For current and soon-to-be 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 pages and pages of assigned reading, and the first rounds of actually seeing clients. Or, maybe you’ve been an associate for some time, you’re burnt the heck out after working at an agency, and are ready for greater independence. You’ve survived, and now you want to thrive. You’ve done some 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. 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 there are some folks in this field that do not always 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 marginalized, and systems of power continue to 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 negative experiences that I’ve greatly learned from. I go into detail of all I wish I knew when embarking on private practice life. As with anything, take what is shared here with a grain of salt. And, if there is at least one thing I hope you absolutely take with you, it is this: trust your intuition. When sifting through job opportunities, you likely have the feelings you’re having for a reason, and even if those feelings are confusing, they are still worth investigating.
I’ve divided what I feel might be helpful information, largely based on my own experiences, into different sections:
Important Information for California AMFT’s in Private Practice
What to Look For in a Supervisor (And What to Avoid)
Where to Look for a Supervisor
What to Ask During Interviews
Conclusion
Important Information for California AMFT’s in Private Practice
Disclaimer: I am not a BBS or California law expert. This is my current understanding based upon my specific location:
- W-2 Employment: You 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. From my knowledge, there are limited circumstances in which you can be paid under a 1099, but it’s not guaranteed that those hours would be acceptable by the BBS.
- 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. Common splits seem to be: 60 supervisor/40 associate, 50 supervisor/50 associate, and 40 supervisor/ 60 associate. 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, to what degree they deem themselves as responsible for providing you with referrals, etc.
These are the two fee-split set-ups in private practice that I personally have come across most often in my area. Each practice will differ, and some might have elements of both. Practices that take insurance might have quite a different set-up.- Fee-Split for Clinical Hours, and a Second Wage for Non-Clinical (Admin) Hours
- This approach seems more common for larger practices with more support, and is overall more compliant with California labor laws. Employers may decide the split for the fee you charge clients, if it’s not deemed as negotiable. They may also decide what you charge your clients. Important overhead costs, such as for marketing, billing, EHR, materials, and other fees, are often (but not always) covered and provided by employers. Sometimes specific benefits are included, such as health insurance, sick-pay/paid time off, or training opportunities. Often, these employment opportunities hold a weekly minimum of client hours for those working full-time or part-time, meaning that you agree to see a certain number of clients weekly, or have a certain number of clients within your caseload. You are paid your portion of the split for each client hour, and in addition, are then paid a second wage (with minimum wage as baseline) for non-clinical, admin hours, such as when doing supervision and notes. From my understanding, these approaches can result in a lower fee-split for associates because the majority of costs are covered.
- Pros:
- You have more time to focus on your work with clients, and meeting your client hour minimum each week.
- You are being paid for non-clinical hours.
- You might be given the opportunity to diversify your skills with specific benefits, such as with trainings.
- You begin building a network, and a caseload that you can take with you.
- You might have more financially security, and might benefit from added structure.
- Cons:
- You might have less agency over specific decisions, such as over your marketing, or the types of clients you can work with (e.g., for child, couple, and family hours).
- You might not gain immense insight or experience into how to market yourself and gain referrals.
- You might not have agency over your preferred caseload, which could lead to burnout.
- You might feel resentful for how much you make per client hour, depending on how you feel about your fee-split.
- Fee-Split for Clinical Hours
- This structure appears to be more common for solo-practitioners in private practice, and is less-compliant with labor laws, but is overall more flexible and adaptable. Your employer may choose your split, unless deemed negotiable. They might provide guidance on what your fee is, but typically your fee is something you decide. They likely provide some support, guidance, or structure around marketing, but likely also give you agency to decide how and where you market. Some may also require a minimum for client hours each week. In this structure, it’s important to note that if you need to meet clients in-person, it is up to your supervisor to both find and pay the rent required to find a suitable space to do so. While these employers may not cover the costs of most overhead, there are certain costs they legally should cover, and that associates should not pay for, such as for rent, and for any platforms used to process payments. Technically, anything they ask and require for your practice, they should cover the costs for. This might mean that specific forms of marketing, or things such as EHR or telehealth platforms, might not be covered.
- Pros:
- You likely have more agency and choice in creating the foundation of your practice, and are able to experiment to find what works for you.
- You might have a greater sense of control over the clients you work with, which might include how many are on your caseload.
- You might gain more skills and experience in having direct control over your marketing and networking.
- You can pick up the bulk of your business as is, and take it with you once licensed.
- This option is more practical when doing private practice part-time, or on the side.
- Cons:
- You don’t get paid for non-clinical hour work, much like when you are licensed and own your own practice.
- It’s not technically as “legal,” which means there might be more space for a supervisor to exploit you, especially regarding pay.
- It can get expensive if you are covering much of the costs required for your practice.
- The lack of innate structure might not suit folks who struggle with being self-led.
- You will only get paid as much as the clients hours you have, which is tough when you struggle to find clients.
- Supervision via Online Video: You can receive supervision online through video, at least until 2025. Your supervisor must deem you as appropriate for online video supervision through an evaluation conducted within 60-days of your start date. You can not receive supervision through the telephone, as there must be a face-to-face component.
- Six-Year Rule: You can collect hours in private practice for six years following the date of your associate registration. After submitting your subsequent associate application, and receiving a new number, you are not able to collect hours in private practice.
- Advertising: Once you find a private-practice position, and you start marketing, you must write “Registered Associate Marriage and Family Therapist #YourLicenseNumber, Supervised by Your Supervisor, Degree #TheirLicenseNumber” anywhere in which you are advertising yourself (such as your website, ads, and social media).
- Number of Supervisees: An individual supervisor in private practice can have up to six supervisees.
- 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.
What to Look For in a Supervisor (And What to Avoid)
Having a sense of what your priorities are at the start, especially regarding your needs, can save you some grief of following roads that aren’t serving you, or finding yourself in frustrating situations. I would recommend laying out what your ideal supervisor in a private practice set-up would be, and decipher 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. Also, expect to encounter much 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, and to learn what doesn’t work for you, which can sometimes be the hard way.
It might be worthwhile to start by taking inventory of the self-knowledge you have gained thus far in your journey. Many of us can come in with what Josie Rosario, MSW, MSEd of The Healing Strategy deems “professional trauma.” So much of our own “stuff” comes up when beginning this work, and in the midst of processing our own traumas, we can collect negative experiences of invalidation in our work spaces, which is worth accounting for. 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 is kind of like your home-base, and can often play multiple roles as your employer, your model, and your teacher. So, it’s okay to be discerning about who you end up working with, I promise!
You might consider:
- Personal limits/maxes regarding client caseload
- Types of clients you work well with vs. those you don’t
- Knowing your personal “triggers” around your own stuff
- Approaches, theories, and interventions you are drawn to, or that worked well for your clients
- Preferred style of supervision — ex. instructional vs. intuitive, group vs. individual
- Relational style with authority figures, and your past experiences of power differentials
- When you felt unsupported vs. supported, and why
- What you enjoy most about supervision
- What you enjoy most about working with clients
- Your blindspots and growing edges — what you’d like to improve on
- Your level of interest in networking with peers and other therapists
- Your internal blocks to being seen and visible
- Your experiences of imposter syndrome, and when it has been the most heightened
- 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:
- Ideal client population (your specialization or niche)
- Population types you want to work with (Individual child, teens, adults, Couples, Families, or Groups)
- Modalities and theories
- Additional trainings to invest in (such as EMDR, IFS, etc.)
- Preference for online, in-person, or both
- Ideal caseload AND 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 get there
- Preference for insurance, or staying out-of-network
- Where and how you want to market yourself
- Your style, which influences your branding — vibes and aesthetics (ex., are you more casual or formal?)
- Diversifying your skills through social media, presentations, courses, coaching, teaching, and eventually supervising, etc.
I personally had the best luck (eventually, after some hardship) following my gut and prioritizing the type of relationship I wanted to have with my supervisor first and foremost. I had harmful experiences with my supervisors during my practicum, and eventually realized that a supportive relationship was my most important need. Luckily for me, I have found supervisors who were flexible and open to meeting as many of my other needs as was feasible for them. If this 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
There are some folks who see taking on associates as pure profit. Supervisors should absolutely be paid their dues for the risks and investments they place into their associates. Yet, 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.
Some signs I’ve found of this are those who 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 might also be totally fine admonishing you. If you find yourself working with someone like this, 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, and now you are equipped with knowledge of what you don’t want. Yay!
Where to Look for a Supervisor
I personally would say that this is the hardest part when searching for a private practice position (and from what I remember, the most miserable.) Finding the right type of private practice opportunities can often be about timing, luck, and patience. Your network is your most valuable resource, even if it is small. It is so 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. Asking your peers and fellow associates might give you more personalized information about what is available (i.e., they might be able to spill some tea 👀), alongside giving you an introduction to your local therapist community. Keep an eye out for job postings through your local CAMFT chapter. Your chapter may give you a chance to start self-promoting, networking, and generally putting yourself out there, particularly if you decide to join the board.
If it’s available to you, putting yourself in a position to build a network might also be helpful. For example, I joined a local non-profit, as I ended up wanting to work in a different location from where the bulk of my network from my graduate school where located. This gave me an opportunity to connect with folks in the community who were aligned with my values, and lead me to meeting my current supervisor.
If these options have not been fruitful, you can always try social media, such as LinkedIn, Facebook groups, and job postings. I personally did not have as much luck finding a private practice space that felt like a great fit from a job posting on a site, such as Indeed, but I have the sense that this depends on your area. I personally found Facebook groups (such as Mental Healthcare Careers – California or MFT Guide) to be much more promising.
What to Ask During an Interview
In my personal experience, I found interviews in private practice to feel less formal, in general, than other therapy job interviews. They do seem to be a mixed bag though, so come prepared for anything! Some folks take immense time checking out references, and have you endure multiple cycles of interviews. Others simply feel like a nice, introductory conversation, or require no interview. Since there is so much variance, I won’t go into depth regarding what to expect to be asked. You’ll likely be asked to describe the work you’ve already done with clients. Taking the time to think intentionally about your “whys” of working as a therapist in private practice, alongside all the work you did in identifying your “wants” up above are likely fair game, too.
During interviews, I recall focusing more on whether I was “good enough” for them rather than whether they were “good enough” for me, and overall coming from a place of fear in questioning being my genuine self. Being yourself is THE plus of private practice! Knowing what I know now, I would lead with being “you” over 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. This might seem too on the nose to ask as a therapist, but: what is your body telling you?
Here are some possible questions to ask your interviewer if you don’t know the answer to them already:
- 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? What is covered by the fee-split, and what are things I should expect to cover?
- 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?
Conclusion
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. Another of my past supervisors openly shared with me that she wants her supervisees to be okay with making mistakes, and telling her about them. That open invitation and permission felt so liberating. Ultimately, you want to feel assured that you are in good hands, and that you have the best chances 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. There are so many incredible supervisors out there, and it is my hope that you will find a remarkable one that is the best fit for you.
Wishing you so much luck on this journey!
Additional Resource: BBS MFT Supervision Brochure
Have a question? Have input or a correction you’d like to share? I would love to know. Contact me here.
- Fee-Split for Clinical Hours, and a Second Wage for Non-Clinical (Admin) Hours