8 Mistakes I made Building a Private Practice

The path to building a private practice is rarely perfect. While most of you know that I was able to build a successful private pay private practice during the recession- many of you don't know all the ways I messed up. The truth is, I tend to look back on things in a glass half-full. Every mistake I made led me to a million great decisions and experiences. But, it still doesn't mean I didn't mess up. 

Mistake #1: I didn't make a business plan... 

The truth is, I didn't know how to make a business plan. I did enroll in Casey Truffo's membership plan and she taught roughly how to develop a fee. However, my numbers at that time weren't build on anything. I had no idea about taxes, expenses, continuing education, and didn't even remotely consider retirement. In some ways, ignorance was bliss. It helped reduce my anxiety that I didn't "know everything I didn't know." At the same time, I started at a disadvantage, not completely prepared for being a business owner. 

Mistake #2: I wasn't confident in my fee... 

I set a decent fee... which I immediately discounted. I don't mean I did a sliding scale- I mean I completely discounted the fee as long as someone paid me at the time of session. It was a $25 "discount" for paying at the time of session if I recall correctly... which was really more like a $25 fee for paying late. It wasn't straight-forward, and it felt a little gimmicky and desperate. Much like my age (I looked young when I started therapy- when I got confident in my fee- others became confident in my fee). I also didn't fully explore the legal and ethical issues of setting a "discounted" fee in this manner. 

Mistake #3: I didn't research what was available in my area

I didn't know what the term "market research" meant when I started my private practice. That led to several bad... or at least odd decisions. The truth is, there weren't many therapists advertising when I started my private practice. VERY few therapists in my area had websites. I was taking advice on marketing from therapists who were in very saturated markets with lots of therapists. While the advice wasn't bad- it didn't completely fit my situation. I learned I had more options for building a practice in an area with less competition. 

Mistake #4: I didn't plan for getting full...

There is nothing more exhausting than finishing a FULL day of clients and realizing you have 3 phone messages from clients who need therapy. I always strove to return calls quickly and take time with each person to give them referrals that were most appropriate- but that takes time. When I identified my schedule and number of clients i didn't plan for returning phone calls because I was getting too many referrals, expanding to add new clinicians, etc. 

Mistake #5: I didn't/don't have an exit strategy. 

I had always planned to live in Modesto, CA. Even when my husband and I started considering a move to Southern California (the job market for his profession in Modesto was not great)... I focused more on where I would get new income than how I would transition the private practice. My private practice website and branding is all location specific which is AWESOME... but it definitely didn't help me as I moved to Seattle and then down to Oceanside, CA. Now, I find myself settled down in SoCal.... and I'm having trouble letting go of the practice and starting over. Being an administrative boss doesn't exactly excite me- and I now I have to decide what to do next.... and I'm avoiding it! I know I need to let go of it to create room for my life down here- but there has been a TON of change in the past two years for me! 

Mistake #6: I didn't have a plan for bookkeeping

As January passed after I started my private practice I started to panic... I had down several things right... I had kept all my receipts... I had opened a separate bank account and put all my expenses through there... but I had NO idea what a profit and loss statement was. I had no idea about quarterly taxes, and I was completely lost as to how to file taxes that first year... So, I did what any self-respecting therapist does... I stuck my head in the sand until late March! I was lucky to connect with a bookkeeper who was SO incredibly kind to make sense of my envelope of receipts and bank statements. From then on out, my bookkeeping got outsourced- it made life SO much easier. She would send me an email every few months asking a few questions about how to categorize a particular expense- and I would get all the reports I needed. Now I use Outright.com which is fabulous and fast- but life is WAY too short to do your own bookkeeping from scratch! 

Mistake #7: I didn't plan for taxes

Well... I sort of planned for taxes. Initially, I really wasn't sure how to make sense of everything. We had two incomes, and that first year my income went down dramatically since I didn't work for part of the year, and it took a few months to get things flowing... I (and my husband) were pretty shell-shocked when we saw how much we owed in taxes! It took a few years before I felt like I had things "locked in" and knew how much to sock away for tax purposes exactly. 

Mistake #8: I let others opinions impact me

I would love to tell you that I am completely confident and never let others thoughts and opinions get to me- but it just isn't true. Throughout my private practice career I have found myself justifying my decisions, and even keeping certain things quiet for fear of how others would react. Whether it was offering "faith based counseling" and being open about being a Christian, charging people from business consultation, or making the decision to stop seeing clients when I moved to Seattle- I have felt deeply many of the statements made online or in-person that were pointed directly, or even generally at me. In fact, I have about 3 half-written blogs with my in-depth, ethically sound justification for not getting licensed in Washington during my 18 months there, or not seeing clients virtually... I have even been known to completely avoid Facebook groups where I know I could add to the conversation because of how stressful it can be to stumble upon someone saying something funky about me. I am a work in progress- and as someone in the "public-ish" eye- I have to stand in my truth. It is a work in progress! 

Here is the truth. You don't have to be perfect to be successful. And even with the best planning- you will make a few mistakes or missteps. You could completely emulate what someone else has done, and find it isn't quite right for you. Do your research, avoid as many mistakes as you can. But, when you do get pointed in the wrong direction- take a breath, re-assess, and re-align! 

Have you made a mistake you want others to avoid? Share in the comments below! Are you looking for more support? Check out our free trainings, or our mini business school bootcamp.

Want to learn more about building your private practice? Check out our upcoming bootcamp 

Miranda Palmer

I have successfully built a cash pay psychotherapy practice from scratch on a shoestring budget. I have also failed a licensed exam by 1 point (only to have the licensing board send me a later months later saying I passed), started an online study group to ease my own isolation and have now reached thousands of therapists across the country, helped other therapists market their psychotherapy practices, and helped awesome business owners move from close to closing their doors, to being profitable in less than 6 weeks. I've failed at launching online programs. I've had wild success at launching online programs. I've made mistakes in private practice I've taught others how to avoid my mistakes. You can do this. You were called to this work. Now- go do it! Find some help or inspiration as you need it- but do the work!