You’re never going to feel 100% comfortable. Private practice involves risk and in order to be successful, it takes continuous risk on the part of the owner/therapist. There will always be some form of anxiety around losing money or failing. This changes with time but the sooner you accept it, the better because once you start operating from a place of trust and confidence in yourself rather than attempting to over-control, your practice will thrive sooner.
As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Isolde Sundet.
Isolde Sundet is a psychotherapist based in New York City Mexico City, MX and her ultimate passion is helping people connect to themselves and others again; her work focuses on individuals and couples who are struggling with disconnection and intimacy avoidance. Isolde attended Columbia University in New York City where she received two master’s degrees in counseling. She is a licensed professional counselor in both New York and Texas. Before opening her private practice she worked for 5 years in community mental health, particularly with formerly incarcerated clients.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?
Sure! My first experience in clinical mental health was at Rikers Island Correctional Facility in New York where I interned in graduate school. I knew from that moment on that I would work in forensic psychology as well as advocate for racial and social justice, particularly for justice-involved folks with mental illness. For the next few years I continued to work with justice-involved clients, mostly mandated, and most recently with clients who had committed some form of sexual offending behavior. At the start of COVID I decided to quit my job and go into private practice — I’m now fully booked and so thankful that I decided to ‘take the plunge’ so to speak, when I did.
I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?
I’ve had more than one. Two in particular stand out and they were both my mentors at the same time, albeit in drastically different settings. One was Swati Jagetia who owns a private practice called Purpose Squared on the Upper West Side of Manhattan. She taught me literally everything I know about the business of private practice and how to build an ideal practice; through things like paying attention to small details and always providing clients with consistency.
The other was Dr. Kay Jackson at Shiloh Consulting, the clinic I worked at for people with a history of sexual offending behavior. She taught me how to hold my own as a female therapist, working with (primarily men, though we had female clients) people who have abused and enacted violence on others. She taught me the power of cautionary empathy — and something I continually try to work on to this day, she taught me to trust myself and to be direct.
What made you want to start your own practice? Can you tell us the story of how you started it?
Everything in my life sort of shifted at once — both for the better and worse. My mother was diagnosed with cancer, COVID happened, and I realized I had reached burnout where I was. I decided to apply to doctoral programs (I didn’t get in and I’m actually thankful now I didn’t!) and part of my “backup plan” was private practice. I figured I would only need a few clients to make a livable wage and I was interested in using the skills I had honed in my years of forensic work with clients who were internally motivated to come to therapy. To my surprise I was halfway full after 4 months and now am fully booked at 6 months in.
Can you share the most interesting story that happened to you since you began your career?
Funny enough-the story that came to mind is something that happened years ago, before I went to graduate school and before I started working as a therapist. When I was about 21 — the summer before going to grad school, I worked as a psychological ‘tech’ at an acute psychiatric facility which meant my job ranged from handing out lunches to restraining patients if they were assaultive — it was intense work to say the least. One day a man (for the reader, I am changing details just so you know) was admitted for suicidal ideation — his daughter had just been killed in a car accident and he was so fraught and devastated that he literally could not stand. I have never experienced such palpable and raw emotion from a person in my life and I will never forget the moment he came in. During this same time period another woman was on the unit who had been admitted a few days before and presented with what some providers call “treatment/medication resistant” depression. This meant that she had tried everything — including electroconvulsive therapy and nothing ever worked. She had resigned herself to believing that she would always be depressed. She had tried to kill herself more than once. They found each other the day after he was admitted onto the unit. They instantly connected. I remember them siting together one night after they were supposed to be in their rooms — I came in to do my rounds and I remember them smiling at me. Needless to say, I let them stay there together. I don’t know what happened to them or if they’re still together. But what was so clear about them was that their connection was exactly what each of them needed at that time. It probably the purest expression of love and care I have ever witnessed in my career. It was a reminder that sometimes it’s the intervention we would least expect — in this case connection with another patient — that ended up being the most therapeutic and helpful for both of them.
Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?
I made a pledge with myself when I started that I will allot 20% of my private practice to sliding scale clients at all times. So, if I have 20 clients, 4 of them will be folks who are paying a much lower fee based on income. The truth is that private practice is a business and therapists — especially in New York and Los Angeles — including myself, charge fees that many people cannot afford to pay because insurance companies reimburse so little that most therapists don’t want to take insurance. Many of the ones that do take insurance have to supplement income with taking on too many clients. The issue is systemic and will take counselors coming together and championing higher pay from insurance companies so that all folks can afford counseling.
Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?
I’m always a therapist first — meaning I’m always operating from an ethical standpoint as a counselor before I am a business owner; ethical standards that include doing no harm and doing what is beneficent for the client first and foremost. So, that’s the first question I ask myself when any sort of dilemma arises in my practice — from that point I make sure that I honor myself, that I charge and collect fair fees and that I practice self-compassion regularly. I ask my clients to practice self-compassion literally every day so it’s only right that I should do the same.
From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?
Money and burnout were the greatest struggles. Within burnout, the self-doubt and exhaustion were probably the hardest to cope through and get past. Making mistakes is something every therapist will do but it’s never easy. When working with offenders, I had a client re-offend by groping a woman on the subway which was what he was in treatment for. I blamed myself initially and lost a lot of faith in treatment and my relationship with all of my clients. It wasn’t anything I could have prevented and blaming myself absolved the client of his responsibility for his actions. In that moment though, it was really hard to not feel discouraged and guilty. Eventually I learned — and internalized — that it’s not our place or helpful at all to work harder than our clients. I learned to put less onus and responsibility on myself because ultimately that wasn’t helpful for my clients and it only led to further burnout for myself.
Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)
- You’re never going to feel 100% comfortable. Private practice involves risk and in order to be successful, it takes continuous risk on the part of the owner/therapist. There will always be some form of anxiety around losing money or failing. This changes with time but the sooner you accept it, the better because once you start operating from a place of trust and confidence in yourself rather than attempting to over-control, your practice will thrive sooner.
- Support and referrals from other therapists is invaluable. Getting referrals from your website or places like Zoc Doc is great, but one steady referral source that will usually always provide clients that you want to work with, is referrals from therapists who know you and your niche.
- Join a consultation group. Join a peer consultation/supervision group as soon as possible. The purpose of these groups is to present clients/cases and get feedback on the work you’re doing with your clients. This is the best way to not only garner support in the beginning of your work with clients, but also to feel like you have some structure and added clinical supervision in your work.
- Take time off before you want to. Take a vacation before you want to. You’re likely going to try to talk yourself out if it but it’s really important to prevent burnout proactively and taking time off is an integral part of that.
- You’re going to have to spend money to make money. Like acquainting yourself to risk, you’re going to have to acquaint yourself to spending money — paying for your website, paying to get on referral sites, paying for continued clinical training/supervision, all of these things cost money and are really important in starting a practice.
As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?
I think working on your practice starts the second you decide to go into private practice. Eventually working on the business becomes easier and it can also be a lot of fun! I spend probably just as much time on by business as I do face-face client hours, if not more. Experimenting with what works was really helpful for me, which means learning how to track metrics and measure the growth of your practice.
I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?
Go to therapy. Starting my own therapy — and sticking with it — as well as joining a therapy group was the single most helpful thing for my own mental health in this field. That, and exercise.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?
From Walt Whitman’s poem “ONCE I PASS’D THROUGH A POPULOUS CITY”
Yet now of all that city I remember only a woman I casually met
there who detain’d me for love of me,
Day by day and night by night we were together — all else has
long been forgotten by me,
The quote is often truncated to “We were together, I forget the rest.” I think of this quote often to guide my practice as well as in my personal life. Your connection with your clients is the strongest predictor of their success with you and your success in private practice. Sometimes we need to remind ourselves that most of what we want has to do with being seen and heard by another human being.
How can our readers further follow your work online?
Thank you for these great insights! We wish you continued success and good health!