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. 🌿💧