Private Practice Lessons Learned From 15 Years Coaching Therapists

For over 15 years, I’ve been working with and coaching therapists in private practice.

And I’ve seen it all.

I have harrowing examples of mistakes, missteps, and failures from my career over these years, all of which have taught me some valuable lessons along the way.

I collected these in this list of private practice lessons for therapists.

Ready to dig in?

*Names have been changed when appropriate for privacy, but all stories are shared with permission.

Private Practice Lesson #1:  We aren’t meant to do this alone

Do what alone?

None of it.

Become a therapist.

Start a business.

Live a life.

We do best when we have supports in place.

On the July 4th weekend of 2005, I failed my second licensing exam by one point.

It was one of the most demoralizing moments in my life, complicated by the fact that I was heading to a family reunion where everyone knew I was taking the exam.

When I told them I failed, they thought I was joking.

And, when they realized I was serious, my grandmother was adamant: “If my Mandy didn’t pass it, there must be something wrong with the exam.”

Thanks, Grandma. That’s sweet. 

Looking back, some of the questions on the test were bizarre.

Others had typos.

But I reached out to the administrators and they were clear: There were no options to retest. The test was just fine. 

At this point, I was working at an inpatient psychiatric facility and then moonlighting teaching for a university.

In a course assignment, I taught students how to utilize online study groups through Yahoo Groups. That inspired me to start a free online study group of my own. 

A few months after failing my exam, I learned the version of the exam I had taken had had something wrong with it. It turned out I had actually passed. (And Grandma had been right.)

How did I learn that?

A letter from the board?

Nope!

It came from a post by a study group member. 

I was and am still completely thankful for that failure.

It showed me the power of community to bring heartfelt people together from across time and space.

I also realized very quickly it wasn’t just about exams.

That study group has touched the lives of over 50,000 therapists since 2005, and each of them have helped others while also receiving help.

It was also the jumping off point for me to step into my role as a guide, consultant, and coach over time. 

Private Practice Lesson #2: Failures can be your path to success

While failing my licensing exam felt terrible at the moment, it was truly the start of my business.

And I’m not alone in a failure, lighting a path to success.

Nicol Stolar-Peterson got called into court as a social worker many years ago.

She asked her supervisor what to do to prepare, and they said just show up and answer questions.

Nicol reported that she got “taken to the wall” during that first experience of being cross-examined. She didn’t help the lawyer and ultimately didn’t help the children who the lawyer was advocating for.

After her initial thought to quit her profession to never have to do that ever again, she decided to learn more so she never had to feel like that again. 

She started to learn about the court process. She reached out to lawyers to help prepare her for future court cases, and she not only became great at being a witness in court, she was also able to help friends and colleagues as well.

Her initial failure started her on her path of helping others (not unlike my own experience). 

At a conference my business was hosting, she shared with the group that she didn’t feel like she had any special skills or anything that she could offer. Several of the attendees were clinicians she had previously helped with subpoenas and court preparation. They saw her value and all rallied to say her knowledge of that system should be in a course, a handbook, or something that any therapist can access.

By the end of the conference, the idea for TherapistCourtPrep.com was born.

Fast forward several years and Nicol is a paid expert witness, and therapists across the county and the world benefit from her resources. 

I am constantly in awe of the power of bringing people together who are aligned in values and intention. It’s truly powerful whether you are trying to jump through licensure hoops, launching a private practice, trying to find your purpose, or trying to find joy in the midst of life. That said, just bringing any community together isn’t always the answer. 

Private Practice Lesson #3: Sometimes a pivot is the answer

Let’s talk about Sara*, a therapist from the Midwest in a suburb of a large metropolitan city.

She felt wonderful when a previous clinical supervisor contacted her about becoming a co-owner of a group practice. It was headed by people who were running several of these cooperative practices. Great community and two experts at the helm, she thought. What could go wrong? 

Fast forward a few years, and Sara was working 15 to 30 hours every week as a co-owner of this practice, and was paying even more into it on a monthly basis.

In other words, the group practice wasn’t only not making a profit, it was operating at a loss month over month.

Even in months where there was a small profit, it didn’t amount to much after being divided among multiple owners. 

Sara had invested thousands of dollars and thousands of hours into this practice. But she started to see the limitations of the business setup, and she just wanted to recoup her investment and move on.

She came to me to work on building up her private practice on the side, so she could have consistent and viable income. As we dove into what was happening, I was stunned. The contract she had signed didn’t even give her a way to leave the practice or sell her shares. 

When Sara finally made the decision to energetically and financially cut her losses, it left her with the space she really needed to build her own private practice. It took some time to heal and rebuild her trust with herself. Now, she runs her own thriving group practice that fits her and serves her clients well. It took some trust to know that pivoting away from her co-owner position was the right move for her, and she now knows that she’s a capable business owner. 

Lesson #4: You don’t know what you don’t know

Lauren* came to therapy as a second career after having her life changed personally through psychotherapy. She started her private practice energetic and ready to have a great experience. She knew the launching phase would be tough—and so initially, she thought that she just had to take what you can get in terms of referrals and fees. 

A few months into running her practice, and she was feeling frazzled trying to become an expert on every concern clients came in with. Lauren truly wanted to help her clients get great outcomes. Consequently, she was carrying around a huge weight of trying to do things perfectly. She also wasn’t making a sustainable income at this time, and realized she would easily burnout before she made it to success—whatever that looked like. 

Lauren realized she was having a difficult time successfully marketing her business to the right clients, and she joined my business school for bootcamp to start learning those skills. There, she quickly realized that taking every referral that came her way wasn’t a sustainable way to grow her caseload either. 

She learned how to focus her clinical energies and attract her ideal client, so that any new skills or knowledge she gained didn’t just help one of her clients, but all of them. She found more energy and alignment in her marketing, and saw her outcomes with her clients soar. And she was able to start to quiet that imposter syndrome that was fueling her overworking and putting her at risk for burnout. 

For Lauran and many others, closing the gap in knowledge is all it takes to open up the potential within. It doesn’t mean you’re an imposter if you don’t know something—it means that you just have something to learn and there are people and resources out there that can help you, so you don’t struggle alone.

Lesson #5: Your business will be a big opportunity for personal growth 

Many therapists I’ve worked with have found that their family of origin issues crept up on them as they were trying to run their business.

I’ve worked with people all over the world who’ve hit a block in running their practice, and when we simply scratch the surface, we found a direct tie back to their family of origin issues.

When you think about it, this isn’t all that surprising.

What you do in one area of your life often bleeds over into what you do in other areas. 

Feeling taken advantage of by insurance companies—but don’t feel like you can say no, or ask for what you need?

Did you grow up feeling trapped in unhealthy relationships and dynamics where you were told you couldn’t say no?

While it’s often initially frustrating for therapists to realize how these “other” issues are replicated in their businesses, I look at it as a beautiful opportunity to dive deeper in,

Take Joanne* as an example, a therapist from California.

As she dug deep into learning more about herself as a therapist, human, and business owner, Joanne became more aware of how she was and wasn’t showing up in the world. 

She started to show up more authentically in the world not just in her business—but also in her marriage, with family, and with the world at large. Over time, she was able to fully claim her truth and speak it in a way that she had avoided most of her life. For Joanne, diving into and speaking truth in her business was the first step to speaking truth in all other areas of her life. 

In my business, we’ve watched therapists who felt empowered by growing a successful business end abusive relationships, come out of the closet, step out into their role as a global speaker, break through long-standing patterns in their family of origin issues, step into healthy relationships, and so much more.

It truly is inspiring to watch. 

Private Practice Lesson #6: Your resources are limited

Tabi* was a single mother, survivor of domestic violence, and faith-based therapist in North Carolina.

She came to us working three jobs trying to keep everything running while still also being present for her son.

Over time, she worked towards dropping her multiple jobs until she finally focused 100% on her private practice. 

As she focused on her private practice, though, she felt the squeeze and struggle. She wanted to make her trauma therapy services as accessible as possible. She also had limited time and energy, and she had very real financial obligations. 

But, Tabi was stubborn. She kept working six days a week—sometimes more than 10 hours a day—trying to make it all work.

She did what many of us do—she saw a broken system and tried to step into the gap to fill the need, even if it was putting her in long-term physical and financial danger. 

Initially, it took insurance regulations that impacted her ability to work in a way that benefited her clients for her to let go of her insurance contracts.

Over time, it took others needing more from her for her to be honest about the real costs of doing business, and for her to start charging a sustainable fee that allowed her to meet the needs of herself and her son. 

Many of us have businesses that are only sustainable if nobody gets sick ever, nobody takes vacations or sabbaticals, there are no unexpected expenses, and our relationship status or partner’s income never changes.

Our bodies will sometimes signal to us that this isn’t sustainable—whether it’s through the development of unexplained ailments, burnout, or an increase in other mental health symptoms.

Sometimes the best thing we can do for our business is realize that we have limited time and resources, and find a way to operate sustainably within those limits. 

Taking a moment to reflect

I chose to share these lessons because I’ve seen stories like them replicated over and over again.

Sit here for a moment.

Do you see yourself reflected in any of these therapists’ stories?

I’d encourage you to take a few  minutes to reflect, and see if there’s anything in you stirring for a change. 

If there’s anything in you saying something in your business isn’t quite right, you’re probably right about that.

It’s okay to make changes, even if it seems hard or scary at first.

Those changes can often lead to more ease and joy for you, not only in your business, but in the rest of your life as well. 

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