Psychotherapy Bulletin

Psychotherapy Bulletin

Clinical Impact Statement: This manuscript offers insight for clinicians considering starting their private practice. It covers the challenges related to tackling business ownership, a push for professional identity development, and the call to be intentional in carving out self-care and social support.

It is so quiet in here this morning that I can hear the soft ticking of the clock in my bookcase. Some days it still feels odd not hearing colleagues in the hall, the click of keyboards in the billing office, or cheery receptionists answering calls out front. A steaming mug of coffee is at the ready as I peek at my full schedule of clients for the day. I make mental notes of a few calls to make during my lunch break, stack billing documents that need to be filed, and submit new checks through mobile deposit. I take a breath as I hear the squeak of the office door—my first client has arrived. I’m ready to tackle the day.

One year ago, when I submitted my resignation from a group practice and began to establish my own business, I was not sure what I would be in for. Like a good student, I had tried to ace my homework—I joined online therapist groups, listened to podcasts about insurance billing, connected with other psychologists in private practice for guidance—but nothing truly prepared me for the journey I was undertaking. It is not only a significant change in career to switch from the support of a group or organization to working solo, but it also is an impetus for emotional and mental evolution as a person and professional.

In school, I was frequently informed that most of my growth and learning as a psychologist would take place after I graduated. At the time I was dubious, but now I can certainly say that this transition into private practice has been the catalyst for the most learning I have ever done in such a short period of time. Although this list is both far from inclusive and ever-evolving as I continue settling into the world of private practice, it highlights some of the sharpest learning curves that come with the first year of making this transition. 

1. The necessity of owning my worth.

I felt a jolt when I first realized I had to put a dollar amount on my services. Working in a group practice as a salaried employee shielded me from naming the cost of 53 minutes of my therapeutic skills. In addition to dollar value, I also found it tough to define and own my specific areas of expertise as a clinician. These struggles likely represented a lingering case of imposter syndrome as an Early Career Professional. However, private practice has given me some tough love through forcing me to name, own, and market the skills and expertise I hold. Now, owning my worth is a major source of my integrity and confidence as a psychologist, and I rarely struggle with doubting my skills and value.

2. How it feels to have professional autonomy.

Recognizing what autonomy truly feels like was something I hadn’t quite grasped until I was a few months into private practice. I had to remind myself repeatedly that I didn’t have to get things cleared by anyone but myself. Being one’s own boss offers an incredible amount of independence and liberation from the constraints of being an employee or contractor. It is a strange and profoundly rewarding feeling to be able to determine every aspect of my work life. However, with autonomy comes a deeper sense of responsibility and a strong call for the utmost veracity and diligence in the work I am doing, which leads me to…

3. A deeper desire to meet my clients’ needs.

Since making this leap I have felt an even stronger calling to be the best psychologist I can be. I take more time to prep for my sessions. I research and share resources for my clients on a regular basis. I have purchased more books and engaged in more continuing education in my down time. Part of this is likely a recognition that I don’t have those safety nets of salary, PTO, and the support of a group behind me anymore. While those safety nets added a sense of cushion beneath me, they also affected my motivation to go above and beyond. This deepening dedication also likely stems from shifting to a direct, pared down business model where there are no other players to manage and worry about finances and scheduling. I want to make sure I am dependable, consistent, and offering optimal value of services for the cost when my clients’ attendance and payment have a more direct effect on the success of my career. In turn, the celebrations of client progress feel more enriching and gratifying when it comes from a place of deep dedication to the profession. 

4. What it means to be a business owner.

If we’re being honest, I’m still figuring this one out. I just submitted another round of quarterly taxes and still feel maybe 75% certain of my computations. Stepping into private practice requires an entirely different skillset beyond being a strong clinician—skills of entrepreneurship, business management, and marketing. They certainly didn’t teach me these things in graduate school for psychology. Carving out time to take care of business documents and registration forms, consult with an accountant, develop marketing materials, connect with potential client referral sources, and manage taxes, income, and expenses is integral to being successful in private practice.

5. The blessing and curse of accepting insurance.

I thought I had a good grasp on this one going into private practice. I heard over and over how frustrating dealing with insurance companies can be from the billers at the group practice, colleagues who were in private practice, and the social media groups I had joined. I understood it would take lots of time and energy, frequent consultation, and many deep breaths. They were not exaggerating. The challenge began at credentialing, which is an arduous process that can take months to complete. Since becoming in network I have also faced frustrating, confusing and time-consuming insurance hurdles, sometimes multiple times per week. Despite these aggravations, though, I have been thankful that I accept insurances. I have found that it aligns with principles of social justice to make treatment more accessible for those who can’t afford private pay rates. Moreover, much of my caseload and the financial backbone of my practice is comprised of clients who use insurance. I have found billing to be smooth for much of the time, although when it is rocky, it can be intensely challenging.

6. The importance of setting boundaries.

“Boundaries” is one of those words I use in therapy sessions with clients endlessly. Moving into private practice has felt like jumping into the deep end of rediscovering professional boundaries and limits. At my group practice, my schedule was largely pre-defined—what days and hours I worked, how long my sessions where, when I would have time off, how my clients would be contacted, and who would contact them. Private practice has taught me to be honest about my needs and limits as a psychologist in terms of what caseload feels comfortable to maintain, what I want my weeks and days to look like, what type of communications I want to have with clients, the types of clients with whom I want to work, and the types of clients I would choose to refer out. I started my business with the aim to set the boundaries I wanted from the start and then maintain them. It felt tempting to add an extra time slot here or there, to take on a client that maybe wasn’t the best fit for my expertise because I wanted to fill an opening, or to not charge someone my no-show fee due to guilt about doing so. Private practice has provided a strong and valuable challenge to look inward at my needs and structure my professional world accordingly and unapologetically.

7. A network of support is vital.

I had gotten used to being surrounded by other therapists daily. There was always an open door somewhere to access in-the-moment consultation, process a difficult session, or crack a joke for some levity during a draining day. In contrast, private practice is, well, private. However, that doesn’t mean it has to be isolating; rather, it requires a more concentrated effort to establish and nurture a network of support. To do so, I share an office suite with other private practice therapists rather than a single office for myself. I also get together for peer supervision with a colleague on a monthly basis. I reach out to other clinicians I have met over the years to talk about a challenging case over a cup of coffee. I am also intentional about scheduling happy hours and lunches with friends in the field to just enjoy one another’s company and debrief. Working in isolation is a recipe for burning out; taking time to build support is key.

8. How to prioritize effectively.

Prioritizing responsibilities is also crucial to running a private practice efficiently and effectively. One thing I’ve learned to prioritize is my time. I made the decision to use an electronic records system that allows me to submit insurance claims for a nominal fee. At first, I was determined to keep my overhead as low as possible by using no-cost clearinghouses for claim submission. Since, I have shifted to making use of my electronic system instead due to how the billing process saves me precious time and frustration. The small fee per claim is worth it. Cost extends beyond just financial expense—considering how you use your time is necessary for successful prioritizing as well. 

9. Self-care is non-negotiable.

Stepping into private practice means adding on more responsibility to an already high-stakes job. Maintaining a business, navigating billing, marketing, scheduling, and the many other responsibilities of this role can quickly feel overwhelming without proper rest and self-care. When life is stressful, we tend to practice self-care the least due to feeling short on time. The challenge, though, is prioritizing self-care the most during high-stress times. Building activities into my everyday routine to nurture my mind and body has helped keep my tank full even during difficult weeks. 

10. I can be successful in private practice.

A common theme I have heard from clinicians who are in a group practice is fear about their ability to take on the additional responsibilities—especially billing—that come with solo work. Before I made the leap, I felt this doubt deeply. In many group practices, the billing process tends to be handled by other employees and kept separate from the clinician’s responsibilities. This separateness can add a great deal of uncertainty about how to do billing, creating a feeling of dread and fear with the prospect of private practice. Doing research to learn about how billing works, accessing support through social media groups, and being humble enough to ask for help, even when it seems like a silly question, have been lifelines in building confidence (and getting the bills paid!). Yes, you can be successful, as long as you are willing to take the initiative to access knowledge and support on the journey. 

Final Thoughts

Although it has only been a year since I made the jump, I have finally found my professional home in private practice. The autonomy, empowerment, and drive I have felt in this new role have provided me with strength to overcome the challenges that have emerged along the way. Private practice has many great rewards to offer, but it is not without its hardships and not for every clinician. If you are embarking on this career transition, I encourage you to embrace the growth you will experience, anticipate bumps along the way, and be intentional in owning your worth, holding your boundaries, and cultivating your network of support. 

Cite This Article

Detwiler, B. (2019). Making the leap from group to private practice: 10 things I’ve learned. Psychotherapy Bulletin, 54(3), 28-31.

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