Building a Private Counseling Practice

Starting a private Counseling practice can be equally exciting and overwhelming for a Counselor. With over two decades of experience specializing in eating disorders, Ann Jacob Smith, PhD, NCC, ACS, LCPC, transformed her expertise into a thriving group practice, The Smith Counseling Group, LLC. She shares her journey, strategies, and challenges with us.

Dr. Smith’s Professional Counseling career began in 1998 at the Duke University Diet and Fitness Center, where she was immersed in clinical work and research. This led to an early passion for evidence-based treatment and the scientific process.

She pursued her doctorate in Counseling at The George Washington University while serving as their director of the training clinic for graduate students. The experience of mentoring Counselors-in-Training and delivering specialized care laid the foundation for her future as a private group practice owner.

While balancing the demands of early parenthood, Dr. Smith launched her own independent practice in 2005 to gain greater flexibility and deepen her specialization in eating disorders. As her children grew, so did the practice.

“Once I decided I wanted to build a group practice in the summer of 2023, I had to do all the logistical things that school doesn’t teach us,” says Dr. Smith. “As a sole practitioner since 2005, I didn’t have an LLC, so my first steps were to secure one, obtain an NPI (National Provider Identifier) as a group practice, become certified and licensed as a clinical supervisor, and locate office space big enough to support multiple associates and other providers.” 

Dr. Smith began seeking Counselors who were licensed, newer in their careers, and open to learning a new specialty. A longtime psychiatrist colleague joined Dr. Smith’s practice as well, adding depth and continuity of care. She dedicated her clinic not only to treating clients, but to training Counselors in family-based treatment (FBT), an evidence-based approach she finds “indispensable for adolescent anorexia.”

While the operational components of launching her practice were significant, they reinforced Dr. Smith’s belief in the importance and impact of collaborative work.

Throughout her 25 years in the D.C. area, Dr. Smith has cultivated a trusted circle of professionals who continue to play key roles: an accountant who ensures regulatory compliance, a lawyer who manages contracts and leases, and fellow clinician-business owners who provide encouragement and perspective. Their guidance has been essential in navigating the realities of small business ownership.

“I cannot stress enough how much logistical and emotional support is necessary to pursue your own practice,” says Dr. Smith. “It requires skills clinicians seldomly develop in school.”

Forming an LLC proved more straightforward than expected for Dr. Smith, though she emphasizes the importance of legal and accounting guidance. She ensures that both the practice and individual Counselors maintain appropriate liability coverage.

Marketing has been one of the more complex aspects of practice ownership, according to Dr. Smith. She has hired various marketing teams to help with digital marketing, all with varying results. She notes the stark difference between web designers and digital marketing specialists and feels ambivalent about promoting clinical services on social media.

“Despite the rise of online marketing, word of mouth and community outreach remain my most reliable referral sources,” states Dr. Smith.

In Dr. Smith’s experience, digital marketing professionals often misunderstand the ethical boundaries of clinical work, including the inappropriateness of soliciting client reviews. Balancing ethical practice with the realities of search engine visibility remains a persistent tension.

On the administrative side, software tools, such as online practice management platforms, have been invaluable to Dr. Smith, streamlining billing, medical records, reporting, and scheduling. She also uses online payroll services and relies on an accountant for taxes and 1099 preparation.

Dr. Smith’s biggest challenge has been hiring other Counselors. Despite offering free supervision, specialized training, and professional development opportunities, she finds that many newly licensed Counselors prefer to open independent practices rather than work under supervision and learn about a new specialty.

“This is something to which I cannot relate,” says Dr. Smith, “as I found so much value in working in clinics and learning from supervisors and colleagues.”

Regardless, she continues to seek more Counselors with a genuine interest in eating disorder treatment and FBT training.

Dr. Smith also advises to expect the unexpected. She never imagined the management challenges that would come with starting her own practice until she had to let an associate go. As a Counselor accustomed to helping others, developing new boundaries and making decisions grounded in the well-being of the whole practice became crucial.

“These moments are when I rely most heavily on my support network to ensure I handle staffing issues both ethically and compassionately,” says Dr. Smith.

Despite the challenges, Dr. Smith has no regrets.

“Establishing your own private practice is a huge amount of work, but it is very rewarding to see it all come together,” concludes Dr. Smith.

Ann Jacob Smith, PhD, NCC, ACS, LCPC, is the owner and director of The Smith Counseling Group, LLC in Chevy Chase, Maryland. She received her master’s degree in Rehabilitation Counseling from The University of North Carolina at Chapel Hill and her doctorate in Counseling from The George Washington University. Dr. Smith specializes in eating disorders and offers supervision to individuals in Maryland who are working toward licensure.

**Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.