Stages of Change into Private Practice: The Contemplation Stage (Part 2 of 5)

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Coming out of denial is a gradual process. It was like having an addiction, an addiction to allowing other people to be masters of my fate, as well as picking up the subtle messages of others that there was no way I could do private pay in Albuquerque, New Mexico – basically a Medicaid state.

Yet, at the same time, I couldn’t live like this. Seeing all those agency clients, doing all the assessments, as well as doing all the clinical supervision; I was being a hypocrite talking to clients and colleagues about the importance of self-care, while running myself ragged and entering the treacherous waters of burn-out.

Deciding Whether to be Self-Pay or Insurance-Based

But, even if I did make the break, where would I find paying clients? How could I start a new business at this stage in my life?

I’m almost fifty-eight and many of my contemporaries are beginning to retire, and here I was considering starting all over again. Was I being delusional?

The Practice of the Practice website, and Kelly and Miranda’s website, another treasure storehouse of ideas and encouragement, both helped me clarify my thoughts immensely.

I’d done it before in St. Louis, where I had been in a self-pay solo practice for 15 years and group practice for over 10 years previous to that. But, I kept hearing it couldn’t be done, not here.

As I contemplated my options, it was time to really start thinking where those clients would come from. Being in an agency that took Medicaid, as well as commercial insurance, I was sure that the majority wouldn’t come with me. Why would they? Having a $10 or $15 co-pay at the agency versus now having to come up with over $100 per session? Yet, at the same time, I knew it was about how I saw my own worth as a clinician, a mind-set that was driving me forward in this new stage of change in which I found myself.

Changing My Mindset

I already had a listing on Psychology Today and did note that there were a number of referrals coming to the agency, asking for me specifically, due to the Psychology Today website.

But, then I argued with myself that this was because the agency was credentialed, as was I by default, by almost all the insurance panels in town. They’d probably never come to see me, either.

I now realized I was doing a really good job of talking myself out of what I wanted and needed so badly – total autonomy in a self-pay private practice. No, I wasn’t going to feed the self-doubt a minute longer. If I failed, then I failed but I couldn’t keep this up.

I was going to take the risk one way or another.

The hardest decision was whether or not to take insurance. If I did, I’d be right back where I started, wasting countless hours on the phone, pressing one or two, listening to awful music or annoying ads for why I really should love the insurance company which was filing all my claims in the round file. I made a few calls, looked at a few contracts, really studied the terms of the contracts and decided they were probably written by the same attorneys who set up the local casinos. You’re never going to win because the house wins every time, even though they throw you a bone or two!

Learning How to Build a Client Base

Meanwhile, I was still fretting over how to build a client base.

I studied how to build websites. I had successfully remained off the Internet grid for decades and now here I was learning about Search Engine Optimization (SEO) and Google rankings and having to learn a whole new way of thinking. If I wanted to make this happen, then this old dog simply had to learn some new tricks…

Any time I had available, I used to study how other therapists had designed their websites. Some were obviously ultra-professional and I figured cost thousands of dollars. Others were awful. But, there were a good number which looked good and got the job done. I then studied the how of building websites, compared hosting companies, compared pricing, and wondered just how difficult it would be.

Having a background as a photographer/illustrator helped of course and, eventually, I put some rough ideas on paper.

At first, it was highly intimidating and I found myself procrastinating. But, I steeled myself, sat down in front of the computer, and got to work binge-watching how to build website videos on YouTube.

So, the question of where the clients would come from was becoming clearer. It was a variety of sources: the Internet, brochures, business cards, word-of-mouth, and cultivating a list of referral sources.

Deciding to go Back Into Private Practice

However, I still had the awful prospect of announcing my intention to leave to my employer and I pretty much knew it wouldn’t go real well, just the nature of employees leaving, I suppose.

Great! Now I now had another anxiety to pile on top of all the others. But, anxiety or not, I was becoming more decided that I had to leave my employer and go back into private practice. The next question was when?


Read Tom’s previous blog post on ‘Stages of Change Into Private Practice: The Pre-Contemplation Stage (Part 1 of 5)‘.


As a progressive clinician in the field of ADHD and Male Psychology, Tom Quinn is a Licensed Professional Clinical Counselor in Albuquerque, New Mexico.

Originally from Scotland, Quinn is former Clinical Director of Addiction Services at Sage Neuroscience Center. Quinn brings a wealth of experience and expertise accumulated from over 30 years as a hands-on, practical counselor. As an Adjunct Professor at St. Louis Community College, Tom taught both lecture and online classes in Alcohol and Drug Studies, Human Growth and Development, General Psychology and Addictions and Compulsive Behavior. 

Author of two books on ADHD, “Grandma’s Pet Wildebeest Ate My Homework” and “ADHD Eddie: Intergalactic Ladies Man!” Tom was also the recipient of the Helen B. Madden Memorial Award for Outstanding Effort and Achievement in the field of Alcoholism and Drug Abuse. For more information, visit