A very nice thing happened to me while in line at the bank the other day. A young therapist standing behind me recognized me and asked for my advice. Imagine! With four young adults in our family who rarely ask for advice and only occasionally follow advice that is offered, it was a startling moment. What, she wanted to know, did I think was the key to success in private practice? Now with a chance like this, I didn’t want to blow it. I quickly ran through all the things I could think of that I wished someone had told me early on. What could I tell her in the next minute or two that might make a difference?
“I’m going to assume that you are skilled,” I said. (I didn’t want to waste my advice-giving opportunity on the obvious.) “But success at private practice takes something besides being an excellent clinician. I think it comes down to two things: Embracing the idea that you are in business and always having good personal support. Do the business of being in business well and your practice will grow. Make sure that you have healthy people in your life who love and care about you and you’ll have the emotional balance to handle all the pain you hear about every day.”
“That’s not what I expected,” she said. “I thought you’d give me hints about networking or marketing or something. But this is maybe more helpful.” It was her turn at the teller so she thanked me with a bright smile and a look that told me she was thinking hard about it. She probably didn’t realize she’d made my day.
The encounter made me think more about success factors. Yes, marketing and networking are important, of course. But I believe a healthy attitude toward business and, even more important, a healthy self are just as important as clinical expertise when doing private work. Perhaps the topic headings are sufficient. But if you are beginning a private practice and would like to know a little more, here’s what I’ve learned over the 35 years I’ve been in the business of being a professional helper.
- Deal with whatever issues you might have about money. Therapists as a rule aren’t in it for the money. How could we be? But it’s important to get over any lingering embarrassment about accepting payment for services. You are helping the client and his or her family by doing the best work you know how to do. The client is helping you and your family by paying you. It’s a fair exchange. In fact, if we don’t take being paid seriously, we are in danger of setting up a dynamic that is harmful to both sides. The client starts to feel guilty, entitled, or beholden. The therapist can start to feel resentful, burdened, or used. Not good. Keep the transaction clean and clear and you are both freed up to do the therapy.
- Dress for success – or at least in a way that is respectful of yourself and your clients. Many therapists seem to think that working for oneself is permission to have “casual day” every day. Yes and no. It’s fine to be a bit more casual than when working for an agency or hospital. But it’s a statement of professionalism and regard for others to dress as if the people you are meeting throughout the day are the most important people you know. One wise young therapist told me that whenever she goes out – even to the grocery store – she dresses as if she is going to meet her clients. Often she does. Even in a big city, it’s ironic how often we bump into clients or colleagues or referral sources. Dress in comfy jeans if you must but leave the ones with holes in the knees and a paint streak down the backside at home.
- Maintain paperwork that is above reproach. Being your own boss doesn’t mean that you can get away with less-than-professional release forms, treatment plans, and progress notes. In fact, it means that you need to set your standards for paperwork even higher than at your last agency. Quality notes show other professionals that you are to be taken seriously. Billing done well gets you paid. Thorough recordkeeping protects you in the event of legal action. So develop some attractive forms and use them. Your paperwork represents you and you want to present yourself well.
- Always, always buy supervision. It may seem like a hefty expense when you are getting started but good supervision on a regular basis isn’t optional. There are few, if any, of us who are so smart and so self-aware that we can think of every possible way to understand and help a person in pain and totally avoid our own biases. Two heads really are better than one. A senior therapist will help you grow as a therapist and will help you recognize when you are perhaps getting yourself into trouble. Regular group supervision with others in private practice can achieve the same goals without the expense if you all agree to commit to the time and do it.
- Be an enlightened employer. Treat yourself as a valued employee. That means that you will set up a good benefit package for yourself including vacation days, personal days, and sick time. That means that you will understand if you need to cancel appointments now and then because there is a family emergency or you are sick. Provide in-service opportunities and good supervision. This is your opportunity to be the kind of boss you always wished you had.
- Above all, live your life in balance. Eat right. Get adequate sleep. Take time off. Spend time with friends and family. Find and maintain friendships and a loving relationship. Doing therapy well means being on the giving end of things for many hours of every day. Although we do “get back” from our clients in our feelings of accomplishment when things go well, it’s inappropriate to expect clients to “give back.” We therefore must find ways to nurture ourselves. It’s a battery model of our work: We can give out empathy, support, intelligence, and caring only so long unless we also recharge with good self-care and with the reciprocal love and support of people in our private lives.