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. 🌿💧
What Is Nesplora VR Testing - and Why We're Bringing It to Our Practice
By: Dr. Jennifer Merthe-Grayson, Licensed Clinical Psychologist
If your child has been struggling with focus, impulsivity, or attention - or if you're an adult who has quietly wondered whether ADHD might explain years of difficulty - you've probably already know that getting a clear, accurate answer isn't always simple. Traditional ADHD evaluations are thorough, but they rely heavily on rating scales, clinical interviews, and paper-and-pencil performance tests that can feel disconnected from real life. 🧠
That's why we're excited to share that the Merthe-Grayson Center is in the process of adding Nesplora virtual reality assessment to our evaluation services. 🎉
So, What Exactly Is Nesplora?
Nesplora is a clinically validated neuropsychological assessment tool that uses virtual reality technology to evaluate attention, impulsivity, and related cognitive functions. Rather than sitting at a table responding to stimuli on a piece of paper, the person being evaluated puts on a VR headset and is immersed in a realistic, everyday environment. 🥽
For children and adolescents, that environment is a virtual classroom - complete with ambient distractions like whispering classmates, paper airplanes, and background noise. For adults, the setting is an aquarium, a naturalistic environment designed to assess attention and working memory in a way that mirrors real-world demands. 🏫🐠
The test takes approximately 18-25 minutes, and results are generated automatically at the end of the session. ⏱️
Why Does This Matter for Diagnosis?
One of the ongoing challenges in ADHD assessment is what clinicians call ecological validity - meaning, how well a test reflects what's actually happening in a person's daily life. A child can perform reasonably well on a quiet, highly structured paper task and still struggle enormously in a busy classroom. Traditional continuous performance tests, while useful, have sometimes been described as "shoot-me boring" - and disengagement during the test can affect results. 😅
Nesplora addresses this directly. By placing the individual in a simulated real-world context full of natural distractions, the assessment captures a more accurate picture of how attention actually functions. The system objectively measures:
Sustained and selective attention
Impulsivity and inhibitory control
Motor activity (in children)
Working memory and cognitive flexibility (in adults)
All of this is compared against a normative sample, and the report is generated immediately - no waiting weeks for scoring and interpretation. 📊
Who Is This For?
Nesplora has been validated for two primary age groups:
Children and adolescents ages 6-16 using the Aula (classroom) environment
Adults ages 16-90 using the Aquarium environment
It's a strong fit for families seeking clarity on ADHD, and it's also useful in cases where anxiety, learning differences, or other factors make diagnosis more complex. Because the assessment is objective and fully quantitative, it reduces evaluator bias and adds a layer of precision that complements the clinical interview and rating scale data we already gather. ✅
What This Looks Like at Our Practice
At the Merthe-Grayson Center, VR testing will be one component of a comprehensive evaluation - not a standalone diagnostic tool. ADHD assessment has always required gathering information from multiple sources, and that won't change. What Nesplora adds is a more immersive, objective, and engaging piece of the picture. 🧩
For kids especially, the technology tends to feel more like an experience than a test - which can reduce test anxiety and improve performance validity. 🌟
We'll share more details on availability, fees, and scheduling as we finalize our rollout. If you're currently on our waitlist or are considering an evaluation, feel free to reach out and let us know you're interested. 📅
Questions? We'd Love to Hear From You.
As we prepare to launch this service, we're happy to answer questions from families, adults, and referring providers. You can reach us at
drjenn@mgcenterforpsychologyandwellness.com 📩
At the Merthe-Grayson Center, we're committed to staying at the forefront of evidence based assessment - because accurate answers are the foundation of meaningful support. 💙
The Merthe-Grayson Center for Psychology & Wellness is a private practice based in Amherst, Ohio, offering in-person and telehealth services for individuals across the state. We specialize in psychological assessment and individual counseling.