A weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next.
How to transition to private practice
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Hey there, Today’s newsletter is dedicated to those of you who still work for an agency and are thinking about transitioning to private practice. If that’s not you, go ahead and skip this and stay tuned for the next one (or, forward to a friend who has expressed a desire to leave their agency). But if you are contemplating or in the process of a transition to private practice, you’re going to love this one. Grab a cup of coffee and enjoy. — Maybe you're tired of seeing 30+ clients weekly to meet productivity quotas, or upset with policies dictated by administrators far removed from the realities you face every day, or maybe you're frustrated by session limits that force you to cut corners because "insurance only approved eight visits." Well good news, you have options. Agency jobs aren't the only option as an EMDR therapist, and you don't have to stay stuck there. Thousands of EMDR therapists have built sustainable private practices where they set their own caseloads, charge what their specialized training is worth, and make clinical decisions based on client needs (rather than insurance mandates). But if I had to guess… Making the leap also probably feels scary, right? A few years ago when I decided to make the leap, I had tons of questions. How do you set up a legal business entity? What technology do you actually need? How do you get clients without depending on insurance? How do you make sure you’re legally compliant? As someone who has worked hard to build a thriving EMDR private practice, here's the roadmap I wish I'd had. Let's dive in. Getting Your Legal & Financial Foundation RightBefore you see your first private client, you need four things in place:
Business Entity Structure: When you're starting out, most therapists form either a Limited Liability Company (LLC) or a Professional Limited Liability Company (PLLC). Both protect your personal assets from business liabilities, but which one you need depends on your state. Some states (like New York, California for certain licenses, and several others) require licensed mental health professionals to form a PLLC or professional C-Corp rather than a standard LLC. Other states allow either. The main difference is that PLLCs explicitly recognize professional services and may require you to maintain licensure and/or malpractice insurance as part of the structure. To form either, you'll need to file with your Secretary of State (typically $50-500 depending on state), which can be done for you by a Registered Agent. You’ll also need to register for an Employer Identification Number (EIN) from the IRS. The EIN is free and takes about 10 minutes online at irs.gov. Once you have this number, you'll be able to file taxes for your practice (which you should plan to do quarterly on the IRS estimated tax payment schedule) . State filing fees run $50-$500, but if you want to be extra cautious, you can also get a healthcare attorney to review your formation (which can save you thousands in compliance issues later). But what about an S-corps? Most advisors would say wait until after your first year, or at some point in the future once your income reaches a certain threshold. You should consult with a financial professional, but the short answer is, you probably don't need to worry about S-corps until later. Business License Also be sure to check with your state if any business license requirements exist and address them accordingly. Policies Some EHRs have generic policy documents that you can use or edit, or you can create your own. A simple web search for private practice policy templates will give you some options of pre-made templates (with the help of attorneys) that you can purchase and modify for your needs. Make sure you have policies in place before you take on your first client. It will help you stay accountable to yourself and your clients, and give you some much needed structure as you get familiar with running your own practice. NPI: Your Healthcare Provider Identifier Your National Provider Identifier (NPI) is a unique 10-digit number that identifies you as a healthcare provider. You'll need it to bill insurance (even out-of-network), generate superbills for clients, and maintain HIPAA compliance. You can apply for free through the NPPES website. Processing can take about 10 business days. Be sure you research the difference between Type 2 (organizational) NPI and Type 1 (individual) NPI. Malpractice Insurance Next up is protecting yourself legally. Professional liability insurance typically costs $300-$1,500 annually depending on your state and coverage limits (and standard coverage is $1 million per incident / $3 million aggregate). Business Bank Account and Credit Strategy Next, you'll want to open a dedicated business checking account immediately. This isn't optional. In fact, having a business checking account is important for maintaining your LLC/PLLC liability protection and simplifying tax filing. To help with cash flow, you can get a business credit card with 0% APR for 12-18 months for startup expenses. Look for an option that offers cash back too! Then put your EHR subscription, state filing fees, malpractice insurance, and office setup on the card, and pay it off monthly during your first year while keeping your cash reserves intact. Just make sure you spend what you can afford in your budget and actually pay it off every month! Startup Budget = Financial Clarity Open up a blank spreadsheet and build a basic startup budget. Include line items for one-time or annual expenses, and their associated costs. The total will be what you’ll have to budget to pay off before your 0% credit card period expires. To make it easy, divide that total by how many months you have to pay it off. Open a second tab and build a budget for monthly expenses. Include all of your monthly expenses (including the number you found from the paragraph above) and have a plan for how you will pay them each month. For a mature budget, be sure to include everything in your expenses column. For example, estimated taxes, retirement, healthcare, PTO, emergency savings, tithing, owners draws/payroll, etc. Be sure to include a line item for projected income, and ensure it is equal to or greater than the expense total. Once you have that projected income, divide it by 4 (weeks in a month), and divide again by your hourly rate (or average if you do cash-pay and insurance). This is the number of clients you would need to see per week to meet your financial goals. Example Scenario: $10,000 (projected income) / 4 = $2,500 (weekly income). $2,500 / $170 = 14.7. If a private practice provider needs $10,000 a month for their budgeting needs and has an average hourly rate of $170, they would need to see 15 clients per week on average. That’s clarity. But it requires you to be honest about ALL of your expenses and the income required to meet them. Your Private Practice Technology StackFor your technology stack, you'll need 3 things:
Everything else is optional. Personally, I use a combination of everything below. Simple Practice: The Industry Standard for Therapy Practices Simple Practice is probably the most widely used EHR, and it covers all of the above features. It is HIPAA-compliant and includes scheduling, telehealth, documentation, and billing in one platform. It's not perfect, but it integrates everything so you're not juggling five different tools. You can also create a website landing page with Simple Practice, making it easy to start marketing and scheduling clients. There are other options you can choose from too. I tried a different one when I first started but chose to stay with Simple Practice because well, it’s simple. Google Workspace Many aren’t aware of this, but you can sign a business associate agreement (BAA) within a paid Google Workspace account to make it HIPAA-compliant. This makes most of the services offered within the account HIPAA-compliant, including Mail, Calendar, and Meet (virtual conferencing). You can even set up a Google Form to link on your website to capture useful info on new referrals and build a waitlist. For those a little tech savvy who want more website features than Simple Practice offers, you can use Google Sites as well. Squarespace For a more feature rich, multi-page website, blog, etc. you’ll probably want to set up your own Squarespace site. This allows you to register a custom domain name (i.e. yourpractice.com), which can be linked to your Google Workspace account for a more professional email address (i.e. yourname@yourpractice.com). This is a little more advanced, but can be great for marketing and offering other services like consultation or training. A lot of therapists pay someone to do this for them once they can afford it, but if you have the time, there are a ton of free resources on the internet that can guide you through the process. QuickBooks: Your Financial Companion You'll also need accounting software to keep track of your finances. Trust me on this. QuickBooks is the industry standard because it automatically syncs with your bank and credit card, categorizes expenses, tracks deductible items, and generates the reports your accountant needs at tax time. Set up a basic account and link your business finances to it starting day one. Once you have the income to pay a bookkeeper like Andrea Rotondo, she’ll take care of the rest. Pricing Your Services: What EMDR Therapists ChargeYou didn't pursue specialized training or certification in EMDR to charge the same rates as a therapist who doesn’t specialize. So don't price yourself like someone without your training. Cash-pay EMDR rates can vary by region, but here's what you'll typically see:
Why can you charge these rates? Well, because you've invested thousands of dollars and hundreds of hours in specialized training. On top of a 50 minute session, they're also paying for your ability to help them process trauma or resolve other blocks that other approaches haven't adequately addressed. You are worth it. Sliding Scale: The Sustainable Approach Many EMDR therapists, maybe yourself included, want to offer sliding scale spots for ethical or accessibility reasons (meaning lower rates for clients who can't afford your full fee). Here's how to do it without bankrupting yourself: First, calculate how many clients you need at your full rate to cover expenses and salary (see financial clarity section below for some guidance). Then once you have that number, figure out how many reduced-rate spots your practice can absorb. Depending on your practice size, this could look like 15-20 full-fee clients, offering 3-5 sliding scale spots. Some therapists also offer specific discounted rates for some clients, like veterans and first responders, who may not qualify for traditional sliding scale but still benefit from reduced fees. Whichever approach you choose, always be strategic about it, not reactive. For example, make sure to set clear criteria upfront (for example, income-based, using federal poverty guidelines), and offer specific reduced rates rather than open-ended negotiation. Include this in your policies to keep you accountable. How to Get Clients (Without Insurance Panels)So you've got the legal stuff and pricing sorted and your tech set up. Now: how do you actually get clients? You have two paths to fill a cash-pay practice. Either help clients use out-of-network benefits, or target clients who pay directly. Most successful practices do both. Out-of-Network Benefits Here's what many therapists don't realize. Many insurance plans, especially most PPO insurance plans, include out-of-network (OON) mental health benefits. Clients can see you, pay your full rate upfront, then submit claims for partial reimbursement (typically 50-80% of your fee). This is what "super billing" means. Therapists generate a superbill for OON clients, and they send it to their insurance company for reimbursement. But here’s the thing. Some clients can’t afford to wait 4-6 weeks for reimbursement checks. So you may lose out on potential clients That's where platforms like Thrizer come in. Thrizer operates as your payment platform (like Stripe or Square for therapy), and every time you charge a client, it automatically submits out-of-network claims to their insurance. No more dealing with superbills. It's all automated for you and the client. Once they hit their annual deductible, clients can either:
Thrizer charges a 3% processing fee for therapists, and clients only pay Thrizer if reimbursement is successful. This makes your practice accessible to clients who want to see you specifically but can't afford to wait 4-6 weeks for insurance reimbursement checks. You also get paid your full rate upfront. Everyone wins. For more information on how Thrizer works, you can check out their cheat sheet on out-of-network billing for therapists. They even have a free OON benefits checker that you can customize and embed on your website so potential clients can check their OON benefit before reaching out to you. You can find it here. And they just launched a guide on starting a private pay practice as well. Check it out here and compare notes with this guide! Yes, I am a big fan of Thrizer. No, they didn't pay for us to share this information. Mixed-Model Option Some therapists prefer a mixed caseload, primarily cash-pay with some insurance clients for stability. That's where Alma comes in. Alma handles insurance credentialing for you with major payers (Aetna, Cigna, United Healthcare, Optum), manages all billing and claims submission, and gets you paid within two weeks of claim submission. They also have some EHR functionality that some therapists like to use, and an internal community tool where therapists can post and find potential client referrals. Here's how it works. You credential under Alma's Tax ID (takes up to ~45 days), see clients, submit session codes through Alma's portal, and they handle invoicing and collecting copays. You keep your full reimbursement rate that you agree on with Alma (they make money from the monthly membership fee, not by taking a cut of your sessions). You're building a practice under someone else's infrastructure. If you ever want to leave Alma, those insurance relationships don't come with you. You'd need to credential independently from scratch. Alma works best for therapists who want 10-15 insurance clients for baseline income while building a cash-pay practice, or those in markets where insurance coverage is essential for accessibility. Building Referral Networks That Generate ClientsInsurance panels aren't the only referral source. Local providers can be more reliable, and they send clients who value specialized care. Who Refers to EMDR Therapists? Think about who sees people before they realize they need trauma therapy:
These providers encounter trauma symptoms daily but may not know where to send clients. Reach out to them and introduce yourself. Become their go-to EMDR specialist. Collaborative Relationships Meeting these providers once won't do much. Try to build a collaborative relationship where you can become more top-of-mind for them all year. Here are some examples: Joint workshops: Partner with a PT clinic to co-host a "Mind-Body Approaches to Chronic Pain" workshop. You present on trauma's role in pain sensitization and they demonstrate movement-based interventions. In doing so, both practices get exposure to each other's client base as well. Written content: Meet to discuss some of their key observations with clients who need EMDR. Write a newsletter or guide providing psychoeducation and how EMDR can help. Then send it to the local providers and invite them to share with their clients if it would be helpful for them. Customize training: Similarly, meet to learn what they see most with their clients/patients, then build a customized training that addresses those insights and educates about trauma and EMDR as an evidence based treatment option. Offer to share with their clients, staff, etc. and repurpose to offer to similar agencies to theirs in the area. These relationships cost you your time and maybe a few hundred dollars to print professional handouts or sponsor a community event. But they also may produce warm referrals from trusted sources – significantly more valuable than online ads! A quick note beyond local providers, there are other agencies who may benefit from knowing about your services to support their people:
Take some time to think about how you want to niche your practice and the type of agencies worth spending the most time building relationships with. How to Make the Move to Private PracticeAlright, so how do you actually make this transition? What's the realistic timeline? Most successful transitions happen gradually, not overnight. Communicating Your Departure Once you know for sure that you’ll be leaving, it is ethical to communicate well in advance. Working with a vulnerable population, don’t just put in a two-week notice. I think anywhere from 3-6 months is reasonable. This gives you time to help each client process the transition, explore their options for continuing therapy, close out treatment goals, and develop closure in your therapeutic relationship. This is the approach I took and I have zero regrets. It was helpful for me to repeat those conversations over the course of several months, providing closure for me as well. You’ll want to find out if any policies exist about bringing clients with you, and have a plan for how to communicate that with your clients during this transition phase. You may have signed something when you started at the agency that would legally prevent you from bringing clients with you, so be sure to investigate. Part-Time Model (6-12 months) If you want to minimize risk, it's a good idea to keep your agency job while building your practice during evenings or weekends. Think of this time as an opportunity to test your systems, prove you can get referrals, refine your intake process, and build a financial runway of 3-6 months of living expenses saved before going full-time. Full-Time Leap Some therapists prefer to jump in completely. This might work if you have:
You might not fill your caseload immediately, so if you decide to go this route, plan for up to 6-12 months of slower income while you build momentum. Hybrid Model If you have the flexibility at your agency, you could maintain 10-15 agency hours weekly for stable income while building a private practice caseload. This reduces financial pressure and allows you to be selective about private clients! There's no single "right" path. What matters is having a financial buffer that lets you make decisions based on clinical fit rather than desperation. Final ThoughtsTransitioning from agency to private practice isn't only about paperwork and technology. More importantly, a private practice allows you to reclaim your personal and clinical autonomy, charge what your specialized training and skills are worth, and create a practice that doesn't deplete you. Sure, the legal setup takes a few weeks, the technology takes a few days to configure, and building a sustainable caseload can take a few months. But the freedom to practice EMDR the way it's meant to be practiced (with adequate time, appropriate pacing, clinical decisions driven by client needs, etc) make it worth every step of the transition. The level of autonomy you gain is irreplaceable. And if you want support in building this kind of practice, that's what Helicon is all about. We're creating a community for EMDR therapists who value autonomy, want to grow their skills, connect with colleagues, and build sustainable practices. I look forward to inviting you onto the official platform later this year. Until next time, Chris Thanks for reading Helicon's EMDR Therapist Weekly, where we aim to provide a weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next. Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion. |
EMDR Therapist Weekly
A weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next.
The EMDR Therapist Weekly aims to provide a weekly dose of insights, tools, and opportunities for EMDR therapists; designed to support your growth, sharpen your practice, and connect you with what's next. To achieve this, we like to invite subject matter experts as guest writers. This week I'm excited to introduce our newest guest writer, Alex Penrod, MS, LPC, LCDC. Alex Penrod, MS, LPC, LCDC, is the founder of Neuro Nuance Therapy and EMDR, PLLC, an EMDR-primary psychotherapy practice in...
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