Private Practice Has Changed. Are We Changing With It?
Remember when you could fill a private practice with a Psychology Today profile and a laptop?
Honestly, for a good while, that really wasn’t much of an exaggeration. Demand was high, referrals were plentiful, and many therapists didn’t have to think much about marketing beyond a directory profile and word of mouth.
For several years, the demand for therapy was huge. COVID changed how people thought about mental health while making telehealth (and all things virtual work and learning) part of everyday life. It also meant a lot of people were looking for therapists and seeking support during an unprecedented, scary time. Many clinicians who started or grew private practices during that period entered a market where demand greatly exceeded supply.
I was one of them. I opened my practice in February 2021 and had a waitlist by mid-March. I kept that waitlist for nearly three years before I started noticing the shift “back to normal.”
With all that demand, private practice also became a real possibility for a lot more therapists. More clinicians realized they didn’t have to spend their entire careers working for agencies, hospitals, or other systems that weren’t always working so well for them. #freedom.
Cue big tech entering mental health care.
Companies like Headway and Alma made insurance credentialing and billing much easier to navigate. Group practices started growing and telehealth meant you didn’t necessarily need an office so the path into private practice got a whole lot shorter. More therapists having access to private practice is a good thing. It also means the airways got a little crowded.
Back to the Ebb and Flow
Depending on where you live and what populations you serve, you may also be competing for referrals with increasingly large group practices. The ebb and flow of referrals isn’t new to private practice. When I talk to colleagues who were in practice before 2020, they’ll tell me that eight referrals one month and none the next was pretty normal. The difference now is that those referrals are being spread across a much larger pool of therapists. In other words, inconsistent referrals were normal before COVID, COVID temporarily distorted that pattern, and now the normal inconsistency is happening with way more therapists in the mix.
We have to also consider the current state of the economy. More therapists are competing for referrals at the same time that many people are thinking twice about taking on another expense.
There’s an understandable assumption that when the world feels especially stressful, people think, “Holy shit, I need therapy,” and start looking for a therapist. I’m not convinced it always works that way.
Shit feels scary and uncertain for a lot of folks right now, and when that happens, people tend to hunker down and guard their resources. Therapy might be something they desperately want, but $150 or $200 a week (or even every two weeks) can feel impossible when groceries, rent, childcare, healthcare, and seven million other things are competing for the same paycheck. Even a $35 weekly copay adds up to a significant expense. Someone can need therapy more than ever and still decide they can’t afford to prioritize it right now.
A Good Therapist Still Has to Be Findable
I wish graduate programs spent more time teaching therapists how to run businesses because most of us entered this profession knowing very little about marketing and SEO. If you’re in private practice, though, you’re a clinician and a business owner.
Thinking about this can feel overwhelming because in the age of Tik-Tok and algorithms, we may feel like we need to become full-time social media influencers to get noticed. Not true but you do need to make it easy for people to find you and understand what you do.
Word of mouth is still incredibly valuable, referrals from colleagues, physicians, former clients, friends, and community members can still help build your practice.
Let’s take a minute to consider what happens after someone says, “You should call this therapist, I’ve heard they’re really good.”
They Google you. This is the marketing piece that we have to account for now.
Okay, They Googled You. Now What?
My website, blogging, and Google Business Profile have made a significant difference in my own referral traffic. It takes time and energy, because running a business takes time and energy. However, I’m not spending hours making Instagram stories and Reels or trying to feed the algorithm daily. I’ll be honest, I felt the downward shift in referrals at the beginning of 2024 and knew I needed to level up my business acumen. There are a million conversations happening among therapists about Psychology Today drying up. I’ve noticed the drop too, but overall, my website swooped in and helped soften the impact. I invested in my website, started paying attention to how potential clients were finding me, and built referral traffic that wasn’t so dependent on one directory.
I’ve focused on creating useful content around topics within my areas of specialty and interest. I’m not getting “quit my day job and become a blogger” traffic, but I don’t need to. In the last month, about 50 people read my newest blog, while another 25 found a post I wrote a year ago. That’s 75 people who found their way to my website through two articles alone.
Someone searches for something they’re struggling with, finds a blog I wrote, pokes around my website, gets a feel for how I approach therapy, and maybe eventually reaches out. They may have even gotten my name from another client first. Either way, Google helped them decide whether to contact me.
Your website shouldn’t just be a digital business card that says you provide a “safe, nonjudgmental space for anxiety, depression, and life transitions.” There are probably 40 therapists within driving distance saying the exact same thing.
Instead, think about your ideal client. Not your favorite client because obviously we don’t have those. But think about the clients who really fill your cup. What do you enjoy about working with them? What are they struggling with? What conversations make you think, “Yep, this is exactly the kind of work I want to be doing”?
Years ago, I went to a business coaching weekend with my sister when she owned a clothing boutique, and one of the speakers talked about finding your “Elle.” Basically, if Elle Woods is your ideal customer, how do you find more Elles?
I still think about that.
Who is your Elle? And once you know, build your marketing around helping more of those people find you. Write about the things they’re Googling at 11 p.m, make your website specific enough that they recognize themselves in it, learn some basic SEO, keep your Google Business Profile updated, and make your directory profiles sound like you.
You don’t need to appeal to everyone. You need the right people to land on your website and think, “Oh. This person gets it.”
Marketing Without the Ick
I understand why therapists get uncomfortable talking about marketing. We work with vulnerable people, nobody wants to feel like they’re commodifying someone’s pain or convincing a person that they need therapy so we can pay our electric bill. That isn’t what ethical marketing is.
Good marketing helps someone who is already looking for support answer a few important questions:
Does this person understand what I’m dealing with?
Do they work with people like me?
Do I like how they talk about this?
Could I imagine telling this person the weird shit I haven’t told anyone else?
Does their philosophy of care align with my values systems?
That’s it.
None of this means we need to start looking at other therapists as the competition. There are a lot of really good therapists out there, and I’m glad there are. It does mean there are more of us for potential clients to choose from. Being great at what you do matters, but people have to be able to find you first.
Private Practice Isn’t Dead. It’s Different.
If your referrals have slowed, I wouldn’t immediately take that as a sign that private practice doesn’t work anymore. I’d get curious about what’s changed.
What does your local market look like? Who are you trying to reach? When someone Googles you, does what they find give them a sense of who you are and what you do? Are you still relying on referral sources that worked three years ago? Are you treating marketing as an equally important part of running your business?
The landscape of private practice has changed, it’s still changing, and it’ll probably keep changing. AI is the newest piece of that. It’s changing how people search for information and, whether we like it or not, giving people another place to turn when they’re struggling. I can understand why talking to a chatbot at 2:00 am might feel easier than reaching out to an actual human and scheduling an appointment.
I don’t think that means AI is replacing therapists, but it is changing the environment we’re practicing in. Five years from now, there will probably be something else we haven’t even thought about yet.
There was a time when you could make a Psychology Today profile, announce that you had openings, and watch your inbox fill up. In a lot of markets, I think those days are over. That doesn’t mean sustainable private practice went with them.
Being a good therapist will always matter. Being a good business owner means paying attention to what’s changing and being willing to rock with it.
Private practice is constantly evolving, and figuring out how to adapt doesn't have to be something you navigate alone. Whether you're looking to strengthen your marketing, attract more of your ideal clients, or build a more sustainable practice, having someone to bounce ideas off can make a real difference.
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