Starting your private practice means you have a wonderful opportunity to take a moment and think about what you really want to create in your business. This intention and effort put forth in the beginning can stave off burn out in the long run. Burn out can happen for many reasons, but commonly I find therapists are building practices that don’t really work for them.
There are many ways “to do” private practice and not all of them include a couch, in an office for a 45 to 50 minute session with an individual or couple. I want to offer some factors for your consideration as you go about creating your ideal private practice – one that keeps you energized and enthusiastic while giving great care and services to your community..
First stop, it is best to know what kind of life you are trying to create by having this private practice. This will often help you discover what would work for you and what wouldn’t. Also, knowing how you like to work clinically has an impact on these factors as well. The goal in the end is to strive for your ideal practice with clinically sound processes.
So let’s take a look at the options. Here are factors to consider when starting out.
Location. When it comes to where you meet with the client you have options beyond the brick and mortar office. I will say that most therapists I encounter work from this type of setting. It is a neutral place for you to be creative and help your clients. Choosing an office is sometimes one of the most exciting parts of opening up your own practice, but others may choose to cut the overhead and work more remotely.
Your office can be wherever your clients are located. For some of you that may mean working in the clients home and for others it may mean working in a designated location such as a park or school setting. We recommend having clear training and supervision on the boundaries of working this way, but for some therapists we have met, this scenario is ideal. You see a client in their environment which can give you an insight you would otherwise never have in an office. There are still costs to other locations such as travel time, gas, and insurance, but for you, the start up cost might be low and the varied settings can be enjoyable.
If you have a home with an office, this might be another options to consider. Therapists that have done this successfully are clear on who they are willing to work with and have a great process to screen clients before they attend their first session. A separate entrance and exit for your clients is ideal as well. Plus you have the added bonus of consulting with your accountant about writing off part of your mortgage as a business expense.
With online/virtual work, your setting is your screen on the interwebs, using a secure platform. This allows both you and the client to meet from where ever. Now it is important to note that there are laws governing how you can do virtual therapy and it varies from state to state. However, the start up cost is pretty low if you start your practice this way. There is additional training in online therapy to help you with best practices and to be sure you understand any legal and ethical issues. Some therapists have said this type of work is difficult for them in being connected with their clients and for others it suits them well.
Length of Sessions. Many of us started our training on the 45 to 50 minute per session model, the “therapeutic hour.” However, with changes in our society the length of a session and type of session is becoming more and more varied (The Double Session in Psychoanalytic Therapy, The Journal of Psychotherapy Practice and Research. Winter 2000; 9(1)18).
Just within the context of your regular sessions, the length can vary. Once I was coaching a person who saw couples and felt that the 50 minutes was just too short and they did better work in a longer session. The person simply needed to give themselves permission to say how best they worked and offer it to the clients. So they lengthened the sessions to 90 minutes. They were happier and they saw better outcomes in their couples.
Others clinicians I have worked with enjoyed working intensely with a couple and then offering a check in, a shorter session in between. Having shorter sessions allowed more time for implementation of what was gained in the couples session. Look at the services you offer and ask yourself if this is your best way of working? What do the clients need? Are their some other session lengths you can offer?
Types of Services. Beyond individual, couple and family sessions, clinicians are starting to offer more intensives. This is where they meet with the clients for longer sessions or more sessions in a shorter amount of time. I have seen this more and more in couples therapy as well. Offering this kind of service all depends on how you work and what is best for the client. It is nice though to offer this if it does work for you. Sometimes clients appreciate digging in more intensely for help.
Retreats are another format that clinicians use to provide education and support to clients and/or the community. These can range from a half day retreat to a weekend or week. This is more of a group format and typically more psycho-educational. This can be a creative avenue for working with others.
Whatever type of service you choose, be clear about your focus. You have to market these services and if you have 50 options, then you create more indecision in a potential client. Explore what is best for you and start there. Keep it simple.
I want to acknowledge, options are more abundant when you run a cash pay practice. If you are under insurance, what you can offer will be limited by your contract. Services you offer should not be contraindicated for the goals of your work with the client. This article is merely to challenge common practices and allow you to start thinking about what is truly best for you and your clients. How do you offer sessions? What variety do have in your practice? Share below!