Setting Up and Running a Therapy Business

Essential Questions and Answers

James Rye

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000202779
• Topic: Psychology
• Subtopic: Creative Ability in Psychology
• Index: Psychology

Setting Up and Running a Therapy Business provides a succinct, practical, and accessible guide for counsellors starting out in private practice as well as for more experienced practitioners who would like advice on how to continue to attract a larger clientele.

This second edition has been restructured to bring all the marketing chapters together to help counsellors understand a variety of ways of helping their business grow, and includes new material on using social media. Through the inclusion of topics such as setting up a website, choosing an ideal workplace, marketing, meeting data storage standards (including new material on GDPR), and methods of accepting payments, the author offers his expertise and guidance to help practitioners make wise, workable decisions based on a thorough understanding of the stakes as well as the viable options.

As a book that bridges the gap between being a good counsellor and running a successful counselling business, it is a comprehensive read not only for counsellors who are just starting in private practice, but also for senior practitioners seeking a fresh perspective on their business.

Part I
Starting up

1 Why should I consider private practice?

2 What qualifications, experience, and qualities do I need to start a private practice?

3 What things must I do if I go self-employed?

4 What should I consider if planning to work from home?

5 What should I consider if planning to rent a room?

6 What insurance do I need as a private practitioner?

1
Why should I consider private practice?

Let’s be honest, a lot of therapists end up in private practice almost by default rather than by enthusiastic choice. Many enter years of training with a genuine but vague notion of “wanting to help people”. And then, years later, they realize that there are very few paid counselling jobs available, and at this point, a significant number of trained counsellors effectively “disappear” and never directly use their expensively acquired skills as a means of generating income.

For those who are determined to try to earn money from their training, they now face what is for many the unwanted task of setting up and running a business. Although there are those who, right from the beginning, relish the prospect of working for themselves, I strongly suspect that they are in the minority. For most of us in private practice, the genuine relishing comes after experience and growth in confidence. However, regardless of whether we are initially reluctant or very willing business owners, there are a number of compelling reasons for considering starting a private practice.

Benefits for counsellors

The benefits to counsellors are those that accrue to all people who are self-employed. They are the increased freedom of choice and power to control when and where you work, and, to some extent, how much you get paid. If you don’t want to drive to an office, you could choose to work from home. If you don’t want to work on a Wednesday afternoon, you can choose not to do so. If you want to work part time, you can set your own working hours. If you want a pay raise, you can try to raise your prices.

Although, as we shall see, there is a cost to that freedom of choice and power, for many people there are also very strong psychological benefits. Most counsellors enter the profession after a number of years in paid employment, and they enjoy the freedom of being their own boss, especially if they have suffered from working for whimsical, capricious, rude, or bullying superiors.

Before becoming a self-employed counsellor, I spent many years in educational management. For some of that time, I performed tasks that I enjoyed, and on other occasions, I performed tasks that I didn’t enjoy but which I knew were necessary. However, on other occasions, I performed tasks that were legal but with which I profoundly disagreed. I knew that I had to do them if I wished to keep my job and continue to pay the mortgage. And when in middle management, I occasionally felt that my creativity and problem-solving abilities were thwarted. I rightly had to yield to my seniors, who sometimes didn’t share my views, my solutions, my timescales, my willingness to take risks, or my confidence in my ability to deliver what was required, or to adapt to and successfully manage any failure.

Now I genuinely enjoy running my own business. I am free from the office politics. Looking back over 20 plus years, I have a real sense of satisfaction that I have been able to create something worthwhile that regularly generates important income for me. I enjoy the freedom I have to plan and make changes that I want to make. It pleases me to be able to try out things and take appropriate and measured risks to see if things work out in a business sense. Self-employment has enabled me to express parts of my personality that were, of necessity, being curtailed while I was being employed by someone else.

Benefits for clients

Although most readers of this book will be thinking about the possible advantages of working in private practice from a personal point of view, there are many potential benefits for clients in having a large number of competent private practitioners available. In a recent paper, Patti Wallace, the then BACP Lead Advisor for Private Practice, cogently set out the many potential benefits of having a large number of private practitioners available to clients (“The contribution of private practice counselling”, BACP 2015). Wallace lists nine potential benefits for the client of working with a private practitioner as opposed to working with a counsellor employed by an organization (such as the National Health Service (NHS)). I have added a tenth.

• Choice of person. If they wish to, clients have the freedom to choose a therapist on the basis of gender, age, sexual orientation, race, spoken language, level of training and/or experience, and experience of, or interest in, particular issues.
• Choice of location. Clients may not wish to travel far for therapy. Alternatively, they may wish to have a counsellor outside of their local geographical area.
• Choice of timing. Clients may not wish to be constrained by the usual norms of a working week and may have difficulty in keeping daytime appointments. They are free to seek out private practitioners who offer evening and weekend appointments if they wish to do so.
• Choice of counselling model. While it may be true that most clients are unaware of the variety of counselling models available, some are aware and have a particular choice. So, for example, because of recommendations from a GP, it is not uncommon for clients to specifically seek out a therapist who offers Eye Movement Desensitization and Reprocessing (EMDR) or Cognitive Behavioural Therapy (CBT).
• Reduced waiting time. Most clients would have to wait weeks, if not months, for an NHS counselling appointment (even if one were available). By selecting a private practitioner, clients who can afford to pay rarely have to wait more than a week.
• Help without a diagnosis. Clients who work in certain sectors (in the NHS, or in the military, for example) often fear having anything to do with mental health, and especially a mental health diagnosis on their medical record, for fear that such information would hinder their careers. Records kept by private practitioners are not part of any formal NHS medical record.
• Greater confidentiality. However secure records are, people who go for a counselling appointment in an organization are sometimes unsure about how many people will have access to their records. When going to a good private practitioner, clients know there is usually less risk of accidental or systematic leakage.
• Less disclosure of risk. Counsellors working for, or within, organizations must follow the rules of that organization about the disclosure of risk. Counsellors working for the NHS, for example, have to disclose concerns about serious risk to other relevant professionals, whether or not the client agrees to that. There is no such compulsion for private practitioners to do so. Some would want to do so anyway and would communicate their policy on disclosure in their initial contract. However, others are willing to keep that risk confidential for as long as the client asks them to do so.
• Empowered customers. Clients who pay for counselling are customers as well as clients. Their decision to choose a therapist, to choose a number of sessions, and to choose to pay gives them a lot more power in the relationship than clients being told who to see and for how long. The clients have much more autonomy.
• Choice of counselling modality. Although the counselling profession as a whole has been slow to embrace the use of modern technology, more and more therapists are now using technology to offer sessions in a variety of ways. Face-to-face communication is no longer the only option. Clients can elect to have telephone sessions, voice chat over the internet, video sessions, and therapy via instant messaging. At the time of this writing, it is predominantly private practitioners who are offering these choices.

A word of caution

Of course, not everything in the private practice garden is automatically rosy. Research published by the Social Market Foundation recently found that the proportion of low-paid self-employed, based on both hourly and monthly earnings, has increased significantly since the recession of 2008. Around 55% of the self-employed have monthly incomes that are less than two-thirds of median employee earnings (https://flipchartfairytales.wordpress.com/2016/03/22/self-employed-slide-further-into-poverty/).

Starting out as a therapist, especially if you have no other sources of immediate income, can be financially challenging. Also, self-employed practitioners don’t have the benefits of working closely with other colleagues and of feeling part of a therapeutic team. They often feel isolated. They do not have the security of a regular income or a substantial work pension, and thus carry the responsibility for having to generate income (week-in, week-out), pay taxes, and face any consequences of failing to do so. They often work unsocial hours. Organizations tend to have many support structures in place, and private practitioners often face greater risk without them.

One of the purposes of this book is to help readers avoid some of the pitfalls and enjoy creating something of significant benefit to others and to themselves.

2
What qualifications, experience, and qualities do I need to start a private practice?

Professional qualifications and experience

Although this may change in the future, at the time of writing, “counselling” and “psychotherapy” are not protected titles, and anyone can claim to be a counsellor or psychotherapist (and sadly, some very unqualified people do). Similarly, there are no “rules” governing who can and who can’t set up in private practice.

However, having said that, there are two things that potential practitioners would do well to consider when trying to reach a decision on the matter.

The first is the ethical code of their professional body. Whichever professional association you belong to, it will almost certainly contain a requirement that therapists work in the best interests of the client. The question for would-be private practitioners is: “Do I feel reasonably confident that my level of training and experience is sufficient for me to genuinely work in the best interests of the client?”

Many counsellors starting out may not be able to give a simple, clear answer to that question. A lot would depend on the type and number of clients they saw. Perhaps they would feel that they could do a good job if they saw a few, relatively “uncomplicated” clients (whatever that means) each week, but they would acknowledge that if they started to see a large number of clients with very “complex” needs, they would struggle to feel that they were the right people to work with them.

In reality, when starting out, new private practitioners are very unlikely to immediately start seeing large numbers of clients each week. And if they have a clear process for screening clients, and for referring them on when necessary, that may be a way for some to start, very tentatively, dipping a toe in the private practice water with a degree of professional integrity.

The second valuable source of help in reaching a decision about whether or not you are sufficiently qualified and experienced is your supervisor. A good supervisor who knows your existing work will be able to be congruent with their judgement about whether she or he feels you are sufficiently professionally competent to take the risk of starting to work without the support of an organization around you. Some private practitioners ensure that they have extra supervision when starting out, as a way of trying to safeguard their clients.

Put simply, you should try to have the best available training as a counsellor and the longest possible period of practice after training before working independently. Some individuals have regarded BACP accreditation (or the equivalent from other counselling organizations) as an appropriate benchmark to achieve before feeling happy about working in private practice. Similarly, some employee assistance providers, insurance companies, and rehabilitation agencies (a significant source of income for private practitioners) would not award counselling contracts to therapists who did not have accreditation.

Personal qualities

Starting and running a business is not for everybody, and would-be private practitioners would do well to be realistic about their own personal strengths and weaknesses before embarking on such a venture. Apart from the professional difficulties of working with clients in an isolated context, there are the personal qualities that are needed to overcome other difficulties.

First, there is the business context. At the time of writing, the market appears to be flooded with counsellors. In an ideal world, the training providers would look at the needs of the nation and come up with a figure of how many new counsellors were required to meet that need, and then allocate the requisite number of training places each year. In practice, training providers are concerned with maintaining their own financial stability and with selling training places, regardless of need. When you add to that the fact that there are many institutions and organizations (not necessarily all of the highest quality) offering varying lengths of training, it is relatively easy to get a piece of paper saying you have “done a counselling course” and to call yourself a “counsellor”. There are lots of private practitioners fishing in the same pond for clients, and the number of practitioners is growing...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• About the authors
• Part I Starting up
• Part II Money issues
• Part III Helping my business grow
• Part IV Other practical issues
• Part V Miscellany