July 30, 2021
First, begin the process of incorporating — a process you know nothing about. Once that is complete, tackle the daunting and frankly masochistic task of credentialing yourself with insurance providers. You may want to activate your social support system prior to that endeavor. Secure your business bank account and business credit card, and while you’re at it, maybe get some tax advice on these matters. Locate suitable office space in your location of choice. Then be sure you’ve maximized your referral sources.
These are just a small portion of the steps I put into place on January 1, 2020 to finally get started on my ultimate goal of incorporating and opening a private practice. I was actually able to get through a lot of these steps surprisingly quickly, even getting credentialed with a few panels in just a matter of a couple of months. Even with plans progressing well, I still had heard the horror stories from colleagues across the country: “Prepare to basically have no income for about a year,” “you can’t just hang a shingle at the door and have 20 clients,” and on and on and so on and so forth. I fully anticipated that there would be significant time spent with a minimal payoff, at least in the initial stages of the process, and I was well-prepared for that eventuality.
Through talking with past clients, I’ve become convinced that the majority of them, especially first-time clients, choose a therapist like most people choose their wine: appeal of the label and price of purchase. I’m a scientific and systematic person with a bit of a marketing background, so I wanted to test a few hypotheses on building a caseload: my inquiry rate with more relaxed pictures versus very professional pictures, whether more casual and familiar profile text yield better results than the most clinical of language, etc. Of course, there was one confounding variable that makes these little experiments uninterpretable and that I could not have predicted: A LIFE-SHATTERING PANDEMIC COMBINED WITH ECONOMIC DYSTOPIA.
The infinite jest of my bad timing — officially opening a private practice in early March 2020 — does not escape me. In talking with friends outside of the profession, invariably they say something like, “Now must be a great time for your practice!” I grind a disingenuous smile each time I hear it, but I understand their rationale. When comparing my experience to that of colleagues, however, I see their referral rates dropping considerably, while also losing clients as a result of switching exclusively to telehealth. I’m told many clients have said that they want to take a break and will return when they can continue in-person sessions; although, I think we all know the attrition rate when a client says they will return after a break.
I maintain perspective. In the last few months in Los Angeles, I have spent a lot of time counting my blessings and really taking stock in how lucky I am that this is my particular problem during the pandemic. So many people who were leading otherwise perfectly stable lives are now reliant on food banks for the first time in their lives. Truly, this seems like a time when you can allow your imagination to go in the darkest of directions about the state of the world, and anything and everything seems like a possibility.
It’s unfortunate, generally, because I suspect the majority of people who could really benefit from therapy right now may have lost their insurance from their employer, or their hierarchy of needs has changed so dramatically that they have to put their mental health aside for the time being. It’s very hard to work on past trauma when you’re just trying to figure out how the rent is going to be paid next month.
During this downtime, I’ve joined a nationwide network offering short-term, free, or low-cost online therapy to essential workers. I’m also trying to use the time as wisely as I can in addressing the minutiae and bureaucracy of entering private practice, improving what I can; however, there’s only so much that can be done before falling back on the reliable and seductive Netflix queue while hopefully waiting for the world to return to some degree of normalcy.
If you’re so inclined, feel free to share your experience. I’m curious about what other clinicians outside of my little ecosystem might be doing professionally during this time.
The author is a licensed psychologist in Los Angeles, CA, who specializes in addiction, sexual issues, relationships, and particularly how the three intersect.
Note: The author has chosen to publish this piece anonymously to prevent the topic from creating potential risks to the therapeutic alliance, e.g. matters of codependency, caretaking, etc.