Starting a Practice

The Best Private Practice Advice for Early-Career Therapists

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August 3, 2023
August 3, 2023
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Starting your own therapy practice can be a lonely experience. Your practice’s success depends upon the decisions you make, and you may not have colleagues you can turn to when you run up against obstacles. 

Add that pressure to a long list of to-dos—everything from tax planning to figuring out how to pay yourself—and the experience can be downright overwhelming.

Part of our mission at Heard is to make starting your own therapy practice easier. So, we interviewed a select group of successful self-employed therapists to learn what has worked for them, what hasn’t, and what advice they have to share with other therapists newly setting out on their own.

Here’s what they had to say.


Understand the difference between a business owner and clinician

Dr. Spirit is a licensed psychotherapist and media personality, and host of the hit series Love Goals on OWN. 

She says it’s important to recognize your role as a business owner is different from your role as a clinician.

There is a difference between operating a business and being a licensed clinician. Understanding the difference and being able to do both well will be critical to the success of your business, and the quality of your clients’ care.

Doubt yourself, do it anyway

Patrick Casale, LCMHC, LCAS is a licensed mental health and addictions therapist, a group practice owner, and a private practice coach for therapists.

He recommends harnessing your anxieties as a new business owner to help you move forward.

When starting your private practice, you're allowed to be scared. This tells you that you're moving in the right direction. Use your fear as a gas pedal, not a brake pad. Doubt yourself, do it anyway.

Learn the power of community

Kenya Crawford, LMHC is an award-winning licensed psychotherapist and racial equity consultant. Part of her mission is to create healing and liberating spaces to dismantle oppressive systems.

She says it’s important to recognize the value of community, and to treat it as a must-have when operating your own private practice.

I'll be honest, community wasn't something that I consciously cultivated early on in my career. But once I started private practice I quickly learned that community was non-negotiable for my mental health.

Don’t be afraid to negotiate with insurance companies

Dr. Amy Marschall is a Licensed Psychologist and owner of RMH Therapy, where she primarily provides therapy to children and adolescents and offers psychological evaluations.

She says therapists billing insurance companies shouldn’t let themselves be intimidated, and should be willing to negotiate rates.

If you choose to bill insurance, remember that you do not have to credential with anyone unless you want to. You can de-credential from plans that under-pay you or require extensive paperwork you don't have time for. When you bill out of network, you can also negotiate the rate. I've had insurances offer less than half my rate, and I responded saying I would accept a higher rate and had them say yes. 

Don’t overlook compliance

Dr. Bryan Harnsberger is co-founder and CEO of Wellesley Counseling & Wellness. He has made numerous appearances on TV, panels, and podcasts.

Dr. Harnsberger says one of the most useful tools for keeping up with compliance has been membership in his local professional organization for therapists.

Now I have a lawyer telling me how to be in compliance (ethically and legally), but early on, no one explains if your documents are up to date, or how to dispute certain issues with insurance. The most helpful thing for me was joining the Massachusetts professional association and utilizing the listserv to ask advice there.


Identify unmet needs

Lisa Savage, LCSW is the founder and CEO of the Center for Child Development and the Delaware Center for Counseling & Wellness. She started her journey because she was dissatisfied with the lack of services available to children and their families in the state of Delaware.

She recommends looking to the needs of your community, as well as your own passions, to help you find your niche.

The most significant key to my success was identifying unmet needs in my local community. It was evident that very few providers focused on children and teens. I also realized that the clients who needed my services could not get to my office easily. So I paired my passion with an unmet need and a solution by developing a model for school-based mental health services. I encourage newbies to focus on what they love doing and how they can use this to meet the needs of their target audience. Understanding the problems of a target audience is good business sense.

Create your own lane

Liz Beecroft, LCSW specializes in working with athletes, creatives, millennials, & Gen Z to manage anxiety, depression, trauma, stress, and challenging life situations.

She says it’s okay to try approaches no-one else is trying in private practice, and to find your own niche.

One thing I wish I knew when I was starting out was that it’s okay, and actually quite important, to find your niche of what you specialize in when it comes to private practice and therapy services. It’s equally okay to create your own lane, to be different, to think outside of the box and that just because it’s not being done doesn’t necessarily mean it’s wrong!

Trust your intuition  

Dr. Marina Harris is a licensed psychologist and CEO of Bloom Psychology Group. She writes the column Letters from your Therapist for Psychology Today.

She says it’s essential to trust your intuition when deciding on your career path.

For me, I knew what I wanted to do right away but I let other people deter me (I was told not to specialize too early, to be a professor, that private practice wasn't prestigious or was a waste of my talents), and I wish I hadn't worried about what other people thought, because now I'm in my dream position based on the things I knew I wanted, and I couldn't be happier. 

Consult with experts

Tacha Fletcher, LCSW is founder of Wellness Tree Counseling, a female, Black-owned private practice based in Rego Park, N.Y.

She says it’s important to reach out to others for advice, and consult with established experts when starting your own private practice.

You may be tempted to DIY your way into private practice. Instead, consult with experts in the field. This will help you avoid costly mistakes.

Still feeling overwhelmed? Heard can help you set up the financial side of your therapy practice—bookkeeping, accounting, and taxes—so you can focus on the rest. See how Heard works.

This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this post.


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