Behind the Scenes of Running a Private Practice: The Realities That Shock New Business Owners

Starting a private practice often comes from a place of passion—whether it’s a desire to help others or a love for the work itself. As a therapist, it’s easy to envision spending most of your time connecting with clients, helping them navigate through challenges, and witnessing those rewarding moments of growth. However, what often comes as a shock to new practice owners is the sheer volume of behind-the-scenes tasks involved in running a business. It’s not all about therapy sessions; there's so much more, and it can feel overwhelming at first.

The Business Side of Things

When you launch a private practice, you step into the role of both therapist and business owner, which brings with it responsibilities you might not anticipate. While you're likely well-trained in therapeutic methods, no amount of clinical training prepares you for navigating taxes, managing billing, and balancing budgets. Suddenly, you’re dealing with things like:

• Budgeting and Financial Management: Keeping track of expenses, income, and taxes is a full-time job in itself. It requires diligent record-keeping, software, and often, consultations with accountants or financial planners.

• Client Scheduling and Admin Work: Managing a schedule is a balancing act, especially when you’re juggling client preferences, your own availability, and inevitable last-minute changes. For many, scheduling quickly becomes one of the most time-consuming tasks.

• Insurance Claims and Paperwork: If you work with insurance companies, there’s the added headache of filing claims, following up on unpaid claims, and dealing with the bureaucracy that comes with health insurance systems.

• Marketing Your Practice: As a private practitioner, you’re also responsible for ensuring that clients find you in the first place. This means managing your website, creating content, staying active on social media, and possibly even running paid ads. Marketing requires consistent effort and creativity, which can take you away from what you love most—working with clients.

The Emotional and Mental Toll

While helping clients through their struggles is incredibly rewarding, it can also be emotionally taxing. Many new practice owners are surprised by the mental load that running a business adds to their emotional bandwidth. You might start the day managing a client in crisis, and then immediately switch gears to handle admin work, leaving little time to decompress between roles. Over time, the emotional weight can lead to burnout if not managed carefully.

• Work-Life Balance: It’s not uncommon to spend evenings answering emails or catching up on paperwork. As a result, many find the balance between personal life and work harder to maintain than anticipated. Setting boundaries becomes crucial, and yet it’s one of the hardest things to do as a new business owner.

• Loneliness and Isolation: Another reality of private practice ownership is the sense of isolation. Unlike a clinic or agency, where you may have colleagues to share the load or debrief after a tough session, running your own practice can feel like you're going it alone. The lack of professional support can sometimes be a surprise to those used to working in a team environment.

The Learning Curve

Despite these challenges, owning a private practice is an opportunity for tremendous growth—both personally and professionally. Most new business owners go through a steep learning curve that teaches resilience, problem-solving, and time management.

• Trial and Error: From selecting the right electronic health record (EHR) system to setting fees, everything requires decisions that have real consequences. It’s normal to make mistakes along the way, whether it’s pricing yourself too low or overbooking your schedule.

• Outsourcing: Many eventually learn to outsource tasks like bookkeeping, marketing, or admin work. This can be a life-saver, allowing therapists to focus more on client work and less on the business side. However, finding reliable support also takes time and resources, which new business owners often don’t anticipate.

Final Thoughts

Running a private practice is rewarding, but it’s far from the picture-perfect vision of spending your days solely focused on therapy sessions. The reality of being a business owner brings unexpected challenges, from managing finances to balancing the mental and emotional load. It’s important to go into it with your eyes wide open and be ready to learn as you go.

But, here’s the good news: these challenges aren’t insurmountable. With time, the right support, and careful planning, you can find a rhythm that allows you to do the work you love while also maintaining a successful business. Embrace the learning curve and take it one step at a time, knowing that even behind the scenes, you're building something truly meaningful.