LCSWs, MFTs, Psychologists in Private Practice - how do you do it?

September 23, 2014 4:41 PM

I'm an ASW in San Francisco, planning to have my LCSW by next year. I have many years of mental health experience and my ultimate goal is having my own psychotherapy practice. My mentors who are either LCSW's or MFT's are pretty negative about the state of private practice. Are there any clinicians in the Bay Area or elsewhere with success stories? Any words of advice on where to start? This is unfortunately not something they teach us in grad school. Thanks in advance!
posted by blackcatcuriouser to Work & Money (5 answers total)

I know someone with an LCSW who joined on to an existing multi-person practice, and they work with an Employee Assistance Program (EAP) company, which brings them a steady stream of referrals. (Nothing close to all their patients, but still a good baseline.)
posted by LobsterMitten at 5:45 PM on September 23, 2014

My wife is an LCSW, and she sees 6 to 12 clients a week in LA county (she also has a day job). One way to get new clients is by getting on insurance panels, but I think they generally require a few years of licensure. Do you have any contacts via your current position that would be able to refer to you? As LM says joining an existing practice can get you clients, but expect to pay for that privilege. Otherwise it's all about marketing and networking.

Feel free to memail me and I can pass your follow-ups to my wife.
posted by Horselover Fat at 6:27 PM on September 23, 2014

Best answer: I can't speak for the Bay Area, I'm in Michigan. I left a long career (27 years) as an Executive Director in the non-profit field when we closed our agency. I elected to make a change and take advantage of my L.S.M.W. and establish a practice as a therapist. There were two options, attempt to start my own practice or join an existing clinic as a contractual therapist. I eventually elected to go the latter route for a couple of reasons.

Establishing my own practice meant leasing office space, paying for the infra structure (phones, copy machine, computer, furniture, etc), establishing relationships with insurance companies and EAP's and taking care of my own billing and accounting, these are all HUGE factors and expenses.

It was relatively easy to find a clinic that welcomed me, in fact, within 6 months I was invited to establish offices at two different clinics, each of them offering me office space 5 days per week. The two locations were about 35 miles apart so there was no conflict in terms of client base.

I am, of course, working for a percentage of the payment, in both cases that number is about 50% of whatever is collected from the client and/or insurance company. My calculations suggest that my cost to be working solo would come close to, or exceed, the 50% I give up by working with a clinic.

A huge benefit of this arrangement is that I'm not spending hours negotiating with insurance companies and doing billing. I'm also not playing the collection game with clients, the office takes care of that and keeps me from having to compromise a therapeutic relationship by making collection calls. In addition, I'm not tasked with doing a huge about of marketing and advertising, both clinics were well established and referrals flowed quickly. Because I work in settings with 10 to 12 other therapists, if a client isn't a good fit it's easy to refer to another clinician. I also have a group of peers to consult with, working a solo office can often be a lonely, isolating experience. In my opinion, the benefits far outweigh the costs.

If I were in your position I would begin to do some networking with clinics within the geographic area in which you would like to practice.

Best of luck.. feel free to contact me if you have any other questions...
posted by HuronBob at 4:20 AM on September 24, 2014 [3 favorites]

Best answer: The people I know who are successful and happy in private practice (not in CA) all do at least one of the following:

*have a day job also and see clients in their "free time"
*work at a clinic and see clients in their "free time"
*share an office, working opposite hours from the other clinician, and split rent
*outsource billing to a professional (an added cost which reduces hassle)
*are on insurance panels
*are members of outside supervision groups, which I assume they must arrange on their own

You say your ultimate goal is to have your own practice. What about that arrangement appeals to you, specifically?
posted by epanalepsis at 10:24 AM on September 24, 2014

Best answer: I don't work in private practice - I'm in a clinic - but in grad school a teacher I trusted said a good way to build a practice was to pair with another person who wanted to start a practice and offer 1-3 group therapy options. Have the fee be monthly/per several month group instead of per session to make balancing the books easier. You can make a decent amount (10$ per session/per person is often doable, for example, and in a 6-10 person group that's 60-100$ for an hour, split in two you're still at 30-50$). A couple of people in the group will likely want individual sessions, at which point you can take them on at the higher private rate.
posted by Deoridhe at 12:27 AM on September 26, 2014 [1 favorite]