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Monday, December 2

Private Practice: Like It or Not, Your Private Practice Is a Business

Denise Duval Tsioles, PhD, LCSW

The NASW Illinois Chapter has started a shared interest group (SIG) devoted to the issues of private practitioners around the state. To be become involved in this group, please contact the NASW Illinois Chapter office: http://naswil.org/naswil/contact-us/.


Most therapists in private practice do not have a business degree, nor would they ever think they might need one. Now just because you have a private practice does not mean you need this kind of degree, but even individual practitioners need some business savvy.

“But I don’t like managing a business. This is not what I went to school for. I just want to do what I was trained to do and help clients.” I have heard these words many times from colleagues and have spoken them myself. As my client numbers grew though, I came to the realization that my practice is a business and attention needed to be paid to it at such.

Even though your practice is a business, it is not necessary to spend all your time managing the business, especially if you put some simple systems in place. If you have systems, the business piece can almost run itself, and you can focus on your true passion—being a clinician.

What follows is a list of a few things therapists can do to simplify the business end of their practice and get on with the work of therapy.

Develop Policies and Procedures

Most therapists, especially those who have been in practice for awhile, have a typical way of doing things that has developed over the years. They return calls within a set timeframe, have forms to track client information and obtain consents, charge specific fees for various services, have policies around missed appointments and late cancellations, etc. These things simply need to be formalized and adhered to for every client (there will always be an exception to the rule, so leaving room for this is fine as long as the exceptions do not become the rule). As new situations arise, new policies and/or procedures should be developed (e.g., working with cases that have attorney involvement). Formalizing policies and procedures takes the guess work out of things and makes it much easier to manage client business.

If you end up hiring contractors or someone to manage intake and/or other aspects of the practice, your practice will have standards, and you can trust that clients will have the same experience. This is not to say that their treatment is standardized, but the practical components of the process will (e.g., cancellation policy, client awareness of payment methods). This not only provides a framework for the client (which most appreciate since they have a lot on their minds already), but it helps maintain consistency among therapists and staff as well.

Have a Formal Bookkeeping System

Even for therapists that use a service, attention needs to be paid to billing. We would like to think that if we send our hours to a billing service, insurance (if you accept it) will be billed and client balances will be collected accurately and in a timely fashion. There is a lot of room for error here—error when sending in billable hours, error when those hours are entered, errors on the part of the payee, and so forth. Although billing companies usually get a percentage of what they collect, you are one of several clients and your priorities and attention to detail may not be theirs. Thus close monitoring and follow up is necessary.

Since monitoring and following up on the financials of the business is necessary, one way to make it feel less burdensome if you are not particularly fond of numbers is to have a bookkeeping system. This is a definite must if you are not using a billing service. It does not have to be an elaborate or expensive system; it just needs to work for you. Some people prefer systems that can track their notes, bill insurance, and send statements to clients, (e.g., Therapists Helper) while others can manage everything such as entering client sessions and sending statements with a basic online accounting program (e.g., QuickBooks). These systems are worth the money, even for a small practice, because they save time, reduce error, track expenses, and provide summary reports for taxes at the end of the year. Few people want to or have the time to spend calculating client balances and figuring out yearly expenses.

Offer Clients Multiple and Easy Ways to Pay

Collecting fees is often one of the most stressful and challenging things for therapists. As therapists we are providing a service and should expect payment for those services, just like a doctor, dentist, or physical therapist office. For most clinicians in solo practices, there is no receptionist to collect fees which leaves it up to us take payment. So we need a good way to do it. Without a specific policy around payment and easy ways to pay, far too much time is spent attempting to collect client balances. What we do not want to do is feel like a collection agency.

First and foremost, clients should be clearly informed as to when payment is expected. Ideally therapists should expect payment prior to or at the time of session. Some collect payments at the beginning of sessions to get it out of the way and ensure it is not forgotten. When to collect payment is a personal choice and something that should become a policy. However if you do not want to turn into a debt collector, payment should be expected at the time of service. If this is a clearly stated policy, most clients will adhere to it.

There are multiple ways to accept payments nowadays: PayPal online, mobile credit card swiping systems such has PayPal Here and Square, bank transfers such as Chase QuickPay, online charging systems such as PayPal where the therapist enters the client’s credit card information and requests payment, and good old fashioned checks and cash. When clients have options, they are more likely to pay and do so quicker. It is also becoming a standard in practices to leave a credit card on file for unpaid balances. Medical professionals are instituting these policies, and therapists should as well. Cards can be charged for any outstanding balances at the end of the month, thirty or sixty days overdue, or whatever interval the therapist chooses.

Document Everything

The best way to stay organized, spend less time managing the business, and handle growth is to document your system. If you have a good, solid system that is well documented, your time can be spent treating clients. The systems are in place and working for you. These are just a few ways to run a therapy practice without feeling like a business manager. Like it or not, private practice is a business. The better you are at what you do, the more you will expand, and the more you will be grateful you have some structures in place to ensure the business runs smoothly while you focus on the real work of therapy.


Denise Duval Tsioles, PhD, LCSW, is a psychodynamically oriented child psychotherapist who maintains a thriving private practice known as Child Therapy Chicago (http://www.ChildTherapyChicago.com). Denise is also on faculty at the Institute for Clinical Social Work where she teaches and consults with doctoral students on their clinical cases and dissertations. She has worked with children and families since 1994 as a clinician and researcher in child welfare, counseling agencies, educational institutions, and private practice. Denise specializes in working with young children using psychoanalytic play therapy and provides parent support and coaching.

Posted on 12/02/13 at 08:14 AM

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