Topic 7: Private Practice {by 7/9}

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?

 

Your original post should be posted by 7/9.  Post your two replies no later than 7/11.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

35 Comments (+add yours?)

  1. Lilianne Elicier
    Jul 03, 2020 @ 13:33:40

    Based on the readings this week my currents thoughts about private practice are that there are pros and cons as well as personal qualities and mistakes to avoid when thinking about pursing this avenue. For me personally although there are cons that I need to weigh there are more advantages to having my own private practice. Having young kids to take care of is my number one priority and having my own private practice although there will be plenty of work and possibly long nights starting off in the long run I would have the flexibility to make my own schedule and to be my own boss. This for me would be very beneficial and having the ability to create jobs for others is also something that I would do.

    My thoughts about my own personal qualities when going over table 8.2 is that I possess some of those qualities and like to think that these are qualities that someone who wants to have their own private practice should have( at least in part some not all of these qualities). Some of these qualities such financial management skills, basic business skills and billing are qualities that I would need to attain but with the right training and expertise I don’t see why I wouldn’t learn. Throughout my years working and studying in the mental health field I have come to acquire some qualities such as being able to cope with acute stressors, including unexpected obstacles when working on a unit. This has been a quality that I have developed and is a daily learning experience still for me to this day. I think that in order to pursue your own private practice these are basic qualities that most individuals should have or be willing to learn.

    My thoughts about table 8.3 are that this is a very helpful list to have. When someone is first opening up their private practices they are bound to make mistakes so this list is useful to look back on. My thoughts specifically revolve around on not planning/saving money for slow periods of the year. Having worked in a salary based job throughout my lifetime this will be something that I will need to get used to doing and that is where the financial management skills will come in handy. This is something that I would need help with and will plan to have someone working with me closely on this matter. My thoughts also go to poor-self care. I tend to do this till this day at work where I barely find the time to eat working in a fast paced environment and need to learn to let go and find time. This has always been an issue for me with self-care and having your own private practice especially starting off at first is going to test my own self-care capabilities. This mistake to avoid resonates with me loudly as I know this one of my areas where I struggle personally. I don’t want to overwork myself where I am not making enough time for friends and family as this is something that I highly value.

    Having my own private practice will prove challenging for me but I think with the right support it is something that I can do and manage thinking about the long term rewards. It will prove challenging for me because there are financial aspects I would need to learn in order to be successful as well as testing my time management skills. This has always been something for me that has proved to be a challenge in session when it is the 45 minute mark and the client is still talking. I have always struggled with this and feeling bad for cutting clients off and some of the sessions have also gone over but I this is something I am working on and have built self-awareness. This topic once again brings me to have those 15 minutes to myself to take a walk between clients or to start a note.

    Running your own counseling practice can be different from other helping professions in that there can be more burnout rates as your working with clients who are mentally ill. Also there can be higher rates of aggression and suicide which can be a huge liability for your own private practice versus if that were to happen someplace other than your own practice.

    Reply

    • James Antonellis
      Jul 05, 2020 @ 11:44:07

      Lilly,

      Saving money for slower parts of the year is a concern of mine too. I’ve been used to always knowing how much my paycheck is going to be, and the thought of knowing that mine could potentially vary greatly over the course of the year is scary. Knowing that I would need to keep money saved and stashed in an account that would only be touched on the ‘rainiest’ of ‘rainy days’ is scary. I guess this is the point where I have to admit that my father may actually be right, and start putting aside money to invest in rental properties so that I have some sort of income to keep me going should business ever get slow.

      Reply

    • Cynthia LaFalaise
      Jul 07, 2020 @ 21:44:20

      Lily,
      I have similar issues when it comes to saving money. I’m not the best with finances and never really had a savings account so this is something I must take into consideration as well when it comes to planning for private practice. Especially when unexpected things having (like COVID-19), I need to have a safety net that can cushion the blow back of not having clients. I have the same sentiments regarding self-care although I am getting better at it. My concern is more overworking and staying longer hours which was mentioned as a disadvantage to private practice. I don’t want to over work myself either but that may come with the territory if I don’t hire additional staff to handle things like scheduling, accounting, and facilitating care with insurance.

      Reply

    • Lynette Rojas
      Jul 11, 2020 @ 22:06:45

      Hi Lily,

      Reading the chapter on private practice I also learned that there are many pros and cons to opening up a private practice. Like you, I am still considering opening up a private practice in the future. However, I would like to gain years of experience even after receiving my license and would need to set a business plan before going through with it. As you mentioned in your post, having time with your kids is very important to you and this is something that I am also thinking of for when I do have my own kids. I would like to have a flexible schedule where I can set it up so that I can be with my kids when they get out of school or so that I can take them to their appointments without much of a problem. Like you said, it might be stressful and difficult at first, but in the long run I think it will be worth it. I will definitely need to learn more about business and how to manage finances, and when I do I will decide whether opening my own private practice is still something I want to do then.

      Reply

  2. James Antonellis
    Jul 03, 2020 @ 14:58:05

    Based on the reading, going into private practice seems to be a huge risk, that could potentially pay off big if done right. I definitely like the thought of being my own boss and having control over how therapy is conducted and fees are collected. What I’m not a fan of is being on my own and having to work directly with managed care. I enjoy the fact that working for an organization provides me with a salary and benefits. Finding space to work is everything and fine, that doesn’t worry me. I have been seriously contemplating starting an agency later into my professional career. I hear things about managed care moving into higher levels of care, and think it would be great to start my own agency that runs an IRTP, res-ed, or CCU, just finding the funding seems to be the tricky part. As far as personal qualities. I think I possess most of the personal qualities that are needed to go it on my own. I think the only struggle I see for me is working with managed care. I’m not really sure how I would react to someone without any clinical experience telling me how I many sessions I am allowed and why. I can guarantee that it would not be a pretty reaction. As far as pitfall concerns go, I see myself struggling with marketing and accounting. Im not sure about how to market and would have to take a couple of courses in it, and well accounting. Im going to be honest, if I cannot manage it through something like TurboTax, well I’m definitely going to have to hire a company to take care of it because, my math skills are trash.

    When it comes to running a private practice, I really like the idea of it. My father has always told my brother and I that the only job security you have is when you work for yourself. I also, would like to make some money, and being in private practice is where that seems to be (if it remains small, then maybe I could keep it under the table, all cash). I also do want to at some point move into an administrative roll, and think that private practice (if it grew large enough) would give me that opportunity. I think that it would be kinda easy for me. I have kind of been ‘planning’ this for a while, and have drawn up a rough sketch of how this would play out if I did it. Again the road block I’m hitting, is how to go about securing funding for it.

    I think running a counseling practice differs from other practices in that we really have to show that we are special or unique about us for us in order to attract clients. Additionally, working with HMOs is vastly different for us. We basically have to barter to provide what we believe to be the appropriate treatments. When it comes to medical and dental companies, it seems to be all standardized and no real negotiation. I needed to see an orthopedist for my hand, my doctor wrote a note and BCBS approved it. Orthopedist wanted to see me 3 more times, BCBS approved it.

    Reply

    • Lilianne Elicier
      Jul 03, 2020 @ 21:24:31

      James,

      As you mentioned I also like the thought of being my own boss apart from the risks that are involved. I haven’t had a lot of experience working with managed care but this is why I hope to hire someone to help with this if that is possible. I also see myself struggling with marketing and financial responsibilities but my plan is to have my older brother help me out with this as he has his masters degree in financing and marketing. My math skills are also trash LOL but we will get through it together, maybe with a complex calculator( we probably won’t know how to use)?!>! I also have been planning ultimately as my goal to have my own private practice.

      Reply

    • Julia Irving
      Jul 06, 2020 @ 18:37:36

      James,

      I agree that off that bat it sounds like a huge risk to go into private practice with all the uncertainties and the financial piece. I also wrote about how it would be nice to be my own boss and make my own hours but I feel like I would miss having colleagues around. I also like the thought of an organization providing me with salary, benefits, and taking my taxes out for me. I see myself struggling with the business side and would definitely need to take some business classes before I would even consider private practice.

      Reply

  3. Julia Irving
    Jul 05, 2020 @ 14:11:04

    (1) My first thoughts when reading about private practice is “wow that sounds like a lot of work. If I were to consider private practice I would definitely take some business or marketing classes so that I know what I am doing. I do like the fact that I would be my own boss and that I could create my own schedule, but being my own boss comes with a lot of other responsibilities that I did not consider. It sounds like it would be a lot of stress getting started but then beneficial once the private practice is established. If I was to do private practice I would probably want to do it with another therapist to share the work load and also to have a coworker because it does sound isolating if it constantly just you and your clients, no colleagues.

    (2) As I stated above, if I considered private practice then the first thing I would do take some business classes. Once you consider private practice, to me you are no longer just a therapist. You have many different roles now in your business. I think this would overwhelm me, as I am not familiar with creating/running a business. I think it would be hard for me to switch between ‘therapist’ role and ‘business’ role mainly because I have never had to. There is a chance that I could be good at it but I would not know unless I tried it. As of right now though I think it would be difficult. A business plan would be very important to develop when starting out. As someone who is a huge fan of lists, I would definitely have a long business plan that would check off all the boxes that need to be covered. The thought of keeping track of my own taxes also stresses me out. As I mentioned in class my internship placement offered me a job post grad but I would have to get my own health insurance and take my own taxes out, they suggested like the book to take 30% out of my paycheck. Having to remember to do that each paycheck right out of graduate school seems like a little much right now. I would rather get a job for now that already takes my taxes out so that it is less of a worry.

    (3) Running a counseling practice is different because mental health does not always get the same recognition as other helping professions. There is still a stigma around mental health and receiving help for it. There is also more liability when it comes to mental health because of suicide and homicide rates; liability insurance is necessary. I feel like advertising would also be harder for therapists with their own private practice because they have to stand out more against all other therapists in the area.

    Reply

    • Cynthia LaFalaise
      Jul 07, 2020 @ 21:50:16

      Julia,
      Prior to this reading when I thought about private practice I didn’t even think of hiring additional staff. I realize now that would be more beneficial than being a one man army because the amount of work that will be required to run a private practice is overwhelming. The accounting aspect and having to do your own taxes is a turn off, nonetheless I think the long term success of a private practice would outweigh the stress full work that goes into it. Like others have mentioned, getting started is the hardest part but once established you get to reap the benefits.

      Reply

    • James Antonellis
      Jul 08, 2020 @ 10:23:48

      Julía,

      Besides your competencies as a therapist, to me it seems like the biggest indicator of whether or not your practice is going to succeed is how you delegate tasks related to the things that you know you do not have a talent for. For me I know it would be marketing and accounting. I would like to think that in private practice we could use some of that software we see advertised on TV that sends bills straight from an app on our phones, but lord knows there is probably some HIPPA compliancy issue that would prevent it…maybe we just have bill for some very expensive coffee (HAHA).

      Reply

    • Kaitlyn Doucette
      Jul 08, 2020 @ 16:29:55

      Hi Julia,

      I had a very similar initial response to yours- this seems like a lot of work! I don’t know much about running a business at all, which I talked about in more detail in my own response, and taking business or marketing classes is a great idea before pursuing private practice. I also share similar concerns to you about running my own private practice. The amount of stress that comes with starting a private practice seems like a lot. I worry that I will get too overwhelmed by the large workload and the additional stress of running a business on top of being an effective counselor for clients. Having a business plan, as you stated, sounds like a great first step. It sounds to me like you would be very thorough to ensure the success of your private practice. I’m sure with some additional education on business skills, you would do great!

      Reply

    • Tricia
      Jul 08, 2020 @ 17:39:46

      Julia,
      I appreciate your blog post reflected being in private practice, you are no longer just a therapist. We are working hard to study aspects of mental health we are passionate about and the business management aspect does not hold any of my interest. I think I would be overwhelmed and I would experience more burn out given it is not a topic I am passionate about. As stated in my blog post I would rather have a positive working environment where I do not have the role of being my own boss rather than being my own boss and balancing counseling and business.

      Reply

    • Danielle Nobitz
      Jul 09, 2020 @ 14:29:48

      Hi Julia,
      I had the same initial thoughts when I was reading this chapter. I really had no idea how much work goes into private practice, however I guess I never really thought that into depth about it. I agree with you and even wrote in my blog post as well that it would be really important for anyone who was thinking about opening their own practice, to take business classes in order to ensure that you would be successful. In my opinion I feel like it would be so difficult for someone in our field to be able to run a successful private practice with no prior business experience. I also agree with you that mental health is not seen as important as physical health. There is definitely a stigma around seeking help for mental health, and I think it shows. I think it becomes difficult in this realm when dealing with insurance companies and trying to plead your case with insurance companies for more sessions.

      Reply

    • Lynette Rojas
      Jul 11, 2020 @ 23:25:58

      Hi Julia,

      Reading the chapter on private practice, I also thought it was a lot of work. I did not know that there was so much to opening up a private practice. As you mentioned in your post, I would also have to take some business classes or something to be able to learn more about how to run a business before I consider opening up my own practice. I also think that it could be very isolating to run a private practice by yourself. I think that I would also prefer to start by opening up a private practice with another therapist to be able to share the work load and have someone to talk to about the business while I’m there.

      Reply

  4. Sam
    Jul 05, 2020 @ 22:47:42

    [1] In reading this week’s chapter and reviewing the tables provided. Ultimately, what was clear to me initially, is that It seems there are more cons to opening your own practice vs. pros. With this, I can say that although private practice is something I envisioned for my future, I can say that those ideals were always realistic. By this I mean that, although I would love to have the benefits of being my own boss, where I can work very flexible hours (which is especially great if you have children), and set my own fees, etc., I also recognize that I lack a significant amount of knowledge as well as some personal qualities for running a successful private practice. I discussed this to a small extent in my previous blog post, where I wrote that we were never taught about doing our taxes or building credit scores, etc., in high school, and I find a similar experience here—where I feel a bit clueless as to how to run my own business. Although I do know that this class will go into some detail about establishing our own practice, and I’m sure this is something you can also learn from colleagues, it is still not something I currently feel confident in pursuing (although, that may be pretty normal). Additionally, after reading some of the personal qualities beneficial for opening a private practice, I do lack in areas of self-confidence, basic business skills, and willingness to take risks and cope with uncertainty (because I’m already poor and can’t afford to be even more poor!!!! Especially with another human to care for). However, on the other hand, I do find that I encompass other qualities listed—which does instill some hope. Notably, I did have the parents of some client’s during internship ask me to reach out to them to let them know “wherever I end up” so they can transfer their children there (which was of course nice to hear), but it did also encourage the notion that I would in some way be able to advertise myself and my practice well. Finally, although I do not have an extensive skill set right now in dealing with this specific population, but I do have a strong motivation to work with families/ couples (particularly young adults) who are expecting while also working through mental health related issues. I realize this population is very small and limited, but feel that it would be a great opportunity for a private practice (I would of course include other populations as well if there was a lack of pregnant couples seeking therapy!)

    [2] As previously mentioned, I feel that I currently lack significant skills related to running a business. With this, if I do decide to pursue a private practice in the future, I would certainly have to acquire some skills in this domain through courses, trainings, etc. (or I could just hire someone to do that dirty work for me!). Regardless, it would definitely be a challenging task for me. Although I am organized, have decent time management, am willing to ask others for help, I still find that I would have difficulties in establishing my own practice as I would have a lot to learn (e.g., learning more about working with managed care and billing). Nevertheless, I don’t want to completely eliminate the idea of having my own practice, so I would surely be willing to put in the effort needed to learn the skills to establish an effective practice when the time comes. I find that perhaps it may be most beneficial to find an opportunity to, in a sense, “shadow” someone who has their own practice, and learn the ropes that way also—I feel I may understand the process better when I can see it actually being applied.

    [3] Well, I wouldn’t entirely compare a counseling to practice to that of other helping professions. I mean, I suppose if you are opening your own business with regard to those professions, the process may be somewhat similar. However, I feel that there are several challenges that those working in the mental health field experience that those in other helping professions don’t. Particularly with managed care. I’m not entirely sure, but I don’t believe other professions have to fight for treatments required for a patient (i.e., if the dentist says you need 7 fillings, well then, your insurance will cover those 7 fillings), where as if a mental health clinician says they need an additional 6 sessions, they’ll get 3. Moreover, as some of my peers have already mentioned, there is an increased liability in our field due to possibilities of suicide. However, I do find them to be similar in the same sense that doctors, dentists, physical therapists etc. are also responsible for a patient’s welfare (however, you probably won’t die from an incorrectly placed filling). Finally, I find our profession to differ in the way that that mental health clinicians learn more about our clients than any other helping profession. We know many significant details of their life as well as their presenting concerns, where as other helping professions typically only gather information related to the current reason for the visit (e.g., typically dentists are unaware of every single negative life experience that has occurred in their client’s life).

    Reply

    • Julia Irving
      Jul 06, 2020 @ 18:41:34

      Sam,

      I also feel a bit clueless when it comes to running my own business. I have never taken any classes in business or taken the time to learn about it. After reading this chapter it is clear there is a lot more to private practice then just doing therapy with clients and having flexible hours. I am not sure if I would be able to take on all that responsibility with such lack of knowledge in the area. Although there are pros to private practice, I would need to do a lot more research and gain some background knowledge if I was to ever pursue it

      Reply

    • Pat
      Jul 10, 2020 @ 22:40:52

      Sam,
      I bet that the population you identified that you’d like to work with would be a great niche population! I mean it has all of the components in your favor: there’s always new couples expecting, there are always a host of difficulties, both mental and physical, that are associated with such a large transition, and you likely won’t run out of business any time soon. I remember reading the suggestion that a private practice needs some sort of niche role it can fulfill, and I don’t think I was able to conceptualize what that looked like. Your population absolutely exemplifies what (I think) a niche role, is!

      Reply

  5. Cynthia LaFalaise
    Jul 07, 2020 @ 20:05:57

    One of my goals entering the field was to eventually do private practice. I’ve always hated working for someone and aspired to be my own boss. Given the information provided from the reading, I am not deterred. Having your own private practice is owning a business, with that comes the sole responsibility and discipline of managing every aspect including financial. This disadvantages listed in table 8.1 did not come as a surprise. I do think that you have to be really motivated to pursue private practice because it isn’t easy. You have to be very organized and be knowledgeable on things outside of practice such as the financial aspects of running a business. This includes possibly losing money before you make it which not many people consider (businesses are an investment=there’s always a risk!). I personally would need more experience as far as learning how to run a business, marketing, and dealing with MCO’s.

    I think counseling private practice differs from other helping professions in that we have to advocate more for our treatment decisions compared to other professions. Insurance companies may not give us the appropriate amount of sessions to bill for where as other professions can simply ask for more and be approved without a hassle. As others have mentioned theirs more liability for malpractice because of the added risk of suicide potential, however as far as the process for starting a business I think it’s quite similar to other professions.

    Reply

    • Lilianne Elicier
      Jul 08, 2020 @ 15:02:19

      Cynthia,

      My thoughts exactly I am-not deterred from private practice despite the hardships at the beginning. This has always been my end goal and I know I will make it happen with the right help. Being your own boss has a lot of advantages especially as a mother in my perspective which motivates me even more! I myself also need more experience in learning how to run and manage a business.

      Reply

    • Kaitlyn Doucette
      Jul 08, 2020 @ 16:56:14

      Hi Cynthia,

      I really appreciated your confidence in wanting to pursue private practice even after weighing the pros and cons since I did not share the same confidence. I wish that I had this same confidence in myself! I liked how you explained your thoughts on private practice and starting your own business. It seems less daunting when you explain it so matter-of-factly. It sounds like you excel at being able to take your emotions out of your planning, and you are very motivated and know what you want. I think this will take you far in the business world! Thank you for sharing your thoughts.

      Reply

    • Tricia
      Jul 08, 2020 @ 17:32:59

      Cynthia,
      I respect that you are not deterred from private practice it shows your resiliency and determination for hard work while recognizing skills you need to improve on such as the business aspect of the financial aspect. I was quickly deterred by the work and possibility of going back to school for another major.
      I also appreciate you mentioned the differences in counseling private practice and other private practice as we have to fight for sessions for our clients and justify the importance of treatment, which is not always similar in other practices. Suicide risk is another key difference I considered as it may be a minimal risk in other private practices but we work closely with SI in the mental health field and its severity with our clients.

      Reply

    • Pat
      Jul 10, 2020 @ 22:35:45

      Cynthia,
      I’d never considered the advocating side in the private practice core of our field. In general outpatient, I imagine we will be playing our fair share of phone-tag with insurance companies, trying to get a few more sessions. That said, I imagine in private practice, the arguments would be more difficult to pull off. It isn’t a company like Spectrum where the insurance company knows the name, the purpose, etc. For a private practice, we’re arguing based on less of a platform right off the bat. I admire your tenacity in pursuing private practice nonetheless; certainly more risky than I can stomach, but if you can then you’re probably in the right frame of mind!

      Reply

  6. Kaitlyn Doucette
    Jul 08, 2020 @ 16:21:45

    [1] When considering the advantages and disadvantages from table 8.1, it definitely seems that there is a lot to consider before deciding whether or not to pursue private practice. The two main disadvantages that deter me from pursuing private practice are working much more than 40 hours per week and needing to have good business skills. Having a heavy workload is something to consider when you have other roles and obligations in your life outside of work. This makes me think of the life span, life space theory we discussed earlier in the semester. I would like to make room for other roles in my life, such as being a parent, friend, and spouse/partner. My interpersonal relationships are very important to me and I would want to ensure that I have enough life “space” for my private practice, as well as my other roles, before pursuing this option.

    Another disadvantage that concerns me is needing good business skills. I will be the first to admit that I know very little about the business world. I am not the greatest at handling my personal finances, bills and taxes; the idea of doing this for a business seems daunting. Marketing and public relations are not a strong suit of mine either. I am sure that these are skills I can develop through additional education or training, however I would not feel competent enough in my current state to handle these additional tasks.

    [2] I think that running my own private practice as a business would definitely be challenging for me. As i previously mentioned, the “business” side of things is not a strength of mine. I know very little about running a business, and from what I do know, these aren’t skills I naturally possess. Personal qualities that I possess are what I am self-motivated and can function independently fairly well. I would need to learn a lot more about business skills, marketing, and financial management skills before I pursue my own private practice. Owning my own private practice has never been something that I’ve thought much about, however it is definitely something worth thinking about in the future because it seems like it also comes with some great advantages. I would enjoy the flexibility and being able to be my “own boss.” It also appears that the financial benefits are worth pursuing (so long as the business is successful.)

    [3] Running a counseling practice seems very similar to running a different practice within the helping profession. For example, both require malpractice and business insurance, documentation of health records, managing finances (budgeting, planning, etc.), setting and disclosing fees, and working with MCOs. I actually never thought of private practice in this context, however it truly does seem similar to running a practice in a different helping profession. The main difference I can think of is the type of care that a counseling practice would provide compared to other helping professions. Additionally, I think that there might be more flexibility in client care compared to other professions. For example, counselors can develop a niche for their practice. I don’t know that there is as much flexibility in other helping professions, aside from possibly having an area of expertise. Another difference I can think of is that fees for services from a counselor are not as high as most other helping professions. I do not expect that I will be making nearly as much money as a dentist or physician in my private practice as a counselor.

    Reply

    • Abigail Bell
      Jul 09, 2020 @ 11:57:28

      Hi Kaitlyn,

      You make a really good point that starting a private practice may not allow us to make time for other important things in our life. Like I cannot imagine how difficult it would be starting a private practice if I had other responsibilities, such as being a parent. I also feel like it makes it harder to have a separation between life and work when your business is basically yourself. I definitely agree that the business part of owning a private practice sounds very complicated and like you need to know a lot of things about a wide variety of fields such as marketing and billing. That in itself is enough to put me off.

      Reply

  7. Tricia
    Jul 08, 2020 @ 17:17:48

    (1) I always thought about running my own practice, but the motivators for it were not a sense of autonomy, while it does sound appealing. To be honest, I think when I was younger and a bit unaware of how the field worked, the prestige piece of having a private practice was a major influence. As I got older, I learned about the hard work and dedication that goes into private practice. Some of my family is in private practice for the medical field and just observing the tasks they have to go through reassured me that private practice is not all it is made out to be. I feel the daunting task of running a business is an exceptional weight to carry and that focus could draw away from my passion for counseling. While an advantage to private practice may be the flexible hours which is without a doubt an important consideration, running your own practice comes with a lot of outside the job homework. As clinicians, we say we are concerned with making all of the paperwork deadlines with a full caseload. Imagine the difficulty in meeting those deadlines when you are trying to obtain grants, work with managed care, and keep the business above water. I am becoming increasingly more confident in my abilities to be a counselor, but I was not a business major for a reason!
    (2) Relatedly, I do not think I possess the skills required to run my own practice, thus making this an exceedingly difficult task. I do have skills such as self-motivation, counseling skills, willingness others to help, etc. That said, I know I do not possess the skills necessary to run a business. I can go back to school and take business classes, learn the process, and work my way to build those skills, but it is not where my passion lies. My aim and purpose for studying in my master’s program is to help clients enhance their functioning and reduce their mental health symptoms. When at my internship, I began to love the outpatient setting. Stress occurs when working in a nonprofit, but I believe working in an environment that promotes growth, enhancement, training, and other key concepts we have discussed throughout the semester can lead to a successful and content career.
    (3) I see the similarities with the amount of work that goes into private practices, both with counseling practices and other private practices. As I mentioned before, I have family members that delegate the tasks of private practice and the amount of time it can take away from the actual medical practice. The hiring process, health insurance coverages, deciding time off requests, and of course, the more critical business components within the private practice. I will say similar to my colleagues, I agree it is different in terms of working with other agencies and asserting the need for more sessions. Furthermore, I find that the main differences lie in the context of private practice (counseling, dental, physical therapists) rather than the business requirements.

    Reply

  8. Pat
    Jul 08, 2020 @ 19:07:52

    Pursuing private practice, in my head, boils down to taking the risk. Working for yourself does have some perks: set your hours, creating jobs for other people, taking direct action within your own causes of interest. All of those are great perks, and none of us would deny having some extra cash on the side would be nice. The thing that keeps me, and likely will continue to keep me, away from wanting to pursue that direction is the steady vs. unsteady part of private practice. If you work for an employer, had you sign a contract that states this many hours to us will result in thus much money for you, there is an understanding that you will make “x.” You plan your budget around this, you decide where you can live, what insurance can you afford, what can you do for yourself and your family, etc. A lot of your planning around a given year is based around what is sustainable. What can we do with this budget, so that if there were unexpected circumstances, we would still be able to afford the home/apartment, payments on the car, groceries in the house, etc. With private practice, there is no guarantee. You can throw everything you have at private practice, spend the money you need to find a position, network to other areas and professionals to create a web of interest, promote yourself well, use reasonable costs for therapy, etc. and still come out on the other side with nothing to show. It’s that uncertainty that would be the most worrying part. I want to be able to know the moments before I fall asleep, that I can support myself and others around me. If I’m in private practice, you move with so many factors, that isn’t always going to be possible.

    (2) The other thing that keeps me unlikely to move into private practice is the business aspect. At the end of the day, you’re running a business. In any business, you have to make tough decisions fairly frequently, and more often than not, someone gains something for someone else to lose something. This would be so hard to do for me. If a location fee is under my name, and it’s a private practice with a few clinicians, and I can’t afford to keep everyone on board for whatever reasons, of which there are many that can fluctuate as well, I don’t think I have it in me to look at someone whose trying to help people and provide for them and theirs and tell them that by the end of this meeting, you’ll be out of a job. I don’t want to spend 55+ hours a week making sure I’m running a successful business instead of 40 knowing that all of my energy is being directed to my clients. I don’t think I’d be able to provide my best therapeutic services to a client when I’m wondering how I’m going to make my practice work.

    (3) I think the difference in this profession is that other professions tend to have a “pass-fail” model. If you’re a dentist, your reputation is built on whether you physically fix someone’s tooth. A surgeon builds there reputation by their successes in surgeries, their bedside manner, and their failures as well. For therapy, I don’t believe it is as “pass-fail” like that. Our reputation isn’t necessarily built on whether we did our job well in a specific moment. Most people can describe what makes a good dentist. They know the qualities they want, it’s fairly uniform across most people, and then they search for it. For a clinician, there are so many different characteristics and opinions on what makes a “good” clinician, that you can’t appeal to everyone in a population. If a surgeon messed up my surgery, I wouldn’t recommend him. If a dentist cut my gums multiple times, I wouldn’t recommend him. But for a therapist, although a silly example, some people will boil it down to “they didn’t talk right.” It isn’t a physical, tangible change that can be perceived, it is a more personal and variable descriptor, which makes running a counseling practice so tricky. What one thing can you show a population of people that proves you are a good clinician that everyone would want?

    Reply

    • Abigail Bell
      Jul 09, 2020 @ 11:47:12

      Hi Pat,

      I definitely agree that pursing private practice seems incredibly risky. The uncertainty aspect is definitely something that scares me, which is why I would probably not pursue it either. I also agree that being the one to make the hard decisions, especially when it would affect other peoples lives, would not feel great at all. However, I can see the benefits of starting a private practice and I think that people with a more entrepreneurial mindset that would excel greatly in starting one. I also definitely agree that that is a big difference between our field and a more medical helping profession. There is a less tangible product that we are offering and there aren’t necessarily clients referring their friends to see us, and even if they did we would most likely not be able to work with them for ethical reasons (lol).

      Reply

    • Sam
      Jul 09, 2020 @ 15:27:46

      Hi Pat,

      I really liked your discussion related to the differences between our field vs. other health professions. You are so right. Typically when people look for a dentist / doctor they basically look for someone who has the highest success rate (along with simple personal characteristics like being nice, etc.) With therapists, the reason people may recommend/ not recommend you may be for so many reasons, and they can be the smallest instances. So in that sense, it’s like–there is so much added pressure on our profession to really please clients vs. other professions. That’s something I didn’t think of in writing my post, so thanks for sharing that perspective!

      Reply

  9. Abigail Bell
    Jul 09, 2020 @ 11:35:33

    It sounds like there are a lot of benefits in pursuing private practice if done well. However, as of right now, I have absolutely no desire to go into private practice. It sounds like there is a lot of work and uncertainty that is involved in opening a private practice and that just sounds really unappealing to me right now. This probably has a lot to do with still being a student and the current state of the world, but I also do not think that I have many of the personal qualities on the list. Which makes sense to me, because I have always been more of a teamwork person and I am looking forward to working in a place that has other clinicians. I think the only way that I would start my own private practice would be if I found a really niche population that I wanted to work with. Otherwise, I would probably prefer to work for someone who started their own private practice in order to experience a lot of the benefits of having a private practice with way less responsibility.

    I think that running a private practice as a business would be difficult for me. All of the background work with billing, working with insurance, finding a place to set up shop and so on would be a lot on top of actually working with clients. I also think that businesses view people just as consumers and they care more about the money than they do about the actual people themselves. If I had my own practice, I think that would be a weird thing to balance. I also know that a lot of private practices do not take state insurance because the rates are so bad. I would feel bad about turning people away because of that.

    I do not think that running a counseling practice is very different from other helping professions. I think that the structure is very similar, billing, working with insurance, building a client base, etc. Before reading this question I had honestly never thought about comparing these professions in terms of independent practice, but it seems as though all of these professions share the same process.

    Reply

    • Danielle Nobitz
      Jul 09, 2020 @ 14:23:14

      Hi Abby,
      I totally agree with you that private practice seems like a lot to handle, and I also see myself not having a lot of the qualities that were on the list. I feel like it would be really difficult to balance the ability to market and do billing as well as have a full caseload and work well over 40 hours a week. It was appealing to me before I knew all of the negatives! I also see myself as more of a teamwork person, and I do not mind having a boss. Sure, being your own boss would be nice, but being able to turn to someone for guidance once in a while is something that would be really important to me. This chapter definitely made me rethink my options, and I would definitely rather have consistency in my occupation rather than taking a huge chance with opening up my own practice!

      Reply

    • Sam
      Jul 09, 2020 @ 15:21:08

      Hi Abigail,

      I liked your discussion for this post, particularly regarding your comments on having difficulties balancing the idea of clients being consumers vs. actual human beings, and with the turning away for not accepting state insurance. I think those two points are extremely valid when discussing the establishment of a private practice. Many of us have already said that it would be difficult to open a practice, particularly with regard to finances. With this, I too feel that many may struggle with taking in as many clients as possible just to start making some money back, which could lead to poor quality of care and quick burnout. Additionally, I myself would also worry about the type of insurances accepted within a private practice. So many agencies that accept state health insurance are so booked up the waitlist to see people is like 6 months- year. Therefor, if I were to ever open my own practice, I would like to be educated or stable enough to figure out a way to include/ work with all types of insurance policies. Great points!

      Reply

  10. Danielle Nobitz
    Jul 09, 2020 @ 14:18:50

    My current thoughts about pursuing private practice after reading the chapter as well as looking at the tables from the reading, are jumbled. I always thought that after I got my license, that I would want to be in private practice because that’s where you make the most money. This job obviously isn’t about the money, however money and a good salary are certainly important to me, especially after going through intensive schooling to do what I love. Looking at first glance of table 8.1, it is obvious that there are far more disadvantages to working in private practice than there are advantages. Even the advantages had their own disadvantages within them. I think the thing that really opened my eyes was the “fluctuation” in pay, depending on caseload. I am someone who definitely benefits from consistency, and that fluctuation in pay depending on client caseload, as well as probably having to work far more than 40 hours a week made me realize that private practice may not be for me. I would rather have a consistent full time job with benefits than to have an inconsistent schedule, and have everything fall on me. I’m sure it would be rewarding to have your private practice succeed, but if it didn’t that would be a lot of stress, time, money, and energy wasted. Something that also surprised me was the mistakes that can be made when having your own private practice. Something I never thought about (which probably sounds dumb), is how much a private practice is business related. I didn’t realize all the mechanics that fall into it, like making your own website, picking your own counseling rate, marketing, having money saved for unexpected expenses, etc. There’s really a lot that goes into private practice that I wasn’t really aware of before reading this chapter. It definitely makes me a bit more hesitant to want to go into private practice, or maybe working for someone else’s private practice could be more beneficial than having your own.

    When it comes to my thoughts surrounding running my own private practice, I don’t think I could ever do it to be honest. I think due to the fact that there is so much of a business aspect behind it, I wouldn’t be very successful. I think to truly be able to have a successful private practice, you would either need to take business classes or hire a business manager in order to help you out with the business part of private practice (which would be added expenses). I really can’t imagine having to focus on a full caseload (in come cases, an extremely full caseload) as well as worry about insurance, billing, marketing, networking for your practice, etc. It would honestly be way too much to handle for me. I don’t think I would do well in that realm.

    I think that there are both some similarities and differences when it comes to counseling private practice, and other practices such as physician, dentist, etc. For the similarities, I believe that the overall business and marketing for the practice would be the same, as well as malpractice insurances, health records, insurance, etc. However at the same time, I think it’s important to acknowledge that a lot of the time in this country mental health is not seen as important as physical health. I believe a major difference when it comes to other medical professions and counseling professions is the fight for more insurance coverage for clients. I know insurance coverage can be crappy for both physical and mental health, but at least in my experience I have seen a lot of cases within my experience of clinicians trying to plead their client’s cases to insurance companies in order to get more coverage and more sessions for their clients. Asking for more coverage or more sessions is difficult within agencies, I can only imagine how difficult this would be for someone to do for their own private practice.

    Reply

  11. Lynette Rojas
    Jul 09, 2020 @ 16:15:31

    (1) After reading the chapter on private practice, I learned a lot about all of the responsibilities, sacrifices, and tasks that come along with it. Private practice is something that has been on my mind before even applying to this program. I would still like to have my own private practice because of all of the benefits that come with it. It definitely seems like it would be very stressful at first, but in the long run I think that it would be worth it. I plan on having kids in the future and having flexibility and being able to make my own schedule would be very helpful to be able to spend time with my kids and take them to their appointments without a problem. Spending time with my family is definitely something I value and having my own private practice will allow me to do this freely. I will definitely need to gain a lot of experience in the field before I decide to go through with this. After I gain this experience, I would be more confident with my competence as a counselor and have an idea of the population I would like to work with. I am very motivated to succeed and determined to only become better as the years come. I think that this will help me when opening my private practice. After reading the common mistakes listed in table 8.3, I will definitely have to learn more about the different key components of private practice to ensure I don’t make these mistakes.

    (2) I always knew that running a private practice would require knowing about how to run a business because that’s what it is. I just didn’t know all of the work it takes. I would definitely need to learn more about business before even considering opening up my own practice. I was glad to have read about the common programs used to keep up with the finances because I actually have worked using QuickBooks before and it was pretty easy to learn. I think that with taking some business courses and asking others in private practice for advice I can figure it out. I would definitely need to make a plan and be prepared to be stressed out for a little while before it’s stable. Marketing is also something that is very important and I will need to learn how to do this through networking and getting involved in the community as much as I can.

    (3) I think that running a counseling practice is similar to other helping professions when it comes to the business part of it. However, as others have mentioned I do think that there is an increased liability with this profession due to the possibility of suicide and homicide.

    Reply

  12. Chris
    Jul 09, 2020 @ 18:06:12

    After doing the readings this week, part of me has a clearer understanding of what private practice entails, but I also think I have more questions on the reality of actually doing it now. I had considered before that there were pluses and minuses to private practice, but I think seeing the comparisons of the two laid out makes it easier to interpret. In all honesty, I’m not sure if private practice is something I’d want to go for at this point. It seems like a lot more work than if I were to work with a coalition of people that can work together. I know that might sounds lofty, but the extra work load, separation from friends and family, and necessity to rely on capitalism prevalent in private practice are definitely big draw backs. I think the personal qualities and common mistakes listed while beneficial, are more based on a business mindset, which I’m again not a fan of. As you can probably interpret by now, it doesn’t seem like I’m going to be a fan of private practice. However, if I want to be able to counsel how I want and be able to help certain at-risk populations, I think it could be beneficial in the end.

    I kind of already said this, but I’m very much against the idea of running a private practice, and honestly counseling in general, as a business. I understand that it has to be this way so we can make money and live, but I personally don’t like having to charge exorbitant amounts of money for mental health treatment. If I did have my own private practice, I’d imagine it be difficult for me to prioritize a business mindset. I’ve already thought about doing counseling pro bono, or for some kind of bartering system, so focusing on making money off of people’s mental health doesn’t sit right with me. This is mostly the reason why I think that the counseling profession is different from other healthcare fields. Even though other healthcare individuals do work to aid people, I don’t think the same level of empathy is as integral to their profession as it is to counseling. This is not to say that they don’t care about their patients, but that they might not feel as guilty charging them money for services and running their practice like a business.

    Reply

  13. Maria
    Jul 09, 2020 @ 18:31:46

    Based on our readings this week I think I still have a lot of thinking to do as to whether or not private practice is the way to go! When I initially looked at the advantages and disadvantages, I saw many of the thoughts that initially came to my head such as being my own boss, having a flexible schedule, having control over who I see, but then I looked at the other side… I think that it really hit me that once we are on our own, EVERYTHING is on us. I had not even fought about the fact that all of the ‘small’ stuff would be on us and it may sound silly but the fact that if we take a vacation or get sick, we take a BIG hit kinda made me think twice. I think I have some of the qualities to have a successful private practice, however, there are some skills I haven’t mastered such as financial management over a business, marketing, investments, etc. I think I would need to be financially very stable before I even considered opening my own practice. I think I’d need to know all the outcomes and be ready for the possibility that it may fail. I also think that I would enjoy it if I felt secure! It’s still a dream, just one for years from now.
    It has always been a dream of mine to have my own private practice ever since I knew I wanted to be in this field. I know multiple people that have their own practice and even seeing it in movies made me want to do it even more. It’s currently still a goal, but one that I’m going to take a few years to get to. I had a conversation with an old supervisor regarding private practice and she agreed that it would be a great idea. However, she was also very honest about what it would take to do so. Like we said, private practice isn’t just about doing therapy on our own, it’s about running a business, something that I don’t know a whole lot about. Renting an office could be expensive and making sure it meets the right standards could be tough too. Also, my supervisor and I talked about the benefit of working privately and in an angency. She said that although it can be nice to be on our own, there are times being with others is super helpful and beneficial. She said it’s nice to be able to talk to others and collaborate with them and just be around others, which I took into consideration because I love talking to people. Also, one of my own reasons I wouldn’t pursue private practice right now is simply because I don’t think I could get it off the ground. My supervisor said it was important to gain experience and get help from others now before embarking on my own. That is why I think taking a few years and working for others would be beneficial right now. Hopefully in 10+ years I’ll open my own practice with another LMHC so that I’m not totally alone but still my own boss. 
    I think that running my own counseling practice is different from any other profession simply due to the personal nature of our work. Yes, we all help people and try to improve or sustain their health. Of course, if a private run dentist ruins your teeth or hurts you there is consequences, but we handle with peoples mental health. It is not something that we take lightly and something that is overlooked. Many people do not see the benefit or the need for us. It would not be us simply sitting and gossiping with our clients, we are helping these people by providing therapy. Therefore, we are not simply a part of the helping profession, we are helping in a very different yet important way.

    Reply

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Adam M. Volungis, PhD, LMHC

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