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Lessons Learned From My First Private Practice | TheraNest Blog

Lessons Learned From My First Private Practice

This post has been authored by Elizabeth Shoop, LPC as part of our guest post series. Learn more about Elizabeth at the bottom of this post.

On December 8, 2014, the testing center attendant casually handed me the piece of paper and wished me a nice day before turning to her other tasks.  It was just a regular day for her. For me, it was a landmark moment. I passed the licensure exam, and would soon be fully credentialed to embark on the adventure of opening my own private practice.   This document affirmed that I had what it took in terms of clinical skill and ethical knowledge to serve my clients well. Yet, I stood under the shadow of a looming question; did I have what it would take to run a business? Could I really be a successful entrepreneur?  I had that roller coaster feeling, like when you’re lurching up the track toward the crest of the first hill, without a view of what’s ahead.

A few days later, I literally hung my shingle and my private practice was open for business.  As I embark on year 5 of this wild ride, there are just a few things I know for sure.

1. It’s up to me!

I know for sure that the best part of owning my own private practice is autonomy.  I have the flexibility and freedom to craft my schedule and achieve the elusive goal of work/life balance.  I get to decide how much and when I want to work.  I get to decide how much money I want to make (which is directly proportional to how much I want to work). Tradeoffs abound, but the balance is completely up to me.  

Trial and error has been my greatest teacher.  I’ve learned, usually the hard way, the optimal number of sessions I should have in a day or a week in order to be at my best for my clients, and also for my family when I get home.  Every clinician learns their own unique rhythm and pace. Some of my colleagues like to stack their day full of back-to-back sessions and work fewer days a week, while others schedule 30 minutes in between sessions for progress notes and self-care.  The beautiful thing is, I get to decide!

Autonomy allows for changes and adjustments along the way. You may find a schedule that works for a while, but nothing is ever set in stone.  I’ve learned not to book myself heavily in the days leading up to huge events in my kids’ lives such as performances or competitions. I’m able to be more present and supportive during their crunch time and volunteer my time to the cause as well.  I take one day a week to focus on administrative tasks, which means I don’t see clients on that day. Yet I could change at any point and try out other scheduling options that might work better.

2. Alone, But Not Lonely

I know for sure that working alone doesn’t have to be lonely.  After 12 years of being surrounded by a like-minded team of professionals in a school setting prior to private practice, being a sole proprietor required some adjustment at first.  For the most part, I have come to relish the solitude. However, I would never, ever attempt this endeavor without my professional support network. I joined a peer consultation group even before I rented office space or started marketing.  It was this edifying group of colleagues who assured me I had what it would take to be successful. They were an invaluable resource as I learned to navigate the choppy waters of budgeting, marketing and insurance credentialing.

We all have those “uh-oh” moments in counseling practice when we recognize we may be in a sticky situation that must be handled with care.  In those times, consultation is more than optional support, it is an ethical mandate according to most codes of professional ethics. My peer consultants provide wisdom and ask thoughtful guiding questions that help with ethical decision making, avoiding liability, and serving my clients with the most effective therapeutic approach possible.  Our bi-weekly meetings continue to be a source of mutual support clinically, ethically and as entrepreneurs.

3. Confidence Takes Time

I know for sure that I’m stronger and smarter than I know.  Early in the process, I was plagued with doubts about my ability to run a successful business.  “I’m a counselor, not a numbers person.” My struggles with math have always limited my confidence, especially in the financial realm.  It was this uncertainty that drove my rigorous attention to detail; checking, rechecking and checking again to be sure the books balanced.  And they always have. The sense of pride I feel on payday is exquisite.

In addition to finances, I was also intimidated by the pitfalls and red-tape of health insurance billing.  (Not every private practice owner will choose to go this route. Each person will weigh the pros and cons of participating with third party payers.)  In my case, I’ll be honest, the learning curve on this was intense.  Many times I crumbled in a pile of “what in the world was I thinking?” and “what have I gotten myself into?”  But nevertheless, I persisted. At the end of the day, red tape is a frustrating hassle, not a course-altering crisis.  Learning to navigate systems, regulations, processes, technology, forms, and more forms is challenging, but I put on my proverbial Nikes and just do it, because I like to get paid.  

In a panel discussion about entrepreneurial leadership, one of the panelists was asked what they do all day.  His answer, “I solve problems.” That statement changed my perspective. I recognized that the primary function of an entrepreneur is problem solving.  Aah, the transforming power of cognitive restructuring! When I came to see billing snafus as my job rather than an impediment to my job, they became more tolerable and even a little fun.  Hey, as long as you’re on the phone with your third insurance company representative within an hour explaining your plight one more time, you might as well use some humor and try to brighten their day!

4. Staying Sharp

I know for sure that self-care is essential.  This is a big deal, y’all! Go back and read it again.  Professional burnout, compassion fatigue, and secondary trauma can lead to impaired practice and pose serious ethical risks.

I believe counseling is an art and a craft.  Just like any other artist or craftsman, we must keep our materials and tools in good working order.  And our primary tool is US.  Our work can only be as good as our own state of being.  Don’t get me wrong, there have been days when I wasn’t at the top of my game when the first client of the day arrived.  But those days are my signal, a friendly tap on the shoulder that it’s time for some intentional self-care.

It took a while to get out of the mindset that self-care is a luxury.  Once again, my peer consultation group was a great help with this. They continually affirm that time away from the office and the pressures of day-to-day life is integral to ethical, effective practice.  Whether it’s planning an extended lunch break to walk through the park or arranging a more extended getaway, we must recognize that we are in a profession that requires us to be rested, renewed and refocused on a regular basis.

Continuing education is an aspect of self-care and part of our ethical mandate to stay sharp.  Getting back into the learning seat from time to time has re-energized my practice and fueled innovative thinking.  If you can combine a getaway to a lovely setting along with a seminar, workshop or training program, all the better!  (Which, by the way, is a tax deductible business expense.)

What a wild ride these last four years have been!  A roller coaster is a fitting analogy for solo private practice.  Through the ups, downs, twists and turns, there is exhilaration mixed with trepidation and concern.  Freedom, autonomy, balance, support, persistence, achievement and self-care are all high points on the ride.  When I pull into the station at the end of the day with a sense of pride and accomplishment at a job well done, I’m eager to get right back on and go around again.

Elizabeth Shoop, LPC, has provided counseling services in the beautiful Shenandoah Mountains of Virginia for 20 years.  Sheblends insights and techniques from family systems theory, cognitive behavioral therapy and mindfulness practices to help her clients achieve meaningful and lasting change.  In addition to private practice, Elizabeth offers workshops, seminars and day retreats on mindfulness.  You can find out more on her website at