The Hidden Work of Private Practice No One Teaches You
By Irrit Mihok
If you are a therapist in private practice, you may not realize the challenges inherent in being a solo practice owner. It’s a common realization: the paperwork is a nuisance, but the isolation is the real challenge. When you move from a bustling clinic or agency into your own four walls, the silence can be deafening.
The Emotional Isolation of Private Practice
In a traditional therapeutic office or agency setting, you have a “forced” community. You vent in the hallway between sessions, grab coffee with a colleague who understands the specific stress of a difficult case, and feel the collective energy of a team. There is a level of support inherent in the agency or group practice setting. In private practice, that safety net disappears.
In session, you are the anchor for your clients. Without a peer group to anchor you, the emotional residue of trauma, grief, or high-stakes crisis has nowhere to go. Because of our role as clinicians the emotions go “one-way”. It is overly taxing over time to hold those emotions. That anchor weighs us down if at the end of the day the process of learning to let go isn’t practiced. This is a professional necessity, not just a self-care tip.
Decision Fatigue and Reducing Burnout
The solitude of private practice also brings on decision fatigue. Every clinical and ethical “gray area” rests entirely on your shoulders. Without a supervisor or trusted colleague down the hall to provide a second opinion, the mental load of second-guessing your own judgment can lead to a unique kind of exhaustion.
What can you do to prevent the exhaustion that builds with the emotions you hold and the decisions you make on a daily basis. You are just doing your job, aren’t you? The success of your work is dependent on creating your own ‘water cooler’ moments, which takes more effort when you’re working alone. You can do this in several ways like the following:
- Consultation Groups: Actively seeking out a group of peers to discuss cases and share the emotional burden.
- Individual Consultation: Seek out a consultant or supervisor to have a safe place to process any transference or countertransference that arises in addition to getting feedback on cases and those ‘gray area’ decisions we make on a daily basis.
- Scheduled Socialization: Recognizing that “work time” must include professional connection, or you risk becoming an island (also named ‘burnout island’).
- Personal Therapy: Many of the best practitioners stay in therapy themselves specifically to manage the challenges that solo work can amplify. We all have a history of relationships and personal experiences that affect your emotions and reactions to situations, and therapy is a continued safe place to express and work on these while providing a needed outlet.
Making Your Practice Efficient Without Losing Your Purpose
While the emotional side is the heart of the work, the business side of your private practice still requires a steady, albeit minimized, hand. The goal isn’t to become an expert administrator, but to become efficient enough that the business doesn’t bleed into your clinical presence. Putting systems and boundaries in place is essential, including:
- Streamlined Systems: Think of your EHR (Electronic Health Record) and billing tools as your “silent partners.” The less you have to think about them, the more space you have for your clients.
- Financial Boundaries: Setting a firm policy for late cancellations isn’t just about the money; it’s about protecting your time and energy so you can show up fully for the people who are in the room.
The bottom line is you didn’t go into private practice to be an accountant or a file clerk, you went into it to be a healer. By acknowledging the emotional toll of the “solo” in “solopreneur,” you can build a practice that is as sustainable for your spirit as it is for your bank account.
How We Can Help
We offer several different options for consultation and continued learning for licensed therapists, including private practice therapists. We understand the importance of being part of a community and feeling connected and supported. Contact us today for more information on how we can support you.
Author Bio
Irrit Mihok is an administrative assistant with Firelight Supervision who is a Licensed Professional Counselor in Colorado. Irrit has worked as a counselor in residential treatment, community mental health, and owned a private practice. Irrit is also an official with US Figure Skating and a blog author.
