Private practice for group therapy only

[ccpsych16]

I’ve considered opening a part time telehealth private practice specifically for group therapy. Groups are my favorite part of the week, and I’d like to add a couple more hours a week to my schedule. I would still do an initial intake assessment before accepting them to the group, and referring elsewhere for individual therapy if it’s clinically indicated. I’m thinking basic anxiety, depression, etc groups. Maybe something more down the line like women’s group or racial/ethnic minority empowerment group, etc.

Has anyone ran groups in private practice before? Is this feasible/wise? Any concerns I should be aware of ahead of time? I am nowhere near ready (or even convinced to follow through), I’m not even licensed in my state of residence so that would happen first. Just getting the wheels turning a bit. TIA.

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[MCParent]

I’ve considered opening a part time telehealth private practice specifically for group therapy. Groups are my favorite part of the week, and I’d like to add a couple more hours a week to my schedule. I would still do an initial intake assessment before accepting them to the group, and referring elsewhere for individual therapy if it’s clinically indicated. I’m thinking basic anxiety, depression, etc groups. Maybe something more down the line like women’s group or racial/ethnic minority empowerment group, etc.

Has anyone ran groups in private practice before? Is this feasible/wise? Any concerns I should be aware of ahead of time? I am nowhere near ready (or even convinced to follow through), I’m not even licensed in my state of residence so that would happen first. Just getting the wheels turning a bit. TIA.

Keep in mind that what you *like* to do for therapy isn’t necessarily what the market will pay for for therapy.

Do you think your area (or, I guess, state, if it’s telehealth, maybe wider if you psypact) market would support a telehealth-based group therapy practice at rates that make it at least feasible?

 

[ccpsych16]

Keep in mind that what you *like* to do for therapy isn’t necessarily what the market will pay for for therapy.

Do you think your area (or, I guess, state, if it’s telehealth, maybe wider if you psypact) market would support a telehealth-based group therapy practice at rates that make it at least feasible?

Thank you for giving me something to think about, that is very true. I live in an area (and state, really) with an immense shortage of mental health services. I and my colleagues go to our own medical appts and the doctors routinely ask us if we work in private practice and are taking patients (I work at a VA). But, I know that doesn’t mean people will want *group* over individual. I could see something like the women/minority stress and empowerment groups being easier to fill. If I figured out how to collaborate with local primary care clinics that could be a nice way to funnel people through, especially for something like a CBT-i group.

I’ve thought about joining PSYPACT. If I was doing it strictly in person, I’m not sure this would be successful. I’m considering telehealth both for cost but also portability, as I don’t plan to live here long term.

Also, I know nothing about setting rates for group or individual therapy, getting on insurance panels, etc.

 

[MCParent]

Thank you for giving me something to think about, that is very true. I live in an area (and state, really) with an immense shortage of mental health services. I and my colleagues go to our own medical appts and the doctors routinely ask us if we work in private practice and are taking patients (I work at a VA). But, I know that doesn’t mean people will want *group* over individual. I could see something like the women/minority stress and empowerment groups being easier to fill. If I figured out how to collaborate with local primary care clinics that could be a nice way to funnel people through, especially for something like a CBT-i group.

I’ve thought about joining PSYPACT. If I was doing it strictly in person, I’m not sure this would be successful. I’m considering telehealth both for cost but also portability, as I don’t plan to live here long term.

Also, I know nothing about setting rates for group or individual therapy, getting on insurance panels, etc.

It’d be pretty essential to make sure your business can generate folks coming through regularly for group to be able to sustain it. If you’d like your whole practice to be group, think about how many people that is. What, let’s say 4 groups * 10 people a day, so already your one day requires as many referrals as more than a week for individual practice.
Not that it would be impossible, but it’d be a different model than a normal mostly individual practice.

 

[WisNeuro]

Virtual group therapy, either as a patient or provider, sounds terrible.

 

[ccpsych16]

Virtual group therapy, either as a patient or provider, sounds terrible.

I enjoy it, I’ve done it in multiple types of settings, and I run some of the most popular groups at my clinic. I’m looking for general logistical pointers.

It’d be pretty essential to make sure your business can generate folks coming through regularly for group to be able to sustain it. If you’d like your whole practice to be group, think about how many people that is. What, let’s say 4 groups * 10 people a day, so already your one day requires as many referrals as more than a week for individual practice.
Not that it would be impossible, but it’d be a different model than a normal mostly individual practice.

Oof, that is a great point. I imagined it as something very low key, especially at first, maybe 1-2 groups at a time. I’ve also thought about cold calling some of the very few private practices around and offering to provide group services. These places have super long waitlists. The biggest logistical issue would probably be space as they tend to only have a small waiting room and small individual offices.

 

[Sanman]

Thank you for giving me something to think about, that is very true. I live in an area (and state, really) with an immense shortage of mental health services. I and my colleagues go to our own medical appts and the doctors routinely ask us if we work in private practice and are taking patients (I work at a VA). But, I know that doesn’t mean people will want *group* over individual. I could see something like the women/minority stress and empowerment groups being easier to fill. If I figured out how to collaborate with local primary care clinics that could be a nice way to funnel people through, especially for something like a CBT-i group.

I’ve thought about joining PSYPACT. If I was doing it strictly in person, I’m not sure this would be successful. I’m considering telehealth both for cost but also portability, as I don’t plan to live here long term.

Also, I know nothing about setting rates for group or individual therapy, getting on insurance panels, etc.

The bolded sounds like something that is popular at some of the VAs I know. That said, how to do plan to get paid in private practice? Are you planning for out of pocket only or insurance? Not sure that insurance would be worth it as you would have to do a lot of 90791s just to establish a dx for each group member and then see if they qualify for group participation. If no insurance, then there is a question of if people are willing to pay cash for something that they might like when it is free.

As for cold calling private practices, you can but I have a feeling you will end up doing most of the work and they will want a significant portion of the billables (30-50% and you do all the development for the group).

You still have a few things to think through. If you want to do virtual groups, I think you need to find a niche that would be hard to fill in person.

 

[R. Matey]

I think groups in PP are probably feasible. A few ppl in PP on our state org listserv post group availability and then post again when the group is full. Making it your entire practice though might be a challenge, depending on exactly what type of group you wanted to run. Mandated anger management groups? I could see it. Process groups? Might be a bit harder.

 

[R. Matey]

Virtual group therapy, either as a patient or provider, sounds terrible.

Worse than "Doc, I was in a pillow fight in 1997 and I now I can't concentrate"?

 

[BuckeyeLove]

If you can get solid word of mouth, group is definitely a great way to go. I lean more towards group being an active and effective mechanism of interpersonal process change/growth (there's a legit body of lit that backs this up), but I'm not sure how much insurance will cover it. I know a guy who has two open groups a week and they are always full and he has solid outcomes. If i weren't so inundated with working for the govt, id be tempted to go that route no lie.

 

[WisNeuro]

Worse than "Doc, I was in a pillow fight in 1997 and I now I can't concentrate"?

I get paid very handsomely to deal with these things. Telehealth groups, not so much.

 

[PsyDr]

I'm guessing your VA setting is skewing your view.

1) Typically treatment is diagnosis based. If you are trying to have a group based upon a social issue like "women's empowerment", you're going to have a hard time getting other providers on board. You're also probably committing insurance fraud.

2) Timing is going to be an issue. Most people are going to be at work until 5pm. That might limit who wants your treatment. Look for groups that want and are available for your services.

3) Support groups are generally free.

4) There is an ABPP for group psychology. Maybe look up how those people practice.

5) There is some practice in my area that does a lot of group therapy. My old office was in the same building, and I never saw them.

 

[quickpsych]

Virtual group therapy, either as a patient or provider, sounds terrible.

The one thing I think I liked about my time in a CMH agency was doing and running groups in "partial" hospitalization programs. Groups in those settings can be quite , dare I say, fun and interesting. During peak pandemic times, it was not great and they tried everything from videoing into the group room with a few patients to, even worse, phone conference calls as the group. In person was definitely the only way those kind of groups functioned and were of any benefit.

That said, I agree with others that a private practice just doing private pay groups is unlikely to be feasible long term to maintain. The CMH systems use groups because it was a cheap way to provide more services with less money and less staff. Most private practices that have outpatient groups are where most of the practice is individual therapy or assessment and they might run one or two groups on the side. I think therapy groups are fantastic, but I always saw them as a possible supplement to a practice not a primary source of caseload and revenue.

 

[ccpsych16]

The bolded sounds like something that is popular at some of the VAs I know. That said, how to do plan to get paid in private practice? Are you planning for out of pocket only or insurance? Not sure that insurance would be worth it as you would have to do a lot of 90791s just to establish a dx for each group member and then see if they qualify for group participation. If no insurance, then there is a question of if people are willing to pay cash for something that they might like when it is free.

As for cold calling private practices, you can but I have a feeling you will end up doing most of the work and they will want a significant portion of the billables (30-50% and you do all the development for the group).

You still have a few things to think through. If you want to do virtual groups, I think you need to find a niche that would be hard to fill in person.

Thank you for this feedback! I have been in brief contact with some women’s health organizations (like 501c3 orgs) since many of them have been wanting to expand into support/therapy groups. They’re often looking for therapists to do this, whether it’s contract basis or as a PT employee. That might be an easier way to start. In terms of getting paid, that is another thing I need to educate myself on and figure out whether it would be wise or feasible.

 

[ccpsych16]

I think groups in PP are probably feasible. A few ppl in PP on our state org listserv post group availability and then post again when the group is full. Making it your entire practice though might be a challenge, depending on exactly what type of group you wanted to run. Mandated anger management groups? I could see it. Process groups? Might be a bit harder.

Hmm. I have thought about dipping into anger mgmt groups that would fulfill someone’s legal requirement and/or doing part time EAP work (group or individual). I have an orientation toward rural care, both due to grad training and where I’ve lived and plan to live. I’ve found they tend to be more open to telehealth for medical and mental health care as it can be a choice between care or no care. And rural primary care has been doing telehealth for a long time, pre-pandemic.

 

[ccpsych16]

If you can get solid word of mouth, group is definitely a great way to go. I lean more towards group being an active and effective mechanism of interpersonal process change/growth (there's a legit body of lit that backs this up), but I'm not sure how much insurance will cover it. I know a guy who has two open groups a week and they are always full and he has solid outcomes. If i weren't so inundated with working for the govt, id be tempted to go that route no lie.

That is good to hear, thank you!

I'm guessing your VA setting is skewing your view.

1) Typically treatment is diagnosis based. If you are trying to have a group based upon a social issue like "women's empowerment", you're going to have a hard time getting other providers on board. You're also probably committing insurance fraud.

2) Timing is going to be an issue. Most people are going to be at work until 5pm. That might limit who wants your treatment. Look for groups that want and are available for your services.

3) Support groups are generally free.

4) There is an ABPP for group psychology. Maybe look up how those people practice.

5) There is some practice in my area that does a lot of group therapy. My old office was in the same building, and I never saw them.

Excellent points. Digging into ABPP for group psych is something I hadn’t considered. As for timing, I’d be looking at evenings or weekends. I don’t plan to ever go into PP full time (only time will tell) so it would be outside of regular business hours anyway.

The one thing I think I liked about my time in a CMH agency was doing and running groups in "partial" hospitalization programs. Groups in those settings can be quite , dare I say, fun and interesting. During peak pandemic times, it was not great and they tried everything from videoing into the group room with a few patients to, even worse, phone conference calls as the group. In person was definitely the only way those kind of groups functioned and were of any benefit.

That said, I agree with others that a private practice just doing private pay groups is unlikely to be feasible long term to maintain. The CMH systems use groups because it was a cheap way to provide more services with less money and less staff. Most private practices that have outpatient groups are where most of the practice is individual therapy or assessment and they might run one or two groups on the side. I think therapy groups are fantastic, but I always saw them as a possible supplement to a practice not a primary source of caseload and revenue.

Good point. Trying to do it as a stand-alone may not be wise, but potentially partnering with a PP or other kind of org as contract or PT employee could be (hopefully more than marginally) better.

I appreciate everyone sharing their perspectives and poking holes in the “day dream”. I’ve got a lot more researching to do.

 

[smalltownpsych]

I have had a private practice for a couple of years now and keeping our group going has been challenging and it is currently not going. It was doing a little better when I was running it, but even then it was a struggle. It has dropped off to the point that it is on hold for now since the greener therapists took it over. We get referrals and solicitations for individual therapy at a rate of at least ten times the amount of requests for group.

 

[R. Matey]

Adding psychedelics would likely improve your retention rate

 

[Therapist4Chnge]

One of the “groups” I’ve seen work consistently are court-mandated DUI groups. Ideally you’d get the local/county contract and look to outsource to NC a mid-level. Those groups are for the 2x-5x DUI ppl who are mandated for 52wk, so you can get 10-25+ ppl per group and have a 90%+ attendance rates. The notes get templated out all so you can make decent $$ that should be consistent for years.

That’s way more hassle than I’d want to deal with, but it’s an example that could be found in most places. Not all group reimbursements are trash, but most are pretty bad. I didn’t mind groups that were connected to research, but trying to make group work economically feasible is its own challenge.

 

[ccpsych16]

One of the “groups” I’ve seen work consistently are court-mandated DUI groups. Ideally you’d get the local/county contract and look to outsource to NC a mid-level. Those groups are for the 2x-5x DUI ppl who are mandated for 52wk, so you can get 10-25+ ppl per group and have a 90%+ attendance rates. The notes get templated out all so you can make decent $$ that should be consistent for years.

That’s way more hassle than I’d want to deal with, but it’s an example that could be found in most places. Not all group reimbursements are trash, but most are pretty bad. I didn’t mind groups that were connected to research, but trying to make group work economically feasible is its own challenge.

Thank you, this is a good idea and aligns with some of my other thoughts about contracting for EAP resources, court-mandated anger management as mentioned upthread. What do you mean by NC a midlevel? I’m sure I will get it eventually but I am kind of fried after the eventful work day I had today.

 

[Therapist4Chnge]

Thank you, this is a good idea and aligns with some of my other thoughts about contracting for EAP resources, court-mandated anger management as mentioned upthread. What do you mean by NC a midlevel? I’m sure I will get it eventually but I am kind of fried after the eventful work day I had today.

I was trying to figure out what I meant. I’m guessing an autocorrect error. A non-contract hire is what I likely meant bc you’d save on benefits for a position that could easily be a part-time gig for a clinician.

EAP can be a great niche, especially if you are a good negotiator and can secure a solid rate. Getting employees in quickly is key. The cases tend to be substance related (mostly alcohol & cannabis), stress at work, and/or conflict at home. EAP plans usually fall into a 4-8 session range and are meant to either address the issue or be triage. Templating out a consult note would save time bc treatment planning is mostly the same bc by design it’s short-term & usually goal-oriented work.

I’ve found the best companies depends on the type of work you prefer. My ideal referrals were white collar firms because there is a better chance to convert those patients to cash pay, if further treatment is warranted. Most employees will want to use their insurance plans, so EAP contracts can be a bridge to convert over to a commercial insurance patient. Ideally, you’d take the primary insurance of the employer and then negotiate the EAP, so the employee can have a seamless transition.

Converting to cash is the hardest transition, but most clinicians use EAP contracts to supplement their “normal” work bc the referrals tend to be sporadic. I love working w white collar execs bc they tend to be motivated and sometimes refer colleagues bc MH treatment is still stigmatized in board rooms, and leadership ppl often need the help the most.

 

[ccpsych16]

I was trying to figure out what I meant. I’m guessing an autocorrect error. A non-contract hire is what I likely meant bc you’d save on benefits for a position that could easily be a part-time gig for a clinician.

EAP can be a great niche, especially if you are a good negotiator and can secure a solid rate. Getting employees in quickly is key. The cases tend to be substance related (mostly alcohol & cannabis), stress at work, and/or conflict at home. EAP plans usually fall into a 4-8 session range and are meant to either address the issue or be triage. Templating out a consult note would save time bc treatment planning is mostly the same bc by design it’s short-term & usually goal-oriented work.

I’ve found the best companies depends on the type of work you prefer. My ideal referrals were white collar firms because there is a better chance to convert those patients to cash pay, if further treatment is warranted. Most employees will want to use their insurance plans, so EAP contracts can be a bridge to convert over to a commercial insurance patient. Ideally, you’d take the primary insurance of the employer and then negotiate the EAP, so the employee can have a seamless transition.

Converting to cash is the hardest transition, but most clinicians use EAP contracts to supplement their “normal” work bc the referrals tend to be sporadic. I love working w white collar execs bc they tend to be motivated and sometimes refer colleagues bc MH treatment is still stigmatized in board rooms, and leadership ppl often need the help the most.

If it’s ok with you I may message you at some point in the future with more questions! I am curious about your experiences and how you made those connections. I can definitely see white collar execs being a good population to work with. And I am a little burned out with feeling a bit helpless when my clients’ issues are related to poverty and lack of education.

I have seen some EAP job postings with insurance companies, large pharmacy corporations, and teaching hospitals (usually for med students and healthcare staff). Sounds interesting but more than likely I’d want to do that as a side thing rather than my entire job.

 

[smalltownpsych]

Building relationships with local docs is essential, but it is going to be hard to do with part time practice. Mainly because it’s a numbers game and it is a slow process. Also, part of that process is having ability to deal with the more difficult cases because that is what they are really looking for especially when they are sending them outside of network. I am having dinner on Monday with my new postdoc, a neuropsychologist, a PMHNP, psychiatrist, and a local family practice MD and his PA. These relationships have been years in the making and each of the individuals except the neuropsychologist and my postdoc have sent me several referrals apeice. Probably a total of 15 in two years of practice. Doesn’t sound like much but since these were pretty intensive cases it has been for 100k to 200k in revenue. If I had a part time practice, doubt that I would have gotten more than a couple of those referrals. If it was telehealth or just group, even less. Message being, think of what the referrals sources want and how to help them. Maybe an IOP or inpatient program would be a better source since I get queries about group from these more frequently because some patients really liked that part of their experience.

 

[ccpsych16]

I

Building relationships with local docs is essential, but it is going to be hard to do with part time practice. Mainly because it’s a numbers game and it is a slow process. Also, part of that process is having ability to deal with the more difficult cases because that is what they are really looking for especially when they are sending them outside of network. I am having dinner on Monday with my new postdoc, a neuropsychologist, a PMHNP, psychiatrist, and a local family practice MD and his PA. These relationships have been years in the making and each of the individuals except the neuropsychologist and my postdoc have sent me several referrals apeice. Probably a total of 15 in two years of practice. Doesn’t sound like much but since these were pretty intensive cases it has been for 100k to 200k in revenue. If I had a part time practice, doubt that I would have gotten more than a couple of those referrals. If it was telehealth or just group, even less. Message being, think of what the referrals sources want and how to help them. Maybe an IOP or inpatient program would be a better source since I get queries about group from these more frequently because some patients really liked that part of their experience.

I appreciate you sharing your experience. Seems like I will need to expand what services I want to provide. I am also an ECP so things are still in flux in terms of where I will plant roots. But telehealth and groups seem to be a double whammy working against this being a viable plan. Certainly nothing to try to jump into without a lot more research and probably geographic stability.

 

[smalltownpsych]

I

I appreciate you sharing your experience. Seems like I will need to expand what services I want to provide. I am also an ECP so things are still in flux in terms of where I will plant roots. But telehealth and groups seem to be a double whammy working against this being a viable plan. Certainly nothing to try to jump into without a lot more research and probably geographic stability.

Also, take the “advice” or shared experience here with a grain of salt. Ultimately, the only way to really know what the market wants and what you offer is to test it. The only sure path to failure is to overplan to the point that you never get going. Good luck and keep us informed as to how it is going.