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Common struggles for new therapists in private practice 


For this four-part series, 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’s 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’s important for us to learn how to run a business that’s cost effective. But when we look at our overhead and operating expenses, we tend to think, “That wasn’t what we learned at school.” 

Office space and billing and insurance, oh my! 

I jumped into private practice the way I always wanted to, but I didn’t 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’re in the beginning stages of growing your private practice, you really don’t 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’re still in training, all that stuff is taken care of behind the scenes. When you’re on your own, you’re 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’d 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 “lay of the land” 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’s 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’t 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’s 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’s still a great deal of trial and error that goes into starting a private practice. In part three of this series, learn more about how Anderson expanded his practice as he became more seasoned over time. 

About the author

Frank Anderson, MD, completed his residency and was a clinical instructor in psychiatry at Harvard Medical School. Both a psychiatrist and psychotherapist, he specializes in the treatment of trauma and dissociation and is passionate about teaching brain-based psychotherapy and integrating current neuroscience knowledge with the IFS model of therapy. He maintains a private practice in Concord, Massachusetts, and serves as an advisor to the International Association of Trauma Professionals (IATP).

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