When Partners Have Concerns

This suggestion came up in the Facebook Group as a blog topic and it was the first one I wrote about because it’s something I see a lot. I’ve had several conversations with partners of therapists who wanted to join the Abundance Practice-Building Groups but their loved one had some reticence around private practice (and thus the investment in the group).  I think our partners' unfamiliarity with the private practice possibilities, in tandem with the risk, makes for some very fair, very real concerns.   I want to make a few assumptions first, otherwise this blog post is going to be 20 pages long and require a couples counselor:

1. Your partner values your role as a therapist. That doesn’t mean s/he has personal experience in therapy or that s/he really understands what we do, but there is an at least vague appreciation for the helping of others through counseling.
2. There’s some sort of shared financial situation going on, even if you keep completely separate bank accounts. By this I mean, maybe you go halfsies on the rent or mortgage or you’re responsible for some of the bills or you’d be asking your partner to float you a little bit as you build.
3. Your relationship has some struggles and “imperfections” but it isn’t riddled with landmines. The idea of private practice isn’t going to be the nail in the coffin that breaks you up.
4. You plan to talk with your honey about venturing into private practice, not spring on him/her a “Hey, so I actually quit my job 4 months ago but it’s ok because I’m making more than I was then. Surprise!”

You with me? Ok, let’s go over the top concerns I hear from partners. Also, I’m writing to the partners today instead of the therapists (but you’re allowed to eavesdrop).

1. Is it smart to build a business in this economy?

While I don’t know that I would encourage some forms of entrepreneurship right now, starting a counseling private practice can be one of the lowest overhead ventures around. You could seriously spend more with a jewelry making business. There are smart cost-cutting options like sharing an office as well as places those that build faster tend to invest in their business like consulting. I have blog posts about Where to Scrimp and Where to Splurge that you can read up on. Let’s do some math. Let’s say your partner averages $100 per session. I’m using $100 because that seems to be the average of what I hear around the country with some very affluent areas in the $175 or more range for private pay and some smaller towns closer to $75 for insurance reimbursement. Now before you get excited and start thinking about $100 times 40 hours per week, you should know that keeping 20-something hours of face to face time with clients is considered full time. So, let’s go with 24 clients per week at $100 a pop. That’s $2,400 a week in income. With an average 4.2 weeks in a month, we’re looking at $10,080 on average per month once your partner is full. (I often get some version of “holy shit, therapists can make that much?!” to which I happily say, “Why yes, we can!”) What is your partner making per hour now? I’m guessing it isn’t $100/hour. Or even adjusted-for-full-time $50/hour. When my consulting clients do the math, they often find that they’re making somewhere in the $12-$30/hour range. With at least a master’s degree! But I digress… Back to math. Let’s say your partner is making $30/hour at a 40 hour a week job (I’m serious when I tell you this is a high estimate). S/he’s making literally half the amount of money at $1,200/week. So once your loved one is seeing just 12 people a week (or maybe 15 if we’re counting overhead), the previous income will be surpassed. In 12 freaking hours per week.

2. Why 20-something hours? Why not 40?

It’s a fair question. For one thing, there’s an emotional toll that happens when you really engage with people around their emotional lives. Think about the adrenaline you feel, maybe a rush in your ears or an increased heart rate or a desperate need to get far away when you and your partner have a really intense argument. While our sessions aren’t usually quite that intense, it’s like a fraction of that every hour. If we see too many clients it builds up. Plus, talking to 8 people for an hour each, 5 days a week would be exhausting even if you were talking about the weather. We have to really pay attention for an extended period of time. Remember how your mind would wander during those long lectures in school? We can’t let that happen while our client is talking about the impact of being molested by her brother, or the grief a client feels over his wife’s suicide, or when a kid may be juuuuust about to open up about something we knew was lurking there, finally.  Just paying attention for that long alone is exhausting. There’s also the research saying no more than mid-20’s if you want to avoid burnout. Burnout sucks for everyone, but folks in other professions can still barrel on in their job, albeit less efficiently. It can render us therapists almost useless at work. If your partner is currently working 40 hours at an agency, keep in mind there are meetings, outreach, paperwork, bureaucratic nonsense, etc filling in his/her schedule. Or, if your partner is seeing 30+ clients in an agency right now, you deserve a medal because you’re maintaining a relationship with someone who is essentially a grouchy zombie. If your partner’s well being doesn’t sway you (and it should), keep in mind that as a business owner, your partner will need to market, network, manage finances, and bill if they’re taking insurance.

3. I barely see my partner in his/her agency job. Won’t it be worse if s/he’s a business owner?

Not if there’s a solid plan and good boundaries. If your partner veers towards the workaholic, those boundaries are going to be key. This agency job may make it seem like s/he is a workaholic (freudian slip: I just wrote alcoholic instead… that too), but sometimes the productivity expectations at agencies are impossible to reach (see the last comment on clinical hours and burnout). I find it best to fit all the non-clinical business stuff like marketing and networking in during traditional work hours, with few exceptions. You may be invited to go to an evening networking event with your partner a couple times a year (you can say no; if your honey is upset about that send them to me), but most of the other stuff can be done while you’re at work (if you work) or at agreed upon non-intrusive times. Most therapists can keep all work under 30 hours/week and do just fine. There may be some more work in the first few months if your partner is lucky enough to bring a caseload from an agency to the new practice, but for most starting from scratch, the few clients in the beginning allow for time to create the infrastructure necessary to be most efficient with time. I encourage all my clients to create financial goals that include at least 6 weeks off per year. That way you guys can actually take vacations! And if the flu strikes your house, there’s no need to panic about bills. And if Snowpocalypse comes barrelling through your unprepared town it’s no big deal.

4. How long does building a private practice take?

This is the question everyone wants to know and I would love to have a formula to offer you. It depends on several factors: taking insurance or not (all marketing being equal, people build faster when they take insurance BUT they usually make less per hour), niche (it’s counter-intuitive, but the smaller the population a therapist serves, the faster they grow. Here’s an explanation), the culture around therapy in your town (“saturation” is actually a good thing), being tech savvy (or paying for it), willingness to network, whether or not the clinician has support and guidance versus just winging it, and commitment to their practice. Obviously if someone isn’t putting in the time or effort, nothing is going to happen. The fastest I’ve seen is a group member who built a full fee private pay practice in a small city and was full in 3 months. She had a niche that affects 3% of the United States population.  Don’t judge your partner by this. On average, I would say my clients are full within 8 months. And that’s FULL. Most of them are surpassing their agency job incomes significantly sooner.

5. Some income is better than no income. S/he should just get an agency job.

With this logic none of us should have gone to college, much less grad school. We should have gotten a job right out of high school. You have to put some time in before you can get some money out. The time it’s taking to build, and for the vast majority of people it will take months and months, is a part of the process. Sure, your partner can take the crappy agency job that s/he leaves feeling demoralized every day and make a consistent $45,000/year. How might that impact your relationship if burnout is a part of your loved one’s daily experience? Alternatively, s/he could work a fraction of the time and make more than twice as much. If it was you, what would you choose? Yes, you have bills to pay. I get it, trust me. When my husband went back to school we moved to a brand new expensive city and I had the big idea to start a private practice as the only person bringing in income and yearly tuition that cost more that I was paid in my first job out of grad school. We were able to live comfortably because I worked my ass off to build my practice.

6. Some income is better than no income. S/he should just take more sliding scale clients since $50 is more than $0.

Some of our clients are long term. At some point, hopefully soon, your partner is going to get full. If 10 of the 24 weekly spots has someone paying $50 instead of $100, it’s not the best long term plan. If sliding scale is a part of the ethics of his/her practice, awesome! But as an act of desperation it’s just shooting yourself in the foot.

7. S/he referred a client out when s/he wasn’t full. That’s ridiculous.

Do you know about stink bugs? Here in NC they are all over the place in the summers. They attract one another with their awful stench. When your partner takes on a client that’s a poor fit, the person who referred the client sends more like that. The client tells their friends, who are likely to also be a poor fit. All the sudden your partner is seeing people that s/he doesn’t do the best work with. Then s/he gets a reputation for not being very good. Or maybe s/he does a decent job and becomes known as THE person for this population. What if this population likes to call at 3 am in crisis? What if this population is a little stalker-y? What is this population makes your partner want to throw things across the room and you happen to be in the line of fire? Think about it like dating instead. Sure, you could’ve married the person that had a big crush on you when you were 16. I mean, better to be married than not, right? Who cares if you are more compatible with other people. Do you sense this theme: This is about the long game. Good fit is integral to success.  

8. My partner has started private practice and is a basket case. Should s/he just get a job at this point?

I’m going to level with you: your partner will probably continue to be a basket case for a little while. Starting a business of any kind brings up our “stuff.” Fear of failure, insecurity, Imposter Syndrome, comparison… all these things are normal. That’s the good news. I haven’t worked with a single practice-builder who didn’t go through a WTF-have-I-done stage. Having started practices in 3 different states, I now know that mine happens at the 2.5 month mark… and I’m extremely confident in my practice-building skills and have no need to worry. I’m going to ask you to manage whatever fear or frustration your partner’s concerns bring up in you. I know it’s scary to hear the person responsible for part of the bills say “I’m never going to be successful. I suck at this. I’m letting you down.” Here’s the truth: your partner is entirely capable of building a private practice. It’s not rocket science. Arguably, the hardest part of building is getting through the slow, early stages with your confidence intact. I want both of you to read this. I want you to do whatever you need to do to be able to look your partner in the eyes, smile at him or her and say, “I trust you. I know you can do this. You have everything it takes. I know it’s hard right now and I’m sorry you’re struggling but if you keep working your plan you will get there.” Among the biggest fears I hear from my clients is that their partner doesn’t/won’t believe in them.  Don’t hold your partner back. Again, this isn’t rocket science. It’s starting a business with incredibly low overhead and an extremely high likelihood of turning a profit WAY before almost any other business. If you haven’t started a business, don’t pretend you get it. It’s ok that you don’t fully get it. And it’s really hard to watch what looks like unnecessary suffering when there are agency jobs readily available. This struggle makes us stronger. I feel like I grew into my power (stop rolling your eyes) when I built my first full time practice. The things I worried about years ago aren’t even a blip on my radar now. My tolerance for discomfort and risk is so much higher than it was before my practice and I’m a lot more fun to be around as a result. My marriage is better because I’m in private practice. I’m a better mom because I’m in private practice. I’m more relaxed, I’m more creative, I’m healthier all because I’m not slogging through 45+ hour work weeks at jobs that have no real investment in me. I don’t have to ask permission for days off. If getting my girls out of the house in the morning is stressful and awful for everyone, I can change my schedule to start later (guess who just did that… so worth it).   I help people build private practices because it has made my life so much better than I thought it could be. I want that for your partner. I want you to have the best version of your partner. My husband would tell you that as a private practice therapist I am more energetic, happier, sick less often, more fun, less stressed, and that I have more to give than when I was in agency work. I used to come home in a crappy mood, exhausted and a little bitter. Now I come home (overly) chatty and either cook dinner or play with our toddler and baby while my husband cooks.  It’s pretty sweet. I want this for you, too. To that end, I’m happy to respond to any other questions you partners have. Just shoot me an email. Please, leave room for your loved one to succeed. Support him/her. You’ll be so happy you did. I'd love your feedback, partners or clinicians. Did I leave anything out? Let us know in the comments.     Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.