Five things I wish I'd known...

Five things I wish I’d known before starting private practice…

When I first stepped into private practice, I thought the hardest part would be the therapy, and working on my own without a team. But very quickly, I discovered that running a practice means wearing countless other hats – administrator, accountant, marketer, website builder, and business owner. If you’re considering private practice, or you’ve just started, here are five things I wish I’d known (plus one bonus lesson I learned the hard way!).

1. Saying yes to everyone isn’t sustainable
In the beginning, I took on almost every client who got in touch. I ignored gut instincts, agreed to ad-hoc sessions, and said yes to reduced fees. Within months, I was drained and spread too thin. Some of the work energised me, but some didn’t feel aligned. Only when I narrowed my focus did things feel lighter – and funnily enough, this created space for the right clients to show up more consistently.

2. Admin takes much more time than you expect
I thought private practice meant spending most of my time in the therapy room. Instead, I was drafting contracts, chasing invoices, and writing notes late into the evening. Add to that website updates, networking, and creating social media posts – therapy was the easy bit! Make sure you schedule admin into your week and account for it in your fees, too.

3. Your fee isn’t just for the session
When I first set my fees, I asked myself, “What feels fair for an hour of my time?” I even charged less than colleagues because I was new to private practice, forgetting the years of training and experience I already had. Clients aren’t just paying for 50 minutes – they’re paying for supervision, CPD, insurance, marketing, and all the behind-the-scenes work. Raising my fees wasn’t just sustainable; I noticed clients took the work more seriously when fees were higher.

4. Boundaries are harder when you’re your own boss
Leaving the NHS gave me freedom, but also made it tempting to over-accommodate. I worked evenings, squeezed people into lunch breaks, and answered emails late at night. Without boundaries, I was heading straight back to burnout. Just because you can fit someone in doesn’t mean you should. When you say yes to one thing, ask yourself what you’re saying no to – family, rest, or your own wellbeing?

5. Clients don’t magically appear
I’ll never forget setting up my website and nervously refreshing my inbox. The referrals didn’t come. Building a caseload takes patience and visibility. No, you don’t have to be dancing on TikTok, but you do need to be visible – networking, writing, or sharing what you do – whilst clearly speaking to your ideal client. Marketing isn’t unethical – it’s connection! Without it, the people who need you won’t know you exist.

Bonus: You can design your practice around your life…

At first, I assumed I’d have to work evenings and weekends because that’s “what clients want.” But now I know, you get to decide. I don’t work before 10am so I can do the school run, I work part time, and I never work weekends. Once I shaped my practice around my energy and family, I felt more present, and the right clients happily fitted into those hours. I know it can seem nerve-wracking at first to hold out, but private practice isn’t just about therapy – it’s about creating a business that feels sustainable, aligned, and supportive for you.

If you’re a female mental health professional who’s ready to build (or grow) a practice that doesn’t burn you out, this is exactly what I help with inside Into Practice – my space for therapists, counsellors, coaches and psychologists who want support with the business side of therapy, from fees and visibility to boundaries and confidence. Come join us! https://www.facebook.com/groups/intopractice

Dr Kirstie Fleetwood Meade is a chartered counselling psychologist, coach and yoga teacher who works from Clifton Village Practice Rooms, Bristol | theyogipsychologist.com