How to start your own private therapy practice [7 steps]

If you’re thinking about starting your own private therapy practice, you might feel overwhelmed by all of the steps it takes to get there. Early challenges include finding clients, getting credentialed with insurance companies, and getting up to speed on the ins and outs of running a business. It’s no wonder that the learning curve can feel intimidatingly steep. Gaining a better understanding of the benefits and realities of starting a private practice — and what resources can support you along the way — will help you take first steps toward achieving your goals.

Is private practice right for you?

The first step is deciding whether private practice is a fit for you. There are no perfect answers here, and what’s right for one person might not be right for another. Even so, there are certain pros, cons, and good-to-knows to keep in mind as you come to your own decision.

The benefits of private practice

The upsides of private practice are clear:

Be your own boss: One of the biggest reasons people go into private practice is for the professional freedom it can afford.
Set your own hours: In private practice, you get to decide when and how much you want to work.
Control your income: Being able to set your own hours means you also get more control over how much money you’re making.

The trade-offs of private practice

There are also trade-offs to consider:

All responsibilities fall on you: If you’re doing private practice solo, it’s going to be up to you alone to figure out the details and troubleshoot issues that come up.

Lack of clinical support: Some private practice clinicians say they miss having clinical support. Many will set up relationships with other therapists who they can call for case consultations — or you might have that in a structured setting within a larger private practice.

You’ll need to build a caseload: As you’re getting started in private practice, keep in mind that it takes time to build a caseload. This also means that income is really variable when you first start.

Credentialing: For most therapists, it’s not realistic to plan on building a private practice composed of self-pay clients only. This also limits the type of client you’ll be able to treat. If you want to accept insurance, you’ll need to learn the process for getting credentialed with various insurance panels. More on this below.

Billing and accounting: You’ll need to determine your rates and set up a process for billing clients. And, you’ll need to figure out your policies for no-shows and for handling situations where clients are unable to pay.

Working non-traditional hours: The flexible hours are great, but you also have to think about when clients are looking for services. In contrast to working nine to five for an agency or health system, in private practice, work often happens on the weekend or evenings — especially if you’re doing private practice on a part-time basis.
Managing compliance: You’ll need to make sure your notes meet minimum documentation requirements no matter the payer source, that all consents and legal paperwork are in place, and that you have a secure way to store all records for the required timeframe in your state (often seven or more years).

How Rula Mental Health can simplify private practice

Working with Rula Mental Health is a great way to experience the benefits of private practice with the support of a dedicated team behind you. Therapists who work with Rula get:

Credentialing with insurance: Rula guides you through the process of getting credentialed with multiple insurance panels in as little as two weeks.

Billing and insurance processing: Rula handles all the administrative details of billing and insurance, ensuring you don’t have to do extra work to get paid. Rula also offers no-show and protection for therapists. If a client doesn’t show up, you still get paid your full fee.

Clinical case consultations: Rula’s clinical team offers clinical case consultation hours to help therapists get the clinical support they need to thrive.

New client marketing and referrals: The Rula team finds clients for you, filling your desired caseload quickly with clients who are a great match for you.

Technical support for you and your clients: Rula’s best-in-class support team is here to help when technical issues arise. You’ll have a team you can trust to help get to the bottom of any issues, fast.

Complete schedule flexibility: Rula has no minimum caseload requirements. You’re in control of how many sessions you have per week, and when you have them.
Medical record and HIPAA compliance: Rula provides a HIPAA-compliant electronic health record, all consent documents required for the provision of services, and stores client records in accordance with state and federal requirements.

How to start your private practice

1. Establish your niche.

In most organizational settings, therapists are required to be generalists and work with all types of clients. This is especially true as therapists are first getting started working on licensure supervision hours. But in a private practice setting, you get to decide what type of work you want to specialize in. Some of the most successful private practice owners are those who have a strong brand or a niche. Ask yourself:

What is it that I really want to do?
What types of clients do I want to work with?
What areas of specialization do I already have?

Calling yourself an expert is something that therapists sometimes shy away from. But if you’ve been working with a specific population for quite some time, you probably do have expertise in that area of your practice. If you’re not quite sure how to establish your brand or niche, talk to someone who works with the types of clients you’re interested in. Then consider the gaps your practice might uniquely address. If you decide to partner with Rula when launching into private practice, our team will match you with clients who fit your preferences so you can focus your practice on the types of clients you most want to work with. Rula also offers seamless rematching if either a client or therapist feels it’s not the right fit.

2. Determine your strategy for building a caseload

Before opening your doors, you’ll want to develop a business strategy. This includes outlining your goals and objectives for how you’re going to build your business and get clients. Word-of-mouth referral is the best way to get clients, but when you’re just starting out, you won’t have a lot of clients who can spread the word. Other therapists who are in private practice are a great resource because they may not be able to take certain clients — or they might not be the right fit for them. Most therapists starting a private practice need to do some type of online marketing to find clients. You’ll have to make some decisions about how much marketing to do, and where you want to do it. ZocDoc, Psychology Today, and Therapy Den are all very popular marketing channels among therapists. Some list profiles for free and some have fees. If you’re contracting with a company or group practice, filling your caseload will be easier. If you start your private practice with Rula, you won’t need to market yourself. Rula handles all of the marketing and sends clients directly to you. You’ll tell Rula what kind of clients you are looking for and we’ll fill your desired caseload accordingly.

3. Embrace the business of being in business.

Being in private practice means that you’re a business owner. The more you can hone your business skills, the more likely you’ll be able to have a smooth process as you build your practice. First, you’ll need to make choices about what type of business you’re going to have: an LLC, a PC, or sole proprietorship. Establishing yourself as an LLC, a PC, or a sole proprietor is pretty easy, but there are legal and tax and liability concerns associated with each option. Do your homework before making a decision: You may want to speak with other practitioners or get legal or tax advice first, since you’ll be in charge of your taxes. With Rula, you get full support on the business aspects of running your practice so you can focus your time and energy on working with clients.

4. Get comfortable with money.

Being in charge also means getting comfortable talking about money. As a private practitioner, you’ll need to discuss and collect rates, set no-show fees, and hold clients accountable for what they’ve committed to paying you. As a business owner, you’ll also need to learn how to predict how much money you’ll make using a profit and loss report. Rula offers therapists no-show and cancellation protection. So if a client doesn’t show up for a session, you still get paid your full fee, guaranteed. Additionally, therapists in the Rula network also get clawback protection. Insurance companies regularly conduct audits. If a therapist’s documentation doesn’t meet minimum standards, insurance companies may recoup monies that have already been paid for prior services. Rula takes on the risk of audits and never claws back payments made to therapists.

5. Make logistical decisions.

As far as logistics go, there are few key decisions you’ll you need to make that have implications for your your business and potential liabilities you need to pay attention to:

Credentialing with CAQH: The Council for Affordable Quality Health Care (CAQH). CAQH is a centralized way to get credentialed on multiple insurance panels. While you can start and run your practice as cash pay, getting paneled will mean more access to therapy for more clients.
Evaluate and purchase software: Simple Practice, Theranest, and Therapy Notes have different levels of plans they offer for small practices. Compare and contrast your options and consider talking to other therapists to learn what they find the most effective.
Perfect your paperwork: If your paperwork doesn’t meet all the requirements needed to be able to deliver care — like HIPAA forms, informed consent, privacy notices, or claims forms — you run the risk of impacting your license and your profitability. Ensure you have everything in order.

When partnering with Rula, you can easily get credentialed with CAQH. We’ll guide you through every step of the process, or manage the process for you if you prefer. Rula also offers therapists robust training on how to use our fully-integrated electronic health record (EHR). And if you have questions, our dedicated support team is here to help.

6. Prioritize client privacy.

As always, you’ll need to pay attention to how you’re managing client privacy in private practice. Here’s what you may need to do that:

A separate, confidential space with a door that closes
A sound machine or headphones
A secure laptop
A HIPAA-compliant email account
HIPAA-compliant electronic health records
A notice of privacy practices

Rula helps guide therapists on best practices for protecting client privacy, and all of our systems are fully HIPAA compliant.

7. Choose between running the practice on your own or getting some support.

Are you going to open a private practice on your own, or would you prefer some support from a group practice model? There are also ways to get started in private practice but get some of the administrative support and liability off your plate. One way is to join a national group practice. These practices typically manage some, but not all, administrative tasks — although the level of support they provide can vary quite a bit. Organizations like Rula can help with even more: getting referrals and quickly ramping up to your desired caseload, taking care of insurance, storing health records, offering clinical support, and fully covering the administrative side of your business so that all you need to do as a therapist is provide therapy. For an even closer look at building a private practice and getting support from a group like Rula as you do it, check out our webinar: How to Make the Leap to Private Practice.