The Challenges of Private Practice Start-Up

the challenges of private practice start upSo you’ve decided to go into private practice. There is much to support the decision. Being your own boss promises a flexible schedule, the ability to set some of your own policies and procedures. There is no “productivity” to meet except what you set for yourself. There are no tedious administrative meetings or mandatory, but personally irrelevant, trainings to attend. There are no paperwork requirements that serve an agency but have little to do with you.

Freeing yourself from all of that can feel wonderful indeed. But do be aware: There are definite downsides to going solo as well.

This article is not intended to discourage you. Rather, it is to prepare you for some challenges of private work you may not have fully anticipated. Forewarned is forearmed. You will be more likely to succeed in private work if you anticipate these issues from the start.

Scheduling: The shift from agency work to private work often means adapting to a shift in scheduling. Most private practitioners are available for appointments at least a couple of evenings a week and some Saturdays because those are the hours most convenient for employed clients.

Some clinicians start at 7:00 a.m. or even earlier to accommodate clients who want to schedule their sessions before they go to work. If you want to see families, you have to have appointment slots after school hours.

The other reality for clinicians who are beginning their practice is a spotty calendar. Catering to prospective clients’ schedules is the way to generate at least some income at the start.

That may mean having a 9:00 am and a 2:00 pm appointment on Monday, a couple of evening spots filled on Wednesday, and a Thursday with just one scheduled session at 4:00 pm. It’s how to get started but it’s a challenge to keep moving in and out of therapist mode.

Your schedule will have an impact on your family and social life. Because you are working evenings and Saturdays, your spouse/partner will be doing more household management, monitoring homework, and attending such things as parent-teacher nights when they fall on your work nights.

You’ll miss practices and games and performances unless you plan way ahead. If you are a single parent, you’ll be juggling child care and working during some of the important hours of your kids’ days.

As for your social life: Yes, you may have blocks of time with no client on the schedule. But those breaks will probably not coincide with times your partner, kids or friends are available. Spontaneous meetings with friends after work hours or in the evenings may be rare since you will be working when they are free.

It’s common for new practitioners to get so caught up in responding to the demands of the practice that they put off responding to their own and their family’s needs. Finding a work-life balance is essential if you are to maintain a private practice over time.

Overworking: Every client hour means income. Every blank hour is filled with anxiety. It’s understandable that the beginning private practitioner fills as many hours as possible. Yes, filling up a day or two with nine or ten clients looks great when the rest of the week is sparsely committed, but the toll may not be worth it. It can lead to overwork and self-neglect.

It’s important to remember that to be effective and healthy you do need to eat, to get out of the office for some air, and to generally take care of your own needs.

Vacations and sick time: Taking vacations or cancelling a day because of a cold is complicated. You not only have to think about coverage but you lose the income.

Even the best expert in self-care gets sick now and then. It’s no service to you or your clients to work when you’re sick but you will probably work when you are feeling “iffy.” It’s important to have a system in place for those times when you do need to stay home.

How will you inform clients? Will you be available by phone or online chat? If you are down with a bad case of the flu or have to have surgery, how will you provide coverage for a lengthy time out?

Although it can feel like a financial hit to take a couple of weeks off or to enjoy a long weekend now and then, it’s essential to your own effectiveness to give yourself the rest and relaxation you need.

Put aside a percentage of income every week so your expenses are covered during time off and it won’t be as anxiety provoking. Consider developing relationships with other local private practitioners for an exchange of coverage during vacation times or lengthy illness.

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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