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Common Struggles for New Therapists in Private Practice

therapist.com Team

For this four-part series, therapist.com sat down with Frank Anderson, MD, to talk about his experience in private practice. Anderson is a therapist, psychiatrist, author, and speaker with three decades of work specializing in trauma treatment. Here鈥檚 his practical advice for new therapists who are thinking about venturing into private practice.

There are many wonderful and exciting opportunities that come with opening a private practice. But there are also a lot of challenges.

In private practice, it鈥檚 important for us to learn how to run a business that鈥檚 cost effective. But when we look at our overhead and operating expenses, we tend to think, 鈥淭hat wasn鈥檛 what we learned at school.鈥

Office space and billing and insurance, oh my!


I jumped into private practice the way I always wanted to, but I didn鈥檛 know exactly how to do it. I was just so excited to have rented an office space and secured my first patient.

Billing was difficult. When you鈥檙e in the beginning stages of growing your private practice, you really don鈥檛 have enough money or established protocols to be able to have somebody else do your billing for you. I had to do it all by myself, and I was really navigating uncharted territory. I remember being very frustrated by that.

Applying to all these insurance companies to get on their insurance panels was also really hard, but it had to be done because most people wanted to use insurance. It involved filling out a lot of complicated and overwhelming paperwork.

When you鈥檙e still in training, all that stuff is taken care of behind the scenes. When you鈥檙e on your own, you鈥檙e left with questions like: Where do I get the necessary paperwork? How am I supposed to fill them out properly? Where do I send them? And how long will it take to get payment back from these insurance companies?

What I wish I鈥檇 known


I wish I had known just how challenging the administrative stuff was going to be. It would have been really helpful to have had the opportunity to take a course that helped me transition into the real world, because nobody told me the different options I had. Nobody really gave me a 鈥渓ay of the land鈥 for what my day might look like if I went into group practice versus inpatient work versus outpatient work versus private practice.

I also wish I had known that, unless you get a full-time job at a clinic, you can expect to be doing a lot of piecework in the beginning. It鈥檚 rare for any therapist opening a new private practice to be able to start a full caseload right out of training, so you can expect to be doing a couple hours here, a couple hours there, for a total of maybe four to five hours a week.

Once I started seeing patients maybe 15 hours a week and slowly building up my practice, I wish I had known more about the process involved with transitioning from renting an office space for a few hours a week to renting my very own office. In addition to being responsible for making rent every month and furnishing the space, you might also need to figure out how to sublet it for a couple of nights a week to help with supplementing income for the rent.

Get by with a little help from your friends


Therapists are typically not great businesspeople, and we don鈥檛 really take business courses in therapy. I would say that if you want to open your own private practice, consider talking to a friend or colleague who鈥檚 done it before, so they can advise you or recommend resources on how to be a businessperson as a therapist.





Even with guidance from fellow therapists, there鈥檚 still a great deal of trial and error that goes into . In part three of this series, learn more about how Anderson expanded his practice as he became more seasoned over time.

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Topic: Marketing | Private Practice

Tags: Advice | Strategies | Success | Video

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