In recent months, I have been spending a lot of time on the phone with clinicians from all across the country who are either in private practice, or aspiring to start a practice. No matter how many consultations I give, I am repeatedly shocked at the disparity between some counselors’ success, and other counselors’ lack thereof. To illustrate, below are two vignettes of counselors I consulted with just this week.

A Tale of Two Counselors

Brian[i] is aspiring to open a private practice in Nashville. He is on one insurance panel, and is in the process of getting on more. After months of stalling, he is just now signing a lease for an office space. He plans to hire a medical billing company, but doesn’t want to sign up until it “makes sense.” Brian won’t start a website or begin marketing his practice because, without being on more panels, he will “lose clients.” As I consult with Brian, he quashes every recommendation that I make. Brian’s practice is going nowhere fast.

Two months ago, Emma[ii] decided to relocate from Cincinnati to a place she had never been—Boston. Three weeks ago she made the move. Today, Emma is seeing 20 clients a week (most at $120 per session) which is the equivalent to 80 clients monthly, and earning revenues of approx. $10,000 monthly! How is this possible? One month in advance of her move, Emma began marketing her practice. She recruited 6 clients, who agreed to wait to begin their work in therapy until she arrived in Boston. At the same time, she began searching for a single office, and signed a lease ($650 monthly) just prior to her move (she furnished the space her first week in Boston). Emma isn’t widely known, and she doesn’t have any special connections. In fact, while Emma is licensed in Ohio, she isn’t even licensed in Massachusetts![iii] Because of this, she runs a “psychotherapy” practice (an unregulated term), and is ineligible to accept insurance. She competes head-to-head against thousands of longstanding licensed clinicians in Boston, and she’s winning!

A counselor can have a number of advantages when starting a practice: clinical experience, business acumen, community reputation, investment capital, luck, etc. However, more often than not (as is the case of Brian and Emma) what separates a successful counselor from and a struggling one is something different altogether.

Constant Forward Motion

When I was starting my business, the best piece of advice I received was summed up in 3 simple words: [always have] “constant forward motion” (CFM). CFM means to always be taking actions that will move you closer to your goal.

When starting a practice or business, the number of tasks that must be completed before the doors can be opened—and before everything can work properly—is daunting.

One practicing CFM realizes that the only way to get to opening day is to do the next thing on the list, and then the next thing, and then the next thing. It’s akin to the adage, “How do you eat an elephant? One bite at a time.”

Emma did this. She explains, “Because I’m a planner, I try and think ahead, and research what someone needs to start a practice.” Emma executed a low cost marketing plan, and started blogging specifically for her new practice in Boston (she writes weekly about her specialty, sex therapy). Emma began calling other providers and potential referral sources around Boston. She researched the rules about practicing in Boston, explaining “I am especially cautious when it comes to legal and liability issues—I want to attack those kind of things first to make sure my practice would run well, and was up to code.”

Moving to a new city is overwhelming. Competing against Harvard-trained professionals is intimidating (they are everywhere in Boston). While well trained, Emma isn’t from the Ivy League. She explains, “I thought, ‘oh my gosh, I’m really intimidated.’ But there is a part of me that has always been very ambitious. I tell myself ‘you can do this’ and I act with confidence, even more than I really have. People see this and they want to be a part of what I have to offer. I pretend I am on the same playing field—and I actually am.”


Brian, like many counselors, is stuck in some common catch22s. The way Brian sees it, he can’t get an office until he gets clients, and he can’t get clients without an office! The irony is that if he doesn’t do either, he’ll never make any progress. Either he will begin marketing and perhaps need to refer some clients until he gets his office up and running, or he’ll get an office and carry the costs until he starts building a caseload and making an income. But he needs to do something!

When Emma rented her office, she had only a few tentative clients. Still, at $650 a month, her maximum loss—over a 6-month lease—was only $3900. Emma realized that one weekly client would get her a good income and pay almost her entire rent. She utilized that helpful piece of education we talked about earlier: she accessed the risk and refused to be stuck in a catch22.

Progress over Efficiency

To Brian, the idea of spending money on marketing before he is fully credentialed with insurance companies is wasteful. Brian won’t market his practice because some potential clients will likely fail to schedule with him… because he doesn’t yet accept their insurance.

Emma sees marketing in the exact opposite way. Emma’s marketing endeavors produce 6-8 calls/inquiries a week. About half of her potential clients fail to schedule with her because she doesn’t accept insurance. Fine by her! With a 50% conversion rate, Emma knows that every week her marketing will generate 3-4 new clients and get her the income she needs.

Is Emma’s marketing efficient? No! But the goal of marketing for Emma isn’t to convert 100% of all leads. Her goal is to convert enough leads so that she can fill her caseload and receive a positive return on her investment. And this, she is accomplishing!

Multiple CFMs

To make timely progress, one needs to have many things in motion. Not just one at a time.

Brian wants to wait until his medical credentialing is finished before signing up with a billing company, even though there is no downside for getting started early. Therefore, medical billing is going to stay on his list of things to do. This “one thing at a time” progression makes getting through all the items and details of starting a private practice difficult.

In contrast, during a conversation with Emma, it’s hard to keep up with how many things she’s doing to run and grow her practice: from blogging, to networking, to social media, to connecting with potential clients by telephone. She’s busy! Even though she’s in session 20 hours a week, 60% of her time is spent building her business. Emma’s strategy for these long days: “You need to put it on your calendar and force yourself.” While it’s not easy, Emma Explains, “It’s important that you have a passion and enjoy what you’re doing, otherwise it’s going to be hard to get out there and increase your business. I have business in my blood.”

A Tale of Three Counselors

Two counselors, at basically the same starting place. Two stories, with two different approaches to the business of counseling. Two very different outcomes. Who do you most resonate with, Brian or Emma? How will you grow your practice?

Counseling Private PracticeDr.  is CEO of Thriveworks is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at

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[i] Brian’s name and some details were changed to protect his privacy.

[ii] Emma’s name and the details of her story are true and not hypothetical.

[iii] Practicing without a license is discouraged. Her licensure status is noted to underscore the level of Emma’s disadvantage in comparison to other practicing clinicians.