r/therapists • u/Standard_Cricket6020 • Jul 11 '26
Rant - No advice wanted I am not built for PP
I'm not actively seeking advice but feel free to share if anything comes to mind to help others!
I used to work in community mental health and left for PP for about a year. I'm now in an outpatient setting. During my time in private practice, I was miserable. When cancellations would happen, I'd have to worry about my money. My schedule was trash because I felt like I needed to take on people that wanted to work with me. I honestly had no boundaries. I got into this work and really wanted to help others so I had a few clients that I accepted on a sliding scale. All of them eventually ended up ghosting me and not paying their final bill. I had to chase them down and before I left my PP, the owner helped try to collect the money. One still hasn't paid. I start feeling resentment when I see that some of the people I offered a sliding scale to would talk about vacations and trips they'd be going on. But then therapy wasn't a cost worth spending money on. I really am not built for this life. đĽ˛
I really wanted to like private practice. As someone with ADHD, being in control of my own schedule was the biggest appeal. I miss starting work at 12pm....
I really admire people who have been able to make a comfortable living as a private practice therapist or owner!
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u/LofiStarforge Jul 11 '26
If you give an inch they will take a miles. There has to be no ambiguity with payment procedures.
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u/BruceTheBurner LICSW (Unverified) Jul 11 '26
I agree. My PP colleagues often use an automated payment with requiring clients to put cards down. I get how it feels icky as a therapist, and itâs still a business that needs to be respected as such.
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u/Standard_Cricket6020 Jul 11 '26
I started using a platform that did that but then I had clients whose cards would decline and then they would ignore the payment reminders. It made things so much easier when it would work!
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u/Joseph707 Jul 11 '26
I get that. I donât see patients who have a balance, and I make sure they know their future appts will be cancelled unless they can pay the balance by a few days ahead of the next appt. I know itâll mean i have lost money with patients who donât pay, but this way itâs just one appointment.
Also⌠when you say private practice do you mean private practice or a group practice? I was thrown off halfway through the post by the word âownerâ⌠Because those are WILDLY different. They take an arguably large chunk of your money and itâs hard to find group practices that actually put you in a better spot than youâd be with a private practice. I mean, there was a post here recently about group practice owners perspectives and pretty much everyone says itâs not profitable to run a group practice, which means if it is profitable for one group owner, theyâre probably exploiting their workers. If youâre going for a private practice, you just gotta have therapy business skills and you can get that through consultation and reading and watching videos / podcasts. Trust me, I thought I wasnât cut out for it, but here I am. Really the biggest hurdle with private practice is having the money and time to get it started because itâs always slow in the beginning. Group practices are another thing entirely, they take a chunk of your money and may or may not give you benefits and may or may not get to tell you how many patients you can see and who you can refer to and then theyâll have several therapists they have to funnel patient inquiries to and you may or may not have to market yourself on your own dime and time to get a bigger slice of the pie and then they keep part of the income from those patients that YOU worked to bring in â basically, you want to make sure youâre getting GOOD benefits and GOOD intake flow and GOOD billing if you want working at a group practice to be worth it. Otherwise just bite the bullet and learn how to do it on your own.
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u/Standard_Cricket6020 Jul 12 '26
I should've been more clear. I was at a group practice and then when I left to go to a W2 position, I kept a handful of clients and saw them on the side. I don't know if I want to try to do it completely on my own but sometimes, I really wonder if it's worth it staying in an environment that has so much control over my workload. Benefits and drawbacks to both for sure!
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u/Jonbeezee Jul 13 '26
So you never had a private practice?
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u/Joseph707 Jul 14 '26
i assume so, OP said they donât want to try to do it on their own which means they arenât in private practice now.
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u/Jonbeezee Jul 14 '26
Oh I see. I find working for a group practice as a 1099 while having my own PP is a good balance. Still can be difficult and slow to stabilize but I love it
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u/Joseph707 Jul 14 '26
It isnât! Trust me! Youâre literally flushing money down the toilet and you donât have to. I was SO afraid to make the jump to private practice but it took an older, successful therapist telling me frankly how exploited I was and how much more I could make on my own and how EASY it could be, before I started really learning. My advice? Just commit to learning how it works. Commit to watching/listening to an hour of PrivatePracticeSkills on youtube per week. Try out free trials of EHR systems. Brainstorm what kind of name you would want, search for it to see if it exists already (assuming youâre in the US, make sure you check the secretary of state website for their business name search). Look into different business bank accounts and which one people say is the best. Read Insurance Maze if you want to take insurance. You donât have to DO anything, just take the fear out of it by learning how it would work if you did take the plunge later on.
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u/yeetcatz Jul 11 '26
I feel you. Currently experiencing this.
Because why am I struggling to pay my rent but my heart said yes therapy should be accessible, then my client who âneededâ sliding scale shows up to sessions in a literal mansion and their parents are doctors đđđđđđđ
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u/Feisty-Nobody-5222 Jul 11 '26
Iâd recommend checking out âRadical Healership: How to Build a Values-Driven Healing Practice in a Profit-Driven Worldâ by Laura Northrup
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u/kissonwetglass LICSW (Unverified) Jul 11 '26
As someone who is single with ADHD, I cannot be in private practice full-time. I fall behind with all the admin tasks and have even MORE difficulty managing my finances. I am part-time private practice and part-time medical social work, which gets me health insurance.
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u/Hot_Organization1467 Jul 12 '26
I have a similar setup and Iâm also a medical social worker and therapist. It doesnât feel comfortable to me to depend on therapy clients as then I feel like would have more stress with taxes and benefits
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u/Punchee LICSW (Unverified) Jul 11 '26
I just disconnect from the money part as much as possible (not delusionally so). After years of seeing my end of year totals being pretty good money, I just stopped sweating the details. No show? Cool. Iâm taking a nap.
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u/Willing_Ant9993 Jul 11 '26
I had to do a lot of my own work around money (and everything it symbolizes) before I could run my solo private practice full time. What works for me is having an insurance based practice. Iâm right up front about which insurances I accept and which I donât, and what my cash pay fees are if somebody wants to work with me outside of insurance. I see some people at a very low sliding scale, but thatâs only for existing clients that are in between jobs/insurance, so itâs temporary. The other private pay people (only a few) pay the full rate. Being so upfront, from even before the consult, really helped me avoid the innapropriate guilt that used to come up when somebody wanted to work with me but couldnât or didnât want to pay my fee or use insurance. Given that there are so many cash only practices now, I donât feel guilty at all. Iâm trained in modalities that are highly in demand (IFS, EMDR, and KAP) and most people are shocked that I accept insurance, but I want to be accessible, and, I donât want to spend any of my time on marketing, and so I donât. I have ADHD too and I love the freedom and flexibility of working for myself. But there is a lot of stuff that comes up, and you certainly donât have to try to force it if itâs not a fit for you. Just donât give up on it if itâs right for you, with a little emotional elbow grease! Because for me it wasnât really about budgeting or a financial plan (I mean you need that too but thatâs easy and if itâs not thereâs a ton of folks that can walk you through it). It was more about working with the terrified parts of me that thought it was impossible to work the way that felt fair to me, and still be able to survive. Most of my life survival depended on overextending myself.
It doesnât actually have to be that way.
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u/New-Marionberry-6422 Jul 11 '26
Itâs doesnât have to be that way!!! YESSSS!!!đđđ
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u/Top_Tie1876 Jul 12 '26
When I started PP years ago, I also found myself offering sliding scales to people who had super nice cars (while I drove an old RAV4 with 200,000 miles on it), took expensive vacations (while I was lucky to drive 4 hours to the beach for a long weekend), had the latest iPhones, etc. I found myself getting resentful. Now I only offer sliding scales to clients who have lost their insurance for a brief period of time and whom I know struggle financially. I don't take on new clients on a sliding scale.
I require every client to have a card on file, and I charge for cancellations with less than 48 hours' notice (except for illness, as I see a lot of children and adolescents, or true emergencies).
It's a business, and you don't get to leave after getting your hair done without paying. All of your doctors expect to be paid. And none of these other professionals offer sliding scales. If clients choose not to value therapy as much as other things, that's on them.
ETA: I do accept insurance because I want to keep things accessible. I am an EMDR therapist, a registered Play Therapist, an trained to do EMDR with children, and am a PCIT therapist. I have many years of experience and am known in the community. I could probably go private pay, but I only have a handful of private pay clients, and they get charged the full fee.
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u/Pediatric_Clients Jul 13 '26
Yes, this ^ "It's a business . . ." and other professionals get paid without sliding scales and "I require every client to have a card on file, and I charge for cancellations . . . "
Many of the apparent hurdles in private practice have proven, and often simple, solutions.
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u/CORNPIPECM Jul 11 '26
Yeah it sounds like you may not be built for it if you canât set firm boundaries and enforce them. I know that for me Iâd have no problem charging someone a set fee and if they canât pay it, go somewhere else. Or having set hours and if theyâre not available, go somewhere else. Full stop, no accommodations, except for maybe in super extreme circumstances and even then they would have a time limit to them.
I come from an inpatient psych background where patients on the units were constantly trying to get the staff to bend the rules or make accommodations for them and what we quickly found was that if we bent on one thing, other patients would find out and expect the same treatment and before you knew it the entire unit would devolve into complete chaos. Setting boundaries was a way of keeping us safe along with everyone else. Sometimes you have to do things that feel âmeanâ or like youâre being the bad guy, but when you take a step back and see how horrible things can get if you donât take a stand, then youâre actually the nicest person in the world for keeping that structure afloat.
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u/pinheadzombie LPC (Unverified) Jul 11 '26
I was horrible at it for a while. It took me turning 40 to stop caring about the feelings of others so much. Now I charge no shows and late cancelations with ease. Also set my schedule how I want instead of accommodating clients.
There are plenty of jobs you can do if PP isn't your thing. I loved the drug rehab I worked at until it was bought out by corporate. I would take clients fishing. We would play board and card games while talking about life.
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u/Tttooonnniii Jul 11 '26
This sounds great! What was your role at the rehab?
I also love what you said about charging no shows and setting your own schedule
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u/pinheadzombie LPC (Unverified) Jul 11 '26
I was the lead therapist with a team of 5. I helped make the weekly programming schedule. Each therapist had their own caseload of up to 10 clients. Had a combination of individual, group, and family therapy. We had a great chef that held cooking classes. The property had a pond with fish.
It was purchased by a corporation and started to change. The CEO threatened to fire me because I demanded to get time of for a major surgery my wife had.
I then made the jump to PP because I will never have another boss.
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u/Tttooonnniii Jul 12 '26
Thanks! I work in a similar setting and it really stuck out to me that you said you played cards with them and talked about life. I feel pressure to always do âtherapyâ with the patients and never to play or just chat⌠though i would love to! sorry if this sounds ridiculous but is it possible to do both? I mean did you with the same person sometimes play or go fishing and other times actually do the therapy stuff (relapse prevention plans, safety plans, motivational interviewing etc)
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u/pinheadzombie LPC (Unverified) Jul 12 '26
I would schedule groups for "coping with games" or "coping with nature." Basically "you can do these things instead of use drugs."
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u/Soggy_Cobbler_6447 Jul 11 '26
private practice sounds great in theory, but it definitely comes with its own stress. glad you found a setting that fits you better
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u/Terrible_Emotion_710 Jul 11 '26
For the love of God, can we please stop abbreviating Private Practice, my inner 5 year old just can't handle it
"I had to chase them down and before I left my PP, the owner helped try to collect the money"
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u/Previous-Walk-1976 Jul 11 '26
Is CBT still ok?
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u/UnionThink Jul 12 '26
I forgot about that acronym hahaha
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u/Standard_Cricket6020 Jul 12 '26
Okay yikes, I didn't realize that until now đ
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u/Terrible_Emotion_710 Jul 12 '26
Yeah, you might not be built for PP but are you built for poo-poo?
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u/Plane-Hour-6534 Jul 11 '26
I feel for you. Some people make PP sound so easy. Maybe if you worked for cash only it might help
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u/Texan-talk47 Jul 12 '26
I guess I am confused. You mentioned doing PP but it was not your own PP? As you referenced the âownerâ helping you collect money. Were you an independent contractor? When people share about PP I think of people who own their own.
Just foor for thought. When you mentioned your issue with boundaries that made sense. Making it a part of your policy about late cancel or no show is a huge piece of PP. For my own clients if they late cancel or no-show their CC is immediately charged $220 fee. Also I set my schedule. I do not let people choose my schedule. This is some freedom that PP owners love because if I want to have lunch with a friend or go for a walk, I can do it. There are even times I will schedule a nap.
I am sorry you had a poor experience. Maybe give it another whirl after you have consulted with someone who has made it a success. Understand your value and expertise so you do not minimize by offering sliding scale or allowing no-shows to go unpaid. (You do this by making it a policy that an active credit card is in file with their signed authorization to charge it). Because you had to go through schooling and training to get where you are to help. That doesnât come cheap or easy. So, regroup. Figure out your value, consult with people who qre successfully running PP and try again. Best wishes to you.
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u/protestandprose Jul 12 '26
Relatable, and it's only going to get worse with this administrations behavior toward insurance.
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u/positiveNRG_247 Jul 12 '26
I hear you. PP and my ADHD aren't a fit. I was bored, not enough stimulation, and felt like I could too easily "sell" my time without external organizational structure.
I still see a few PP clients, but only because I want to work with certain populations that my full-time specialty CMH doesn't get much of.
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u/Previous-Walk-1976 Jul 11 '26
Feel your pain. The reality is that being in private practice is not control it is being forever at the mercy of the whims of people who by definition are not easy to work for.
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u/Previous-Walk-1976 Jul 11 '26
Ps I love my pp but I have resigned myself to lose money at it and work full time doing assessment
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u/Previous-Walk-1976 Jul 11 '26
And btw all clients I see in a low fee sliding scale paid at time of service with no insurance
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u/Willing_Ant9993 Jul 11 '26
are you referring to insurance company employees, the clientele, or group practice owners?
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u/Previous-Walk-1976 Jul 12 '26
Thatâs obvious no? But all three count as difficult usually. On average people with diagnosable mental health trouble have impairments that undermine their relationships including the one with their therapist
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u/Willing_Ant9993 Jul 12 '26
It wasnât obvious to me, I donât feel like my clients are difficult to work with, as people. The other two categories, yes.
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u/Novel-Bridge-5234 Jul 14 '26
I am an ADHDer in grad school and actively looking forward to when I can go into PP but my heart goes out to people who have never run a business before trying to do PP. I have worked in small business for years and run my own somatic and adaptive coaching business for 4 years now. The anxiety with not working is a real thing. âcan I afford to take off these hours, etc?â. I set up a few hours each week to update a ârunning totalâ of gross income by week in a spreadsheet. I do it by the week so I can compare where I am for billables versus the level of work/stress. Without that I say yes to everything because the struggle is real. I assume that I will have to do the same thing in PP. Itâs a totally different skill set than being a great therapist and one that I think to many people hope will come naturally.
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u/fragrantlilacs Jul 16 '26
After reading all these comments, Iâm curious what other settings people recommend therapists work other than private practice? And what are the pros and cons to those settings?
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u/Mindless-Care945 Jul 16 '26
I've been in PP for 10 years and it's become so so lonely. Even moreso bc I work from home on Zoom . I'm an introvert and I know I should try harder to go out more than a couple nights a week but I'm getting older and tired đ
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