Prelicensed in Private Practice

Prelicensed in Private Practice

There are a lot of things to consider if you are going to go into private practice as a pre-licensed clinician.You may first think about things such as fee splits, entity formation, and which supervisor to choose. That's totally normal (and all important stuff) but here are some things that any pre-licensed clinician can do BEFORE they start their private practice. 

If you are considering going into private practice here are some top tips to get started.

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Tips for Getting Your Paperwork Done On Time

by Dr. Maelisa Hall, Documentation Expert

by Dr. Maelisa Hall, Documentation Expert

What’s one of the most common problems I see with students and recent grads? They have trouble getting their paperwork done! I’m the Quality Assurance Manager for a community mental health agency and it’s my job to make sure I give all our students and therapists the best tips and tools to make the documentation part of their job easier. I know, I know, you thought my job was to make their lives miserable, right?  

As a student or a recent graduate you usually have external requirements for your paperwork. You have deadlines, you have people reviewing your notes, and someone else has likely chosen the template for you. If you’ve had multiple supervisors you’ve probably also gotten disputing opinions on how much to write and what should go where. But I’m sure you also got one overarching message- get your paperwork done on time!

Easy Tips for Timely Documentation

Here are some easy tips for getting your paperwork done on time. You can start using these right away. Warning: Not every method works for every person! Be disciplined about sticking with a method for at least two weeks and then evaluate whether or not it’s working for you.

1.     Write in chunks. Some people are able to see a client for 45 minutes, write a 10 minute note, see the next client for 45 minutes, etc. If you can, stick to it and more power to you! Most of us aren’t able to do that, though. An alternative is to write notes in chunks. For example, see 6 clients on Monday from 11am-5pm and then spend an hour writing notes for all those clients. The time you select will depend on your schedule and flexibility, but try to keep it within 72 hours of your session so you don’t get backed up or forget what happened. When I worked at an agency I always scheduled assessments in the morning and made sure my afternoon was clear so I could finish it that same day (and then it was off my plate!). For regular sessions, I often saw clients in the late afternoon/evening so I didn’t want to stay until 8pm writing notes. I would schedule an hour or two in the mornings the next day and do all my previous day’s notes then.

2.     Be consistent. Regardless of whether you write in chunks daily, every other day, or hourly you have to be consistent! Missing one day’s notes means adding an extra 60-90 minutes on the next day you come in. Find the schedule that (realistically) works for your lifestyle and then write it in your calendar. Documentation time has to be kept as sacred as a client’s weekly appointment time and your lunch break or you’ll always find other things to do.

3.     Create a plan to catch up. If you do get behind in your notes (and most of us do, at some point or another), the workload can spiral out of control very quickly. Be honest with yourself and create a plan as soon as you notice the problem. A common mistake new therapists make when catching up is neglecting their current notes to complete the older notes. This keeps them in a constant battle of catch up. Stay consistent with your current notes schedule and make additional time in the short-term for writing the overdue notes. Start with the oldest notes and just move forward until they’re all done. Once you catch up, you’ll be glad you stayed up on your current notes and you can get right back to your regular schedule!

4.     Get support. If you’re having difficulty figuring out which schedule works for you or find that writing notes seems to take you longer than your colleagues, seek out help from your supervisor. Tell them your struggles early on so you have someone to keep you accountable as you problem-solve. Also, talk with colleagues to find out what strategies work for them. It’s great to stay connected with others so you know your struggles are normal and you can also find others who have worked through them. If you’re not a part of the MFTGuide Facebook group, click here to join and connect with likeminded therapists who are making the transition from student to working professional.

Follow these tips and you should be successful in completing your documentation on time! I know it’s not the most exciting part of what you do, but it’s just as necessary as being present during sessions. If I’ve learned anything from reviewing hundreds of client charts it’s that timeliness has a significant impact on the quality of documentation. I can tell when a therapist wrote an assessment or progress note within 24 hours and I can definitely tell when they waited 24 days!

As therapists, we deal with such ambiguous but powerful feelings and ideas. Much of what we do is intangible and it’s sometimes difficult to put into words. Combine that with the stress of studying for exams, dealing with client crises, and lapses in memory over time and you have a recipe for disaster when you procrastinate writing notes.

If you’re looking for more tips on time management and making documentation more relatable to your clinical work, check out my free online training: The Private Practice Paperwork Crash Course. Regardless of what stage you are in your career, there are helpful tips that apply to therapists working in all settings. Now, use the strategies above and map out your plan to get your paperwork done in no time!

Dr. Maelisa Hall of QA Prep

Dr. Maelisa Hall of QA Prep

Author Bio:

Dr. Maelisa Hall is an expert in clinical documentation who loves teaching therapists how to create rock solid documentation so they can spend more time focusing on their clients and less time worrying about paperwork. Click here for instant access to her Private Practice Paperwork Crash Course for mental health professionals.

Miranda Palmer

I have successfully built a cash pay psychotherapy practice from scratch on a shoestring budget. I have also failed a licensed exam by 1 point (only to have the licensing board send me a later months later saying I passed), started an online study group to ease my own isolation and have now reached thousands of therapists across the country, helped other therapists market their psychotherapy practices, and helped awesome business owners move from close to closing their doors, to being profitable in less than 6 weeks. I've failed at launching online programs. I've had wild success at launching online programs. I've made mistakes in private practice I've taught others how to avoid my mistakes. You can do this. You were called to this work. Now- go do it! Find some help or inspiration as you need it- but do the work!

Private Practice Internships

FINDING A PRIVATE PRACTICE INTERNSHIPGetting a private practice internship isn't easy. And truth be told, getting one is easier than having a successful private practice internship.

What you don't know about private practice internships: 

 

  1. In California, and some other states, you are required to be a w-2 employee. That means you get paid for everything you do in the business. 
  2. If you don't have any clients, and you are spending 20 hours a week working to find clients- technically your employer should be paying you for all of those hours.
  3. That is good right? Yes, and no. What if you spent 25 hours a week for 10 weeks looking for clients, or even just learning on the Internet, but you don't see any clients? Even if your employer/supervisor was only paying you $10 (a bit above minimum wage)- they have just lost thousands of dollars! 
  4. In addition to your pay, they have to invest in payroll taxes, insurance, worker's compensation, provide oversight, training, etc. They may have lot even more income in lost wages. 
  5. Taking on a private practice intern is a big deal and a bit of a gamble. 
  6. Most clinical supervisors don't have time to walk you through every aspect of getting clients. 
  7. But won't they just give me their overflow? What if their overflow doesn't click with you? What if you dont' instill confidence on the phone? What if you slide the fee everytime? 

 

For a therapist in private practice who is primarily seeing clients as their income- they are looking to invest their time and energy into an intern who will be a good investment. You are kind of like stock! You need to show them that you have done some pre-work, you know your stuff, and you are ready to hit the ground running and you know how to not just do good therapy- but how to get good therapy clients. 

A private practice internship will help you start your private practice

I know that can be overwhelming and anxiety provoking. However, it will be an amazing training ground for your future private practice. I recommend that anyone who plans to go into private practice in the future- start today! 

Wait- I'm still getting my Master's degree- can I start today? Yes. 

Wait- I'm not done with my hours- should I start today? Yes.

It may be a period of time before you can legally start seeing psychotherapy clients in private practice. However, that doesn't mean you can't start the process of growing a practice today. 

What can I do as a psychology student or pre-licensed therapist to prepare for private practice? 

 

  1. Launch an online presence. Commit to blogging at least 6 times per year (I'd recommend 12) on the topics you are most passionate about. Bonus points if you already know what area you want to specialize in- write on those topics. 
  2. Launch a community presence. Commit to attending at least 6 trainings per year, and follow-up with 2-3 people you meet at each of those trainings after the event. 
  3. Develop a list of people to refer to. Get to know what people are passionate about- if they are awesome- refer people to them. 
  4. Start creating a vision for your practice and add in 3 business trainings per year- even if you don't think you will need it now. Start to create a mental foundation or schema for what building a profitable private practice will look like. Here is a free private practice 101 training you can watch today. 

 

There are more things you can do to build a private practice- but let's keep it simple! Post your private practice internship questions below. Did you do something awesome to snag a private practice internship? Tell us about it! 

What I wish I’d known about a Private Practice Internship

by Kimberly Sandstrom, LMFT

Well, first, I wish I’d known that private practice would challenge every “I’m not good enough” crack in my “I’ve got it all together” veneer. Yep, people think I’ve got it all together. I don’t. Every time I called a client and they asked if I took insurance or how long I’d been in practice, or what my fees were…the hesitation took over.  “The ruse is over. They will know I’m a poser.” If they find out, they are going to run for the hills…or the therapist next door!”

These are things I wish I could tell you as you begin your journey in private practice as an intern.

  1. No one will EVER ask you what your GPA was in grad school. (Well, one client did, but his son was in my practice for anxiety…hmmm.) So, don’t stress it while you are studying. Just learn what you are supposed to and enjoy the journey—you will miss the opportunities to learn and discuss (but not the papers and exams).

  2. I would feel like a poser for a while. Sometimes I would catch myself in the middle of a session thinking, “Wow, look at me! I’m a therapist!”

  3. I know more than my clients do. Telling clients I was an “intern under supervision” was one of the scariest things in the beginning. I was sure they would say, “I’m outta here. I want someone who can actually help me!” No one did run or tell me that. In fact, once they were in the office, they stayed—I’m good at connecting with people. My life experience couples with my clinical training and awesome supervision gave me the edge I needed.

  4. I can charge what I’m worth. I thought I would have to charge $25 per session because that’s what all the interns before me did. I sat down and made a list of what I knew and what I need to learn. Surprisingly, all the extra training and interests, books I’ve read over the years, and my life experience being married 20+ years, raising 3 daughters, actually gave me a competitive edge. I started out lower than I am now, but worked my way up. I’m worth it. You are too. You have unique experiences no matter how old you are. You have a reason you pursued this career. Capitalize on that and think about all the work you’ve done in that area for yourself.

  5. Helping people heal is like taking ecstasy! Well, I’ve never taken ecstasy but I hear it’s like the love drug. That’s exactly how I feel when a couple I’m working with begins to heal, lowers their escalation and begins to fall in love again. All the dopamine centers in my brain begin firing. It motivates me while working with the tougher couples I work with. There is hope and I’m a vessel for healing in their lives (not the only one, but one vessel they can access).

  6. Transparency is okay in the therapy room. Remember #2? I thought I had to pretend I knew everything. I don’t. When I’m stuck with a couple, it’s okay to share that. “Hey guys, I’m feeling like we are getting stuck in this same place, are you feeling that too?” Usually this opens up conversation for where they are getting stuck and I don’t have to do all the work.

  7. Opportunities don’t “present themselves” you have to go find them! During my practicum, the site I was at had to send me clients and there was no shortage—they took on students to provide for their clients and I needed the hours to graduate. Private practice, no one hands you clients (my supervisor was very generous with referrals). You have to go out and get them. This meant asking people to meet for coffee, asking people if I could blog for them (like here) and emailing audiences I wanted to speak to and asking them if they needed me. My name was unknown and I had to make myself known to others. While you may not like to speak, you can certainly put yourself out there in other ways. I networked with key people in my area and the referrals begin to trickle in. Now licensed, I have a steady stream of clients and community referral sources that I can rely on to keep my practice full. Oh, and about “full”…

  8. I don’t have to see 45 clients a week. I’m exaggerating, of course, but I found a good number of clients that I feel comfortable with each week. They get the best of me when I stay within that client-hour range. There was one month during my internship that I saw 25+ clients a week. I was exhausted, irritable with my family, and not doing my best work. I got sick the moment I slowed down. I made a decision that this was not in my best interest. So, I raised my fees a bit with new clients and see less.

  9. The BBS does eventually approve your hours. The past few years it has been a long seemingly endless wait for hours to get approved, but it meant I got an extra year of supervision and experience. Silver lining.

  10. I don’t have to know everything and I don’t have to figure it all out on my own. Are you seeing a theme here? There are people out there, like Miranda, who LOVE to help you succeed. There are free resources available and ones worth paying for. They are investments in your current and future practice. Take advantage of them!

Want more specifics on how I did it? Feel free to contact me. Miranda has amazing resources and is so willing to connect with you and connect you with others, don’t miss out on what she provides.

A note from Miranda: Ahh thanks Kim! A huge shout out to Kim for sharing a piece of her journey with all of you! Comment below with what you learned in today's article, or what wisdom you would like to share with others! (Maybe even just say "Thank You" to Kim for taking the time to give back to the MFT Interns out there!) If you aren't on the list yet- be sure you are getting these awesome articles delivered right to your inbox! If you are looking to start a private practice internship, here are some other articles that might be of interest: 

Finding a paid private practice internship

Learning to network to find a paid position

Your MFT Resume


 

Finding a Paid MFT Internship or Private Practice Internship

Are you looking to get a paid internship? Well, in many areas of the country the competition is fierce and the jobs are scarce. And you know what that leads to? A lot of of fear, frustration, and hopelessness. 

Calling all pre-licensed therapists! You CAN be successful- even in this economy! I'm going to give you some tips to finding a paid internship as a MFT Intern, ACSW, Associate LPC, etc. today.

Ok, so let's starts simply: 

1. Be professional. 

I think it is crazy that I should even have to write this one down. It seems so obvious. And yet, I talk to therapists who are searching high and low to hire pre-licensed therapists for private practice internships. What do I hear about? 

 

  • Unprofessional clothing
  • Interns who aren't taking care of their own mental health
  • Unprepared therapists
  • Entitled therapists
  • Angry therapists

 

While I know that none of you would ever do this. I want you to take a moment to think about this. A private practice internship is someone's baby. It is a licensed professional's small business that they built from scratch. It is should (hopefully) be successful if they are looking to hire someone to come to work for them. 

However, an unprofessional therapist who dresses poorly and doesn't know how to carry themselves could lead to more than just a headache for the supervisor. It can lead to a loss of new clients, a loss of income, and even the loss of the business. It is a VERY big deal for someone to trust you with their practice. Their business will be judged by your actions. 

So, put a little extra oomph into your dressing choices. Dress as you would if you were presenting at a state conference, or you were going to be on Television. If you find the position is more casual- great. But never assume. And prepare for that interview! 

2. Understand the position

One of the key tips i describe in my job interviewing 101 podcast are ways to gather information about the position you are interviewing for. Understanding the position more completely prepares you beautifully for an interview. You need to know what they are looking for,  and, you need to know whether this is even a position you want! 

Private practice internships are not like traditional agency jobs. In 95% of cases you don't show up and see clients. In fact, if you find an internship where you show up and see clients- chances are the pay will be low, or non-existent. 

A successful private practice internship gives you an opportunity to legally market your psychotherapy services. It is a chance to present yourself to the world, start to build your reputation online (and offline), and it can be the foundation with which you launch your own private practice after you get licensed. 

You want a therapist who is going to give you freedom to develop your own website, market in the community, etc. If you get an internship where you aren't allowed to do these things, you are going to have difficulty finding clients- either now- or when you launch on your own. 

A private practice internship that includes the responsibility to market your practice isn't a minus- it is a plus. It is a perk! Having a clinical supervisor who expects you to get clients means having a supervisor who understands how business works and will have more support for you as you move forward. 

A private practitioneer is looking for someone who doesn't just "want to go into private practice someday" but someone who is "preparing to launch a successful private practice in the future by taking specific steps today." Are you passionate about starting a private practice? Are you willing, and ready to learn about marketing, business planning, business boundaries, clinical boundaries, and more? 

3. Don't wait for things to "happen." 

I see many therapists who are complaining that there are "no jobs." While therapists in the exact same places are getting offers from multiple positions. How can this happen? Are some therapists just "lucky?" Maybe. However, every pre-licensed therapist I've seen experience this has made some very specific choices. They make time for trainings and networking early and often in their careers. They are well known by licensed and pre-licensed therapists alike. They are strategic in their thinking and have a bigger plan in mind. 

Do you have a goal of starting a private practice once licensed? Start developing your specialty today. Start your blog today. Start building a contact list today. If you wrote even 1 blog per month, and got even 30 new subscribers per month, in 3 years you would have over 1000 people on your e-mail list. Google would know who you are, 1000 people would know your name. Let's say 50% of those people unsubscribed, and only 1% of those that were left wanted to become your client when you opened your private practice. Do you know what that means? Five new clients when you open the doors. 

Pre-licensed therapists, you can be successful! Think outside of the box. You have (or are getting a master's degree). Build your reputation, make connections, and choose to be successful. You can do this! 

(Are you on the list? If not, get on the list and you'll get the Job Interviewing 101 podcast send out to you after a few days).