Psychologists most common private practice mistakes and how to avoid them

Jamie Frew
Jamie Frew

We, as psychologists, are an integral part of our society. We often work behind the scenes with countless individuals, providing psychotherapy within our community. Making sure each individual can do their best and, in turn, make our society a better place. As important as that role is, we, too, are only human and bound to make mistakes (heavens knows how many I have made throughout my career). I'm not here to tell you what to do or even that you need this help, but I want to share my past mistakes and some tips I wish I knew 10 years ago.

Tips for those who run their own practice

Having started a practice myself, I made a few mistakes that I hope you can learn from. The first one is to start out with good habits. Something tiny and seemingly insignificant in your practice's initial phases, such as spending a few extra hours of un-billable time with each client on the phone (which may initially seem significant for the therapeutic relationship). It will quickly become problematic as your caseload grows.

Clients will still expect the same attention and may become disappointed when you can't continue to put in as much time as you did at the outset. In addition to this, writing lengthy or unstructured client notes and assessments may be manageable with a caseload of fewer than 7 clients but will quickly become too time-consuming and increasingly unreliable as your time becomes more and more scarce with a growing caseload. For your sake and your clients, start out with sound systems and practices. Even if you only have one client, it's better to be prepared. Have the know-how and be ready for new clients rather than waking up one day and realizing your practice isn't running effectively. Then experiencing the consequences in your personal and professional life (take it from me, I should know, having experienced this exact situation myself).

The next thing I had to learn was that there's a reason all mental health clinicians don't go out on their own. It is hard work -and not for the reasons you might think. I am not sure whether this is a common theme among mental health professionals. Still, I specifically chose not to study anything to do with business at university because managing finances and other 'businessy things' are not my strong point. I don't know why, but it didn't occur that starting my own practice would involve so many non-clinical hours and tasks. I was an experienced and successful practitioner and naively thought that was all I needed to create and maintain a thriving private practice. New clients and referrals will come flooding in the door. I'll be able to work the hours I want and get the pay I deserve. I can tell you that I have finally achieved this goal now, but boy did I experience the opposite initially.

Having no entrepreneurial skills or training in anything to do with running a business. I simply opened the door to clients and waited for the phone to ring… it didn't. I was quiet for weeks! Finally, a friend in the field told it to me straight, and I realized starting a business was an active process, not a passive one. I needed to go out and learn, just like every other entrepreneur. There is a wealth of knowledge out there. You just need to access it. I found blogs (similar to this one) the most helpful. Connecting with other therapists through social media and psychological associations to determine where their missteps were and what recommendations they have would enable me to improve my entrepreneurial competency to become a good therapist. Other options you could consider using might be youtube videos, online classes, mentors, coaches, podcasts, or just good old-fashioned books.

The final tip I have in starting up your own practice would be to take yourself and your practice seriously. If you expect others to trust you and invest their time, you need to be investing in yourself. I always felt that spending the little money I did have on professional or personal support such as therapy for myself or coaching seminars was a luxury and not something to splash out on initially, but that is wrong. If you're on your own, you are the practice, and the practice will be a projection of you.

Therefore you need to give yourself the best chance at success and ensure you are as happy, healthy, and educated as you possibly can be. Self-care is imperative to success as a new therapist. Further to this, I would highly recommend investing in infrastructure for your practice. This will include things like a functional phone, a comfortable workspace, and (most importantly for me) a great software management platform. Self-disclosure...I currently use Carepatron and absolutely love it. Carepatron is excellent because it helps me be so much more productive and streamline how I do the parts of my role that I am not that excited about. Here are some of my favorite things about it:

  • It's HIPAA compliant and certified, so there's nothing to worry about regarding privacy and confidentiality. It's certainly much safer than keeping loose bits of paper in my office!
  • They have a free version with unlimited users and all the fancy features, so I don't have to spend anything on something as unexciting as software.
  • A simple, intuitive interface, even I was able to navigate around without any trouble.
  • They have AI-powered voice-to-text transcription, so I can now take notes on the road, meaning that I don't forget any of those little details when rushing between clients.
  • They have support available 24/7! I have needed help a few times, and they actually answer and speak to me and help me! Therefore in such situations where I required it, I have been able to get the help I need and be the supervisee myself!
  • Billing and payment automation, who knew it existed?! This has been life-changing for me. I cannot recommend it more for someone who struggles with finances and keeping up to date with billing.
  • The note and clinical report software are good and mean that I don't have to keep switching between different places to get down what I need about a client. When I am rushing to get into a session, I don't have a panic right before trying to locate a client's notes from last time.

So.. to summarise that all for you:

1. Create your practice from the ground up thoughtfully

2. Clinical skills might not be enough to create your business

3. Invest in yourself

Tips for practice in general


This might seem like a pretty obvious tip to be pointing out as confidentiality is of paramount importance to all mental health professionals. Any missteps or violations in terms of confidentiality would represent a cause for significant concern in terms of the competency of any good therapist or mental health professional. This is a gentle reminder that it is essential to avoid some common mistakes made around confidentiality regarding decision-making as a clinician. These include making sure you keep your client's electronic documents on a secure and compliant online platform. If you still keep paper files that they need to be behind locked doors. Only those who are legally able to access any client details, notes, or assessments should have the capability to do so. Aside from having secure client notes, another thing to consider is the physical nature of the office you are practicing in. The room you see your clients in should provide adequate privacy, and so too should the conversations you choose to have with your client's in the waiting room. I always struggle to remember to not start talking about personal details until we are seated in the room with the door closed. Ensuring you meet confidentiality requirements is not only professional but is required by law. This is definitely, something to keep at the forefront of your mind in your day-to-day practice as a mental health professional.

Practitioner-Client Fit

As a psychologist and person, you will more than likely have areas within the mental health field you prefer and are more knowledgeable in. Maybe you like to practice psychotherapy as a family therapist. Perhaps you choose to employ a slightly different treatment approach or therapeutic process to your peers. There is no 'right or wrong' way to practice (well, aside from using research-based methodology) or better specialization. Still, the one crucial thing to remember is that working with different clients is like finding a shoe (in this case, I would say you are the shoe, the client is the foot). You are there to help, support them, and you want to provide them with the best service possible. Therefore working with clients that require help in your area of expertise is best for you and them. That is because you will be the most well-practiced at treating their needs, helping with their presenting problems, and meeting any expectations they have. You will gain more knowledge in the area you are interested in and feel more accomplished because you are more likely to actually make a difference for that client. You will develop a better reputation and more clients! For example, my expertise is in family therapy, and I tend to work with many clients with eating disorders. I ensure that I am paired with the right clients by being actively transparent in my background, training, and professional manner. I am sure to have a professional summary online and have a good relationship with those who are likely to give me referrals to be aware of my expertise as a practitioner.

Here, the take-home message is to make sure your practice isn't undermined by a poor client-practitioner fit; therapeutic alliance with your client is paramount in client success.

Multicultural Competence

My third and final tip for a psychologist in the field would be to make sure you demonstrate multicultural competence. As an older practitioner, I initially found this difficult as there was minimal/ no mention of multicultural aspects of practice in my formal training. To remain current and appeal to a wide range of clients, you need to demonstrate your ability and willingness to learn. Understand and empathize with different cultures or ways of life to your own. Failing to understand or convey cultural competence represents a vital mistake in the realm of psychological practice. As demonstrated by many different studies, not making an effort to relate to a wide range of individuals within our society has become a critical issue when practicing. This is because having an inability to empathize or be introspective speaks to a deep, underlying problem as a practitioner. To be the most effective psychologist, you need to put people at ease and select what should be the most effective form of treatment for them. Neither of these things would be possible without first understanding the cultural practices of an individual. Make an effort to become aware and able to relate to clients of other cultures, whether through learning a language, attending seminars, and making sure you are receiving cultural supervision or all of the above.

In summary:

  1. The cardinal rule of psychological practice: confidentiality
  2. Finding the right shoe, practitioner-client fit
  3. Staying relevant...Multicultural competence

Practicing as a psychologist isn't always easy. I hope these tips have been relevant and useful for you and that you can learn from my mistakes instead of making them on your own!

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