“If you build it, they will come.” This is a popular quote many of us know. If you don’t know it, it’s from the movie Field of Dreams, a movie that features Kevin Costner as a farmer who hears a voice that tells him to cut down his corn fields and build a baseball field (all the while teetering on the edge of bankruptcy). While you may be thinking “If I set up my private practice, clients will come!”, it rarely works out like that in reality. When starting a private practice for the first time, you need a plan. Fortunately, you’ve landed on our blog post “Starting a Private Practice in Counseling Checklist: 14 Things to Consider.”
You can jump to a specific section here:
- Create a Plan
- Set Goals
- Choose a Niche / Specialty
- Website Requirements
- Legal Requirements
- Office Space or Online or Both?
- Hire Staff or Start Alone?
- Determine How Much to Charge Hourly
- Take Insurance or Private Pay Clients?
- Have Clear Patient Policies
- Gather the Right Forms
- Marketing Your Practice
- Tracking Progress and Expenses
- Do Great Work
Let’s dive in!
The Challenges of Running a Private Practice
Starting and operating a private practice can be an amazing experience full of fulfillment. But there are also many challenges you will face. Before we jump in on our starting a private practice in counseling checklist, let’s highlight some of those challenges you will face while running a private practice:
Running a business can be expensive. You might pay more in taxes with FICA, you’ll have to plan your own retirement, and you’ll also have to buy your own health insurance. If you hire employees, you’ll have to pay payroll taxes (unless they are contractors). Here are some more expenses you can expect to pay:
- Your own personal insurance
- Business insurance
- Accounting software or an accountant
- Invoicing software
- Website hosting
- Website design and build
- Domain name
- Electronic health record system / patient management system
- HIPAA compliant email address
- HIPAA compliant web forms
- IT support
- Marketing costs
- Lawyer fees
- Incorporation fees
- Tax accountant
- Networking memberships
- Payroll costs and fees
- Permit costs
- Software costs
You can begin to see that there are quite a few costs associated with starting a private practice in counseling.
With any entrepreneurial adventure, you need self discipline. You are the boss, and you have to manage your own time. Time management, organizational skills, and motivation will be needed to push forward when things seem slow. If you don’t do it, no one else will (unless you pay them to!).
Starting a business requires a lot of paperwork. Starting a therapy business requires even more. From insurance reimbursement forms (if you decide to take insurance), to therapy notes for your clients, you can plan on spending a set amount of time each week filling out paperwork. When you first start, you probably will be doing a lot of this paperwork yourself.
Getting New Clients
Getting new clients is an important part of starting a private practice in counseling. For many mental health professionals, this process is not second nature. Many therapists try an assortment of strategies, from trying to be an Instagram influencer to spending money advertising. One common way is to build referral networks with other therapists. But referral networks can be hit or miss when it comes to a steady amount of new clients. Simply put, getting new clients is one of the biggest challenges facing therapists.
However, there is a top strategy we’d recommend to get new clients called SEO. We will talk about this more in section 12 below.
Another challenge of running a private practice in counseling is burnout. After you see your full caseload for the week, you still have many more tasks to do. From filing paperwork to getting new clients, you’ll be spending a lot of time building your practice. Months of this process can cause burnout. It’s important to take care of your own mental health so that you can best help your clients.
1. Create a Plan
Creating a plan early can help you succeed more quickly than just jumping in without a plan. Your plan should be an evolving document as you learn and grow. Here are some things to include in a plan for your private practice:
- Your vision
- What makes you and your practice unique (your value proposition)
- Unique offerings
- Your target client(s)
- Financial goals
- Practice goals (solo therapy practice or a group practice?)
- Marketing goals
- Goals for 3 months, 6 months, 12 months, 5 years
- A loan repayment plan if you are not self-funding
With a good plan in place, you’ll have a blueprint to follow as you build your practice out.
Ryan Pope, Business Coach at Out of the Box Advisors, highlights the importance of a clear marketing strategy for your practice:
One of the most common and potentially dangerous mistakes a new practice can make is to lack a clear marketing strategy. It is crucial that you not only set a budget that can meet your initial cash flow needs, but to also invest in items that reflect your quality of service. Off the cuff, internally designed websites will not cut it in todays marketplace. Unless you happen to be exceptionally skilled in web design, make sure you’re allotting budget for a professional website. Then invest in SEO or other efforts to get your site pushed out to the internet on tools like TherapyByPro and others.
Ryan Pope, Out of the Box Advisors
2. Set Goals
Setting goals for your private practice is an important part of achieving your dream practice. You should strongly consider setting milestone goals 3 months out, 6 months out, 1 year, 2 years, 5 years, and 10 years out, for example. Here are some steps you can use to set goals for your practice for each milestone:
- What do I want to accomplish in ___ months/years?
- Be specific as possible with tangible numbers you want to achieve. Ex: I want to have 5 counselors in 2 years in my group practice
- Commit to your goals
- Track results at regular checkpoints (weekly, monthly, quarterly, etc)
- Hold yourself accountable with deadlines that you set
- Celebrate when you achieve milestones – As a private practice owner, celebrate the little things, and definitely celebrate the big milestone accomplishments
You should also answer some questions very early on, such as: What kind of private practice are you trying to build? Do you want a solo therapy practice or do you want a group therapy practice? Making these decisions will save you time and money if you make them early on. When you choose your branding and website name, will you name your practice after your own name or will you create a brand? We recommend using your name if you’re in a solo therapy practice, and a brand if you plan on a group therapy practice.
3. Choose a Niche / Specialty
When you first start your practice, you’ll probably need to take any and all clients that come your way. But having a specialty niche is the best way for long-term growth. Why? Because you’ll make more money and spend less effort to help more patients. Without a niche, you’ll be getting all types of clients with all types of issues. This is a recipe for burnout disaster.
We recommend choosing a specific area of treatment, like eating disorders for example. With eating disorders, there are many conditions that fall under this umbrella, so you can choose 4-5 that you enjoy working with. Not only will this help you to finetune your craft, but other therapists and even patients will know you to be the expert in this area, and will come to work with you because of how highly skilled you are in this area.
When starting a private practice in counseling, it’s important to know who you want to work with and create your practice to target those individuals. It’s better to be known for helping 1 type of person or need than being not known for helping every type of person or need.
You can ask yourself these questions when choosing your client type:
- Who do I enjoy working with?
- Which condition(s) do I enjoy treating?
- Who can pay for my services?
- Who can I help best?
After you know your ideal client type, everything you do can be focused like a laser on getting those types of clients.
From a marketing perspective, a great strategy can be built around a mental health professional with a niche. For every niche, there are near unlimited opportunities to get in front of your patients. One question we always ask new clients is “please tell us your niche along with a list of conditions that you treat.” If you bring in another counselor later on, you can expand your offerings and begin to reach a new audience type.
4. Website Requirements
You need a website for your new private practice. Why? Because a website is one of the major ways of legitimizing you to clients who don’t know you. Think of a website as your online practice.
Why Do I Need a Strategic and Professional Website for My Therapy Practice?
Here are some reasons why you need a professional AND strategic website for your therapy practice:
- Potential patients that don’t know you will judge your website based on its design. In fact, according to Stanford, 75% of people judge the credibility of a company based on their website design
- Your website will make it easy for clients to contact you and/or sign up for a session
- Your website will make it easy for a client to pay you
- Your website is the foundation for your online marketing strategy
When it comes to operating a website, there are basic costs you need to know:
- Website hosting – a monthly fee for getting your website online through a hosting provider
- Domain name – a yearly fee for your website name
- Maintenance – You can do this yourself or hire a professional
- Website Design – You can do this yourself or hire a professional
Getting a Professional Website to Start Your Practice on the Right Foot
If you want to expedite how fast your practice grows, we’d recommend getting a professional website built and start a SEO plan. But not just any website will cut it. We’d recommend investing in a website that will grow with you and position you for success online. Many new private practices start with a basic website that they build with their spare time while waiting for new clients, and that is fine. But when you’re serious about growing your practice, you need a website strategy.
5. Legal Requirements
Every state and local municipality has their own business regulations. Speaking with a business lawyer is a good idea so that you can follow laws where you want to open your therapy practice. Some important considerations include:
- Insurance for malpractice and professional liability
- Incorporating your business
- Determining if you need a business license
- Zoning laws that dictate where you can open a practice
- Any other therapy practice concerns
6. Office Space or Online or Both?
Many mental health professionals we speak with are debating where they should offer their services: In an office, online, or both. Let’s review each option:
Therapy In an Office
Therapy in an office has it’s benefits and negatives. Karolina Mankowski, a holistic healer we spoke with had to say this about having an office:
After more than a year and a half of being isolated and deprived of human interaction during Covid19, people are longing for deeper connections and new experiences. Online video may have been a good short term solution but I am seeing that more and more of my clients prefer to come see me in person and are tired of logging on to yet another technology platform. Technology will never trump the human experience.
-Karolina Mankowski, Serene Soul Studio
Let’s review some benefits and negatives of doing therapy in an office:
- Human interactions
- Higher rates can be charged typically
- Much better Search Engine Optimization
- Higher costs
- Less convenient for the owner
There are many factors to weigh when deciding if you should get an office. I would highly suggest getting an office for your marketing strategy. Our clients typically get 10 to 20 new patient calls per month by having a physical location from our Google Maps strategy.
Offering therapy online was a necessity during the earlier months of the pandemic. Some therapists love the idea of being able to work from home and still operate their practice. Let’s review some benefits and negatives of doing therapy online:
- Lower costs
- Very easy to operate sessions
- Your SEO is hurt by not having a physical location
- Many patients want in-person sessions
Offering Both in Office and Online Therapy
The final option for you as a new therapy practice owner is to offer both in office and online therapy, the best of both worlds! Let’s review some benefits and negatives:
- You can offer more flexibility to your patients
- You can benefit more from SEO
- Higher costs
- More technology services needed
Making a Decision Where to Do Therapy
So which option of doing therapy works best for you and your goals? It’s really a personal decision. As mentioned above, we typically recommend our clients to get a physical location to benefit most from their marketing strategy.
7. Hire Staff or Start Alone?
Hiring an administrator can save you time and sometimes even money once you have enough clients. They can assist in answering your phone, managing paperwork, getting payments from clients, and performing other key duties to keep your office running smoothly.
8. Determining How Much to Charge Hourly
Determining your hourly rate can be a difficult process. On one hand, you have a desire to help more people, so offering a lower rate is tempting. On the other hand, you can only take in so many patients realistically, and it’s important that you feel financially secure so that you can continue building your practice out. Here are some steps to help you determine your private practice fees:
1. Determine Your Personal Income Goals
What kind of lifestyle do you want to be able to afford? Do you have goals of owning a house, paying for an exotic vacation each year, or growing into a group practice? How about going out to eat or paying for that fancy gym membership? Also, saving for your retirement should be a strong consideration.
You should determine your monthly costs, you will start to see a picture of how many clients you need and how much you need to charge. Of course this is not the only consideration, let’s continue exploring other factors when determining how much to charge hourly.
2. Figure Out Your Lifestyle Goals
Money is not everything. Many people value time over financial rewards. Having time to hang out with the kids, take short trips, or take care of your own mental health can be extremely motivating factors for many therapists. It’s important to determine the lifestyle you want while working in your practice. By doing this you’ll need to know:
- How many clients you want to see each day
- How many hours you want to work each day / week
- How many weeks of vacation you want to take each year
3. Calculate your Monthly Expenses
After considering your income and lifestyle goals, think about your monthly expenses. Some of your expenses might include:
- Personal salary
- Practice management software
- Liability insurance
- Continuing education courses
- Marketing costs
- Website costs
- Retirement / additional savings
After you add up all the expenses you have, you’ll have a good idea how much money you need to make to keep your practice financially healthy and running.
4. Think About Other Sources of Income
Many mental health professionals get or search for other sources of income to compliment their practice. Here are a few examples:
- Renting out a room in your office
- Supervising sessions
- Freelance writing
- Speaking opportunities
- Selling books
- Consulting services for other therapists
- Products you sell online
Your additional income should factor into your overall income number.
5. Factoring in No-Show Rate
It’s important to figure out about how many clients don’t show each week, yet cancel outside the cancellation fee window. Many times it’s hard to fill this spot, so you need to subtract out a specific number of no-shows from your overall patient numbers needed. This will further help you determine your rate.
6. Look at Your Local Competitors
How much are your local competitors charging for services similar to yours? You should look at mental health professionals with a similar educational background, similar work experience, and similar expertise as you. It’s a good idea to find a range they are charging and place yourself somewhere on that scale. Many times having the lowest price won’t benefit you because people often associate lower prices to lower quality service.
7. Calculate Your Hourly Rate
Now it’s time to calculate your hourly rate! Here’s a basic formula:
Your Practice Income Goal
Add up all your expenses. This will be a good place to start to show you how much you need to earn (your income goal).
Here’s a formula for you to figure out how much your practice needs to make:
Your income goal – other sources of income = how much your practice needs to make
Sessions You Need Per Year
Now, you need to determine the number of sessions each year based on your lifestyle goals. The fewer clients you see, the more you’ll need to charge hourly. Here are a few formulas to figure this out:
Clients per day x days per week x (1 – no show rate) x Weeks you’ll work in a year = Number of sessions per year
Here’s a real world example:
5 clients x 5 days per week x .92 (2 clients not showing up each week out of 25) x 50 weeks per year = 1,150 clients per year
Determining How Much to Charge Each Session
Your final step is to determine how much you should charge each session. To do this, take your yearly income goal and divide by your total clients per year. Here’s an example:
9. Take Insurance or Private Pay Clients?
This is a big question many practitioners think about when going through their private practice checklist. There are major pros and cons of taking insurance or accepting only private pay clients. Let’s reviews some pros and cons of each:
Taking insurance has it’s pros. Let’s dissect some of them:
Pros of Taking Insurance
- More clients that find you through insurance providers
- Advantageous for private practices in rural areas
- You’ll get a greater diversity of clients
- You get a little more credibility since the insurance company credentialed you
- Lower costs for clients
- You’ll get referrals from other doctors who are in your network
Cons of Taking Insurance
Now let’s talk about the cons of taking insurance:
- The credentialing process is very tedious and time consuming
- Filing claims can be overwhelming and may require additional staff to handle
- Rejected claims can slow down your ability to getting paid
- You’ll most likely need other software in place
- Insurance companies will determine your reimbursement rate for their patients
Now let’s review private pay and why it may or may not be a great option for you:
Pros of Private Pay
- You can charge what you want to and will on average make more money per session
- You will get paid quickly (usually credit card or cash before a session begins)
- You won’t need to file any paperwork with insurance companies (hooray!)
- You will need less staff to handle this paperwork
- Your services will appeal to more affluent clients
Cons of Private Pay
- Your marketing strategy will need to be top notch to generate private pay clients
- You’ll receive a less economically diverse clientele
- You may receive less referrals unless your referral sources are also higher-end
- You’ll need to educate your clients on not using insurance
Conclusion On Taking Insurance or Private Pay Clients
Most of the mental health professionals we work with do not take insurance. But there are definite benefits and negatives to each. If you can not take insurance and still get enough clients, then from a financial perspective, the choice is clear. But not every decision is determined by your bottom line. You need to consider who you want to work with and help.
10. Have Clear Patient Policies
Setting clear patient policies is an important part of running a smooth operation. Here are some important private practice policies to create:
- Have a a clear policy on appointment cancellations
- Have a document outlining steps you take to protect client privacy and how you comply with laws such as HiPAA
- Have a policy that outlines what to do if a client is a danger to themselves or others
- Have a policy to determine when you will refer a patient to another treatment provider
- Have a policy as to your hourly rates, if you offer any discounts, any sliding scales, or multiple session discounts
- Have a policy that spells out how a client can pay, when they should pay, and a refund policy (do you offer refunds or not?)
11. Gather the Right Forms
Gathering the right forms is an important part of streamlining your private practice. Let’s review a few aspects to think about when it comes to forms.
Types of Editable Forms to Run an Efficient Practice
Building forms will definitely be a pain, but can streamline your private practice. Here are some forms you may need, as well as some of our editable templates we’ve built for mental health professionals:
- Editable Client Disclosure forms that will outline policies and other important guidelines they need to know
- An informed consent form authorizing their consent for treatment
- Editable Referral form for clients you refer to other mental health professionals
- Editable Insurance reimbursement forms
- ABC Model CBT Template
- Addiction Relapse Triggers Worksheet PDF
- Anger Triggers Worksheet PDF
- Anxiety Triggers Worksheet PDF
- Biopsychosocial Assessment Template
- Biopsychosocial Spiritual Assessment Template
- CBT Behavioral Activation Worksheet PDF
- Challenging Beliefs Worksheet PDF
- Challenging Negative Thoughts Questionnaire
- Challenging Negative Thoughts Worksheet PDF
- Cognitive Restructuring Worksheet PDF
- Cognitive Triangle Worksheet PDF
- Coping Skills Worksheet Template Bundle PDFs
- Coping Skills Worksheet PDF
- Counseling Intake Form PDF
- Depression Triggers Worksheet PDF
- Distress Tolerance Scale PDF
- Eating Disorder Assessment PDF
- Informed Consent Form PDF
- Habit Tracker Template
- Daily Mood Chart Template Tracker PDF
- Emotional Triggers Worksheet PDF
- Identifying Triggers Worksheet PDF
- Mental Health Check In PDF
- Mental Health Check In Questions PDF
- Mental Health Daily Check In PDF
- Mental Status Exam PDF
- Perceived Stress Scale PDF
- Psychiatric Assessment Template PDF
- Relapse Prevention Plan PDF
- Shame Triggers Worksheet PDF
- SOAP Note PDF
- Stop Think Act Worksheet PDF
- Stress Triggers Worksheet PDF
- Substance Abuse Assessment PDF
- Teletherapy Consent Form PDF
- Therapy Progress Notes
- Trauma Triggers Worksheet PDF
- Treatment Plan Template
View all of our mental health forms here
How Will My Clients Fill Out My Forms?
You should consider how you want your clients to fill out your forms. Here are a few options:
- In person – This is an old way and will take more time for you and the client. Documents filled out will also not be digital, so storing and accessing these will not be as easy as other options.
- In a EHR system – EHR systems are a popular choice for getting forms filled out by patients.
- Using a system like DocuSign – With systems like DocuSign, medical professionals can create and send forms to be filled out by clients and patients securely.
12. Marketing Your Practice
Marketing your practice is a major part of growing and accomplishing your practice goals. Investing in the right mental health marketing strategy in the beginning will save your practice time, money, and your sanity. With so many marketing options available, it can be difficult to decide where to spend your time and money. Here are our top marketing recommendations in order:
Your website strategy is the absolute foundation of your marketing strategy. Without a strategic and professional looking website, you won’t get many patients.
What Makes a Website Strategic?
When it comes to a strategic website, you might be asking “What is a strategic website?” Here are some principles:
- Is your website built in a way that clients will find it?
- Does your website include thorough, knowledgeable resources about what my clients care about?
- Is your website built to get clients the way they search for treatment or information online? Some ways include:
- By condition
- By treatment style
- By level of professional care
- By location
- By specific topics related to a specific condition
It’s incredibly important to have a strategic website if you plan on growing your practice online. Without it, many of the strategies below will fail.
What Makes a Website Professional Looking?
Here are a few questions you can ask yourself to determine if your website is professional looking:
- Does my website’s looks correlate to the rate I’m trying to charge per hour?
- Is my website mobile friendly?
- Do I get patients from my website?
- How does my website look compared to top mental health professionals in my city?
- Has my practice outgrown my current website?
- Am I embarrassed to send a client to my website?
We wrote a post on “10 reasons why your private practice needs a new website” if you’d like to see this list in more detail.
Search Engine Optimization (SEO)
Search engine optimization, or SEO, is our flagship service we offer. We believe it is the best strategy to grow your practice long-term. Our proven process ties in a website strategy with SEO. Here are some things you need to know about SEO:
- SEO is a process of getting pages on your website connected with search keywords your clients are searching for on Google and other search engines
- With SEO, you are competing against other mental health professionals for exposure. The higher you’re ranked for particular search terms, the more likely a potential client will visit your site and reach out to you
- SEO takes time, on average about 4 to 6 months to start generating new clients
- We recommend at least 12 months of SEO services to benefit your practice long-term
- Unlike advertising, SEO is a more permanent option
- With advertising, you pay to be at the top of search rankings. With SEO, you work your way to the top of search rankings.
- SEO clicks are free, advertising clicks cost you money
- Once you stop advertising, you stop getting new clients. After you build out SEO, you’ll keep getting clients for the long haul
Google advertising, also known as PPC (pay per click) advertising, is a great way to get clients fast. While a SEO strategy takes time to build out, Google Ads may be a great route for your practice to get new clients quickly. We suggest building out a SEO strategy and also complimenting that strategy with Google Advertising, at least in the first 6 months.
Social media is usually a go-to strategy by many mental health professionals. Social media is easy to use and allows you to showcase your personality and expertise on a more personal level. However, we recommend social media as a complimentary strategy to your website strategy, SEO, and advertising.
Directories like TherapyByPro work in the same way SEO works, by being found by potential patients searching for many different topics on Google and other search engines. Joining directories can benefit you by placing you where patients are searching. However, you’re typically limited to only being ranked for a few keywords patients search for in your city. If you have your own SEO strategy, you’ll benefit from hundreds or even thousands of keyword rankings. Directories can be beneficial to your overall marketing strategy.
13. Tracking Progress and Expenses
Tracking your progress by keeping up with your expenses will help you build a more streamlined private practice. We asked data expert Jack Tompkins at Pineapple Consulting Firm what the most important things a new private practice can track and why:
When starting a new private practice, there are a few main things that you’ll want to track to make sure you start successfully. First (in no particular order) would be “Conversion Source”, or “where are your clients coming from”. Important because the answer might surprise you and it’s important to lean into what works best. Second would be “number of visits per client”. Important because it will be an indicator for your whole financial picture, which I always recommend viewing in a financial dashboard. Third would be “hourly rate”. It’s not likely that you are drastically undercharging yourself, but make sure you know where you sit in the market as it will be a potential client’s first impression of your services (before they meet you!) and another key metric to your financial picture.
– Jack Tompkins, Pineapple Consulting Firm
To sum up Jack’s recommendations, as a private practice in therapy, you should track:
- Where your clients are coming from
- The average number of visits per client
- Hourly rate that you’re charging (and what it means for your practice’s overall financial picture)
When you have the right tracking tools in place, tracking key performance indicators (KPIs) can be easy. Without proper tracking, you won’t have an idea how effective your efforts, time, and money have been.
14. Do Amazing Work
The final step on our checklist, but perhaps one of the most important will make or break your practice: Do amazing work. No matter how great your marketing is, if your work is done poorly and receive many negative reviews, clients will begin to look elsewhere for more highly rated mental health professionals.
You should guard your reputation fiercely as it can directly affect your private practice’s bottom line. Here’s how to check your reviews:
- Go to Google
- Type in the name of your practice and click search
- Browse the top 2 to 3 pages and you’ll start seeing reviews on various sites, including google My Business on the far right (desktop search) outside of search results
- If you don’t see a Google My Business (found on the right side when you search for your practice on a desktop), you need one
If your reviews are below a 4 / 5 rating, you should work on getting reviews. With mental health professionals, there are ethical questions around asking patients for reviews. An idea you should try is reaching out to colleagues and friends who have experienced your professionalism. You can kindly ask them for a review and send them the link to your Google listing.
The bottom line is, you need positive reviews. The best marketing plan in the world can’t help you if patients are turned away by your low online ratings.
Final Thoughts on Our Starting a Private Practice in Counseling Checklist
Thank you for reading our checklist of 14 things to consider when starting a private practice in counseling. It can seem overwhelming at first, but building a private practice can be extremely fulfilling and also profitable. You’ll have ultimate freedom to run this practice how you dreamed it should be run, and you’ll be helping hundreds of people each year who desperately need help. While you may struggle the first year in business, don’t give up. Protect your own mental health when starting your private practice, and fight for your dreams.
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