Ask A Therapist: The Challenges of Starting A Private Practice

Deciding to shift from working in a community mental health outpatient setting to launching my own private practice was a mix of thrill and challenge. I struggled with feeling of uncertainty and loneliness due to the absence of mentors during this career pivot.

It was because of this experience I wanted to create a small corner of the internet where others can tap into into authentic stories and wisdom shared by those who have ventured into the world of private practice before them.

Private practice owners all over the country have graciously donated their time and perspective to share their their unaltered experiences and advice that I have consolidated into this blog post series

I believe their stories can be a great source of wisdom, providing real-life insights that offer clarity, motivation, and actionable advice to support individuals in transitioning from working in community mental health settings to starting their own private practices.

By sharing these honest and voluntary responses (obtained via an online survey), the goal is to bridge the gap for those seeking guidance, while also creating a network of shared experiences that can illuminate the way forward for others considering the leap into private practice.

If you ask a therapist about the challenges of starting a private practice, what would they say?

Question Asked: What were the biggest challenges you faced when starting your private practice, and how did you overcome them?

I feel like everything was a big challenge! The logistical stuff was challenging – credentialing, figuring out what set up and equipment I’d need for a telehealth practice, initially getting used to not bringing in as much income as I built my practice. But for me, I think the biggest challenge was impostor syndrome. I’ve been a social worker since 2006 but being on my own really forced me to confront my own “stuff” in the context of confidence and feeling capable. What helped was acknowledging I was struggling with that and talking about it with friends.

Megan Tavares (Started Practice 2023; States Licensed: MA)

My biggest fear was the financial piece, which included, would my clients come with me and what would retention look like, how would I get new clients? I talked with other therapists who had started their own practice and that was highly encouraging and gave me confidence that I would thrive. Additionally, trying to understand all the costs associated with private practice.

Greta Bellinger (Started Practice in 2023; States Licensed: FL, TX)

Credentialing is a headache, and I did it on my own before joining a platform (Headway), which made it easier. Marketing was initially a challenge as I started too broad instead of identifying my niche. I would have saved more time by identifying my niche sooner.

Jennifer Rowe (Started Practice in 2020; States Licensed: NY)

Marketing was the biggest one. I spent a lot of time on my website copy, got on a few directories, and networked with local colleagues. Learning a bit about SEO is very helpful for creating a more successful website. The other big challenge was financial insecurity starting out, but I had other freelance work to rely on in the beginning.

Augustin Kendall (Started Practice in 2019; States Licensed: MN)

Biggest challenge was in myself and letting go of a w2 and learning how to bill services

Kabian Brown (Started Practice in 2018; States Licensed: GA, NY, FL)

I started my private practice about 9 months before the pandemic hit, which no one could have predicted. I had to quickly pivot to marketing and networking 100% virtually and found that the pandemic almost had the opposite effect of why I started my private practice… so many people needed support at that time, so I was taking on new patients or fitting in former patients because there was such a need at the height of the pandemic that I lost that sense of a smaller caseload or my ideal schedule. The biggest challenge was getting back to my foundation of why and when I started the practice.. once things calmed down from the pandemic 🙂

Dr. Nikki Lacherza-Drew (Started Practice in 2019; States Licensed: NJ, NY, FL, VT)

It is scary to let go of the paycheck that you know is coming. I am letting go of by slowly titrating into a full time practice

Claudia Christina Soddano (Started Practice in 2022; States Licensed: NY)

Self doubt, not having a guaranteed income, the business side of things

Ashley Steineger (Started Practice in 2010; States Licensed: NC)

Just the vastness of opening a practice can feel really intimidating. There are a lot of steps and moving pieces that go into building a practice such as legal requirements, system and operation considerations, and a need for a business plan. Not many therapists get training in business or management so knowing where to start isn’t necessarily second nature. Connecting with the right resources, consultations, and legal representation are vital to get yourself moving in an ethically sound and legally secure direction.

Dr. Cynthia Shaw (Started Practice in 2022; State Licensed: NY and all PsyPact states)

Because I was initially not able to take insurance — the insurance panels were full in my area at that time — I was challenged to figure out how to market for people willing to private pay. I learned to be creative about reaching out to prospects to educate them about my offerings.

Karen Carnabucci, LCSW, TEP (Started Practice in 1995; States Licensed: PA & WI)

My biggest challenge was confidence when I first started. I felt like I was not experienced enough, that it was too early in my career, and I had not “earned” this yet. However, I was reminded that everyone has to start somewhere. Imposter syndrome was very loud, but when you are actively learning, asking questions, and finding resources, then you are not an imposter, you are doing what you need to be doing. I had to work on my trust in self, to feel confident that I will figure it out as I go. I have made mistakes, but they were all learning lessons. It can be scary and overwhelming, but I just reminded myself that I have done scary and overwhelming things before.

Another challenge was being scared to ask for help. I was worried that I was going to be judged for not being smart enough, asking stupid questions, or people would catch on that I was not ready for this leap. However, I remembered that every therapist I talked to had taken this leap, and they remember how scary it was. People want to help people, especially in this field. People want to help the next generation and provide them with information. The best thing you can do for your business is to ask questions and to ask for help.

Elizabeth Hamm (Started Practice in 2023; States Licensed: NY)

The biggest challenge I faced while starting my practice was knowing where to start in the process. The idea of starting a private practice was extremely overwhelming and foreign initially. The way that I overcame this was connecting with other private practice owners, asking questions, and utilizing All Things Private Practice group on Facebook for guidance.

Anna Brewer (Started Practice in 2022; States Licensed: OH, NM, & WV)

I held our insurance for a long time because I worked for larger companies with better benefits. It was scary, but something told me it was time. I just continued to remind myself that this was going to give me the flexibility I was wanting. Getting credentialed was a nightmare and took so long.

MacKenzie Bradke (Started Private Practice in 2007 – part-time; 2017 full-time; States Licensed: MO, telehealth in AZ)

Private Practice Start Up: What Types of Insurance Do I Need? [Show Notes]

Key Points

In conclusion, starting a private practice as a therapist can be both exciting and daunting. Imposter syndrome may creep in, but it’s important to remember your qualifications and expertise. Finding clients and knowing how to get started are common challenges, but with determination and strategic planning, you can overcome them. Financial worries may arise, but setting a budget and seeking support from other professionals can help ease the burden. Remember, you are not alone in facing these challenges – reach out for guidance, connect with peers, and believe in yourself as you embark on this fulfilling journey of building your private practice!