Why Some Shrinks Fly Solo

WHITE IBISIn past posts I've explored the the positives and negatives of joining a group private practice. Now, it's time to focus on the pros and cons of running a solo private mental health practice. When I opened Wasatch Family Therapy nearly 10 years ago, it started out as a solo practice that slowly built over time into a group practice. While I like being "in charge" and autonomous, I'm also an extravert and I highly value my connections with others.

I reached out to other private practice therapists who practice alone to see why they chose to "fly solo."


Florida social worker and healthy eating expert Therapist Karen R. Koenig, LCSW, M.Ed. grew up as an only child, so she's used to being independent and working alone. That autonomy and comfort level has helped her to succeed. “I love being in private practice. I make my own schedule, decide whom I want to see and whom I don’t, set the fee schedule and slide if I want, and get to have an office in my home which makes both life and work easy,” Koenig shares.


Creating an environment that accurately reflects who you are is important to North Carolina therapist Erika Myers, LPC. "Having your own space in which to practice in a way that feels authentic to you, building an individual reputation rather than relying on a group name for recognition,” are reasons why Myers chooses to practice in a solo setting.


Illinois counselor Melanie Dillon, LCPC of Center For Wellness, Inc. practiced independently for 17 years. Of her experience she says, "Private practice gave me a very flexible schedule and autonomy. It also helped me grow to learn all aspects of being a small business owner. It was ideal for parenting and having a second income.” Eventually Dillon developed a mind/body group practice with two chiropractors when she found herself as a single mom and needed to provide a stable income.

As the second oldest of nine children in my family of origin I am used to being "in charge" and in having close connections with others. So, it makes sense that eventually, I grew my own solo practice into a group practice where I am still the sole owner and decision maker. Guess I just can't get away from being the "bossy" older sister.

Creative Commons License photo credit: cuatrok77

Why I 'Broke Up' With Managed Care (Part 2)

Several months ago I wrote a post titled, "Why I Broke Up With Managed Care" that stirred up some passionate discussion! While I understand that it's not the route for every private practitioner, I have continued to build a private practice free of managed care and recently hired my 12th therapist.

While we don't bill insurance directly, we do give a superbill to clients so they can seek reimbursement from their health insurance so they can still use their benefits. As I've continued to write this blog, I've come across several therapists who have also "broke up" with managed care and asked them why they decided to build a fee-for-service therapy practice. Here's what they had to say:

Increased Reimbursement Rate

I've been in private practice for over 15 years. So, I experienced the first major transition of health care to "managed" care. I had friends and colleagues who began working in the managed care industry, and it quickly became clear to me that despite all the rhetoric about the necessity for evidenced-based care (which can be a very useful model of care), managed mental health care was really about making corporate the work of individual psychotherapists.

I also did the math. The last time I checked, insurance reimbursement was the average rate charged by psychotherapists in the 1980s. Today, I can afford to have two additional office hours available for new clients, by taking just one fee-for-service patient. This also allows me more discretion in seeing clients who are needing a low fee. Will Courtenay, PhD, LCSW "The Men's Doc"

Control Over Therapeutic Work

I wanted the freedom to determine, along with parents, the course and length of treatment and felt managed care would impede on that. Pam Dyson, LPC, RPT

My training is in social work, which is the source of the old adage "start where the client is at." That's my barometer for treatment, not where an insurance company believes my client and I should start or end our work. Will Courtenay, PhD, LCSW "The Men's Doc"

Increased Client Commitment to Therapeutic Process

Being a Christian counselor, by law I cannot bill insurance, even if I could I think private pay gives each person responsibility in the therapeutic efforts. When people  have to pay it makes them take their  therapy more seriously. Natalie Davis

No Diagnosis Required

My services are specialized in that I will work with children as young as three, something many therapists in my area will not do. The problems child clients present with are often not clinical but rooted in the parent-child relationship. I feel strongly that young children do not need a diagnosis on their permanent health record. Pam Dyson, LPC, RPT

More Time With Clients (Less Time Doing Paperwork)

I had worked in a managed care setting in the past, and I decided that in my practice that I want to avoid the incredible amount of paperwork, defending sessions, and over-diagnosing.  I also think it provides clients with more privacy. Sara Levitsky, LMSW, Birmingham Counseling For Women

Paperwork was the other major decision (in building a fee-for-service practice). I put a great deal of time and energy into my work with clients outside of our scheduled hours, including receiving professional consultation on a consistent basis. I have no time or patience for administrative busywork. Will Courtenay, PhD, LCSW "The Men's Doc"

More Flexibility To Offer Reduced Fees

Like Dr. Courtenay mentioned earlier in this article, when his practice is doing well financially, he has more (not less) time to devote to seeing clients at a reduced fee. I have found the same to be true. As my practice grows I am able to offer more free community workshops and do more pro bono work.

Do you run a fee-for-service mental health therapy practice? What led to your decision?

Adventures In Private Practice: Vocational Social Worker Dawn Vincent

Dawn Vincent Specializing in vocational rehabilitation and work/life issues, Australian social worker Dawn Vincent has been  in the mental health field for 25 years. Like many therapists, she considered opening a private practice, but says she lacked the confidence to actually do it. Read how one private practice course helped her muster up the courage to open her private practice in Camberwell, Victoria, Australia where she helps clients work toward mental health and well-being and navigate changes and choices in life and in work.

Why did you decide to open a private practice?

I had thought about it for about 10 years, but lacked the confidence to go ahead.  After spending over 20 years in vocational rehabilitation I decided to take my long service leave and think about my options.  After an overseas trip I came home and enrolled in an Introduction to Private Practice course run by the Australian Association of Social Workers.  At that time there were only a small number of Social Workers in private practice and it was still somewhat controversial here in Australia.

The profession has a very strong welfare orientation where most Social Workers are employed by the Commonwealth or State governments or work in hospitals and community based settings. Having worked for a large government bureaucracy myself, I liked the idea of the independence and autonomy private practice seemed to offer. I had been a bit of a workaholic and I wanted to move to a better work/life balance and be able to work my own hours.  The course helped me to decide that private practice was what I wanted and I committed to this goal.

Clients that therapists find to be the most "difficult" are sometimes the ones who can teach them the most. What have you learned from your toughest clients?

Before private practice I had worked with clients with physical, intellectual and psychological disabilities, helping them to enter or re-enter the workforce after injury or disability.  At times it was very challenging and distressing working with people with acquired brain impairments and severe physical disabilities, particularly the younger ones whose lives were permanently changed.

I found I was drawn to the mental health clients and tended to specialise in this group and continue to do so in my private work. Working with people with disabilities reminds me how lucky I am to be fit and healthy and not take this for granted. It has also taught me about the dignity of risk and courage and resilience in life. Helping people overcome their barriers and live a full and meaningful life is incredibly rewarding. I learn from my clients daily and I am a better person from my interactions with them.

What's your biggest pet peeve about private practice?

The uncertainty of income. There are obviously times of the year when referrals are quiet and I used to worry about when I would get my next referral. Over recent years I have become more relaxed about this and accept it as part of the natural seasonal variations. I do get annoyed when clients cancel at the last minute when I have made a special time to see them outside of my normal schedule, although fortunately this does not happen often.  As a member of both the Australian Association of Social Workers and the Career Development Association of Australia I have double fees and professional development requirements from these bodies which becomes very expensive.

How did you discover or develop your practice "niche"?

As mentioned above, my background is in vocational rehabilitation specializing in working with people with psychological disabilities.  I always enjoyed working with this client group and was fascinated by the workings of the mind.  When I entered private practice I was naturally drawn to working with mental health clients. Originally I had intended to focus on general counselling and psychotherapy, but I found that some of my colleagues were referring clients to me for career counselling.

With my experience in general counselling and vocational counselling it made sense to continue to use my skills in both areas and mix the two streams of work.  I now see approx. 70% of clients for personal counselling and psychotherapy and the other 30%  for career counselling, although sometimes there is an overlap as people may have psychological issues which impact on their career decisions. I find the career work provides some “light relief” from the common presentations of anxiety, depression and relationship problems as it is shorter in nature and less intense.

What resource (book, website, person) helped you the most when setting up your private private?

The Introduction to Private Practice course I did was based on Lynn Grodzki’s workbook Twelve Months to Your Ideal Private Practice. I worked my way through this workbook and reported back to the group each week. I found this helped me to be well prepared for the realities of private practice.

I still frequently refer to Lynn’s books when I need to focus on how to develop my practice further. One of the social workers who ran the course allowed me to rent her room for half a day a week and on the days I went there we would spend some time talking about my practice and she provided ongoing support and advice to me as I waited for my client base to build up. My husband was incredibly supportive and encouraging.

What has surprised you most about being in private practice?

The number of people who have been prepared to help me learn what I need to know about running a business and the amount of resources available to support this.

I belong to several business networks which have been very useful in making contacts with various professionals with expertise in website development, social media, business systems, coaching etc.  It took me a while to find these, but they are out there if you ask and look.

Has your private practice helped you grow professionally? How so?

Every day I am learning new things. The longer I am in private practice, the more I realize there is to learn. Working with people and studying the human condition  is  exciting and stimulating. My skills and knowledge are continually growing as no matter what I may know about any topic or therapeutic approach, there is a constant stream of new knowledge out there.

Being in private practice makes me resource myself. I am responsible for my professional development – no one else, so I seek out opportunities to grow my knowledge and skills so I can continue to provide my clients with the best service I can and deepen my satisfaction at work.

Has it helped you grow personally, too? How so?

Absolutely. My confidence and self belief  have developed as a result of taking a risk and putting myself “out there”.  I could have continued in my former job with a safe, secure income and never grown to be the person I am now.   It is great to have been able to overcome my own fears and insecurities and put in the hard work required to realize my dream.

I have had to learn about marketing, networking, managing a business, budgets, Business Plans, etc.  I am more independent and I have a better understanding of myself, what I need and what I am capable of.   I am happy doing work that I love and which I believe makes a difference in people’s lives.  It is for me the perfect combination.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?

I am a great believer in self care and I constantly talk to my clients about this so I make an effort to practice what I preach.  Some days it can be emotionally draining working with human pain and giving out to people. I debrief with professional colleagues as needed and I attend monthly private supervision. I try to exercise regularly, get enough sleep and eat healthily.  My husband and I love travel and we visit our daughter in New York annually and have mini breaks in between.   I make sure I catch up with family and friends on a regular basis.  I use mindfulness breathing and meditation to help me relax and I listen to music and go for walks or do some gardening to unwind.

How do you cope with the inevitable stressors involved with being your own boss?

I love being my own boss so I don’t find it too stressful, but I imagine you are referring to having to do everything myself. I have no office assistance so I manage my appointments, type my invoices and reports, do my own marketing, pay the bills etc.  I’m pretty organised and I am a bit of a control freak so it does not bother me to do all this myself. Sometimes I think it would be nice to have someone take on some of the small practical things while I focus on the things only I can do.

What personal strengths have helped you succeed in private practice?

Well, I think I am persistent and resilient and if I make up my mind to do something I don’t give up easily.  I am quite disciplined and conscientious and hardworking. I am happy spending time alone so although I sometimes do miss having a team of people to work with, I operate better when I have time to think, reflect and plan. Private practice requires a lot of this.

I have good people skills and I have no problem forming trusting relationships with my clients. I network well and I seek out other people when I need social contact, but I don’t need a lot of people around me all the time. I am not afraid to ask for help when I need it and I am committed to life long learning.

To learn more about Dawn's practice visit her website

Getting 3 'Fs' In Private Practice Is A Good Thing!

letter FMy motivation for starting my private practice, Wasatch Family Therapy, was very clear. I wanted to create my ideal work environment and I knew that no one else could do that for me. I felt called to help people heal themselves and their relationships.  I knew that I wanted work with therapy clients who valued my services and time, and who were dedicated to working hard to improve their life. I wanted the flexibility to set my own schedule and take time off to be with my children and attend school and sporting events. I wanted to do paperwork that was relevant and helpful for treatment. I wanted to invite other clinicians into my professional space who were gifted therapists, genuine people, and who I enjoyed spending time with. I wanted to work as a social worker part-time and make a full-time income (a lofty goal in a profession where many work full-time and make a part-time income).

I know why I chose to go into private practice but I was curious if other therapists and counselors around the country had similar motivation opening private practice. I recently asked several therapists about their reasons for taking the leap into the business world of owning their own practices and noticed three common themes emerged. I call them the 3 "F"s of private practice: flexibility, freedom, financial opportunity.

1) Flexibility

Therapists who take the leap into private practice value flexibility in their work schedule to better balance work and family life, and to pursue other interests.  Dr. Mary Sidhwani, a psychotherapist in private practice since 2000 in Ellicott City, Maryland opened her practice so she could have the flexibility to care for her two young children. "I wanted to be able to balance both my professional and family life; to be able to spend as much time with my children as possible while they were young."  Social worker Diane Spear, LCSW-R of New York City said, "I had worked at an agency with wonderful colleagues, but private practice gave me the opportunity to set my own hours and fees."

Of his decision to open his own practice psychologist Dr. John Duffy says, "I wanted to go into private practice as I wanted control over my career: my schedule, niche, fees, client base, whether I accepted insurance, and so on. I also wanted to be able to write, consult, speak, and expand my practice, or take fewer clients, as I went along."

2) Freedom

Freedom to select a particular client population to work with and choose your own approach to treatment has drawn many therapists to open a practice. After agency work left her overworked, underpaid and burned out, Esther Kane, MSW of British Columbia chose to open a private practice because it allowed her to focus on her passion - women's issues. Kane says she loves the "autonomy and flexibility of not having to answer to anyone."

Spear says she appreciated being able to choose who she worked with and how she approached treatment. "I wanted to choose level of pathology I want to treat, choose the theoretical orientation and supervisor I'm most comfortable with, and set the environment as I prefer. In short, autonomy, autonomy, autonomy!"

3) Financial Opportunity

It's a risk to open your own practice, but when it grows, you are the one who benefits most from the financial growth. Private practitioners have the opportunity to grow their income in ways that are unlikely to happen when you work for someone else. New York City therapist Emma K. Viglucci, CFT, LMFT, CIT experienced the growth potential first-hand. Since opening Metropolitan Marriage & Family Therapy, PLLC she says, "I've grown the practice to the point where I had 10 clinicians working with me as part of our clinical team. My practice has become an Internship Placement Site for MFTs in training."

Financial need helped Lisa Gomez MA, PLC of Surprise, AZ transition from part-time to full-time private practice. After being laid off from a full-time staff position due to budget cuts Gomez says it was "the perfect opportunity to take the step of faith into full-time private practice. I love private practice because I can be as successful as I want or as flexible as I want."

What motivated you to start your private practice?

If you're thinking about venturing into private practice, what do you hope to gain?


Creative Commons License photo credit: Leo Reynolds