Starting a private practice in counseling can be one of the most rewarding ventures for social work professionals. However, in order to get such a venture off the ground on the right foot and to maintain a successful practice over time, there are several factors to consider.

We recently caught up with two social work professionals who operate their own counseling practices to offer some practical expertise on this field. Prof. Elizabeth Ruegg is an instructor of social work in Saint Leo University’s Master of Social Work degree program and has had her own counseling practice for over 20 years. She is licensed to practice in both New York and Florida. Emily Gilbert is an alumna of the bachelor’s in psychology and MSW programs at Saint Leo. The 39-year-old became licensed as an LCSW in Florida in 2017. Her son, Trent, started as a freshman at Saint Leo this fall.

With both being licensed clinical social workers, they shared their experiences on how to start a counseling business and explained what has worked for them and how they have overcome any challenges along the way.

Formally Establishing a Counseling Practice

A head shot of Elizabeth Ruegg, an instructor of social work at Saint Leo University in the Master of Social Work program, wearing glasses with a neutral expression on her face; Ruegg is also a licensed clinical social worker (LCSW) with her own private counseling practice in Port Richey, FL

Since 2000, Ruegg has operated Counseling Works in Port Richey, FL. She specializes in working with adult survivors of childhood sexual trauma. The majority of her clients range in age from their 30s through their 70s, but she certainly will support most ages.

In 2019, Gilbert launched Meridian Counseling Center. Its main location is in Dade City, FL, just about six miles from the Saint Leo campus. She also operates smaller locations out of facilities in Carrollwood and Winter Haven.






Getting Their Ventures Off the Ground

For those seriously considering starting a private practice in counseling, one big piece of advice Ruegg has is to connect with SCORE, a nonprofit organization affiliated with the U.S. Small Business Administration. SCORE offers a plethora of free services to aspiring and established small business owners.

“They have a large network of retired business professionals who offer mentoring services to entrepreneurs,” Ruegg says. “They can help you create a business plan, complete the paperwork for incorporating, and connect you to an attorney to make sure you are structuring everything legally. It is very important to get this professional help when you are first starting out.”

Gilbert agrees that planning is critical.

“For years, I was writing ideas down, making lists of things I wanted to do and areas of need I wanted to focus on,” Gilbert explains. “I made a list of people who already had a business so I could reach out to them for advice and resources.”

She consulted with LegalZoom to establish a PLLC for her practice.

Finding a Niche

Both women have found a general niche to focus on in their respective practices. Ruegg, who is trained in traumatology and certified in addiction and animal therapy, explains her primary areas of focus.

“Many of my clients struggle with suicidal impulses, chronic suicidal ideation, and self-injury,” Ruegg explains.

She also has two Golden Retrievers who support the clients as therapy dogs in her practice.

A photo of one of Prof. Elizabeth Ruegg’s therapy dogs, Lucy, a Golden retriever sitting upright on a sidewalk with grass behind her; she is smiling and wearing a bandana with an American flag; the bandana says ‘Please pet me’ on it

“We form a therapeutic triad,” she explains. “This includes the client, the dog, and myself. The dog adds a unique aspect to the treatment that would not otherwise be possible. For instance, if a client is overcome with emotion during a counseling session, it’s generally not appropriate for a therapist to physically comfort them, but the dog can do so.”

According to Gilbert, experience in the field is the key to determining one’s preferred client demographics.

“It’s important to get some work experience before starting a private practice in counseling so that you have a background working with different populations. You can learn where your best skills fit and whom you are most effective serving.”

Gilbert, who is certified in clinical trauma and telehealth and also specializes in brain spotting and addiction therapy, previously worked for Pasco County Schools as a social worker and at the Pasco Juvenile Detention Center. While she still serves children, she leans on her diverse team of providers as well.

“All of my providers have their own specialties, including one who is certified in yoga,” she says. “We do see a lot of veterans, first responders, and those dealing with trauma.”

However, she emphasizes that she does not want to limit her client base and will do whatever it takes to lend a helping hand to the broader community.

“I enjoy working with other agencies to collaborate to provide services for each of my clients,” she says. “I don’t want to just offer one service and focus on 1 population. I want to reach as many people as I can across the board.”

Gilbert also works with uninsured clients and students in schools who are also in this category.

Financial Considerations When Starting a Private Practice in Counseling

From accounting to setting the rates for clients, there are several financial factors to consider when starting a counseling practice.

“In the beginning, you might be able to handle the bookkeeping and accounting yourself,” Ruegg explains. “As my practice grew, I eventually hired staff to handle billing and finance.”

In terms of setting her rates, Ruegg uses the standard Medicare rate to determine how much her clients should pay for an hour of therapy. Gilbert did a lot of research and looked around at statewide averages and other providers to check out their rates and fees. She also offers a sliding scale and recommends exploring the forms needed for financial hardship cases.

Connecting with insurance companies is another important component to a sustainable practice. Ruegg says the application process to bring on insurers for her clients is fairly simple.

“It’s in the insurer’s best interest to have as many providers as possible.”

Gilbert and her staff do their best to keep up with as many insurance providers as they can. It can take a few months to get paneled for an insurance company, she adds.

“We will offer payment options if there is an urgent need, or the insurance company can often approve a one-time session if needed,” she says.

Assembling a Team

A head shot of Emily Gilbert, an alumna of the bachelor’s in psychology and Master of Social Work degree programs at Saint Leo University, wearing glasses and smiling; she is standing next to a sign on the wall that says ‘Welcome’ with the ‘o’ in the shape of a heart and an American flag inside of it

Gilbert’s practice consists of eight therapists and a psychologist. She started out with only an office manager. Since then, she hired a credentialing specialist to help her bring on insurance providers and a client coordinator to assist with scheduling.

“The best way to find providers is through your connections,” she says. “Building relationships is so important.”

She has also taken on student interns, including some from Saint Leo University. For instance, she recently hired Naomi Florez, an alumna of the graduate social work degree program.

To advertise for job openings, she uses Indeed, LinkedIn, and other online job boards.

Ruegg says she has added staff over time, including an office manager and receptionist. Once again, she recommends leaning on SCORE for advice on hiring, salary negotiations, and other human resources matters.

Providing Therapy in an Office vs. Virtual Setting

Since starting out, Ruegg has had three different office spaces. She now houses her practice in a converted bank with 5,000 square feet of space. For those early on in the process, she advises finding a small, affordable space initially.

In Gilbert’s case, she rents out the building for her Dade City location. Her other two locations are housed through a collaboration group where a business can reserve space during specific days and times.

The COVID-19 pandemic brought an increased demand for telehealth services, including in the mental health space. Both women offer remote options for counseling sessions. They use HIPPA-compliant video conferencing platforms to facilitate remote sessions with their clients. Ruegg says there are pros and cons to this format of therapy.

“You can miss physical cues and emotional energy,” she says. “The therapist has to be much more observant as well.”

However, she notes that there are often benefits to this modality.

“One of my clients struggles with a hoarding disorder. She can take me on a virtual tour of her home. In this case, it is a benefit because it adds more context to her situation.”

Gilbert offers up some tips on facilitating virtual counseling sessions.

“Make sure you have a good Internet connection. Be sure to be in a good space that is both quiet and confidential, and the client should be in a similar environment.”

Marketing Strategies for Counseling Practices

Ruegg and Gilbert agree on certain strategies to spread the word about their practices but also have paved their own paths on this front.

“In the beginning, it was word-of-mouth marketing,” Ruegg recalls. “Once I was open for a year, clients who graduated from therapy sent me other clients as referrals. Now I have had a waiting list for many years. Once the news of your good work gets around the community, people will come.”

She developed a business website but is not active on social media.

Gilbert agrees that making a good impression on one client can lead to additional interest.

“Dade City is a small town, so I get a lot of word-of-mouth clients,” Gilbert says.

Unlike Ruegg, she is very active on Facebook, Instagram, and Twitter. She also uses referral portals through the Psychology Today and Open Path websites. She was even recently featured on a podcast. Plus, she participates in community events to get her name out there.

“I volunteer with the Pasco Commission on Human Trafficking. I’m also involved with Premier Community HealthCare Group. Forming those partnerships is critical.”

Why Collaboration is Crucial

In addition to marketing, collaboration is a key ingredient to success in this field. While a private practice can provide many of the services clients need, there are sometimes instances when a client must be referred to another provider for additional support.

“It’s important to know the mental health hospitals and services in your local area that can complement your services,” Ruegg advises. “There have been times I have had to refer clients to outpatient treatment programs that are more intensive.”

Networking is also key, Gilbert says, such as finding a consultant or professional with experience in such a business to lean on during challenging times.

“Always have support and know who your support is,” Gilbert adds. “At times, you can feel alone in a private practice, so you should have a network of individuals you can reach out to and consult with.”

Why They Recommend Starting a Counseling Practice

Based on her experience, Gilbert explains why social workers may want to seriously consider starting their own private practice.

“If you know u want to meet with people and do therapy, then a private practice is the way to go. In social work, we wear lots of hats, from case management to advocacy work. When you have your own practice, it’s definitely a different world than working in a school system or community agency where you’re expected to handle different duties. You can be your own boss by defining your client base, making your own schedule, and enjoying some flexibility in what you do each day.”

After decades in the field, Ruegg cannot stress how rewarding it still is for her to help others improve their mental health.

“Becoming a clinician gives you a lot of freedom. You can work for an agency or build your own agency. This field can help you earn a happy and successful professional life on your own terms. I have been practicing for 35 years, and I still enjoy going to work every day.”

Photo credit: The photographs included in this blog article were provided by Elizabeth Ruegg and Emily Gilbert and are used with permission.