A calendar with a note that reads "start business" and has a dart above the words

In years past, several of my associate licensed supervisees have transitioned into their own private practices right out of the gate after earning their full licenses. This wasn’t luck and it wasn’t accidental. Each of them invested a lot of planning — around 12 months — but it paid off with profitable businesses as quickly as three months afterward. A couple of them were even hiring staff within a year’s time.

Now is an opportune time if private practice is an aspiration of yours. COVID-19 changed our culture in two distinct ways that apply to our discussion. First, the pandemic magnified preexisting conditions. The effects of COVID-19 on mental health are still lingering today. Depression, addiction and marital issues that predated the virus only got worse as we went into lockdown, leading to more people seeking help.

Second, as I’ve written about several times in past columns, the virus pushed all of us into a digital world. Clinicians who had never previously considered telehealth were forced into it, and many subsequently realized how convenient it was and chose to continue offering telehealth services long after the heat of the pandemic was past. Many clients had similar revelations.

Telehealth has made it possible for a clinician to run a private practice without any brick-and-mortar office. Home offices are economical to operate and may also qualify for tax breaks. At home, you are already paying rent or mortgage, the electric bill, internet costs, etc. With a brick-and-mortar office outside the home, these costs are doubled. Plus, with home offices, there are no travel expenses and the child care options are potentially easier.

That being said, transitioning to private practice takes planning. The clinician must be willing to run all parts of the practice — scheduling, billing, taxes, etc. No more life of just showing up, seeing clients and then going home. But in exchange comes the freedom to carry whatever caseload you want, take vacation when you want, work whatever hours you want and specialize as you choose. Nearly all agencies take a percentage of client fees. In private practice, 100% goes to you — the owner.

There are several steps to launching a private practice. A first step is ensuring that you honor your current contracts and the limitations that might come with them. The Risk Management for Counselors column in the March issue of Counseling Today recently discussed noncompete clauses that are common in both public and private agencies. Transitioning to private practice will require honoring the specifics of any existing noncompete clauses. This can be onerous in some cases. For example, “No practice within 25 miles” might require the clinician to move or to rent office space outside of the noncompete distance.

A second step is marketing. How will people find you? Why should they choose you? You have to earn a reputation, but that takes time. The biggest key to marketing a private practice is having a referral stream. My most successful clinicians have built relationships with churches, schools, psychiatrists, physicians, the courts or other agencies that channel clients their way. Unless you already have a client base that you can take with you, starting out without a referral stream can be challenging.

Marketing will also require the clinician to examine the type of practice they want to run. Each practice will look a little different depending on whether it is a general practice or whether it is focused on marriage and family, trauma, children or any other specialty. This will also determine the direction the clinician takes for pursuing referral streams.

Licensing, certifications and specialties must be considered. Counselors are ethically bound to present themselves accurately to the public, but certifications such as eye movement desensitization and reprocessing for trauma workers or Gottman training for marriage and family therapists can improve your marketability.

Many clinicians have found success with rather inexpensive marketing through websites such as Psychology Today’s “Find a Therapist” tool. A website is critical and cost-effective. Other social media outlets might work for advertising, but clinicians need to ensure that they are complying with ethical standards regarding social media.

One last issue to consider is whether your practice will be cash-pay only or whether you will accept insurance. Most insurance boards have a standard pay scale. This means that while you might be able to charge $125 an hour in a cash-only setting, you might make only $85 an hour on an insurance board. Boards also require more time to manage in billing.

I’ve had a private practice for decades and have been cash-only since the mid-1990s. I don’t do any advertising at all because I don’t need to, but when I started out, I followed the suggestions in this article. I’ve never regretted not working in an agency. If this is something you would find meaningful, now is a great time to begin working toward the independence of private practice.


Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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