Despite the snarky title of this blog, I actually fully support and admire anyone who chooses to leave the comfort of someone else’s company to start their own. It is an incredibly brave act to leave a stable paycheck and benefits behind to achieve and fulfill a dream of becoming your own boss. This also does not come with a slew of challenges and hardships that most people do not learn until they take the brave leap of opening their own business, therapists or otherwise.
While there are several rules and caveats that every business owner has to go through in order to start a business and ensure that it runs smoothly, this blog is aimed mainly at psychotherapists who plan to open a private practice of their own. I hope to explain my own experiences I’ve had so far with having New Wave Counseling, PLLC since January 1, 2022. I’m in no way an expert, but let’s just say if I ever wrote a book on entrepreneurship and psychotherapy, it would be called I Sucked as a Business Owner So You Don’t Have To!
There are so many aspects about the post-grad school experience that they don’t tell us while we pay an exorbitant amount of tuition, so consider this a behind-the-scenes look at starting up a mental health practice. No one should have to experience a “trial by fire” approach while being a licensed clinician. We do such intimate, vulnerable, and intense work with our clients. And if our business is hardly staying afloat behind the scenes, we are not going to be fully present with the paying customer clients who deserve us at our most settled and grounded.
It’s unfortunate that in our first few months (or sometimes years), the “norm” is deferring student loans as well as having to rely either on our families or our partners to financially support us as we depend on the mere hope that enough clients will show up and pay us what we are worth. It’s also unfortunate that we receive a graduate-level degree and immediately are catapulted into a world of learning how to be business people on our own. I’m here to tell you that you do not have to do it on your own.
My intention of this blog is to not scare my therapist friends away from opening their own practice if they have not done so already. If anything, I’m here to tell you all that it is possible to open one, and have it become a well-oiled machine no matter how much self-doubt or lack of guidance going into it. I hope that the free resources I so happily give to my wonderful community of therapists will be helpful!
As you got through the anxiety of the scary words I somewhat brutally declared in the beginning part of this blog, I’d like you to take a moment and breathe in. Check in with yourself. And I’d like you to tell yourself that if you want a successful and thriving private practice, Everything will fall into place if you want it. Everything will happen for you, but the process itself can feel like a murky swamp of uncertainty.
Your Ideal Client
The first and perhaps most important part of this blog is to understand who our most ideal clients are–That is, if you had 80-90% of your caseload as these kinds of clients, it would not feel like difficult work as opposed to extremely challenging clients who require a certain kind of care that you or your business are not used to.
Exercises (better if typed out in a separate file or written down on nearby paper):
1) Who is your ideal client in private practice? What kind of client do you enjoy working with the most?
2) Where does your ideal client most likely go the most? Where could they easily see your business cards displayed?
3) Is your office space convenient to an area where most of your ideal clients can easily find you?
4) What can you do to have more ideal clients on your caseload if you are not currently full?
As an example, some of my ideal clients are couples who are already seeing their own individual therapists, single fathers going through divorce or custody battles, adolescent clients struggling with existential questions or feel too intellectual around people their ages, and gay cisgender men who are navigating relationships with their partners and families. But I can safely say that everyone on my caseload, I genuinely enjoy seeing on a regular basis!
While we are on the topic of ideal clients, I have over the years realized that we have the ultimate decision to keep clients on our calendar or refer them to people who are more equipped to handle what they are struggling with better than us. Most of our clients should be our ideal clients, with room for the ones who are very challenging and take up a lot of our space. For this understanding, I use the 95-4-1 rule–95% of our clients in private practice should be our ideal clients, 4% of our clients have a healthy way of challenging us to grow and expand our skill sets, and the 1% of our clients are the ones who are extremely challenging to work with and could possibly use a referral to a higher level of care.
What sets your brand apart?
In a progressive and therapist-friendly town like Austin, our market is absolutely saturated with therapists. I moved to Austin a year before COVID-19, and I was absolutely overwhelmed by the amount of mental health marketing events, therapist organizations, and a general sense of welcoming mental health clinicians who accepted me into their community with open arms. While this contributes to virtually every positive aspect when it comes to a quality of life, it can get a little challenging knowing that we have a high supply alongside a high demand.
This is where understanding who we are as clinicians that sets our own individual kind of work or businesses apart from the rest. Below are exercises you can do to ask yourself about your own marketing strategies.
1) What can you and your business bring to the table that not many others can?
2) What special training and certifications do you have?
3) What populations do you feel comfortable working with that most other therapists shy away from?
4) What about your knowledge and skill set can you walk into any marketing situation and safely say, “I am that psychotherapist” and/or “My practice is that practice”?
As for my individual training, I can safely say I trained alongside a cohort of Dr. Sue Johnson’s for Emotionally Focused Couples and Family Therapy. I also have Pia Mellody’s Inner Child/Love Addiction training. I have shadowed Brene Brown’s Daring Way group therapy model as both a client and a trainee. Regarding what sets my practice apart, New Wave Counseling offers a safe, judgment-free space for people of all cultures, backgrounds, sexualities, and genders. Our mission is to dismantle some harmful systems that have marginalized clients as well as provide opportunities for our clients’ growth and healing.
The goal is to have more than one income!
Sadly, not many therapists talk about having an error-prone and inconsistent income that is 100% commission-based. While not every therapist can do this immediately starting their practice, it should always be a goal for a therapist to not rely solely on clients showing up as their sole source of income. Clients are human and are prone to forgetting appointments, susceptible to illness, and have emergencies come up (as certainly do we!).
Since working in private practice beginning in 2017, I have witnessed such Earth-shattering events as Hurricane Harvey, gas shortages, power outages, the snowstorm of 2021, city-wide floods, and COVID-19. All of these events have prevented me from seeing clients on whom I was depending on attending sessions. And all of this has taught me to have another source of income coming on independent of hoping that all of my clients will make their appointments.
Some ways I have seen therapists have multiple streams of incomes:
1) Podcasts: Hopefully having podcasts successful enough so that companies can pay for advertisements.
2) Writing: Since we have to write notes every day we are at work, most therapists are naturally able to write. This can look like writing paid blogs, magazine articles, or publishing your own book.
3) Teach courses: Many therapists I know have wonderful and brilliant classes that other therapists take which are CEU-certified
4) Becoming a supervisor: This is guaranteed income at the very least for supervisors! Therapists have to pay a supervisor a monthly fee, regardless if the supervisees show up for their supervision meetings.
Exercise:
What are ways that you can plant seeds so that you can have more than one stream of income?
Find your “Golden Egg” in marketing!
This was told to me early on when I first moved to Austin and was still under supervision. As much of an introvert as I am, marketing is an absolute must in this business to get referrals. Someone told me one time that opening a business without marketing is like sending someone a wink from across the room, but the room is pitch black. Valuable advice.
The first few months of marketing to find your golden referral source will feel like throwing noodles at a wall and seeing what sticks. As you meet with different professionals in your community, introduce yourself to different professionals like law firms and doctor’s offices, you might go mad wondering why none of your hard work is paying off. But one day, you’ll more than likely stumble upon a business owner or company who desperately needs a place to send referrals. They might also come from a person within your community who is simply just too full!
Find what works for you and is not too far off from what you would do in your everyday life without your marketing hat on! If you like coffee, get coffee with a therapist as a marketing move. If you like cocktails, grab a margarita with a therapist who also drinks. If you like hosting parties, throw a mixer in your office space! If certain forms of marketing make you want to claw out your own eyes, simply stop doing itand refocus.
Exercise:
1) Do you feel you have found your “golden egg” when it comes to getting referrals?
2) If so, what is it? How can you get others like it?
3) If not, how can you manifest having a golden referral source?
Fiscal Responsibility
This is another hot button that most therapists do not get adequate education or proper guidance. Most of us are 1099, and this means that we are required by law to pay in 25% of our earnings to the Internal Revenue Service every quarter. It’s a bleak reality, but it is a part of our job. And if we are disciplined enough to pocket 20-25% of our earnings every week, month, and year, we should be good… Right?
Sadly, this is not a very common practice, and it has taken some therapists years (like myself) literal years to feel comfortable doing this on a regular basis. So many of us have student loans, rent, mortgages, car notes, and other mandatory bills we sadly cannot get around as adults. And using a good chunk of your earnings to pay these bills your first year in private practice is incredibly seductive. But your business staying open depends on being in good graces with Uncle Sam!
Find yourself a great accountant, financial advisor, or CPA. I use Christina’s Tax Service in Houston, Texas. Everyone in her office has been a huge resource of information regarding saving taxes and paying my business dues!
Further points of advice:
1) Do not operate business without a PLLC or incorporating yourself: This is a must to protect your personal assets if from some small chance you get sued.
2) Increase your online presence: This does not get direct referrals from clients mostly, but other therapists who know your specialties list online will remember you when they need to refer a client as they see you popping up in their stories or on their timelines.
3) Facebook referrals: This a brilliant way to connect with other therapists, receive decent referrals, and also find other therapists should you need to refer a client out.
4) Location is everything: If your office is in an ideal location for your ideal client, you are golden. If you are 100% online, ask yourself if this would be appropriate and befitting to all of your clients.
5) For every government entity, have patience with the process: When dealing with my PLLC filing as well as my Employee Identification Number, the response times were very slow and it felt discouraging.
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