Starting a Private Practice from Scratch - Checklist and Training Replay
Starting a Private Practice from Scratch
You're needed right now, and the demand is high — but that doesn't mean opening a practice magically leads to a full caseload and a great paycheck. This free training covers the three pillars every sustainable practice is built on: systems, finances, and marketing. Watch it before you make any decisions about platforms, contracts, or fees.
In this training, you'll learn:
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The Systems Pillar: The infrastructure of a sustainable practice Financial systems, your consultation process, a sustainable business plan, a viable marketing system, and self-care systems — the five systems every practice needs before it can grow without burning you out.
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The Financial Pillar: Your fee = cost of business + cost of your life Confidence comes from knowing the math. Your rate covers far more than the hour in the chair — and we'll walk you through exactly what it needs to cover so you set a fee you can say out loud without flinching.
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The Marketing Pillar: Claim your brilliance and find your people Marketing starts with knowing who you are, claiming what makes you brilliant as a clinician, knowing who your ideal clients are, and getting clear on the transformation you want to facilitate. Everything else follows from that.
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Real stories, real starts Real examples from therapists who started their practices the good ways — and the not so good ways — so you can learn from both.
Enter your email to watch. You'll also get access to our free private practice resource library.
"Enormously helpful. I have such a good sense of what I need to do, and where I need to go in the next 6 months."
"I'm not insane for running into the barriers that I've run into, and it speaks to the inkling for mentorship that I was feeling I needed."
"What you said about it was what I needed to hear from coaches in the space. I'm aligned with your business practices, and that is important to me."
Download your fee-setting worksheet to use alongside the video training above.
Find out exactly where your hours and money are going
We reference the Make More Work Less report in the training because the data behind it changes everything. Answer a short series of questions about your practice and get a personalized report showing exactly where you can earn more and work less — without adding clients or working longer hours. There's a version for solo practice and one for group practice owners.
More options than ever — and more ways to get stuck
There has never been more information available about starting a private practice. There have also never been more options, more models, more platforms, and more voices telling you which path to take. For a lot of therapists, that abundance isn't clarifying. It's paralyzing.
The most common thing we hear from therapists who haven't started yet isn't "I don't know how." It's "I don't know which way to go." Contract with a platform or go independent from day one? Take insurance or private pay? Start solo or join a group? Telehealth or in-person? The options have multiplied — and so has the indecision.
We want to name one thing directly: the platforms are designed to look easy. And in some ways they are — they handle credentialing, they send you referrals, they manage billing. For a therapist who has never run a business, that feels like a relief. What they don't make obvious is what you're trading for that ease.
VC-backed therapy platforms — Alma, Headway, Grow Therapy, and similar — typically pay therapists significantly below private pay rates while taking a cut of every session. The referrals feel like security. But over time, they create a dependency on low pay that is genuinely difficult to exit. Your rates are set by the platform. Your clients are technically the platform's clients. Your ability to raise your fee is constrained by your contract. And the contract you signed — often without reading it carefully — contains provisions that give the platform rights over your data, your client relationships, and your income in ways most therapists don't discover until they try to leave.
This isn't an argument that platforms are never the right starting point. For some therapists, in some situations, they serve a real purpose. But the decision should be made with full information — not because the platform made it look easy and everything else looked hard.
Going independent from day one means building your own referral pipeline, setting your own fee, handling your own credentialing if you take insurance, and figuring out the systems and marketing on your own — or with people who know what they're doing. It is more work upfront. It is also what gives you a practice that actually belongs to you.
The three pillars in depth
Systems: the five infrastructures every practice needs
Most therapists think of systems as administrative chores. We think of them as the difference between a practice that sustains you and one that slowly consumes you. There are five systems every private practice needs — and most therapists are missing at least three of them when they launch.
1. Financial systems — not just your fee, but the full infrastructure around money. How you determine your budget and track your expenses. What to charge, when to charge it, when to raise your fees, and how to think about the financial health of your practice as a whole. This is where most therapists are flying blind, and where the consequences of not knowing show up fastest.
2. Your consultation process — therapists also lack systems when it comes to talking with potential and current clients. How do you screen out bad-fit clients before they're on your caseload? How do you say no — clearly, kindly, and without leaving the door open for negotiation you don't want? How do you talk about money without your nervous system hijacking the conversation? How do you set boundaries before a boundary has already been crossed? The consultation call is one of the highest-leverage moments in private practice, and most therapists navigate it without any real system in place.
3. A sustainable business plan — not a lengthy document, but a clear, workable plan that keeps you focused, keeps burnout and frustration at bay, and gives your practice the growth it needs without giving yourself ulcers. A business plan isn't something you write once and put in a drawer. It's a living document that guides your decisions, especially in the moments when you're too close to the work to think clearly about the business.
4. A viable marketing system — the best clinical skills in the world can't help people who never find you. A marketing system isn't a social media strategy or a content calendar. It's a clear, repeatable way of getting in front of the people who need what you offer — consistently, without burning yourself out doing it. Built around who you are, not a template for someone else's practice.
5. Self-care systems — who takes care of the person everyone else comes to? This is the system most therapists think they can skip, and the one that will end a practice faster than any marketing failure or financial mistake. Your self-care systems aren't luxuries you add when you have time. They are the infrastructure that makes everything else sustainable.
Finances: your fee = cost of business + cost of your life
That equation is the entire financial pillar. It sounds simple. Almost no therapist is actually doing this math when they set their fee.
Confidence comes from knowing the numbers — not from feeling ready, not from what your colleagues charge, not from what feels like a "reasonable" place to start. When you know exactly what your practice costs to run and exactly what your life costs to live, you can set a fee with certainty. When you don't, you're guessing — and the guess almost always lands too low.
Your rate covers far more than the hour in the chair. It covers your business expenses (software, liability insurance, office space, continuing education, marketing). It covers the non-billable hours in your week — consultation calls, documentation, phone calls, supervision. It covers self-employment tax, health insurance if you're buying your own, and retirement contributions. It covers sick days and vacations and the weeks when your caseload naturally dips. It covers your student loans and your rent and the life you're trying to build.
When you do that math, the number that comes out is almost always higher than what therapists set when they start. That discomfort is real. So is the alternative: spending years undercharging and trying to recover.
Free training: How to Set Your Fees in Private Practice →
Marketing: who you are, who you serve, what you create
The marketing pillar isn't about tactics. It starts with three questions that most therapists have never sat with long enough to answer specifically.
Who are you? Not your license, your modalities, or your theoretical orientation. What makes you a brilliant clinician, specifically? What do you bring to the room that nobody else brings in quite the same way? What experiences — personal and professional — have shaped how you work? Most therapists minimize this. They hedge. They use language that sounds appropriately humble and clinically neutral and says almost nothing about who they actually are. Claiming your brilliance isn't arrogance. It's what makes the right client recognize you.
Who are your ideal clients? Not a diagnosis. Not a demographic. The person. What is their life like before they find you? What have they already tried? What are they afraid to say in a first session? What would they type into Google at 2am? The more specifically you can answer these questions, the more directly your marketing can speak to them — and the more clearly they can recognize themselves in what you've written.
What transformation do you facilitate? What does your client's life look like differently after working with you? Not in clinical terms. In their terms. The answer to this question is the heart of your marketing message. Everything else — your website copy, your directory listings, your referral conversations — is built around it.
Free training: Marketing for Therapists →
What most therapists get wrong in year one
The biggest mistake isn't the fee, the niche, or the website. It's doing it alone.
Therapists are trained to refer out when something is outside their scope. They are not trained to ask for help building their businesses — and so they don't. They figure it out by trial and error, in isolation, while also trying to serve clients, complete documentation, handle billing, do their own marketing, and navigate every business decision for the first time without real support.
There's also a pattern we see consistently in therapists who struggle in their first year: they minimize. They charge less than the math requires because they're not sure they're worth more. They undersell themselves in referral conversations. They hide behind clinical language on their website instead of writing in the direct, warm voice that actually connects with potential clients. They shrink themselves professionally in ways they would never encourage a client to shrink themselves personally.
This doesn't serve anyone. Not the therapist, whose financial stress will eventually affect their clinical work. And not the clients, who need to find a therapist who can sustain the work of caring for them over time.
The therapists who build thriving practices fastest are the ones who find community early — other practice owners at a similar stage, coaches who have done this before, a structure that gives them accountability and answers when they hit the inevitable walls. Not because they can't figure it out alone, but because the shortcut that community provides is worth more than the months of trial and error it replaces.
The real costs of starting a practice
One of the most under-discussed topics in private practice education is what starting actually costs. The good news: it doesn't have to be expensive. The important thing is knowing what you're getting into before you spend anything.
The essentials you'll need from day one:
- Professional liability insurance — non-negotiable before you see your first client. CPH & Associates and HPSO are commonly recommended. Budget $100-300/year for a solo practice.
- EHR/practice management software — Jane, Sessions.health, and TherapyNotes are solid options. Budget $30-80/month depending on features and caseload size.
- Website — Squarespace runs $16-23/month billed annually. Domain registration is $10-20/year. Business School for Therapists members get a website template included.
- HIPAA-compliant contact forms — any HIPAA-compliant form tool with a Business Associate Agreement in place. Options vary in cost; Google Workspace is one starting point.
- Business bank account — many options with no monthly fee. Non-negotiable for keeping personal and business finances separate.
- Professional phone number — separate from your personal cell. Google Voice or a VOIP service runs $0-15/month.
The costs that depend on your model:
- Office space — if seeing clients in person, subletting by the hour from an established practice is the lowest-risk starting point. A full-time lease is a significant commitment — don't sign one until your practice is generating consistent income.
- Directory listings — some are free (professional association, state licensing board's public directory). Evaluate whether paid directories generate enough referrals to justify the cost in your market.
- Credentialing — if taking insurance, primarily a time cost (3-6 months minimum) rather than a financial one.
- Consultation and supervision — required in many states. Budget varies by your arrangement.
The total monthly overhead for a lean telehealth solo practice starting from scratch can be as low as $200-300/month — far lower than most therapists assume. Know your numbers before you launch, not after.
Business School for Therapists
The training shows you what's possible. Business School gives you the full curriculum, the coaching, the calculators, the website template, and the community to actually build it — at every stage of solo or group practice.
Learn About Business School → Breakthrough Sessions available for personalized 1:1 support