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Spring 2024 Issue

Private Practice: The Business of Private Practice
By Sue Coyle, MSW
Social Work Today
Vol. 24 No. 2 P. 10

Starting a private practice requires more than clinical knowledge and experience. Social workers must consider the business aspects, too.

Opening a private practice is a long-term goal, if not a dream, for many clinical social workers. It certainly was for Kimberly Bonds Grocher, PhD, MA, LCSW, ACC, RYT, founder and CEO of Life by Design Psychotherapy PLLC, a clinical assistant professor of social work in psychiatry at Weill-Cornell Medical College, New York Presbyterian Hospital, and senior lecturer in social work at the Columbia University School of Social Work.

“I knew I wanted my own practice from the time I was in middle school,” she says, adding with a laugh, “I used to watch a lot of Frasier with my mom.

“Going through school and growing up, it was just a matter of how to make it come to pass.”

Attaining that goal—which Grocher has done—meant not only acquiring the clinical knowledge and experience needed to provide therapy but also coming to understand what running a private practice requires from a business perspective. That wasn’t something that was readily offered through her education. “I did my bachelor’s in psychology. There wasn’t anything,” Grocher says of courses on starting a private practice or business courses in general in the department. “There wasn’t anything at the master’s level either. The closest I got was taking electives that were macro courses. I wasn’t even thinking that I needed business classes at that point.”

When Grocher did take the leap, she started out with what she describes as a very basic practice. In the years since, she’s learned through mentors, resources, and her own experiences how to build her practice into the business she wants.

All social workers seeking to open a private practice must do the same and, if they plan to be successful, come to understand that they won’t just be providing therapy but running a business.

Big Picture
One of the first steps in starting a private practice is forming an understanding of the big picture—what do the practitioners want their practices to be in the long run? This enables social workers to put into place a foundation that they can build upon as their businesses grow or even as they remain purposefully small. For Marjorie (Margie) Thomson, LCSW, owner of Koru Counseling, and CEO of Affirming Consultants and Coaches, LLC, both based in Juneau, Alaska, that meant “deciding if it would be a sole practitioner model or an LLC practice,” for example.

“I found a colleague in my town who was willing to help me to map out my big picture practice, my ideal client, [and] my legal obligations,” she says. “[He] asked me thought-provoking questions. He essentially mentored me for free because he wanted me to be successful and our town needs more practitioners.”

The big picture includes who social workers want to serve and how they want to serve them in terms of population, location, type of therapy, and method of delivery. Online and in-person therapy are both valid options today. But it also includes details such as the type of business they will have and what is required for those businesses. As Thomson points out, a social worker may start a sole proprietorship practice, in which the government views the individual and the business as one entity, or an LLC, in which the business is viewed as an independent entity. In some states, LLCs are not options for licensed practitioners. In those states, social workers may form a PLLC, which is for licensed professionals only.

Decisions such as this allow social workers to determine the next steps and research requirements, such as whether a separate tax ID will be needed. Sole proprietorships and LLCs without employees do not necessarily need an employee identification number, for instance.

The big picture planning may start as a conversation or brainstorming about goals and future steps but should eventually take the form of a formal business plan. Lynn Grodzki, LCSW, MCC, offers business coaching to small business owners, specializing in those who are change agents. Author of Building Your Ideal Private Practice, she says one of the biggest mistakes practitioners can make when opening their private practices is “lack of any business or marketing plan.”

Marketing is another key component of launching a successful private practice. It may seem like one of the items on the to-do list that can be considered later, but in fact it’s vital and must take priority from the start. Social workers who start a practice without understanding the concept begin by “not knowing how to build a community around the business and generate referrals and connections for other opportunities,” Grodzki says.

A marketing plan for a private practice will help social workers identify ways to reach their target audiences—the client populations they wish to serve—develop an online presence and utilize community resources and networking opportunities to grow their businesses and reputations.

Even if practitioners hope to rely heavily on word-of-mouth referrals, they need to attract their first clients. What’s more, they need to have a professional community and online presence when future clients follow up on referrals from friends.

Solid marketing can also help practitioners achieve their long-term goals. For example, Grocher knew marketing would play an important part in her being able to have a practice that served clients in both New York and Florida. For that reason, she sought a marketing course from therapists she knew who were launching a coaching program, preparing her to take the marketing steps necessary to have a business that served multiple locations.

Utilizing the Right Resources
Moving from planning to action requires still more decision-making. Practitioners need to determine, for example, how they’ll keep notes and other documentation; how they’ll pay themselves; how they’ll take payment; whether they’ll utilize a business coach, an accountant, or other professionals; and much, much more.

It can be overwhelming and often costly to get going. “Most small businesses expect to invest around $10,000 in a start-up,” Grodzki explains, “but psychotherapists usually don’t plan for any business investment expenses. It’s important to have an idea and a budget to be able to build the practice in a careful way to generate return on the investments you make.”

To decide how and where to invest money, Grocher recommends thinking about immediate needs, advising social workers to visualize themselves in their practices and working to identify the priorities. “I’m in this office and on the screen, what are the two things that make me the most anxious? Making sure I get clients and having a way to pay myself,” she says of her own top concerns when starting. For this reason, Grocher focused on marketing, as mentioned previously, and on having the tools she needed to facilitate tracking her finances and providing herself with an income.

Once social workers decide what they want to check off on their to-do lists first or allocate a part of their budget toward, they must determine which resources are the best fit for them. This, too, can be overwhelming. After all, a quick Google search of almost anything will present an onslaught of possibilities. It can be challenging to find the person or tool that’s in budget, of quality, and the right overall fit.

“Look at their track record,” Grocher advises specifically of individuals a social worker may use such as a business coach. “Look at what they’re doing. Look at how they show up in spaces. Look at their bio, their reputation in the community. Start by following them for a bit first so you can get a sense. Then schedule a consultation. It has to feel like a good fit, not just can you give me the materials and tell me the steps I need to take but also do I like talking to you? Do you listen to me? That’s part of it, too.”

Social workers should not be afraid to look to and for mentors in the field as well who can help guide them, not just as they start their businesses but also as they maintain them. Social work mentors can offer clinical guidance, of course, but also business support. As Thomson described, a mentor helped her craft the big picture of her private practice, and she since has mentored more than 10 social workers and therapists herself as they do the same. Mentors can be invaluable.

Grocher agrees. “Mentorship has been everything,” she says. “When I say that, I mean having that support is so helpful, having different types of support has been helpful. It can even come down to there being natural ebbs and flows in this business. It’s going to happen to all of us. Even though you know [this], it’s still very anxiety provoking. It’s good to have somebody say, okay just remember this is part of it.”

In the end, a social worker should also remember that this is their practice to make of it what they want. “I hope that social workers think outside of the traditional idea of a 9 am to 5 pm, one-on-one counseling, and think about what is the best method/time/place for you to do your work so that you can give your best,” Thomson says.

By doing so, social workers will be able to launch and maintain a private practice that they can be proud of and fulfill a dream that perhaps they had in middle school.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.