The Private Practice Start-Up

One of the reasons I’m passionate about helping other therapists get licensed is because of the freedom licensure provides. If you’re straight out of graduate school, it’s the gateway to your first job. If you’re further along, it’s a gateway that can potentially allow the freedom of independent practice.

Freedom might look different to everyone—for some it may involve rising to leadership positions in their agency, going into consulting work, or ultimately having your own practice.

Today I wanted to focus a little bit on giving some start-up advice to those who are pursuing their LCSW exam to go into private practice. By no means is it meant as a comprehensive guide to starting your own practice, but it might provide a basic frame for some of the things to think about when starting up.

  1. Get licensed. This is an obvious step :-). Even though the clinical exam will have a lot of mental health and psychotherapy-related material, it will still contain and bring you back to the foundations and values of social work. The clinical exam isn’t just testing your knowledge of mental health, but your integration of social work values (empowerment, systems theory, cultural competence, and social justice) with traditional psychiatric knowledge.
  2. Decide whether you want to take health insurance. Deciding whether or not to take insurance is a very personal decision since it might depend on many factors. On the one hand, insurance provides accessibility and affordability for people to access therapy. It can also help you reach out to ideal referral sources (for example, if your niche is working with educators or law enforcement, you can decide to take city insurance). On the other hand, it can raise some challenges like lower reimbursement rates, higher overhead (since you might have to hire a biller), and more time doing paperwork. This is a whole post within itself because money our ideas about it are totally clinical issues in their own form.
  3. Did you say niche? Yes, niche. While some practices can thrive on seeing everyone and anyone who comes through the door, and you always want to focus on increasing your clinical skills, you will do your best work by reflecting on which types of clients and issues you have worked with the best in the past. We can’t realistically be the jack of all trades for every single clinical struggle ever. While a niche may change or evolve, clients will be getting the best clinical care when the type of work you feel most excited about doing resonates with their personal pains and challenges.
  4. Find space. This is one of the biggest barriers for people since it involves putting down a large amount of money. Also, whether you’re leaving agency work forever or just doing a part-time practice, signing a lease “makes this private practice stuff real.” Still, even in an expensive city, this doesn’t have to be the case. Many therapists are more than willing to sublet their unused office days to other therapists who are starting out, which can make for a really accessible gateway to branching out on your own.
  5. Systems.  Even before you see your first client and may think you can wing it with a pen and marble notebook, don’t.  Having systems in place will help make your billing, paperwork, and clinical work a lot more streamlined. Before I saw my first client, I invested in software to keep electronic charts, scheduling, and even billing insurance all in one place (so you might not even need a biller). Systems also means having a separate business account set up, and consulting with a lawyer to get information about how you want to set up your business (sole-proprietor, LLC, PLLC, etc.).
  6. Don’t do it alone. Going into private-practice requires a lot of support since it also involves integrating your clinician-self into an entrepreneur-self (which to some might seem like the antithesis of social work!–though trust me, it’s not really), and you want to reach out to people whom you can learn from and who can also hold you accountable to your goals. Whether you start by reading books, listening to podcasts, or joining online or in-person communities, you want to make sure that you’re doing the “inner work” in addition to the external work of creating a practice.
  7. Keep Learning. So I obviously created a number 7 on this list since I internalized hating the number 6 from religious/superstitious grandparents even after years of not aligning with those beliefs, but let’s roll with it. Even if you get your independent license, private practice is going to feel like a total reset of your learning journey in that you’re doing it from a different angle. Instead of only getting CEUs for the sake of getting them, invest in creating more depth and meaningfulness in the education you seek out. It will make the work that much more fulfilling and solidify the kind of message you want to deliver to your clients about their own personal journeys.

Ready to get licensed? Contact me.

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