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Starting My Practice, What I Wish I Knew

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I wanted to create a simple guide to help you start your ideal private practice. I know that when I was considering leaving my agency behind I was scared, nervous, and very unsure of myself. I had no idea where to start. I met with several colleagues of mine who had graduated before me who were working for themselves and picked their brains. I bought them lunch, coffee, offered to pay for their time, etc. I followed the appropriate Facebook groups, listened to podcasts, etc. All of this was helpful yet I still had doubts about the process.

If you’re like me you question literally everything and anything. Call it anxiety, call it perfectionism, call it obsessive thinking. Whatever you call it, that mentality creates blockages. Almost like putting your own barriers in your way to ensure that you will stumble over them. I’ve written about Impostor Syndrome before and how damaging that type of thinking can be.

Starting a private practice is like building a house, and guess what? I’ve never built a house and I’m sure that most of you haven’t either. Nevertheless, the foundation is the most important part.

The foundation consists of the following: Office space, furniture, intake documents, a way to accept payment, liability insurance, a business name (even if you’re doing business as yourself), an EIN (employee identification number) attached to said business name, and a way for clients to contact you. This is it. Nothing more, nothing less. And it does not have to be perfect by any means. We can get caught up in that mentality that things need to be absolutely perfect or they won’t work. Just get two chairs from a garage sale and put them in an office. Make sure that you have informed consent paperwork, a professional disclosure statement, privacy policies, and releases of information. Getting an EIN is quick and painless and takes less than 5 minutes on the IRS website. It is completely free (please do not fall for any scams where they ask you to pay for one). Find a HIPAA compliant payment method. IVY Pay is easy to use and meets that criteria. It is a HIPAA compliant app designed for therapists. The client puts their card info in on their phone, it encrypts the information, and you hit “charge” whenever you see them. The client gets a text telling them their card has been charged. Easy! And obviously make sure you have a way for clients to contact you. A HIPAA compliant phone/text is recommended. I use Spruce Health. It’s HIPAA compliant phone, text, and fax, all in one!

After building the foundation of the house/private practice we need to start on the walls. The walls are also essential but not as critical as the foundation. The walls consist of a landing page/website or some way to find you and contact you. Sometimes I think we can assume that clients are just going to appear. They need to be able to find you via internet search. If you are a part of local/national therapist Facebook groups you’ll need a place to link your contact information to when asking for referrals. The walls consist of an electronic medical record system to keep yourself organized and to bill appropriately. I prefer using Simple Practice but you may have a platform you feel more comfortable with. All of the EMRs offer free trial periods. Try them out, see what feels the most comfortable. You will also want a business bank account. I hear this time and time again. You do not want to use your personal bank account. Please make sure to open a business bank account with your EIN #. This is so important for tax purposes. Most banks offer business accounts. Choose one that has 0$ fees, is accessible for support, somewhere you can develop a professional relationship with.

After we put the walls up we want to deal with the roof. The roof keeps us safe and out of inclement weather. This is where I’d want my systems to be fine tuned. I’d want to ensure that I have my no show/cancellation policy down pact. I’d want to be confident in my fee setting, and asking for what I’m worth with confidence. I’d also want to know my sliding scale amount, and how many sliding scale slots I was going to offer. I’d start thinking about how much vacation time you’d like to take each year and how much money you need to make to survive. If you need to make $50,000 and want to take 8 weeks of vacation time, how many clients do you need to see with the remaining 44 weeks of the year? How many days a week do you want to see clients? I’d suggest building a 3 day weekend into your schedule, whether you are taking Fridays off or Mondays off. You need the time to re-charge. A lot of new therapists think that if they don’t offer constant availability that you’ll never get clients. Here’s something I want you to think of. I want you to make a schedule that works for you and your needs, not the needs of everybody else. You cannot be available 24/7. Self care is critical. I know we preach it in community mental health but in self employment, you need to re-charge and reassess.

Let’s furnish and decorate the house now. These are the extras. The things that make a house feel like a home. Picking out office furniture that you really like. Buying a computer or tablet that you enjoy using. Finding an office chair that doesn’t hurt your back each time you sit on it. Designing your website, business cards, marketing materials, etc. These things are all very important but don’t need to be done on day 1. These are the things that you can tweak and improve as you go. Remember, things do not need to be perfect on day 1. They can’t be. You’ve never done this before and there are going to be unexpected circumstances. We are selling healing, support, encouragement, learning. We are professionals who understand growth and healing is a lifelong process. So please exhibit some self compassion when you think to yourself “my website looks like shit” or “I need to do this more efficiently.” This stuff is going to constantly evolve, change, and grow, just like your business will.

I also want you to be thinking about the client population that you really enjoy working with. I also want to encourage you to be thinking about your marketing and networking plan. I like to think about networking as a 2 way street. I don’t ever want a networking to feel 1 sided or selfish. Think about which professionals are seeing your ideal client in your area and who are full or usually full. I’d want to network with them. Not just because they need referral sources but because you do too. I’d also want to be making sure I am networking with psychiatric providers. These folks are full all the time. As we know, psychiatric medication management is not a luxury we all have, and those who provide these services are often full or at capacity. Most of these providers want to collaborate with a therapist. They want to ensure that the client they see for 15 minutes at a time is taking care of their mental health needs.

I hope that this was all helpful. I will be starting a private practice building and coaching business. I will be focusing on small, 6 person 6 week mastermind courses on building your private practice, taking the leap, and betting on yourself. I know that it’s a really scary and unsettling thought process. I believe that I can coach you through all of the uncertainty, coming out on the other side as a successful small business owner who can work with clients to the best of your abilities, and better yet, at your own pace and on your own terms. Freedom, flexibility, and financial security. That’s what it’s all about.

Subscribe to my mailing list to learn more about my upcoming 6 week mastermind course on creating your own private practice.

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