With an increasing number of licensed and associate licensed therapists considering a transition into private practice, many are questioning whether this is the right path for them. Leaving group practices or agency-based clinical practices can be a significant change, particularly due to factors such as pay, work-life balance, and job satisfaction.

In this blog post, we will discuss the pros and cons of starting a private practice, explore the experiences of those who have already made the transition, and provide resources for further exploration to help you decide whether private practice is the right choice for you.

The Great Debate: Private Practice vs. Agency Work

The decision to move into private practice can be influenced by numerous factors, including dissatisfaction with current working conditions. Many therapists report feeling stuck with low pay, fixed hours, and cases that they don’t feel are a good fit for them. On the other hand, some argue that it is essential to gain experience and build connections in an established agency or practice before venturing out on your own.

One perspective suggests that the best time to start a private practice is ten years post-graduation and eight years after licensure. This would allow time to gather resources, knowledge, and a professional network to support your transition.  Others have found that they are not able to stay in an agency for that long due to the stressors and poor work environment.

“I did two years for community health in our county and you have an enormous caseload, and the pay was just atrocious, I could not make a living. It was not sustainable long-term because I was burning out.” (Duquette & Morgan, 2023)

Amidst the pandemic, numerous psychotherapists transitioned from their mental health roles to establish private practices. As the world shifted towards virtual work and remote setups, an opportunity arose for these professionals to navigate away from the hurdles of traditional employment and embark on their independent ventures.

“Covid made so many things easier, there were just so many people that needed help, even with private pay I got busy so quickly.” (Duquette & Morgan, 2023)

The motivation for entering private practice often boils down to money. Agency work has a financial ceiling, and there isn’t much room for upward mobility.

“The major one, I think, is money. Private practice just pays so much more.” (Duquette & Morgan, 2023)

Nevertheless, engaging in private practice can pose certain difficulties, such as absence of health insurance and retirement benefits, financial instability, isolation, and a steep learning curve. Conversely, clinical literature cautions that venturing outside of organizational structures may result in financial insecurity, social isolation, and inadequate support.

“Private practice offers the potential for increased autonomy, but there are risks associated with this newfound freedom.” (Duquette & Morgan, 2023)

The Challenges of Starting Your Own Private Practice

Despite the allure of improved pay and increased autonomy, starting a private practice is not without its challenges. Some authors have highlighted the potential pitfalls of operating outside of organizational structures, including financial insecurity, social isolation, and lack of support (Adams, 2013; Thistle, 1998; Weitz, 2006). As Weitz (2006, p. 83) warns, “Whatever you have been used to doing in your counselling work, you will need to do even better in private practice. You will need to be even more rigorous in your management and have the highest possible standards in your clinical practice… In private practice you are more vulnerable because you are isolated and less well supported.”

For many psychotherapists, the heightened sense of vulnerability in private practice arises from the non-reciprocal nature of psychotherapeutic relationships (Campagne, 2012; Farber, 1990). Hammond et al.’s (2018) study found that all participants “suggested that their client’s expectations and needs were more important than their own” (p. 9), a sentiment echoed by Saddichha et al. (2012). This imbalance can lead therapists to feel increasingly depleted over time (Gustafsson et al., 2008).

Adding to these challenges are the self-imposed and job-related expectations that can put psychotherapists at risk of burnout (Campagne, 2012; Gustafsson et al., 2008; Lambie, 2006; Rosenberg & Pace, 2006). Indeed, Lambie (2006) argues, “when counselors believe that they are responsible for a client’s behavior and have the power to control his or her behavior, they are at an increased susceptibility to burnout because of these unrealistic expectations” (p. 38). Therefore, while private practice offers certain advantages, it also demands a high level of resilience, resourcefulness, and self-care.

Why This Topic Matters

So, should you start a private practice or not? The answer ultimately depends on your values, strengths, and professional goals. Both private practice and agency work have their challenges and benefits. It is crucial to thoughtfully consider your options and make the best decision based on your individual needs. Starting a private practice may not be the right choice for everyone, and that’s okay. The most important thing is to find a career path that aligns with your values and brings you fulfillment.

Action Step

To help you make an informed decision, compile a list of your values, strengths, and pros and cons related to working for an organization vs. starting or maintaining private practice. There is no one-size-fits-all answer, and by evaluating your personal situation, you can better determine the best approach for your career. Additionally, seek advice from experienced therapists who have successfully navigated the transition to private practice. By gathering insights and perspectives from others, you can make an informed decision that aligns with your personal and professional goals. Remember, this is a significant decision that does not need to be rushed, so take your time and consider all factors before making the leap into private practice.

Conclusion

The decision to start a private practice is a personal one that requires careful consideration of your priorities, values, strengths, and career goals. By understanding the pros and cons of both private practice and agency work, you can make a more informed choice about the best path for your professional development. We encourage you to continue researching the topic and engaging with other therapists to gain insight into their experiences. Understanding others’ perspectives can help you make a more confident decision and set you on the path towards career satisfaction and success.  So, whether you decide to start your own private practice or continue working within an established organization, remember to stay true to yourself and prioritize your well-being as a therapist. Keep in mind that both paths have their challenges and benefits, so it is essential to find what works best for you and your unique situation. Best of luck in your decision-making process!

Additional Resources:

Private Practice vs. Agency Work: A Guide for Therapists (https://www.goodtherapy.org/blog/private-practice-vs-agency-work-guide-for-therapists/)

The Pros and Cons of Starting a Private Practice (https://www.psychologytoday.com

Duquette, C. L., & Morgan, S. M. (2023). Experiences of psychotherapists transitioning to private practice during COVID-19. Counselling and Psychotherapy Research, 00, 1–8. https://doi.org/10.1002/capr.12643Finan, S., McMahon, A., & Russell, S. “At What Cost am I Doing This?” An interpretative phenomenological analysis of the experience of burnout among private practitioner psychotherapists. Couns Psychother Res., 2022; 22: 43–54. https://doi.org/10.1002/capr.12483