In Spring 2011, I became Private Practice Consultant for the ACA, and in July that year Counseling Today published my first column, “Building a Full Caseload of Counseling Clients.” In the months and years following I wrote about everything from office culture to technology in private practice, and it has been my honor and joy to write to you every month, as well as answer countless emails and phone calls from ACA members.

Hiring AdFor many years the topic of making money in counseling practice has been taboo, but the tides are turning, and the culture changing. People are asking, ‘healthcare professionals of many flavors are running successful (thriving) practices, why not us?’ Still, if someone challenges a point in this column, there’s often an ad hominem attack that posits I value cash over client care: “Contrary to Centore’s argument, [value is] not necessarily measured in the size of one’s practice, prestige or bank account.” It’s not always fun to be the face of money in counseling, but it’s part of the role. And it’s more than worth it when I meet counselors who I’ve been able to (in a small way) help make a living or put their kids through college.

In reflection on 6 years, this month I thought I’d provide 72 private practice ideas—points taken from 72 columns.

  1. Now is a great time to open a practice
  2. Having a well-run business will allow you to provide better service to your clients
  3. You don’t need a lot of money to get started
  4. Good therapists can fail because of poor practice management
  5. Practice ‘constant forward motion’
  6. Complete all your clinical notes before you leave for the day
  7. Work on your practice, not just in your practice
  8. Starting a practice is a big transition, ‘technician’ to ‘entrepreneur,’ like a cook deciding to open a restaurant
  9. Marketing takes a lot of energy at first, but gets easier in time
  10. There is hope for you even if you hate networking or ‘selling yourself’
  11. Know who your target client is, then get to know him/her better
  12. Make your practice different from all the rest
  13. Solo-practices can provide a good income, but are difficult to sell
  14. You should know what your practice is worth right now
  15. Contrary to popular belief, entrepreneurs don’t like risk
  16. There are more counselors per capita in my area than anywhere else (says everyone, everywhere)
  17. Practice ‘thought leadership’; put what you know if writing
  18. Some counselors are excellent, but half are below average
  19. In our culture, the character of the incompetent counselor is a pervasive cliché
  20. Don’t criticize insurance reimbursements if you’re letting sessions run 20 minutes over
  21. Medical billing is important; a 90% collection rate is death
  22. There are about 19 reasons insurance claims are denied
  23. Protect your time to protect your creativity
  24. Don’t be timid to charge for services
  25. Don’t be shy about a no-show fee
  26. Preventing provider turnover starts at recruitment
  27. Hire team members slowly, carefully, and check references
  28. Even when contracts are well written, they suck at getting people to do stuff
  29. Be generous to your employees, your clients, your profession, even your competitors
  30. To retain clinicians, you need to provide a better experience than what they can get on their own
  31. Your team members should know where they stand, and what it takes to be promoted
  32. It’s important to honor employee birthdays, anniversaries, and achievements
  33. Great employees demand more money, recognition, and ongoing training/growth opportunities
  34. Don’t wait for someone to pick you; don’t seek approval from others
  35. Ignore people who hate you; unfriend on Facebook liberally
  36. Don’t blame anyone if you’re not where you want to be; look in the mirror
  37. What prevents you from success is within, not without
  38. Be curious, and question many things
  39. It’s okay to not have all the answers
  40. Seek to learn what you don’t know you don’t know
  41. Nobody has everything figured out. Seriously, nobody
  42. Have patience, but proceed with urgency
  43. Stress management and rest are important, too
  44. Proofread, for the love of god
  45. You will lose money on most advertising.
  46. Don’t spend thousands of dollars on advertising unless you’re sure it will work
  47. Sometimes you need to spend money to make money
  48. Invest real money in improving customer service
  49. Answer your phone, for the love of god
  50. Being an employee can be a great choice, and will allow you to focus on your craft
  51. Consider buying your building if you’re going to be there a while
  52. Time is of the essence; get your service to market quickly
  53. You can open a counseling center, and see your first client, in a week
  54. McDonalds opens at 5am. Coffee refills are free
  55. Delegation is a learned skill, an important one
  56. Name your practice well, please no puns!
  57. Set goals for the year, and work like crazy to break them
  58. A new website looks dated so quickly
  59. Figure out what you need, then find the technology–not the other way around
  60. Embrace technology, but know that it’s not a replacement for a sound business plan
  61. If you want to grow your practice, online therapy usually isn’t the answer
  62. No matter how good you are, you’ll get some negative online reviews
  63. Plan ahead to pass an insurance audit (do this even if you don’t accept insurance)
  64. Start getting on insurance panels now, because it takes months
  65. Whether to hire counselors as contractors or employees is an important decision
  66. The idea of a superbill can be misleading to clients
  67. Anyone can build a successful practice, if they’re willing to do the work
  68. Ethics and success are not incompatible
  69. You can make six figures a year in solo-practice
  70. Growing form a solo-practice to a group isn’t for everybody
  71. A million-dollar a year practice has less than 8 fulltime providers
  72. While your office might look better than most, clients expect what they see on TV (the bar is high)!

There’s still a lot to say. What do you still want to know? Message me @anthonycentore or @thriveworks.