Private Practice: When It's Not Right For You

By: Sheila Peck, LCSW-R

A few years ago, I wrote an article for The New Social Worker on when to start private practice. Later on, I realized that I had left out something important, something that I had hardly considered. Let my experience with Charlene tell you what I mean.

    I teach classes on “How to Start Your Practice, How to Build Your Practice,” at several schools of social work in New York. “Charlene,” a member of one group, blew into the first meeting with breathless enthusiasm. The air conditioning currents in the October too-warm room atmosphere feathered her long blonde hair around her face as she said, “I just got my LCSW, and I’m ready to begin!”

    Her behavior underlined her excitement. As the class progressed, I saw how eager she was to learn. Her pen scratched busily over her pad as we talked about various aspects of starting private practice, and she eagerly participated in our discussions.

    At the start of the first session of each class, I usually begin by inquiring, “Who has clicked?” This is a shorthand way of asking, “Have you really committed to the hard work and necessary expenditure of time and money to create or build a private practice?” And I ask the question again at the beginning of each of our meetings. Every time I asked the “click” question, Charlene was one of the first to raise her hand.

    In December, when the group finished, Charlene rushed up to me, shook my hand, and said, “I want to thank you. You gave me some important information and really clarified my thinking.”

    Inside, I was pleased as my ego secretly gave itself a hug at another job well done. Then Charlene explained what she meant. “I’ve decided that I’m NOT ready for private practice now—that I’m happy with the way things are. I have a job and two private clients, and I also want to have a life. If I put all that time into expanding my practice, I couldn’t have lunch with my friends or go to the gym or have time to just lie around and loll.”

    I must have looked surprised. “But I never would have discovered that without this class,” Charlene informed me in her breathless way. “I would have gone into building my practice ineffectively without knowing what I had to do—all the tasks, the time, the expenditures, that were necessary. And I wouldn’t have done it right.”

    As she left, she added, “But one day I might well be ready for this, and then I’ll be aware of what it takes. Thank you.” She breezed out the door, leaving me disappointed and nonplussed—until I thought about it more diligently.

    Charlene was absolutely right: there is a time and a feeling that must exist when you take on the difficult job of being your own boss, even taking into account the idea that this condition may generate expanded income and job satisfaction. But readiness is important, and I have incorporated this concept into later classes.

    For example, when “Steven” participated in a later class, I was ready to steer him in a different direction. He was an LMSW who had been a computer specialist in his first profession. (Many clinical social workers have had previous careers.) Although he came to class to learn how to build a practice, he didn’t quite seem to fit. During the course of our work, it became clear that he loved working with computers and was reluctant to give that up. Together, as the class went on, we discovered a possible alternative niche for him, one that would incorporate both his clinical and technical skills. He decided indeed to build a practice—but not the kind that we had been talking about in class. Steven’s idea was to develop Web sites for clinicians. And he did so quite successfully, using the marketing principles we had discussed in class.

    So how does all this apply to you? If you are contemplating that jump to private practice, now or in the future, how do you know whether you are or aren’t ready?

    Given appropriate licensing and experience, you will still have to make that inner decision to go ahead. Some think it’s easy. It isn’t, but if you have the “click,” it’ll give you a lot of the motivation you need to continue.

    Besides motivation, what DO you need in order to help yourself “click”? You certainly need to understand that being in private practice means you’re in business. You’ll have to develop business and marketing skills. Starting with a simple business plan will help. You can find information about how to go about doing this at http://www.bplans.com/dp/ and many other sites, as well (try Google). Completing such a plan will help you focus.

    Next, begin to develop a marketing plan. You can download this from The New Social Worker’s Web site at http://www.socialworker.com/marketingplan.doc .

    It’ll also be important for you to have a budget, to figure out how much you’ll need to spend and how much you’ll need to earn to cover your expenses and support yourself, too. Many social workers overlook the idea that one part of being in private practice is the necessity of being a good boss to yourself. If your budget shows that you cannot earn enough to give yourself some vacation or other time off, then it probably is not the time for you to enter private practice.

    Many people begin private practice by gradually cutting down on hours they put in on their “day jobs,” thereby retaining an income and, equally important, health insurance. As you consider this, decide whether or not you have the energy to put in all those hours. Some clinicians decide to use Saturdays specifically for private practice. Might this work for you?

    Two more questions to ask yourself are: (1) whether or not you need additional education to sustain a private practice, and (2) whether the possible feeling of isolation that private practice might engender will be overwhelming for you. Be honest with yourself.

    That leads to the important idea that you’ll need a clinical supervisor, and you’ll be financially responsible for paying for this service. In New York (and several other states), if you are an LMSW, you are required to have supervision to be in private practice, even if you only have one or two clients. Make sure you check out your state’s requirements before going forward.

    Do you have a psychiatrist to work with? Presumably, some of the people you work with will need to be evaluated for medication. And, very important, do you have an accountant? When anyone, even a clinician, begins a business, she needs to keep accurate books that will allow her to easily retrieve information about income, profit, and taxes. Probably the person who helps you with your taxes can advise you about how to set up your books, but do this at the beginning of practice so you don’t get confused. When I got a computer some years ago, my first act (after learning how to use the darned thing) was to set up client and financial records. I use FileMaker for the former and Quicken for the latter. At tax time, I just need to click on a few buttons and I have all my expenses and income for my Schedule C.

    “And what is that?” some of you may ask. A Schedule C is the form you file with your taxes if you are in business. You’ll need to know all about it even if you don’t do your taxes yourself, because it can profoundly affect your return.

    There are many other considerations. You’ll need to be familiar with marketing, forms, and policies for clients. Use the short checklist on this page to think about additional items. You don’t need all of them, but you ought to be aware of what they are and how to get them. If it all seems to be too much, just work on one of them at a time. Or you might decide that it’s not yet the right moment to enter private practice.

    This may seem overwhelming and “click”-aversive. And if you feel that it’s too much, then it’s probably NOT time—at least not yet—to go into private practice. But at least you’re now thinking in the right direction. Perhaps you’re even unconsciously preparing yourself to learn what you need to learn so you will be ready in the not-too-far future.

    That’s what seems to be happening with Charlene. She called a few days ago to schedule a consultation to talk over beginning her private practice. As she said, “I’ve clicked.” And perhaps you will, too. If not, that’s fine. You will have made a responsible decision as to what’s right for you. That’s what we try to help our clients do—and we should do the same for ourselves.

Sheila Peck, LCSW-R, is a practice-building consultant and family therapist who works in Island Park, NY. Co-president of the Nassau Chapter of the New York State Society for Clinical Social Work, Sheila also edits several professional social work newsletters and teaches at Adelphi University and Hunter College Schools of Social Work (continuing education). She may be reached at Sheila2688@aol.com .