Topic 9a: Private Practice {by 3/26}

Based on the readings due this week consider the following three 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 3/26.  Post your two replies no later than 3/28.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

32 Comments (+add yours?)

  1. Rachel DiLima
    Mar 22, 2020 @ 17:14:05

    1. After reading the chapter and reviewing the tables, I don’t feel as overwhelmed as I thought I would have. When I first considered this career, I had no doubt that I wanted to go into private practice (the farm, PTSD, y’all have heard me go on about this enough). I remember thinking that I was “running out of time”, i.e. getting too old to start down that career path. Its funny though how now, I feel as though I’m just building up to the right moment. I used to be pretty terrible with money, and I had no idea what its worth was to me. Until I didn’t have any. Long story bearable, I have learned how to budget and I know that I can deal with financial setbacks and I can cope with (many) unexpected obstacles. I also know when to ask for help, and I value paying for a service that can help me (like hiring an accountant or a marketer). In short, I think I have the qualities to own my own business, but only with help. And I consider that a strength.
    2. This might be controversial, but I think that prioritizing my private practice as a business will only help me. I think it will help me shut off some part of my “helper” brain when it comes to asking for money, or scheduling, or bookkeeping. I scheduled and tracked my clients while at internship, and I learned quickly that I couldn’t book people with my heart and not my head. I had clients back to back, running over time left and right, and filling any of my private time (lunch break? What lunch break?). It definitely started to take a toll. I then began telling clients when I was available first rather than asking what worked for them first. I began to look at it from the lens of a former life: as a hairstylist. I was here to offer a service, I would do my utmost best in delivering that service, and with that service comes a fee and restrictions. No, you may not book a full highlight a half an hour before we close, and no, I do not offer discounts because you have “easy to style” hair (true stories). Similarly, no, you cannot come in 20 minutes late and still receive a full session, and no, I cannot charge you less because you “only have anxiety.”
    3. I think that running a counseling practice is different from running other helping professions because people expect counselors to make adjustments for them. I think about individuals missing therapy – not showing up, no notice – and the counselor will still call them back and gently ask if they wanted to come in the next day. Would a doctor, dentist, or physical therapist do that? Doubtful. And why is that? Likely because they have someone else who needs their service, so they move onto the next patient. There’s still a stigma with seeking mental health treatment, and there are individuals out there who are unconvinced that therapy is even REAL. I think about how often I positively reinforce people through praise and remarks about their bravery for continuing with their therapy, because it is so easy to just STOP treatment and fall into that “I can do this on my own” and “my friend has anxiety and never saw a therapist and now their fine” kind of mentality. People don’t question the validity of the services they receive from their doctor or dentist (maybe the quality of the service, but not its validity). We, on the other hand, have something to prove almost every time we take on a new client. That the services we provide CAN and DO help, and that they are worth the time and investment.

    Reply

    • Amanda Russo-Folco
      Mar 23, 2020 @ 11:49:07

      Rachel,

      I appreciate you bringing in your own personal experience with your answers. In terms of your last answer, I have not really thought about that until you said it because it is true. I was trying to think of how a counseling practice is different than other practices and that is definitely a difference to think about because we always have something to prove, unlike other professions. Also, I had the same thought that people would think just because we are counselors, we would make adjustments for them but that is not always the case. We have other clients just like how other professions do as well. However, I really hope that one day there will not be a stigma around mental health and people will not have to question going to therapy so it can take a little bit of pressure off of us.

      Reply

    • Marissa Martufi
      Mar 24, 2020 @ 09:03:25

      Rachel,

      I really like how you mentioned knowing when to ask for help. I really relate to that because I have always been the type of person to ask for help when I needed it but as I got older, particularly in grad school and internship- I stopped asking for help, even if I needed it. I guess this came from feeling like I should know the answer or I should be able to do x,y,z without asking for help. I quickly realized this is so untrue and that asking for help is all part of learning. It’s ok to not have all of the answers! Especially with regard to opening a private practice, there is no way we would have all the answers so asking for help and doing this with help is important to recognize and consider. In the end, it will only help and make you a stronger therapist and business owner!

      Reply

    • Mikala Korbey
      Mar 24, 2020 @ 15:38:25

      Rachel, I appreciate, as always, hearing what you have to say. I totally agree with you regarding the second question, that thinking of your practice as a business is helpful/the best way to be successful. Yes, we get into this field to help people, but we need to make money to support ourselves too. I almost feel like people think its a black and white thing, its either helping them and not thinking of it like a business, or business mind only. I disagree with this, I think there can be shades of gray. What I mean by that is, that is you can still help your clients to the best of your ability while also making a profit. I think you stated it really nicely in this response and I totally agree with you!

      Reply

    • Alyce Almeida
      Mar 24, 2020 @ 16:52:28

      Rachel,

      I loved your discussion on your goal to have your own practice and how it could only benefit you – I agree! I think you have great self-awareness on how you could manage your own practice especially when it comes to over booking clients and then taking a toll on yourself. It seems like you were able to really be more assertive and looking at the business lens of things to help manage everything better. I think you can truly achieve your goal for private practice and I hope it works out for you!!

      Reply

  2. Shannon O'Brien
    Mar 23, 2020 @ 02:02:47

    (1) Honestly, I never really considered getting into private practice. I was fortunate enough to spend most of my life knowing that at some point in my career i would want to work both within the psychological friend as the criminal justice field. So, i never really though that this fit into the private practice world. However, i’m slowly learning that this really isn’t true, especially when you need to find your “niche” in this comparative field. Tables 8.1 and 8.3 really put some other things into perspective that were most likely contributing to my lack of desire for private practice. First, the idea of truly understanding all aspects of managed care…FORGET IT. It is not that I am unwilling to learn, I would if i really needed to, it is more that I just struggle SO much with it already. I swear it is in one ear and out the other. Totally a barrier for me both for managed care of the client but also accounting/insurance/retirement stuff for myself. All of that is super overwhelming (even despite there are people out there that could help) for me and totally a contributing factor as to why I may steer away from private practice. Also, the idea that I would have to start out slow and keep it as a “side hustle” for a little while still keeping a full-time job wasn’t something i thought about. Additionally, i would have never thought about having “slow times” during the year either.
    (2) I really utilized tables 8.2 and 8.3 for this question and really took sometime to get personal/realistic with myself. I know i am motivated. I know I am driven. I know I am organized. However, I also know that i benefit from having a boss/someone to report to/a chain of command – whatever you want to call it. I do feel like to be as successful as possible I would need that structure. So, with running my own private practice as a business, I do worry about how effective I would be if I were my own boss. I think there are other contributing factors to this – a lot of other personal ones that many of us have disclosed in the past (confidence level, seeking approval from others, etc…) which we all know we can work on. However, I do overall feel pretty strongly about my need for this type of occupational structure.
    (3) I am having trouble answering this question, but I think I’ve come up with a little something. I also think what I am about to write applies to the therapy world as a whole, not just private practice. Anyway, I think in our world we focus so much more on personal growth and gains than dentists or doctors offices do. I mean personally I feel like when I do to the dentist or doctors office is always focused on problems, not really what is going right or what we are doing well with regarding our physical health and upkeep. As long as nothing is “wrong” we’re good to go. I feel like in our profession we just as equally strive to identify and emphasize strengths as we do things clients need to work on. I hope that makes sense. I don’t know if I even answered the question haha. But, there ya go!

    Reply

    • Marissa Martufi
      Mar 24, 2020 @ 09:21:49

      Shannon,

      I really like what you said in response to question #3. As therapists, we are trained to focus on individuals growth, progress, gains, etc. whereas a doctor or a dentist is more focused on physical aspects of an individual as they should. Like you said, for doctors and dentists, there is a focus on the problems or what is going wrong but not necessarily what is going right. As therapists, although we do have a focus on a client’s presenting problem, we focus on the things that are going right or going well much more than we do what is going wrong. Identifying client’s strengths and successes is such a huge part of the work we do and that really sets us apart.

      Reply

    • Rachel DiLima
      Mar 24, 2020 @ 11:47:47

      Shannon,

      I really respect you for mentioning how you benefit from a “chain of command” in order to keep you accountable and organized. That’s because I LIKE to think that I can be accountable on my own, but reality may be a little less true. Although we are all responsible and capable on our own to some extent (uh, hello, we’re successful grad students after all), there are a lot of moving parts in a private practice. I wonder if without someone to fall back on for guidance or reminders, will I be as successful as I hope? Thanks for the food for thought!

      Reply

    • Jayson
      Mar 24, 2020 @ 17:39:44

      Hi Shannon,

      I can relate to your statement, ” First, the idea of truly understanding all aspects of managed care…FORGET IT. It is not that I am unwilling to learn, I would if i really needed to, it is more that I just struggle SO much with it already. I swear it is in one ear and out the other”. Simply hearing the words managed care or finance is a big turn off for me because it is just so complicated and hard for me to understand. If i were to do private practice, I will definitely struggle and will probably ask for help, but in private practice, you are all alone doing it and have nobody to turn to!

      Reply

  3. Amanda Russo-Folco
    Mar 23, 2020 @ 11:20:39

    1. After I looked at all three tables, there is A LOT to consider when pursuing private practice. I did not know how much goes into having a private practice such as working long hours, not having a steady income, having good business skills, working directly with managed care, etc. Personally, I have mixed feelings about pursuing private practice because I have thought about pursuing it but now actually looking at the tables, the readings, and seeing how much goes into private practice, I am not exactly sure if I could do it. When I was looking at the advantages/disadvantages table, there were a lot of disadvantages I have not thought about such as feeling isolated and lonely working alone and when I take time off, I would not get paid for it and also having a lot of overhead expenses. I know pursuing private practice is very expensive and I know it would take a long time to save up for it but in the end, it could be rewarding as well if it is done correctly. There were also advantages that I liked as well such as being your own boss, having flexible hours, creating jobs for others, creating your own work environment etc. Also, it was interesting to see the personal qualities for a successful private practice because all of the qualities had a common theme of being very independent, confident, problem-solver, being able to handle/cope with stress, and having multiple skill sets (e.g. marketing, financial management skills). I would definitely agree that those personal qualities will lead to having a successful private practice. Looking at table 8.3, it seems those mistakes are mainly around the theme of business/marketing, not being fully motivated or being all in, and billing/insurance purposes and that is definitely something I would personally struggle with because I am not aware of the business/marketing world and how it all works. So, my thoughts about it are mixed because if it is done correctly, it could be rewarding in the end, but if it is not, it would be considered a loss.

    2. My personal thoughts about running my private practice as a business are that it would definitely be difficult for me because like I mentioned in the previous question, I am not fully aware of what goes on in the business world and how it all works. Although, as I was reading the chapter for this week, it helped me to understand and have an idea of what this entails. I know I would have to further familiarize myself and educate myself about how businesses work and what that involves so that way I could increase my understanding of what exactly goes into pursuing a private practice and how it is done correctly. Also, like it is mentioned in the reading, I would have to come to terms with helping clients while enjoying it and making money is a balance that is okay to value and that is something that might be difficult for me in the beginning. However, I do have a strong support system and I know if I wanted to pursue private practice later down the road, they would be there to support me and help me through the process which would make it a little bit easier for me. Personally, if setting up a private practice is done correctly, it would be rewarding in the end because all the hard work put into it ended up being successful. Still, I know it takes a lot of time, effort, money, and knowledge to make a private practice successful. So, my thought about this is that in the beginning, it would definitely be very difficult but then as time goes on, I think that the process will get easier once everything is established and set in place.

    3. I think that running a counseling practice is similar to other helping professions such as a physician or dentist office because I feel that they all entail the same thing. They all require renting/leasing office space, hiring other positions, doing all the paperwork, working with insurance, having malpractice insurance, marketing, networking, gathering their own clients etc. I feel that all private practices are similar, except the only difference is what exactly is the private practice for (e.g., physician, dentist, counseling, physical therapist). Additionally, in terms of charging client’s late fees, is also a similarity between all professions because if a client no call no shows or cancels, they would be charged with a late fee. However, individuals might think that with a counselor, they might be more lenient in terms of rescheduling the appointment and asking the client if they want to come in the following day or whichever time works best for them. In my opinion, I personally feel that they share a lot more similarities than differences.

    Reply

    • Shannon O'Brien
      Mar 27, 2020 @ 02:02:06

      Amanda – I really liked reading all your thoughts about private practice! I feel pretty similarly. There is definitely WAY more that goes into it than I had ever thought about. You really drove home the struggle of having to wait a while for the business to start up, which is really important thing to consider and be prepared for! I think maybe later in our carer paths this would be something we are more inclined to endure, but I think this can be a turn off right now since we have been working so long and hard just to get our degree. It’s like, okay now I have to wait even longer to get my practice going to it’s full potential?? Thanks for your honest thoughts! I think we all got pretty personal in this week’s post and I really enjoyed your discussion!

      Reply

  4. Alyce Almeida
    Mar 23, 2020 @ 12:55:11

    1. As someone who was very interested about the idea of private practice I was looking forward to this reading and information about the in’s and out of it all. After reading about private practice, some of my perspective changed. I still at one point would like to be apart of a private practice or potentially have my own but realized that there is SO MUCH more to it that I need to be prepared for (insurance, financing, ALL the paperwork, marketing, etc.). The biggest one for me is of course finances! Financially I’m concerned as to how I could even do that as a job since it’s not big bucks of course, but also develop and maintain my own business. All these things I have to establish, like a setting to actually conduct therapy and all the insurance and liability that goes behind it, and a business entity – I’m not going to act like I knew what that was before reading because I sure didn’t. Sad reality is that I feel like I’m going to have to be quite comfortable to pursue this goal of mine, and that it will definitely have to be far more along than I anticipated. But I think thats okay and realistically I wan’t as much experience as I can before I’m the head of my own practice.

    2. The idea of running any business has always been something that intrigues me and a personal goal of mine. When I first started the program I was like “heck ya- I’m gonna become a Dr. and own my own practice!!” obviously being in the program and in the field more I realized that a goal like that is very expensive and something I need to put more planning into before truly going for it. And I want to be honest here in saying that my career and education is very important to me, but I would like to take some time to focus on developing my personal life too (build a house, get married, have kids all that jazz) so I want to consider that too when thinking about pursing this idea of private practice. However, I do like the idea of having my own practice because I do like that I am entirely responsible for the business and call the shots or “be the boss.” I’ve always considered myself to be a leader and have strong personality characteristics to run and be in charge of high responsibilities. Don’t get me wrong I still 10000% believe that owning your own practice and business in general is ridiculously challenging and takes a special person to really manage it all. I’m a big team player so I’d like to have a team beside me helping me achieve this all but am also realistic and confident I could do it all on my own. Like I said, still open to owing a private practice at some point, but would love to at least work in a private practice first and work my way up before fully committing.

    3. I think counselling is different than other help professions for multiple reasons. For one, I do think those other services like a physician for example is considered a more “essential” profession to others perspectives – trust me I think we’re extremely essential but the reality is that mental health still isn’t considered “crucial” services that people all have. I think that alone impacts business because realistically our private practice could fail if we stopped having clients whereas for a physician they’ll always be people getting medical services or yearly check-ins. I think the flexibility around our services makes it easy for our services to not be taken as seriously too where we notice a lot of our clients canceling frequently or just no-shows. Which we all know if you no-show or cancel your yearly doctors check-up you’re lucky if you could be seen within several months. I think the process of running a private practice could deal with more obstacles in regards to consistency and success as I feel like it could be easier to flop in comparison to other services.

    Reply

    • Rachel DiLima
      Mar 24, 2020 @ 12:15:08

      Alyce,

      I completely relate to the whole “I’m gonna be a Dr and go into private practice!” thing, especially when beginning this journey. I have found that the best laid plans often fall through, though, and we should be flexible in adapting our plans and sometimes our professional goals. I’m conflicted regarding continuing with education, as I think I’m ready to be done with school, and then another side of me wants to keep going in order to give myself more options for the future. I have a friend who has just recently left her doctorate program in order to focus on her mental/physical/relational health, and was seriously conflicted about doing it. Seeing how relieved she is after making her decision, however, (not to mention her getting a great job with her masters) has opened up my perspective about pursuing my doctorate. Who knows, though. We make plans and backup plans and backup-backup plans and just kinda hope we hit the target at some point. I think you are making the right decision for yourself by prioritizing personal life goals. Keep going!

      Reply

    • Becca Green
      Mar 26, 2020 @ 19:50:42

      Hi Alyce! I had a similar feeling of having this idea of having my own practice but after reading more I felt a little discouraged or as though I couldn’t handle all of the different aspects. I still don’t think I will start my own practice without some sort of business partner who wants to work with me at the practice and feels comfortable leading the business end of things. Maybe someday I will have enough experience to feel comfortable learning about running a business, but that feels distant. Don’t lose hope! You are going to be a great counselor and I can see you doing well with your own practice. You gotta decide that on your own though. 🙂

      Reply

  5. Marissa Martufi
    Mar 24, 2020 @ 08:56:43

    1. I had always had an interest in opening my own private practice. To be honest, I always had the idea that this was much easier than it truly is. I guess I hadn’t really considered all that goes into such as insurance and all the other components that go into running not only a practice, but a business. I also never really considered the time frame of when this goal could become a reality. I think in undergrad I always had the idea that I’d go to school, get my masters, work a little, then open up my own practice and surely that is not how it goes! I think like anything else there are pros and cons to opening your own practice or going into business for yourself. Fortunately, I have experience in finance and running a business but there would still be a lot more for me to learn in regard to running a private practice. However, it is still something that interests me and is something I think I would still consider pursuing in my career.

    2. I have always had an interest in running my own business and I have gained experience in running a business with my family and also with my husband. However, this experience is running a financial services business- much different from a private practice. I do feel that this experience is helpful in regard to potentially opening and running my own private practice. I ultimately think it would be great to run my own private practice and have that experience, but I do not know if I really see that in my future right now. I always thought I did but as I get older, I can’t help but think about what I want my future to look like and if that is something I want to pursue. I actually really go back and forth on this topic a lot. Currently I am married, own a home and a business, but I would eventually like to have kids, etc. and I’m not sure that my plan to run my own private practice will be as quickly or in the timeline I had imagined. I also don’t think that it’s completely off the table though and could be something I potentially pursue down the line – who knows?! In the meantime, I think I would enjoy working in a team environment as a therapist and working with others as I gain more experience in the field and gain more confidence in myself as a therapist. I think confidence is critical to opening your own practice and something I definitely need to work on!

    3. I think running a counseling practice is similar and different from other helping professions. It is similar in the sense that these all require obtaining a location, staff, paperwork, insurance, gaining clientele, and marketing yourself and your brand. Without these things, you would not be able to effectively or safely practice or do your profession because these are all necessary things. In addition, like a dentist or a doctor, counseling all requires a professional to help and treat an individual in the best way possible. I also think that they are different however because I think many people don’t view counseling or therapists in the same way they do a doctor or a dentist. Maybe that’s because a doctor and dentist are treating physical things and physical health whereas a therapist focuses on mental health which is not something you can necessarily pick up on the way you can a toothache, if that makes sense. In regard to this, I think running a counseling practice is different because there is more flexibility in who you can see and when you can see them. Many therapists have hours that coordinate with most people’s work schedules such as having evening availability whereas this may not be the same as a doctor or a dentist availability. I also think that because of this many people may not take appointment times as serious as they would a doctor’s appointment. For example, a client may cancel or re-schedule their therapist appointment last minute whereas they would cancel a doctor’s appointment 24+ hours in advance. I think it is important to reinforce the importance of set appointment times with your clients as a therapist and have policies in place for these situations.

    Reply

    • Amanda Russo-Folco
      Mar 24, 2020 @ 13:11:23

      Marissa,

      I also had similar thoughts about wanting to have my own private practice and I also thought “Oh, how hard could this really be?!” But like you said, I did not consider all those extra components as well. I had no idea so much went into having a private practice and now thinking about it, it makes sense why it would take a while to open one. A lot goes into opening a private practice, but at least you have some financial experience. That’s really awesome because that could help you in this process. Having some experience working in a business is a lot better than not having any experience at all. But, I appreciate you sharing your own personal experience and I hope one day you are able to pursue opening your own private practice!

      Reply

    • Alyce Almeida
      Mar 24, 2020 @ 16:39:04

      Marisa,

      I too had that same plan to own a practice and didn’t realize how much actually went into it. I think it is awesome that you already have some business experience because you can at least have an idea on what to expect business wise! But I admire your honesty about the lonely aspect in regards to private practice because I too felt similar to that – I love that group supervision and team aspect of a work environment. It’s a great point that honestly had me thinking on how I could potentially feel lonely too if I decided to go the route.

      Reply

  6. Mikala Korbey
    Mar 24, 2020 @ 11:12:34

    1. I honestly have never really considered doing private practice. I am not sure that private practice is something I want to do, but is nice that eventually it could be an option if I wanted. After looking over those tables, it does seem like it has a lot of advantages that sound really nice honestly. It seems like it would take a lot of work and time, especially in the front end to get started. I think I could handle it, because I am a very organized and driven person when I have a goal I want to achieve, however I am not sure it is something I want to do. Maybe sometime down the line, many years from now I might be interested, but for right now it is not something I see myself doing.

    2. I think running it as a business would be necessary to ensure that you are making smart business practices. Yes you want to help people, but at the end of the day it is a business and you need to make money too for your livelihood. I do not know much about the business aspect and would need to seriously educate myself about all of that stuff. I think overall, I could do it and manage everything, but I would question if it would be worth it. Keeping track of money and paperwork, scheduling appointments, holding sessions, etc., all seems like it would be a big undertaking and I feel like if it was something I wanted to get into, I would wait several years from now once life is settled, if that makes sense. I also think navigating the insurance world would be hard to do alone and without any help. I assume that too would require a lot of learning too. Also, one last thing, I wonder if I would get too “lonely” working in private practice. The potential of not having co-workers or built in supervision (group or individual) and wonder if those things would be difficult to seek out on your own. I greatly value having co-workers and supervision to bounce ideas off of or vent about a difficult session, and that is something I feel like I would greatly miss in private practice.

    3. I would assume that running a private practice is different than other helping professions, however I feel unsure. I think the nature of therapy is much different than the nature of other work, in that each profession wants to help people “get better”. In other helping professions, such as a physician or a dentist, they are helping the client “get better” in a physical sense, whereas a clinician is helping a client in a less physical sense. I hope that makes sense. I also wonder how billing for insurance might be different for other helping professions versus mental health clinicians.

    Reply

    • Jayson
      Mar 24, 2020 @ 17:46:54

      Hi Mikala,

      I can relate to your comment, “I wonder if I would get too “lonely” working in private practice. The potential of not having co-workers or built in supervision (group or individual) and wonder if those things would be difficult to seek out on your own”. I completely forgot that supervision will not be built in the private practice. Supervision or my co-workers have helped me so much whenever I needed help with something and simply not having anybody to turn to, that just makes me worry I won’t do as an effective job alone. I much rather be in a team with others who are also struggling than just struggle alone.

      Reply

    • Becca Green
      Mar 26, 2020 @ 19:54:37

      Hi Mikala! I honestly didn’t even think about the isolation factor of a private practice until I read your post. Now I am thinking about and worry about the accessibility of consultation and guidance around different cases. I personally enjoy my space and alone time, however I can imagine that if you don’t have a good amount of people at the practice then it would get lonely or discouraging if you feel you want consultation around something. I also just thought about the safety factor of being more isolated.

      Reply

  7. Jayson
    Mar 24, 2020 @ 17:31:33

    1. Private practice has never crossed by mind ever. I know for a fact I would not like to have my own private practice because I essentially think it is just too much work for one person to do on their own. When viewing the advantages and disadvantages, I immediately looked at the disadvantages and began to relate more to the disadvantages than the advantages. For instance, a disadvantage that I related to is I do not want to work on my own and I do not want to feel isolated. I enjoy working in a team with others and I cannot imagine it will be like working alone and simply having nobody to turn to. Furthermore, due to the reading, having your own private practice essentially means you will be running your own business and that is something I never wanted to do. Aside from just doing therapy and other case management things, I never want to do any work involving finance on my own because I already struggle with understanding my own financial problems.

    2. It will definitely be a struggle for me to do my own private practice. Simply hearing the word finance or business plan just already sounds like so much responsibility and complications. As we are all beginning our therapy career, I mean, doing therapy can be overwhelming at times and now we have thought about how to construct a business, it just sounds like it will be very hard to do. In the reading, the sentence that I can most relate to is, “Obviously, if you can barely manage your own finances you will not be able to manage your business finances”. I have an extreme difficulty understanding finances and how everything works so having my own private practice, the financial portion will definitely cause me much difficulty.

    3. In regards to the business portion of a private practice, then I don’t think it really is that different compared to a business done as a physician. They both deal with clients, marketing plans, financial plans, and dealing with insurance companies about how clients will pay. Essentially, they are both business and there is not really much of a difference I think. On the hand, if we are talking about the focus of the business then there is a big difference. For example, as counselors within a certain clinic, the goal is to assist clients help themselves with their psychological and mental problems (internal problems), while physicians and dentist try to physically (external problems) treat their clients. Overall, their goal is to help people, but counseling practices and physicians practices help people in different ways.

    Reply

    • Dee
      Mar 26, 2020 @ 13:50:18

      Jayson,
      you make an excellent point about concerns for private practice. I have 0 experience of private practice other than what I have learned academically or have heard informally, so take my comment with a grain of salt. The concerns about isolation is a very real fear. I agree with you that the “aloneness” is something that is not appealing to me. I really benefit from supervision and seeking out my colleagues for advice. I have heard that many private practices still have meetings with colleagues and allow for counselors to get access to help/supervision if needed. Perhaps this is a myth about private practice that you are totally alone?

      Reply

    • Nicole Plona
      Mar 28, 2020 @ 21:37:58

      Jayson,
      I like how you pointed out both sides on comparing a private counseling practice to other helping professions. It is definitely true that at the foundation they are both businesses which in one aspect makes them the same. However the work being done in each business is very different even though they are helping clients/patients.

      Reply

  8. Dee
    Mar 26, 2020 @ 13:36:57

    (1) Pursuing private practice has always been one of my goals. I knew at the start of entering the program at Assumption, that one day I wanted to either be a part of a private practice or have my own. I know from my own personal experience that I am a determined individual with the skills to “make it work”. This came with surviving, resolving, and making the best of many obstacles in my personal life, financial experiences, and professional/career experiences. I have lived for a long time basically on my own, with the mindset of holding myself accountable for successes and failures (but also recognizing when I was not to blame, or if I had support). From the reading I have learned that many of these qualities and experiences would assist me in a private practice career, and that did well to decrease my anxieties about pursuing such a career. I feel that towards the end of my career here at Assumption I have finally developed more confidence in my skills, and I’m going to cultivate that as much as I can not only for my clients, but for myself and my goal of working in private practice.

    (2) Personally, I would find running a private practice as a business easy for me. It may come with some initial “guilt” about treating mental health as a business. But to be fair, if you are seeking for professional help, why shouldn’t that professional be fairly compensated for their skill? Yes, counseling is a skill. We’ve been taught that, and we’ve learned from out internship experiences that there are some that have counseling skills and some that don’t. Thus clearly, it is a skill. We’ve received a fair amount of education to develop our counseling skills, and we will continue to educate ourselves. But from experience many of us have seen that just education alone does not make a good counselor. There are some other innate qualities and factors that contribute. How is this different from other professions? Not entirely different!

    (3) This ties a bit in with my previous answer, but I believe running counseling practice is pretty different from other helping professions. It is different in that if anything, we are held much more accountable for our services, we most likely serve a larger clientele with a wider variety of needs on a more frequent basis. As well as, despite our skills as “professionals” (don’t feel comfortable calling myself that personally) are undervalued in terms of pay, prestige if you will, and are stigmatized much more than other helping professions. Personally, I came into this profession to help. How original right? But if anything, counseling is probably more truly a “helping” profession than others that also take that title. We treat so much more than other professions but are treated so much differently. This may be more a cultural impact, but nonetheless it’s a bit different. Similar to other professions we are treated (usually) as a medical practice, and administratively run around the same. I would say the main difference is who and how we serve clients (everyone, basically everything).

    Reply

    • Shannon O'Brien
      Mar 27, 2020 @ 02:07:53

      Dee – I REALLY enjoyed your take and confidence regarding your ability to run a private practice a a business. I think you made some really good and refreshing points – especially regarding our “skills” and how that should be seen a “professional” or “business like.” You’re right in the sense that we have put a lot of time and effort (and our own money) into learning and correcting our skills to provide the best treatment possible, why shouldn’t we be compensated in some way for that? I admire your confidence and strong feelings regarding this topic. Definitely made me think in a different light about this.

      Reply

  9. Liisa Biltcliffe
    Mar 26, 2020 @ 13:39:05

    1. I know for me, that I do not want to have a private practice. I never did. But reading over the chapter and the tables associated with Chapter 8, I realized even more that having a private practice is really daunting and there is so much involved that I just do not want all of that headache. Also I have been pretty clear from the get-go that I want to work on a team, where I will have a built-in network of colleagues to whom I can go for feedback and consultation. I just want to be able to focus on my clients and not all of the business aspects of having a private practice. I do not know if I will change my mind at some point. If I do, this chapter is great for advice and tips.

    2. So if I were to have my own private practice, running it like a business, I think would be difficult for me. I have such a soft spot for people who cannot pay because when I was in therapy years ago, I could not pay and I struggled with finding a quality therapist and then being able to stick with him due to inability to pay. I would have such a hard time with that aspect–telling people they have to pay when they are struggling to make ends meet. I feel as if I would be a therapist who would let it slide and that wouldn’t be good for business. I mean, I guess I could have a sliding scale, but even still…I just know myself pretty well, which is why I wouldn’t do well with a private practice.

    3. I think that it’s different from a physician or dentist because…well actually, I don’t know because I was going to say that we have different theoretical applications, but I imagine they do too. They focus on the disease model, but in general, so do many of the mental health practitioners, although many of us are working hard to get away from that. A difference is that there is not such an easy fix; it’s not so cut and dry for us. For example, you go to a dentist and you have a cavity and they fill it. Or you go to a doctor, and have a broken bone and they splint it. But for us, we work with the symptoms of different disorders and help build skills to combat these symptoms. And it’s unique for each person, whereas a cavity is the same for everyone and the fix is pretty much the same for everyone.

    Reply

    • Dee
      Mar 26, 2020 @ 14:07:30

      Liisa,
      Two of your comments stood out to me. One, the soft spot for clients. I agree wholeheartedly with this, which is why I want to emphasize the sliding scale that you mentioned. I think we can still be softies while still running a business. I’ve been in many services and paid many different ways. One that sticks out to me personally is a private medical provider that had the stance of sliding scale however it works for you. I really think even in private practice, there’s a way to help clients and still be paid, you just have to find it and figure it out. The other comment you made referring to the uniqueness of counseling. This is so true. The mental health profession is very different in this aspect compared to other medical providers. We have to personalize everything for our clients, even with similar diagnoses. I imagine the medical world has its share of unique treatments, but in mental health this is the norm.

      Reply

  10. Nicole Plona
    Mar 26, 2020 @ 19:36:11

    (1) Initially, when I first decided to pursue psychology as a major and then continue onto a graduate degree, I had figured opening up my own practice was going to be my general game plan. When looking at the advantage of taking this step, I like the idea of being my own boss. I also like the idea of having a flexible profession where I make the hours and decide who I provide services for. On the other hand, the idea of working over 40 hours a week and still having an unreliable paycheck is worrying. Though I could potentially make more money working in private practice, I don’t know if the unpredictability is something I’m willing to gamble with. As far as the characteristics listed in Table 8.2, I feel like I meet the majority besides the money aspect of things. I have never been comfortable with the world of billing. I often get overwhelmed telling clients that they have a copay, so I couldn’t imagine having to be the one to bill them for each session out of pocket. That also leads to the list of common mistakes as well in Table 8.3. It’s listed that choosing the wrong counseling fee was a common mistake. I honestly think that would be my main issue because I would end up feeling bad for charging people money. As of right now, I feel as though I would prefer working for an organization or agency instead of opening up a private practice.

    (2) I think running a private practice as a business would be incredibly hard to do alone. There are so many different aspects to keep track of, between clients, paperwork, equipment, costs, billing, location, public relations, etc., that doing this all by myself would become too much. I feel as though if I started a joint practice or could have other employees to help with running the business then I would be able to manage the work more effectively. I also feel as though I wouldn’t be able to make all of the billing/money decisions on my own anyway. It would be something I would need additional input from someone else. Again, looking at the qualities listed in Table 8.2 I think I meet most of what would be needed to get through it. But in the end, I would be so burnt out or overwhelmed that it wouldn’t feel worth it.

    (3) I’m honestly at a loss for how to answer this question. I’m not really sure there are too many differences in running a counseling private practice from other helping professions. I mean obviously, the work being done with the clients is different (tooth pain= go to the dentist, mental health issues= go to the counselor). But other than that, they are fairly similar in the way they would be run. All these professions are held to a professional standard, are required to bill/ work with insurance potentially, etc. I guess the only difference that I can really think of is that with a counseling practice what your helping to solve doesn’t always have a standard way of being treated. The work/interventions need to be changed or adjusted for the client unlike the physical problems one may go to a doctor for (broke a bone=cast, anxiety/depression= treatment adapted to fit the needs of the client).

    Reply

  11. Becca Green
    Mar 26, 2020 @ 19:45:52

    1. For me the idea of a private practice sounds great. Reading through the pros the flexibility of scheduling and choosing which populations to work with are the first two that stand out. I am also low-key very into interior design and would absolutely have fun designing and decorating the physical space. However, I think I would be a terrible business owner. Perhaps as I get older and gain more experience I would feel more comfortable balancing owning a business and also being a therapist but at this point in time it just sounds unrealistic. I think I would set numbers too low for cost because I would worry about scamming people in need. I know that is a dramatic statement but it is an honest thought I already have. Owning a business is stressful and being a therapist can be stressful. I am unsure if I would do well at managing both. Additionally, the financial piece of starting a business sounds unrealistic. Honestly, sometimes even the thought of buying a house for myself sounds unrealistic with how much student debt I have to pay off. I can’t imagine being able to save up money to do both. I guess I would probably space them out… And yeah I’m already stressed just thinking about it and I am not even planning on starting a business. I think that is a sign!

    2. Again, I think I would be a terrible business owner. I would have a hard time separating the business side of it from the counseling side. I could see it working if I had a business partner who mainly dealt with the business side and I mainly dealt with the counseling side. I think I would do well at being a supervision/boss. I would enjoy having an array of different populations that are supported by one practice. I think it gives opportunity to connect with others and get different perspectives. I think I would do my best to support other counseling in staying up to date with research, provide feedback and support, and generally make it a comfortable and positive work space. However, I just am not organized enough to do both.

    3. Initially I couldn’t think of anything other than purchasing supplies that would make a counseling private practice different from other helping professions. After thinking about it more I realized that there are a couple of key differences. One: we see people long-term. Counselors see people for extended periods of time and watch the growth that happens over time. Physicians are seen maybe once or twice a year unless you are sick, dentists are seen once or twice a year unless there are complications, etc. Most of the other helping professions aren’t as in depth over an extended period of time. We really get to know each person that we work with. I think that does impact how the business is run. Two: I think the obstacle of client no call/no shows is different from other professions simply because we just don’t have as many clients. There isn’t as much turnover with specific clients as there are in other professions.

    Reply

    • Nicole Plona
      Mar 28, 2020 @ 21:33:18

      Becca,
      I didn’t even think about us as counselors seeing clients long-term in comparison to other helping professions but that’s a really important factor to consider. We do have the opportunity to be no called no showed more often by specific clients which has an effect of their treatment progress. In a private practice we are helping smaller quantity of people compared to a dentist or a doctor so those no call no shows definitely have a more severe effect.

      Reply

  12. Sarah Mombourquette
    Mar 26, 2020 @ 22:49:21

    I had previously felt this way, but after going through the readings for this section I was reassured that private practice is not for me. The first challenge I would have has to do with the disadvantage of working alone. I know myself well enough to know that I thrive off of the creative energy that comes from my co-workers. Therefore, I predict that I would feel remarkably isolated if I was not surrounded by peers who are experiencing the same successes, challenges, and anxieties related to our field of work. Another reason that I know that private practice is not for me is that I predominantly want to work with underserved and minority populations to the point where I can get involved in policy change that could benefit these communities. I do not feel that private practice would allow me these opportunities because it substantially limits the populations I could work with. I also feel like private practice would not be for me because it would encompass far too much of a business model for me. I can imagine myself being very bored having to go through all of the financial paperwork (I appreciate those who do that for us in our agencies so much!).

    I think that I would be capable of running a private practice as a business, I just think I would not enjoy it at all. I believe that the process itself would be easy because I really enjoy organization and numbers, but that the monotony involved in the business side of it would make me dread the day to day work life of running a private practice. What would be challenging for me would be asking for payments and going through insurance companies. I have come to love living in “grant land” as my agency refers to the programs that are funded by the government and require no insurance from clients. To a certain degree I feel spoiled by it because I do not have to experience the same challenges that my peers do in terms of battling insurance companies for sessions. I think this would be my largest struggle in taking on a private practice, despite recognizing that payment is so essential for the business model.

    I think that running a counseling practice is different from other helping professions because there are still so many restrictions to accessing mental health services compared to medical services. In that respect, it makes a huge impact on clients’ ability to regularly attend services. Similarly, there is also still collectively an attitude that mental health does not need to be as highly prioritized as physical health. Although this mentality is slowly starting to shift, it makes running a counseling service drastically different. Because the changes that come from therapy are not as tangible as something like physical therapy, it could make the service itself seem unhelpful or unimportant to the client. Each of these factors are likely to increase client no-shows and cancellations, all of which interfere with running a business. I believe that this is something that will change over time, but it is a realistic challenge that the world of mental health faces both in terms of receiving funding and receiving resources to provide quality services.

    Reply

    • Mikala Korbey
      Mar 27, 2020 @ 15:14:17

      Sarah, I agree with you that I don’t think private practice is for me, especially the more I think about it and learn about it. I would HATE working alone, I too really enjoy the energy of others, but also having others around me to vent or consult with. I know there are groups out there for people in private practice, but it is not the same as having that built in team where you work. Overall, I do not see myself going into private practice.

      Reply

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Adam M. Volungis, PhD, LMHC

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