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One Clinician’s Journey to Creating a Sustainable Business

June 19, 2024

Julia Smith looks at her laptop and smiles. She has her brown tied back and wears a black blazer and silver necklace. She is at a desk in her clinic with a white background and the shadow of a plant behind her. Illustrated elements around the laptop include three teal lines in the upper left corner of the laptop to signal a notification, and a teal-colored bag of money to the right of the laptop on the table.

As narrated to Vasiliki Marapas

Julia Smith finished her Master’s, moved to a new city, and laid the foundation for what would soon become a successful private practice.

Today, she’s not only the Clinical Director at Insight Mental Health Counselling, but the owner of Fearless Practice: a consulting company for Canadian therapists navigating the business side of the mental health profession.

We had the chance to chat with Julia about her journey — and how she’s maintained a financially sustainable business.

You have your degree – now what?

I was lucky enough that going to school wasn’t a financial burden for me. Not having debt after I graduated helped me take the leap into private practice. That being said, I definitely had rose-colored sunglasses on, thinking, “In a couple of months, I’ll have a full caseload and life is going to be amazing.” Then reality set in. Maybe for some people, that’s what happens. But at least for myself, it took years to build my caseload into something solid.

I recommend starting off with a part-time or full-time job, so that you know you can pay the bills. Then you can start seeing private practice clients one or two nights a week and slowly build that up. I got a part-time counselor position at Dalhousie University to support myself as I grew my private practice. I also don’t think debt should stop you from starting a private practice. In a way, it might motivate you to start sooner so you can start making more money on the side.

It’s worth it to pay for expert advice

For me, it was really important that I had a consultant when I started my practice. The business of private practice can be a grey area when you’re starting out. You can sometimes feel lost or have no idea what to do in certain situations. So I budgeted $500 a month to speak to a consultant for the first couple of months. It was super important not only for the growth of my business but for my mental health, for my anxiety and stress, to make sure I had someone who I could talk to and say, “Okay, this is where I’m at. What should I be doing? What am I missing? and have that support.

Julia Smith meets with a client virtually. We see behind Julia's shoulder that she is looking at the screen of her laptop with a blurred out view of a patient.

Chasing dreams, embracing sacrifice

Investing in a consultant meant that I moved into a bachelor apartment instead of a larger space. I didn’t have the fanciest furniture for a long time. I didn’t go out to eat a lot. I really conserved my budget so that I could focus on building my practice. I was also renting a clinic room by the hour, which was a really sweet deal that meant I didn’t have to pay for any time I wasn’t there with a client.

Basically, I knew I didn’t want to have any regrets looking back if my practice didn’t work out. So to cut back on things in my personal life in order to put that money towards my business wasn’t difficult for me. I had a goal and I was enjoying moving towards it. I do love to save! It’s a challenge in and of itself, not spending money and asking, “What could I cut out?”

First-year private practice essentials

Beyond the consultant, my website and my Electronic Medical Record (EMR) were the main expenses in my first year. Some people might not think they need an EMR so early because they don’t have a lot of clients yet. I think it’s worth it to build a solid foundation. Yeah, you could use inexpensive third-party tools for scheduling or online therapy, and you could encrypt your notes on your computer. But it might get complicated for onboarding new clients. At the end of the day, having an EMR is professional, and you are running a professional business.

Charging what you’re worth

Talking to my consultant helped me set my rates. Everybody in Halifax at that point — this was several years ago — was charging between $80 and $100 for counseling. My consultant told me to go to $125. They were like, “You have a Master’s degree, you’re skilled, you have experience. Start at $125 and see how that goes.”

If I didn’t get any clients at that price, I could have just lowered it. There was no risk there. But that doesn’t mean it wasn’t stressful. It was really, really uncomfortable. It’s so uncomfortable to charge for services, especially in a helping profession. But my thinking was, if an expert is telling me this is what I should do, I’m going to do it and push through the discomfort.

Regularly reassessing your rates

In year three and four of running my practice, I took a break from meeting with my consultant because everything was going great. I wish I had checked in a little bit more, because they would have directed me to make decisions that needed to be made sooner, like raising my rates.

Raising my rates has allowed me to work a 50/50 workweek where I’m only seeing clients three and a half days a week. Not seeing as many clients means I’m not as burnt out, and I can do other things, like starting Fearless Practice. Raising my rates also allows me to afford a lifestyle that helps me be a better therapist. I’m more relaxed, I’m more engaged, and ultimately, I’m giving my clients better care.

Marketing your genuine self

One of the best things I did was make a video about who I am as a therapist. I would strongly urge practitioners not to rely on static content alone on their website.

It can be as basic as recording yourself on your computer. Many potential clients want to see you and hear how you talk. They want to feel your energy, your vibe, and a picture doesn’t speak to that as much as a video does.

Julia Smith's headshot with a block quote of text in white against a teal background. Julia has brown hair and wears a black shirt and black blazer, and smiles for the camera. The quote reads: "Raising my rates also allows me to afford a lifestyle that helps me be a better therapist. I'm more relaxed, I'm more engaged, and, ultimately, I'm giving my clients better care.

What to do when it’s time to grow your practice

Right before the pandemic, I left my counselor job at Dalhousie. I was definitely kicking myself when the pandemic hit, like, “Why did I leave the secure job?” But I was also lucky enough to have six months of emergency savings saved up. That was helpful because it made making decisions easier knowing I had savings to fall back on. It also made it more ethical because if you really need money, you might take on a client that you’re not qualified to see.

One big risk that I took was deciding to keep my private practice solely online, and by the fall, I was busy and getting full again. Because I didn’t have to pay rent anymore, I was able to hire a virtual assistant and an additional therapist. It was a feeling of, “Hey, I’m getting full. What help can I get to continue to grow my private practice?”

You don’t necessarily have to expand into group practice; there are other ways to approach it. You could refer out to other therapists, or you could raise your rates so it slows down how many people are coming to see you. But I had somebody in mind to come on board.

We decided on a percentage split, and I didn’t include a non-compete clause. I want to make it worth it for therapists to work with me so that they’re staying because they want to, not because of a non-compete.

Hire out when you need it

I recommend people with a solo practice hire a virtual assistant as soon as possible. Having a VA makes your business professional, and allows you time to focus on being an awesome therapist instead of spending time doing admin work.

I really believe that an hour of work should equal an hour of pay that allows you to live, and paying a living wage doesn’t have to be overly costly for your business. In Halifax, a living wage is $26.50 per hour, so if they do 10 hours a month, that’s $260.50. That only equals out to one or two client sessions, depending on what you’re charging. Saving money doesn’t have to mean paying people too little.

Later on, I also hired a social media manager because I don’t like posting on social media. I think the goal as you grow is to outsource everything you don’t enjoy doing, so you can focus on doing more of what you love.

An infographic highlighted in teal blue with a white section and black text. Above the title, a teal icon of a lightbulb with a white dollar sign in it. The title states: "Marketing on a tight budget?" followed by a paragraph of text that says: "If professional services are too costly at the start, try investing in tools that allow you to do things yourself — external mic, ring light, quality camera, and self-recording software." There is a line break, followed by a subheading in a teal circle with white text: "Tips for DIY video recording" Each tip is a bullet point with a teal icon in the shape of a camera. First point: "Film in a well-lit space with soft, front-facing lighting, whether natural or indoor. Avoid overhead lights, which can cause shine." Second point: "Minimize elements that might take attention away from you. Neutrals, wood tones, and plants offer a safe, clean, and inviting feeling." Third point: "Opt for a quiet space. Avoid whirring fridges, running dishwashers, and spaces with echoes (or sirens or crowing birds!). These become small distractions for the viewer." Fourth point: "If the audio from your phone is sounding crackly or your mic is picking up background noise, test out some headphones." Fifth point: "Warm up your vocal cords by pretending you’re talking to a friend. If you’re the only one in the room, this may seem a little awkward, but try acting as though you’re catching up for coffee. This honest and sincere tone will translate to your recording and showcase the real you." Fifth point: "This might sound obvious, but look at the camera! What’s less obvious is that a smile can trigger an audible change in a speaker’s voice, often for the better. Try smiling while you’re talking and keep your hand movements to a minimum, if possible."

Want more business advice just like this? 💼

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