Reality Checks in Private Practice

Prior to the holidays, right through them and into 2007, I was ill. Ill enough that driving seemed beyond imagination, and dangerous. A fever scattered my reasoning. I could not work (and in good conscience could not expose my clients to whatever I had).

Perhaps it was a blessing that it was the holiday season; however, adult clients (and parents of young clients) wanted to be seen before the holidays 'really' began, some in between and some randomly. A few colleagues suggested I contract with an SLP to see these clients. I learned that when you establish a precedent of developing a consistent relationship as the sole therapist, clients tend to reject this option.

Many clients reported feeling they had two options: find another SLP and hope for the best, or hope they/their children could sustain their progress and that I would return soon. Some who had attended centers or university clinics had experienced transitioning therapists due to a center's staffing (loss, policy, moves, etc.) or student therapists changing clients with semesters and classes. Young adults did not seem to mind this as much as teens' parents or those over 25. I do not know if in fact the children were as concerned as their parents, and wonder if there is any research on this.

I've only been back for less than two weeks, and not full-time. Thus far I'm finding approximately 80% are indicating a return, or have returned already, though I won't know the actual percentage for a while. It seems that some return as I catch up with reports and phone contacts. I did not send out a "mass mailing" about either my absence or return to work, and I wonder if this would be easier if I could have. But, this quirky illness was a guessing game for me, so I found I could not predict the length of my absence. Now that I've returned, my choice has been to make individual contacts by email, snail mail, or phone. Why? Because my client treatment approach has been a very personal one and this seems to support the validity of that.

This is a major issue in a sole-proprietorship and could be even more so if an illness or injury causes a longer absence. Anyone considering this should investigate the value of disability insurance.

Less significant than the above, but sequelae that bring stress, guilt, and more time demands (perhaps risking relapse), are the multitude of those other commitments to the profession, community, family and friends. I have professional obligations from prior to the illness left undone. You know how it is when you are late in doing something and the later you get the less you want to make contact and seemingly have a "new excuse." Such guilt! There's family you promised to see after the holidays/illness but now you must postpone all that to build your practice up again. How patient can they be? The time crunch is on. In the back of your mind you know that you can end up sick again or worse, but how many of us listen to our bodies and our common sense under the professional (and personal) pressures that never seem to let up?

Over the years I've investigated taking my skills to a different venue because of the above and other factors, too. But I always find that what I have done and can possibly do in private practice still suits my personality best. Yet I write about this so that those who consider a private practice become more aware and ask the right questions of themselves and others before making a change.