The 4 Stages of Starting a Private Practice

For therapists the initial pull toward starting a private practice may feel like a true calling—a deep, intrinsic urge to help people. 

That emotional connection so many of us feel to our work in therapy makes the typical path of a private practice therapist feel like a real journey.

It’s an intense and prolonged experience to go from a graduate student to a licensed therapist running a thriving practice. 

In many ways, the journey that a therapist takes to become a private practitioner goes on is a version of the hero’s journey.

And, whether or not you know that term, you know the story. The heroes of many stories you may be familiar with—Star Wars, The Lord of the Rings, even The Lion King—all go through a version of the same journey. 

In his book The Hero with a Thousand Faces, literature professor and author Joseph Campbell laid out more than 15 stages that the hero of almost every narrative must go through.

At a very high level, though, the four main stages are a call to adventure, an initiation, a transformation, and the return. 

The hero’s journey: Navigating private practice

The experience of starting a private practice has irrefutable parallels with Campbell’s hero’s journey.

Many of the common stages in a practitioner’s career—getting licensed, opening a brand-new practice, filling your client caseload, and then branching out into other areas like teaching or writing a book—fit into key stages of the hero’s journey. 

The initiation, which in the hero’s journey is also sometimes called a supreme ordeal, is the licensure process.

Remember the long hours, low pay, tiny offices, and tough exams?

It’s certainly an ordeal. However, at the end of that process, you’re ready to jump into being a practicing clinician. 

Transformation can, and does, happen at any stage of your career, but the challenges of starting a private practice bring on unique and valuable changes within you.

We learn how to set fees, how to market ourselves, and slowly we become skilled business owners and clinicians. 

And finally, this adventure of private practice helps us develop gifts we can share with our clients and our larger communities. Beyond the work we do in our sessions, we can share our wisdom and experience with others as educators, writers, podcasters, and public speakers. 

1. The adventure: Answering your calling

Has anyone ever asked you what led you to starting a private practice?

I’m guessing the answer is yes, however it’s usually pretty difficult to come up with a quick response.

Most of us feel called to this work from a deeper place that is full of personal meaning and purpose. 

If you and I sat down to have a cup of coffee and share our stories, we’d likely be there for quite a while.

Becoming a therapist isn’t an easy career choice. And, while everyone comes to this work from a different place, we choose to become practitioners because it feels like an essential part of our life’s mission. 

My path, for instance, involved working to heal from a difficult childhood and discovering that my capacity for empathy and connection was useful to others.

Even though I was fairly confident in my choice, becoming a therapist was definitely a call to the unknown. And I’m sure others have felt something similar—this work is a call to explore our own inner worlds and seek an adventure that will create positive change in the world. 

When you’re at this early stage of your career, you may not know for sure what your future holds—and that’s OK.

I was certainly not sure of anything past my licensure, which took up all of my focus and energy. 

2. The initiation: Choosing private practice

It’s a rigorous initiation to go from the demanding coursework in grad school to the extensive licensure process. This is why therapists clap and cheer when they get the news that one of our peers has passed exams. We feel all the pain and pleasure of this epic accomplishment.

I’ve often wished that my own initiation process wasn’t so lengthy and challenging.

Thanks to transferring schools mid-degree and choosing a three-year graduate program, it took me a full eight years to complete all my studies. I was also slow to complete my required training hours. That process ended up taking the entire six allowed years for a variety of reasons—I had a few internships that didn’t give me enough hours, and my wife and I had two amazing daughters. On top of all of that, I was also struggling to develop my confidence as a fledgeling therapist. 

So, as someone who got started on this journey right out of high school, I didn’t actually get fully licensed as a marriage and family therapist until I was nearly 30 years old.

At the end of the day, I’m grateful for this intensive initiation. Though, it was an ordeal, it was a formative experience, and it helped me build up the confidence I needed to take the next step—opening my own practice. 

If you’re at this initiation stage of your journey, you may be thinking more seriously about the possibility of starting a private practice.

Or, maybe it still seems a bit uncertain and unknown, but it’s something you are considering.

As you get closer to becoming licensed and are thinking about your next steps, you’re also getting closer to the transformation that comes along with running your own practice. 

3. The transformation: Becoming a business owner

Once you’ve completed your licensure process, you come face-to-face with your career options (a many-headed beast if I ever saw one).

Many careers offer chances for transformation and growth, but there’s something unique about the transformation that happens when you decide to start a private practice.

It’s a whole new initiation beyond licensure that can test your grit, your resilience, and your tolerance for uncertainty.

If you’re like most new therapists, you don’t have a business degree or any formal training in how to open or operate a business. You’ve got the treatment part down—but the rest is a bit of a mystery. 

In the first year of private practice—my own included—you have to figure out how to solve so many new problems. How do you build a website? Should you have business cards, and what do you put on them? How do you negotiate a lease for an office space? How do you set your fees or bill insurance?

There are so many questions, and in that first year, and yet seemingly so few answers. 

It was a massive learning curve that I wasn’t prepared to face. In my experience, the key to finding solutions to most of these problems when starting a private practice was reaching out and seeking help from others.

Before you’re even posed with the task of learning how to do any of this, it’s important to find reliable resources and information that you can refer back to as these new challenges arise. 

I had many tearful conversations with my consultation group about the rollercoaster of starting a private practice. When I was new and trying to support my young family, every new referral was a thrill, and every client who left therapy made me feel like my whole ship was sinking. 

Initially, I found early success by focusing on my niche, which was working with teenage boys and their families. I set up my therapy website and started a parenting blog. Then, I sent out a regular newsletter with helpful tips each week. Slowly, over time, my schedule filled up—and has stayed full. 

To this day, my confidence as a therapist and a business owner increases every year. I’ve learned to manage personal anxiety and the uncertainty of private practice, as everyone must. The experience of starting something from nothing and watching it grow creates a transformation that’s beneficial on many levels. 

Many of the people I know in private practice have had similar experiences. If you’ve already opened your own practice, maybe you have too. If you’re thinking about starting one, it’s helpful to know what you’re getting into—this is hard work. But fortunately, there’s an abundance of resources that didn’t exist even just five or ten years ago that can help you make through this transformation to the next stage.

4. The return: Figuring out what’s next

The last stage in the hero’s journey is called the return. This looks different in each story, but at the core of each narrative is the hero returning from his adventure as a changed person, with gifts or new knowledge to share. 

Once a practitioner has a full and thriving private practice, many people often experience a desire to explore other ways to share their own gifts. Some people continue to focus on direct client care, which is a gift in itself. But there are more ways today than ever before for skilled practitioners to benefit their communities. 

For me, this has evolved over time to include things like writing ebooks, teaching online classes, speaking at events, starting a group practice, and starting a virtual assistant business. I went through my initiation and transformation, and now I have a chance to share what I’ve learned over the years with my peers. 

As the field and technology continue to evolve, there’s an ever-growing number of ways for practitioners to make a difference, both in their sessions and beyond. I’ve certainly not explored all the options, and the ways we as practitioners can use our gifts to benefit others will only keep growing from here. 

So, what’s next? 

When you’re in the early stages of this journey, it can seem impossible to see where the road ends. There are a lot of side trips to take and downed trees to climb over, and it can seem overwhelming to even take that first step. Luckily, other travelers have walked this road before, and we have a map ready for you. 

When you’re thinking about where you want your career to go, ask yourself what your dream project is and use that as your North Star. If you could create anything and share it with the world, what would it look like? Although the roads other people have taken can act as a guide, they’re not the only roads you can take. Your unique ideas, dreams, and goals will guide you through whatever stage of this journey you’re in.

You’re the hero of this story.

You get to choose how the next chapter unfolds. 

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