The Challenges of Private Practice Start-Up

Administrivia and office management: When in private practice, you are “it.” There is no one else to fill out insurance forms and keep the books. There is no one else to file what needs to be filed. There is no one else to make sure you have enough tissues and toilet paper or to clean the office and water the plants. It’s all on you. It can be overwhelming.

In the anxiety to fill hours with clients, some beginning clinicians neglect to factor in office time. Paperwork piles up, billing doesn’t get done, and the plants start to wilt. Beginners then compensate by staying late or going in on Sundays – much to the distress of family members who already feel neglected.

It’s important to build in at least an hour at the end of each day to do the work of the day. It’s not the fun part but it is necessary.

Marketing: Related to office management is the necessity for marketing. When setting out on your own, you are competing with other already established therapists. Building and maintaining a referral network and community presence is yet another skill set you’ll need to learn.

The particulars are beyond the scope of this article but if you don’t know how to do it or dislike the commercial aspects of being in business for yourself, do consult with someone who can teach you. Being comfortable with self-promotion isn’t optional if you want to make a living.

Personal loneliness and depletion: At the end of a long day, it’s not at all unusual for therapists to not want to talk to another human being or to hear another human problem. But maintaining your own social and intimate relationships is essential to your mental health. It’s not unusual to think that your social needs have been met by talking all day with other people.  But however interesting and fulfilling talk with clients can be, it’s a one way street of conversation and care.

Be sure to prioritize time for your family and friends every day and social time each week (even if it means putting it in your calendar as an “appointment”).

Professional Loneliness: In a solo office, there is little to no opportunity to get emotional or intellectual support from another professional. There is no supervisor immediately available to provide supervision for a tough case and no colleague immediately available with whom to share our triumphs or our worries. No one is around to share a cup of tea and some sympathy in the lunch room or when there is a no-show.

Lacking the prompting that comes from case sharing and information exchange, you can quickly find yourself falling behind in a rapidly changing field.

The antidote is forming a peer supervision group to meet regularly and buying supervision from a senior clinician. This is not a luxury. Supervision keeps you sharp and provides some protection if a client is litigious.

When You’re the Boss

Success in private practice requires being the boss you most admired or always wished you had. An enlightened boss (you) takes care of her or his staff (also you) by maintaining a sane schedule, taking care of the business end of the business, providing supervision, and ensuring down time away from the practice. It’s a challenge but it’s also the opportunity to do it on your own terms.


The Challenges of Private Practice Start-Up

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). The Challenges of Private Practice Start-Up. Psych Central. Retrieved on April 1, 2020, from


Scientifically Reviewed
Last updated: 20 May 2016
Last reviewed: By John M. Grohol, Psy.D. on 20 May 2016
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