The Business of Therapy: It’s a Growing Up Thing!


Therapy school teaches us how to work with clients, but doesn’t teach us how to make a living from our qualification. And that’s not their job! But it does leave us with a conundrum. You have spent all this money, time, and effort getting your qualification, not to mention the internal turmoil of the process work, and then… what?
Options post qualification
I had a very clear intention when I qualified, that I wanted to have a private practice. Others not so much.  So, what are your choices? How do you use your qualification and skill to earn a living? There are a number of options:
1. Work for salary: You could find a job working in an organisation where counselling or therapy skills are offered. This might be a counselling service, a treatment centre, or other related environment.
2. Volunteer: You could offer your services for free to low cost or complimentary services. This assumes of course, that you do not need to earn an income.
3. Use your skills to complement your current role: If you are already working in a helping profession such as social care or nursing, a counselling or therapy qualification could enhance your existing work.
4. Private practice: You could establish yourself as a practitioner, on your own or in conjunction with other people.
5. Combination: You could offer your counselling or therapy skills on a part-time basis, while maintaining your existing role.
What to do with your qualification is a subject worth thinking about, and if you’re veering towards private practice, it’s particularly important to consider it carefully.
So, what do you want? And why do you want it?
Private Practice is not like a Job
The reason I’m asking this is that private practice is something that needs to be chosen. It is different from working for someone else, very different. It requires a different mindset and a different skill set. Self-employment is not for the feint hearted.
You need to be committed to self-employment in order to give you the impetus and energy to make it work. Or at least have a desire to be committed to it. If you choose private practice, your clear intention is one of a number of important supports you’re going to need during the initial start-up period. (There are others, but more about that another time.)
A practice doesn’t emerge fully formed the day you decide you’re going to create it, any more than you became a therapist on the day you signed up for your training. I see the process as having three stages which can be likened to the developmental stages of a human being:
Baby Practice (Or “Not Enough” stage)
At the first stage, a practice, like a human baby is fragile and it needs considerable support if it’s going to survive. It has a vague and unformed identity, and the reputation of the practitioner is not yet established. There is generally sporadic and insufficient income, and costs may be unexpected and exceed the income. The practitioner may experience a lot of doubt and anxiety, their confidence may be shaky, particularly as regards their ability to create sufficient income to sustain them. At this stage, a practitioner needs reassurance, and may look to more senior members of the profession (e.g. supervisor) for guidance. They may follow this advice quite rigidly (A good therapist must do this…). This stage may continue for anything from a couple of months to a couple of years.
Adolescent Practice (Or “Just About Enough” stage)
As the practitioner gains in confidence and in business skill, the practice becomes more robust and begins to settle down into a discernable pattern. However, the practice still needs a lot of support. Like an adolescent, identity is beginning to form, and the reputation of the practice is beginning to grow. The practitioner will begin to allow that there is more than one way of doing things and may begin to experiment and reach out more. Income at this stage is generally just enough to cover expenses, but there may be very little extra. So “luxuries” like pension contributions or holidays may not be affordable.
Adult Practice (or “More Than Enough” stage)
At the adult stage, a therapy practice needs less active support. Income flows freely and constantly enough to be largely predictable, with sufficient income, not just for expenses but for extras too. The practitioner is confident in their ability to earn what they need, and comfortable making decisions that fit for them, even if those decisions differ from those of their peers.
Transition from stage to stage may not be organic
The transition from stage to stage may not happen organically. This is especially so if the practitioner has no previous experience of business. In the same way that a person can have the body of an adult on the outside, but still be a child on the inside, a practice may never progress from stage to stage. Many practitioners give up, not because they are bad therapists, but because they don’t know how to change what’s happening.
Creating a practice is very like growing up: it’s a process. And our internal journey brings us where we need to be to grow from stage to stage. Setting up your own practice is a big step up from working for someone else. Much like leaving home for the first time, we must learn a new way of being in the world, we must seek out information relevant to business, and practice business skills. And we also have to do the internal work that goes along with it.
Developmental Support
A child is born into a family and the family holds the child. Even if the family falls far short of ideal, the existence of parents and siblings in the family home provides stability for the growing child. There are expected milestones to measure a child’s development. These include health milestones (he should be this tall, or she should enter puberty at this age…), and educational ones (he should be able to read, spell, dress himself, feed herself…) The child receives stimulation from school, creche, and play dates, which introduce him to the world outside, to diversity. These are all opportunities to learn and grow.
A similar pattern happens in college and in therapy school. There is a clear path along which the student or trainee is expected to travel. There are syllabi, timetables, tutors, assignments and fellow students. All of these provide a structure and a support as you complete your education at college or as a therapist.
Similarly, in the workplace, an employee is offered many supports. There’s the organisational brand and image, the organisational structure: management above to make decisions or escalate problems to. A job description means everyone has a defined role, and others take care of other parts of the whole organisation. There are known colleagues, a certain income, your income tax is sorted for you, you may get paid holidays and sick leave.
When you are Self Employed, all these structures and supports have to be created and maintained by you in addition to your client work.
In my experience, working with therapists over the last eight years, the client work is well supported, but how well supported are you on the business side?
What structures do you have in place to support your therapy business? What timelines are there to measure your progress? What intentions, goals or expectations have you created for your business? What information do you need, and have you sought it out? What stimulation do you provide yourself with on the business side? Do you meet other practitioners to discuss your businesses, or meet other business owners to create referral relationships?
And by the way, if you’re interested in giving some serious support to your business of therapy, come along to one of my workshops to explore some of these issues in further detail. Click here for more details and booking.
This article has been written by Jude Fay who is an experienced psychotherapist practising in Co Kildare. She also supports other practitioners to establish and develop their practices. You can view more information here