Starting a therapy private practice can be overwhelming at first, but the initial effort it takes is well worth it. Here are the 11 and a half essential steps I went through to set up my private practice.
1. Face what comes up
Before you begin, know that starting a private practice will bring up ALL of your internal issues and fears: Will I be able to make enough money? Will I get enough clients? Do I have enough experience to do this?
It is NORMAL and natural for such a huge endeavor to bring up all your internal issues. This is a wonderful opportunity for self-growth and reworking old beliefs and narrative that no longer serve you. In my essay Entrepreneurs are Ready for Therapy, I explain how much comes up as you start a business and why it is the perfect time for therapy. I also firmly believe that therapists need their own therapist.
This is also a good time to start or return to a journaling practice. Write down and work through what comes up for you. My essay on Journaling Can Be So Much More provides some good starting points.
2. Examine relevant laws
Start by looking at the laws in your state or country. In the US, the laws vary from state to state for who can have a private practice and what is necessary to have that private practice. Look first at the laws and then the governing board of your license. If there is no state regulation, look at the national regulation or national governing board.
For example, I live in Arizona and am both an art therapist and a mental health counselor. I started by looking at the Arizona state laws for art therapists. Art therapists have title protection in Arizona, but no other regulation beyond that. Since there is no state law for art therapists, I then looked at the national governing body for art therapists - the ATCB.
For my mental health license, I looked at the Arizona Board of Behavioral Health and made sure I complied with all of their requirements for a private practice. (You can read more about how I navigated this in my essay Starting a Private Practice as a New Graduate).
Even if someone tells you what the laws and policies state, LOOK THEM UP YOURSELF. I was told incorrectly multiple times. Laws and policies are updated frequently.
3. Decide where you want your practice
Would you like to work in-person, online, or hybrid? This decision will guide where you set up your office and what your schedule will look like.
For example, I knew I wanted to work with people in-person, but would also need telehealth as an option. As I looked at office spaces, I made sure that I could have access to the internet.
I suggest this step before you submit your business paperwork so that you can use the physical address of your private practice if you choose in-person.
4. Submit necessary paperwork
Once you know where you will be working, you are ready to submit business paperwork, such as applying for a LLC, getting an EIN, setting up a business bank account, and more. What you need will vary depending on the laws of where you live and board that your report to. This is also a great time to purchase liability insurance for your business.
David Meer wrote an excellent article on the specific paperwork you will need:
5. Select your EHR system
Whether you’re in-person or telehealth, an EHR system will dramatically help your business. Most EHR streamlines systems such as intake paperwork and easy billing. Some of the common ones include TherapyNotes, Simple Practice, Theranest, etc. I currently use Simple Practice and have been impressed with how they continually enhance their product.
6. Decide your ideal schedule
One of the major benefits of a private practice is that YOU get to determine your ideal schedule. I’ve seen many new private practice owners fall into a scarcity mindset and select a schedule that they think will be best for their clients.
Your practice will fill up no matter what schedule you set. The number one factor of a successful private practice: the health of YOU. So make sure you pick a schedule that aligns with you. I learned this the hard way, which I write about in my essay What is Success When You’re an Art Therapist.
How many days a week would you like to work? How many clients per day? Will you see a mix of weekly, bi-weekly, or monthly clients? For example, I work M-Thursday and see no more than 3 clients a day. My sessions are 80 minutes long and I require all clients to meet with me weekly. I also have an essay on Finding Your Ideal Work Schedule.
7. Determine your population and narrow your niche
This is one of the hardest aspects for therapists. To make the first step easy, determine what age groups you will see. Do you see kids, adolescents, and/or adults?
Afterward, you can begin to think about your preferences (what clients do you LOVE working with) and what areas of expertise/specialities you have. For example, I work with highly intelligent adult women who experience overwhelming emotions and thoughts. I also have areas of expertise in grief, autism, and religious deconstruction.
8. Determine your budget
We all have unique situations when we set up our private practices. I am a single individual with no other financial support, so I need my private practice to cover ALL of my personal and expenses. I’ve known other therapists who have a partner and only need their private practice to be side money.
Start by estimating the monthly expenses for your new business. Your understanding of your expenses will improve with time, but for now you can estimate what you will pay for rent, internet, EHR, insurance, supplies, website, and anything else you need. If you need your business to cover your personal life, determine how much you need monthly for that. Once you add your personal and business budget together, you know how much you will need to make at the minimum.
You can then create your ideal budget. How much would you like to make if your income paid for all of your needs (retirement, health insurance, vacations, charity work, and more).
If you need a good place to start, I suggest using Tiffany McClain’s “Fun with Fees Calculator”
9. Set your fee
Once you know your ideal budget and the number of hours you’d like to work, you can do the math to figure out what fee you charge. Tiffany McClain’s “Fun with Fees Calculator” also helps you with this.
Most therapists set their fee based one what they think people will pay them or what therapists around them charge. In my essay Please Stop Basing Your Therapy Fee on the Market, I explain how the market number isn’t sufficient and prevents you from shaping a practice around your needs.
Many therapists also wonder about insurance. Once you know what fee you will need, you can look at the reimbursement provided by popular insurance panels in your area. If it’s lower than This is one of many reasons I don’t take insurance (my essay The Many Reasons I Don’t Accept Insurance explains more).
10. Create your practice paperwork
Create all of the necessary paperwork your clients will need (informed consent, intake questionnaire, etc.). Most EHR platforms offer sample paperwork you can use as a template. I strongly suggest reading through it all and tailoring it to what fits you best.
11. Create a simple marketing schedule
For you to get new clients, people need to know you exist and are accepting new clients. I recommend you start with a website. It is your chance to showcase all that you are and clearly state all of the information you determined above. You can look at great inspiration in my essay Therapist Websites I Love.
You can then start telling people about your business. You can reach out to fellow therapists and other friends/professional colleagues to let them know you’re ready to see clients.
One of the biggest fears I hear from other therapists is that they will not get enough clients. You will get them, it will just take time and consistent effort. You can do this by creating a simple marketing schedule
Start by determining how many hours a week you would like to devote to marketing. Then write how you would like to use that time. You can start by making a list of all of your marketing ideas. Then, prioritize your list and write what you would like to accomplish that week.
Read 3 new articles about best ways to market as therapist
Reach out to 5 therapists for networking
Create Psychology Today profile
Add more copy about my specialties on my website
Step 11.5: Face What Comes Up
Yes, we’re back where we started. I cannot state this strongly enough: starting a private practice will bring up ALL of your internal issues and fears. This does not mean you’re not ready. It means you’re a normal human going through a stressful experience. The more you can face whatever comes up, the better you’ll do.
Here are the three most common myths and mentalities that I see holding therapists back:
The wonderful part about a private practice is that both you AND your practice will continue to grow over time.
The hardest part is facing the unknown to START your private practice. Once you've done that, you can tweak and refine it with time. A list like this will never teach you as much as you can learn just doing the work.
I provide consultation to therapists creating their ideal private practices.