For associate marriage and family therapists in California
So, you want to be an associate marriage and family therapist in private practice? For many, this is a logical choice after enduring the grueling process of completing your graduate program, including the multi-hour long classes, the many pages of assigned reading, and the first rounds of actually seeing clients. Or, maybe you’ve already been working as an associate for some time, you’re burnt out, and you’re ready for greater independence. You’ve survived, and now you want to thrive. You’ve done the baby steps, and want to get through the awkward teenage years of associateship before differentiating as a licensed clinician in private practice.
As an associate, you are inherently vulnerable.
The options for getting paid and making a living wage are limited, creating rampant opportunities for us to be taken advantage of for our needs of countable hours and some sort of pay. The model for a work-life balance, something so essential to sitting with clients, is sadly a luxury at this stage. As a testament to this, a recent study found that about half of the MFT trainees in their sample reported experiencing burnout, with caseload and supervisor satisfaction as contributing factors (Glebova, et al., 2022). While there are many opportunities for greater autonomy in private practice, such as having a sense of choice over the type of clients you see and how you work with them, that sense of vulnerability does not disappear. In working under someone’s license, your employer has ultimate say over the practice you begin creating, and sadly there are some folks in this field that do not wield that power with immense care. Becoming a therapist can be akin to the hero’s journey when factoring for all of the forms of trauma we incur while trying to help people — even more-so when you are a marginalized identity, and systems of power horrifically play themselves out.
A key component of private practice is putting yourself out there, and being visible.
Finding a safe, connective space while discovering and declaring your therapeutic identity is essential, and something you absolutely deserve while doing this work.
I’ve been fortunate to have some invaluable models of mentorship, and I’ve also had some difficult experiences that I’ve greatly learned from. When I first considered private practice, I realized that with the newfound independence also came a vast amount of considerations. It was overwhelming, and difficult to know what to prioritize, as I didn’t know what I needed to know. It is my hope to provide associates with pivotal information to help them make informed, empowered decisions as they embark on becoming an associate therapist in private practice.
I’ve divided up what I feel is useful information and reflection into different sections, which you can explore here:
W-2 Employment: Associates must be a W-2 employee to work in private practice, and for your hours to count towards licensure. W-2 forms are submitted with your licensing application. According to the BBS, there are limited circumstances in which you can be paid under a 1099, and it may not be guaranteed that those hours would be acceptable for licensure (Board of Behavioral Sciences, 2023).
Fee Splits: You will encounter fee-splits when interviewing for a private practice position. This is a percentage of the fee you charge clients that is split between yourself and your employer. Many practices (though not all) will provide a fee-split for clinical, face-to-face hours, and then provide an additional wage for non-clinical, administration hours, paying you for completing paperwork and attending supervision. Fee-splits are determined by a number of factors, such as what your supervisor provides you with as the terms of your employment, what your fee is, how many clients you see, and to what degree they are responsible for providing you with referrals. Some employers also provide benefits, often for full-time employees, such as PTO, health insurance, or training opportunities. Some may cover the many costs of marketing, which, aside from being expensive, can take extensive time to create.
It’s worth noting that there are certain aspects of your practice that should always be paid for by your employer, which includes anything that is required for you to adequately perform your job (California Labor Code § 2802, 2021). As examples, they should cover rent for office spaces, or supply you with a HIPAA-compliant mode of collecting payment. It can get tricky when it comes to figuring out who pays for non-essential aspects of practicing that you would like to use, but that your employer is not requiring of you.
Deciding what feels fair in a fee-split is crucial for both parties, as this is an area where resentment can quickly appear on either side of the arrangement. Having an idea of what you are wanting to get out of your time in private practice can shape what feels fair. Some fee-splits support the goals of financial security and the ability to primarily focus on the refinement of your skills as a therapist. Others endorse greater flexibility and independence, supplying you with knowledge about the business aspects of private practice.
Supervision via Online Video: Associates can receive supervision online through video at an “exempt” setting (such as private practice) until at least 2025. Your supervisor must deem you as appropriate for online video supervision through an evaluation conducted within 60-days of your start date. Supervision should be conducted through video, and not by telephone, as there must be a face-to-face component. (Assembly Bill 1758, 2022).
Six-Year Rule: Associates can collect hours in private practice for six years following the date of your registration as an associate marriage and family therapist. After six-years have passed from this date, you can submit a subsequent associate application, and receive a new number. With this second number, you are not able to collect hours in private practice (Board of Behavioral Sciences, 2023).
Number of Supervisees: An individual supervisor in private practice can have up to six supervisees. (Assembly Bill 690, 2021).
Supervisor’s License: It can be worth double-checking that your supervisor’s license is current, and that your employer has a business license. Also, that they’ve met the qualifications to be a supervisor, including being licensed for at least two years, completing necessary training, and complying with continuing education requirements (Board of Behavioral Sciences, 2022).
Before going through the process of writing up a resume, or sending in an application, taking the time to reflect, assess your needs, and develop a sense of what your priorities are can save you the grief of following roads that aren’t serving you. Begin by laying out what your ideal supervisor in a private practice set-up would be, deciphering what qualities are necessary, and what qualities are okay to compromise on. Chances are, you will not find an opportunity that meets every single one of your criteria, because every site will likely have their caveats. Take inventory of the self-knowledge you have gained thus far in your journey. Many of us can acquire what Josie Rosario, MSW, MSEd deems “professional trauma” (2023). Our own traumas can inevitably come up in this work, and in the midst of processing our past, we can collect negative experiences of invalidation in our work spaces. It might be helpful to think about your past experiences of supervision and leadership. What felt encouraging? What felt harmful? In private practice, your supervisor serves as your home-base, and can often play multiple roles as your employer, your model, and your teacher. Since they are so instrumental, take this as permission to be discerning about who you end up working with.
You might consider:
- Your personal limits or maxes regarding client caseload
- The types of clients you work well with, and the types you do not
- Knowing your “triggers” around your own mental health experiences
- The approaches, theories, and interventions you are drawn to
- Your preferred type and style of supervision
- Your relational style with authority figures, and your past experiences of power differentials
- When you have felt most supported and unsupported at past jobs or intern sites
- What you enjoy most about supervision
- What you enjoy most about working with clients
- Your blindspots and growing edges, and what you’d like to improve on
- Your level of interest in networking with peers and other therapists
- Your internal blocks or resistance to being seen, visible, and marketing yourself
- Your experiences and patterns of imposter syndrome
- Your relationship to money and getting paid
- Your relationship to boundaries and expressing needs
I would then recommend reflecting on what you want your practice to look like, and studying who in your community you admire, or best exemplifies what you value when embarking on building your practice.
This might look like identifying:
- Your ideal client population, specialization, or niche
- Population types you want to work with (individual child, teens, adults, couples, families, or groups)
- Modalities, theories, and your overall approach to treatment
- Additional training methods or approaches you’d like to invest in
- Preference for seeing clients online, in-person, or both
- Ideal caseload and your ideal schedule
- Ideal fees in relation to your area and offerings
- How much money you need to make, and how long you can give yourself to acquire a “full” caseload
- Preference for insurance, or staying out-of-network
- Where and how you want to market yourself
- The type of branding you’d like to create for yourself based upon your style and approach
- Your level of interest in diversifying your skills. This could be through social media, presentations, courses, coaching, teaching, or eventually supervising.
After experiencing hardship, I personally had the best luck in finding the right fit by prioritizing the type of relationship I wanted to have with my supervisor first and foremost. I had harmful experiences with past mentors throughout my traineeship and early associateship, and eventually realized that a supportive relationship was my most important need. If it is an option for you, I would highly recommend waiting to begin building your practice with someone you sense you can trust, and who you share aligned values with as clinicians. We do relational work, and it does feel easier to grow and expand when you have reliable relationships to turn to.
What to Look Out For, and Avoid
It can be helpful to expect to encounter trial and error on your search. If there is any silver lining to being an associate, it’s that this is a time to cultivate lessons, which are sometimes gained through adversity. On your journey, you may come across folks who take-on associates predominantly for profit. Supervisors should absolutely be paid their dues for the risks and investments they place into their associates! And, it doesn’t mean that these supervisors don’t also have good intentions. Yet, at the end of the day, some do not provide a safe container, do not provide adequate support, do not abide by laws and regulations, and unfortunately become another space where our inherent vulnerability is exploited.
In my personal experience, I’ve noticed these types of supervisors make big promises, particularly around the number of referrals they can provide, their expertise, and your expected income. You might get the feeling that they are trying to “sell you” the idea of working with them without also demonstrating those qualities, and that they come from a more ego-driven place. They might have a lot of rules or limits. Some early red flags in your work with them might be: not adequately explaining any of their “rules,” expecting you to constantly be available, pressuring you in any way, a lack of curiosity into your experience, not following through on what was agreed upon, and blaming or shaming you. I’ve also found that when a supervisor admonishes clients, they may also eventually end up admonishing you.
If you find yourself working with someone who embodies these characteristics, it’s okay to leave and find something better, if that option is available to you. In my experience, it is worth the stress and uncertainty to acquire the right fit, and now you are equipped with the irreplaceable knowledge of what does not work for you. In these situations, you have the right to be heard, and can file a complaint against a supervisor through the California Department of Consumer Affairs “Breeze” website (Board of Behavioral Sciences, 2022).
Finding the right type of private practice opportunities are difficult, and seem to often rely on timing, luck, and patience. Your network is your most valuable resource, even if it is small. It is absolutely worth asking professors or supervisors you know, trust, and like whether they are available to take on an associate, or know someone that would be a good fit for you. Your associate peers may be able to provide you with an introduction to your local therapists-in-private-practice community, and might give you more personalized insight based upon their own networks. Your local CAMFT chapter also holds a wealth of opportunities for self-promotion, networking, or finding job postings. Joining the board of your local chapter allows you to start getting your name out at the forefront.
If it’s available to you, putting yourself in a position to build a network might also be helpful through firstly volunteering at a non-profit, agency, or organization. Job search websites occasionally have private practice positions for associates, alongside specific job search websites for therapists, such as mentalhealthcareers.com. If these options have not been fruitful, you can consult social media, such as LinkedIn or Facebook groups. In finding job postings online, always do your due diligence in investigating the job offer to ensure that it meets all the necessary requirements.
Interviews in private practice can widely vary. Some interviewers take immense time checking out references, and have you endure multiple cycles of interviews. Other interviewers prefer an informal, introductory conversation as the interview. Since there can be variance, it might be best to loosely prepare by being ready to describe the work you’ve already done with clients. Thinking intentionally about your “whys” of choosing private practice, describing your approach, and stating the preferences you’ve identified so far might also be fair game.
During interviews, I recall focusing more on whether I felt “good enough” for the prospective employer rather than whether they were “good enough” for me, which caused me to refrain from asking questions. Our ever-constant imposter feelings can cause us to fear being our genuine selves. Being yourself is a major plus of private practice, and can be your best marketing asset. Knowing what I know now, I would lead with being “you” before focusing on being “professional.” I personally felt the best in interviews where the expectation to impress was out the window, and the questions were more process-oriented. The interview is a time to tune into your intuition the most, trusting yourself, and exhibiting curiosity over your inclinations. It’s worth asking yourself what we ask of our clients so often: what is your body telling you?
Here are some possible questions to ask an interviewer:
- Is this a W-2 opportunity?
- How would you describe yourself as a supervisor? What is your style?
- What do you value in a supervisor-supervisee relationship?
- Do you have a consistent stream of client referrals? If so, what types of clients do you generally see, or get inquiries for?
- Do you offer any benefits? If so, what would that include?
- What is the fee-split? Is it negotiable at any point in our work together?
- How long have you been in private practice?
- Do you see clients in-person, online, or both? Would there be availability for me to see clients in-person?
- Do you take insurance? If so, what is your process for handling billing?
- To what degree can I expect to learn about running my own private practice?
- To what degree am I responsible for finding my own clients?
I knew my current supervisor was someone I could trust when she deliberately asked me how she could best support me, and if there was anything about me that I felt was important for her to know. It was the first time anyone had asked me that question, and one of the first times I felt a supervisor cared about my internal experience, apart from how it related to a client. Ultimately, you want to feel assured that you are in good hands, and that you have the best chance for a great start in creating your business. And, you want to feel assured that your supervisor handles the power of mentorship with great care, creating a secure base, and a safe attachment. A skillful supervisor models the type of genuine, insightful relationships we aspire to create and hold with our clients.
Board of Behavioral Sciences. (2022, January). A guide to supervision for those pursuing board of behavioral sciences LPCC, LCSW, or LMFT licensure. BBS. https://www.bbs.ca.gov/pdf/publications/mft_supervision_brochure.pdf
Board of Behavioral Sciences. (2023, January 1). Important answers to frequently asked questions. BBS. https://bbs.ca.gov/pdf/publications/mft_faq.pdf
Glebova, T., Lal, A., Girard, A., & Van Ligten, J. (2022). Burnout in MFT trainees: Impact of demands and resources. Journal of Marital and Family Therapy, 48(3), 908-926.
Rosario, Josie [@thehealingstrategy]. (2023, March 11). I’m convinced that as clinicians and business owners, therapists in private practice need a corrective emotional experience. [Text]. Instagram. https://www.instagram.com/p/CppWuTvMoZs/