How IFS can help you build and sustain your private psychotherapy practice.

Max Littman, LCSW

June 20, 2024

 

Introduction

The following article is intended to support therapists build, improve, and sustain their private practices through the framework of IFS. It addresses what parts of your internal system you may need to rely upon and attune to when you have your own private psychotherapy practice. If you are already in private practice, I wish to help you to notice and appreciate your parts that have gotten you to or sustained your private practice. And for those wishing to improve their private practice, I hope this article offers you and your parts some clarity on what is needed. 

I recognize private practice is not for everyone. I have parts that are highly protective and supportive of other therapists, especially when they are taken for granted, strictly seen as a resource to mine, and undervalued by macro and mezzo systems of care (e.g. for profit and non-profit agencies, group practices, governmental programs, hospitals). My parts have been wounded in some of these ways on my journey to private practice. These parts informed my decision to move to private practice and my investment in supporting those interested in and already in private practice.

Please note, this is not a step by step guide to building a private practice. For that sort of guidance, I recommend this checklist created by Dr. Marie Fang.

When reading, I recommend paying attention to if parts get overwhelmed, anxious, react with shutdown, or set a deadline to answer every question. There is a lot covered here and not all of it needs to have a deadline. Much of this is more reasonably attended to over the course of your private practice’s lifetime, not prior to going active or even in the first year. Hopefully your parts are reassured by this recognition.

Infrastructure

To begin, I invite you to consider: 

What internal and external infrastructure do your parts need in your private practice so they can safely relax when you are with your clients? What parts are needed to build and maintain that infrastructure? 

Self cannot create this infrastructure alone because Self is receptive and supportive. Parts are needed because, unlike Self, they are active (reactive and proactive). 

I invite you to pause to process. Take whatever time you and your parts need. Continue reading whenever it feels right to you.

In creating this infrastructure, some important areas to check in with your parts about include: money, laws & ethics, policy making, administrative tasks, self care, marketing, and accessing external support.

I invite you to notice if any of these areas bring your awareness to managers, firefighters, exiles, polarizations, burdens, legacy burdens, and/or cultural burdens.

Again, I recommend to pause and take your time with this. Read on when you are ready.

Next, let’s flesh out each category to identify possible trailheads for you to follow.

For each category, I will offer questions to assist in revealing potential trailheads. In the sections thereafter, I offer common parts and burdens (personal, legacy, and cultural) for therapists in order to further discern any trailheads. I recommend moving through the questions slowly, pausing often, to notice and give time for what may surface. It may even make sense not to finish it in one go and to refer back to each category over time. It might be helpful to write down any parts, reactions, or trailheads you discover. What you notice may also offer a clearer sense of the infrastructure your parts need to safely relax when you are with clients.

Money

  • How do you feel toward money? Toward having money? Toward making money? Toward making money as a therapist?
  • Does making money bring up guilt or shame? Maybe anxiety or fear? Competitiveness or comparison?
  • What thoughts arise when thinking about money? 
  • What happens in your body when thinking about money?
  • Do you feel hyper- or hypo-aroused around money?
  • Experiment with the numbers of what you want to or already do charge per session. Notice your internal response to each number. I invite you to get curious with your parts’ responses to the numbers.
  • If you are already in private practice, how often do your parts look at your bank account statements or your projected earnings? Do your parts avoid looking? What responses do you notice from them about the numbers seen?
  • Do you know the various tax structures available to you as a business and their differing legal/financial requirements?
  • What limiting beliefs do you have about money (e.g. burdens)? 
  • What cultural burdens do your parts hold around money? Some possibilities to consider: progress at all costs, more is better, making money is my responsibility and how I spend it is my own business (individualism). 
  • What legacy burdens do your parts hold around money? Some possibilities to consider: I must sacrifice all that I earn for others (family or culture of origin), fear of scarcity. 

A helpful tool in uncovering parts, burdens, and beliefs around money is Brad Klontz’s online quiz about what beliefs you may unconsciously have around money. The quiz can be accessed here: https://www.bradklontz.com/moneyscriptstest

Laws & Ethics

  • How do you feel when you think about the legal responsibilities of running a private practice? Does this evoke any anxiety, confidence, or other emotions?
  • What emotions arise when you consider the ethical implications of client confidentiality and privacy? Do you feel reassured, worried, or something else?
  • How do you react emotionally to the idea of navigating dual relationships? Is there a sense of discomfort, or do you feel prepared to handle such situations?
  • What feelings come up when you consider the potential for ethical dilemmas in your practice?
  • What are your thoughts on the importance of understanding local and federal laws relevant to your practice? How do your parts balance legal and ethical obligations with client relational dilemmas? 
  • Are you aware of any polarizations between your parts regarding any laws or ethical guidelines?
  • How do you plan to stay informed about changes in laws and ethical guidelines? What strategies or resources do you consider essential? Do any fears arise when considering this? Are any parts avoidant of this? Are any parts hypervigilant or hyperfocused on this?
  • How do you approach decision-making when faced with an ethical dilemma? What frameworks or processes do you find helpful?
  • Are you aware of and have relationships with the parts of you that keep track of and uphold legal and ethical standards of practice?
  • What is your understanding of informed consent, and how do you plan to implement it in your practice? How confident are you in your current knowledge, and do you see any gaps? How do your parts react to the legal need to provide informed consent?
  • In what ways do your cognitive strategies for managing legal and ethical issues align with or differ from your emotional reactions? Are there any noticeable themes or polarizations between parts?
  • What support systems or resources do you rely on when you are unsure of a legal and ethical responsibility? Are there specific mentors, colleagues, or educational tools you find particularly valuable? What reactions do you notice internally before, during, and after you access these supports?
  • What parts agree with established legal and ethical standards? What parts disagree? What other input do your parts have on following legal and ethical standards?
  • How do you plan to address issues of accessibility (e.g. office location, sliding scale, inclusive website copy)? What reactions or sides do your parts take on accessibility?
  • How do your parts react, respond, or plan for situations that are outside your scope of competence/expertise?

Recommended reading on ethics: Right Use of Power by Cedar Barstow.

For further IFS informed support around laws and ethics, I recommend my colleague Laura DeSantis, LPCC.

Policy Making

  • How do you feel when you think about creating policies for your private practice? Does this task feel daunting, exciting, or something else?
  • What internal reactions arise when you consider enforcing policies you’ve set for your practice? Do you feel confident, anxious, or conflicted?
  • How do your parts react to the idea of having to revise or update your practice policies?
  • What feelings come up when you think about the potential impact of your policies on your clients? Do you feel empowered, responsible, guilty, compassionate, frustrated, or worried?
  • How do you approach the task of researching and drafting policies for your practice? What resources or guidelines do you find most useful?
  • How do you plan to keep your policies updated in response to changes in laws, ethical guidelines, or best practices? What mechanisms or processes will you put in place? What emotional reactions do you notice when considering this process?
  • In what ways do your cognitive strategies for policy-making align with or differ from your emotional reactions? Are there any polarizations between a cognitive manager and any other parts?
  • How do you plan to communicate your policies to your clients? What methods will you use to ensure clarity and understanding?
  • What steps will you take to ensure that your policies are consistently applied in your practice? How will you monitor adherence and address deviations?
  • How do you evaluate the effectiveness of your policies and make necessary adjustments? What criteria or feedback mechanisms will you use? 
  • How will you speak for your parts in setting boundaries through policies? 
  • What internal reactions arise when receiving feedback, positive or critical, about policies?

Administrative Tasks (e.g. scheduling, billing, documentation)

  • How do you feel when you think about managing scheduling for your clients?
  • What emotions arise when you consider handling billing and financial transactions in your practice? Do you feel confident, nervous, or overwhelmed?
  • How do you react emotionally to the idea of keeping up with client documentation and records? Diligent, frustrated, guilty, ashamed, or avoidant?
  • What feelings come up when you think about potential administrative errors or issues (e.g., double bookings, billing mistakes)? Do you feel anxious, prepared, or indifferent?
  • What are your thoughts on the importance of effective scheduling in maintaining a well-run practice?
  • How do you prioritize and manage your calendar?
  • What do your parts think and feel about being paneled with insurances?
  • How do you approach the task of setting up a reliable billing system for your practice? What strategies or tools do you use to ensure accuracy and efficiency? What parts do you rely upon?
  • What considerations do you take into account when creating and maintaining client documentation?
  • How do you balance thoroughness with time management?
  • How do you plan to stay organized with administrative tasks to prevent burnout and maintain efficiency? What systems or routines do you find most helpful?
  • Are there any noticeable polarizations between parts about attending to administrative tasks? (e.g. taskmaster and procrastinating parts)
  • How do you plan to set up a scheduling system that meets both your needs and your clients’ needs? What will you do to ensure flexibility and reliability?
  • What steps will you take to ensure that your billing processes are transparent and efficient? How will you handle discrepancies or disputes? What internal reactions do you have to discrepancies and disputes?
  • How do you plan to keep your client documentation thorough and up-to-date? What methods will you use to streamline this process?

Marketing

  • How do you feel when you think about marketing your private practice? Does the idea of self-promotion evoke excitement, anxiety, doubt, criticism, guilt, or discomfort?
  • What emotions arise when you consider putting yourself and your services out there publicly? Do you feel vulnerable, confident, or ambivalent?
  • How do you react emotionally to feedback or criticism about your marketing efforts? Are you resilient, sensitive, defensive, or something else?
  • What feelings come up when you think about differentiating yourself from other therapists in your marketing? Do you feel competitive, collaborative, or pressured?
  • What are your thoughts on the importance of marketing for the success of your private practice? How do you view the role of marketing in building your client base? Do you notice any parts that are anti self promotion?
  • Who are your ideal clients? What clients elicit excitement, calm, confidence, compassion, creativity? What clients elicit hyper- or hypo-arousal?
  • How do you approach the task of identifying your target audience and their needs? What strategies or tools do you use to understand and reach your ideal clients?
  • What considerations do you take into account when developing your marketing messages and materials? How do you balance authenticity with the need to appeal to potential clients?
  • How do you plan to measure the effectiveness of your marketing efforts? What metrics or feedback will you rely on?
  • In what ways do your cognitive strategies for marketing align with or differ from your emotional reactions? Do you notice any polarizations between parts regarding marketing and promotion?

Self Care

  • How do you feel when you think about balancing the needs of your private practice with your personal self-care needs? Does this evoke any anxiety, excitement, or guilt?
  • What emotions arise when you consider taking time off for self-care while managing your practice? Do you feel relaxed, guilty, or ambivalent?
  • What internal reactions do you notice when thinking about setting boundaries with clients to protect your self-care time? Are you feeling confident, hesitant, or conflicted?
  • What arises internally when considering session length, arrangement of and cap on clients seen in a day, and holding to the timeframe of a session? Are there parts that hold loose or strict boundaries? Any polarizations noticed? What parts bear the brunt of the burnout?
  • What internal reactions come up when you notice signs of burnout or stress in yourself? Do you feel worried, motivated to make changes, or overwhelmed?
  • How do you plan to identify and address your self-care needs while running your practice? What strategies or tools do your parts use to monitor and manage your well-being?
  • What is your ideal weekly caseload? Do parts agree or disagree on this? 
  • What considerations do you take into account when creating a self-care plan for yourself? How do you balance your personal needs with the demands of your practice?
  • How do you plan to incorporate self-care routines into your daily or weekly schedule? What specific practices or activities do you find most beneficial? What helps your parts to relax and trust you in the short term and the long term?
  • Do you notice any polarizations between parts regarding self care? 
  • What personal beliefs might affect your commitment to maintaining self-care?
  • What arises internally when your professional obligations conflict with your self-care needs?
  • How do you plan to set and maintain boundaries to protect your self-care time? How will you communicate and enforce these boundaries (e.g. speaking for your parts)?
  • What steps will you take to ensure that your self-care practices are consistent and effective? How will you monitor and adjust your self-care routines as needed?

Accessing External Support

  • How do you feel when you think about seeking consultation or supervision from other professionals? Does this evoke any anxiety, reassurance, excitement, avoidance, or ambivalence?
  • What emotions arise when you consider joining professional organizations? Do you feel excited, overwhelmed, or indifferent?
  • How do your parts react to the idea of pursuing ongoing training and professional development? Enthusiastic, stressed, or neutral?
  • How do you prioritize and integrate consultation and training into your professional life?
  • How do you approach the task of selecting and joining professional organizations? What criteria do you use to determine their value to your practice?
  • What considerations do you take into account when planning your ongoing training and professional development? How do you identify the areas in which you need further education or skills? Which parts are involved in that process? What areas of training energize your system? Which drains your system?
  • What polarizations do you notice between parts regarding consultation and training?
  • Are there specific mentors, colleagues, consultation groups, or resources that your parts feel safe with? Any that embody or evoke Self energy (e.g. the 8 Cs and 5 Ps)?
  • What personal beliefs might affect your parts’ willingness to engage with various external supports?
  • What arises internally in situations where your personal values conflict with the norms or expectations of professional organizations or training programs?
  • How do you plan to find and maintain a relationship with a trusted consultant, consultation group, or supervisor?
  • What qualities do you look for in a consultant, consultation group, or supervisor?
  • What steps will you take to actively participate in professional organizations and benefit from their resources? Are there any polarizations around staying engaged and involved?

Common Therapist Parts

  • People pleasing, self sacrificing, and caretaker parts – These parts may make decisions in areas like policy making, scheduling, and boundary holding that lead to burnout (e.g. parts being activated to do more than they have bandwidth to take on).
  • Achievement oriented parts (and parts that fear failure) – These parts often track back to exiles burdened with feelings of never being good enough that can be personal, legacy, and/or cultural. 
  • Taskmasters – These parts keep track of what needs to get done for our practices to run smoothly.
  • Risk taking and risk avoidant parts – These parts affect decision making in areas such as which clients to take on and how much time and money to invest in professional development.
  • Procrastinating parts – These parts can signal to us when we need to slow down and attend to parts that are burnt out. They can also indicate when a burden is held around what is being avoided (e.g. shame about the task at hand).
  • Activist or social justice oriented parts – These parts can inform decisions about which clients we work with, how we market our practices, the professional organizations we join, and our adherence and approach to upholding ethical standards.
  • Money managers (e.g. spending parts, saving parts) – Personal, FOO legacy, and cultural burdens highly inform how these parts operate with managing money. 
  • Public relations parts and parts that indulge in or avoid promoting oneself (e.g. prideful and humble parts) – These parts can inflate or undervalue what we have to offer potential clients.
  • Relief providing firefighters – When missteps happen in building and running our private practices (and they will happen), oftentimes an exile will get activated, surfacing the pain of their burden. Firefighters will use their typical strategies to address the activation such as dissociation, numbing, shutting down, and seeking external sources of comfort (e.g. food, media, substances, approval from others).
  • Validation or advice seeking parts – These parts may be scared of not having a built in external system to go to, such as a supervisor or a trusted coworker, for witnessing, validation, or advice. 
  • Inner critics – These parts can criticize us, or more accurately other parts of us, when a client’s system gets activated or when one of our own parts limitations becomes apparent. They can also get activated when errors happen or difficulties arise in running your business.

Common Personal Burdens Amongst Therapists

  • I’m never good enough
  • I don’t matter (or my needs don’t matter)
  • I’m alone in this
  • I’m never safe
  • No one can be trusted
  • I’m worthless/useless

Common Legacy & Cultural Burdens Amongst Therapists

  • Productivity valued above all else (capitalism) – Although the reality in private practice is you don’t make money if you don’t have or see clients, we can still carry the burdened belief that our value as a human is linked to how productive we are (e.g. how many clients we see, how quickly their goals are met). 
  • There’s something wrong with me if I don’t do this all on my own (individualism).
  • Scarcity fear – This can drive parts to worry about and hoard money without considering the consequences it can have on other parts and the body.
  • Perfectionism – This can show up as “I’ve got to get this right from the get go”.
  • Worship of the written word – An aspect of white supremacy culture which may contribute to parts that restrict their perspective to what is written about how to build, run, grow, and sustain one’s practice.
  • Licensed professionals are to be trusted (or mistrusted) absolutely – This can also be a personal burden for those who have been wounded in relationships with licensed mental health professionals.
  • Fear of open conflict – This may impact what is and is not addressed with clients in session, marketing materials, policies, and informed consent contracts.
  • Quantity over quality – Some parts may hold the belief having more clients is better than serving fewer more effectively.
  • Sense of urgency – This may lead to firefighters running the show and reacting to clerical errors, money issues, or ethical dilemmas in ways that compound problems or miss the crux of them.
  • Either/or thinking – e.g. I am a good therapist or a bad therapist. I run a good practice or a bad practice.
  • Earning more than a living wage in a helping profession is bad and would make me bad.
  • “It is my responsibility to work with whomever arrives at my doorstep” – Many post graduates begin their careers working in community mental health settings where they have no choice or say over the clients on their caseloads. This can contribute to the belief that no matter how activating a client’s presentation may be to one’s parts, one must stick with this client.
  • Racism – Many if not all of our parts grew up in and were socialized into a racist culture. Depending on your ethnic background, your parts will be influenced, often in covert ways, in choosing continuing education, marketing, fee structures, and decisions about taking insurance that perpetuate white supremacy cultural ideals.
  • Patriarchy – Parts may assume paternalistic, top down views and express them unconsciously through wording in your practice’s written policies and marketing content.

Conclusion

Please note that when I suggest building an infrastructure that allows your parts to safely relax when you are with your clients, I do not mean asking parts to soften back. In my experience, asking parts to soften back when in session with clients can be shaming to them and backfire in the long run. Additionally, parts can have extremely valuable information and insight about the client’s system that Self may not be privy to. 

When parts are relaxed in session, this means they are able to provide input without their energy being at the forefront and blasting through the client’s system. Our client’s parts can often detect better than us when one of our parts is active and agenda driven. In turn, their parts get activated by our parts’ energy being a potential threat (e.g. further shaming of an exile). Our parts’ attachment to an outcome can be felt by the client’s parts and impede on Self energy facilitating healing, both in ourselves and in our clients. Self has an agenda to support and heal, but is not attached to that outcome.

To wrap up, I moved into my own private psychotherapy practice full time three years ago. My parts have been highly satisfied with this decision for four main reasons: increased income, logistical flexibility to pursue training in interest areas, more downtime to devote to the needs of my own system (e.g. self care), and no longer being beholden to institutional control (e.g. not having a supervisor or a non-negotiated salary). However, there are stresses that come with being in my own practice. These include a lack of guaranteed income, no paid sick time or time off, and the need to promote my own services. 

I could say much more about my own system as it relates to my practice, but I’ll leave that for another time.

I hope all of this supports you and your system on your journey.  

If you’re looking for more support, I provide private practice mentorship, consultation, and therapist/practitioner part intensives.

For feedback and comments, I can be reached at max@maxlittman.com.

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