1. An hour is not just an hour. While you are paid to see patients for 53 minutes, you cannot treat them effectively unless you do individual research on patients’ cases monthly. Take time to go over their notes each month to see if anything jumps out you. Therapists some times cannot see the “big picture” in the one hour session each week. If you come across a presenting problem or something in a patients history that you have not seen before, you will have to spend a couple hours reading and researching new treatment approaches. All of this is part of the “hour” you get paid for in private practice. Some large firms create systems that make this level of care impossible for the caseloads that therapists are given, but in private practice this level of specialized care is what will let you help heal patients, get clients, and thrive

2. Your favorite model or approach cannot treat every patient or every problem. Penicillin is not the “best” medicine because it works for the most people. Antibiotics cannot treat high cholesterol. As a therapist I know that not everyone thinks like me, thank God! There is no one size fits all solution for patients no matter what your supervisor told you in grad school. Be prepared to have to switch gears if a patient hates your approach or it doesn’t fix their issue.

3. Never stop learning. You don’t know what you don’t know. Therapists start to become obsolete once they decide that they have nothing more to learn. Subscribe to academic journals. Buy a pile of used books on Amazon. Spend the 45 minute commute listening to audio books and podcasts. The therapist that has been discovering things that genuinely interest them for 5 years will always have the advantage over the therapist that sits through the Q and As in free CEUs about preventing burnout each week.

4. Pay for CEUs. While it might seem tempting to go to that monthly free CEU lecture, you will be much better off paying for skills and certs that you will actually use. Certifications like EMDR, Brainspotting, or IFS will bring patients in the door to your practice and help you treat them more effectively. An added bonus is that you can deduct CEUs from your LLC and get them out of the way in a single weekend.

5. Start you LLC as an S-Corp. Your LLC will have its own bank account and everything you buy can be tax sheltered. Plane tickets, computers, gas, classes, consultation lunches, everything! This will make you more likely to travel for professional development, grab a consultation lunch with a colleague, and buy expensive the tools and materials that you will need to be the best therapist you can be.

6. When you pick the PO Box or physical location for your business notice how much the occupational tax is for the area. A Business in Birmingham pays 1% of its gross income to the city, while a business 2 minutes away in Homewood pays nothing. Pay consult with an accountant before you start your practice. No one is born knowing these things, and you can’t become an expert in a month with your google-fu.

7. You can only take patients as far as you can take yourself. Never stop working on your own self improvement. Therapists are often in touch with patients pain but not their own. You need to confront the unconscious and disowned parts of your own psyche, not just for yourself, but for your patients.

8. Be prepared to fail. If you lose a patient, try and figure out where you failed to be engaging, insightful, or to make them feel safe. You will never improve unless you are willing to examine where you were not the best you could have been. DO EXIT INTERVIEWS! Even when “everything goes great” there is still room for you to improve.

Bibliography:

Yalom, Irvin D. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. Harper Perennial, 2017.

Kottler, Jeffrey A. On Being a Therapist. Jossey-Bass, 2010.

Norcross, John C., and James D. Guy Jr. Leaving It at the Office: A Guide to Psychotherapist Self-Care. Guilford Press, 2007.

Barnett, Jeffrey E., and Jeffrey Zimmerman. The Ethics of Private Practice: A Practical Guide for Mental Health Clinicians. Oxford University Press, 2019.

Cummings, Nicholos A., and William T. O’Donohue, editors. Practitioner’s Guide to Evidence-Based Psychotherapy. Springer, 2008.

Further Reading:

Goldfried, Marvin R., editor. Handbook of Psychotherapy Integration. Oxford University Press, 2005.

Macran, Sue, and William B. Stiles. “The Significance of the Therapist’s Personal Therapy for Therapists and Clients.” Psychotherapy, vol. 36, no. 3, 1999, pp. 281–284.

Skovholt, Thomas M., and Len Jennings. Master Therapists: Exploring Expertise in Therapy and Counseling. Allyn & Bacon, 2004.

Castonguay, Louis G., and Clara E. Hill, editors. Transformation in Psychotherapy: Corrective Experiences Across Cognitive Behavioral, Humanistic, and Psychodynamic Approaches. American Psychological Association, 2012.

Barkham, Michael, and Gillian E. Hardy. “The Evaluation of Psychological Therapies: Developing a Rigorous Approach.” Clinical Psychology & Psychotherapy, vol. 1, no. 1, 1994, pp. 3–14.

Lazarus, Arnold A. “Multimodal Therapy: Technical Eclecticism with Minimal Integration.” Handbook of Psychotherapy Integration, edited by Marvin R. Goldfried, Oxford University Press, 2005, pp. 231-263.

Leahy, Robert L. “roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges into Opportunities for Change.” Cognitive and Behavioral Practice, vol. 10, no. 2, 2003, pp. 121-127.

Wampold, Bruce E., and Zac E. Imel. The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. Routledge, 2015.