Public or private therapy?

When therapists in their Clinical Fellowship Year (CFY) ask whether they should work privately or for a district, my advice depends on their personal situation. There are several factors to consider when making this decision. For instance, many therapists need the benefits and stability that come with working for a district, such as insurance coverage or the ability to support a family. During my early years, when I had a family to support, I chose to work as a district employee, where I gained experience and worked with a variety of caseloads. I embraced every task given to me, which helped me build a strong foundation.

Over time, I realized I could create innovative programs within the district. For example, I worked with preschoolers who had articulation delays, many of whom no longer needed special education services, while others transitioned to special education due to other conditions like autism and developmental delays. If you're someone who enjoys creating and expanding services like I did, district work can be a great place to start.

However, private practice has its advantages and challenges. It offers flexibility since you typically work with one client at a time, but it does not provide a steady income. Clients can choose to stop therapy or may not be able to afford it anymore. While private therapy is rewarding, it's not always reliable, and it may be best suited as a side job or part-time work.

When I first started seeing private clients, I continued working full time in the district (8:00 AM to 3:00 PM), and then I took on private clients in the afternoons. I realized that managing both became overwhelming, especially with a family. I set a goal: I would give private practice a year. If I succeeded and felt it was sustainable, I would leave the district. If not, I would reduce my private practice and remain in the district. Over time, I built my private practice enough to leave the district and eventually opened my own clinic, which I ran for 10 years.

Ultimately, it's about choosing the path that works best for you. I recommend starting your career by working for someone else, where you can gain experience and receive mentorship. I am open to mentoring anyone who needs guidance, as experience is key to growth. Having worked in this field for over 40 years, I can confidently say that there is always something new to learn. Don’t assume that once you gain experience, there’s nothing more to learn. The field is always evolving, and it's crucial to continue acquiring new skills and perspectives.

I also encourage therapists to work with children in early intervention (ages 0–3), preschool (ages 3–5), and in the school system. The experience in schools is particularly valuable because it exposes you to a wide range of disabilities and challenges. It also helps you develop the skill of working with teachers and other adults who support the child's development. It's important to build relationships with these adults, as they will be essential to your success. If teachers see that you're genuinely making progress, they’ll support you more effectively.

In terms of collaboration, it’s best to avoid giving direct commands to teachers. Instead, suggest strategies or share what’s working well for you. For example, you can say, “I’ve been doing this, and it seems to be working. Would you like me to share the materials or a video of how I’m using it?” Teachers appreciate being involved in the process and feel more connected when they can replicate strategies themselves.

Lastly, remember to respect confidentiality. Videos or materials you share with teachers should not be sent outside the school, and always ensure that you have parental consent before sharing any videos or materials.