There’s a particular way we talk about private practice in the therapy world. It shows up in casual conversations between colleagues, in the quiet fantasies that flicker through your mind during a particularly grueling agency meeting, in the way seasoned clinicians ask newer ones, “So, when are you going to start your own thing?”
The implication is always the same: private practice is the destination. The reward for surviving the trenches of community mental health, the marker of having “made it,” the natural next step for anyone who’s serious about this work.
But here’s what rarely gets said out loud: private practice isn’t a promotion. It’s a pivot.
It’s not a better version of the same work—it’s fundamentally different work. And not every gifted, thoughtful, deeply competent therapist wants it. More importantly, not every gifted, thoughtful, deeply competent therapist needs it.
Before you start asking the practical questions—When should I launch? How many clients do I need? What EHR should I use?—there’s a quieter, more honest question worth sitting with first:
Is this kind of work actually aligned with how I think, how I tolerate uncertainty, and how I relate to my own growth?
I don’t offer what follows as a checklist or a screening tool. Think of these as mirrors—three places to look that might show you something useful about yourself and what you actually want.
Your Relationship With Risk
Let’s start with something that doesn’t get acknowledged often enough: private practice asks your nervous system to do something fundamentally different than salaried employment.
When you work for an agency or a group practice with a guaranteed salary, there’s a certain kind of ground beneath your feet. You might hate the paperwork. You might feel suffocated by the policies. But on the fifteenth and the thirtieth of every month, money appears in your account. That predictability isn’t nothing. For many people, it’s everything.
Private practice removes that ground.
Income fluctuates—sometimes dramatically. Referrals slow down in ways you can’t always predict or control. The systems you build will break, sometimes at the worst possible moments. You’ll make decisions without knowing how they’ll turn out, and then you’ll have to live with the consequences either way.
This doesn’t mean you need to be someone who loves risk, who thrives on chaos, who gets energized by uncertainty. That’s a particular personality type, and it’s not a prerequisite. But you do need to be able to stay reasonably regulated in the presence of not-knowing. You need to be able to tolerate the discomfort of ambiguity without it sending you into a spiral.
Think honestly about how you respond when things feel uncertain. Do you freeze? Do you over-function, trying to control every variable until you exhaust yourself? Do you avoid, pushing the hard decisions down the road until they become crises? Or can you sit with the discomfort, make an imperfect choice, and adjust course as you learn more?
Private practice doesn’t reward certainty—because certainty is rarely available. What it rewards is the capacity to keep moving, keep thinking, keep showing up even when you can’t see the whole path in front of you.
A Willingness to Grow Beyond Clinical Skills
Here’s an assumption I see all the time, and it makes a certain kind of sense: Growth means getting better at therapy.
More training. More modalities. Deeper attunement. Sharper interventions. That’s the work, right?
In private practice, growth also looks like something else entirely.
It looks like learning things you were never trained for—business systems, marketing, accounting basics, legal considerations, technology platforms. It looks like being genuinely bad at something before you become competent at it, which is a humbling experience for people who are used to being skilled in their domain. It looks like receiving feedback that has nothing to do with your clinical work: a client who’s frustrated with your cancellation policy, a colleague who thinks your website copy misses the mark, a mentor who challenges how you’re thinking about your fees.
And sometimes, growth in private practice means confronting an uncomfortable truth: your values and what’s most profitable don’t always align. You’ll have to make choices about that tension, again and again.
You don’t need to show up on day one with business savvy or entrepreneurial confidence. Almost no one does. But you do need to be willing to learn without shame. You need to be able to say “I don’t know how to do this yet” without your nervous system interpreting that as “I’m failing.”
Because if every gap in your knowledge feels like evidence of inadequacy, private practice will quietly erode your confidence. You’ll be confronted with how much you don’t know on a regular basis—not because you’re doing it wrong, but because building something requires learning as you go.
A Comfort With Ownership (Even If “Entrepreneur” Feels Like a Foreign Word)
There’s a certain kind of clinician who recoils at the word “entrepreneur.” It feels too corporate, too hustle-culture, too far from the relational, values-driven work that drew them to this field in the first place.
I get it. And I want to offer a reframe.
You can be deeply values-driven. You can be relational to your core. You can reject hustle culture and refuse to treat your practice like a productivity machine. And you can still be an entrepreneur—because entrepreneurship, at its heart, isn’t about grinding. It’s about ownership.
Private practice asks you to own things that employed positions handle for you.
It asks you to think in systems, not just sessions. What happens before a client walks through your door? What happens after they leave? How do the pieces of your practice connect and support each other? These questions matter, and they require a different kind of attention than clinical work.
It asks you to make real decisions about money, about policies, about boundaries—decisions that affect your livelihood and your clients’ experience. You can’t defer to someone else’s judgment or wait for institutional guidance. The call is yours to make.
It asks you to hold responsibility for outcomes you can’t outsource. When something goes wrong, there’s no HR department to escalate to, no supervisor to absorb the weight. You troubleshoot, you repair, you learn, you move forward.
And perhaps most importantly, it asks you to understand that sustainability isn’t a moral flaw. Taking care of yourself financially, protecting your time and energy, setting limits that allow you to do this work for years instead of burning out in a blaze of over-giving—these aren’t signs of selfishness. They’re ethical necessities. A therapist who can’t sustain themselves can’t sustain their work with clients.
Ownership means holding all of this. Your time. Your capacity. Your limits. Your mistakes. Your growth. It’s a different posture than being “just a therapist,” and it’s okay to notice if that difference feels exciting or exhausting to you.
A Gentle Reframe
If you’ve read this far and something feels activated in you—a tightness, a defensiveness, a creeping sense of “maybe I’m not cut out for this”—I want to offer something.
That activation doesn’t necessarily mean private practice isn’t for you.
It might mean you’re early in the reflection, and there’s more to explore before anything becomes clear. It might mean you need more support—mentorship, consultation, a community of people who are navigating these same questions. It might mean you’re in the process of disentangling your own identity from the expectations that have been placed on you, figuring out what you actually want versus what you’ve been told you should want.
Or it might mean you’re discovering that you want something different. And that’s allowed. That’s more than allowed—it’s valuable information.
Private practice is one path. It’s not the path.
The goal isn’t autonomy at all costs, independence for its own sake, or proving something to yourself or others. The goal is alignment. Finding work that fits who you actually are, not who you think you should be.
Sometimes the most ethical decision a clinician can make is choosing the work structure that genuinely supports their nervous system, honors their values, and allows them to do this work with longevity instead of burning bright and fast.
Whether that’s private practice or something else entirely—the path that’s right for you is the one where you can thrive.
So many good points of reflection. Having grace oneself is so important when embarking on a new journey! Thank you, Dr. Band :)
Thank you for this thoughtful guidance 💛