Starting a Private Practice: Things I Learned the Hard Way So You Don’t Have To 🛋️

By Dr. Jennifer Merthe-Grayson, Licensed Clinical Psychologist

There is a particular kind of optimism that comes with starting a private practice.

You picture meaningful work, control over your schedule, a cozy office, and a plant that communicates, “Healing happens here.” 🌿

You probably do not picture having strong feelings about a fax number.

And yet.

Building a private practice has been rewarding, exciting, and occasionally an elaborate exercise in whispering, “What does that even mean?” at my computer.

If you’re a mental health professional thinking about taking the leap, here are some lessons worth packing before you jump.

1. Being a good therapist and running a business are two different jobs 🎩

Your clinical training may have prepared you to sit with grief, navigate conflict, and help someone recognize a lifelong pattern.

It may have spent considerably less time explaining why a claim was rejected because one box contained the wrong number.

Private practice asks you to be a clinician, business owner, marketer, administrator, and occasional detective.

What I’d tell someone starting out: Make two lists: what you know clinically and what you need to learn operationally. Being experienced in one does not mean you should magically understand the other.

You are allowed to need help with spreadsheets while being excellent at therapy.

2. A full calendar and a healthy bank account are separate accomplishments 💸

A scheduled appointment is not a completed appointment. A completed appointment is not a paid claim. And a paid claim may arrive on a timeline that seems unrelated to the continued existence of your bills.

Meanwhile, software subscriptions are impressively punctual.

Before building your budget around a full caseload, account for cancellations, administrative time, overhead, time off, and the gap between doing the work and getting paid.

The lesson: Know what you actually collect and what it costs to keep the practice running. Your calendar cannot tell you the whole financial story.

Unfortunately, “very busy” is not a payment method.

3. “I accept insurance” comes with several follow-up questions 📞

Which plan? Which clinician? Which service? Under which arrangement?

Insurance can make care accessible and support a practice, but the administrative details deserve their own chair at the table.

One of the most useful habits is getting specific answers and keeping a record: the question, the answer, the date, and any reference number or written confirmation.

The lesson: Build a verification process. Memory is a wonderful thing, but “I’m pretty sure someone told me that” makes a terrible filing system.

4. Your website needs to help someone make an appointment 💻

I love a beautiful website. I also know someone looking for therapy may be overwhelmed, exhausted, and reading it on their phone between responsibilities.

They should be able to quickly figure out:

• Who you help.

• What services you offer.

• Whether you offer in-person care, telehealth, or both.

• How to ask about cost and insurance.

• What to do next.

“Begin your journey toward your most authentic self” can be lovely.

“Accepting new clients. Here’s how to schedule” is also doing important work.

The lesson: Let the website sound like you, and make the next step obvious.

5. Opening your doors does not automatically tell people you exist 📣

You can have excellent training, thoughtful services, and immediate availability while the people who need you have absolutely no idea you are there.

Marketing means helping people understand who you serve and how to find you.

That might include introducing yourself to other professionals, explaining a specialty in plain language, or following up with a referral connection.

The lesson: Make outreach a regular part of the job. Waiting until the calendar gets quiet makes every marketing decision feel like an emergency.

You do not have to become a dancing therapist on the internet. Unless you want to. Please assess your own choreography. 💃

6. Hiring creates capacity - and a whole new set of responsibilities 🤝

Growing a group practice is exciting. It also means thinking about referrals, onboarding, supervision where applicable, scheduling, documentation, and how each clinician will build a sustainable caseload.

Adding a clinician does not cause a matching group of clients to materialize in the waiting room.

Rude, honestly.

The lesson: Build a plan for supporting the people you bring into your practice. Available appointments need a way to become actual appointments.

7. Boundaries belong on your calendar, too 🗓️

It is easy to open “just one” evening slot.

Then another.

Then your schedule starts to resemble a group project in which everyone else chose your availability.

Flexibility is valuable, but so is having a practice you can continue enjoying.

The lesson: Decide what your working hours need to protect: family time, rest, documentation, meals eaten while sitting down. Give those needs a place in the schedule before every open space becomes bookable.

Being able to work at a particular time does not mean you need to offer it indefinitely.

8. Every exciting idea needs a slightly boring plan 💡

A new group. A new specialty. A new service. A bigger space.

The ideas are fun. The questions about staffing, expenses, demand, workflow, and payment are less glamorous.

They are also how an idea gets a fair chance to succeed.

The lesson: Before adding something, ask what it will require each week, who will do that work, and how you will know whether it is working.

Enthusiasm gets the project started. A workable process helps you deliver it on a random Tuesday when you’re tired.

9. You need people you can ask the “embarrassing” questions ☕

Sometimes you need a clinical consultation.

Sometimes you need someone to explain a financial report.

Sometimes you need to ask, “Is this portal confusing, or have I lost the ability to read?”

Build relationships with people whose expertise complements yours. Ask questions before a small uncertainty becomes an expensive mystery.

The lesson: Getting support is part of running the practice. You do not earn extra credit for personally solving every problem.

10. Define success before you keep moving the finish line 🎯

There is always another milestone: more referrals, another clinician, a new program, a higher revenue month.

It is surprisingly easy to reach something you once wanted and immediately replace it with the next requirement.

Success deserves a more specific definition.

Can the practice support your needs? Are clients receiving thoughtful care? Is your workload sustainable? Do you have room for your life outside the office?

Those answers matter alongside growth.

Would I do it again? 🛋️

Yes - with a better spreadsheet and fewer assumptions about how quickly administrative tasks happen.

Private practice gives you the opportunity to build something meaningful. It also asks you to learn skills you may never have expected to need.

Start with a manageable plan. Ask specific questions. Check the numbers. Build relationships. Leave room to adjust.

And buy the office plant if it makes you happy.

Just remember to water it. Apparently, “holding space” for a fern does not meet its basic needs. 🌿💧

🤖 When Your Chatbot Takes Your Side: The Psychology of AI Relationship Advice

By: Dr. Jennifer Merthe-Grayson, Licensed Clinical Psychologist, Ohio

You have an argument with your partner. You replay the conversation, reread the texts, and wonder whether you were asking too much.

Then you open a chatbot.

“Was this manipulative?”
“Am I being unreasonable?”
“What should I say back?”

Within seconds, you receive a thoughtful response. It names your feelings, organizes the conflict, and offers words you could never seem to find on your own.

That can feel remarkably comforting. It also raises a question: Is this helping you understand your relationship - or making you more certain of the story you already believe?

💬 Why it feels so good to be understood

There is nothing strange about wanting a calm response when you feel overwhelmed.

AI offers an appealing combination: immediate availability, room to explain yourself, and no visible frustration when you revisit the same concern. The American Psychological Association has highlighted how chatbots can simulate empathy and validation, creating a powerful sense of being heard.

For someone who feels dismissed or struggles to put emotions into words, that experience may bring relief.

Imagine typing, “I’m exhausted because I handle everything at home,” and receiving a response that acknowledges your frustration. Sometimes, having language for an experience helps you begin a conversation you have been avoiding.

But feeling understood and having a complete understanding are different experiences.

🧠 Your feelings matter. Your interpretation still deserves examination.

Consider this scenario:

Your partner barely speaks during dinner. You feel rejected. You ask a chatbot why your partner is emotionally unavailable.

The question already contains a conclusion.

Perhaps your partner is withdrawing. Perhaps they are exhausted, distracted, or upset about something they have not shared. Perhaps this dinner is part of a painful, longstanding pattern.

A chatbot receives the version you describe. It does not independently observe the relationship or hear the other person’s perspective.

This distinction matters because validation of an emotion does not establish the accuracy of an explanation.

“I felt hurt” describes your experience.

“They wanted to hurt me” makes a claim about someone else’s intention.

Both deserve attention, but they require different kinds of evidence.

🔄 When reflection turns into a search for certainty

One potential trap is repeatedly asking for a verdict:

“Was I right?”
“Does this prove they don’t care?”
“Would a healthy partner ever say that?”

Each answer may provide temporary relief. Yet repeatedly seeking reassurance can leave you returning to the same question instead of deciding what you need to do.

A useful self-check is:

Am I leaving this conversation with a clearer next step, or with a stronger urge to ask again?

Relationship decisions rarely become simple because someone - or something - delivers a confident judgment. Often, clarity comes from observing patterns, communicating needs, and seeing whether meaningful change follows.

🤝 Use the tool to prepare for connection

If you use AI to think through a conflict, consider changing the questions you ask.

Instead of: “Explain why my partner is selfish.”

Try: “Help me describe the behavior that upset me without assuming their motives.”

Instead of: “Tell me who is right.”

Try: “What information might be missing from my account?”

Instead of: “Write something that makes them realize how wrong they are.”

Try: “Help me communicate what happened, how it affected me, and what I am asking for.”

Read the response before sending it. Remove language you would never use. A polished message is only useful if it honestly represents you.

Also consider privacy: avoid entering names, identifying details, or someone else’s sensitive information, and review how the service handles your conversations.

📱 Notice what happens after you close the app

Does the conversation help you approach someone with more clarity?

Or are you spending more time analyzing the relationship while participating in it less?

APA has described both potential benefits and concerns around AI companionship, including opportunities to rehearse conversations and the risk that heavy reliance may displace human connection. These effects are still being studied; using a chatbot does not automatically mean someone is becoming isolated.

The practical question is how the tool functions in your life.

💛 Sometimes you need more than a well-written answer

A chatbot cannot provide the clinical assessment, professional accountability, or ongoing care of a licensed therapist. Psychology faculty at Columbia University caution against treating general-purpose chatbots as substitutes for mental health professionals.

If a relationship involves fear, threats, intimidation, or control, prioritize safety and individualized support. A better communication script cannot resolve every relationship problem.

For other conflicts, therapy can offer space to examine your feelings, your assumptions, and the patterns that keep repeating.

You deserve to be heard. You also deserve support that helps you decide what to do with what you are feeling.

🌿 The Merthe-Grayson Center for Psychology & Wellness offers individual and couples therapy, with telehealth across Ohio and in-person services in Amherst.