How To Start Up a Private Practice

Is starting up your own private practice one of your dreams? As per Michael Langlois, LICSW, “private practice is a business, and you need to learn how to create and run a business if you are going to be successful.”

What made you decide to become a social worker?

I had always had an interest in social justice growing up.  As a teenager I remember buying donuts and delivering them to some workers striking at the mill that was a huge employer in my town.  I was always excited and motivated by people standing up for others. 

Also, I had a lot of turmoil in my emotional life growing up, and when I went to college it was really the work of a couple of different social workers who really helped pull me through.  

Prior to that the only social worker I had ever seen was the one Joan Collins played on Star Trek.  The idea that there was such a thing as a clinical social worker was news to me.   

The other reason I decided to become a clinical social worker was a business one:  I was putting myself through graduate school, and with an MSW I could be out in the field practicing as a professional in less time than other mental health degrees.

Can you briefly describe your career trajectory of how you first started out and how those initial steps led you to where you are today?

I have had such a great first 15 years of my career in terms of learning.  Before I graduated from Smith College School for Social Work I went to Nantucket, where I had been living before school, and offered to work for free for 5 weeks at the local mental health agency doing whatever they wanted me to do.  They were the only agency in town, and so if I wanted to move back to Nantucket I wanted to work there.  They hired me right after that, and I always encourage students to consider taking initiatives like this. 

From there I decided I wanted to work more primarily with inner city kids, and I moved to the Cambridge/Boston area and got a job up in Lowell, MA in the public school system.  I spent the next 11 years working there, and loved it!  I got to work with kids ages 4-18 and their families, assessing them and providing a lot of group and individual therapy and class consultation.  It was a great job in that it grew with me, and there was never a dull moment.

In 2005 I decided I wanted to try something a little different, namely being an administrator in another school setting, so I applied to and was hired to be the head of the school district’s guidance department.  It was a job choice for me.  I missed the direct work with the kids, and wanted to make too many changes to the department, so I made tons of political mistakes and it was a disaster.  Fortunately for me, I was not rehired, because I might not have had the courage to move on and tried to stick it out a few years. 

This was a great learning experience for me, in that I realized how stressful and debilitating a bad job fit can be, and decided that I’d take the time and unemployment resources to build a full-time private practice in the 30 weeks or so my unemployment insurance provided. 

This is another thing I often encourage my supervisees to consider, if a job feels like a bad fit and you’ve tried to make it work and learn from it, and it is still making you miserable, get out!  And do not ever be ashamed to use your unemployment benefits, that’s why they are there.  They’re benefits you paid into your entire work life, and don’t be shamed or pressured into giving them up.

I had always had a private practice part-time, but since 2006 I have been in my own practice full-time.  I have a portfolio career, in that I do a few things:  I do psychotherapy, I teach at Boston College, and I provide clinical supervision privately and for Harvard Medical School.

If you were to divide your time between your different roles, about how many hours or what percentage of your time, do you spend on each of your roles per week?

I spend about 25 hours a week on providing psychotherapy, 5-10 on supervising students and postgraduates, and 5 hours teaching at Boston College.   And then there is the time around that I spend blogging, marketing, doing workshops and growing the newer parts of my business.

What do you find most rewarding about each of the positions (therapist, committee member, professor, researcher, supervisor/mentor) you have? And conversely, what parts about each role, do you find most challenging?

Please don’t make me choose!  For two reasons:  First, because I don’t want to give any of the positions up, and second, because each of the positions enriches and informs the others.  I will always enjoy the work and privilege of being a psychotherapist, I get to have so many meaningful conversations daily, and see people confront and overcome huge problems in their lives. 

The biggest challenge is not to take on too many patients at a time, because if I get overextended the quality of each person’s treatment begins to suffer.  I enjoy being on the MCLGBTY and other committees I serve on because they help me stay politically active and affect policy, while representing people who don’t always have a voice in society.

The biggest challenge with that is trying to make the most of my time with committee work and not get bogged down in process—I really don’t like meeting for the sake of having a meeting. 

The most rewarding part of my teaching MSW students is the students.  I feel very confident in the future of our profession:  The students at Boston College Graduate School for Social Work are extremely dedicated and talented to becoming social workers.  They work so hard!

The biggest challenge is that I sometimes can see how stressed out they are getting because they want to be perfect!

How do you help your students deal with their stress and/or desire to be perfect?

I try to stress being professional and human over being perfect, because it is possible (and necessary) for us to be professional and human but impossible to be perfect.  I also help them reframe mistakes:  the goal in therapy is not to stop making mistakes, but to decrease the amount of time between making the mistake and correcting it.

I understand that you are researching the impact of social networks on interpersonal relationships. What drew you to this subject and what is it that you are hoping to learn or achieve through this research?

Partly because in my other life my partner and I founded and own a social media software company.  We’ve had the opportunity to work with lots of different groups and companies to set up social networks, and over the years we have learned what works and what doesn’t. 

And I have learned that social media is changing the ways we interact permanently.  It’s not going away, and as a therapist we’d better learn about it, because more and more of our patients are finding us that way. 

I’m also doing a lot of work on Massively Multiplayer Online Role-Playing Games (MMORPGs) and my goal is to help colleagues learn about them, rather than dismiss them as silly or pathologize them as addictions without understanding what they mean to their patients.

Establishing a private practice almost sounds like an impossible feat to an upcoming MSW graduate student. How did you go about first establishing your private practice?

As I mentioned above, I decided to make the best out of a job loss situation.  That said, it took a lot of hard work and marketing.  It also took a lot of time reading and getting consultation on how to start a business. 

One thing I discovered is that if I had a part-time frame of mind, my practice lingered at part-time.  But when I rented an office, rather than subletting a few hours from somebody else, I had more pressure AND freedom.  I began to take myself more seriously as an entrepreneur, and I began to have more mature attitudes about money and managing the expenses that come from running a business. 

I was also lucky to have a partner who was able to help out the first year when I was ramping up.  But it is not at all impossible, I guarantee you that.  It is hard work and takes a lot of consistent effort, but I can’t begin to tell you how worth it it is in the long run.  If you’re thinking about starting one I say, research it a little and then GO FOR IT!

What career advice would you offer to upcoming MSW graduate students who are looking to develop their own private practices?

My first career advice would be, “don’t sell yourself short!”  Don’t take the first fee-for-service job that calls you back.  You have 2-3 years before you can get licensed in most states, and that is a lot of time to spend bouncing from one unhappy job to the other, or becoming increasingly hopeless and helpless in the job you first pick. 

I really do think that your first job out of school has much more value to it than just money.  It sets the tone for your professional development and your career.  So if you are just graduating don’t act desperately, wait for a job that provides you with good learning supervision and benefits, even if that means you have to do something else in the short run to earn money.

Also, when you are ready to move into private practice get coaching and supervision from someone whose done it, someone who has what you’d like in a practice.

How did you get your first clients and ultimately manage to build up your practice to be large enough to support a full-time practice? And what advice would you recommend to someone thinking about starting up a practice in this regard?

I started by applying to be on insurance panels of all kinds and EAPs of all kinds.  That way I could take referrals from all insurances and EAPs.  However, I should stress that that has limitations, specifically income limitations.  But the second phase of growing a practice is beginning to discontinue being on the insurance panels one at a time, beginning with the one that reimburses the lowest.

I’d also recommend that if you are starting a practice you invest in some private supervision to get started.  If you don’t think you can afford it than you aren’t ready to start a practice—you are either reluctant to commit you resources to your business, or you need a few months to save up to have some resources. 

Are there some professional associations that you have found helpful when you first established your private practice?

I always think NASW is a good place to start, I have met some great friends and colleagues through our MA Chapter and the DC office.  There is always something that needs doing, and usually you can find groups that best suit your interests. 

Depending on your theoretical interests there are usually associations that you can join as well.  I’m a member of the Massachusetts Institute for Psychoanalysis because I work very psycho-dynamically.  Other than that I thing the Small Business Association has good free materials for developing a business plan. 

By the way, did you notice how many times I used the words “business?”  That’s because you need to remember that private practice is a business, and you need to learn how to create and run a business if you are going to be successful.

Do you feel that getting some training from a psychoanalytic training institute is a good idea following one’s MSW degree?

I think it is, because I am a psychodynamically-oriented therapist.  I think that social work schools have decreased the amount of training in this theory over the past 10-15 years, for a number of political and economic reasons, and if you want to get that training you may need to look outside of the MSW program you are in.

Finally, when did you first start your blog and what is it that you are hoping to achieve via your blog?

My blog started a few months ago, when I decided to start focusing more on Psychotherapy in a Web 2.0 world.  A lot of my colleagues were spending time complaining about insurance companies, and although I still do some political advocacy around managed care, I quickly discovered that complaining about it was not going to help my business.

Instead I started to notice how we therapists neglect to learn about technology and the technological worlds of our patients, when that very technology could begin to help us do better work and make money. 

So now I blog about these things and more and more colleagues are coming to me to ask for consultation and supervision around technology.  And I love talking about it with them, and seeing how they begin to get more enthusiastic about the work they do, and more willing to take risks. 

I am also a gamer-affirmative therapist, and am going to start blogging more about that in the next few months, to help compliment the workshops and webcasts I have done on it.  In fact, the next blog coming out Tuesday is on Second Life. 

And next weekend I’m going to be at Blizzcon 2010, so you can bet there will be a blog or two about World of Warcraft in the future too!  I hope this people will get curious about all these ways technology and psychotherapy connect, and check out and subscribe to my blog!

What do you mean by a gamer-affirmative therapist?

A gamer-affirmative therapist is a therapist who does not pathologize people who game online.  Rather than dismissing gaming as silly or an addiction or a substitution for the “real important stuff,” a gamer-affirmative therapist sees gamers as a specific population and culture, with values and ways of being that need to be understood, not criticized.

It is similar to the idea of being a “gay-affirmative therapist.”  If you are coming to therapy because you want me to change you into a non-gaming person, I’m not the therapist for you.  If you are coming to therapy to find a way to understand your gaming and integrate it into the rest of your life in a way that feels enriching to you, that I can help you with.

World of Warcraft is the largest Massively Multiplayer Online Role-Playing Game in the internet.  Basically imagine a internet version of Dungeons and Dragons that you can log onto and play with thousands of other people all over the world.

Second Life is a virtual simulation platform that allows you to create an avatar and live a virtual life online.  You can do most things with your avatar that you would do in real life, including shopping, making friends, attending lectures, exploring the world, etc.