Developing a coalition of colleagues as a mental health practice owner

Welcome to the "What to Know Before Opening a Mental Health Practice" series by Kristin Trick, MA, LPC-S, RPT. Drawing from a decade of diverse clinical experience spanning psychiatric hospitals, nonprofit agencies, and private practice, Trick shares the top 5 lessons she wishes she had known before becoming a solo practitioner. Packed with practical advice and insights from her journey, this series supports mental health professionals looking to establish a thriving and sustainable practice.

As the owner of a private counseling practice, you can make your own schedule, choose your preferred clients, and collect full payments for your services. Woven among these privileges, though, are the feelings of isolation and loneliness that accompany independent practice. 

Without the onsite presence of colleagues, whether they be clinicians or administrative staff, your work can gradually become humdrum and tedious. Having worked at a group practice during the COVID pandemic, I acutely recognized my social needs and utilized this insight when I transferred to a solo practice.

When you open a practice, you assume full responsibility for all the tasks involved. Besides the familiar duties of meeting clients and maintaining their medical records, you add the new jobs of processing payments, returning phone calls, handling office repairs, filing taxes, and paying bills, to name just a few. These undertakings can add significant stress if you try balancing them entirely on your own. 

A support network composed of other professionals will help you skillfully identify and address entrepreneurial stressors, enabling you to cultivate longevity for your practice. Specifically, it will assist you in avoiding burnout, preventing unethical practice, and broadening your practice’s services.

While working at a past job, I saw a high number of clients who had experienced sexual abuse. Roughly 80% of my caseload was made up of individuals whose treatment plan included the processing of this specific trauma. 

After a couple of months of conducting this work, I began having nightmares about some of the stories I had heard. The dreams were so disturbing that I shared them with my supervisor, who thankfully was receptive to my concerns. 

He immediately informed our administrative team to assign clients who noted this experience on their intake forms to a different counselor. In addition, he increased the frequency of our individual meetings so as to provide more opportunities for me to process what I was exposed to during sessions.

Independent practice drastically limits our ability to ask for help, as I did in this scenario. There is no onsite supervisor or other clinicians around from whom you can seek advice or assistance.

Unless you have chosen to open a group practice in which you have other counselors available, you are the sole therapist with whom clients can book their appointments at your business. The combination of all these effects raises your risk for professional burnout.

If you are proactive, you can reference a professional contact list when situations such as the aforementioned one occur. Though these colleagues are not instantly available in person, you can call, text, or email them with a request for their input. 

Your support network can give you wise ideas to consider, such as building up your waitlist rather than immediately scheduling intakes or referring particularly taxing cases to another clinician. They can serve as accountability partners by regularly checking in with you to inquire about how you are handling your caseload and business responsibilities.

Across the nation, regular supervision for at least 1 year is required for counselors-in-training. The consistent guidance and answerability by licensed supervisors are expected to help uphold the integrity of the counseling profession. 

After receiving your coveted independent license, the decision of whether or not to continue supervision is yours. Though many therapy certifications require the accrual of supervised experience hours, some counselors will never reenter a supervisory relationship in the entirety of their careers.

As we advance in our counseling careers, we can develop blind spots that may bring harm to clients if they are left unchecked. We may have become so accustomed to working with a certain diagnosis, for instance, that we are quick to make its assignment rather than explore the deeper details of a client’s history. In attempts to avoid financial loss, we may continue to schedule clients who we know would make better progress with a different counselor due to our unfamiliarity with their presenting problems.

Supervision offers us the chance to have a well-seasoned clinician review our cases and make fresh observations. It is a significant way to avert unethical practice because a mature counselor, who is detached from the case at hand, can ask and comment about details that we have minimized or completely overlooked. This intervention can help us to promptly modify treatment in ways that better support our clients rather than risking their regression while in our care.

The independent business you yearned to bring into existence can plateau if you do not incorporate novelty. A private practice that focuses solely on counseling appointments may be manageable but is not sustainable over the years due to the substantial toll of clinical work. Connections with other professionals open the doors for you to spread out your practice’s services.

Counselors are not limited to the offering of mental health therapy as their sole livelihood. Our graduate school training and therapy experiences lend themselves to numerous other prospects. 

These include supervision at the graduate school or postgraduate levels; facilitation of trainings and presentations centered around interpersonal relationships and resiliency; research on the effectiveness of popular therapy interventions and underserved populations; and writings about advances made in the mental health arena.

You may have a knack for teaching, which, up to this point, has been confined to psychoeducational counseling sessions. Imagine if you established close connections with several non-profit agencies in your community, all of whose grant funding paid for you to conduct quarterly trainings for their staff members. A contract such as this would serve as a channel for you to apply your instructional strengths and advertise your business, all the while earning income.

While attending my monthly meeting for a local community group, another volunteer asked if I was interested in applying for a counseling job at their workplace. Though I declined, they inquired about my availability for presentations since my business card listed “Trainings” as one of my company’s services. 

Our 5-minute conversation resulted in my contract for a 3-hour paid presentation for their company. The experience was sublime as I took a day off from clinical work and instead taught an attentive audience about resiliency, a topic I regularly discuss during counseling.

Your initial motivation to create a support network must be viewed with the long-term in mind. If not, your freshly developed connections are likely to fizzle out due to poor scheduling and unrealistic expectations. To avoid this experience, think through the following questions as you organize your supportive cohort.

Be specific when cultivating this answer. Acknowledge how many clients you wish to have in your caseload, which insurance contracts you want to acquire, and what services you hope to offer. Your conclusions will help you narrow down which professionals you should prioritize in building your network.

Recognize your potential as a business owner. As your own boss, you decide what will differentiate your practice from others and how the work is carried out. 

If you are interested in offering supervision, connect with local professors who can inform their graduate students of your availability. If you want to provide mental health trainings, offer these presentations to community organizations that value this information (i.e., child development and youth centers, emergency shelters, foster care and adoption agencies).

Answer this question by picturing your target caseload. For instance, if you plan to work with families involved in custody cases, it will profit you to consult with lawyers who frequent the family court circuit. On the other hand, if you expect to mostly treat eating disorders, you will benefit from connections with registered dietitians (RDs).

The reality is that all of us know at least one counselor to whom we would never make referrals. After significant time in the field, we have a mental log of which counselors treat their clients well and which do not. 

Consider the therapists you have come to know through mutual work or meetings in the community and prioritize your relationships with those you hold in high regard.

Time equals money in private practice. If we are conducting business-related work but not accruing funds, we must seriously evaluate the non-monetary benefits. 

You and your support network may wish to meet weekly, but at the end of the month, this will equal 4 hours of unpaid “work” for everyone involved. Check out your schedule and identify creative ways to incorporate your colleagues. A weekly 30-minute walk during your lunch break allows sufficient time for consultation while exercising away from the office. 

Alternatively, a once-monthly dinner at your practice, whether you pack a meal from home or order food to be delivered, provides a comfortable backdrop for case conceptualizations. In both examples, you can arrange to meet your colleagues in person, through video, or by phone.

Our existing stress levels only increase in response to new endeavors. Identify your current stressors and be honest about how you are handling them. 

If you think that opening your practice will push you over the limit, schedule an intake for personal therapy. Use your counseling sessions to address challenges related to your business, as well as unresolved issues from the past. 

Your coalition of colleagues should include at least 3-5 individuals who you trust to provide honest feedback and who can be relied upon to follow up with you. Reflect on which professionals you have considered dependable at previous worksites and consider their current accessibility to you. Compile a diverse list of providers to ensure that you can gain holistic input.

A benefit of regular consultation with other licensed therapists is their familiarity with counseling work. They understand the limits to confidentiality, licensing board requirements, and insurance standards that others do not. 

Likewise, they are well-versed in case conceptualizations, which can add efficiency and focus to your conversations. Discussing cases and work-related struggles with other counselors has a deeper feeling of camaraderie, too, since you all provide similar work. 

Connections with professionals other than counselors are fundamental to your practice’s advancement — not to mention your own clinical skills. Providers with ties to the counseling arena, namely psychiatrists and psychologists, will enable you to make confident referrals for your clients. If you already have an established relationship with these providers, you can more easily get in touch with them to discuss your mutual client’s treatment. 

Professionals in less related fields, such as lawyers and accountants, have a wealth of knowledge to share that will help you become proactive with legal and financial matters. Imagine the relief that can come upon learning that your new client’s attorney is someone who knows you by name and often sends clients your way. Think also of the decreased stress you can feel during tax season as you reflect on conversations you have had with Certified Public Accountants (CPAs) over the past year.

Before opening a practice, I made a significant decision to begin meeting with my own therapist. The hours we spent together helped me to overcome doubts about my ability to operate a business and gave me significant points to ponder about how I wanted to conduct sessions. 

Sitting in the client’s role for a change increased my empathy for others and guaranteed one hour each week for self-assessment. I also learned that while personal therapy is not the same as supervision or consultation, it does offer a confidential space in which you can disclose details of client work that you cannot share with others.

I recently celebrated my practice’s anniversary by treating my husband and daughter to dinner at a fancy restaurant. While there, we reflected on all the arduous work it took to make “Grounded Counseling & Services, PLLC” a reality. 

The insight I have shared throughout this series was developed over time, often accompanied by tears, tension, and reservations. As you start your private practice, welcome all the challenges and celebrate every victory involved, knowing that you are not alone in your experiences. And above all, remember that you are part of a precious and indispensable profession; treat it with great care.