Establish Your Private Practice Like a Pro

Are you yearning for a private practice but have no idea of where to begin? Would you like some guidance from a mental health professional who is an expert on the topic?

Social Work Career is delighted to have Tamara G. Suttle, M.Ed., LPC, as a guest today. Whether you’re a social worker, mental health counselor or other type of helping professional, you’re going to have a few of your most burning questions answered !

Tamara has not only been maintaining a private clinical practice since 1991 but has also been providing therapists with either supervision or private practice coaching for nearly 20 years. Many of you may know her from her well-known Private Practice from the Inside out blog.

Tamara, Could you give us a bit of your background? What led you to become a mental health counselor?

In college, it was obvious that mental health was exactly where I was supposed to be. When I got ready for graduate school, I looked at psychology, social work, marriage/ family therapy and counseling.

The emphasis on research and behavioral psychology was not a good fit for me. The social work curriculum I looked at emphasized working in hospitals, institutions and the welfare systems. That wasn’t what I was looking for.

Marriage and family therapy didn’t interest me at the time because I had no plans to marry and family was still quite narrowly defined back then. That wasn’t going to work for me either.

And, then I learned about counseling – I was immediately drawn to proactive, holistic emphasis on working with individuals, groups, and families with both an educational and depth of focus.

I graduated, got licensed first in Texas as a Licensed Professional Counselor and then in Colorado. I have been in mental health since 1982.

What I know now that I didn’t know then is that research shows that while the various disciplines certainly provide different foundations for our work, after we’ve been in our respective fields for a while, regardless of our various disciplines, our clinical practices are much more similar to each other than they are different.

I started out in the 1980’s doing trauma work when the only research that had been done in the field was on war veterans. We were really flying by the seat of our pants working with adults who had been sexually abused as children, rape and domestic abuse survivors.

Our treatments back then were informed by the works of Pia Mellody, John Bradshaw, Melody Beattie, Charles L. Whitfield, and Claudia Black; the work was considered to be cutting edge; today, much of that work been absorbed into many different protocols.

What experiences helped you the most in terms of building up the requisite clinical skills to enter private practice?

The first experience that comes to mind was early on in my career. I often fantasized about donning that white cape and swooping in to rescue my clients. I wanted to wrap them up in blankets and take them away from whomever it was that was mistreating them. It’s embarrassing to say that but I think it’s also important for new professionals to understand that it’s common . . . almost predictable for many clinicians to have to grapple with rescue fantasies.

This wasn’t talked about in my graduate training – at least not in any meaningful way – day dreaming about how to save / fix my clients . . . and how that isn’t about their dire straits nearly as much as it is about my own rescuer fantasies . . . the role my own history plays in the counseling relationship . . . countertransference.

The first time I heard anyone talk about this in a real and meaningful way was when I attended a feminist conference for mental health professionals in the mid 1990’s. Two psychologists facilitated a workshop that focused on what therapists don’t talk about.

As a new professional with probably no more than 5 years experience in private practice, I had never heard colleagues (or professors or anyone else, for that matter) talking about their own issues . . . emotional / physical attractions to their clients, how disgusted / repelled they were by some clients, how far they would go to avoid confrontation, their own dual relationships and the complications they incurred because of them, and many other personal disclosures.

The revelations in that workshop showed me that therapists don’t necessarily have all the answers; we’ve just been trained to help others find their own answers. It also showed me what countertransference looks like in real live situations and what confident and committed therapists do when they have their own stuff come up in their own offices with clients sitting across from them.

Another experience that really stepped up my game was learning what denial looked like. My first jobs in the field were working in community mental health – at a group home with teens who at the time were referred to as “emotionally disturbed” and then in an alcohol outpatient treatment program with court-ordered, coerced clients – mostly DUI [drinking under the influence] offenders – the majority of which were in total denial about the seriousness of their relationships with alcohol.

I will always be grateful for the seasoned clinicians that were so committed to mentoring me in those formative years of my professional life.

Nancy T. Heffernan, LPC showed me how to balance professional boundaries with deep compassion and how to advocate with righteous anger for children that had far more unmet needs than I could have possibly imagined with my privileged 22 year old eyes.

Frank Hunt was a co-worker working a 12-step recovery program seemed to be ancient, ornery, and wise. I don’t remember how many years in recovery he had but what I do remember is that he took me – this very naïve 23 year old, middle class, tee-totaling young woman who wanted to save the world – under his wing – taught me how to recognize what the early stages of alcoholism looked like and the role that denial plays in keeping clients stuck, how to support clients in seeing clearly exactly what their relationship with alcohol is and how to chip away at that denial. He gave me a copy of The Big Book, took me to my first Alcoholics Anonymous meetings, and answered endless questions that guided me in becoming the therapist I am today.

Geneva Heckard, LPC offered me opportunities to work with the county court system when she hired me. She afforded me the opportunity to better understand the interconnectedness of community systems of support. I think that’s something that social workers are taught to understand early on. But, most counselors don’t get that lesson until they are actually out in the field – often learning in a more haphazard way that leaves gaps in knowledge.

Each of these individuals taught me what professional boundaries look like and how to confront clients in supportive ways, what denial looks like and what to do when countertransference shows up in my work; they modeled humility and grace and the appropriate use of humor in the face of incredibly challenging work.

Which are the 4 or 5 primary go-to books that you find helpful (or did at the beginning of your journey as a therapist) to support you in terms of your clinical work?

Oh, my gosh! I love this question, Dorlee! Can you ever have too many books?!

One of my mentors taught me to use a genogram as the structure for my intake with new clients. This format, Based on the book Genograms: Assessment and Intervention by Monica McGoldrick, Randy Gerson, and Sueli Petri, floats up problem areas and potential treatment goals all the while couched in a conversational and educational format. I can’t think of a better first book and early skillset to develop for an therapist.

Every client that we work with is either seeking change or has been thrust into the middle of change. For that reason, William Bridge’s book Transitions: Making Sense of Life’s Changes has been invaluable to me in conceptualizing and normalizing my own and clients’ reactions to change.

Callings: Finding and Following an Authentic Life by Gregg Levoy is a book that really upped my clinical game. The premise of the book is that life is whispering invitations to each of us every moment of every day pointing us toward our life’s purposes. Sometimes therapist’s struggle with this . . . and often clients come to us not knowing but wanting to know what their own life’s purpose is. This is the book that I point them to.

Almost all clients will be touched in some way by family dysfunction / addictions. Facing Codependence: What It Is, Where It Comes From, How It Sabotages Our Lives by Pia Mellody, Andrea Wells Miller, and Keith Miller is one of the classics that helps both therapists and clients to understand the patterns that erode away at our personal power and our ability to even recognize what it is that we want, need, and deserve to attain.

And, finally, Ken Pope, Ph.D. and Beverly Greene, Ph.D. wrote a little white book called What Therapists Don’t Talk about and Why: Understanding Taboos that Hurt Us and Our Clients. I think it ought to be required reading in any graduate program. It’s an easy read that will help float up a therapist’s own issues that need to be considered, reflected upon, and resolved if you are going to do the work of psychotherapy.

What do you enjoy most about your work? And approximately how much of your day/work is psychotherapy vs. supervision vs. private practice coaching?

For the first 20 years in mental health (the first 10 working in agencies, criminal justice, and a hospital setting), I was 100% immersed in clinical work. Then, in 2002, when I relocated to Colorado, I had an opportunity to start over and redesign a new practice with a split focus. It was an unexpected perk!

These days I keep a 50-50 split between my clinical work and the coaching / consulting work and I love it. Each half informs the other. 

By keeping my head and hands in the clinical work with more seasoned professionals, I get to experience first hand the highs and challenges of continually honing that edge. 

And, by staying connected to relatively new therapists – at least new to private practice – I get to feed off of their fresh ideas and enthusiasm! That keeps me current and on my toes!

What I love most about my work is really hard to say . . . . I love the variety of my work, the puzzle of something new and the sleuthing to make it all make sense. I love connecting the dots and mentoring the way for therapists to leave me with a greater sense of purpose, a clearer understanding of their strengths and gifts, and my own sense of changing the world by supporting them on their journey. What’s not to love about all of that in a day?!

What are the most challenging aspects about your work?

At 54 years of age with 30 years in the field, it is easy to get sloppy and there’s tons of research out there that shows that the longer we’re in the field, the more likely we are to make errors. So the challenge, of course is to stay sharp!

It’s easy to assume that the new clinician I am talking to understands what I am talking about. It’s easy to rationalize skipping over finishing a report or putting off balancing a checkbook, but each one of those rationalizations has consequences for both me and my clients.

In my coaching and consulting work, the same is true. Putting off responding to emails or even writing down a date for an interview can be costly for everyone involved.

Another challenge is that I meet so many people in a month both face-to-face and online. I really love talking to therapists in particular so it’s frustrating when I don’t have time to visit with every single one or remember every one’s names. I hate that! Often I will remember a face but can’t connect where I last saw it or what name goes with it!

Could you share a few questions that a mental health provider hoping to join an established private practice might expect to encounter in an interview?

Sure! I think most owners of a group practice are wise to ask “What are your long term plans for your career?”

Some owners of group practices pride themselves on being training grounds for new clinicians. Mentoring, consultation, and even training – both clinical and business-focused may be included in their expectations. Other owners want clinicians coming in ready to function independently both clinically and from a marketing / business perspective.

Another question that many group owners ask is “How do you plan to bring in clients to this group practice?”

Even if that question doesn’t come up, therapists would be wise to find a way to weave this answer into their interviews. Whether a group owner expects clinicians to actively market the group or not, marketing skills and knowledge will always be appreciated by the owner.

If therapists don’t know yet how to attract clients, then let this be a good nudge to learn from the more seasoned therapists around you and from research both in and outside of health care about effective strategies for marketing a private practice. It will make you much more valuable to the clinician that hires you.

Moving onto the business side, where/how did you learn how to start up your own private practice? (Were any books of particular help?)

Oh, of course! There were lots of books (because I started in private practice pre-internet) and, at least in the first 10 years, none of the books I read were about setting up a counseling practice because they just didn’t exist.

The first book I read about marketing, The 101 Best Practice-Building Strategies for Today’s Physician by Alan L. Bernstein with Donna Freiermuth, was actually written for physicians and it was ridiculously expensive – $40. (and that was way back in 1991!)

I found it at a medical bookstore. It was incredibly well-researched and I still remember some of the things that I learned from it like where you physically locate your office matters, what to tell clients when you are selling your practice to another owner to maximize continuity of clientele, and advertising do’s and don’ts.

Another book that really helped me hone my niche was Nichecraft: Using Your Specialness to Focus Your Business, Corner Your Market, and Make Customers Seek You Out by Lynda C. Falkenstein. Although most of us hear early on that we “should choose a niche” to help focus our businesses, we really resist this – mostly out of fear. This classic book spells out exactly why niching is a really smart business move and exactly how to drill down to find your own niche.

The Cluetrain Manifesto: The End of Business as Usual by Rick Levine, Christopher Locke, Doc Searls, and David Weinberger probably seems like an unlikely book for me to mention. However, I am a bit of a digital dinosaur. Even though today you find me on LinkedIn, Twitter, Pinterest, Google +, Facebook and blogging away on Private Practice from the Inside out, the truth is that I have resisted every one of those tools every step of the way until I got over my fears and saw the results I got from using them.

Reading this book back in 1999 before therapists were ready to embrace even simple, static, old-fashioned, HTML-based websites was a game-changer for me. These geeks wrote this little book predicting the many ways that the World Wide Web would change business practices around the world.

They were making audacious claims like “Markets are conversations,” insisting that businesses should be having those conversations with their audiences in voices that “sound human,” and noting that “Hyperlinks subvert hierarchy” and thus level the playing field for small businesses like yours and mine!

It took me another 8 or 9 years before I put up my first website up for my clinical practice but by the time I got there, those visionary geeks-turned-authors had predicted the upheaval and leveling of business, communications, and marketing in ways that we are still unraveling today. And, even today, 15 years later, when I get bored with my marketing and want to spice things up, I typically turn to the first few pages of this book and re-read The Cluetrain Manifesto’s 95 Theses  for inspiration.

And, then finally, Lynn Grodzki came out with Building Your Ideal Private Practice: A Guide for Therapists and Other Healing Professionals in 2000. It was the first book I ever saw or read specifically for mental health professionals about building a private practice.

Although I had been in independent practice for 8 years by the time this book was published, I read it and found it useful in helping me reinvent my practice in 2002 when I relocated from Texas to Colorado. While there are now several books out there competing for new practitioners’ attention, I almost always recommend Lynn’s as a favorite place to start learning about growing a business in mental health.

What would be your top 10 tips to mental health providers interested in starting up their own private practice today?

1. While you are honing your clinical skills in graduate school or in an agency, even if private practice is 10 years down the road for you, start your networking (online and face-to-face) now. Even if you plan on relocating and don’t have a clue where you will be, maintain your network at all cost. It will be the difference between starving to death and thriving when you open your doors to private practice.

2. Create a plan for your own self-care. Read about it. Talk about it. Write your plan down and put it on your calendar before you ever schedule your first client. In the beginning, you may find that this is an exercise that feels totally disconnected to your clinical work. However, if you establish those habits of self-care now, when the crises hit (as the inevitably will), you will be better prepared to weather them.

3. Join or create a consultation group. You will need them to bounce ideas off of, check in for reality checks, and to continue to grow your edges in private practice. Most therapists are not prepared for the extreme isolation of sitting in an office, listening all day, and giving, giving, giving of themselves. Your consultation group can be your lifeline to counterbalance your clinical work.

4. Be strategic in your networking. Take the time to identify the clinical areas that you are not trained in, don’t have an interest in working in, or simply are not competent in. Declare your weak suits (as well as your strong suits) and know that those areas of weakness are the best places to strategically focus your networking. There’s a good chance that your weak suits will nicely compliment someone else’s strong suits and vice versa. When the clients start knocking on your door (but they don’t happen to need your strong suits), you’ll have a list of professionals who are better fits for those clients. In turn, you will have garnered favor with those that you referred to and will likely reap reciprocal referrals from them!

5. Stay focused on building reciprocal referring relationships. There are only a zillion competent therapists these days working with trauma. Make every effort to build relationships with and refer to those who are qualified and are willing to also refer back to you. Referring a client out obviously needs to be a clinical decision based on that client’s particular needs; but referring out also needs to be a business decision. Make it your mission to find professionals to refer to that can meet both of those needs.

6. Get your paperwork in order before you schedule your first client. Intake forms, referral documents, progress notes, psychosocial history forms, disclosure statements, handouts, receipts, and more are required to conduct your work in private practice. In the beginning, you will have 0-2 clients and what you think of as “too many free hours” in the day. That’s a great time to be creating and polishing those documents.

7. Establish systems for everything. When you are in graduate school or working for an agency, the systems are already in place i.e. how to handle initial inquiries, how to write progress notes, how to deal with a client in crisis, how to handle no-shows, etc. Once you are out on your own, it’s entirely up to you. Set those systems up early on so that they become ingrained habits. Otherwise, you will find that 10, 20, even 30 years down the road, when your practice is full and thriving, you will be wasting your time reinventing everything from scratch with every new client.

8. Plan on investing in a website on a good solid platform like WordPress.org from the beginning. Having a good website helps establish your credibility and tells the general public that this isn’t just a hobby for you – that you are a professional who is serious about her work. And, don’t be taken in by the sites that claim to offer you a “good deal” by hosting your site for you. Do the math. They are not cost effective in the long run – 3, 4, 5 years down the road you could have paid for a fully customized site with all the bells and whistles.

9. The most efficient way to get known online is through blogging. You can start blogging long before you hang your shingle out and make the move into private practice. Dorlee, you are a great example of doing this while still a student, and it has obviously helped you get connected around the globe with social workers and resources that you rely on today. It’s a very smart way to get a head start on your peers.

10. And, finally, remember that private practice is a marathon . . . not a sprint. You need to pace yourself, anticipate the slow start and lulls that inevitably will come throughout your career and plan for how you are going to handle them both financially and physically. There will also be feast days when you can hardly come up for air. Plan for those, too – what you will do with the extra money and how you intend to fit into your schedule your own self-care, your family obligations, etc. And, throughout the feast and famine days of private practice, keep an eye on what it is that you are supposed to be learning . . . about yourself, about your clinical work, and about the business of running a private practice.

Thanks so much, Tamara, for all the wonderful guidance you have shared with us on starting up a private practice and building up clinical skills!

What are your thoughts or concerns about starting up your own private practice? What helpful tips or books would you add to what Tamara has provided?

Disclosure: This post contains affiliate links. This means Social Work Career may receive a small commission if you make a purchase. Regardless, I only recommend or include recommendations for products or services I believe will be good for my readers.

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