Kristin Trick, MA, LPC-S, RPT is a therapist in private practice and specializes in the treatment of post-traumatic stress and anxiety disorders. She has worked in the psychiatric hospital, non-profit agency, and private practice settings over the past 10 years.

This is the second installment of The Ethical Private Practitioner" series. Part 1 covers the foundational role of ethical codes and the weight of mandated reporting through a real-world clinical lens.

After I transitioned into private practice, I felt the heaviness of clinical autonomy. I no longer had a supervisor to consult or decades-old policies to which I could defer. It seemed I was on my own in figuring out the “right thing” to do.

Today, years of practice have taught me to keep a list of key players in mind as I navigate ethical choices. First and foremost is the client's wellbeing and the duty to protect them from harm. Next is my practice's reputation and financial standing. Finally, I consider the impact of my actions on third parties, such as insurance companies and state boards.

In this guide, I lay out a practical framework for navigating these moments of private practice management ethics — real-world ethical dilemmas, thoughtful options for action, and concrete ways to embed ethical decision-making into both your clinical work and business operations.

In a solo practice, you often have to make high-stakes decisions in real time. Anticipating these scenarios allows you to respond with confidence rather than reacting out of stress. Consider how you would handle the following:

When navigating private practice management ethics, there's rarely one clear solution for every ethical problem; the answer in most situations is, “it depends.” Your response will depend on the client's clinical needs, your practice's financial runway, and your specific state laws.

Here’s a sampling of ethical considerations you could apply to the scenarios above.

Clear intake paperwork is your best defense. My intake paperwork defines a “no-show” as 15 minutes late, and in such cases I charge my no-show fee to the card the client has left on file. If a client arrives after the 15-minute mark, I enforce my policy and suggest we set a new appointment time.

However, you can offer flexibility: waive the fee if they can make any of the remaining openings you have for that week, or see a low-risk, self-pay client for the remaining time while still charging the full session rate.

Legally, you must generally be licensed where the client is physically located at the time of service. If a client moves, explain the rules about state licensure boundaries, use their remaining sessions to prepare for the transition, and provide 3 qualified referrals in their new state. If you wish to keep them, research their new location's temporary practice allowances or even an additional state license.

Don't let a backlog become a crisis for your business. Investigate any unpaid claim after 14 days and update clients about their insurance payments so they’re aware if sessions aren’t being paid in full.

Your informed consent should note that you may pause or terminate treatment if you don't receive payment. You can ask clients to contact their insurer to advocate for the claim, or set a deadline by which a portion of their claims need to be paid before they can set new appointments.

Upholding strong private practice management ethics in your clinical work should extend into your business operations. The care with which you treat clients in the therapy room should parallel the way you interact with them outside of it.

 A 2023 study from the U.S. Department of Education found that 54% of American adults read at or below a sixth-grade level. Keep this in mind as you compose intake paperwork, explain diagnoses, and update treatment plans, ensuring that your clients understand this information.

Research consistently shows that the relationship between counselor and client is the highest predictor of therapeutic progress. If you tell a client you’ll do something on their behalf, do it. Whether it’s calling their insurance company, completing forms, or faxing records, show that you’re trustworthy in upholding these commitments. 

Privacy breaches often happen in the lobby, not the session room. A client's health information can be overheard or noticed by other clients who are waiting to be seen or scheduled.

Arrange furniture and devices so that computer screens and calendars aren't visible to waiting clients. Use white noise machines to muffle conversations held by administrative staff.

Being an ethical practitioner isn’t a box we check off and then forget about. It’s a professional lifestyle we develop and maintain through our daily choices.

As you navigate the new year, take stock of your clinical and entrepreneurial habits. Identifying areas for improvement now will protect both your clients and your business in the long run.