Feb

6

2024

Private Practice: Making it Sustainable and Successful

Written by Shelley Holland, Owner of Brighton Therapy Partnership

We are very fortunate to have the amazing Simonne Gnessen join us at Brighton Therapy Partnership for an online evening seminar on Monday 19th April to discuss *Understanding our Relationship with Money: New Perspectives for Therapists*. Knowing Simonne’s work I know this is going to be an insightful and exciting deep dive into the ways in which we all have a complex relationship with money and how it impacts our private practice work. I hope you can join us then! In the meantime….

I’ve had a draft of this article on my desktop for almost a year now. At the time of writing a lot of therapists on social media are reporting a downturn in enquiries for their services (February 2024), which makes this article more relevant than ever. I’ve added some of our own resources for therapists in private practice at the end of this article, but if you know of more please pop them in the comments section right at the end. Let’s share the knowledge and share the love!

Being a therapist is not always the bowl of cherries we sometimes imagine. Every therapist will experience a dip in their available work. At some point they will find they have less work than they need, and this will be a recurring theme throughout the lifetime of most therapists. It is what most self-employed people experience, no matter what their trade.

If you are an employed therapist, you may be earning less than your self-employed colleagues, but your income will be consistent, and you will probably have other benefits such as holiday pay and sick pay and liability insurance and clinical supervision provided as part of your role. You will have no marketing outlay, and you are more likely to have colleagues to rub shoulders with!

As a self-employed therapist in private practice how do you manage both financially and emotionally when you are not doing the amount of therapy work that you want or need?

There are a wide range of practical and emotional responses to this, and I will touch on these in this article, and finally suggest that a self-regulatory process that we tend to use with those we work with (clients, patients) that can also be helpful for us as therapists.

I’ve been working as a therapist for over 25 years and working as a therapist in private practice for over 19 years and running a therapy clinic for 10 years which currently has around 30 therapists receiving client referrals from us. So, I often get asked to share my thoughts on how to get going in private practice and how to make being a therapist in private practice both successful and sustainable. Here are a few of my thoughts.

It can be difficult, and can even feel shameful, to admit to not having enough work as a self-employed therapist; it can really tap into feelings of ‘am I good enough’? And yet business and cashflow ebbing and flowing is a normal part of self-employment, and with therapy being a high and regular expense for those seeking therapy it is understandably considered as a luxury item by many people when purse strings need to be pulled in.

Therapists are often trained that their work involves putting their needs aside for those of their client. Within the therapy hour this is certainly the right approach, but we also need to balance giving with receiving, that is, ensuring we are reasonably compensated for the heavy emotional lifting that being a therapist often involves. After all, we all have bills to pay, rent or mortgages and living expenses that we need to meet.

If you find yourself concerned that you don’t have enough work, or you find yourself feeling anxious when a piece of work with someone comes to an end, then read on.

Let’s look at the practical side of things first:

1. Build up an Emergency Fund

It helps to realise that you are working in a precarious industry and that workflow is never guaranteed, so do what you can to gradually build up a financial cushion for those times when your income is more variable. It will help reduce the stress of having to meet regular bills.

2. Budget for Different Income Scenarios

It pays to think ahead and consider having different income and expenditure budgets for different earning scenarios. Every business has to manage the challenges of a variable cash flow, and being a self-employed therapist is no different.

3. Diversify your Income

I feel this is one of the most important things a therapist can ever do, not just from an income point of view but to enhance their effectiveness as a therapist. Hear me out.

If we are relying solely on our clients/patients for our income we’ve built a dependency in our therapy work which has the potential to be unhealthy. I would go as far as to say that no therapist should ever be 100% reliant on therapy work for their income because of the unhealthy financial and emotional dependency this puts on the therapeutic relationship for the therapist. I know I’m not going to make many therapy friends saying this, but I believe it strongly.

If we remove the need for us to be entirely dependent on our clients to pay our bills, we free up the therapy space to be something else. We can be truly available for our clients, whatever their need for therapy is; it will no longer bring anxiety when a client leaves if we are not entirely dependent on their money to pay our bills.

Some therapists may be the sole earner in their household and the need to keep the household income as stable as possible can become even more important.

What do we mean by diversification? It might be offering workshops or becoming a supervisor, other therapy-related roles, but my caveat would be that some of these can be variable or scarce resources too. If you can, find a piece of work that is regular and consistent, even if you feel it pays less than you could earn if you were doing the same number of hours working as a therapist. The consistency and the regularity of the income can actually be worth more in non-financial terms.

4. Employee Assistance Programmes (EAPs) or Charities

There are many therapists who supplement their private practice income by joining a number of EAPs or part-time work with Charities. The hourly rate is much lower than in private practice, but it can help to fill gaps and provide a reasonable stream of alternative work.

5. Fee Structure

Some therapists will offer a lower-than-usual-fee to attract clients and have some level of income during a difficult period. If this sits okay with you, it may be something to consider.

It’s a route that does have potential pitfalls. It’s vital we keep feelings of being undervalued or feelings of resentment at working for a rate lower than we feel acceptable, out of the relationship dynamic with those we work with, especially given the heavy impact that therapy work can have on a practitioner. We owe it to those we work with (clients/patients) to be as present with them as we can be, not sitting with concerns about how much we are being paid.

6. Marketing – effort, specialisms, and being realistic

You do have to invest quite a bit of time and some money in marketing in order to attract enquiries. You need to decide the best marketing route for you. It might be your own website if it is well optimised for being found on Google, or trying out one of the many directories that exist, or networking with others so they get to know your work (especially if you have a niche). Also consider joining with others and doing group marketing; the impact can be greater.

To give you an example, I run The Palmeira Practice, a therapy Practice with around 30 therapists currently available to receive referrals from us. Our Practice website SEO is very robust, and our marketing spend is large. The Practice website usually performs much better on Google than any of the individual therapist’s websites and even in slow periods we continue to get enquiries. The power of the group is not to be underestimated!

The idea of having a ‘niche’ as a therapist is much talked about. The main purpose of a niche is to differentiate you as much as possible from all the other therapists in the market. It’s not a bad idea, but also don’t force it. If something doesn’t naturally sit with you then wait until something does.

There’s a small health warning that comes with having a specialism or niche however, which is to remain aware of overload. Obviously, it depends on what your specialism is but working with the same specialism for most of your working week can sometimes lead to burnout.

I worked for a counselling charity many years ago and got funding for us to employ a therapist to work with a particular client group. I soon realised that if we asked this therapist to work with clients with the same presenting issue, they’d soon get overwhelmed; the issues this client group tended to bring were very impactful. So, despite the requirements of the funder, the therapist would be allocated clients with a range of presenting issues to vary their workload and decrease their stress.

Finally remember that marketing your therapy private practice is a bit like playing the stock market. No matter what anyone tells you or whatever promises and gimmicks a marketeer tries to sell you, you will never outperform the market. In a slow period you cannot make people seek therapy who are not already looking. What you can do is put yourself in the best possible position to capture as much of the available market as possible. That’s what good marketing does.

7. Training and CPD

You will have more to offer if you stay up to date with new developments in the therapy field and add further training to your CV as and when you can afford it. There are plenty of really good training and CPD providers around, but of course I need to give our very own Brighton Therapy Partnership a mention. We do a great range of live one-day workshops via Zoom, and we also have an on-demand video CPD library over on our sister site Therapy Education Online. Go check us out!

Of course, it’s difficult to completely separate the practical considerations of running a private practice from the emotional ones, as you can see. But for a moment let’s take a look at what might help or hinder therapists’ worries about their private practice.

8. Self-Care

This is such an important part of being a therapist. What I notice is that it doesn’t come easy to many of us. Therapists are more likely to have grown up with a need to care for others, and a need to put their own needs aside for others for a whole variety of reasons. Putting our own self-care and emotional well-being centre stage can be hard. It can of course include the ‘usual suspects’, things like exercise, mindfulness, and prioritising sleep. It can also be about getting involved in activities that are not related to therapy at all.

Remember self-care does not have to be ‘the big stuff’. I recently started buying ready chopped onions because I really hate chopping onions! And I labelled it an act of self-care. So being mindful about what we do for ourselves and incorporating it into our lives rather than it being a special event is very important. Self-care and self-compassion will help us to stay grounded at moments of stress.

9. Supervision and/or Peer Support Groups

Supervision is definitely the place to discuss your private practice and what works or doesn’t work for you. Your personal therapy is also a place to take your worries about work and life issues. But even better in my view is a peer support or peer supervision group that has the remit to look at private practice support issues as well. Our peers, if generous enough, often have some of the best ideas and also the best understanding of what another therapist is experiencing when they have a variable workload.

10. Expectations

The biggest mistake most self-employed people make is not understanding how much they actually need to earn. There can be a tendency to just keep working, with the huge potential to over-work, because there isn’t a budget in place. Once you know what you need, you can work towards meeting your needs. If you don’t know what you need, you may just keep going until you burnout.

Examine what your hopes and wishes are for your lifestyle and what you need to earn. Are they reasonable and realistic? How much work do you expect to do to develop your business from scratch and then maintain it? Typically, it takes 3 years to grow a business and it’s not unreasonable for the setting up stage (perhaps the first 2 years) to be spent doing a lot of groundwork to develop the foundations of the business.

11. Managing anxiety

If you are someone who needs a level of safety and stability, and don’t have alternative income streams, you will find it helpful to manage the anxiety that an unpredictable workstream brings. You will need to find ways of managing this internally and resisting the temptation to make sudden changes in the way that you work, for instance the number of hours that you work, how much you charge etc. All of these moves are panic moves.

Of course, it’s natural to get worried about income and outgoings, but if you have planned your work forward in the ways suggested in this article and have a strategy in place, then having a number of empty appointments for a few months could be a minor inconvenience rather than a super stressful experience.

12. The Window of Tolerance

The Window of Tolerance is a model often used by therapists to enable those they work with to understand the ups and downs of their feelings and is sometimes used as a basis for exploring grounding techniques and other types of affect regulation.

The best chance we have of helping our clients to regulate their emotions is to be regulated ourselves, to be able to sit with the pain and discomfort of another human without dissolving into our own distress or joining them in theirs.

And the window of tolerance and the ability to self-regulate our feelings is essential for managing a therapy private practice too. If we pay attention to how we are feeling in our bodies, and remain as far as we are able within our own Window of Tolerance we are more likely to react mindfully, to not make panic moves when our workload dips, and be increasingly more able to take a long view about how to make our private practice successful and sustainable by working through some of the strategies explored earlier in this article.

Conclusion

Managing a variable client load can be challenging for therapists, both emotionally and financially. In this article I’ve outlined a few strategies which you can start working with. By combining emotional resilience strategies with proactive financial planning, therapists can navigate the challenges of a variable client load more effectively.

Resources

BTP Workshop – Monday 29th April, 6-9pm on Zoom – Simonne Gnessen –  *Understanding our Relationship with Money: New Perspectives for Therapists*. Tickets available on this website via the link or on Eventbrite.

BTP Articles

How to Start Your Private Practice

Useful Skills for Counsellors and Psychotherapists

Counselling and Social Media – Dos and Don’ts

How Much to Charge for Counselling and Psychotherapy

Your Recommendations and Resources

Do you have additional suggestions of resources that have helped you in your private practice journey? Please leave a comment in the section underneath this article and share it with the therapy community! 

Join our Therapy Community on Facebook

We have recently created a private Facebook Group for therapists which might be of interest to you if you are on social media? You will need to answer all 3 Joining Questions and agree to the Group Rules to join the Group!

Click Here to Join *The Therapy Partnership* Facebook Group – Be Part of the Therapy Community!

Picture Credits – Towfiqu Barbhuiya (Unsplash), Pixabay, Josh Appel (Unsplash), Joyce and Sills, Joanna Kosinska (Unsplash).

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