Chapter 25: Career Success! Building A Psychotherapy Private Practice

In the last chapter, I mentioned being employed at Brynn Marr Psychiatric Hospital. While the work with clients was rewarding, the values and norms of the setting were not a good match. I then worked in two public mental health settings. The second one was Sampson County Mental Health Center. That lasted just about 9 months before I wanted to move into private practice.

I was able to complete all the requirements for licensure as a Licensed Clinical Social Worker (LCSW) within the state of North Carolina before I left my employment at Sampson County Mental Health Center.

It was clear that whatever problems I had on the jobs at this agency or at Brynn Marr Psychiatric Hospital had nothing to do with how I performed with clients or patients.

During this time, I had sought feedback, counseling, support, and guidance from my colleagues. I had joined the local chapter of the Society for Clinical Social Workers which had regular meetings where I could interact with colleagues in a congenial setting where we got to share our ideas, request feedback on casework, and learn from one another.

It is through these meetings that I kept in touch with Chris Hauge who was a mentor of mine as I have mentioned previously.

I had approached Chris seeking advice on entering private practice because I looked up to him... I had known that he had kept a private practice for some time. He had been very supportive of my goals as they related to making a positive difference in the lives of others.

The Keys to Success and Accomplishments

As it turned out, Chris said that he was considering retirement and that he was cutting back his office hours. He offered to let me rent his office space at a certain rate per hour if and when I used the office. This was a very affordable way for me to find success.
 

I believe it was about $15 per hour - Chris wasn't using the office anyway during these hours. He told me the hours in which he used the office and when the office would be available. He shared an office with a partner - they had the main waiting room and reception area and two private office rooms where providers, like myself, could meet with clients.

If I had to build a private practice on my own, it could be challenging to get started. I would need to build a base of clients that would be paying every week for treatment with me. If you rent an office full time you have access to the building any time, day or night, but you pay a monthly rate to do this.

The cost to rent an office every month would be higher than the costs that Lynn and I were paying to rent our home - though her mother had been renting it to us and therefore we had gotten a great deal, a cheap rate for renting a home.

Chris gave me a key, introduced me to his partner and we discussed how I would record the hours in which I was going to use the office. He had a schedule I could consult to find out when the office was available.

There are so many things to consider when you are pursuing a career in this field and when you are seeking to work in private practice. As noted, I had to consider Professional Liability Insurance also called malpractice insurance, which are different names for the same thing. Chris needed to know that I had this coverage.

Billing is another issue. I had to file insurance claims for treatment with a client's insurance company or agency. So, I had to get registered with various insurance companies including Medicare.

I had contracted with someone to do the medical billing as well and I got a post office box (PO Box) for non-personal mail.

Having all my mail go to Chris' office didn't seem like something that I wanted to do yet. If I did not go to the office because I didn't have a client that day, then I might miss my mail that day. There was a place where I could get a PO Box close to our home.

It's great to have someone with whom you can consult when you are doing all these things and Chris was helpful in this regard as well.

Then I had to advertise in the newspaper and online. The internet was still a bit new in the late 90s, but I was able to create a website.

Other Advice That I Received from Colleagues

It's important to reflect upon the support I got from colleagues as well as the therapy or treatment that I had been receiving.

I became interested or curious to learn something about psychoanalysis and I began to study this formally from an organization that provides certification in psychodynamic/psychoanalytic therapy. The organization provided learning objectives, credits, coursework, as well as certifications for mental health and psychological professionals.

I would go and see Marjorie Israel, who worked out of her home. She was a clinical social worker like myself and I met her at those meetings.

Marjorie invited me to her home office. It was an interesting and scenic location. She had a nice yard with flowers and plants in a beautiful and serene garden with a curving sidewalk.

I would lay back on her couch and do free association or recount my dreams. It was reminiscent of Freudian psychoanalysis with the psychoanalyst and the couch. Marjorie said that she had to modify her approach since psychoanalysis traditionally had been done with a client coming four or five days a week for years.

Oh, I was paying her out of pocket, also. Lynn and I didn't have a great deal of money but she was supportive of me getting the guidance and support that I needed.

She also engaged in more talking than traditional psychoanalysis. 

While so much of psychoanalytic theory is hard to prove with research, I was interested in a technique where I would not be censoring anything at all. I was interested in making sure that I covered everything going through my mind – my motivations and hidden desires. I didn't want any issues from my past to interfere with my role as a therapist for clients.

It is so special that Lynn didn't ask me to work for a big agency that might offer "good insurance." We both knew that insurance wasn't the answer. She was born with a pre-existing condition. Even forcing insurance companies to cover pre-existing conditions is not a guarantee that we would need.

Starting My Practice

One of my counselors cautioned me that Wilmington was a saturated market, meaning there probably isn't a market for another psychotherapist in the Wilmington area.

I was going to prove him wrong, which would make him happy actually. I mean, he had my best interests in mind. He was speaking only about the market for therapists.

I did start to pick up clients rather fast. I had selected a few words to use in the advertisements as specialization areas that I hoped would be problems that people in the area had and/or things that interested me.  So, initially, I thought of advertising that I could help individuals who are dealing with anxiety, depression, eating disorders, and relationship issues. 

I had previously had problems with relationships which was manifested in the form of shyness, social anxiety, and social phobia. 

I added that I could use hypnosis to help with quitting smoking, weight loss, or other problems.

This seemed to work out well for me. I used a second phone number that rang at my home, but the location of where I was living was not revealed.

One guy started paying me out of pocket for weight loss.

Then I picked up a client who had relationship issues. He said that he was gay and asked if I could help. I reported that I could help. To me, relationships require active listening. So, I would demonstrate that in the sessions with the client and help him to learn how to increase his communication skills in the same way.

It's interesting that people in relationships that are non-traditional relationships will understandably want to know if we (the therapists) are comfortable listening to details about their intimate relationships.

Returning to the topic of psychoanalysis, we get terms like transference and countertransference from this field.

Transference is about how the client reacts to or responds to the therapist. It can relate to projection where a client projects onto the therapist ideas and feelings that exist in another relationship.

Countertransference is how therapists respond to the client and the client's behaviors. I was working on my own "issues" to ensure that none of my past was carried into the therapy sessions with others and would cloud my judgment. This was part of why I went for analysis with Marjorie.

Anyway, I also picked up a client who was dealing with major depression. Another issue that I was treating was anorexia. I had taken on a client who was in college and had come home with her family hoping to return to college later.

My client base was growing, and it was getting to the point that I needed more access to the office than what was available while renting from Chris. I also found that by paying a flat rate every month, I could save money.

Recognizing these accomplishments was amazing and a cause for celebration. So, Lynn and I went out to dinner at one of our favorite restaurants. Everything was amazing and a celebration was called for!

This has been an overview of the various types of clients I was seeing and the problems or issues I was treating. Later chapters will go into more detail so I will ask you to keep reading with me.

First, let's talk about family life so that you, dear reader, will know that I had another life outside the office.