Starting a Private Therapy Practice in a Big City

What you will find reading this post is my own personal reflections on starting a private therapy practice in a big city—be it in counselling or psychotherapy. I am sure there is no cookie cutter approach to it—especially given that geographic location is such a massive factor to a therapist’s work—but I guess anyone can learn from anyone else’s experience. At least somewhat. And if they choose to.

I started my psychotherapy and counselling practice in Central and North London knowing it’s going to be a lot of work getting new clients. But I never really knew how much work will need to go into it. To make things harder on me, my private psychotherapy practice is based in one of the most saturated areas in terms of number of psychotherapists and counsellors. I practice in Central and North London, which might be even the most saturated area in the UK. But what is one to expect when they are setting up their psychotherapy and counselling practice in Freud’s area.

I will not go into the legal, safety and ethical aspects of starting a private therapy practice as I think that this is something that most you future psychotherapists and counsellors can workout for yourselves. And that’s also the easy part, I guess. However, what I will focus on is the hard part—client pipeline.

Client referral

Of course, the first thing anyone contemplating starting a private therapy practice will think of is “How do I get my clients?” And even more so “How do I keep getting my clients as time goes by?” Now, some therapists will choose to set up a referral system that won’t really depend on their marketing and advertising.

One of the ways to do that is to join an existent private therapy service or any other psychotherapy, counselling or mental health organisation that already has a client stream in place for their therapists. While this can be a seemingly easy way around, it also means that you will usually need to work under their terms and pay portion of your rates to them. It will also mean that the set of clients you will get will likely not be diverse. This is something I was never fond of as a therapist. You will have a similar experience joining a private health insurance scheme. Moreover, if you ever decide to move into another area—or even another country—your client pipeline will be cut of instantly. Your client referral will depend on the branding of the service you had a deal with and not your own.

Myself, I never felt comfortable joining such client referral scheme. If you choose to go down a similar route, you will likely need to build your personal brand to a larger extent than you would need to had you been part of an established scheme.

Of course, you can always count on your fellow colleagues to refer clients to you, but I never dared to base the success of my therapy practice on that.

Dedicated online psychotherapy and counselling directories

Starting a private therapy practice by predominantly relaying on getting clients through online psychotherapy and counselling directories is a common thing. This is the route majority of my colleagues chose as they were starting out as therapists and counsellors. What appears to be the case is that referrals through dedicated online directories strongly depend on the geographic location you intend to practice in. I didn’t put my research into this, however, what I found is that the therapists that practice in London, especially Central and North London area, hardly ever got any referrals through online psychotherapy and counselling directories. I would guess the reason for that is that a vast number of online search hits a certain therapist gets is relatively lower in an area that is highly populated by psychotherapists or counsellors. That’s also why I chose not to spend my money relying on these directories.

Offline promotion

A lot of therapists I know, when starting a private therapy practice, intuitively thought that offline promotion is the way to go. I thought the same. But when you look at the cost side of it, you are basically left with two options—word of mouth and dispersing flyers. Obviously word of mouth is no good when you are at your beginning—there is no word about you to even be out there. So I had to forget about that.

As for the flyers, I had a good few thousand of them made and my plan was to disperse them around the area—mainly to homes, coffeeshops and other community areas. Every morning before I started my work I went for a run and dispersed them around the wider part of the area where I practiced—about two hundred at a time. To this day, I have no indication that any of the clients that came to my therapy practice actually came because of the flyers. But it did get me into shape.


So, I ended up not relying on any of these options and decided to resort to internet searches when it comes to promoting psychotherapy and counselling services. Because a vast majority of businesses today—obviously not only therapists—rely on internet to promote their services, online promotion is highly saturated. This also means that SEO has become both an art and science in itself. If you want to stick out and not be a needle in a haystack, you’ll need to put a lot of work into it when starting a private therapy practice.

So, when it comes to your clients finding you searching the internet, you pretty much have two options. Either you can use paid ads to get your search engine ranks up or you can do your SEO organically. Paid ads are obviously an easier way to do it. However, it will cost you money, on one hand, and on the other, I am not the type of person that actually clicks on these ads as I search the internet, so I figured my clients won’t either. But, people are different and that’s the beauty of it all.

So, I went for the hard organic way of building my online ranking. And, again—as with anything these days—you will also have two options of doing this. You can either pay a specialised SEO expert to set your site up in the way that it ranks well or you can do it yourself. Looking into it I found that getting an expert to do it would, first of all, cost me a lot of money; it would also mean I would have less control over the “feel” of my site, which I didn’t want; and it would mean that I would need to keep paying other people indefinitely as SEO is an ongoing task. And I didn’t want any of that.

Even though SEO today is quite complex and requires specialised knowledge, it is not something one is unable to get a grip over if they put their mind and time into it. And because I didn’t want to have to deal with the drawbacks of outsourced help, I decided to invest my time into doing my own SEO. Also, my experience is that it’s better to do it at the point when you are starting a private therapy practice, because you might get too comfortable later on down the line.

If you are contemplating doing the same, here are a few hints:

  • Analyse what the most used keywords are in your area and set up your website in the way that it acknowledges that. This will mean you need to navigate yourself between what you want to say (i.e. your content) and what keywords yo want to rank for. It may seem like an impossible task at first, but you’ll get a hold of it.
  • Constantly keep tracking and analysing what keywords are being searched for in your area and also in relation to what services you offer. Use these keywords in blog posts and keep posting interesting content constantly (at least once a week). This will increase your ranking or at least keep it from dropping. I know, anytime I stop posting fresh content, my SEO ranking starts dropping quickly.
  • You may feel it undermines your creativity or what you’re about, but posting content without analysing and following the keyword statistics will mean your content will not increase your online exposure—it will just be out there. It is important to find the right balance about what you want to write about and what you have to write about to keep your ranks up. And when starting a private therapy practice you don’t need just to say things, you need things you say to rank well.
  • Increase your exposure by writing for other online magazines and have them backlink to your website. The more quality backlinks you get, the better search engines will rank your site. However, avoid having any kind of backlinks that are not quality ones because search engines will sense that and could penalise you with lower rankings.
  • If your psychotherapy or counselling practice is within an existing service or part of a larger organisation, ask the organisation to include your backlink on their own website.

Managing SEO has a high learning curve. So, when starting a private therapy practice you will obviously need to put a lot of time into it, but this is an investment that will later on pay off.

SEO does take a lot of trial and error and because search engine crawlers are slow, it will take some time—measure it in weeks—for any changes to reflect in your search rankings. So, I guess you’ll also learn to be patient along the way.

Vast majority of my current clients found me searching online. Even though it took me a lot of time and work to learn, build and also sustain my online presence, the fact that I was persistent also means that I don’t need to rely on other channels of referral and promotion. It also makes potential changes of my geographic location much more smooth. I can move my practice anywhere and take my SEO with me.

But, on the other hand, it seems once you’re out there for a long time, clients just manage to find you in ways you never planned for and ways you’ll often never even know of.