Real World Clinical Blog: Leaping Into Private Practice

by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way

     So you are considering starting a private practice, but you don’t know if the time is right. I know you are thinking about it, because you decided to read this, and that means  you are at least pre-contemplative. It might be worth talking through this a bit. And given that I have a lot of experience with this whole thing, I thought that I might be able to help you.

You can do this

     There are all different private practices. There are full-time and part-time practices. There are practices with evening hours or weekend hours. There is no reason to think of a private practice as an all-or-nothing scenario. One of the best parts of starting a private practice is that you can take it slowly. You can rent an office full time or for just a few hours a week. If you are ambivalent, I think it is worth finding out how it feels by giving it a shot.  The investment, which I will talk about, isn’t so high that it should be prohibitive.

It is important to do this

     There is a lot of criticism around private practice - particularly that private practices don’t properly serve underserved communities. The fact is, though, that there is something radical about helping clients on your own terms in a space where you have brought your own version of safety. In most agency settings, there is a certain amount of triangulation that dilutes direct client-to-clinician contact. Cutting out the significant complications that this reality brings can deepen the work. There are ways to provide incredibly affordable treatment that might make private practice work more accessible. For example, in my practice, we have a group in which everyone pays full fee. This allows us to offer a group to lower-income clients for $1-$5 per meeting. The notion of inaccessibility can be remedied with sufficient creativity and forethought.

     Furthermore, the financial transactions that private practice requires are actually of terrific import. I don’t know why, but starting to establish a set of fees and asking for money forces us to deal with some of the most intrapsychic issues that we have. It brings to the surface our old wounds and patterns of functioning. The facing and ideally resolution of these issues strengthens us clinically.

     We are also forcing our clients’ hands by asking for money. The fact of this transactional dynamic lends itself to healthier boundaries, a more solid clinical frame, and the psychological resonance of money in the lives of our clients. Money is a legitimate and essential realm of clinical fodder and bringing it directly into the relationship allows for the closer examination of its complex role.  

Everyone has a niche

     Many suggest that they are unable to start a private practice because they don’t have an area of specialization. This feeling of not being able to properly describe your own practice can feel prohibitive. First, it is important to note that some people claim an area of specialization that is based on nothing more than a conference they attended or some CEUs that they collected. Others, more authentically, claim an area of specialization because their experience really does run deep. But having a niche is actually just a way of branding. The fact is that no two clients are the same, and even if you have an expertise, it will not prepare you for what you will see hour after hour. So, suffer the feeling of having a false sense of self in order to brand yourself. Then let your false sense of self get repaired by the truly complex and idiosyncratic work you will do.

Marketing is cheaper than ever

     One of the central reasons why starting a practice can feel overwhelming is because of the expectation that associated expenses will be too high. But the advent of social media as a marketing tool has leveled the playing field tremendously. In the practice that I run, all of our marketing has taken place using Facebook. We didn’t even need to use Twitter or Instagram. There are many Facebook groups that you can make use of to market yourself. For example, if your area of specialization is eating disorders or infertility, chances are there are local Facebook groups for people who identify with these issues. There is trust and buy-in within these groups, and they serve as resources that can create the possibility of word-of-mouth and reputation building.

     Others use Instagram or Twitter to brand themselves.

     These communication tools allow you to create a voice for yourself in ways that therapists have never had the capacity to do before. You can share articles, write things of your own, and build up a dialogue with your targeted treatment community. And for the most part, it is all free.

There is no lack

     The mantra “there is no lack” is one I repeat to myself over and over again. What this means, basically, is that there is no lack of resources to go around. There are enough clients, there is enough money, and there is enough healing. The work we do is too essential to underestimate. And, it is my strong conviction that the need for excellent clinical social workers in practice is more powerful than ever. The need for therapy is both timeless and timely. There is enough work to go around. So, whatever mantra you need to keep reminding you of this, claim it!

Mastering Psychology Today

     When building a private practice, Psychology Today will be your best friend. You need a Psychology Today ad to have any credibility. This is where most people go to find and verify the credentials of a new therapist. It is really useful to assess your market using Psychology Today, as well. If you do a search for your area of specialization with your intended ZIP code and five pages of therapists come up, it will be hard to get clients. If you find a ZIP code very nearby, in a neighborhood that is not as saturated, you have a better chance of coming up in a search and getting phone calls.

     Writing your Psychology Today profile is an art unto itself. It is helpful to have as many friends as possible read your ad, basically crowdsourcing responses to it.

End of paperwork

     The fact is that there is very little paperwork involved in starting a private practice. You need your license, your malpractice insurance (which shouldn’t cost more than $200 a year), a criminal background check, and a child abuse clearance.

     All of your other paperwork should be web-based. There are many software programs available at this time. I certainly don’t know about all of them, but have heard that both Simple Practice and Theranest are user-friendly and intuitive. If you are going to take insurance, these programs interface with insurance companies and simplify the cumbersome reality of those processes.

     And the cost of them, of course, is tax deductible!

Leap of faith

     Whenever you start a private practice, it will be a leap of faith. There is no level of preparation that will allow you to dodge this fact. While planning is essential, because you can start slowly, there is a fair amount of learning as you go that takes place. There are people who spend months creating a website. Others launch it and tweak it as they go. There is no right way to do this; many different styles work. What doesn’t work is preparing to the point of paralysis.

     Starting your own business, big or small, is scary, and it should be. But that doesn’t mean it is wrong or that you are unprepared. I have heard many people speak to the feeling that they will feel as if they are throwing a party and no one will come. I have felt this way myself. However, every fear that comes up when building a practice is emblematic of a larger life theme. Trying to avoid facing these life themes only gives them a more powerful hold over our lives.

Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. Read more of her clinical perspective and tips on the most burning questions of developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.