The Practice of Therapy

[00:00:00] Gordon Brewer: So, one of the things about going into private practice, I think they're the biggest thing that I see people struggling with initially is their mindset. One of the things that you have to do in order to have a successful career. private practices, you do need to develop a business mindset. This episode is sponsored by TherapyNotes, therapynotes.
com. Be sure and check them out and be sure and use the promo code Gordon, G O R D O N, and you can try them out for two months for free.
A little over 15 years ago, when I started my private practice, I had to learn a lot, and most of it the hard way, and I don't think you need to do the same. Hi, I'm Gordon Brewer, a licensed psychotherapist, and welcome to the Practice of Therapy podcast, part of the Psych Craft Network, a podcast. Join me in this journey of discovery as we have conversations with other leaders and professionals in both the mental and allied health fields.
Join us as we explore both the business and clinical sides of running a private practice.
Well, hello folks, this is Gordon Brewer and this is episode number 360 of the practice of therapy podcast. Hope you're having a good holiday season as this episode is coming out And hope you're looking forward to the new year. I know for me. This is a special time of year Although I recognize too and this is some somewhat true for myself that The holidays might not always be so happy for folks.
I mean, for those of us that have experienced losses in different ways, the holidays can be a little bit trying, a little bit hard. And also just the added stress of, you know, just wanting to shop and give and Do all the things that people traditionally do around the holidays. It's, it's an interesting time of year, so I don't want to digress too much, but anyway, hope you're having a good holiday season and you're spending it with the people that matter most to you in life.
That's, that's my plan anyway. So in this episode, I'm just doing a solo episode and just wanted to talk with you about some of the challenges of running a private practice. You know, I've been in private practice since probably about 2006, started out as a solo practitioner. practitioner and started a group practice in 2014.
And so here it is 2020, almost 2025, 2024, and been a lot of changes along the way and the way that we run our practices and the things we do in, in private practice. But anyway, I want, I want to talk with you about that and hopefully it'll, you'll find it interesting and be some good information for you.
But before we get to that, one of the things to maybe think about is we're coming up on a new year. I always think about New Year's resolutions and setting goals and, and that sort of thing. And one tool that I have used consistently over the last several years is the Full Focus Planner. It's a, it's a paper planner that is produced by Michael Hyatt and Company.
And I absolutely love it. It's got So many details to it, and now is a good time to think about ordering it, and you can get a discount if you order now during, you know, during the end of the year. If you'll go over to practiceotherapy. com slash full focus planner, you can check it out. And that's, I will be transparent there, that is an affiliate page, but I've put a lot of information there about my use of the planner and also just.
Why I like it so much. So be sure and check it out. Practiceoftherapy. com slash full focus planner. And you'll get to that landing page. And also before we get to my thoughts on the challenges of running a private practice, I'd love for you to also check out my friend Ashley's online store, mental health, where.
tn. com and you've heard me talk about that before if you've been listening and depending on when you you're listening to this particular Episode there are some holiday discounts available. So be sure and check it out mental health where tn. com And there's all kinds of swag related to mental wellness also recovery And addiction, addiction recovery and also a lot of T shirts and sweatshirts and things for mental health providers.
And also real quickly before we get to my thoughts on the challenges of running a private practice, love for you to hear from one of the members of the Psychcraft network, along with our sponsor of the podcast, Therapy Notes.
[00:05:16] Dawn Gabriel: Hi, Don Gabriel here. If you don't know me yet, I'm the person behind soul care for therapists podcast, which is part of the site craft network of podcast.
The site craft network is a collaboration of independent podcasters focused on helping people live more meaningful and productive lives. This network of podcasts provides both self help and business building resources to create an impact in the world and change people's lives. I'm so proud to be a part of this network.
And if you haven't discovered soul care for therapists podcast, you can find us wherever you listen to your podcasts. I'd love for you to join me as we explore the layered inner world that comes with being a therapist and entrepreneur and just plain human. I invite you to intentionally tune in holistically to your body, mind, and spirit in order to build a sustainable business and fulfilling lifestyle.
We dive in to what it looks like to grow your business. We also look at how soul care Authentic community and spiritual practices can help you prevent burnout and live a life you love. Join me as we allow the sacred to intersect with our work.
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[00:07:40] Gordon Brewer: You know, as I mentioned in the introduction there, I've been in private practice now for nearly 20 years or more. I started my, my private practice in around 2006, and when I started my private practice, I really started into it part time. I was working for an agency at the time, an agency that did intensive in home counseling or in home therapy with at risk children and youth.
It was, at that time, we were using a method or a, called multisystemic therapy. Some of you might be familiar with that. And it was a non profit and I kind of started there right after graduate school and kind of worked my way up there. The ranks there was a supervisor and then later a clinical consultant for that organization.
But it really prepared me clinically for a lot of different situations, even though we worked with children and youth, I also worked with families and a lot of times with parents and that sort of thing. So. A lot of great clinical experience I gained from that, from working at the non profit, but one of the things about private practice, and I think this is probably true for those of you listening to this, whether you're already in private practice or you're thinking of starting a private practice, is the, the attraction of private practice is the autonomy that you can get by working for yourself.
And I know that was true for me when I started my private practice. I, when I, when I moved full force or moved full time into private practice, which was around 2010, there were a lot of life changes going on for me then. I'd worked for the agency for nine years and pretty, pretty long time for, I think for some folks working for agencies, it's very tough and demanding work, but I was really ready to kind of get that autonomy and move into private practice, which is why.
Why, why I did it. And of course, back then around 2010 or so, there weren't as many resources as there are today around starting a private practice or running a private practice. There was a lot of stuff I had to figure out on my own. I remember contacting a person here in my town that I knew was in private practice, and he really, he, he really.
Let me know that, okay, there's some things you need to know about private practice, particularly if you're going to be insurance based and it might not be as easy as you think. In fact, when I started the practice of therapy, this podcast, which originally was a blog, I remember making a post about something and There was a comment one time that's, that said, Oh, you can't make any money in private practice.
Of course that years ago, and that was not good information to somebody responded with because you can make money in private practice and you can have a very lucrative career. But being, being aware of the challenges I think is, is important. You know, it's interesting because yesterday, the day before this, that I'm recording this, I had my mastermind group or my practice, the Practice of Therapy Collaborative, which is, is a community, a membership community that I run for mental health providers and those, particularly people that are getting started in private practice or are really looking at How to scale their private practices.
It's a great group of people that we meet once a week online. You can check that out by going to the website and there'll be links here in the, in the show notes about that. But anyway, one, one of the people I asked, and they're in the process of just Getting started in private practice, they asked a very good question.
Why go into private practice? This particular person is still working for an agency and there's a lot of security with that, but they just don't feel like they're making the kind of money they want to make in, in that position. So One of the things about going into private practice, I think they're the biggest thing that I see people struggling with initially is their mindset.
One of the things that you have to do in order to have a successful Private practices, you do need to develop a business mindset. In other words, you need to be thinking about things like, what is your return on your investment? What do you need to invest in both with your time and your money in order to make your practice successful?
Also, just depending on how you set up your practice is going to determine, you know, as much as anything, Your success. So one of the things I would say to do and people hear this from me all the time is really explore and understand and have clarity around what is your why for going into private practice.
And I think for the majority of people, really, it is two things. One is giving yourself the autonomy and the ability to be your own boss, so to speak. And the second is, is that there's potential for Grady for earning more in private practice than you would working for someone. Now, that being said also, There's a lot of opportunity to make, uh, uh, a decent living actually working for someone that owns a private practice.
I know most of the people I've hired in my private practice are people that are not really interested in running a private practice, but they enjoy working in this atmosphere and in an atmosphere where you have a lot more autonomy and are not really, um, Faced with the demands of the bureaucracy of an agency, that sort of thing.
And so that's a, that's a big positive for going into private practice, but as much as anything, I think being able to develop a business mindset and really think about your practice as a business, because it is, and you have to make a profit. You have to make some money over and above what you pay yourself in order for it to survive And especially so, that's true if you start bringing on other clinicians and start a group practice.
One of the challenges in private practice, particularly for solo practitioners, is that there is somewhat of a ceiling to what you can earn just in a traditional private practice. Solo private practice in other words where you're Sitting in front of people and you're seeing people one on one Or in couples or in groups and that sort of thing There's a a limit to the number of people you can see and so in that sense It kind of limits, uh, your earning potential because if you reach that ceiling, in other words, you max out on the number of clients that you can see in a week or in a month, and all of your time is spent in working with clients, there's some limits to that, of course.
But the other, the other thing about it is, is that And when you reach that point, that really sets you up well to really kind of take it to the next level. And when I think of taking a practice to the next level, I think about going from kind of the one to one mindset to the one to many mindset. So in other words, the time that you spend in working with people, the more people that you can work with and.
In a particular time frame the better it is so doing things like maybe starting groups or being able to maybe create some courses or some webinars or similar seminars or workshops and that sort of thing. are things that you can monetize in order to bring in additional income but not having to put a lot of a lot of one on one time in with individuals.
So in other words it's going from the one to one to the one to many as I like to call it. Also when you are full in your practice it's also a great opportunity to maybe think about bringing on are partnering with other clinicians because when you do that, you, there's no such thing as true passive income, but you can begin to, uh, create some passive income for yourself.
In other words, you reap the benefit of other people's work, uh, which is, uh, Really what happens in group practice as much as anything, pertent, depending on how you set that up. There's a blog that I did several years ago, just on business models of private practice. And it's still one of the most downloaded or visited places on my website.
I probably need to go in there and update it. There are a lot of different ways you can go from solo practice into group practice. One simple way is just to form some co ops with people where you share, share expenses, maybe share an office, that sort of thing. Another one would be to, would be to hire somebody as a contractor.
Although, uh, Again, thinking of challenges within private practice, the ability to hire someone as a contractor is getting a little more difficult. I think depending on where you live and particularly what state you're in and the employment laws, hiring, hiring, uh, contractors in your practice is getting a little more challenging because they really kind of see.
If they are working under your name and doing things the way that you want them to do it, then they are really more acting like an employee than a contractor. So that's something that a lot of people are running into. And so I would say if you're thinking of starting a group practice, you probably want to think about just going ahead and hiring someone as an employee rather than a contractor.
Not to get on too much of a tangent, but I know one of the things. That I learned kind of the hard way was when I switched from hiring people as contractors to hiring them as employees, I actually became much more profitable. And part of the reason for that mistake I made is that I was paying the contractors too much.
And so I wasn't able to keep up with my overhead or the cost of running a practice plus making a enough of a profit to keep the practice going without it being. Being supplemented by me. So anyway, that's, that's one of the, one of the challenges in running a private practice, I mentioned already in solo practice, your earning potential can be limited to some degree if you're just strictly a solo practitioner without bringing on other people to start doing some of the work, the other, the other thing too, is in just thinking about bringing on other people, one of the One of the things that in doing consulting with people that people sometimes struggle with is, is that they are feeling overwhelmed or even burnt out, particularly as a solo practitioner, when they get full.
And the main reason that that happens is that they are trying to still do it all themself rather than outsourcing things. One of the first places that I think a person can, can outsource is hiring a virtual assistant. My friend Uriah Guilford's got a lot of great information about that over at his website, The Productive Practice.
And he talks about that a lot and he's got some checklists and that sort of things. We'll have some links here in my, in the show notes and stuff for Uriah's website, but he's got some great free resources that you can tap into about being doing a better job with your intakes and, and also just what it means to hire a virtual assistant.
So you can check that out. But anyway, one of the things to remember and just running a practice is that your time is valuable and any time that you are spending time doing administrative stuff, Even though that contributes in an indirect way to your income, if you're spending more time on administrative things like calling people back or doing billing and all of those kinds of things, that doesn't bring you any income.
That's just time that you're having to put in into those things. So I would encourage you to think about outs, begin to think about how you can outsource those different, different things along the way. You know, one of the things I mentioned as I started this particular episode is when I first went into private practice, there were just not a lot of resources for people in private practice.
And so much has changed since then. I really, The, the cup is pretty full with resources for helping you run your private practice. There is just really kind of a, an explosion that I've seen over the last four or five years of people getting into doing not only private practice consulting, but tons of resources that are out there from electronic health record systems to now AI and note writing.
And note session, note taking, and that kind of thing is just exploded over the last several years. And I think that's going to continue. And I think sometimes we can get kind of lost in the weeds or lost in the, lost in the shuffle of trying to figure out which, which of these platforms, which of these services are going to be best for our practice.
And because there's so many to choose from, and I would say, The most important thing is to, you know, talk with colleagues, talk with other people within the business about how they're running their practice, and then figure out which ones are going to benefit you the most on the ones that you want to want to use.
You know, one of, one of the things I'll tell a little story here, one of the, one of the new things that is becoming pretty popular within private practice is the use of CRMs, which are customer, CRMs or customer rr Retention management or customer management systems. One of the things I, I had signed up for one and it, you know, is a very robust platform that we were trying to use.
And one of the things I realized when we tried to implement that sort of thing, we were really kind of. creating some redundancy for ourselves because we already had some pretty good systems in place. Now, I will say, if you're a completely private pay in your practice, I think a good CRM would be a benefit for your practice.
But in my practice, we had an insurance, we're an insurance based practice. So the, the way in which we, Collect and the way in which we do our billing and that sort of thing. The CRM was kind of already built in through our electronic health record system, which is therapy nodes. And so it was doing a lot of the stuff that we didn't necessarily need a CRM for.
So. Things like that can be overwhelming to think about. Should I get this or should I get that? Which, which software should I use? Should I use Google workspace or not? Should I use an electronic health record system like therapy notes? Should I use a CRM customer retention management? All of those kinds of things are things that you just might have to try.
And the, the other thing I would say about one of the challenges of private practice is is that the things are constantly changing. And the way that you run your business now isn't going to be the way that you run it five, ten years from now. I know that's very true for my practice. So I think being able to talk to others.
Learn from others in terms of how do they have their systems and processes set up, how do they run their practice on the business side of things. It is an important, important piece to kind of keep your pulse on along the way because As I've already said, things are constantly changing and there's constantly new products and services that are coming out.
And the truth of the matter is, probably all of them work well if you learn how to operate them or learn how to use them. And I would say, find what is a good fit for you and just go with that. And try it out. And like I said, if it doesn't work well, you can always change it later. And I think one of the, one of the things that I too, I hear from, um, people when I'm doing consulting with them is that they're looking for the, uh, the correct way to do something or the right way to do that, something, or the best way to do something.
And that is so individual And so very, so many variations of the way that you can do things that there's no one size that fits all with any of the things that are available for people. And one of the things I'll say just to kind of wrap things up here is that The biggest, I think one of the biggest challenges for people that go into private practice is that it can be a lonely place.
You know, when you're working for an agency, you've got folks that you can bounce ideas off of, you've got people that you have to report to, you have to be accountable to, and that sort of thing. In private practice, it's not always that way. And so I've heard from numerous people that having a private practice can be lonely.
And so it is so important to develop a network or community of people that you can trust and people that you can rely on for mentorship and support during the hard times. If you've been listening to my podcast or this podcast for a while, one of the things you'll know is, is that that I'm part of a mastermind group with my good friend, Whitney Owens and Uriah Guilford and also Jessica Tapana.
And we meet pretty much weekly. And I think having that group of colleagues and good friends just to bounce ideas off of. Of and share things even down to sharing your numbers and sharing some of the struggles that you have Is just invaluable and so don't try to do too much on your own So I'd encourage you to find some mastermind groups to join as I mentioned earlier I've got my my membership community the practice collaborative love to tell you more about that.
You can go over to practice of therapy Therapy. com Slash practice collaborative and, um, learn more about that. Um, I'll be opening the doors for that here at the beginning of the, of the year to see if there's, you know, people that would be interested in joining in that community. So anyway, fine, fine. It doesn't necessarily have to be mine, but fine.
Some group, group of network of other colleagues, whether it's locally within your own community. Uh, geographic area or online, I think is such an important piece in helping you grow and being able to think outside the box and think about the, the challenges that you might have in running a private practice.
And so lots of, lots of stuff to think about. To take in and just thinking about running a private practice, but to kind of recap, I think one of the things to think about, and I think this is something you can always go back to and ground yourself in, is what is your why for going into private practice?
And it might not be a, you know, it's probably not a single why. They're probably Multiple aspects to that. So for example, wanting to help more people, a passion for helping a certain niche, all of those sorts of things could be part of your why. Certainly the independence of running a practice on your own is part of people's why of having a practice that you're the boss, you're the one that is in control of things.
And that's a, that's a big, big thing. Um, really also in the challenges of running your private practices, make sure that you're developing the right mindset. I think, um, as I mentioned, I think a lot of times people, um, can develop a scarcity mindset. In other words, they're afraid to invest in their practice either through getting mentorship or getting different products and services to help you run your practice more efficiently.
I think that's an important piece. And also not trying to bootstrap or do too much on your own for too long. I think in those initial stages of starting a practice, that's important. But as you grow and, and if you're gonna grow, you've got to outsource, you've got to depend on other people to start taking on some of the tasks that are needed in running the practice.
And then also, as you think about scaling, if you want to begin to hire people for your practice, being sure that you hire the right people, getting people that share your same values, people that share your same work ethic, all of those kinds of things are in important piece and just running, running a practice.
And also don't let yourself get stuck in the weeds around just all the different products and services that are now available to us as private, private practice owners from the electronic health record systems to CMRs to AI. AI driven software that helps us with our process, progress notes, and that sort of thing.
Don't get yourself bogged down with all of that and also find someone. I didn't mention this already, but make sure you find some good people. Whether it's your CPA or somebody that has experienced in the financial side of running things to get some guidance from. So many times people heard stories of people getting themselves into some tax trouble by not understanding the financial side of things.
So get some good people to help with that. My good friend, Julie Harris is a good expert with Green Oak Accounting. They are a great experts in the whole financial side of running, running your practice. So quick, quick shout out to her and her team with, with all of that. So hopefully this has been a helpful episode for you.
I have just some things to think about. You know, as we move into a new, starting a new year, spend some time thinking about how you want to run your practice, why you're running your practice the way you are. And also what are the challenges that you want to overcome in your practice or challenges you want to tackle as you move forward.
Well, folks, I hope this has been a helpful episode for you. I know for some people, this is just kind of a review of some things. But, you know, as we, as we transition into a new year and transition into, Uh, new, new seasons of things, I think it's always good to kind of revisit some of the basics and just thinking about running a practice and, and thinking about why you're doing what you're doing.
What we do in, as mental health providers is tough work and we see a lot of heartache and a lot of struggles for people and I'm grateful to you for having the passion to do what we do. Whether it's in the mental health field or all any other sort of Allied health field which most of the listeners of this podcast are in that that category Kudos to you for doing the things that you are doing So keep up the good work and keep it up and hope that you have a great new year do reach out to me with your comments and your thoughts and also if i'd love to hear from folks if you have A story to tell or something you want to share about Running a private practice.
I'd love for you to apply to be a guest on the show I'm always looking for good people to come on the show and share their knowledge and share their Story and their expertise around this whole running a private practice. So Be sure to go over to PracticeTheTherapy. com to apply. And one other thing I want to kind of leave you with before we close out here is, a lot of us have experienced a lot of change and struggles.
Just in life in general, you know, for me here in the Southeast, here at the, in the Appalachian region, just down the road from me here, Asheville, North Carolina, and just even here in East Tennessee, there are a lot of people that were affected by Hurricane Helene, and they're still struggling to get through that.
So, I want you to be aware of that, that people, People, we don't really know people's backstories well, and one of the things that's been disturbing to me just over the last several weeks is just, particularly on social media, just a lot of judgmentalness and just a lot of chatter around people being accused of this or that, being accused of being racist or anti anti semitism or anti Palestinian or whatever.
Our, you know, just the whole political climate and the polarization that's going on. Folks, we can do better. We can, we in our professions know how to dialogue and we know how to have conversations. And so I would just encourage you to be kind. not to be judgmental. You know, one of my favorite series that I've, I've watched three times now is Ted Lasso.
And there's a great scene in there where he's being, Ted Lasso is being confronted by this guy that's a little bit of a misogynistic kind of guy. Bigot bigoted kind of guy and he's being judged about something and kind of I'm paraphrasing the quote here is Ted lasso kind of confronts him with that and says Don't judge be curious Because I think one of the things that we can do very quickly is we can assume Things about people that might not be true or we can Uh, project our own stuff on to others.
So just be aware of that and be aware of your language and your tenor with things. Yeah. So I'll just leave that with you, particularly here at the, at the holiday season. You know, I think one of the things that I think we can all do better at is just being kinder and more compassionate with people. And I'm not saying everyone, Is that it is not, but just be, just be aware of how important your words are and what that, how that can affect people.
So I just wanna leave you with that. So be sure and take a look at our sponsor of the podcast Therapy Notes. You can find them by going to practice of therapy.com/therapy notes, and you can try them out for two months for free by using the. Promo code, just Gordon, G O R D O N. They're who I use in my practice and absolutely love that platform.
And so I invite you to go over and check it out. And also be sure and check out the Full Focus Planner. You can get to it by going to practiceoftherapy. com slash Full Focus Planner. And, um, See how great of a tool that is. I really love mine. It's a paper based planner and you know, sometimes old school is good.
So I'm, I'm dating myself, but anyway, I do love using the planner and I find it just a really useful tool and helping me stay more organized. So take care folks. Looking forward to being with you in future episodes here. And stay warm if you're in the colder weather and hope you have a great holiday season ahead.
You've been listening to the Practice of Therapy podcast with Gordon Brewer. Part of the site craft network of podcasts, you can find out more about the other great podcasts in the network by visiting site craft network. com. And if you haven't done so already, please visit us at practice of therapy. com and get your free private practice startup guide along with a lot of other great resources and webinars and free things.
Just visit us. Also, be sure to follow us wherever you might be listening to your podcasts. This podcast is intended to be educational in purpose, and is not intended to give legal, accounting, or counseling advice. If you need a professional, find the right person for that.