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Jun 01, 2015

How Long Does it Take to Open a Counseling Practice?

Zero to One Client in Seven Days

I was speaking with a licensed counselor and she asked me “If I wanted to get started in private practice, how long would it take me to open my doors and see my first client?” I thought about the question for a minute, and replied: “With a couple thousand dollars and a close to full-time commitment, you could be open and seeing your first client within a week.”

Seem impossible? Here’s a how-to.

Day 1:

You go to Godaddy.com and register “Counselingby[MyName].com.” You subscribe to GoDaddy’s web hosting and “Website Builder” DIY services. You browse through pre-made website templates and choose colors for your site. Even though you don’t have any technical experience, you find that a little patience (and reading the instructions) gets the job done.

You create 10 pages for your new website, each related to a service you provide. You create a page for couples counseling, anxiety therapy, depression therapy, and an “about me” page (to name a few).

You write a thoughtful description of your services on each respective page and email the site to a friend for proofreading. Your friend emails back almost immediately saying “It looks great!” You re-read your pages and find typos everywhere. You fix them.

You post your cell phone number prominently at the top of every page with the promise “Call for a free 10-minute consult.”

The website is live! It’s clearly a DIY job, but it looks good.

Time to complete: 4 hours.

You need to get your website seen by potential clients. You go to “Google Adwords” and follow the prompts for creating an online advertisement. You remember you have a coupon for $100 in free advertising. While making your first ad you get confused. You are shocked to notice that Google offers free telephone support. The representative helps you post your first Google Ad.

Next, you go to Psychology Today’s therapist directory, upload a headshot and write a bio, and begin your 6-month free trial membership.

You can’t believe it. In just one day you’re already on the web!

You login to Facebook and post a status update telling your friends that you’re on a mission to open a counseling practice, and see your first client, in only 7 days. You include a link to your new website. Your friends congratulate you! They say they know people to refer. A counselor comments on your post, “Is that ethical?” You consider un-friending him.

Time to complete: 3 hours

Day 2:

You need office space. You search Craigslist and find several health-oriented groups in your area that are looking to rent or share rooms. You respond to the ads by phone (reach voicemails) and by sending emails expressing your interest.

You let your friends and family know that you’re looking for a temporary office where you can begin seeing clients. They say they will let you know if they “think of anything.” You call Regus®, and they offer you space. The price is $700 per month for a single office, which is more than you want to spend. You tell them that you’ll keep it in mind.

Time to complete: 3 hours

In the meantime, you begin compiling all the necessary paperwork you’ll need to provide to clients. You ask old professors and colleagues if they have sample intake forms, confidentiality forms, HIPAA privacy policy forms, consent to treat minor children forms, etc. You get a slew of files by email, by surfing the web, and you also reference a textbook from graduate school, and remember you created some sample intake forms for an online counseling project you got a pretty good grade on. With some adjustments, the forms work well.

Time to complete: 3 hours

You create a Facebook and Twitter account for your practice. You adjust the account settings so that you can post updates to both accounts at once. You plan to write frequent articles on mental health problems, but for now you’re going to tell the story of your practice. You take pictures and videos of your day-to-day progress, and post them.

Time to complete: 2 hours

Day 3:

Someone from Craigslist calls you back. You visit the space and find that it’s fully furnished. However, the room is only available in the mornings, Friday afternoons and Saturdays.

A friend, who is an accountant, tells you that he has a 10x12 office that he’s not using. You’ll need to furnish it, but you’ll have access whenever you need it. You sense that running a counseling office out of an accounting firm isn’t ideal, but it’ll get the job done.

You go to a local furniture store and purchase a couch and a chair for $550 (they will deliver later in the week). You drive to Ikea and spend another $300 on a desk, rug, and some accessories.

You head back to your new office to un-box and assemble your desk. As you look down at the pieces strewn across the floor you wonder if you’ve made a terrible mistake with your life.

You assemble the desk and arrange the rest of the Ikea items. You feel better. The space doesn’t look half bad!

While cleaning up Styrofoam and cardboard, a number you don’t recognize appears on your phone. A woman says she found you online. She wants to know if you can accept her insurance. You tell her that you hope to take insurance in the future but you don’t now. You ask her if she has out-of-network benefits (she doesn’t). You ask her is she’d be willing to pay out-of-pocket if you could offer a price she could afford. She thanks you but says that she needs to think about it.

You make a mental note to apply to Blue Cross, United, Aetna, Cigna, and Tri-care. You know it’s going to take much longer than seven days to get on insurance panels. You decide to start the process next week.

Time to complete: 9 hours 

Day 4:

You don’t have a logo, or a brand name, or a Limited Liability Company (LLC), or even a sole proprietorship.

While you can put off the logo, you call your accountant friend and ask him what you must do to “register the business.” Per his advice, you make a trip to a municipal building and register “[My Name] Counseling” as a sole proprietorship with the city.

You pay an $8 fee. A couple next to you is getting their marriage license and talking about pre-marital counseling. You consider telling them about your services but lose your nerve. You make a mental note to “add pre-marital counseling” to your website.

Time to complete: 3 hours

You want a business card and a brochure. “VistaPrint” looks good and cheap, but you need materials fast. You create a simple business card and brochure using software you already had on your laptop (who knew?). You drive to Staples and they print your brochures.

The woman behind the desk convinces you not to print and cut your own business cards. You thank her for the tip.

That evening, another unknown number appears on your phone. The caller saw your online ad. He doesn’t have insurance, or money. He’s looking for free counseling. You speak with him for a few minutes, making sure that he’s not in an emergency situation. You then refer him to a local community health center. He thanks you and says he will call.

Time to complete: 3 hours

You log on to Google Adwords and review the data. You’re spending $2.13 on average “per click,” and you’ve received 15 clicks to your website. You’ve spent $31.95 in about 3 days. While still within the $100 coupon, you note that advertising could get expensive fast.

You start to panic and wonder if you’re in over your head, and if you need more education or supervision. You call an old supervisor and talk it through. You hang your license on the wall and feel slightly more bonafide.

Ten minutes later you decide no one is ever going to schedule. You call your mom. She believes in you.

Time to complete: 2 hours

Day 5:

You wait half a day for the furniture to be delivered. It arrives and looks amazing!

You realize that the overhead lighting won’t cut it and you steal two lamps from your apartment. You also steal an alarm clock radio to use as a sound machine.

The little things in setting up the office feel never-ending. Hanging pictures, another trip to staples to get light bulbs, a printer (for intake docs), printer paper, clip boards, pens, organizers, etc.

Time to complete: 8 hours

Day 6:

You hand out brochures to everyone you know, and even visit other local health practices. You call your friends to tell them (gently) to hurry up with those referrals.

Time to complete: 4 hours

You go to Best Buy and purchase a Square® brand credit card reader. You download the Square app and create an account. You can now accept client credit cards. To test the system, you run and charge your own card. Noticing that you just paid a fee to run your own card, you chuckle because you just became your first therapy client. You think to yourself, “how appropriate.”

Another unknown number on your phone! You answer. It’s the person who called you on day 3. She says that nobody else has answered her calls or called her back, and she’s willing to pay out-of-pocket. You schedule an appointment for tomorrow.

You go online and announce that your practice has its first client on the books! An hour later, you get another call (this one a referral from a friend) and schedule a second client.

Time to complete: 4 hours

Day 7:

Your client shows up for her first appointment. It’s after hours, so the office suite is quiet and private.

The client doesn’t seem to mind that you’re operating out of an accounting firm. In fact, she comments on how easy it was to find the office. She says she loves how you decorated. You play it cool.

As your first session unfolds you realize that you’re both going to be fine.
________________________________________________________________________

Anthony Centore, Ph.D., is private practice consultant for the ACA, founder of Thriveworks Counseling (with locations in 9 states), and author of the book, How to Thrive in Counseling Private Practice. Anthony is a licensed counselor in Massachusetts and Virginia. Find him on Twitter at @anthonycentore or @Thriveworks.

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3 Comments

  1. 3 Joe 03 Jun
    Having maintained a private practice for 20 years, here are a few lessons learned.
    1. It can take 2 to 6 months just to get on an insurance panel. Most patients prefer to use their insurance and don't want to go out of network.
    2. Better to spend 5 to 7 percent on a good billing service as counselors are infamous for not billing correctly. My bad debt from insurance companies is almost zero and more than covers the billing service.
    3. Networking is key.
    4. Customer service is the other key.
    5. be prepared to work some nights and weekends.

  2. 2 Crystal B 20 Sep
    This is such a belief building article! 
     
  3. 1 Anne Marie 14 Jun
    Loved this and literally "laughed out loud" to the humor.  You've helped make this journey of starting my private practice enjoyable!

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