How To Start Your Private Practice
(and avoid burning yourself out in year one)
Every year, a great many therapists and counsellors move directly into seeing clients immediately after qualifying without first constructing a robust container for their client-work, and then find that they struggle to draw good boundaries and create balance for themselves as a result.
This article is a breakdown of some of the important steps you can take before going into private practice to ensure your best chance of success, practice good self-care and ultimately make doing this work a great deal easier. It’s a practical, step-by-step, non-exhaustive guide I call ‘Creating The Container’ that I sometimes provide to graduating students and supervisees in the UK, in order to offer them some kind of framework at a time when the task of ‘starting up’ can seem utterly overwhelming.
Your Ideal Working Hours
Before you begin to advertise for clients, decide for yourself what your absolute ideal is in terms of days you want to work.
By that I don’t mean ‘what hours are practical for me to work?’, I mean what would your choice be, e.g Tues, Weds, Thurs, from 09:30 until 17:30. Decide whether you want to work wholly face-to-face or online or a mix of both, and the maximum hours you want to work a day and a week. Seeing more than 5 clients a day is probably not sustainable for most, so consider this when deciding how many days a week you’ll need to work to make the money you’ll need to make to survive (see ‘decide your rates’).
Now create set ‘time slots’ for your appointments — with sufficient space left between them for notes and resetting the room (15 mins minimum) — and make sure to give yourself an adequate break for lunch every day (at least an hour). Do not make the mistake of scheduling your clients closer together or skipping lunch to make your workday shorter. It will not feel shorter, it will feel exhausting. The goal is to finish your workday, and still feel like a functioning human being with the energy to live a life outside of work.
Regularly schedule downtime, longer holidays (ideally at least one week off every 3 months) and 1 or 2 activities every week that allow you to unplug, ground yourself and spend time with all the people who exist outside of your work container.
Decide Your Rates
Look at what everyone else in your area is charging, and do not undercut them. If you’re newly qualified you need to be charging the standard rate that professionals are in your area, not embodying an idea that you ‘don’t feel you’re worth as much yet’. Undercutting others with an idea that this will attract more clients is a false economy, as you’ll likely be perceived as ‘less than’ rather than ‘low cost’, plus you’ll have to work that much harder to make the money you need.
If you want to offer a concessionary rate or a sliding scale, think about how you’re going to make that decision and to what percentage of your entire client list. Offering a blanket concession to all students or the unwaged, for example, is not practical if 85% of your weekly client hours are students or the unwaged. Many practitioners offer a free initial session, but — again — consider the value of your time, and balance needing to attract potential new clients with the amount of time and energy you can potentially spend being ‘interviewed’ by them.
It’s also worth considering that seeing a potential client without the security of a contract that includes verified identity and emergency contact details (see ‘contracting and insurance’) can create tricky ethical situations you may wish to avoid.
Finding A Face-To-Face Place
If you’re going to be working face-to-face think about where you want to be based, and whether it’s important you can also work flexibly (online) from the same space. If you’re only going to be working one or two days a week face-to-face, taking out a lease on your very own therapy room when you’re just starting up is both impractical and expensive, so consider ad hoc room rental or sharing a lease with a trusted colleague/s.
Some places offer ad hoc rooms on a hourly basis, some rent a block of a half-day or whole day at a time. Some places charge a monthly membership fee on top of room rental, or offer a certain number of hours per month for a set fee. The important thing is to find a comfortable, well-furnished room with good lighting, heating and ventilation, that you feel happy and relaxed in, and ideally has good access for both non-disabled and disabled clients. The walls should be thick enough that you can’t hear noise from the other rooms or hall, and there should be good security system. A good easy-to-use online booking system is a must, as is an idea of how many practitioners are currently using the rooms, particularly if you’re not block-booking and so may be vying for slots.
Start conservatively, i.e don’t block book 2 whole days a week if you don’t have any clients yet. If you can book rooms for an hour at a time as and when you get clients, great, but try and book them alongside eachother rather than one at the start of your morning and one at the end (see ‘your ideal working hours’).
Project forward to a time when all your set ‘slots’ will be filled, and you’ll have the structure you set out to create, rather than thinking ‘I need to accommodate the requests of every client I get’ and so creating something impractical for you to manage.
Working From Your Home
If you’re working face-to-face from home, think very carefully about why. The savings are obvious, but the number of considerations are substantial.
If the room you’re using is a room inside your home, you’ll be losing use of it for your work week, and it’ll have to be stripped of the majority of your (and your family’s) personality to create a fairly neutral space. Then there’s the thorny ethical and safety aspects of allowing a client access to your home, knowledge of your home address and potentially of your family. This can be a minefield when choosing to work with clients who have family or childhood trauma, so this must be considered when making what seems like a purely practical financial decision. There is also the essential need to be able to psychologically separate work-life from home-life, and working from home in this way can make the division very tricky to maintain.
If you have a home office separate from your house, some of these issues feel easier to manage. However it is important to remember that not all clients we see for an initial session are people we ultimately feel safe working with, and occasionally tricky ruptures happen when we’d prefer to be able to maintain distance and privacy. A home office means that our location, and maybe even our family set up, is known from the very first session with an unknown client.
Working Online
Working with clients via platforms such as Zoom or Skype can be a great way to broaden your geographical reach, and lessen the feeling of having to ‘compete’ with everyone local to you for clients. That said, many people move into online practice without considering the legal ramifications of working with clients outside of your own area or country, where you may be subject to the law of that land. Some platforms like ‘BetterHelp’ provide a legal framework that allows for this, but if you’re in private practice, taking clients via directories or a website, you need to consider your legal obligations and the terms of your insurance policy (see ‘contracting and insurance’), as well as your ethical duty to your client and professional body.
Aside from these considerations, you also need to think about what you would do in situations like the following, and what information you might need in order to deal with them if they should arise:
- Your/or your client’s internet connection drops out in the middle of a session
- Your client’s partner is seen or heard in the background of the room
- Your client has their baby or small child with them
- Your own child or partner is home sick with you
- Your client needs to answer the door or the phone during the session
- Your client is unable to join the call because the link you sent didn’t work or their system required an update
- Your client falls ill or is hurt on camera, or clearly indicates to you that they need medical assistance
- Your client tells you they are about to harm themselves or another
- You suspect your client is in imminent danger from another person
It is important to remember that working online with clients requires the same contract (see ‘contracting and insurance’) in terms of timekeeping, cancellation policy and of boundaries around contact. It’s sometimes tempting to allow more flexibility when we’re not renting a room or aren’t losing money directly as the result of that room going unused, but a robust container and clear boundaries are essential to building a strong therapeutic relationship.
Your time is valuable, and a booked session is a commitment on both sides, regardless of the venue.
Contracting & Insurance
Writing a client contract can seem like a daunting business, but the good news is that there are resources available to new practitioners to help them. The BACP Contract Toolkit provides an excellent template, and there are numerous helpful articles written on the subject. Read through any templates, changing details that need to be changed and deleting anything irrelevant, and don’t be afraid to adjust the language so that it feels more reflective of you as an individual.
Make sure you provide your client with a copy of your contract at the earliest opportunity, preferably before your first meeting, to make sure they understand their obligations to you and vice versa. Many practitioners use the initial session to go through the contract, clarify their cancellation policy, payment details and answer any questions. This can feel like a lot of housekeeping though, and — if a client is paying for the initial session — can feel like it leaves them little time to outline their issues, or work out if you’re the therapist for them.
Make sure you ask your client at the initial contract stage for all the information you feel is necessary in the unlikely event that you ever need to break confidentiality, as well as making sure you have clearly defined what the reasons for that might be. An emergency contact number and/or GP details can provide enormous security in the event of a concern, and — if you have requested this — make sure those fields have been fully completed. I personally prefer an electronic copy of clients’ contracts, as secure longterm storage of such sensitive paperwork is vital. It also lessens the likelihood of important information being lost, misread or wrongly transcribed.
There are many insurance companies in the UK that provide comprehensive insurance for therapists and counsellors, and often a recommendation from a colleague or your training college is the best way to go. Generally speaking, your policy should include public liability as well as professional indemnity cover, and will need to be appropriate for your chosen model and for you as a individual practitioner — for example if you offer walk-and-talk or work solely online. This BACP article is a good resource and includes a list of reputable UK insurers.
Your contract should include details of your insurer as well as a clearly detailed complaints procedure. In the UK, you are also legally obligated to register with the ICO and provide a GDPR agreement, detailing how you will securely store and press your clients’ personal information. The BACP’s guidance on how to do that is here.
It should be noted that ‘marketing yourself’ and ‘finding clients’ are not subsections included in this article, which is no oversight. Advertising and marketing yourself as a practitioner is a difficult task when you have no practical structure to accommodate new clients, and all the stages detailed above should be completed (or well underway) before you begin advertising in any of the online directories, or exploring any of the marketing opportunities available.
You will never regret taking the time to construct a container that supports both you and your potential clients. Taking the time to build something that will support you in the future may seem as if it takes energy away from working and earning in the present, but it is time very well spent.
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Law Turley is a BACP Registered Integrative Therapist, Supervisor and Certified Radical Honesty Trainer living and working in the south west of the UK.
