When starting a private practice, common advice you might hear to help you prepare for the roller coaster ahead might sound like

    “There will be up years, and down years,”
    “There will be seasons of feast, and famine,”
    “There will be good days, and bad days.”

However, the reality is that the experience of growing a private practice (or any company) isn’t ups then downs – it’s experiencing both at the same time, a lot like this most recent example from my own practice.

The Day We Were #1 on Reddit

It was 10:30 Saturday evening. A couple hours earlier, I had set my phone aside (a rare event) to charge. On my way to bed, I pick it up and see dozens of missed calls and texts.

Up: Text: We’re trending on Reddit science.
Text: We’re at the top of Reddit science.
Text: We’re on the homepage of Reddit!
Text: We’re #1 on the homepage of Reddit!
Text: We need to call our hosting provider!

I open Google analytics and see that thousands of people are on our blog. Amazing!

Down: I go to Thriveworks.com and see just a white screen; our site hasn’t crashed but…almost. The heavy traffic is overwhelming our website’s server and it’s taking minutes to load a page. This shouldn’t happen. We pay a fortune just so this doesn’t happen.

My team has called our hosting provider, but nobody can find the security code they need to get anything done. The one person (besides me) who had that info left the company the week before. I finally get through to support and learn that there’s nothing we can do. It is what it is—a mess. I go to bed.

Up: While slow to load, our website doesn’t crash. In fact, overnight we receive tens of thousands of visitors. By 8am Sunday morning Thriveworks.com has already experienced its busiest day in history!

Down: Also Sunday morning, a scheduled newsletter is sent to our email list of professionals interested in counseling private practice/business topics. This newsletter is on a particularly sensitive subject, selling a counseling practice. The newsletter goes out to ~50,000 subscribers, and also erroneously to 2700 persons on our “general interest” list (i.e., persons interested in psychology/counseling topics). A number of those recipients reply to us confused, or annoyed. A few are very angry.

Up: I receive a text from a franchisee who has hit a new personal record. Their practice is rolling at $1,500,000 a year in revenue. Their hard work has paid off. They’re thrilled, their clinicians are thrilled, and I’m thrilled for them!

Down: We get a 1-star review on yelp. Someone reportedly disagrees with her psychiatrist’s recommendations. She hammers us for not having another psychiatrist on staff. The review is full of false information. It’s one of those reviews where there’s not much we can do to fix the problem. It’s brutal.

It’s still not even noon. And shall I restate, it’s Sunday. And it’s not that unusual of a morning. For one starting, running, or growing a private practice, this is par for the course.

Being okay with ups/downs

For years, after such a morning, I’d be stressed. My stomach would be in knots. I’d ask myself, “Am I cut out for this? Is this worth it?” Today, it doesn’t affect me (much). Here are three thoughts/maxims that help me keep the “downs” in healthy perspective.

1) I have a friend who once apprenticed with a plumber. He was in someone’s home when a pipe he was working on broke and water started flooding everywhere. He began to panic. The experienced plumber calmly stopped him and said “We don’t panic. We don’t get upset about anything. We handle it.”

I’ve found that to be good advice. Getting upset, or stressed, is unproductive. Even when things are going very badly, it doesn’t get the mess cleaned up any faster. And frankly, in both the work of plumbing and counseling private practice, sh*t happens. Try to get comfortable with it.

Maxim: We don’t get upset about anything. We handle it.

2) Here’s a strange truth. The more success you have in private practice, the more people you help, the bigger you grow, the more problems you’re going to have every day. If you’re not experiencing problems, you’re probably not doing much.

Maxim: If I don’t have problems, I don’t have much.

3) A therapist-friend had a client with terminal leukemia. The client had just a few months to live, and was depressed. One day my friend was consulting with me about the basics of the case when I thought, “If I had leukemia, I think I’d be able to be happy and enjoy the remaining time with my family.” But, citing work stresses that day, I was miserable—and that made zero logical sense (like being upset about a parking ticket on the day you won the lottery). Immediately, I started feeling very grateful. Now, when I find myself getting twisted up about something at work I just think the quasi-maxim: “Leukemia”, and that quickly brings life back into perspective.

If you’re feeling overwhelmed, hang in there. And remember, when growing a private practice, good times and bad times usually happen at the same time.

How do you handle ups and downs? Let me know @anthonycentore or @thriveworks

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Dr. Anthony Centore

Anthony Centore, PhD

Anthony Centore, PhD, is Founder and Chair at Thriveworks — a counseling practice focused on premium client care, with 340+ locations across the US. Anthony is a Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and author of "How to Thrive in Counseling Private Practice". He is a multistate Licensed Professional Counselor (LPC) and has been quoted in national media sources including The Boston Globe, the Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."