Episode #764: When You're the Only Clinician in the Building

Summary

Abundant Practice Podcast

Episode #764: When You're the Only Clinician in the Building
Host: Allison Puryear
Guest: Rebecca Smith
Date: June 6, 2026

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Episode Overview

This episode addresses the emotional and practical challenges therapists face when transitioning from an agency setting—where team support is readily available—to private practice, where they may find themselves the sole clinician in the building. Allison and Rebecca discuss building clinical confidence, distinguishing between the need for professional consultation and the need for camaraderie, and actionable strategies to ensure solo practitioners feel supported both clinically and socially.

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Key Discussion Points and Insights

1. The Emotional Realities of Solo Private Practice

• Listener Question: A therapist transitioning from agency work to private practice expresses concerns about missing the ability to “knock on someone's door” for support and wonders how to build confidence when alone ([00:49]–[01:17]).
• Rebecca's Insight: The need might be less about clinical inadequacy and more about missing having someone to talk to:

  “How much of this is clinical competence and how much of this is I need a buddy, I need somebody... like, I want to talk to somebody who's not my client.” —Rebecca Smith ([02:32])

2. Clinical Readiness vs. Social Connection

• Allison and Rebecca highlight:
  • Therapists with years of agency experience are usually clinically competent; the real challenge can be emotional isolation.
  • Private practice typically involves a less acute client population, depending on one’s chosen niche ([03:26]–[04:08]).
  • The act of making all decisions alone can be daunting, even when clinical skills are strong.
• Notable Quote:

  “You can build all the good things you had. It just takes more intention. Right. You can still consult with people, you still know people.” —Rebecca Smith ([04:19])

3. Proactive Strategies for Support and Connection

• Intentional Community Building:

  • Creating intentional clinical consultation groups with previous colleagues, even across state lines, using HIPAA-compliant technology ([05:14]).
  • Socializing outside of work—dinners, coffee with friends, forming monthly routines to stave off isolation ([06:11]).
  • Making a conscious effort to separate getting social needs met from the professional environment.

• Allison’s Experience:

  “I had two friends that I had worked with in my previous job that... just do our own consultation group. We were in three different states... we would talk through cases. And that was really helpful.” ([05:14])

  “A solo practice doesn’t really yield that for you outside of your clients. So, making sure that you were still getting your social needs met...” ([05:34])

• Rebecca's Experience:

  “Liz and I, after we both got out, dusted off and realized we were free, we set up a monthly dinner every single month. I called it Biz with Liz. And it was a write-off. Thank you to our shared tax guy.” ([06:11])

4. Reframing the Fear of Being Alone Clinically

• Challenge the Narrative:

  • Allison and Rebecca encourage listeners to question whether the anxiety is truly about clinical inadequacy or more about missing social interaction.

• Notable Quote:

  “We think you’re wrong about your clinical.” —Rebecca Smith ([07:10]) “I did miss being able to pop into, you know, somebody’s office just to shoot the shit. Not even to talk about a hard clinical case... but just to be like, what'd you do this weekend?” —Allison Puryear ([07:14])

• Maintaining Perspective:

  • Many aspects are under your control, including how you build your support network and set up your practice.

5. Practical Tools for Listeners

• Free Worksheet:
  • The episode offers a worksheet: “Eight factors to help you remember what you have control over and what you don’t,” designed to empower therapists making the transition to private practice ([07:43]).

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Timestamps for Important Segments

• 00:49 – Listener's question about loneliness and clinical confidence in private practice.
• 02:32 – Rebecca dissects the difference between needing “clinical competence” vs. needing a “buddy.”
• 03:26 – Allison on differences in client acuity between agency and private practice; calming clinical nerves.
• 04:19 – Discussion of proactivity and intentionality in building new support systems.
• 05:14 – Allison’s approach to maintaining professional consultation post-agency.
• 06:11 – Rebecca’s personal ritual for ongoing connection and support.
• 07:10 – 07:14 – Direct discussion challenging perceived vs. actual clinical need.
• 07:43 – Mention of the free worksheet and its focus.

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Notable Quotes & Memorable Moments

• “You can build all the good things you had. It just takes more intention.” —Rebecca Smith ([04:19])
• “A solo practice doesn’t really yield that for you outside of your clients... So making sure that you were still getting your social needs met.” —Allison Puryear ([05:34])
• “Liz and I, after we both got out, dusted off and realized we were free, we set up a monthly dinner every single month. I called it Biz with Liz.” —Rebecca Smith ([06:11])
• “We think you’re wrong about your clinical.” —Rebecca Smith ([07:10])
• “I did miss being able to pop into, you know, somebody’s office just to shoot the shit... But just to be like, what'd you do this weekend?” —Allison Puryear ([07:14])

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Actionable Takeaways

• Take initiative to create your new professional and social support systems—don't wait for them to form organically.
• Use technology and intentional scheduling to maintain clinical consultation groups and friendships.
• Reflect on your needs: Is it really clinical support you lack, or is it connection?
• Remember that autonomy brings freedom as well as challenges—be proactive in meeting them.
• Utilize available resources, such as the episode’s worksheet, to maintain perspective and feel empowered.

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Conclusion

Allison and Rebecca reassure therapists that feeling isolated in solo practice is common, but with awareness and proactive steps, you can recreate the support and camaraderie you need in new, intentional ways. Clinical confidence isn’t likely the real issue for seasoned practitioners—the need for connection and friendship outside client work often is. Their warm, candid conversation highlights practical solutions and the importance of seeking both professional consultation and authentic community as you grow your private practice.

Transcript

[A]

Foreign. Welcome to Ask Abundance. Y' all ask the questions about having a fun and thriving practice. We answer them. We have a worksheet for you today so you can bring this answer into your life. If you want support in your practice, we have you covered with on demand or one on one support. Links for the worksheet and support are in the show. Notes can't get enough Ask Abundance. Check out our YouTube channel for the entire library. Hello.

[B]

Hello.

[A]

So welcome back to Ask Abundance. Today I'm joined by Rebecca Smith. Rebecca's a limitless practice grad who came aboard Team Abundance. She has a premium fee private pay practice in New Orleans and she's great at helping Abundance therapists imagine what's possible for them. She's going to tell us today's question.

[B]

Yes, I am. This question says I'm making the move to private practice after years of working in agency settings where I could knock on someone's door if a session got complicated or I needed a second opinion. Logistically, I feel prepared, but emotionally I'm realizing how much I relied on having a team around me even when I didn't think I was. How do you build clinical confidence when you're suddenly the only person in the building?

[A]

This is so real.

[B]

Yeah.

[A]

So before we get into it, I do want to thank our sponsor, TherapyNotes. I've talked about them for years, know their features by heart, but what really sets them apart is that they genuinely care about your experience. It's not just troubleshooting stuff. They actively implement user suggested features like Therapy search, secure Messaging, and their AI notes feature. Therapy fuel. Everyone at TherapyNotes believes in the product and wants you to love it too. Plus, they're independently owned, which means no venture capital, no pressure to prioritize investors over customers. And this independence allows them to keep their prices fair to to focus on innovation and to prioritize customer experience. With over 100,000 therapists already on board, they've proven that you don't have to compromise success for quality. If you're ready to see for yourself, you can try TherapyNotes free for two months with code [e-mail] all right, so all of a sudden I'm out on my own clinically piece is very real and I'm glad this person brought it up because it's not something that most of us anticipate when we're starting our practice. What do you remember from this phase for yourself? Do you remember what you did to kind of get the, the support you needed or just the confidence you needed?

[B]

Yeah, you know I think that the interesting thing is this, this therapist says that they've worked in agency settings for years. And so that whole. The thing that I was kind of trying to pick apart in this question is how much of this is clinical competence and how much of this is I need a buddy, I need somebody. It's like when, when your kids are little and you want to talk to a grownup, like, if you're like, I want to talk to somebody who's not my client, like. Yeah. And so I think that this person has been in practice for years. They actually know, I feel like clinically, I bet they actually really know what they're doing.

[A]

Yeah, yeah.

[B]

But emotionally realizing that you rely on a team might be clinical, but it might also just be like letting off steam and like having friends and still seeing people. I'm curious how much it's about that too.

[A]

Yeah, I wondered too, the difference in population between working at an agency versus private practice. The acuity of my clients in private practice, it was like a different ballgame than some of the agencies I worked in. So it might be that you're imagining a much more high acuity client population then you're actually going to be bringing in or attracting in your private practice. It depends on your niche. Maybe you love high acuity and that's who you're wanting to bring in, but if not, it's not something that you have to, you know, you might not. I think this person thinks they need training wheels and they probably don't. Yeah. So kind of what you were saying.

[B]

Well, and honestly, where they might need training wheels or support or something is just in the process of making all the decisions themselves.

[A]

Yeah.

[B]

You can build all the good things you had. It just takes more intention. Right. You can still, you can still consult with people, you still know people. You can still grab coffee with a friend. It might take more effort because you might need to like, get out of your office and your own private practice office and go down to Starbucks. But figuring out what, like, needing what you need is still fine. It's just you have to get it a different way, I think.

[A]

Yeah.

[B]

And you're right. You like, you totally get to pick who you're seeing. You get to pick your niche, you get to pick what this practice looks like. And while that is really wonderful and freeing and maybe I don't need as much clinical consultation or whatever, that's also a little bit scary. Scary, like you have to build it from scratch and getting some friends support in that area might be really helpful.

[A]

Yeah, I know, I had two friends that I had worked with in my previous job that we were like, let's just. They ended up going into private practice too, at different times. So we were like, let's just do our own consultation group. We were in three different states and we just, like, would hop on a HIPAA compliant zoom that one of us had and we would talk through cases. And that was really helpful when we did have something we felt stumped on clinically. And for the rest of it, you and I were just talking about this. We're both extroverts and we need people. And a solo practice doesn't really yield that for you outside of your clients. So making sure that you were still getting your social needs met. Because I think that's the thing about adulthood is a lot of us will get our social needs met at work. Yeah. And so I would love for you to invest in your life and your people in your life and reform friendships or make new friends or something like that so that your social needs are met. Yeah.

[B]

And to answer your question, Allison, about what I did, that is part of what I did. I got out of my group practice, like, sayonara. That was terrible. And then right on my heels, one of my good friends did, too. And shout out to Liz. Liz and I, after we both got out, dusted off and realized we were free, we set up a monthly dinner every single month. I called it Biz with Liz. And it was a write off. Thank you to our shared tax guy. Yes, you get to still have this, but you get to have it in a different way. You get to go to dinner. You get to still connect with people, and it's okay that it's not happening. You are the only person in the building.

[A]

Right? Yeah. So I think you're right. Like, it just takes a different level of intention. And I think it's being clear about what you need, too. Is it really clinical? This person seems convinced that it's clinical support that they might need. But you and I don't feel very confident.

[B]

We're sorry. Yeah, we think you're wrong about your clinical.

[A]

You could be right. You could not be great clinically. That could be true. But you've been doing this for a long time, and I think we both always want to give the benefit of the doubt clinically to everybody. But I think that there is this sense of it is lonelier. It just is. I did miss being able to pop into, you know, somebody's office just to shoot the shit. Not even to talk about a hard clinical case, but just to be like, what'd you do this weekend? So, yeah. Okay, great. So today we've got a free worksheet for you. As usual, it's eight factors to help you remember what you have control over and what you don't. Because I think that there are maybe some things that you have control over that you're not factoring into this equation that will make you feel better. So awesome. All right, we will catch you next week.

[B]

See you later.

[A]

If you're ready for a much easier practice, TherapyNotes is the way to go. Go to therapynotes.com and use the promo code abundant for two months free. I hope that helped. Please get in touch with any of your questions for Ask Abundance. If you're Listen, you probably need some support building your practice. If you're a super newbie, grab our free checklist using the link in the show notes. I'd love for you to follow rate and review, but I really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.