10 Things I Wish I Knew when I Started my Therapy Practice

Jeff Guenther, LPC on Dec 10, 2017

My first attempt at starting a private practice was a complete and utter failure. It was 2005 and I was fresh out of grad school at USC with a masters degree in marriage and family therapy. Right after receiving my diploma, I drove 15 hours up the coast and landed in Portland. One of the appeals of moving to Oregon was that I could jump into private practice relatively easily (California’s rules are a little more rigorous). Also, I had a crush on a classmate named Molly and I figured there would be tons of Molly’s to meet when I arrived in Portland. That part was true. Lots of smart, hip ladies. But my dream of easily launching my practice fresh out of graduate school failed miserably in only three short months. 

I was instantly in over my head. I was completely freaked out internally when I was talking to clients. So much so that I was experiencing a new anxiety symptoms that made me feel like I was peeing my pants when I really wasn’t. My rented part-time office space was decorated by the landlord who purchased mismatched floral furniture from craigslist that made my office look like a joke. The landlord was super nice…. until you got on her bad side and then she would try to sabotage you as a therapist. I still have no idea how I ended up on her bad side. I was able to attract clients, but they were mostly all high needs and some of them would abruptly stop coming. I could go on, but suffice it to say, it was a rough time and I had no idea what I was doing. 

I eventually closed down the practice and worked in community mental health for the next couple years. When I was ready, I tried again, slowly building my caseload and creating the thriving practice I still have today. But if I could give my younger self some advice on how to create a successful therapy business from scratch, I would have the following ten tips to pass down. If I had known these things before my failed first attempt at private practice, I might have been able to make a go of it.

1. Find a good office space with a good landlord

The first thing a new therapist does is usually securing an office space for their practice. When I was first looking for space, I wasn’t thinking about how I might be judged harshly on how my office looked….I was only focused on affordability. But in hindsight, it makes complete and total sense. My clients figured I picked out the bizarre and stinky craigslist furniture. The first impression of me as a professional was that I didn’t take my surroundings seriously. I don’t think a therapist’s office needs to be professionally decorated. But there should be some amount of thought put into how it will look to clients. 

Also, I can say this firsthand since I have been a landlord for literally hundreds of part-time therapists, it’s important that you find a landlord who understands the needs of counselors and either actively helps therapists reach their potential or, at the very least, stays out of the way and doesn’t get enmeshed in your business. When renting part-time office space it is very important to interview other renters at the space. Otherwise, you could be setting yourself up for a very messy situation. 

2. Start with clients that are good matches

I swear this was my intention when I first started my practice. But I was so nervous that I wouldn’t attract any clients that I just said yes to every client that called me. I ended up taking clients that sucked up a lot of energy from me each time we met. I knew they were high needs but I didn’t yet know how to protect myself from burnout. I now only take high needs clients when I have the emotional resilience and time to treat them with my best care. 

3. Charge more

This is embarrassing to admit, but when I started out, I only charged $25. The biggest problem with charging that little was that I didn’t attract clients that valued therapy as much as someone who was willing to pay more. A handful of clients were trying to negotiate me down in price as well. While I was able to meet with clients who really appreciated me making it affordable, it turned out to be a bad idea because it gave my practice a blue light special sort of feeling. As an unlicensed therapist, I eventually found that the sweet spot was charging between $60 and $90. 

4. Have boundaries with your schedule

Similar to accepting any client that called me up, I also let clients choose when they’d like to come in. I didn’t have any other job so I figured my flexibility would make me an appealing option to folks. That turned out to be true, but I ended up working one to four hours six days a week which left me feeling totally out of whack and unable to recharge. I’m now very strict with when I can see clients and clients have responded well by fitting me into their schedule if they feel it’s important to see me.

5. Learn to manage your anxiety

As I mentioned at the top, I was freaking out during sessions. I felt so much anxiety as a therapist that I started getting phantom pee attacks. It literally felt like I was peeing my pants while I was talking to clients. I wasn’t! Thank God!! But I had to look down and check my pants every so often just to make sure nothing was leaking out. It was awful. When I restarted my practice the second time, I was armed with five self-soothing techniques if I felt that level of anxiety again. Luckily, I didn’t have to use them very much and my bizarre phantom pee problem never came back. Phew!

If you are a therapist, listen to the new podcast Say More About That. In this episode Jeff and Rochelle talk about using self disclosure with clients in session. They are on opposite sides of the spectrum when it comes to how much they'll reveal about themselves to clients. They talk about what the client can expect to hear and what's appropriate for the client to ask. Click play below or listen on Apple Podcast.

6. Create a community

Since I was new to town, I knew absolutely nobody. So I had zero community when I started out. And since I was failing miserably at being a therapist I was too ashamed to reach out to the other counselors in the office in fear that they would make fun of me and see I was an obvious imposter. When I decided to go back into practice, I was equipped with an awesome supervisor, a consultation group and tons of therapy friends who would be able to support me through anything I might struggle with. I relied on them big time and that’s what kept me buoyed during the hard parts. 

7. Interview many supervisors

The supervisor I found when I first moved to Portland was a super nice guy and totally smart. But our personalities were not a good match. I didn’t realize that I should find a supervisor who I enjoyed sitting in a room with. It wasn’t until the second go around where I interviewed five supervisors that I was able to find my perfect match. In fact, 10 years later, I still get to see my supervisor for group supervision once a month and I still get a lot out of our relationship. 

8. Don’t take rejection so hard

Not all clients are going to stick around. I knew this would be the case, but I had no idea I would be so horrible at handling it. I had a pretty fragile ego back then and every time a client would no show or drop off the face of the Earth, I would feel devastated and question whether I was good enough to be a counselor. But now if a client turns out to be a bad match, I know that’s all it really is. It’s just a bad match! It doesn’t mean that I am the worst therapist ever and I wasted way too much money on grad school and I should never work in the mental health community and my biggest fear of never amounting to anything is finally realized and I should probably just quit trying to do anything with my life. 

9. Don’t wrap up each session in a bow

Isn’t it the best feeling when a client comes in bummed or confused about something and then at the end of the session they leave with a smile on their face and a spring in their step? When I started out, I figured every session would end like this. I quickly found out that I wasn’t able to do that. I felt like the worst therapist ever if clients left unhappy. It felt like I didn’t do my job. As a more experienced therapist, I now know it’s unrealistic to expect that every client will leave a session feeling fantastic. I also know how valuable it can be if you allow a client to leave on an awkward note. Sometimes the best healing can take place in those situations. 

10. Take out as many experienced therapists to coffee as possible

One of the best ways to naturally market your practice is to take out therapists for coffee and ask them how they got started and if they have any wisdom to pass down. You will learn a ton and if they like you, they may even refer some of their overflow to you. Plus, the clients that they refer to you have a good chance of being a really good match for you. An added bonus is that you’ll grow your supportive community and feel more connected to fellow therapists. 

Want to hear more about my private practice journey and everything I got right (and wrong)? I recently recorded a podcast with Annie Schuesller, a therapist and private practice builder in San Francisco. You can listen to my interview below and subscribe to her podcast if you want to hear more inspiring stories of therapists starting a private practice.

Click play on the podcast to listen to the interview or visit the podcast on iTunes for more wonderful interviews by the amazing Annie.

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Jeff Guenther, LPC, is a therapist in Portland, OR. He has been in private practice since 2005. Jeff is the creator and owner of Portland Therapy Center, a highly ranked therapist directory. Jeff, and his team, have launched a new progressive therapist directory, TherapyDen.

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