Lessons from My First Three Years in Private Practice

It’s been about three years to the day since I filed for an LLC, and subsequently began my journey as a private practice owner at Ascend Therapy Group. Time has flown. It’s hard for me to wrap my head around the fact that I already have years in the rearview in this journey. In the time since, there have been many twists and turns, and I’ve needed to re-evaluate and evolve many times over. Perhaps one of my favorite parts about owning a business is the need for constant learning. Staying in place is simply not an option, and I am so grateful for how much this endeavor has forced me to learn and challenge myself, both personally and professionally. 

In recent months, the continued pace of growth within the practice has caused me to think more seriously about scaling, and I began paving the way for that to happen. Last week, I decided the time had finally come to post a position and look to hire. Next month, we will also have two Master of Social Work (MSW) graduate school interns from Wayne State University start with us, and I look forward to being a part of their learning and development, and seeing the value and insight that they can bring to the practice while they’re with us. 

As I approach the three year anniversary of Ascend, I thought I would take a look back on some of the biggest takeaways from my time as a practice owner. If you are early in your private practice journey, my hope is that this can help you learn quicker than me! Enjoy. 

Build Slow, But Not Too Slow

When I opened my practice, I worked full time as a school social worker. This proved to be an ideal job to have a private practice as a side gig in the beginning. Having the summers off gave me time to get the back end of the business set up, and spend time learning about insurance credentialing and billing. The reasonable school hours also allowed me to see clients in the evening without burning myself out. Furthermore, having a full time job allowed me to build intentionally, and think about what clients I wanted to serve, what certifications I wanted to pursue. It also gave me the opportunity to see if running a practice was for me, without the pressure of relying on it as my sole source of income. As I reflect, keeping this arrangement for a few years was one of the best things I did for myself, as it allowed me to grow my caseload, and develop my skills. In the beginning, I wasn’t certain this was something that I wanted to do full time. Being able to live it with lower stakes for a few years helped confirm that I did in fact want to eventually go all in. If you are starting a practice, and you have the opportunity to start it on the side, I would highly recommend it.

At the same time, building too slowly can stunt growth as well. If I was fully ready to make every decision before making them, I probably would have never settled on a name for the practice! Being able to make decisions before things were “perfect” helped me to keep things moving. In the book Shoe Dog, Nike founder Phil Knight talks about how he always wanted to fail quickly if he were going to fail. By making decisions before the conditions were perfect, it allowed me to gain experience and feedback, and then quickly pivot as needed. Research shows that businesses who make strategic decisions more quickly tend to have a higher growth and profitability. Waiting for the perfect conditions may never come, and ultimately may in turn stunt the health of your practice. 

Surround Yourself With A Community

Perhaps the most helpful tool I’ve had in building my practice is being able to build a group of trusted colleagues in the field that I can go to for guidance, ideas, and feedback. There is so much that is not taught in graduate school, particularly related to the business side of running a practice. Things like setting up a business bank account, how to credential with or bill insurance, and how to market are all things that we primarily need to learn on our own (what on earth is SEO?!). For me, being able to talk to several different people helped me gain a clearer understanding of the direction I wanted to take my own practice. 

Being your own boss is a tremendous perk, but I underestimated how isolating it can be as well. Networking, and building work relationships and friendships has been the best way that I’ve found to combat against that. Private practice is a very unique space, and connecting with others in the same boat helps keep me energized and sharp. 

Have a Financial Plan

Being self-employed comes with a lot of financial implications. We pay more in taxes, and are responsible for managing our own benefits, such as healthcare and retirement. This can be a steep learning curve at first. A way that I shortened the curve for myself was educating myself by talking to several other practice owners about how they manage finances. This helped me make my own plan of how I wanted to pay myself, and save, etc. Giving that thoughtful effort up front eliminated anxiety and impulse decision making later on.

Additionally, I cannot recommend hiring a CPA enough. They can help you with taxes, and ensure that you’re taking advantage of write-offs. Lastly, there are many expenses while starting out, such as credentialing, liability insurance, website, office space, among many other things. Being financially prepared for those expenses, and a potential temporary income hit while building your own caseload can help alleviate anxiety. I’d highly recommend having a couple months of financial “buffer” put away before starting out. 

Yes, Self-Care and Boundaries Do Matter

I’ll be honest, when I was in grad school, I thought that self-care was nonsense, and not something that really applied to me. The longer I’ve gone on, the more that I’ve realized these things actually are necessities for the well being of both myself and my practice. Making sure that I am aware of what an ideal caseload looks like for me (it varies for everyone) and trying to stick to that has been tremendously impactful. That means that I can’t say yes to everyone. At first I had a hard time doing that, because I want to help others and struggle to say no. But over time, I realized that by saying yes to everyone, I was short changing the clients that I do have, because they were not getting the best version of me.

Additionally, giving myself time away has allowed me to work on the business, instead of only for the business. 

Since developing better boundaries, I’ve remained intentional about being aware of my energy levels, and putting effort into maintaining them. For me, this looks like more time with friends and family, exercise, and time alone to think (often at a local coffee shop). Quality sleep and proper nutrition matter a whole lot too. Some of my best business ideas have come from detaching, and simply experiencing life. Self-care, and adequate boundaries have allowed me to do that.

The last three years have been some of my favorite yet. Building this practice has taught me more than I could have imagined — and with a new hire and two interns joining soon, I'm excited to see who's shaping Ascend three years from now.

Disclaimer: The content on this blog is provided for informational and educational purposes only and is not intended to be a substitute for professional mental health care, medical advice, diagnosis, or treatment. Reading this content does not establish a therapeutic relationship. If you are experiencing mental health or medical concerns, please seek the guidance of a qualified healthcare provider.

Max Sturm, LMSW

Owner and Clinical Therapist at Ascend Therapy Group

Max is a licensed therapist who has been working in the mental health field for the past 7 years after earning his Master’s in Social Work from the University of Michigan. He is trained in several evidence-based approaches, including EMDR and the Gottman Method. Max works primarily with men, couples, individuals on the Autism Spectrum, and clients recovering from trauma.

He is passionate about making therapy feel approachable, practical, and genuinely helpful while reducing the stigma around seeking support — especially for men. In his free time, Max is a frequent traveler, passionate sports fan, and enjoys playing guitar and spending time with his family and friends. If you’re interested in working together, feel free to reach out here.

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