As I consulted the internet and fellow therapists, I came across a plethora of advice on how to transition into private practice. Start part-time and build a caseload. Join an insurance panel. Find a Facebook group or referral community. I took the road less traveled. While my route into private practice is not a one-size-fits-all approach, I found that it taught me essential lessons in flexibility, faith in the process, and how authentic connections will always serve me well.
As my three-year internship in a college counseling center came to a close in 2019, I saw the opportunity to transition into a different kind of therapy work. I longed for the autonomy and flexibility to focus on my passions outside of therapy (including writing!), while preserving a sense of community and collaboration. Life was telling me to take a chance. Do something brave. Born and raised in Nevada, I started to explore clinical opportunities across the United States. At one point, I interviewed for positions in a variety of cities, including Boston, New York, Seattle, San Diego, and Oakland.
I now realize that during this time period, I was operating out of a sense of scarcity. I come from working class roots. I am the first in my family to obtain a college degree and a graduate degree. I am the primary earner in my relationship and manage my family’s finances. I do not have a financial safety net or deep savings. Because of this, I felt pressure to not only market myself a certain way, but also to submit to work that felt secure, though less fulfilling.
Fast forward to June 2019. I decided to join a small group practice in Oakland, California. My partner and I packed up our apartment and pets to start a new life in the Bay Area. My fear and anxiety felt crippling that summer. I waited for my caseload to fill while my partner struggled to find work. A personal loan offered a temporary reprieve, but every day I wondered if the pieces would fall into place before my loan diminished.
This sense of powerlessness affected my clinical work. I was more available to clients, very willing to accommodate last minute rescheduling, and eager to accept any type of work that came my way. I also experienced power dynamics that made me feel small and dispensable. When I felt uncomfortable with the leadership at the practice, I said nothing. While I valued work with my clients, I also knew I was not being my authentic self.
As a trained behaviorist, I am well aware that ignoring problems rarely works. My discomfort and unhappiness within and around the workplace were inevitably felt by my colleagues. After a few painful and honest conversations, I decided that the group practice was not a long-term fit for me. Again, I toiled with the idea of starting my own practice, aiming to fulfill my desire for autonomy and flexibility. However, what if I failed as a business owner? I felt terrified that my courageous move to the Bay Area would end in disappointment. I was not ready to be a solo provider. As a result, I joined another group practice spearheaded by a clinician who I had consulted with for several months.
I felt incredibly fortunate to join this group clinic. Additionally, the clinic director encouraged me to build up my own practice on the side. Nevertheless, I still felt a sense of failure. I had endured so much uncertainty and change only to wind up at another crossroads. While sitting with my disappointment and grief in December 2019, I created a transition plan to officially start my own practice. I imposed a deadline of March 2020. I slowly chipped away at logistical tasks, including setting up a website (which I found creatively fulfilling), obtaining a business license as a sole proprietor, setting up practice documents such as informed consent, and creating care plans with my current clients. I already had a work phone number and email as well as practice software. It was both invigorating to have freedom to make these decisions and intimidating to assume the role of a solo business owner. I soaked up as much knowledge as I could to inform the practice decisions that I made. I also applied to companies that could supplement my practice with referrals as well as those that provided employee assistance programs. I finally felt ready to launch my new clinical practice.
Then a global pandemic arrived. The first case of community transmission of COVID-19 was in California and suddenly my business worries felt both too big and too small. How could I start my own practice during a pandemic and survive? Would the success of my practice even matter if everything in the country fell apart? My partner was laid off and I sat on my couch, wondering where I would go if I broke my expensive lease in Oakland during a plummeting economic crisis and the spread of a virus that did not care about borders.
I am deeply grateful that I did not need to break that lease. Many Bay Area companies started offering therapy to their employees, which allowed more people to seek help than before. I had open conversations with my clients about their ability to pay, allowing them to stay in therapy at sustainable rates. Former clients contacted me to resume therapy to manage the stress of shelter in place mandates.
In the past six months, I have learned that success in private practice is not about referrals and networking, but about relationships. It is the relationship between a therapist and client that can heal past trauma and improve a client’s current distress. Relationships between therapists help us feel supported and connected. The relationships we invest in make us feel seen, valued, and worthy both personally and professionally.
In pursuit of authentic connection, I joined Heard, a professional community for private practice therapists. With Heard, I met fellow clinicians in my area through therapist happy hours, scheduled video calls, and online business trainings. Additionally, I participated in list-serves, both regional and international, by adding my voice to their conversations. I joined consultation groups and therapist book clubs. I refined my website to reflect my values and style. As I put myself out there in these ways, I discovered unique and exciting referral sources. I created partnerships with mental health organizations. I developed relationships with clients. Authenticity is a core value of mine. I do not enter interactions with a specific agenda in mind. I aim to connect and see what comes next. That motto has served me well as I have moved across states and started my private practice amidst the disruption of a global pandemic.
Looking forward, I dream of turning my solo business into a group practice. I also have a book that will be released at the end of 2020. I intend to blog and use social media to increase my online presence. While I am excited for these future steps, I am also trying to be present in this unique moment and express my gratitude for my ability to live authentically. I have realized that professional fulfillment comes from working with the people that make me feel alive. From that, financial stability can follow. And as always, I aim to nurture my relationships with the clients and fellow therapists in my life. After all, relationships build businesses, but most importantly, build lives.
Founded in 1979, ADAA is an international nonprofit membership organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research.
Rachel Willimott is a licensed clinical social worker in San Francisco, CA. Her clinical approaches include CBT, DBT, and ACT to treat depression, anxiety, panic disorder, trauma, OCD, perfectionism, and relationship issues.