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A Practical Guide to Setting up a Private Practice in Therapy

Timewith

Timewith

Friday, 27th March 2020

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If you are a qualified counsellor or psychotherapist registered with one of the professional associations, you may be considering ‘going it alone’, whether it is the right time, and how to start. There are some aspects which require immediate consideration and others which can evolve as you build your practice.

Your business will reflect your personality and your key strengths, however an awareness of your limitations is equally important. Being a great therapist does not necessarily equate with having a keen business acumen and superb record keeping abilities! On the other hand, you may come from a business background and have a totally different take on how to start a practice. You will find your own path in this, just as you are finding your own unique style as a therapist.

Are you ready?

You may have found due to the current situation that you have more time than usual and you might have the space to consider your options.

Do you have confidence in your proficiency to start a practice?
Most therapists are apprehensive at the start. Remember when you saw your first ‘real’ client? What was that like for you?

Your supervisor is a great person to discuss this with as they have a comprehensive view of your work and skills. They will be able to advise you, not only based on their own experience, but also the experience of their supervisees. Support from colleagues and sharing knowledge is equally useful.

Private practice can be isolating, so it is important to take that into account. Research local professional networking groups and peer or group supervision and consider balancing private practice with organisational work.

Where are you going to see clients?

Location
Depending on where you live, you may join a group practice, or rent a room from one. There are other types of wellbeing practices, such as osteopathic, chiropractic, dental or medical practices which may have rooms available to rent on an ad hoc basis. This can be a great option as you will be working alongside colleagues from different disciplines with a ready established client base. If you plan on working from home, assess whether there is a suitable space separate from the rest of your household, taking into account toilet use and personal safety.

If you happen to be at this stage of the journey, have a read of our guide to finding and setting up a therapy room.

Research your location
You may live in an area which has an abundance of therapists, or in an area with few. Some therapists who begin practicing in more than one location report that one practice is far busier than the other. Consider whether you are prepared to travel further afield or whether you can take your time to build your reputation locally.

Online Therapy
This might have been something you would not have considered initially when starting a practice. Much has changed rapidly since the start of the pandemic and now therapists and clients are regarding this as a necessity. Indeed it might be that the pandemic will change the way therapists work in the future.

At present, rules about online therapy have been relaxed so that therapists can provide much needed services to their clients. Check with your professional body to ensure that you have the skills to work online, for example the BACP provides information about competencies and has updated resources in light of COVID-19, including links to short courses on online working, which will cover topics such as different encrypted platforms for video conferencing, telephone working, and messaging/email communication, as well as issues to be aware of when working online such as the disinhibition effect.

ACTO, the Association for Counselling & Therapy Online, provides a wealth of information and a list of accredited training providers. You can become an ‘Accredited Cyber Therapist’ if you complete a course with an average of 80 hours. Whilst this may not be necessary for occasional online working, this may be something to consider if therapists are going to be engaging in more telephone and online counselling in the long term.

Check with your insurance company to ensure you have cover for online working. Most insurance companies cover you, but not for clients living in the US and Canada, as they have more stringent regulations than in the UK.

Other sources of useful information, webinars, and groups include Online Events CPD and Kate Anthony’s website.

We've also written a guide to setting up an online practice.

Important Practical Items

Insurance
Insurance is mandatory, and is not prohibitively expensive. The main ones are Towergate, Howdens and Balens. They may have discounted rates for certain professional associations so it is worth getting a quote from each of them.

DBS certificate
You may want to apply for a certificate; this may be mandatory if you work with children or vulnerable adults.

Professional Membership
Ensure that you abide by the requirements and ethical guidelines of your professional organisation, such as the BACP’s Ethical Framework.

GDPR compliance/confidentiality and data storage
Your professional organisation should be able to advise you on this. You need a privacy statement on your website, here is an example and a statement about how you will store and secure data included in your therapeutic contract/terms and conditions. Check your insurance policy as it may stipulate how long you are required to keep records.

You must clarify whether you are required to register with the ICO (Independent Commissioner’s Office) and pay a fee. There has been a considerable amount of conflicting advice circulating around this. The ICO has therefore produced a guide on GDPR compliance and a self-assessment checklist and fee checker.

Sole trader or limited company?
Most therapists start as sole traders. This means that you have full liability for claims, but a comprehensive insurance policy should cover you in the event of a claim. You also need to register with HMRC as self-employed and be issued with a unique taxpayer’s reference (UTR). This is a simple procedure which can be completed online.

Setting up as a limited company is more complicated but it does mean your liability is limited. HMRC is a good source of information for this. It is certainly something to consider once you are established.

A simple Excel spreadsheet will suffice, or paper records, detailing all of your income and expenditure, including professional memberships, directory listings, CPD, insurance, supervision, room rental, etc. You will need this for your own records and also for your self assessment tax return (see HMRC’s website).

Additional admin

Forms
You need a therapy contract, terms and conditions and can additionally produce the following forms: initial assessments, risk assessments, risk action/safety plan, confidentiality waiver, etc. Think about what works best for you.

Phone/email
Consider having a separate email address and phone number from the start, as this is difficult to change subsequently and can become troublesome as your practice builds. Boundaries are crucial for self-care and you will need to switch off.

Record keeping
Both handwritten and electronic notes are required to be adequately secured, anonymised and kept separately from clients personal data. Payments can simply be recorded in a notebook and transferred to your income and expenditure spreadsheet. You will in due course devise a system which works for you or invest in software, such as Assistant.

CPD
Check with your association for recording requirements.

Marketing and Business Considerations

How do clients find their therapists and what are they looking for? A good way to think about this is what attracted you to your therapist when you were training? Empathy and trust are key to every modality, but what do you offer specifically? How do you work? Are there any areas which you have a particular interest in or have experience with?

Business plan
Although you may not need a formal business plan, it will be helpful to consider matters such as, envisioning your ‘ideal’ clients, or target market. If you have a business background on the other hand, you may consider a formal plan mandatory.

Directories
It is not necessary to sign up to every directory! It is best to start with your professional association. As a member of BACP, for instance, the annual cost of a listing is £76. Counselling Directory starts with a subscription costing £19.50 per month and it is the probably the most well-known. Do not be tempted to tick every box in ‘areas I work with’. Choose the ones that accurately reflect your experience and interest. Bear in mind that you can provide links to your website, Facebook and Twitter accounts, etc, if you have them.

Be aware that some unscrupulous organisations target therapists once they are listed on a directory, so do investigate before signing up with any organisation that contacts you directly.

Our Head of Marketing, Seb shares some broader tips on directory strategy here.

Websites
You do not need a website initially, although you can consider free website builders such as Wix, Go Daddy or Wordpress. For something a little more tailored to therapy, Webhealer offers low cost or bespoke websites specifically for therapists. Webhealer also has a free e-book on web marketing to promote your services to clients.

Business cards/leaflets
Business cards or leaflets can be printed cheaply from companies such as Vistaprint, if needed.

Writing a directory entry/introduction on website
It is important to think about the mindset of your prospective clients and what you can offer them. Our founder Mark shares some tips on how to do craft a compelling profile here.

Ultimately, a strong online presence will be reassuring to potential clients, even though you are unlikely to attract clients directly from Twitter or LinkedIn, for example. Social media is also a great way of connecting with other therapists.

Also, consider signing up with us :).

Fees

It is difficult for many therapists to focus on fees. You have spent a great deal of time and money in years of study and self-exploration in therapy to get to this point. You may have altruistic reasons for becoming a therapist, but you are ultimately running a business. Many qualified therapists volunteer and give some concessionary rates. However, as a business owner, you need to earn more than just meeting your costs.

You may want to research what therapists charge in your area. Look at the average and use this as a guide. Being comfortable with what you are charging is essential but do not undersell yourself.

Keep a list of expenses and income. Investing in specific software is not necessary, a simple Excel spreadsheet will suffice at present.
Include all expenses; some will be start-up costs but most will be ongoing. This will give you a clear idea of what you need to earn to make this a viable business. There may be a discrepancy between what you realistically and ethically can manage and how many client hours per month you need to work from a financial perspective.

Don’t ‘give up the day job’ just yet!

It is important to think about where you are at the moment. If you have a steady income you might want to continue that alongside private practice, at least at the beginning. It takes time to build a practice and requires some financial outlay from the outset. The upside to this is that you can take your time and gradually develop your practice.

And finally

Think about how many clients per day are appropriate for you and how many days per week you want to work. Remember to reflect on your self-care, adjusting the balance as you go along.

Building your practice slowly certainly makes it less daunting and more manageable and will increase your confidence and ability to run a business.

Ultimately there is no one way to run a practice - test stuff out, speak with others, and figure out what works for you..

Good luck!

Have a suggestion or a topic you want answers to? Join our group, send us an email with a topic you'd like us to write about or [book a private practice audit](https://calendly.com/mark-tsirekas/1-on-1-practice-consultation to discuss your own challenges with a member of our team about your practice.

For full details on what we offer to support therapists to grow their private practices, head here.