Your Checklist for Starting a Private Practice in Counseling

Working for yourself might seem like a dream come true, especially if you already love being a therapist. But private practice requires a hefty dose of business acumen and adds myriad new responsibilities to your daily life. So talk to other therapists in private practice to get a better understanding of what they like and what they don’t. Some important considerations include:

• The expenses of private practice. You will likely face higher taxes if you are a business owner or self-employed. You’ll also have to plan for retirement and fund your own health insurance. If you hire employees, you’ll need to pay payroll taxes, offer benefits, and provide a competitive salary. Office space, phones, internet, and other costs can further eat into your budget.
• Work style. When you’re in private practice, no one else tells you what to do. You’ll have to manage your own time, which can be both a blessing and a curse. Time management and organization skills, as well as significant motivation, are key here.
• The endless paperwork. You’ll need to seek insurance reimbursement, ensure you comply with state, local, and federal laws, provide your clients with the right forms, and keep track of therapy notes. Plan to spend at least an hour or two of each day managing the business side of your work.

Every state and municipality has its own regulations governing businesses. Plan to consult with a business lawyer so you can follow the laws in your area. Some important considerations include:

• State and local zoning laws that may limit where you can practice.
• Whether or not you need a business license.
• How best to incorporate your business as a separate entity.
• Malpractice and professional liability insurance.
• Scope of practice concerns.

If you seek a loan to start your business, you’ll likely have to provide a detailed business plan. Even if you’re funding everything out of pocket, a business plan can help you succeed as early as possible. This should be an evolving document that changes as you learn and do more. 

Some things to include in your plan include:

• How much money you need to make each year to keep practicing.
• How much you need to bring in each year to earn a decent living.
• Financial goals, such as earning enough to hire a second therapist.
• Your marketing plan.
• Goals for the first months, first year, and first 5 years. This enables you to track your progress and assess whether your plans are realistic as you hit various benchmarks.
• A loan repayment plan, if you need a loan.
• Funding options. For example, do you have savings that can help fund your marketing costs?

To run a successful business, you must have a safe and inviting space to see clients. That doesn’t mean you have to invest in a fancy office. Some therapists cordon off a room in their home to use as a home office. Others share office space with another therapist. No matter what you choose, you’ll need to ensure you’ve budgeted for all of the following:

• A secure, confidential space to meet clients.
• Office furniture and decorations.
• Office technology, such as a phone or answering service, and internet access.
• Security concerns. Depending on the client population you counsel and where you see clients, you may need to consider security issues. Some therapists may need to install a panic button or ensure their office is only accessible with the right security code.

An office administrator can save you time, and possibly money, by answering the phone, managing paperwork, tracking down payments, and performing other key duties. If you pay an administrator half of what you make hourly, for example, the time the administrator frees up is time you can spend earning money on paying clients rather than dealing with administrative hassles.

Of course, hiring help also presents some additional expenses: salaries, benefits, payroll taxes, and more. Spend some time weighing the costs and benefits of employees such as a receptionist, office manager, or even a second therapist.

Joining insurance provider panels can help you find more clients since you’ll be listed as part of the insurer’s provider network. Joining a provider panel allows you to receive payments directly from insurers. This makes therapy more accessible and affordable and may expand the network of clients to whom you can provide therapy. Start by applying to the largest providers in your area. You can usually find an application and information about joining the provider panel on the insurer’s web page.

Networking is free marketing. Other therapists can offer tips for running a business, refer clients to you, and serve as a sounding board when you need advice. But networking is about more than just letting someone know you’re opening an office. Networking should be a reciprocal relationship built on mutual trust, not name-dropping. So get to know other therapists. Invest in their work and businesses. Find ways to partner on projects together. Gaining the respect of your colleagues takes time, but it is well worth the effort.

There are dozens of ways to market your business and not all require a significant financial investment. You’ll need a quality website, since many clients find a therapist by searching online. Others search for specific problems or questions, then choose their therapist when they find a therapist who offers a quality, compassionate answer. So a website full of useful information and inviting language is a potent marketing tool.

Some other affordable strategies for marketing your business include:

• Posting useful, helpful content on other websites. Writing blog posts and web articles raises your profile and displays your knowledge.
• Attending professional seminars where you can network with other therapists.
• Answering mental health questions on online forums and message boards.

Providing quality care remains the single most important thing you can do to market yourself, so don’t spend too much time focusing on marketing gimmicks. Establishing a niche can help you do the best possible work, since clients who know you’re experienced at treating a particular issue may recommend you to friends and family.

Other strategies for marketing your business include:

• Creating a social media following.
• Investing in social media or Google ads.
• Getting quality, professional-looking business cards.
• Investing in a professional headshot to post on your website and use in bios for professional events.

Clear policies help you better manage your practice while ensuring clients know what to expect. Some considerations include:

• What types of payment are you willing to accept?
• What will you charge per session? Can you offer discounts, such as sliding-scale fees or multiple session discounts?
• What is your appointment cancellation policy?
• What specific steps will you take to protect client privacy and comply with laws such as HIPAA?
• What will you do if a client is a danger to themselves or to others?
• Under what circumstances will you refer a client to another treatment provider?

It’s important to memorialize these policies in clearly worded forms. But don’t assume that clients will read through these forms. During your first session, discuss your policies with clients. This fosters a sense of mutual trust and ensures clients understand what they can and can’t expect when they choose you as their therapist.

Building forms might seem like a pain, but over time, they can streamline the process of running your practice. Some forms to consider include:

• A client intake form to gather basic information that can inform treatment.
• Client disclosure forms that outline your office policies, privacy policies, and other important guidelines.
• An informed consent document authorizing treatment.
• A referral form for clients whom you refer to other therapists.
• Insurance reimbursement forms built to comply with the guidelines you must follow for each provider panel you join.
• Client information forms that ensure all basic client information is in one place.

Ultimately, the most important marketing strategy is to do good work for clients whom you are qualified to treat. When you make a meaningful difference in someone’s life, they are more likely to recommend you to a friend. Supporting a person as they change their life for the better can be immensely fulfilling, making it easier to juggle the many roles you must fill in private practice.