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Private Practice Pragmatics: Needs

By Ray Wm. Smith, Ed.D.

If you’re interested in a successful private practice, you are probably driven by some legitimate personal and professional needs. In Maslow’s famous hierarchy of needs, he described our basic needs for physical care of our bodies and security or safety, then our psychological needs for belonging and self-esteem, and only after those are satisfied, self-fulfillment needs for self-actualization and achieving our potential. Later in life, Maslow said there was another, higher need for self-transcendence and for serving with all life.
Our clients have many of the same legitimate needs and come for therapy to grow in life from merely surviving to accomplishing something worthwhile in their lives and relationships. They need hope and certainty from their counselors that they can grow and become their best selves.

Hopefully in graduate school we learned enough about the clinical interview and helping relationships to serve clients as their needs are being met. Fewer of us learned about the business of a private practice and how to meet our own needs while helping others meet theirs.

Sadly, there are too many therapists in the news who violate boundaries by using illegitimate means to meet their needs. Virginia Satir taught that we need four hugs per day, but we are not to get that affection from our clients. We also need the opposite, some space, but we need to be available to our clients. We need some influence over our environment and other people, but we are not to use our power in selfish ways or in dual relationships. We also need the opposite, some protection, but we are to be appropriately emotionally present to our clients and vulnerable. We need to enjoy some exciting adventures, but we are not to take risks with clients that could potentially harm them. We also need the opposite, some peace, but we are not to abandon clients or withhold ourselves during their time of crises.

Part of your supervision, self-reflection, and personal therapy should be to identify your legitimate needs and the legitimate means to fulfill them. A solo private practice can be lonely and emptying, so counselors have to be conscientious with self-care, ethical boundaries, and constant consultation.

We cannot help as humans but to be a little needy, and, in client-centered therapy, there may be disclosures that are designed to build the therapeutic alliance appropriately. In The Wounded Healer, Henri Nouwen suggested people cannot be led from the wilderness by someone who has never been there, which is why a lot of recovery work is led by people in their own recovery.

What do you need (or want) from and through your private practice?

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