ACA Blog

Feb 19, 2013

The dark side of private practice: it’s not getting clients; it’s keeping up with the demand that is tough.

As a guy who has lectured to folks from as far away as Japan on issues related to private practice (and wrote a chapter on the topic a few years ago), I always look forward to reading blogs related to the topic. Like any blog topic, sometimes I agree, sometimes I shake my head but I always feel that I have left with something from the process. From time to time I chime in with a thought or two on the topic, usually on an aspect that I have not seen covered, or that has not been covered in a very long time. Below are a few issues that I feel needed to be explored. I hope they help.

While most conversations start with how you will get clients, I have found in my experience that that is not necessarily an issue. Unless you are in an area that is flooded with clinical professionals, believe me they will find you. My office is not listed in the phone book and you cannot get the number via 411; instead it can only be found if you happen upon our website, get a referral from an insurance company or through a current or former client or colleague. This started out as an oversight but soon became a saving grace as within months of opening I was beyond capacity, it seemed that no matter how many hours and how many days I worked I just could not keep up with the demand. I can only imagine what it would be like if there were not several very large agencies in my area. So instead of worrying about how to get clients, my humble suggestion is to formulate good and firm boundaries in terms of number of sessions per day and the number of days per week you are willing and able to work. Once you set realistic ones, do what you can to stick to it lest you wind up working 7 days a week 10-12 hours days (something I wish I had avoided).

Now that you have your set days and times, have you considered having a reciprocal agreement with a clinician in the state whereas you agree to take referrals from them should they be incapacitated, retire or gone for an extended time? Are they willing to cover for you should a client have a crisis while you are away? The Client would be responsible for fees of course but this could be the difference between having a nice day on the lake and living a real life “What about Bob?” situation. Many times independent folks would love a chance to have such a relationship; they realize that we are not competition and the worst that could happen is that should you cover for them and the client feels more comfortable, they may lose a client. Like any seasoned pro they will not worry as they know that are a hundred to replace every discharge.

Speaking of waiting, have you thought how you will handle a waiting list? I personally do not have one as I found them to be cumbersome. Instead I do what I can to help potential clients find folks who have active openings. I will also give them my best guess as to when I anticipate an opening. Some folks can and often do wait, others have too extreme of a need, so again we do what we can to assist. One fear related to this is that you may get a reputation for “never” having openings, should this occur you may find yourself faced with less and less potential new client calls. Should this happen and you find yourself with multiple opening, reach out to normal client referral sources and let them know you are again taking new clients. A press release or a posting on social media may help as well.

Rest assured that my experiences are far from unique; this has been a not uncommon theme in presentations and training that I have given to folks from all over. I have been surprised to hear that practices in towns of 600 had the same issues as practices in Los Angeles and New York City. It is likely that it will happen to you should you venture out.

When planning the next step in your career, do your homework but do not fret where clients will come from, especially if you take major insurance plans. Find a comfortable office that is congruent to your personality, let a few folks find you, show that you offer something unique as a clinician and the rest will follow. So long as you keep your overhead low, you will do well. Well, as long as you set clear boundaries not just with your clients, but with yourself as well.

The ACA website along with my site has plenty of free information on the topic. Take a look and please share your experiences; we learn best from one another.

Warren Corson III (Doc Warren) is a counselor, writer and the clinical & executive director of Community Counseling of Central CT and Pillwillop Therapeutic Farm (

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