The Bootstrapper’s Guide to Building a Private Practice

One great thing about being a counselor is there are so many places to perform the trade. One can work for schools, insurance companies, employee assistance programs, group practices/agencies, nonprofits, residential care, government-funded programs and clinics, and many others. Although the employment landscape is diverse, many counselors begin their careers with the dream of someday having their very own private practice. To be their own boss! To steer their own ship!

This article is for those counselors.

In the paragraphs that follow, we will look at eight fundamental disciplines for striking out on your own. The approach is that of the “bootstrapper.” It requires little financial capital but lots of sweat equity.

1. Make the commitment.

Ambivalence is the enemy of change, and when it comes to starting a practice, many counselors have it in surplus. This is understandable! Counselors often work multiple jobs — full time for the school system, part time doing in-home therapy and then top off the week with a few hours of supervision. Even when these jobs aren’t one’s ideal, they can provide enough to keep a person questioning whether he or she should leave well enough alone.
Add to this financial pressures. I often hear providers say, “I’d rather work for myself, but my job with the university means my daughter will get free tuition” or “I’m not financially secure enough that I can give up my salary.” These are real dilemmas.

However, most counselors don’t need to quit their day jobs if they can find a few additional hours each week to direct toward their practices. For those with no room in their schedules, they may be wise to determine that starting a private practice isn’t right for them.

Whatever the decision, bootstrappers know whether they’re in or they’re out. If they’re in, they’re committed to the challenge.

2. Pay the price.

A wise Mexican proverb translates, “Make your choice and pay the price.” Indeed, there is a cost to starting a private practice. For the bootstrapper, that cost is time! Are you ready to quit book club, the bowling league, the band, and to cancel cable and box up the Xbox? You’re going to need those hours.

When starting a business, life as you know it will consist of work, family time, exercise and building your practice. That’s it! Make another pot of coffee and get ready for some late nights. Get ready for early mornings, too. You’ll know you’re on the right track when you can greet the entire 5 a.m. McDonald’s staff by name.

Want to know what you’ll be doing during these long hours? Reference my July column, “Building a full caseload of counseling clients.”

3. Focus.

Because your time will be limited, you will need to be extremely focused. This means nothing can interfere with bootstrapping time: no e-mails, no phone calls, nothing that doesn’t directly relate to moving the business forward. My wife Ellen is currently in her second year at law school. Being a wife and a mother (and an adjunct professor), she has a fraction of the time her classmates do to study. However, she still makes the dean’s list! This isn’t just because she’s brilliant. It’s because when Ellen studies — from noon to 3 p.m. every weekday — she’s super focused. In contrast, her classmates have their books open all the time, sometimes camping out at the law school, but they waste huge swaths of time with unfocused study habits.

Ellen, like the bootstrapper, knows that the power of focus cannot be overstated.

4. Pursue constant forward motion.

When I built Thrive Counseling in Cambridge, Mass., the best advice I received was just three words long. I was told to always have “constant forward motion.” This means to execute, even when the results won’t be perfect. When it comes to clinical care, you need to be superb — but everything else can and will be improved upon later. For example:

• You have an ugly logo? GREAT! An ugly logo is better than no logo.
• Your business cards say Vista Print on them? GREAT! Crappy free Vista Print business cards are better than no business cards.
• You were misquoted in XYZ publication? GREAT! You can now say you’ve been mentioned in XYZ. How fancy!

I sometimes speak with counselors stuck on a tough Catch-22 such as, “I can’t get an office until I find some clients, but I can’t recruit clients without an office to see them.” Yes, you can. In fact, you have to! Either decision will work, but doing neither means you’ll never move forward.

The bootstrapper knows when to stop writing the business plan and when to start building the business.

5. Reject excuses.

“There are more counselors per capita in my town than anywhere in the USA.”This is my favorite excuse of all time because I hear it every week from therapists all across the country. (By the way, if anyone knows what city actually has the most therapists, please e-mail me at marketing@thriveworks.com.)

My second favorite excuse is, “Building a caseload is impossible in this economy!” What does the economy have to do with anything? Maybe a small percentage of people have lost their health insurance, but most haven’t. Also, rent is cheaper, as is advertising, and people need someone to talk to about the economy!

Other excuses: I’m too old. I’m only 30, and I look young (i.e., I’m too young). I don’t have capital. All the good insurance panels are closed. Managed care has ruined the profession. Life coaches are stealing my business. Corporations aren’t referring like they used to. Rent is too expensive. I have too much debt. I have a family to provide for. And the list goes on!

Each of these is a challenge. However, bootstrappers don’t succeed because their path is easy. They succeed because they refuse to let excuses overtake them.

6. Build risk tolerance.

Allow me to stereotype. Counselors hate risk. For a bootstrapper, items at risk are time, effort, pride and, to a lesser extent, money. The startup costs for a counseling practice can be as low as a few thousand dollars to rent an office, do some advertising and delegate a few of the more heinous tasks such as medical credentialing and billing.

Here’s the full truth: There’s no risk concerning whether you will fail. You will. That’s part of the process! Thomas J. Watson, the founder of IBM, once said, “If you want to succeed, double your failure rate.”

Bootstrappers know that if they work hard, and smart, in the end, they are likely to succeed. Starting a private practice might be risky, but (in this economy!) it’s no riskier than being an employee.

7. Avoid nonessential partners.

When consulting with someone starting a practice, often at some point he or she will say, “Thanks! I’m going to share this with my business partners.”

It’s often believed that partners help to spread out the risk of starting a practice. They don’t. In some ways, they increase the risk. Having partners can dilute one’s sense of responsibility and are sometimes used to avoid necessary hard work (partners are also useful for sharing the blame when, after two years, the practice still isn’t thriving).

Partners are not necessarily bad, but they often exist for the wrong reasons. Bootstrappers ask themselves why they need a partner. Is it because they’re scared or lack confidence? Is it because they don’t want to be responsible for their business (if so, maybe they should remain employees after all)? No, bootstrappers get a partner only when someone brings a huge amount of value to the table and is willing to work as hard as the bootstrapper is to skyrocket the company.

Note: Two counselors sometimes make a poor partner match because they have the same strengths. (Even if one works with kids and the other knows eye movement desensitization and reprocessing, they’re still both clinicians.) Instead, how about a counselor and a medical biller? Or an accountant? Or an experienced manager? Or someone great at starting small businesses?

8. Track your progress.

Milestones are achievable company advancements. For the nascent counseling practice, they may include signing an office lease, furnishing an office, getting on 10 insurance panels, publishing an ad in a local magazine and so on.

Action steps are all the smaller efforts required to reach a milestone. For example, publishing an ad in a local magazine involves 1) selecting the publication, 2) contacting the publication, 3) determining a fair price, 4) negotiating a price, 5) writing the ad, 6) hiring someone to design the ad, 7) submitting the ad for publication and 8 ) paying the bill.

Write out your 10 most important milestones as well as the action steps necessary to complete them. Then, assign a deadline to each one. Include how many hours of bootstrapping each milestone will take to complete. This is your guide to help you stay on track and also to affirm your progress on days when it feels like you’re spinning your wheels and getting nowhere.

Complete a few milestones and you’ll be well on your way. You’re a bona fide bootstrapper, starting your private practice!
In this lesson, Dr. Anthony talks about the art of bootstrapping a practice to success! He gives road tested advice, and records the video at the end of a weekend of working long hours on his practices. To watch full video, click here: https://twx.atlantacounseling.com/private-practice/