Starting and Succeeding in Private Practice
Actionable steps you can take to help you succeed.
Posted January 23, 2019 | Reviewed by Ekua Hagan
Even though the unemployment rate is the lowest in 50 years, many people are attracted to self-employment.
A particularly intriguing type of self-employment is a private practice. Whether you’re a mental health professional or a doctor, lawyer, architect, etc., many people prefer the autonomy and control of private practice over having to play by the rules and politics inherent in organizations.
But starting and succeeding in private practice can feel daunting. I hope this post will help.
Choosing a niche
Especially when starting out, it's tempting to be a generalist. After all, newbies don’t feel expert at anything. Besides, when struggling, it’s hard to turn away clients even when their problem isn't in your wheelhouse.
But do realize specialization’s many advantages and that if you learn in the time-effective way described below, you can often, in a short time, be good enough to legitimately claim you’re a specialist. No, in the beginning, you won’t be world-class but nor will be your fee.
Specialization allows you to feel real expertise, reducing the Imposter Syndrome that’s pervasive especially among generalists. Also, specializing allows you to market in a targeted way, for example, as in anger management or interracial relationships rather than being a generic counselor. Not only does specialization reduce your marketing costs, but most people would rather consult with someone who specializes in their problem.
Pick a niche that builds on your natural strengths, experiences, and interests, but keep the market in mind. For example, growth niches would seem to be, for example, counseling on marijuana and other substance abuse, LGBT or interracial couples, lawyers specializing in employee claims or in immigration, architects specializing in small-space or mixed-use infill housing, physicians specializing in palliative care or tropical diseases, and career counselors specializing in nonprofit or high-tech employment. My career counseling niche is what I call “brilliant strugglers:” doctors, lawyers, professors, psychotherapists, etc. who, despite high IQ, struggle professionally and often personally.
Learning your specialty
Whether your field requires certification for basic employment, for example, psychotherapist, doctor or lawyer, or it doesn’t, as in the case of consultants and coaches, you can often learn your specialty more efficiently than with courses, let alone certificates or degrees. Those are inefficient because you’re learning masses of material all at once, at a pace ill-suited to yours, and if at a university, it's often taught by academics rather than by master practitioners.
I believe the model I used to become a career counselor is appropriate for many people and in many fields. I started by reading a well-reviewed introductory textbook on career counseling. In the margins, I wrote questions and comments, and in a Word file, recorded nuggets I wouldn’t remember but wanted to. I then attended a conference of career counselors and asked the speakers who seemed to be the most effective career counselors if I could ask them the questions I’d noted in my book’s margins. Then I asked if I could watch them in action (with client permission of course), and later, had them watch me doing volunteer career counseling, asking for honest feedback both from them and the client.
When I felt I was adding sufficient value, I started charging clients but still asked for honest feedback. I continued to read articles that would help me with whatever problem I was struggling with. I usually found those articles simply with a Google search. I soon developed a full practice and have long enjoyed a high client-satisfaction rate and great Yelp reviews.
To pick a helping professional, most people use a personal referral or Yelp reviews. But when starting out, you don’t have those, so begin by creating a simple website that describes what you do and your approach. Then make a list of your friends, family, and colleagues who might hire you or refer people to you. Email them the link to your website and perhaps phone them or even offer to get together.
Now let's assume you have at least a few clients. A week or two after completing your work with a client, call to follow up, saying something like, “You popped into my head and I’m wondering how you’re doing.” Don’t ask for referrals or whether they could use more sessions — that would make transparent that your main interest was not them but getting more clients.
This may be surprising but I have not found writing articles or books, or media appearances to be a good source of clients. Ninety percent of my clients are referred to me by past clients, friends, or colleagues. Five percent are from live speaking engagements — and only another 5 percent are from my 12 books, 3,500 articles, and hundreds of radio and TV appearances.
Converting a prospect into a client
My website requests that prospective clients email me a letter of introduction and what they’re hoping to accomplish in working with me. If I decide to work with one, I send an email such as this:
I'm willing to work with you and likely will be helpful. I have an opening at 10:45 a.m. on Mar 5 and one at 6:30 p.m. on Mar 13. After we set an appointment, I'll email a rather probing questionnaire to complete at home and email me at least two hours before our session. It will be the springboard for that session, which runs about two hours. The fee for the pre-session review of your questionnaire and that two-hour session is $450. Typically, to maximize chances of success, one to three follow-up sessions are advisable. Those are $175 an hour. Do you want one of those slots, and do you want our session to be by phone, Skype video, or in my home-office on the Berkeley-Oakland border?
If a prospective client phones me, I ask them to tell me a little about their situation. I might ask a follow-up question or two. Then, if I decide I want to work with them, I describe how, for example, as in the email above.
Running session 1
The first session is particularly important. You want to be sure the client doesn't leave feeling s/he got too little to justify another session. So, per the above, I recommend having new clients complete a probing new-client questionnaire. That allows you to hit the ground running. Of course, carefully review their questionnaire before the session.
At the session, I pay particular attention to how the client initially comes off: friendly, shy, aggressive, mean? That's likely the impression they would make in a job interview or in other work and personal meetings. If I have any concerns about that, I’ll store it in the back of my mind to bring up at the appropriate time. If it’s an in-person session, I’ll offer coffee, tea, or a soft drink, which affords a little informal chatting time, of course, during which I’m sizing them up — they’re often authentic in that informal setting.
When the session begins, I make clear with my body language that, unlike some counselors that have had many clients, I am not spacing out or distracted; I am fully paying attention to them.
Before launching into the questions I derived from having reviewed their questionnaire, I usually ask them to briefly tell me their life story, focusing on the most important moments. That’s helpful in providing a more organic sense of them than is possible in the questionnaire. Also, it gives them a chance to talk up front, which they usually appreciate.
Then, I'll ask questions in light of their story and questionnaire. I might ask about lessons learned from past travails but usually move quickly to identifying steps forward. I ask lots of questions and, at some point, make a choice as to whether to mainly just be a facilitator of their ideas — being a questioner and sounding board — or whether they’d benefit from my tactfully suggested advice. At the end of the session, we agree on homework that would facilitate maximum progress yet be something they’d actually do rather than procrastinate.
That process results in nearly all my clients getting a lot from session 1 and if they're not one of my "one-session wonders," making an appointment for another session.
I take notes right after each session and review them right before the next session.
Alas, consciously or not, some counselors tend to drag out the process so they can get more money or keep the relationship going. Stay vigilant to getting the work done as efficiently as possible without the client feeling you're pushing them away.
Of course, sexual relations with clients is not only unethical and perhaps illegal, but exposes the practitioner’s career and finances to great risk.
An ethical issue specific to career counselors: I won't write people’s resumes because employers use resumes not just as a recitation of work history but as an index of the candidate's ability to think, organize, and present information clearly. If I write their resume, the employer gets as misleading a sense of the candidate as when a parent writes their child’s college application essay.
A last word
Being in private practice, or any self-employment for that matter, is far from easy. Most people decide to forgo the autonomy in exchange for not having to market, do the IT, accounting, etc. But for the right person, private practice can be the ideal life. It certainly is for me.
I read this aloud on YouTube.