The Unspoken Challenges of Private Practice
By Irrit Mihok
When I first decided to open my own private practice, I was excited. The idea of setting my own hours, choosing my own clients, and creating a therapeutic space that was truly mine was invigorating. What I didn’t fully realize was that being a good therapist was only half the job. The other half was becoming a CEO, a billing expert, and an office manager all at once.
If you’re considering private practice, or you’re already in it and feeling a bit overwhelmed, know that you’re not alone. The business side of therapy can be a beast. Here are some of the biggest unspoken challenges I’ve faced and what I’ve learned along the way. It’s okay to find support and guidance as you build something that makes you proud to be a business owner!
The Never-Ending Game of Scheduling in Private Practice
As a therapist, your time is your most valuable asset. But managing it is a constant tightrope walk. You have to balance the needs of your clients with your own need for a break.
The 50-Minute (or 53-Minute) Hour
I remember being so focused on back-to-back sessions that I’d forget to even take a breath in between clients. I would say goodbye to one person and hello to the next client in the same sentence. I quickly learned the importance of buffer time—those 5 to 10 minutes between sessions to write a quick note, use the restroom, or simply take a deep breath. Without it, you’re not just rushing; you’re risking burnout.
The Dreaded No-Show
Nothing stings more than a no-show. It’s not just a lost session; it’s a hole in your income and a slot that a client in need could have used. A firm cancellation policy is your best friend here. It’s not about being harsh; it’s about valuing your time and the commitment you both make to the therapeutic process.
The Maze of Billing and Insurance
If I’m being honest, I think I’ve spent more time on hold with insurance companies than I have at the gym. Billing is a massive hurdle, and it can feel like you’re fighting for every dollar you earn.
Credentialing is a Marathon
Getting paneled with insurance companies can feel like an endless process. You send in your paperwork, you wait, you call, you wait some more. It’s a necessary step for many practices, but you have to be prepared for the financial lag at the beginning.
The Denied Claim
A single typo on a claim can result in a denial. I’ve learned that a good billing system, or a reliable billing service, is worth its weight in gold. It frees you up to do what you do best: help people.
Low Reimbursement Rates
This is a big one. Many therapists feel that the reimbursement rates from insurance companies don’t reflect the years of education and experience we bring to the table. This is one reason why many clinicians eventually choose to be out-of-network or private pay, or only take a select number of insurance plans.
Finding Your Sanctuary (The Office)
Your office isn’t just a place of business; it’s a sanctuary for your clients. It needs to feel safe, private, and comfortable.
- Privacy is Paramount: Soundproofing is non-negotiable. The last thing you want is a client worrying that their intimate conversation can be overheard. Investing in a sound machine or having good acoustic insulation is a must.
- Location Matters: Parking, accessibility, and a discreet entrance are all important. Your clients need to be able to come and go without added stress or fear of being seen.
- Creating the Right Vibe: I spent a lot of time choosing the right colors, lighting, and furniture for my office. You’re building a space where people will be vulnerable, and the environment needs to reflect that with a sense of calm and safety.
The Burden of Notes and HIPAA in Private Practice
Clinical notes are a requirement for ethical and legal practice, but they can be a major time sink. I’ve found that the key is to have a good system. Many clinicians use an Electronic Health Record (EHR) that’s designed for mental health practices. It keeps everything organized and helps clinicians stay compliant with the next big hurdle: HIPAA.
HIPAA can be a scary word for a solo practitioner. You are the sole guardian of your clients’ protected health information (PHI).
- Secure Everything: You need a secure, encrypted EHR. Emails, video calls, and even text messages with clients must be sent through HIPAA-compliant platforms. I learned early on not to use my personal email for anything work-related.
- Psychotherapy Notes Have Special Status: This is a crucial one for therapists. The personal notes you take during a session—your “process notes”—have a different, higher level of protection under HIPAA. They must be kept separate from the rest of the client’s medical record.
- Breaches are Serious: Even a simple mistake, like sending an email to the wrong person, can be a breach. You have to have a plan in place for what to do if it happens.
How We Can Help
Does this all feel overwhelming? It can and it did for me when I started out in private practice. BUT, it does not have to be. Take a look at the Booked and Balanced in Private Practice an 8 week virtual and interactive course through Firelight Supervision.
This course is a wonderful resource for those just starting out and for clinicians who want things to be more streamlined. The reality is that your private practice should fit into your lifestyle and you should be excited and challenged, not stressed and heading towards burnout. I was happy with my practice but would have relished the opportunity to have support in dealing with some of the common stressors of private practice.
Take the time to gain confidence, skills, and a clear plan for a successful and sustainable private practice where you can concentrate on your clinical work. The ability to work directly with clients, build lasting relationships, and create a practice that reflects your own values is incredibly rewarding. Just remember, you’re not just a therapist anymore, you’re an entrepreneur. And that’s a lot to be proud of.
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.
