Managing the Anxiety of Private Practice

Close-up Portrait Of A Young Woman Scared ,afraid And Anxious Bi“If you weren’t anxious, I’d say you weren’t paying attention.”

I vividly remember the conversation I had with my supervisor, Rev. Robert L. Powers, at the Adler Institute (now Adler University). It was 1978 and I was considering going into solo private practice for the first time. I was excited but I was also more than a little anxious. I had sought out Rev. Powers for the kind of reassurance he was famous for: Gentle confrontation with hard truths and the support to take them on.

Rev. Powers didn’t give me direct advice. Instead he encouraged me to acknowledge my own strengths, to boldly face my fears and to do the personal work I needed to do to be my best therapist self.

He also challenged me to consider what it meant to shift my working identity from employee to business owner. That included facing my ambivalence about taking money for my work and figuring out how to gain the skill sets I needed to be a business owner as well as a healer.

“Private practice,” he said, “is in many ways more personally risky than agency work. You really are on your own in an office with no one to call if things get out of hand. Graduate school didn’t offer you courses in entrepreneurship or accounting. You are redefining your career and, indeed, yourself.”

Forty years have passed since I had that conversation. I’ve been in part or full time private practice for decades. The reasons to be anxious haven’t changed a bit. But I did take his advice to heart and I did learn a thing or two. Managing our anxiety comes down to building competencies and maintaining good self-care.

8 Anxiety Busters:

1. Acknowledge your strengths: Clients can sense when we aren’t confident in our skills. It makes them anxious. It makes them resistant. It makes them leave. It’s therefore important to regularly remind yourself, without embarrassment, that you do have much to offer those who come to you for help. Yes, you probably have skills you need to learn or improve. But you wouldn’t attempt private work unless you were reasonably confident in your abilities.

 2. Continue to develop your therapy skills: The more competent you feel, the more confident (and relaxed) you will be. Read your journals. Go to classes and workshops. Sign on for an externship in a new technique. Take advantage of webinars. It’s one of the responsibilities of responsible practitioners.

3. Do your own therapeutic work:  If you tend to be anxious or to respond to new challenges with hesitation and fears, do your own work. See a therapist to address your issues and to maintain awareness of what it is like to be on the other side of the couch.

4. Develop a practice of mindfulness. Mindfulness simply means being present in the moment but it isn’t as simple as it sounds. During sessions, being “mindful” requires shutting down the anxious thoughts in your heads so you can truly focus on your client’s presentation and needs. When out of sessions, having a practice of meditation will help you let go of negativity and stress and will free up your creativity. 5.

5. Pay attention to the business end of your business. Very good therapists often fail at private practice because they haven’t had any training in running a business. Having gone into the work as a calling, they are unable to matter-of -factly deal with the exchange of money for their services. Talk with established therapists about what you need to know and how to know it. Read up on good business practices. Take a class or two in entrepreneurship, marketing and bookkeeping. Make clear decisions about what tasks you need to learn to do and if and when you can afford to hire out some tasks like billing or cleaning the office.

6. Don’t let yourself become isolated. It’s a fact. You are only as isolated as you decide to be. Buy regular supervision. Create a peer supervision group of other private practitioners that meets at least every other week. Introduce yourself to the local crisis team. Make lunch dates with other therapists. Network. Network. Network. Connection to other therapists will reduce your anxiety and will eventually become a reliable back-up system when you want to go on vacation or need time off for medical or parental leave.

7. Make good life-style choices: You are more likely to handle stress well if you are healthy. Do take care of yourself. Exercise is a reliable stress-buster. Schedule times to take a walk or go to a gym at least every other day. Make sure you have breaks each day to get a drink of water or meditate or read or just to do nothing. Make sure you get enough sleep at night and that you eat well.

8. Maintain strong, positive personal relationships: In order to be an effective therapist, you have to stop being one for a significant part of every day. Spend time with friends. Give your partner and family members the attention and time they deserve. Regularly have some fun with other people doing whatever gives you joy.

Every profession has its stresses. Being in private practice is no different. We can’t eliminate stress from our lives but we can develop the competence and confidence necessary to handle it. In fact, as therapists, our integrity requires that we do for ourselves the very things we often counsel our anxious clients to do. By taking care of ourselves and developing our skills, we become more relaxed in our work and more helpful to the people who come to us for help.






Managing the Anxiety of Private Practice

Marie Hartwell-Walker, EdD

Marie Hartwell-Walker, Ed.D. is an author, licensed psychologist, and a marriage and family therapist who has been in practice for more than 35 years. She is a regular contributor to Psych Central and one of the therapists who answer questions at Ask the Therapist.


APA Reference
Hartwell-Walker, M. (2016). Managing the Anxiety of Private Practice. Psych Central. Retrieved on November 26, 2020, from


Scientifically Reviewed
Last updated: 18 Jun 2016
Last reviewed: By John M. Grohol, Psy.D. on 18 Jun 2016
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