to clinicians.

    2. I have mixed feelings about running a private practice in that, at this moment, in my mental health professional career, I am not considering opening up my own private practice within the next 4 years. However, I can see myself eventually opening up a private practice further along in my career. If I have support from my loved ones, which I believe I will, I will be able to run my own private practice if that is what I really want. However, opening up a private practice is not my dream job or the dream work environment for me (aka it is not a deal breaker for me if I never do open up my own private practice).

    3. The main difference about running a counseling practice compared to other helping professions, such as a dentist or a physical therapist, is that there are more kinds of different counseling practices and different therapeutic orientations compared to the different ways a dentist can fill a cavity or do a root canal. So, in our helping profession, I believe there is a wider range of the kinds of services a counseling practice can provide a client compared to other helping professions. This, in my opinion, is a negative aspect. This is because there are some counseling practices who do not practice empirically based evidence treatment techniques and clients who are uneducated about empirical based evidence mental health treatments may receive mental health services from a counselor who will not provide them with the best treatment options for their issues.

    4. One question I have is that for Zach’s practice, I noticed Family Therapy sessions were $50 more than individual sessions. Is this the “norm” for providing individual versus family therapy sessions?

    Reply

    • Melanie Sergel
      Jul 14, 2021 @ 09:57:37

      Hi Monica, you discussed how your biggest concern about private practice is not having a steady income and I think that this is a reasonable concern and definitely something I would be worried about too as we want to make sure that we can make a living. When thinking about this further, it makes me also wonder about how we do not get vacation pay and how we may start to lean against taking time off. I also feel the same way as you do about not having coworkers and feeling some isolation. Right now, I cannot imagine going to work every day and not having coworkers to chat with and especially how I am used to working as a team with my coworkers. I do agree that there are some good advantages to having a private practice but at this time I feel that there are a lot of disadvantages I need to consider which seems like something you think about too. I like the question you have for the presenters as this is something I noticed and am wondering also.

      Reply

    • Madison Armstrong
      Jul 16, 2021 @ 14:17:21

      Hi Monica! I am also concerned about the loss of a steady income and initial investment a private practice might take to get up and running. Like you mentioned with looking up what the low end salary may be, I think it’s important that we do our research so we know what we can expect. Just being able to learn about private practice over the past week has been insightful about the advantages and disadvantages. If I ever were to open a private practice I think I would try to feel prepared and ready to take that step by making sure I learn as much as I can about clinical work and the business side of private practice.

      Reply

  2. Jenna Nikolopoulos
    Jul 12, 2021 @ 17:09:01

    1. I have mixed thoughts about pursuing private practice. One on hand, all the advantages look really good and enticing (e.g., being your own boss, schedule flexibility, setting your own vacation time, setting your own fees, etc.), but on the other hand, there are a lot of disadvantages that put me off from wanting to pursue private practice (e.g., working more than 40 hours, unsteady income, overhead expenses, needing good business skills, financial and emotional losses if it doesn’t work out, etc.). In looking at both the advantages and disadvantages, it seems like the disadvantages somewhat outweigh the advantages, depending upon how you look at it. I think a lot of people initially focus on the benefits of opening their own private practices, but forget about the work that goes on behind the scenes to achieve those benefits. Pursuing private practice can be difficult, especially if you don’t have the necessary skills to run one. In looking at the personal qualities for a successful private practice, I may possess some of those qualities, but when I think about the bigger picture, I honestly don’t know if I have what it takes to not only open a private practice, but also be able to run it successfully. Maybe I’ll feel differently further on into my career as I gain more experience in the field, but as of right now, I think I would rather work for a private practice than be the one to own the private practice.

    2. As touched upon in my previous answer, I am unsure about my capability to run my own private practice and in terms of running my private practice as a business, I know this will be difficult for me because I know nothing about running a business. As someone who solely has been studying in the social sciences, thinking about the business aspect of private practice seems very foreign to me because I wouldn’t even know where to begin in terms of paying bills or taxes, marketing, working with insurance agencies, etc. I currently have no business skills. I have people in my life that do know how to run a business and I know that if I wanted to open my own private practice, I would have the support from my family in helping me achieve what I want. However, as I mentioned above, I am not sure this is what I want. I think private practice is an end goal for a lot of clinicians because that’s kind of the moment when you feel like you’ve made it, but I think I’ll be able to have a fulfilling career even if I decide not to pursue a practice of my own. I won’t say that I’m never going to open my own private practice because things could change, and I may feel like I have acquired the business skills necessary in order to do so, but as of right now, running my own private practice as a business seems intimidating and difficult to do.

    3. In relation to other helping professions, running a counseling practice is different, mainly due to the fact that the counseling profession is more specialized. By specialized, I mean that the counseling practice could be geared towards certain populations or certain disorders (e.g., adolescents with eating disorders or adults with depression) whereas a profession like a dentist just focuses on working on individuals’ teeth. In terms of a profession like a physician, physicians can be specialized as they can concentrate on a certain area of medicine (e.g., cardiology, oncology, neurology), however, in terms of their treatments, there is usually a set treatment physicians follow depending upon the diagnosis, whereas in counseling, there are different interventions a clinician can choose from to treat the same disorder, it just depends upon what works for the individual. So, while physicians can see multiple individuals with different bacterial infections, they could easily just write them a prescription for antibiotics and send those individuals on their way. But with therapy, clinicians can’t do that because there isn’t a “one size fits all” treatment option. Treatment is individualized to the client and consists of interventions that work for him/her; and it is important to remember that what works for one client, might not work for the next client, even if they have the same diagnosis because there are other outside factors that can affect an individual’s diagnosis and treatment outcomes.

    4. How do you decide the amount of your fees? Is there a certain range that clinicians should stick to when setting their fees or is it based on one’s subjective opinion?

    Reply

    • Monica Teeven
      Jul 13, 2021 @ 14:58:27

      Hi Jenna! I think you and I have similar concerns about opening up our own private practice. The question that you came up with to ask the presenters for this week’s class made me question how I feel about potentially opening up a private practice that does not accept any form of health insurance. I know a clinician can make good money having their own private practice and having clients pay out of pocket, but excluding clients who are unable to afford paying for mental health sessions out of pocket does not settle well with me. I think part of the reason I would feel guilty is because when I interned at a private non-profit organization, my clients desperately needed additional mental health services and excluding individuals from receiving good mental health services due to their economic status, makes me uncomfortable.

      Reply

    • Melanie Sergel
      Jul 14, 2021 @ 09:50:06

      Hi Jenna! I feel the same way when it comes to thinking about opening a private practice. There are definitely a lot of advantages to why we should but like you said right now it feels like the disadvantages outweigh the advantages and we could feel this way right now possibly because we are so early in our career. I had also thought the same thing when looking at the personal qualities and how I only hold some of those currently, but as you mentioned this could change when we advance/gain experience in the field. Also, when looking at your question for the presenters this week made me also wonder if fees change after you get a good private practice business started and get new clients (so the fees for those that are currently in treatment would not change).

      Reply

  3. Robert Salvucci
    Jul 13, 2021 @ 10:43:13

    1. I have mixed feelings, having a private practice sounds mostly great to me once it is established, however the initial process sounds like it can be overwhelming and potentially demotivating. The flexibility, autonomy, and income boost sounds very appealing, however the potential lack of stability and inconsistency could be quite anxiety inducing. I’m confident however that, given the high demand for mental health services and my ability to network, I’d be able to develop consistent clientele base and other LMHC’s to work with. In an ideal situation, I’d like to open up a practice with a few other clinicians and be able to afford to hire someone to help with the secretarial/administrative work. I’m drawn to the idea of being entrepreneurial and marketing myself, there’s an excitement to that. The potential drawbacks seem worth the risk if I’m able to approach the situation wisely, and make sure that I save enough and have a financial, professional & emotional safety net if things don’t go well.

    2. Again, some mixed feelings of entering the business realm. Working as a mental health professional involves being in a position of power and working with people who are vulnerable. At some level, I’d like there to be relatively equal accessibility to effective care, regardless of socioeconomic status. I’d want to find some sort of system, whether it be a sliding scale or something of the sort to have an outlet to support more clients. However, I also don’t want to be taken advantage of and risk my financial security. Marketing is also an area that introduces a new dynamic that is different than working for an agency. There is some excitement in the idea of flexing my expertise and credentials, but at some level I’m not a fan of being income focused and trying to make myself look “better” than other professionals. Although, I think that it’s manageable to promote myself and/or my colleagues based on their own merit, and approach the business in a balanced way that is confident but humble, and can work to help others while also respecting our own financial stability.

    3. I imagine that the marketing element of running a private counseling practice differs a fair amount from that of a more medically based practice. Generally speaking, when a layperson is selecting a dentist or doctor, they aren’t considering a theoretical orientation or a particular approach to addressing a medical problem. There is less “hype” so to speak around medical procedures as compared to how pop psychology and psychotherapy is represented, so marketing a private practice lends more room to highlighting particular skills or approaches. As others have also mentioned, there is often more flexibility in how to treat a mental illness as opposed to a purely medical illness.

    4. I’m curious as to what the organizational process looks like when starting a private practice – Such as how Zachary and Jacleen kept track of all the moving parts involved and ensured that they covered all of the necessary bases to become successful.

    Reply

    • Monica Teeven
      Jul 13, 2021 @ 14:59:14

      Hi Bobby! When I was reading your blog post, you said that “The flexibility, autonomy, and income boost sounds very appealing…” and reading this reminded me of when my internship class professor (Dr. Brenda King), told the class that one thing about having your own private practice is the flexibility that you have, but also the ability to do other things such as teach a college course while having your own private practice. I am not sure if I would ever want to teach a college course, but having the flexibility to do other things with our degree besides providing counseling is extremely appealing to me. I think having the option of doing other things with my degree relieves my worries about me wanting to take a step back from counseling full-time if I ever begin to notice that I am experiencing burnout symptoms due to work and/or personal issues.

      Reply

    • Jenna Nikolopoulos
      Jul 13, 2021 @ 15:30:02

      Hi Bobby! I liked what you said about your ideal situation for opening a private. If I were to open a private practice, I would also like to do that with a few other clinicians and hire someone to help with the secretarial/administrative work. This way, the responsibilities of running a private practice would be split amongst the few clinicians as opposed to solely being placed upon us. And if we are able to hire someone for the administrative work, that is even more weight off our shoulders! I think by doing this, it would also make me feel better financially as I wouldn’t be solely responsible for financing the private practice and also make me feel better emotionally as now I would have the support of the other clinicians in the practice to lean on. Also, going into a practice with other people would allow us to combine our skills and expertise together where we could collaborate with one another and help each other in areas where some of us may be weaker and others may be stronger.

      Reply

    • Shelby Piekarczyk
      Jul 14, 2021 @ 07:39:33

      Hi Bobby!

      I really resonate where you say that when running your own private practice you’d really want to make sure that you are having an equivalent relationship with your clients. This also makes me very nervous when running my own private practice because I tend to be taken advantage of when helping people and I would need to learn to be a little more bold with clients in a private practice setting. Additionally, I think you’re right when you say in one way it’s nice to be able to flex our credentials and promote ourselves as mental health providers. But on the other hand, trying to “beat out” other professionals or make ourselves look better can be intimidating. Nice job!

      Reply

  4. Melanie Sergel
    Jul 13, 2021 @ 13:22:54

    1. When thinking about pursuing private practice, I have mixed thoughts, feelings, and concerns. One overall concern that I have is that you are responsible for a lot of things and have to make sure that they all get done. This is a concern for me because I wonder if there is enough time to do counseling and complete all the responsibilities. I know that you need to make sure everything is done on deadlines and I would worry that I would forget something and worry about staying organized enough to remember everything that needs to be completed. There is a great deal of advantages that do attract me to opening a private practice, such as,I would be my own boss, can work wherever I want, and have flexibility when I see my clients. I think it is helpful that we are provided information on mistakes that are often made by those who start a private practice. There are a lot of skills and preparation needed before starting a successful private practice and I worry that if I do start a private practice in the future that I may not be ready or have the skills needed which would lead me down a path of making a mistake. I think there are a lot of personal qualities needed to be successful in private practice and I know that I do not have all those skills right now, but I hope that over the years while working for an agency I can build these skills.

    2. Although it would years until I would open a private practice if I did, I also have worries about running my private practice as a business because I do not have any education or background in running a business. It is clear that it is important to run a private practice as a business to be successful, such as marketing. Luckily, my whole family went to school for business, and I know that they would be able to help me with learning how to run a business. However, if I did not have this support system, I think that this aspect to private practice would really put me off to even thinking about opening a private practice.

    3. I do think there are differences from running a counseling practice versus other helping professionals. First, like dentists, physicians, and physical therapists they are focusing on specific areas of treatment for the medical problems they treat, such as filling cavities. Whereas, in counseling practice professionals are providing therapy to individuals with a wide variety of mental health problems and treatment is going to differ among the clients. Another difference I think about populations being served. I know that it can be difficult for parents of adolescents and children to find openings in counseling practice, however, in other helping professions there is easier access for children and adolescents.

    4. Do you think that depending on the area where you setup your private practice, it can be more difficult to be cash only payment for services? What are some important considerations you have to make when building a clientele on cash only?

    Reply

    • Jenna Nikolopoulos
      Jul 13, 2021 @ 15:14:44

      Hi Mel! I totally agree with your concern about being responsible for everything when it comes to running a private practice. This is also a concern of mine because we would be the boss. We would be responsible for making sure the practice is running smoothly and making sure we are getting all of the things that need to get done, done. The thought of that is kind of intimidating since you would have to make sure that you are super organized and on top of everything you need to do. I feel like that could be hard, especially because we would also be managing a caseload of clients and would need to make sure we are taking the time to complete our progress notes and prepare for sessions.

      Reply

    • Shelby Piekarczyk
      Jul 14, 2021 @ 07:36:12

      Hi Mel!

      I agree that running my private practice as a business makes me very nervous as I do not have a background in business. I think that it is awesome you have a support system who has a background in business because I believe this would make a huge difference in your success as a private practice clinician. I also think especially because they are family members they would want to see you succeed and help you even more throughout this process that i’m sure at times can seem very scary! I do not have this support system that has a business background, so it makes me even more nervous to start my own business as I would need to learn a lot before beginning.

      Reply

  5. Shelby Piekarczyk
    Jul 14, 2021 @ 07:33:20

    1. There are many different thoughts I have when considering pursuing private practice. My first thought (concern) is the financial piece of private practice and ultimately advertising myself enough to develop a solid clientele base. Private practice is a lot of hard work to start up and that financial burden is an area that concerns me and makes me wonder if I could eventually turn my business into a successful private practice. Another area that concerns me is working alone and not being able to collaborate with coworkers. Throughout my internship I have heard clinicians say they like private practice but at times it can be lonely. This concerns me because I enjoy working with people and having the ability to discuss a case with other (maybe more seasoned) clinicians. On the other hand, I think being able to be my own boss and make my own hours would be a huge advantage when opening up my own private practice. I have personally always wanted a family (children etc) so being able to choose my own hours would be a large benefit in my professional and personal life.

    2. I personally think that if I were to open a private practice as a business it would be very difficult for me at first. The reason I feel this way is because first, I have no experience in the business field nor do I have experience advertising myself to the public. These reasons make me think that I would at first struggle to run my private practice as a business. However, I am a very motivated individual who wants to achieve. Because of this I envision myself learning what I would need too and putting in the time / effort to make my business very successful. So in short, I have mixed feelings how I would do running my private practice as a business. I would burn myself out trying to make sure I was successful.

    3. I believe that running my counseling practice differs in many different ways. The first way my practice differs is the different mental health diagnosis a clinician can choose to work with or does work with. A doctor or dentist tend to work on the same issues at hand (unless they are specialized in their field). However, even doctors who are specialized tend to have one way to complete a surgery or fix a broken bone. In my therapy practice even when working with the same mental health diagnosis (e.g. depression) there are a multitude of therapies to choose from when considering the best course of treatment for your client. On the other hand, I think my counseling practice would be very similar in the sense that we all have a clientele base that we keep information confidential and ultimately help each client (patient) achieve satisfaction. I believe all of these fields are helping professions with similarities and differences in each.

    4. Did you ever want to give up when you first started? Where there times that you didn’t see a light at the end of the tunnel or you brought ‘maybe i’m making the wrong decision’?

    Reply

    • Madison Armstrong
      Jul 16, 2021 @ 14:19:06

      Hi Shelby! You had mentioned that people you have talked to mentioned private practice is something that is lonely. This is also something that concerns me as one of my favorite parts of my internship was being able to connect with other clinicians about clients and being able to learn from their experience. I think being a new clinician this is an important component to becoming licensed and feeling competent. However, I see the advantages of working as your own boss and I do believe that a confidence boost will come with being able to do it all on our own. The idea of having a group private practice is also something that is appealing to me to still be able to have that interaction with other clinicians.

      Reply

    • Robert Salvucci
      Jul 16, 2021 @ 18:19:34

      Hey Shelby!

      The transitional element of private practice also is my biggest concern, as leaving a relatively secure full time position or trying to start a business on the side sounds quite anxiety inducing. I’m also considering when the appropriate time in my life to make the transition might be, given other responsibilities such as family planning.

      That’s a good point regarding the flexibility of therapy vs. medical practice. Generally we have a much wider range of approaches to work with, whereas something like an infection will simply require antibiotics.

      Reply

  6. Madison Armstrong
    Jul 14, 2021 @ 11:15:24

    1. When looking over the advantages and disadvantages table there are many thoughts that run through my mind when thinking about pursuing a private practice. When looking at the advantages it seems appealing that I would be my own boss, I would have flexibility with my scheduling, and being able to set my own fees. Having the flexibility with scheduling and being my own boss, I think would be very rewarding and allow me to have a good work-life balance once I am established. I also think that the financial emotional reward of having a private practice would make me feel very self-effective while also increasing my confidence in my counseling practices. There are a significant number of disadvantages that seem overwhelming right now, but I am sure as I grow and learn as a mental health professional these disadvantages become less overwhelming. Some of the disadvantages that caught my attention are not having a steady income (at least at first), the expenses that come with owning a business, working with managed care organizations, and financial and emotional loss. Right now, I do not have any knowledge about working with managed care organizations and how I would submit the information for client’s insurance companies. This is something that I would hope to learn over the coming years so I would feel more prepared if I were to open a private practice.

    2. Running a private practice as a business is something that I would have to learn much on how to do. I have only taken one business class during my undergraduate degree and the information I learned was introductory. I think that I would have much to learn on the business side of things in order for my private practice to be successful. Not to mention, there is the possibility of being able to hire other clinicians to work for my private practice and at this time I would not know how to be an effective boss. I know that once I am licensed, they do offer trainings on supervision skills which would be one component of being a boss in private practice. The marketing side of the business is also something I would need to learn how to do. Marketing your business is an important aspect because this is how clients would find you and how your business would be built.

    3. I think that a counseling practice differs greatly from other helping professions because of the specialization aspect of counseling. For example, if someone was looking for a new dentist, they would most likely google search a dentist that is close to their home and then book an appointment. With counseling, services are generally more specific, meaning that when looking for a counselor the search for a new counselor is more specific. For example, they wouldn’t just try and find the closest counselor to their home, instead they would search for a counselor that specializes in their presenting concerns and desired therapeutic approach. However, I think that there are many more similarities than differences, especially on the business side of things, between helping professions.

    4. One question I have is how Jacleen learned to work with managed care? Was it something she learned over time or did she have someone who was able to show her how everything worked?

    Reply

    • Robert Salvucci
      Jul 16, 2021 @ 17:22:30

      Hey Madi!

      That’s a good point regarding the confidence boost that a private practice could create, as we’d be primarily responsible for the income we generate and bringing in/keeping clients. As you mentioned, the elements of private practice that seem overwhelming would likely be more manageable over time.

      Becoming a boss is another element we didn’t discuss that much. When running your own business and having employees, so many more variables come into play regarding other people’s employment and accounting for financial resources. It’s an added stressor that can seem overwhelming but also exciting.

      Reply

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Adam M. Volungis, PhD, LMHC

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