One of the main things we hear is ‘I’d like to start working in private practice but where do I start? How much would it cost to start up? How do I find clients? What do I need to do?!!!’. A lot of therapists think setting up in private practice means lots of hurdles to jump over and this can put them off… but it really isn’t too hard at all and it also doesn’t need to cost the Earth!
We previously wrote a blog about the essential things to think about and do when setting yourself up as a therapist working in private practice. We thought that a follow up blog would be helpful for practitioners to know what else they need to think about in various scenarios- for both the therapists who only want a few clients on their caseload versus those who might be going into this as their full time job.
Like our previous blog, the information below is written from the viewpoint of a clinical psychologist in private practice but the general advice would still apply to anyone who is hoping to start working for themselves. We frequently get asked ‘I’d love to work for myself but where do I even start?!’. So here are the things that we often get asked and what we think are important to consider, including the things that you might think you need in place but aren’t always totally necessary.
1. How do I find any clients? Do I need to market myself and how do I do this?
One of the first things therapists ask is ‘How do I actually find any clients?’. Marketing yourself is all about letting potential clients know you exist and showing yourself in a way that highlights what you can offer. Marketing however is not necessarily an ‘essential’ as many practitioners get clients contacting them through word of mouth or signposted from other colleagues. However, we reckon it can be really helpful to actively get your name out there, both for your services to be found and to increase client choice when they are seeking a therapist. This can be done via specific marketing websites such as The Counselling Directory and Psychology Today. Advertising on The Counselling Directory costs from £19.50 a month and Psychology Today is £19.95 a month (however they often have ‘6 months for free’ offers). If you are renting a room space from a therapy centre or working within another service as an associate there may also be an option to have your profile on their own website (often for free).
Things like business cards, fancy logos and headed paper are often under the ‘marketing’ category but they have a cost attached and aren’t that necessary (but can give a professional touch if you really wanted to have them!).
Having your name and profile or health insurance websites can be another free option to market yourself to particular health insurance client groups.
2. Should I have a website?
This is something that often puts people off working for themselves. The thought of developing a website can be really overwhelming, out of your skill set, too expensive, too difficult, too time consuming. Firstly, it’s not always necessary to have a website especially if you are advertising yourself on specific marketing websites where you can display your profile and image. Such websites are specifically for marketing and (as outlined above) examples include Psychology Today and The Counselling Directory. You might also work at a therapy centre (such as The Wellbeing Rooms) that has their own website and a space to show your profile and that may be enough to connect you with clients without requiring your own website.
The advantage of having a website of course is increased visibility online and an opportunity for you to present yourself, your skills and experience in a more thorough and personal way to potential clients. A website might therefore be worth it if you are looking to build a large caseload and have more visibility via internet search engines, but if you are just looking for a few clients, you could probably be fine with just being on a few marketing websites as outlined above or by building up connections with a local professional network. Websites also don't need to be an expensive outlay involving a paid website designer, there are plenty of platforms where you can easily make your own website such as Wix and Squarespace etc.
3. Where will I see my clients?
There are various options of where to see clients as outlined in our previous blog here. Some people may see clients online in which case they can see clients cost free and from their own home. Some may see clients in their own home in person. These options can bring both advantages and disadvantages.
Online work may be free but it can often impact the genuine connections of being face to face with a client in a room, in addition to potentially missing nonverbal communication not to mention the risk of computer technical difficulties. We have also noticed that the requests for online work have significantly reduced post pandemic as people crave connection again with people face to face. Seeing clients in person in your own home can also often feel too risky and can have a lack of boundaries which is really important for therapy.
A common option is for practitioners to rent a clinic space to see clients in person or online. This obviously has a room hire cost attached to it but it can be really worth it in order to provide an in person safe, consistent, boundaried and therapeutic space for both clients and therapists. Room costs can vary depending if you just rent a room ad hoc or on a block booking or full time basis. A lot of room rental places such as The Wellbeing Rooms can rent rooms out by the hour and this can be a low cost option if you only have a few clients to see.
4. How do I keep records of my practice?
The beauty of working for yourself is that you can decide what system you want to develop and this can range from being totally FREE to paying a monthly subscription for a fancy practice management package.
There are many all singing all dancing ‘practice management software’ packages out there that promise to do everything like recording client notes, invoicing, diary management, texting, collating client details, storing forms, generating reports etc etc. These can often be great as a one stop shop for all the things you need to do but they obviously come at a price. Examples of such systems are Writeupp, Clinix and Cliniko. These range from around £10 to £30 a month, often depending on what features you require and how many clients you have. Many of these systems have free introductory offers which can help you ‘try before you buy’. Some people love having a system like this to keep everything in one place but they really aren’t that necessary, even if you have a full caseload of clients.
Cheaper (or free!) alternative ways of keeping a record of your appointments include using a good old fashioned paper diary, or an electronic diary on your mobile or laptop. Record keeping can be something as simple as keeping a clear record in your clients file with columns to show if they have attended and if and when they have paid for your service. A simple Excel spreadsheet can also help you keep track of clients, attendance, payments, and anything else you wish to record.
Choosing how to record and store client information can range from free or low cost options such as having paper notes kept in a file or folder, having electronic client notes on a note keeping app, to having typed notes in a practice management software system. The storage of these must be considered too- paper notes should be kept in a locked filing cabinet within a locked building and electronic notes should be password protected and stored in an encrypted cloud system (such as OneDrive, Dropbox etc) or in one of the aforementioned practice management systems. Systems such as OneDrive are basically like a big cloud based electronic locked filing cabinet and range from being FREE to being around a few £ a month if you have lots of information to store.
5. How do I invoice clients?
Invoicing seems to really scare people off! But it doesn’t have to be scary…. Invoicing is simply sending information about the service you’ve provided and the amount of money that’s due for this. Not everyone sends an actual invoice to a client either (they may just take a note of the payment themselves) but it can be a helpful process to get into in order to keep clear records of your practice.
Invoicing can be something as easy as typing a word document outlining information which (at a minimum) would include the clients details, the date, the invoice number, the service provided, the amount owed, and your bank details. As long as you make sure you keep a record of these then it’s essentially a cost free method of invoicing.
Another option is to use accounting software to invoice clients, such as Quickbooks or Xero. These have a cost attached to them (starting from around £8 a month) but many people like these systems so everything is recorded electronically. These systems can also link in with your bank account so it can automatically see if you’re up to date with all your invoiced payments. A system like this can be helpful if you are seeing lots of clients but is probably not necessary if you are only seeing a couple of clients.
Practice management systems (as outlined in Point 4 above) also have options to invoice and many people like this method too as it keeps everything in the one place (again, at a cost though).
6. Do I need a business bank account?
It probably depends on how big or small a practice you have but an official business bank account isn’t necessary. It can be sensible however to keep any business transactions in an account that’s separate to your personal bank account but you could just use a normal everyday current account for this. Many ‘business’ bank accounts charge huge rates for services you may not even need! There are also many great business bank accounts that are free such as Starling, Tide, Monzo etc, a quick Google search will help you find one that suits your needs.
Keeping accurate business transactions however is essential for tax return purposes which bring us to our next point….
7. Do I need to do a tax return?
The simple answer is yes! Tax is one of those certainties in life so yep, remember that a % of whatever you earn will need to be kept by for the taxman.
8. Do I need an accountant?
If you only have a few clients and your tax affairs are straightforward, you can often get by with doing your own tax return (at no cost). However if the thought of doing a tax return scares the living daylights out you or if you have a complicated set up due to other sources of income, it would probably be worth seeking the advice and services of an accountant.
9. Do I need to register with health insurance companies?
No it’s not necessary whatsoever. It’s a personal choice but being registered with some health insurers can often be another source of referrals. Registration with health insurers is free as is ongoing access and use of their client management systems.
10. Do I need a work phone?
This isn’t necessary either and is personal choice. Some people take work calls on their personal mobile (so no extra charge), some add another phone number to their personal mobile, and some buy a completely separate work mobile phone. Adding the numbers 141 before dialling an outgoing call can hide your personal phone number and many use their personal mobiles to make work calls this way. If you only intend on using a work phone as a point of contact for phone calls and texts, SIM only phones can work out to be very cheap on a monthly basis. Some also choose not to use a work phone at all but ask clients to email them as a point of contact.
11. Can I do all this myself or can someone do it for me??
The points above might seem a bit overwhelming or scary to do on your own therefore some practitioners opt to work as an ‘associate’ for a larger private therapy business. There are pros and cons to completely working for yourself or being an associate, so many that we plan on outlining these in more detail in a future blog. Briefly however, the associate model can be helpful as it can be a source of client referrals, it provides a room, does your invoicing and can provide systems for record keeping. What is offered by associate businesses can vary widely and some also provide admin support, supervision and CPD.
It is important to note that due to the provision of these services, associate work usually comes at a significant cost (from anything around 20% to 50% of each session fee, depending on the company and the services provided). Plus you’d still have to manage your own bank account, tax return and so on. Associate practices may also have some practice restrictions and provide you with less autonomy so it’s always worth reading the small print to decide what route is best for you.
What we would say here though is… the ‘do it yourself’ route honestly really isn’t that hard at all! At The Wellbeing Rooms we have shown that many people on the ‘DIY route’ can set up their own business themselves and within a supportive, encouraging and empowering environment and network. We have a space on our website to promote each practitioner for free and we have an established professional network which practitioners can meet like minded professionals and can also get signposted client queries at no extra cost. Not to mention having the choice of 9 beautiful therapy rooms to choose from!
12. Can I, and am I ready to, do all this??
Probably one of the most common things we hear is therapists inner imposter syndrome screaming at them saying things like ‘You need to really know your stuff, what if you don’t have a clue what to say to clients, do you really know how to do therapy, what if you muck it all up?!’. Imposter syndrome is a very common phenomenon amongst many people and therapists are no stranger to this. It’s the feeling that you will be found out at any moment for ‘winging it’, that you don’t really know anything, that you aren’t good enough but it’s just that no one has found out yet. Ironically it tends to affect those with a tendency towards high achievement and high standards, and even those who have been therapists for many many years. A way to help calm your inner imposter is to seek out peer support and a supportive supervisor who can help guide you along the early path of working in private practice. Supervision is usually a mandatory requirement of regulatory bodies and the beauty of private work is that you can choose your own supervisor who can provide a nurturing, supportive and safe space to help you step into this new world of working.
We hope that this blog has been helpful to see that it doesn’t have to be scary when you set up your own business as a therapist. Taking things step by step, getting support and knowing that you don’t need to spend a fortune in set up costs can be really helpful in taking that leap.
If you are on this venture, best of luck and enjoy the journey to a working life worth living!
Jo, Jan & Catherine