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My journey to becoming a psychotherapist came with lots of twists and turns, not unlike many other mental health providers in the field. My experiences working for big corporations and early stage venture backed start-up companies throughout my twenties and early thirties consistently left me feeling uncertain and unsettled about the impact of my efforts.
Meet the Expert
Benu Lahiry is the Chief Clinical Officer at Ours. She is a licensed marriage and family therapist with over 10 years of clinical experience. In addition to practicing therapy with individuals and couples, she is also an executive coach. Prior to becoming a therapist, Benu worked in early stage start ups leading customer experience teams. Having grown up in a small town in Appalachia with limited access to health care, she is passionate about broadening access to mental health care services across the nation.
Ultimately, I knew I worked best 1:1 with people. I was more curious about their lived experiences and understanding how they were driven to make decisions. Understanding who they were as people excited me way more than improving the company’s margin growth.
It took me a couple of years to decide what track I wanted to pursue. Eventually, knowing I wanted to work with couples, I decided to pursue a Masters in Counseling with a focus on Marriage and Family Therapy. So, after a few panic attacks, I decided it was a great time to go to graduate school to become a therapist.
My experience working as an Associate Marriage and Family Therapist (AMFT) in community mental health drove me to explore what starting a private practice would look like. And, the reality is, I think this is how many of us therapists choose to go into private practice - a reactive decision as a result of being overworked yet underutilized.
The disillusionment starts early. I wanted more time and collaboration with my patients, something that wasn’t afforded to me working within community mental health where measurements of evidence based therapy modalities are encouraged to drive successful outcomes which directly correlates to funding of many community clinics.
I started my private practice making a decision from the start to not accept insurance. I was wary of my burn out from working in community mental health, and didn’t want to deal with the hassle of managing all the administrative work on my own. I would know quickly if this was a poor business decision, in which case, I could change my mind.
It turned out to be the right decision for me, but there were a couple of huge considerations I had to come to terms with and accept as policies as a small business owner. Policies that even felt counter to my personal values as a therapist.
First, I was actively making the choice to only see private pay clients, which closed me off from seeing a more diverse segment of the population. This decision not to take insurance felt extremely fraught. Being a less accessible provider was not the point of going into mental health.
I heavily weighed the fact that I had spent a decade prior to going to grad school working in addition to the two years post graduate school in community mental health. I was still an associate MFT only earning a fraction of my earnings since I was employed by my clinical supervisor so I could continue to obtain clinical hours for licensure. I was also still working my day job (as a high school wellness counselor) in community mental health.
I initially saw clients in private practice one weeknight and on Saturdays. As a first time mom to my one-year-old daughter, I felt overwhelmed by the idea of managing insurance claims on my own. I knew I needed to start slow.
Second, I was making the decision to not just be a therapist, but also a business owner, which felt like I had to integrate two identities that felt polar opposite. The idea of being a small business owner excited me, but it also meant I had to think carefully about how I wanted these two identities to co-exist.
How would it impact my values as a therapist? I had never thought about it prior to starting my practice. It forced me to think through a framework for how the two roles informed the other, understanding that they will change and adapt over time.
Third, I believed that this approach would allow me to provide more personalized and effective care to my clients, which ultimately outweighed the drawbacks. By seeing my clients consistently without the constraints imposed by insurance limitations, I was able to foster stronger and more meaningful therapeutic relationships. This consistency was invaluable in building trust and understanding with my clients.
By having the time and space to spend on my clinical work, I was able to be an “out of network” provider for many of my clients by providing superbills for them to submit to their insurance. Initially, I was manually doing these on my own, which ate up into my administrative time. Since starting my practice, there have been many EHR platforms creating ease around generating superbills.
Ultimately, transitioning to private pay has been a rewarding experience that has allowed me to connect more deeply with my clients and tailor my services to meet their individual needs.
If you're considering making the switch to private pay, perhaps the most significant consideration is to first evaluate your priorities. Here’s an exercise to get you started, based on my own experiences:
Reflect on your values, goals, and the type of practice you want to build. What might it look like 2, 5, or even 10 years down the road? Are you working alone or with peers? Are you 100% virtual or in an office?
Consider whether the benefits of autonomy and personalized care outweigh the potential limitations in client diversity and administrative responsibilities. Do you enjoy marketing, branding, and accounting or are these things you’ll want to outsource?
The biggest mistake I see fellow therapists making is not spending the time to understand what it truly means for you to be a business owner. Are you comfortable with the business aspects of running a private practice, or would you prefer to focus solely on clinical work?
Every therapist is different and it can take anywhere from 3 to 18 months to fill your practice. Do you have the savings and emotional foundation to handle that takeoff period?
How will you set your rates and how many clients will you need to have a sustainable practice? Can you use superbills or benefits programs to lower the costs to your patients and increase the number of people you can see?
These are just some of the things I would recommend considering. Overall, aligning your decision to go private pay with your values, goals, and the type of practice you want to build can help reduce burnout and create sustainability in your private practice.
Deciding to build your own practice is an important, impactful, and deeply meaningful journey. But it’s not one to take lightly! Spend the time to understand what you want and the tradeoffs you’re making. And if you’re interested and experienced working with couples, check out Ours.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
