Pregnancy in Private Practice: 4 Key Questions To Help You Prepare For Maternity Leave

4 key questions to help you prepare personally and professionally for managing maternity leave in private practice.

I'm a mother of four children. My first two children were born during my educational journey and my last two were born while I was in private practice. Being in private practice provides many perks for balancing work and family life. The flexibility of being my own boss has been wonderful. However, taking time off for extended periods of time, like maternity leave, can prove to be tricky.  Unlike working for an agency, in private  you don't get paid leave in private practice,  you still have expenses to pay even when you're not seeing clients, and you have unpredictable income as you "wind down" to take time off and then build your client load back up after taking family leave.  Becoming pregnant while in private practice and planning for the new addition in your family requires some extra planning, coordinating, and saving.

How Much Time Will You Take Off?

These little babies can be a BIG adjustment. It's important to really think about taking enough time for you to adapt to being a parent to this new, little person. Dr. Jennifer Fee, psychologist from California found that one of the most helpful things was taking sufficient time off after giving birth. She suggests coming back gradually and not carrying a full load for awhile.

"Rushing back [to work] while you're adjusting to and bonding with a new baby is not good for you, your baby, or your clients. The great thing about private practice is that it's not an 'all or nothing' business. You can start practicing with a few clients rather than jumping back into a full load," says Dr. Fee.

Determining the length of your maternity or paternity leave can be extremely important in keeping your practice thriving. If you are a sole practitioner, taking a three month leave could potentially leave you with very few clients upon your return. You must decide not only how long is financially feasible but also how long works for your family and your clients.

Who will provide services to your clients in your absence?

It's important to consider who will provide clinical services to your clients while you are on maternity leave. If you are in solo practice, consider reaching out to another trusted private practice colleague who has openings to provide services to your clients while you are on leave. Make sure that your clients have the contact information of the therapist who'll be covering for you. I suggest that clients in crisis have appointments set up with this therapist before you take time off.

I recently talked with a private practice colleague who is pregnant with her third child. I suggested that she consider hiring another therapist to cover her clinical cases and also to generate income for her practice while she is on maternity leave.

When will you stop taking new clients?

You'll also want to think about when you will stop taking new clients. If you plan on taking new clients up until your leave I suggest that in your first conversation you inform them that you will be taking time off so they can have the option of seeing someone who can provide uninterrupted services.

Jennifer Venable-Humphrey, LCSW of Social Work Solutions stopped accepting new clients one month before her due date. When put on bed rest with her third child, Jennifer used Skype or phone sessions to check in with current clients that she had to stop seeing earlier than planned.

How will you cover your fixed expenses and lack of income?

Taking time off in private practice is tricky because you have to plan not only for lost income but for paying the fixed expenses of maintaining a practice while you are on leave. Expenses like rent, phone, internet, or perhaps the cost of support staff may need to be paid whether you are practicing or not.

Joseph Sanok, LLP, LPC of Mental Wellness Counseling in Traverse City, MI suggests considering the cost of being away from your family once you have returned to your clients. Sanok decided to increase his fee when his wife became pregnant. "For me, I knew that working in my practice was going to be difficult when I had the draw of a wonderful new addition. By raising my rates, it made it easier to give up the time."

I'm curious to learn more about the changes you made or creative ways that you found for your transition to parenthood in your private practice. Share those here!

10 Things I Accidentally Did Right In Building My Private Practice

As I reflecting back on 10  years in private practice I did a few things right, mostly by chance.

With a business license, professional license, and big dreams, I opened a private practice ten years ago. Having never taken a business, marketing, or management course, I have learned "on the job" how to be a small business owner. Hopefully, you can learn from what I accidentally did right and intentionally apply them as you build your private practice.

1) Start small, think big

At the time I opened the doors I was a solo practitioner. Those of you in solo practice know that means I was the receptionist, the billing manager, the webmaster, the marketing specialist...Being a "one woman show" for a few years not only taught me what it takes to run a practice, but also how to teach others what I had learned as the practice grew. My vision was to grow my practice into a group with several practitioners and over time, that has happened.

2) Grow slowly

I didn't know it then, but one of the main reasons new businesses fail is because they grow too quickly. As a mother of 3 children at the time, I was fine growing slowly so I could manage the multiple demands on my time. Turns out it was good for business too. Growing slowly allowed me to build a business without loans or going into debt.

3) Charge more than you think you're worth

From my first day in private practice I have always charged a higher fee than I felt I was worth. This forced me to deal with my own money issues, and to learn to value my own services and skills more highly. I came to understand the value of the perceived value of my services as clients assumed that I must be very skilled in order to charge at the high end of the scale for my location.

4) Think like a business owner

My family of origin tends to have an entrepreneurial mindset where self-employment, flexibility, and freedom are highly valued. This framework helped me to be able to think like a business owner and a therapist and to find an emotional place where those two roles weren't mutually exclusive. Although they are occasionally in conflict, I've found that that is a rare occasion. Thinking like a small business owner has helped me to set better therapeutic boundaries with clients as well.

5) Trust your gut

In all areas of practice, from office location, to logo design, to who to hire, to which practice software to purchase, after researching the best options I ultimately followed my intuition in making key decisions for my private practice. While the path hasn't been perfect, I can't think of one decision where I trusted my gut and regretted it.

6) Hire qualified people that you trust with your reputation

One of the scariest things in growing from a solo practitioner to a larger practice is hiring people who have the power to impact  your professional and business reputation. In addition to hiring very qualified staff, also hire people that you'd trust and train them how to present themselves in a way that builds your credibility.

7) Set strong boundaries with money

Whether it's following through with your office policies regarding collections, or saving for those dips in client numbers, I have tried to be consistent with money policies. This also applies when hiring employees. My tendency was to give away a little too much at first, because of my inexperience. I soon learned that there is a cost, emotionally and financially, to having employees, and that I deserve to get paid for management time and for holding all of the liability in the practice setting.

8) Create a home away from home

Creating a comfortable yet professional office space has helped me, and my clients, to feel welcomed and safe. I've found self-expression in my private office environment and decor helps foster a sense of safety and nurturing and creates a space where I feel at ease.

9) Integrate your passions into your practice

I have always integrated current interests and passions into my private practice. If there's a film that I really like, I'll use that with clients. More recently I've become a tech geek, so I've integrated technology into my private practice by launching an online therapy division, moving to electronic records, and building a social media following.

10) Take good care of you

Personal self care has always been high on my priority list. I've known that if my own needs were going to get met it was my job to make it happen. Whether it's scheduling exercise, bringing healthy food to work, making time for social events, or attending my own therapy, I am fiercely committed to making sure I am taking care of me. I think those habits have allowed me to energetically continue investing in my clients, my practice, and my employees without feeling burned out.

What things have you accidentally done right in building your practice? Please share so we can learn from each other!

Pros And Cons Of Group Practice (part 1)

A common private practice question is whether a therapist should join a group practice or venture out on their own as a solo practitioner. The answer is different for everyone depending on your strengths, goals, personality, financial needs, and many other factors.

There are also other options in between solo and group practice, like sharing an office space with other practitioners while maintaining your own practice. "There are numerous ways of forming a group practice including cost/office sharing, partnership, and employment as associates under a licensed provider," according to Kansas Psychologist Wes Crenshaw PhD, ABPP of Family Psychological Services, LLC.

To help make your decision easier, here are some of the benefits and drawbacks of joining a private practice group.

Benefits Of Joining A Group Practice

1) Established business systems

If you're considering joining an established practice, a huge benefit is that they already have office systems in place to support the practice. Michigan therapist Jacquelyn J. Tobey, MA, LLP of  Sollars and Associates says, “I have benefited from joining a group because many of the business practices such as marketing and billing are already established.”

2) Shared expenses and responsibilities

Sharing the costs of operating a business can be appealing. Therapists often underestimate the financial requirements when starting a private practice. Sharing operating costs, office space, equipment, marketing, and administrative expenses are just some of the benefits that North Carolina counselor Erika Myers, LPC enjoys about group practice.

Tobey has learned what it takes to run a business by first joining a group practice. She likens a group practice to renting a furnished room in a house that is already built, whereas private solo practice is more like  designing and building the house on your own. I think that is an excellent analogy.

3) Consultation and camaraderie

Meyers enjoys having colleagues to consult with on difficult cases as well as the camaraderie inherent in interacting regularly with colleagues. "The work we do can be isolating, so having fellow professionals around can help you have more social contacts beyond the professional consultation," Meyers says.

Melissa J Templeton, MA, LPC, LMFT compares working in a group setting to a good relationship. “Like a good marriage, it is the ‘fit’ of the various personalities that determines whether the cohabitation is going to work and work well,” shares Templeton.

4) Referral sources

Illinois counselor Melanie Dillon, LCPC, at Center For Wellness, Inc values the internal referrals generated within her multidisciplinary practice.

My business partners are both chiropractors. One provides acupuncture/Chinese medicine and the other chiropractic care/sports medicine. We have also employed a massage therapist. This way we have created a system that supports internal referrals. The other benefit is that all expenses are now shared, and that my income is no longer dependent on how many clients I see, but on the group as a whole.

Now that you have a feel for the benefits of joining a private practice group, check back later this week for part 2 - the drawbacks of group practice.

(c) Can Stock Photo From your experience, what are the benefits of joining a private practice group?

Adventures In Private Practice: Pastoral Counselor Rev. Christopher L. Smith, LMHC

The Reverend Christopher L. Smith combines his spiritual insight as an ordained minister in the Presbyterian Church with impressive mental health and marriage and family therapy training in his New York City private practice Seeking Shalom.

Christopher offers a variety of mental health, EAP, and consultation services with the overarching theme of helping clients and professionals seek peace in their life. See how Christopher balances his ministry and private practice.

Why did you decide to open a private practice? As someone who has been gifted in different ways and who enjoys the peace that comes from balancing different interests, I was interested in working on a part-time basis and to preserve some degree of flexibility.  The easiest way to do this while being able to maintain control over the way I would practice in helping others was to formalize my own practice.

Formalizing a practice in the same building that I also serve as a pastor both added a degree of efficiency in my work as well as adding to the quality care in a community (Harlem and Washington Heights) that was lacking in some of the services that I offer.

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? "Difficult" clients come in a variety of forms.  Difficult clients with complex symptoms motivated me to seek training, consultation and supervision in new areas strengthening the breadth of my knowledge and abilities.  Clients that are difficult in terms of their methods of interacting with people (especially those who are working on or need to work on personality disorders) strengthen my own interpersonal skills, especially around boundaries and providing clear expectations, which then makes me better able to work with a wider range of individuals.

Clients that are difficult because their situation touches on personal issues help me both develop better boundaries (remaining focused on the client and not working on my issues through the work with the client) and to learn of areas that I need to work on for myself in other ways.  Then there are those difficult clients that have helped me learn my limits whose tough issues had to lead to the end of the therapeutic relationship in order to protect my own physical safety.

What's your biggest pet peeve about private practice? My biggest pet peeve is the way that economies of scale cannot be reached in private practice, especially on a part-time basis.  This is exacerbated in my case, as New York requires me to practice through two professional corporations as I am licensed in two mental health professions that are not allowed to be practiced in the same professional corporation.

How did you discover or develop your practice "niche"? I was fortunate that my "niche" is what led me into being a mental health professional.  My motivation began within counseling and pastoral care work within the seminary building on other experiences that made this calling evident to me. While my career has involved practicing outside my "niche", there was no question that pastoral counseling would be the focus of my own practice.

What resource (book, website, person) helped you the most when setting up your private private? There was not one resource that most helped me while setting up my private practice.  My original private practice was small to help maintain my skills and was possible because of the support of a number of pastors.  In developing a larger (but still part-time) practice that is more formalized, a wide variety of resources were helpful.  Probably most critical, though, was the encouragement and faith of a number of people in my relationship circles.

What has surprised you most about being in private practice? The largest surprise has been that the clients that have been attracted to my practice have almost exclusively been ones within the area of my niche.  Prior to moving in this direction, most colleagues have talked about needing to start out with a broad base of clients to make their practices work.

Has your private practice helped you grow professionally? How so? Being in private practice has forced me to become much clearer and to be able to more concisely describe what I do professionally.  This clarity is clear professional growth.

Has it helped you grow personally, too? How so? Being in private practice the way that I am has helped in my overall balance.

Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health? While I care for my emotional and psychological health in the standard ways (such as meditation, walking, music and friends) that are the case for other therapists whether they are in private practice or practicing in a different form.  As my practice is in the same building as another role, I do not have to see large blocks of clients without breaks.  I am able to see clients for a little while, then go down to my other office and do something different as a respite before coming back to work with another client or two.  Additionally, I take time each week to be out of town.  While away, I am engaged in another role but it also tends to provide sort of a weekly mini-retreat.

How do you cope with the inevitable stressors involved with being your own boss? These stressors are not things that I cope with as they are positive stressors for me.   Rather than coping with them, I enjoy the challenges and exploration of the possibilities.

What personal strengths have helped you succeed in private practice? Patience, self confidence, motivation, my own spiritual understandings of vocation and social networks are probably the personal strengths that have most helped me to succeed in private practice.

To learn more about Rev. Christopher L. Smith, LMHC visit SeekingShalom.org

What Do You Love About Private Practice?

Ask me about my private practice and I light up. I love it. I just spent the last day and a half furnishing and decorating an additional office location in a neighboring city. I'm excited to be able to expand the reach of my practice and help clients in other geographic locations. There is such a satisfaction in feeling fully self-expressed professionally and to make a difference in the lives of my clients and my colleagues. My passion for building a private practice is why I asked Dr. John Grohol, CEO of PsychCentral.com if I could start this blog. I can't imagine being happier with a work situation and I want to help you develop the tools to feel the same way about your practice. I asked several successful private practice therapists the question, "What do you love about being in private practice?" I wanted to share their answers with you to inspire those of you who are considering going into private practice to do it! If you're unhappy with your practice, I hope you'll draw from these successful private practice experiences to create a practice that you love.

It's not "work"

Lynn Krown MA, MFT:

When you do something you are passionate about it's not work. I intend to work well into old age. The more life experience and mindfulness I have, the more wisdom I have to offer. I'm grateful to feel so fulfilled and alive as a psychotherapist age 70 this month.

Accurately represents who I am

Julie Jeske, M.S.:

I love it because it is mine. It is an accurate representation of who I am and the work I do. I truly love what I do and having a private practice gives me the freedom to really design and build my ideal practice. I can work when I want...in fact this summer I spent 5 weeks in Paris. I don't know if I could have done that if I didn't have my own practice.

I look forward to work

Gabby Acord, LCSW:

I look forward to my work and the days fly by. I don't get insurance benefits or paid time off, but I also earn 50% more than I would working full-time for the local University hospital and they pay very well. I feel good that my children know that my work is to help people and they don't resent the time away.

I'm my own boss

Amy Luster, M.A., LMFT:

I am passionate about maintaining a private practice as it grants me the ability to participate in the way that best suits me. I am an active parent to four elementary school aged children and I am able to schedule clients in a way that permits me to be present for my children. As they grow older and more independent, I am able to increase the amount of hours I can see clients in my private practice. I am not beholden to a specific way of working with each client, but rather, I'm able to respond to the needs of each individual, couple or family.

Allows me to refine my specialty

Geoff Steurer, MS, LMFT:

Private practice allows me to refine my specialty in working with marriages impacted by sexual betrayal. When I was working in an agency setting, I was required to see whatever cases walked through the door. So, in any given day I could end up working with children, teens, couples, elderly, and families. Even though I certainly enjoy the variety that comes from working in an agency setting, there is something deeply gratifying knowing that I'm developing a skill set that comes from working with the same types of cases day after day. I love knowing for certain that I can make a difference in the lives of the clients sitting across from me in my office.

I set the rules

Esther Kane, MSW:

I set the rules and love it! I’m independent and it suits my personality. I love the flexibility- going away whenever I choose and working hours I prefer. I get a highly-motivated client-base who are ready and willing to do the work. I own my own office overlooking the ocean and it’s like my second home.

It adapts to my changing lifestyle

Shannon Purtell MA, LPC:

In the last 3 years I have gotten married, and had 2 children. Private practice has allowed me to adapt to my changing lifestyle. It worked great when I was single and could work evenings/weekends, etc. and it works great now when I need to be home evenings and weekends to be with my family. Private practice affords me the opportunity to build a company that makes a difference in the lives of our clients, and provide a healthy work environment for my associates and interns.

It's a thrill to see people change

Eileen Kennedy-Moore, PhD:

There is no greater thrill than seeing people make real change for the better in their lives and being part of that change process. I'm grateful for the opportunity to do work I love, as my own boss, with hours that mesh with my family needs.

Meaningful connection with others

Loren A Olson MD, who is in the process of retiring from his psychiatry practice:

I have experienced the joy of connecting with people in the most emotionally intimate ways. I *know *them deeply and meaningfully. And although I've always maintained professional boundaries, I find that they know me, too. And so I grieve the loss of these relationships even while knowing that I am responsible for my own happiness. And as I retire I will find new ways to find pleasure in my life, but I also look back with a sense of satisfaction about having chosen such a meaningful profession.

Do you love being in private practice? Tell me about it! If you're not happy with your practice, what would you like to change?

If you have any topics you'd like me to write about, or specific questions for me comment below, ask me on Twitter @Julie_Hanks, or contact me directly here.