Topic 10: Private Practice {by 7/21}

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://jacleen-charbonneau-lmhc-3.jimdosite.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 7/21.  Post your two replies no later than 7/23.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

41 Comments (+add yours?)

  1. Anne Marie
    Jul 14, 2022 @ 17:18:34

    An advantage that I am looking forward to the most in having a private practice is being able to create an office environment that best fits my needs. I have visualized the space in my mind and have a garage full of supplies that is driving my husband insane given the fact that it is at least 2 years away. Some of the disadvantages that stand out to me are the idea that I will be so isolated. I find feedback from other professionals invaluable. Therefore, I believe I would need to continue to be a part of a cohort of other professionals to be able to problem solve and maintain a level of connectedness to others in the field. I had not really considered that when I don’t work I won’t be paid (sick, holiday, etc.). I am so used to having an annual salary it may be challenging to plan ahead for unexpected time off. I ran a cleaning business at one time and remember how challenging it was when people canceled unexpectedly or chose to cancel their service. You are reliant on income based on people showing up, the pressure to be providing effective quality care is very high. However, I do believe I possess some of the personal qualities needed to be successful in a private practice. I can effectively function independently, have solid financial management skills, have a solid set of morals and ethics, and have speciality in working with children. I am less uncertain about marketing myself and billing. Thankfully I know people who have ventured out on their own who have offered to help me navigate the process when the time comes.

    Running a private practice like a business will be a new venture for me that I assume will have a learning curve. I need to do research on starting a LLC. I am less concerned about malpractice insurance as it is easy enough to obtain. Counseling forms are typically standard and can be duplicated to meet my clients needs. I have a network of professionals that I hope to benefit
    including accountants. However, marketing is an area that I know little about and will need to take steps to educate myself about.

    In some ways running a private practice is very similar to other helping professions. There are clients seeking a service. There are aspects such as taxes, forms, fees, legalities that come with that. However, counseling practices are unique given the intimacy of the work that is being provided. Clients are trusting you with the most vulnerable parts of themselves and it can not be taken lightly.

    Reply

    • Tayler Weathers
      Jul 19, 2022 @ 09:38:21

      Private practice is providing a service, and as providers I think this is important to keep in mind. Depending on your population, the services we provide are voluntary and (with obvious exceptions) a client’s not going to be forced into a corner to use or not use our service. In that respect, we as service providers have the ability to negotiate and set our own limits. But I think you’re right about the vulnerability. I wonder with a client who is experiencing suicidal ideation, how would it feel to have to terminate if they can’t pay and you can’t afford to see them for free? Even with referrals, it would have to feel gross. I think I wonder about a lot of worst case scenarios, even in the context of “providing a service.”

      Reply

    • Yen Pham
      Jul 19, 2022 @ 12:13:17

      Hi Anne,
      Like you, I also want to have a private practice after I finish my studies and return to Vietnam. I also agree with you that there are many benefits to having a business of our own. But it is a process and requires a lot of talent, money and effort. Thank you so much for sharing the challenges you’ve faced as a cleaning business owner. Besides, your qualities and talents are very respectable to be able to succeed in a business.

      Reply

    • Anne Marie
      Jul 20, 2022 @ 15:27:22

      **Question for Presenter: What part of starting a private practice have you found to be the most challenging and how did you navigate through it?

      Reply

  2. Tayler Weathers
    Jul 19, 2022 @ 09:33:47

    1. I think private practice scares me a little! Mostly, the being totally on my own part – I like having coworkers, people to chat with and bounce ideas off of. I think I could do the actual work of private practice, but I don’t know that I’d like it. I think I’d get lonely or sad, especially since there are limits to what you’d discuss with peers in consultation (finances, etc.). And, I think I would be worried that I’d work myself too hard, since I would struggle to give myself days off because I could see the numbers in the projection spreadsheet go down…
    2. I think running the private practice “as a business” would be somewhat simple for me logistically. When your income is very clearly related to your work (i.e., each session has an associated dollar amount), I think there’s a pride and investment in doing that work that would be fulfilling. Plus, I already keep obsessive spreadsheets and financial records. It might feel weird at first to focus so much on the money, but I guess I would have to think of it more like a doctor – I have a skill, they need that skill, and it’s helping the client, so it’s not a bad thing to charge for it.
    3. A counseling practice is different from other helping professions because there is so much more emphasis on the interpersonal relationship. Plus, as a private practitioner, you do the scheduling and the billing – unless you hire a receptionist to be the bad guy, you have to be the one to talk to the client. That means that your business practices might directly interfere with your work, or helping the client get better, because now you’ve entered into a weird conversation about money. I can imagine also that people would expect a therapist to be more flexible and accommodating than a doctor because of this interpersonal element, and because it’s less common to see a therapist so the social niceties of paying a medical bill might be less prevalent. Plus, I think the sometimes jagged curve of improvement (i.e., worse before it gets better, sometimes stalls, backsliding can happen, etc.) can make people nervous and perhaps aggravated about paying for therapy – something I don’t think we see too often in a doctor’s office!
    4. Would there be any utility in posting a fee range on the website, or has that gone poorly in the past?

    Reply

    • Yen Pham
      Jul 19, 2022 @ 12:28:35

      Hi Tayler,
      I agree that the significantly different between counseling practice and other helping professions is interpersonal relationships. An interpersonal relationship is built on trust. When we build a good relationship with our clients, they will trust us more, and they will open up and share their concerns with us. If so, it’s a great thing for us to help our clients rediscover themselves and change their lives.

      Reply

    • Maya Lopez
      Jul 19, 2022 @ 13:28:42

      Hey Tayler,

      I totally agree, I think having a receptionist be the bad guy might be best so it isn’t us who has to talk about the money like “okay we are at the end of our time today, now hand over the cash” It feels cheap, awkward, wrong and shallow. It may even damage or change the therapeutic relationship with some people and this does make me nervous about private practice too

      Reply

    • Alison Kahn
      Jul 19, 2022 @ 18:07:48

      Hi, Tayler!

      I totally agree with you about how daunting being on your own feels. I also talked about how much I value my social connections at work not only for my own self-care but also to hold myself accountable as a professional and ensure that I am always learning and growing. My question for the presenters has to do with social supports and supervision, so hopefully they have some good news for us!

      Reply

  3. Yen Pham
    Jul 19, 2022 @ 12:02:22

    (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?

    Pursuing private practice for me is my dream and the purpose of my superior general who decided to let me study abroad. But currently, I am a little scared and nervous to think about pursuing private practice. I know I have more authority when I have a private clinic. I can be a boss and flexible with my schedule and environment of work i.e., I can work wherever I want (office or remote). I can work with any type of client I want to. I can have my own approach/style to counseling. On the other hand, I realize that if I am a boss, I am responsible for everything (e.g., counseling, scheduling, paperwork, working with managed care, record keeping, paying bills) unless others are hired). I am also responsible for my own benefits (e.g., health and dental insurance, retirement, disability). Besides, I just have a little experience working in this field. Thus, it is not enough for me to be successful in my own business. Pursuing private practice requires some business skills. I feel weak in basic business skills from finances to marketing and financial management skills.

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

    My thoughts about running a private practice as a business are difficult. As discussed in question 1, I am not good at financial skills while running a private practice need these skills a lot. I also do not have much money to start up, especially if I plan on buying or leasing office space. I then feel hard to have a business plan, which includes knowing how to budget expenses, bookkeeping/accounting skills, setting fees, marketing/advertising, payroll, and benefits, and working with managed care organizations. In addition, I can picture that if I have my own business, I will be doing much more than counseling: receptionist, bookkeeper, accountant, marketing director, and public relations director.

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

    Running a consulting business will be essentially the same as other support professions in terms of preparing money and having a good motivation and plan before starting it. However, running a counseling practice differently from other helping professions is in the way in which the counselor was listening to his/her client’s stories. Because when the counselor listens to the clients’ stories with understanding and without judgment it shows the respect that the client should have. Therapy is a talk and through these talks, the therapist helps clients change their negative thoughts to think positive and live more optimistically. When there is a healthy mind, the clients will live healthier.

    Reply

    • Maya Lopez
      Jul 19, 2022 @ 13:41:23

      Hey Yen,

      As you said, therapy is much more interpersonal. We see a deeply personal, vulnerable side to individuals that many others do not see in these other professions. So it is very different and hard to compare these different professions in the same way

      Reply

    • Elizabeth Baker
      Jul 23, 2022 @ 23:22:46

      Hello Yen,

      The idea of being in control of everything that goes into successfully managing a private practice is also overwhelming for me. Alongside the idea of being in the field for such a short time, considering a private practice almost feels too soon to even think about it. But of course, as we know, it never hurts to start questioning the process and obtaining guidance so when we do choose the private practice path, we have more knowledge under our belt to succeed. I hope you continue to grow your confidence as you continue working in this field (I know you will), because your dream will be incredibly helpful to whomever you decide to bring into that therapeutic space. I wish you the best of luck! 😊

      Reply

  4. Maya Lopez
    Jul 19, 2022 @ 13:25:17

    (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 desirable advantages such as being able to make my own schedule, the type of therapy I offer, how much documentation, and the type that I decide to do. However, it does seem hard in that the responsibility falls upon me, especially for insurance and healthcare. It sometimes does seem easier to just work at an already established place or in a group practice so I can have the flexibility with less responsibility. I plan to work at a group practice first anyways so I can learn more about the ins and outs of private practice.

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

    I am excited to do this, I do believe the business part will be difficult at first but once I reach the learning curve it seems like it will be the same each year and I can fall into a routine running it. I am a very organized person by nature and think once I get a rhythm down for the business it will not be hard. However building the business, learning what I have to do, building my clientele, etc all seem like a lot of work.

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

    This is a really great question, I think it is mostly similar except for the supervision part. To my knowledge, most Drs and dentists do not sit down for weekly supervision in order to continue practicing ethically. Our field is very interpersonal and I think this is why supervision is needed, to be sure we are not becoming biased. Most of these other professions do not seem to get as sucked into their client’s life in that it would impact their care. So having a private practice and trying to find or provide supervision sets them apart.

    (4) My question is for Zachary: why do you enjoy working with resistant males specifically? (as it was mentioned at least twice on the website)

    Reply

    • Alison Kahn
      Jul 19, 2022 @ 18:09:51

      Hi, Maya!

      Totally agree. It seems like a LOT of work developing and maintaining a private practice. I definitely think I would want to recruit help in one form or another if I do end up taking on the endeavor!

      Reply

    • Anne Marie
      Jul 20, 2022 @ 15:26:03

      Hi Maya, I agree that navigating insurance will be overwhelming. I am so grateful that friends have figured this learning curve out and have offered to help. I think I will probably rely on a billing program to navigate this for me to streamline it. Plus, I would be so nervous about making mistakes with it.

      Reply

    • Cailee Norton
      Jul 21, 2022 @ 11:51:29

      Maya,

      I’m glad to see how confident you feel about running your own private practice! I think like you said that having a routine makes the stress of running a private practice much easier. I think that as we enter the work force we will be able to get a lot of good information from others about their experiences and resources for running private practices, and that will help us in pursuing it ourselves! Like you said, starting with a group practice is a really great jumping off point!

      Cailee

      Reply

    • Tayler Weathers
      Jul 21, 2022 @ 17:18:06

      Hi Maya!

      I love your observation of supervision. LMHCs have continuing education just like other professions, but you’re right in that we have more of a professionally-collaborative mindset than other professions! This is a huge difference for private practice, as a dentist can set up his own practice and function individually, but a therapist needs consultation with other therapists!

      Reply

  5. Alison Kahn
    Jul 19, 2022 @ 18:04:22

    (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?

    Private practice has always been something I pictured in the “ideal” version of my career future. I have always been super interested in stepping out on my own, and even more so after working for a non-profit residential care agency for over five years. After reviewing table 8.2, I can definitely say that the two biggest advantages for me would be having a personalized office environment (I don’t have an office at my current job) and the flexible schedule that private practice offers. Some disadvantages that caught my eye were the potential for feeling isolated/lonley (I very much value the social connections I have regularly with coworkers as well as support and supervision) and the emphasis on having solid business skills (which I have very little experience/knowledge of). Regarding personal qualities, I feel like I am confident in my problem solving and organizational skills/qualities, but I struggle when it comes to coping with uncertainty and I do worry about the potential for lack of social support and regular supervision because I rely heavily on it in my day to day work.

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

    I think running a private practice would be difficult for me, at least at first, but I think ultimately I could be successful as long as I invested enough time and effort into the practice. Knowing that I have some time before jumping into that kind of endeavor does make me feel a bit better and like I could spend a lot of time preparing and educating myself on the ins and outs.

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

    I think that running a private counseling practice is different than other helping professions because it feels more isolated and almost like it has fewer parameters. My understanding of dental, physician, and other medical practices is that there needs to be several people employed (administrators, receptionists, nurses, dental assistants, accountants, etc.) that all work together to make sure the practice runs smoothly. I think this can be a big advantage because not only are you not carrying all the responsibilities alone, but you have social supports and people to consult with right in your office. They can also help to build the culture and atmosphere of your practice. It also seems like there are more specific standards of practice in medical professions. For example, if I am going to a doctors office for inflammation of joints, I definitely want to make sure that my doctor is treating me with anti-inflammatory medication rather than something else ineffective like antibiotics. Alternately, the same mental health diagnoses are often treated with different interventions based on the clinical orientation and treatment models of the counselor, even if they are evidence based.

    (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://jacleen-charbonneau-lmhc-3.jimdosite.com.  Please come to class with a few prepared questions.  Simply just share one of those questions here.

    Where do you go for social supports, supervision, and consult? Do you have a standing meeting with a supervisor weekly/bi-weekly/monthly? How do you go about finding someone to provide consultation?

    Reply

    • Anne Marie
      Jul 20, 2022 @ 15:22:10

      Hi Alison,
      I related to a lot of what you said about your fears for having a private practice, specially the isolation from others. I love my coworkers and it is a bit daunting to think about working alone. You also noted that in owning a private practice you carry the responsibilities alone which is a bit overwhelming to think about the importance of the work and the level of responsibility. Great questions for the presenters as well

      Reply

  6. Beth Martin
    Jul 20, 2022 @ 21:03:58

    1. Like a lot of people here, my current thoughts on private practice is it being lonely! I am so used to working in either a team, or in an environment where I can say hi to people or take a coffee break at the same time and be a human – i think there’s a lot to be said about sharing environments with people who are likely holding the vicarious trauma, or burn out, or just know what you’re going through day-to-day. I do like the sound of the ability to pick my own case load and my own hours (I hate mornings with a passion), but there’s a lot of concern about working alone that somewhat balances that interest out.

    2. I think running a business is always going to be difficult as you figure out what works, what doesn’t, what taxes you need to be filing, what’s deductible etc etc. I’m lucky in the sense that my partner runs his own business, so I anticipate being able to borrow some of his knowledge for the business-specific-but-not-private-practice questions I have. I am mildly terrified of book-keeping and billing, but it sounds like there’s plenty of services out there that we can use to keep that manageable. Most of my concerns about private practice are human-based; I figure with time and research, the business stuff will start to make a lot more sense.

    3. I don’t imagine running your private practice in the day-to-day is really any different, bar maybe we don’t have to order a bunch of equipment on a regular basis, but I can definitely see there being a slight difference in the acceptability of our rates vs. Other medical/health professionals. I think the cost and insurance nightmares are normalized for dentists and PCPs etc., but I do know there’s a view that we got into the profession to help so charging is unfair etc. from certain parts of society. That viewpoint exists for all healthcare providers, but I don’t see that particular line mentioned when talking about traditional medical professionals. So I can perhaps see differences in how clients react to billing, but nothing else.

    4. One of my questions for the presenters is how they went around selecting what populations etc. they wanted to work with, and did they find that limiting when they were first starting up? Or was it easy to find the population they wanted in a private setting?

    Reply

    • Alexa Berry
      Jul 21, 2022 @ 10:18:07

      Hi Beth,

      When I was reading your post, I thought it was interesting you mentioned being lonely in private practice. I genuinely had not considered this, but I suppose it may have something to do with the fact that I work better in solitude. However, you make a good point about being able to socialize throughout the day with others who are experiencing the same things- definitely something I will keep in mind!

      I agree with your section on differences in running private practice- I wonder if the general unrest about mental health fees will reduce first or if insurances will actually start to reimburse at an appropriate rate! It does not seem fair that many other helping professions do not get questioned for their cost of service (i.e., 1k for wisdom teeth removal) but if a counselor only offers private pay they are criticized.

      Reply

    • Cailee Norton
      Jul 21, 2022 @ 11:48:55

      Beth,

      That is definitely a benefit that your partner has business knowledge! I think that eases a lot of the anxieties many would feel in that situation, and having that support seems absolutely vital (even if your support doesn’t have that knowledge!). I’m with you on the terror of book keeping and billing, but I’m really interested in that organization Alma that Dr. V mentioned, and I’m sure like you said there are systems out there we can utilize!

      Cailee

      Reply

  7. Alexa Berry
    Jul 21, 2022 @ 10:09:29

    After reviewing the advantages/disadvantages, personal qualities and common mistakes related to private practice, I feel that I am in a fair position to pursue private practice. Some of the disadvantages that I am going to keep in the back of my mind are the >40-hour work week to start and responsibility for protecting business (i.e., malpractice). For some reason I have an irrational fear of things related to the legalities of mental health counseling, like malpractice and subpoenas. I suppose I can reassure myself by getting really good liability insurance. I think the advantages definitely outweigh the disadvantages for the kind of lifestyle I would like to have eventually (i.e., flexible hours to be able to spend time with my family, eventually a reduced case load). As luck would have it, I also possess many of the personal qualities outlined in table 8.2.

    I think running a private practice as a business naturally presents challenges, as challenges are encountered in running any business. Luckily, I was a double major in business and psychology for a few years before I decided I hated business, but I retained a lot of the information from the courses I took. I may need a refresher or to seek assistance from someone with business experience, but again I am fortunate in that I have various family members who have started their own successful businesses and would be happy to offer guidance. I don’t know if I would consider this either easy or difficult, more tedious than anything because like I said I did not find the business course content all that enticing. However, I’m sure with it being my own business it will be a bit easier to engage with and be interested in.

    I think one of the main ways running a counseling private practice is different from other helping professions relates to insurance. Insurance loves doctors, dentists, and various other “physical” helping professions. It is common for those working in private practice to set private pay rates because insurance truly does not reimburse or cover enough for mental health (sad!). Additionally, unless it’s a smaller family practice I don’t imagine other helping professionals are in charge of doing all their own billing, furnishing their office, etc.

    What are the benefits of offering a free consultation? From both a practitioner and business perspective

    Reply

  8. Cailee Norton
    Jul 21, 2022 @ 11:45:13

    I think that as many people have pointed out, running a private practice is somewhat terrifying especially at this point of our budding careers. Looking at the advantages and disadvantages, the idea of being on my own right now makes me physically sick, but when I reframe the idea of me creating a private practice at a later point down the road, let’s say 20 years, I realize that will mean I have 20 years of experience under my belt. So making decisions about things seems less intimidating in that mind frame. I’ll be much more comfortable in my skin, have a clearer picture of what population I want to serve, maybe I’ll even be a proponent of a specific type of treatment or group who knows. That being said, the business side of owning a private practice is very unfamiliar. The idea of treating it as such feels icky, especially considering what we do for a living. We are often told things in the therapeutic setting that those clients haven’t spoken to anyone else about, and sometimes the idea of charging for that feels ethically murky. Obviously we need a pay check, but when I think of a business minded individual I really don’t picture myself nor someone with much empathy. I think that to pursue a private practice really early on into licensure is a really big risk, and not one to be taken lightly as the tables mention so many important factors to consider (insurance, liability, paperwork, billing, marketing, etc.).

    I know that running a business is incredibly hard. My father’s side of the family has historically owned several different businesses, and it really took a toll on my father’s family. After seeing that and the amount of hours worked, fights fought, and lack of work life balance, it’s really something I feel I have to consider for my family and how it may impact them. While the idea of working for myself and following my own rules is tempting, it is a massive undertaking. I know it would be difficult, but if I feel it’s something I want to pursue I really think I would after I’ve gained more experience in the field.

    Running a counseling practice is a bit different than other helping professionals in that we place such an emphasis on the relationship that we build with our clients. In order to see a change, we have to have a strong working alliance, and so much of the work is done on the client. If my dentist just focused on getting to know me and not on cleaning my teeth, I’d be pretty annoyed (and weirded out). You expect certain professions to be an in and out, the professional does their work, and you kind of just leave (obviously this is very dependent on situations, especially medical ones). That’s just not how counseling work. We guide them, and the client really puts the work into making the changes. I think in a way that puts us at an advantage as we are able to use that relationship we’ve built to motivate our clients.

    My question would be for Zach: With such limited time available, how often do you do phone consultations and how long do they take for you. For Jacleen: I noticed you have pictures of your space on your website, do clients find this to be comforting as they know what to expect?

    Reply

    • Abby Robinson
      Jul 21, 2022 @ 14:11:18

      Hi Cailee

      I love your insight/question to Jaqueline about the photos! This is a great idea as I know I am alway a bit curious and anxious when I have to go to a new place, seeing pictures always helps reduce these feelings- knowing what I can expect to see when I get there. This is a great strategy to promote the practice!

      Reply

  9. Elizabeth Baker
    Jul 21, 2022 @ 13:19:31

    1) The thought of owning my own practice is both exciting and horrifying. I will be on my own and the success of my business will be in my own hands. The work behind building up a private practice is extremely overwhelming, but that is why it is important to ask for help I would, however, look forward to going through the journey and seeing a physical representation of my aspirations. What I do look forward to is working on my own time, creating my own policies, rates, and working with my desired population.

    2) I find the idea of running private practices as a business logical, as we need to have this mindset in order to profit and for it to be successful. As horrible as that may sound, we still need sustainable income so we need to be strict regarding fees and rates. As I previously stated, the idea of developing a private practice is overwhelming and I know it will be difficult and that I will need a lot of guidance along the way. Starting is always the most difficult, but after I get the hang of it, I am sure everything will run more smoothly.

    3) The obvious difference is the services we provide and how we provide them (i.e., remote). Then there are private practice mental health professionals working alone most of the time, while other professionals work with a team. We spend most of our time working alone and then reaching out for guidance (weekly or “as needed” supervision, from social support system, from social network) when needed.

    4) As for my question for the presenters, that was inspired by last week’s Private Practice presentation: How is your private practice unique from those around you? Did this difference come to you before developing your private practice, or did it come to you along the way?

    Reply

    • Abby Robinson
      Jul 21, 2022 @ 14:08:56

      Hi Liz!

      I feel completely the same way about pursuing a private practice- exciting AND horrifying. I think that the process seems stressful too, and that there are so many aspects that I don’t have experience in that makes me worried. I think that there are some things we can’t really prepare for- which makes me even more scared! But I think that with practice and gaining hours we will be able to make good choices!

      Reply

  10. Abby Robinson
    Jul 21, 2022 @ 13:45:53

    (1) My current thoughts about pursing private practice seem so conflicting. On one hand, there is a lot of liability falling on one person, having to run business-y aspects (book keeping, billing, scheduling, etc), and that type of stuff make me feel intimidated. I also wonder about what type of independent company I would be- for example, and LLC? I’m not sure how picking those out would work and what the pros and cons are to each type of independent company. I would also want to make sure I had a great finance team (accountant, tax person, financial advisor) behind me since I have little experience working in finances. All of these questions and factors make me not want to run private practice.
    However, on the other hand, pursing private practice also seems enticing as I get to create me own schedule, set my own caseload, set pricing for my clients, have flexibility. This seems like it would end up being something I would like as quality of life is more important to me than the money aspect (which I know is not the case for everyone). This makes me feel conflicted about my original anxious thoughts about pursuing private practice.
    (2) I think that running a private practice as a business would be hard for me since I enjoy turning my computer off and leaving my office and not have to think about work until the next day. I’ve heard from others who do run their own business, that the business owner lives it constantly and rarely gets a break from these business aspects. I think that I would find this too overwhelming and I would have a hard time setting boundaries between work and non-work if I was the business owner.
    (3) I think that running a counseling business is different from other helping professionals is there is usually a lot more appointments (you normally only see your doctor 1 or 2 times a year), whereas therapist tend to see their patients once a week or every other week. This creates a different type of relationship between the client and the professional than the relationship between the client and dentist.
    (4) For the presenters: Do you think there is a good timeframe to start or join a private practice? For example, right after graduation? Or get clinical outpatient experience at a site for a few years first?

    Reply

    • Beth Martin
      Jul 23, 2022 @ 06:26:42

      Hi Abby!

      You make a really interesting point on how it may be more difficult to shut off at the end of the day in private practice! I can also see home/work balance being more precarious if we’re having to manage the business aspect too. I’m thinking that, if we set our own schedules, scheduling in specific time to get business-y stuff done may help with that boundary – I also feel like I’d really struggle to set that boundary too! “Why not just hop on your laptop as you’re waiting for the oven to preheat to do that one thing?” has been a constant battle. Hopefully with having other people to handle all the complicated billing things will mean we’ve got less to do and it’ll help with that!

      Thanks for sharing!

      Reply

  11. Anna Lindgren
    Jul 21, 2022 @ 13:57:48

    Eventually opening a private practice has been a goal of mine since applying for grad school, and I think that given the information in the chapter, I am relatively well suited and positioned for it. I have management experience, including some light book keeping and online marketing. I also have people in my family who have started businesses to turn to as a resource for online marketing tips, which is helpful! I’ve been working on my time and finance management skills, and plan to start a savings account for my practice soon.

    I don’t think I’ll have a problem running my practice as a business because I have personal financial goals that I want to reach (e.g., buying a house, having children). I’ve also spend the time and money on getting this degree, and won’t feel badly about making a good living from my hard work. One obstacle I could see is if I have a client that I like who is having trouble paying. I want to think about solutions to making my services available to those who are lower income, while also being paid appropriately. Something I’ve considered for this is a sliding pay scale, but I’m not sure exactly how that would work or if it would be an issue with potential clients.

    I think that mental health practice is different from other helping professions in the nature of the work we do with our clients. Establishing that string therapeutic alliance, empathy, and respect early on is extremely important. I think these can be nice in other helping professions as well, but isn’t as necessary to successful work with their clients.

    A question I have for our guest speakers is how they decided on their fee and which insurances they take/why?

    Reply

    • Connor Belland
      Jul 21, 2022 @ 18:49:08

      Hi Anna,
      I definitely agree that you will be great at running a private practice, and you definitely deserve to make a good living after all the hard work you have put in, it is great you have family that have opened businesses before so they can give you tips on the business side of things.

      Reply

  12. Nicole Giannetto
    Jul 21, 2022 @ 15:18:22

    (1)
    When considering the advantages, I really am motivated by the idea that I can be my own boss, which comes with the flexibility of creating my own work schedule and incorporating more of my own style into therapy. On the other hand, I would need to develop a strong foundation in business before venturing out. I don’t meet all of the personal qualities for a successful private practice currently as I read through Table 8.2. Although I feel I have strong attributes including a solid set of morals and ethics, ability to problem-solve, and basic counseling skills, I have not yet explored the business aspect of private practice, and am curious and willing to learn about it as I move along in my career. In order to avoid making missteps, I would want to have a solid grasp on what it means to run my own business before venturing out to do this on my own one day,

    (2)
    I hadn’t really begun to consider the business piece of counseling prior in depth before reading about it in the book this week. For someone who has been studying psychology in school for several years, and who has very little knowledge about business, the thought of starting up and maintaining my own business is both nerve racking as well as very exciting. There is, of course, a lot I will need to learn from now until whenever I may see myself running my own private practice. I think that by getting more exposure to how a business is started and maintained, that I will improve my confidence and improve on my skills that are important to have when running a business, such as time management and budgeting.

    (3)
    In several ways, running a counseling practice is different from other helping professions. I think that all of these jobs, physicians, dentists, and physical therapists, along with counselors, all have the heavy task of balancing both a business as well as their own specialized service. However, with counselors, the weight they are expected to hold seems to be much greater, as they are not only tasked with running business, but they are also responsible for holding spaces for their client’s to share their own experiences which can take a toll overtime. I could understand how this combination could lead to potential burnout, especially if the business isn’t doing well.

    (4)
    I really like both of your websites. I am curious about the designing and marketing piece. Did you both come up with it individually or were you able to seek guidance from a marketing specialist/website designer?
    Are there pros and cons to posting your session rate on your website?

    Reply

    • Alexa Berry
      Jul 24, 2022 @ 09:38:05

      Hi Nicole,

      I agree with your point about how therapists have to both run their business and hold the emotional space with clients, which differs from a lot of other helping professions! Although smaller practices exist within other helping professions, I think its much more common for them to belong to a larger organization (like doctors at hospitals), and thus they really do not have to worry about the overview of running the business. I suppose that is the draw to not opening a private practice for any helping profession though!

      Reply

  13. Carly moris
    Jul 21, 2022 @ 16:40:09

    1. Considering the benefits of running your own private practice I think that I would eventually be interested in starting my own private practice. I like that it would give me more control over my professional life. Such as being able to set my own schedule, choosing what populations to work with, and having a personalized office environment.however. I am nervous about some of the disadvantages like the potential for isolation and loneliness. So I know that it will be important for me to build social supports that aren’t related to work if I am interested in pursuing private practice.
    2. I think that running a private practice as a business makes sense. I am a bit nervous about the actual logistics involved in starting a business and making sure I take the right steps to do it successfully. But I also know that these are skills you can learn, and I am confident in my ability to learn how to do it. Before grad school I didn’t know how to be a counselor but I went to class and learned the skills that I needed. While I wont go to classes for starting a private practice I am confident in my ability to do research, learn new skills, and problem solve for any issues that occur.
    3. One of the differences with running a private practice in other health care settings is that there is less overhead for getting started. Counselors don’t need to invest in expensive equipment that other medical professions need. This also allows you to start a practice independently versus a group practice that would split the costs.
    4. What was your biggest challenge or doubt for stating your own private practice? What is the biggest challenge you actually face running your own private practice?

    Reply

    • Connor Belland
      Jul 21, 2022 @ 18:54:28

      Hi Carly,
      Interesting about the increased overhead costs of other helping professions i never thought about that, technically all we really need is the license and a computer to get started. Opening a private practice will definitely be a big learning curve.

      Reply

  14. Connor Belland
    Jul 21, 2022 @ 16:44:07

    1. I am very excited for when I get to that point in my career where I can start up my own private practice. Working for myself has always been a dream of mine and the first thing I think of when becoming a therapist is having my own therapy business. I do think I will be able to run a private practice, but it will be challenging for me, I am not always the most organized person and often can fall into routines and procrastinate doing some work. I can see myself putting off all the business type paperwork until the end of the month or something and not being organized with it unless I make an active effort to stay on top of it.
    2. I don’t think I will have a problem running my private practice like a business. I do think it will make it a little more stressful if clients aren’t showing up or I am having trouble maintaining a steady caseload because my earning will depend on seeing clients. I think I will have to keep a clear boundary in my head though of when to conduct business and when to be a compassionate therapist, I have to remember to do good therapy first and foremost because that is the best form of marketing, and then handle the business side of things once I have done my job the right way providing the best possible service I can to help my clients.
    3.) The main difference from other helping professions I think of is that we know way more about our clients than their dentist would. We make deep emotional connections with clients and know all the details of their life that other helpers would not be able to gather from small talk. It could be hard sometimes to charge people for no shows or drop them if they cannot pay because many of the clients we might see have probably fallen on hard times. Often times we may hold a clients life in our hands more than a medical doctor would, which is wild. Other than that the business side is pretty similar.
    4.) If you have a no show/ cancellation fee? If so do you ever find it hard to charge/bill clients who you know may be struggling financially or are in a tough spot?

    Reply

    • Anna Lindgren
      Jul 21, 2022 @ 17:29:12

      Hey Connor!

      I think you have some real insights into what might be challenging in running a private practice. I also struggle with procrastination at times, and while I love the idea of being my own boss, that means I have to figure out how to manage myself and stay on top of time-sensitive tasks. If you are looking to improve your time management skills, I recommend reading Four Thousand Weeks by Oliver Burkeman. I read it and found it really helpful! 🙂

      Reply

  15. Brianna Walls
    Jul 21, 2022 @ 17:17:37

    1. Although I would like to think having a private practice will be ideal there is a lot of work that has to go into the process of opening one. Taking into consideration the tables, the thing that stood out to me the most was poor self-care and neglecting relationships with family and friends. These two aspects make me nervous because when you first start your private practice it is encouraged not to start full-time right away and therefore, I would have to keep my other job while also trying to open a business. This means I will probably be working more than 40 hours a week for at least a few months if not longer. I feel like it is going to be very difficult for me to maintain relationships and self-care due to the amount of time I need to dedicate to work and my private practice.
    2. When I think about running my private practice as a business it sounds intimidating to me. When I think of a business, I think of a company that has multiple employees, managers, and a boss that all work together towards providing a product or service to their customers/clients. However, when I think of my future private practice, I do not see myself hiring other employees, especially not at first. Before starting any business there needs to be careful consideration and research completed. You need to take into consideration all expenses, your clientele, marketing, where your office will be, will you hire an administrator or additional clinicians and so much more. So yes, I believe opening a private practice will be complicated and difficult but once I get my private practice open and I build a clientele and I am open for a few years I believe it will get less complicated and stressful and be much more rewarding.
    3. Running a counseling practice is not much different than running a dentist’s office or physician’s office etc. as they all provide some type of service to individuals. All practices require insurance, an office, taxes, employees, (depending on if you want to expand your practice from one Dr. or clinician) paperwork and so much more. However, a counseling practice requires much more interpersonal relationships between the clinicians and the clients as there are many more personal discussions happening between one another.
    4. If you could do it all over again, what would you do differently and why?

    Reply

    • Anna Lindgren
      Jul 21, 2022 @ 17:36:55

      Hey Brianna!

      I totally understand your worries about self-care and relationships taking a hit when starting up a private practice. I also worry about this, because based on the plan I have for the next few years I’ll probably have young kids while trying to start my practice. We definitely want to make sure that we are still getting the self-care and social support we need to be competent therapists and thriving people! I kind of think of it as an investment of time in the beginning so that you can build up a thriving practice that provides a nice quality of life in the long run. But, yes, I think the transition of opening a practice while working full time will be stressful, to say the least!

      Reply

  16. Laura Wheeler
    Jul 21, 2022 @ 18:31:52

    I am definitely interested in pursuing private practice at some point… I’m just not sure when. What appeals to me most is setting my own guidelines/hours/niche clientele and so on. Ultimately I know that when working for an agency there is very little (if any at all) say in the people you work with, the hours you work, the ways in which you complete paperwork and assessments, and so on. Having that control for myself is definitely appealing, in addition to potential financial benefits. However, I know that organization of completing paperwork and developing paperwork are not things that I am confident enough in yet to be on my own.

    As for running my own business, I haven’t given it a whole lot of thought yet because I know that it is a while down the road. In general, I think running any kind of business takes time and resiliency as far as troubleshooting what is going to work and not work (which also creates financial risk and being flexible enough to pivot to make sure you don’t fail).

    I don’t know that running a counseling practice would be different from running another practice as far as the business aspect. As for the clients, there would definitely be a difference in the way you treat and interact with them.

    A question for the guest speakers would be: have you ever regretted your decision to go into private practice? Why?

    Reply

    • Beth Martin
      Jul 23, 2022 @ 06:19:52

      Hi Laura!

      Being able to choose who I work with (or don’t, in this case) is something that’s really enticing about private practice for me too, and I’m with you on paperwork confidence! Hopefully having some time in agencies as we get our licenses will help boost it, and let us get a better feel of what works, and what feels like it’s a waste of time. I’ve seen private practice…advocates (for lack of a better word?) advertise that they help people sort out their intake paperwork etc during that transition from agencies to private, so maybe they’ll be helpful for us down the line!

      Thanks for sharing!

      Reply

    • Elizabeth Baker
      Jul 23, 2022 @ 23:11:54

      Hello Laura,

      I agree that the aspect of full power within our own private practice is also enticing! We will have far more control over any bumps in the road and won’t have to worry about working in a disorganized and chaotic setting. The idea of being able to see what is not working and changing the process, rather than the statement of “this is just how it’s always been,” is really great.
      I wish you had asked your question in class, it was a good one!!

      Reply

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Adam M. Volungis, PhD, LMHC

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