Less than a year after Lauren Behrman, PhD, completed her doctoral degree in clinical psychology, she owned her own private practice. It wasn’t much at first. She started off by seeing clients, mainly children and adolescents, on nights and weekends in her supervisor’s office while working part-time as a school psychologist in Nassau County, New York. Now, 34 years later, she manages a thriving full-time solo practice with three locations, and she continues to love her work. Much of her success can be attributed to her willingness to take risks and think creatively about her practice—skills she did not learn in graduate school or on internship, at least in any formal sense.
"I did everything by the seat of my pants those first few years, picking up ideas from the different clinics and institutional settings I’d worked in during graduate school," recalls Behrman. That lack of information is one of the reasons she co-founded The Practice Instituteopens in new window, which is dedicated to helping mental health professionals build ethically responsible, thriving practices.
To help others sidestep such steep learning curves and build flourishing practices of their own, Behrman and other established practitioners share 11 keys to independent practice success.
1: Think like an entrepreneur
Counseling and forensic psychologist Charmain Jackman, PhD, says she gets her best private-practice inspirations from the business world, particularly when it comes to marketing and branding her services. "A corporate workshop I attended early in my career taught me the importance of seeing myself as a brand," says Jackman, who in addition to running a part-time clinical, forensic and business development practice serves as the dean of health and wellness for the Boston Arts Academy.
She consults with psychologists who want to launch their own practices about the importance of determining their core values, honing the image they want to project and then developing a mission statement that sets them apart from the crowd. "We don’t often think like that in psychology," she says.
This brand-building strategy has worked well for Frank Gaskill, PhD, co-founder and managing partner of Southeast Psych, a group practice serving adults, children and adolescents with locations in Charlotte, North Carolina, and Nashville, Tennessee. His team decided that one of the practice’s core values should be creating a fun and enjoyable atmosphere for patients. Gaskill and the clinicians who work at the practice value spontaneity, humor and enjoyment of life, and those values are reflected in everything the practice does, from the way the waiting room is decorated to the videos they post on their website.
2: Determine your specialty and augment your training
In graduate school and early in your career, think about the populations you most enjoy and are best at treating, experts advise. Shortly after graduate school, Behrman decided to focus on serving children and adolescents. She launched her practice after fine-tuning her abilities with four years of postdoctoral training in child, adolescent and family therapy. As her practice grew, she saw a need for help among families experiencing divorce, so she sought training in high-conflict co-parent counseling and parent coordination. Such services continue to be in high demand, and providing them helps her stand out from other child and family-focused mental health practitioners. To promote her expertise and help even more families, she co-authored a book, "Loving Your Children More Than You Hate Each Other"opens in new window (New Harbinger, 2018), with her husband, psychologist Jeffrey Zimmerman, PhD, ABPP, on how to parent as a divorced couple, and she leads workshops with him on how to recover after divorce.
3: Add unexpected services
Sometimes expanding your practice means offering a service that your patients need but don’t expect to find in a psychologist’s office. After Gaskill realized how much he and others in his practice were recommending certain books to their clients and families, they created mini bookstores in their reception areas. Now, each of Southeast Psych’s locations has a full bookstore that stocks the therapists’ most recommended books.
Four years ago, in response to client demand, clinicians at Alvord, Baker & Associates, LLC, a psychotherapy practice with two locations in Maryland serving adults and children, began offering a weeklong "Cool, Confident and Courageous Kids Camp" for children with severe social anxiety and selective mutism. The summer camp, modeled after a program developed by child psychologist Steven Kurtz, PhD, ABPP, is designed to boost children’s confidence and skills before the start of a new school year, says Mary Alvord, PhD, director of the practice.
"The response we received to the camp led us to now offer specialty groups for this population," Alvord says. "Seeking out needs and providing specialized evidence-based skills has really helped expand our practice in so many ways."
4: Be responsive
Alvord also credits her success to the value she places on being approachable and doing what she says she’s going to do, whether with clients or outside sources. "When you call people back and collaborate with them, they remember that," she says.
She emphasizes that message with her clinicians, instilling the importance of returning potential client calls as soon as possible, for example. She also encourages her clinicians to keep primary-care physicians, psychiatrists, pediatricians, teachers and school counselors in the loop throughout a client’s treatment process, both to ensure integrated care and to strengthen ties with potential referral sources.
5: Create a welcoming atmosphere
When Gaskill and his colleagues opened their doors in 2000, they offered a waiting-room benefit that generated excitement among his young patients: video games they could play before their appointments. When the movie "Inside Out," was released, the clinicians designed different interactive stations throughout the practice to enable children to better understand each of the emotions the movie featured: joy, sadness, disgust, fear and anger. Today, both of Southeast Psych’s locations have waiting areas decked out with life-size Disney princesses and "Star Wars" characters in addition to the video games. They also provide complimentary coffee, tea and snacks. All of these perks get people talking and draw in new clients, Gaskill says.
"We designed it to be an experience that you walk away from and feel like you just have to tell someone about," he says.
It’s not just about making it an enjoyable experience for clients, Gaskill adds. Southeast Psych invites friends and colleagues from outside the practice to a gathering every fourth Wednesday of the month.
6: Fine-tune your office design
Natural light is a big mood booster, so interior designers suggest that when possible, therapists should incorporate windows or skylights into their clients’ view during therapy sessions. If your office lacks windows, they suggest using floor and table lamps with soft lighting—or better still, lightbulbs that simulate natural light—rather than overhead fluorescent lighting, to promote a feeling of comfort and coziness.
Bringing nature into the office with plants or artwork of natural settings can also enhance the healing quality of a space. One study showed that among office workers, a view of nature out a window was associated with lower stress and higher job satisfaction (Scandinavian Journal of Forest Research, Vol. 22, No. 3, 2007). (For more design principles for practitioners, see "Healing by Design" in the March 2017 Monitor.)
Gaskill and his team produce psychology podcasts and videos for the public in Southeast Psych’s in-house recording studio.
7: Make it easy for people to find you
In our technology-centric society, an active social media presence is becoming a must for private practitioners looking to increase their client bases, says clinical psychologist and New York private practitioner Chloe Carmichael, PhD.
Creating a Facebook page for your practice is free and can be a great way to connect with potential clients, provide more information about yourself and your practice, and help you come across as more approachable, she says. Once you have a page set up for your practice, investing even a small amount of money into a Facebook ad or simply paying extra to "boost" a post on your page will increase your exposure. "Even spending just $3 a day for a Facebook ad to run for five days, you could reach a pretty decent swath of people, and you could set it up to be targeted specifically to your area," says Carmichael, who provides an online course for those looking to enhance their private practices at www.profitablepractices.netopens in new window.
It’s also important to keep your website updated—and to blog often. "So many psychologists underestimate the importance of having a blog section on their website," she says. Blogging regularly improves your website’s search engine optimization, ensuring your website pops up closer to the top of a search when someone in your area is looking for a mental health professional. Just as important, blogging creates immediate rapport with potential clients.
"I’ve had so many clients come in and say, ‘I read your blog about such-and-such,’ and that’s why I reached out to make an appointment," she says. (See "Is Your Website Outdated?" in the February 2018 Monitor for more tips on using technology to reach more clients.)
8: Reach out to the media
Carmichael also encourages practitioners to sign up for daily emails listing active media contribution opportunities from www.HelpAReporterOut.com. Anytime a topic pops up around your area of expertise, submit a three- to five-sentence quote to the media outlet, she says.
"Getting quoted by the media increases your credibility, and, in my opinion, can lead a client to expect to pay more for your services, because by virtue of the fact that you have a lot of eyeballs on you, you’re likely in higher demand," Carmichael says. Even if the quote you submit doesn’t end up being used in a reporter’s piece, it’s a good idea to keep a record of all the material you’ve submitted for quotes because you can use that material for your own blog posts.
Gaskill and others at Southeast Psych have taken the matter into their own hands by starting their own media websites, ShrinkTank.com and Psychbytes.com. With contributions from psychologists all over the world, ShrinkTank offers articles, videos and podcasts on pop culture-based content with a psychological spin. With thousands of followers on social media, the websites have helped Southeast Psych build a wider audience and allowed for a greater understanding by the public of how psychology is intertwined in so many aspects of our lives.
9: Acclimate and accommodate
Alvord notes that one of the reasons her practice has grown so much is that she and her co-founder have always prided themselves on being flexible and trying new things. If a family has a scheduling conflict or is available only one day of the week at a certain time, the practice works with the family to make sure the child can be seen by a therapist. When their wait list has gotten too long, they’ve hired more clinicians. And they don’t require their group therapy clients to see someone within their practice for individual therapy.
"We open our groups up to the entire community, and if someone is seeing an individual therapist somewhere else, we encourage them to continue with that therapist and we collaborate with them," she says.
10: Don’t shy away from raising fees
Many therapists hate talking about money—especially with clients, Carmichael says. But the reality is that when therapists aren’t comfortable financially themselves, they may take on any client just to supplement their income—even if they don’t have training in the type of services the client needs. Cash-strapped practitioners may also forgo getting quality supervision or other continuing education for themselves, moves that threaten their ability to stay up to date on the latest evidence-based treatments.
"Therapists are just better-positioned to offer good therapy when they’re not feeling financially compromised," she says.
Alvord and Carmichael both suggest making annual fee increases a standard part of every client agreement. Alvord notes that in her practice, the increase occurs on May 1 each year, and they start printing an automated message on the bottom of clients’ bills starting March 1, reminding them of the upcoming increase.
11: Serve the community
Accepting speaking requests and providing free talks in the community are another way to bring in more patients. Last year, Gaskill and his colleagues from Southeast Psych’s Southpark office in North Carolina gave nearly 300 talks, on everything from parenting a child with autism to how to manage stress.
The practice also offers more than 100 one-minute practical online videos for parents on its Psychbytes website. These "Psych in 60"opens in new window clips offer insights on a wide range of parenting concerns, including teaching table manners and how to talk to your teenager about marijuana.
"When we say we’re popularizing psychology, it’s not a gimmick—it’s just what our passion has always been," Gaskill says. "If we get referrals as a result, fine, and if not, we’ve made a good friend."
Alvord agrees, adding that her practice has been facilitating monthly Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) parent support meetings pro bono for the past nine years.
In addition, she has founded a nonprofit charity, Resilience Across Borders Incopens in new window., to sustain the work started by the practice in providing Resilience Builder Program® groups in disadvantaged schools across the Washington, D.C., metro area. The nonprofit hopes to increase access to mental health care.
"In many ways, Resilience Across Borders furthers the mission of the practice—to disseminate evidence-based practices in multiple settings—and also helps reach populations that the practice does not," says Alvord.
