How You Can Take Maternity Leave in Private Practice

I'm a mother of two very young children. Many colleagues tried to convince me that I wouldn't be able to spend time with my babies and maintain my practice. I wanted to prove them wrong.

First, I'd like to emphasize that it's 100% possible to take time off from your private practice while caring for your baby. That said, you'll need to have a solid plan for telling clients, navigating pregnancy, and preparing for your upcoming leave.

There aren't a lot of resources on this topic. Many therapists worry that they can't take a few months off without extreme financial hardship or without losing their practice. Here is my extensive guide!

Start Prepping Early

Congrats! You're pregnant!

But now what? How do you balance everything in your personal life when it comes to managing your business and navigating all these new changes?

Prepping early means thinking ahead about what you want. Of course, there's nothing like a brand new baby to throw a wrench in your plans, but you should still have some loose guidelines for how you want to maintain your private practice.

If you have a partner, I recommend having these conversations as soon as possible. That can mean before getting pregnant, but it can also mean as soon as you're in your first trimester. Your due date may seem like forever away right now, but it will be here before you know it.

Consider Supplemental Disability Insurance (Before You're Pregnant)

As a private practice owner, you can enroll to purchase elective disability insurance.

These plans can be expensive, but they essentially offer subsidized maternity leave. At the very least, it's worth looking into these options if you plan on trying to conceive soon.

Please note that you cannot qualify for these plans if you are already pregnant. They will require testing and records. They may also require that your business is structured in a particular way.

Some companies to start with are Colonial Life, Aflac, Mutual of Omaha, and Northwestern Mutual.

If you are in a state that offers short-term disability and/or paid maternity leave, you may be eligible to receive benefits IF you pay into them (i.e., your company issues you a paycheck). This will typically only apply if you have an S-Corp or similarly-structured business.

Get a Grip On Your Financial Plan

Budgeting is so important. If you plan to go on maternity leave, you need to ensure your family can afford the costs.

Get a Birds-Eye View On Everything

I cannot emphasize this enough! Even if the numbers scare you, even if your money situation is a mess, even if you really don't want to know, you need to know how your cash is or isn't flowing.

And I don't just mean for your private practice. I mean for every dollar your household earns or spends. Because it's all connected.

I use Personal Capital to track all of this. It's free. It syncs with almost every type of account (savings, checking, credit card, investments, mortgage), and it allows you to create categories for both income and expenses.

The other big contenders out there are Mint and You Need a Budget. You can also make your own spreadsheet if that interests you!

Review Your Medical Costs

I highly recommend familiarizing yourself with any anticipated costs during your pregnancy. We all know that navigating health insurance is challenging, but you should have a basic ballpark for how much certain visits, testing, lab work, and labor and delivery will cost you.

If you were thinking about switching insurance plans, pregnancy is not considered a qualifying life event. Birth, however, is.

Determine What Income May Still Be Coming In

Is your private practice your sole source of income? If not, you may still be earning income elsewhere.

If you have a partner, will they still be working? Does their employer (if applicable), offer any sort of paid maternity/paternity leave? How long (if applicable) do they intend to take off from work after the baby is born?

Beef Up Your Emergency Savings

Having a cash buffer during this time can provide you with invaluable peace of mind. Most financial experts recommend having 3-6 months of savings on hand.

However, only you can really decide what that number is. This is why having a budget is so important. If you don't know how much your household is earning and spending each month, you have no way of knowing how long of leave you can realistically take (or how much cash you should have on hand).

When Should You Tell Clients That You're Pregnant?

This is such a personal question, and there isn't a one-size-fits-all answer that will apply to every therapist. Instead, you need to consider your own well-being when it comes to telling clients about your pregnancy.

I didn't experience too much morning sickness during my first pregnancy. I was able to work without significant discomfort. I told most clients around the 4-5 month mark, just when I began showing more obviously.

My second pregnancy was different. The morning sickness during my first trimester was unreal! However, I had transitioned into my fully virtual practice. So, clients couldn't visibly see all my body changes. That said, I still told them around the 4-5 month mark.

I recommend thinking about your communication plan well in advance. You may indeed want to break the news to certain clients earlier than others. I found that my long-term clients had more reactions to my pregnancy than newer or short-term ones. This isn't always the case, but it's how the dots connected for me.

Once I told clients, I found that I felt less anxious about everything! There's something to be said about just breaking the news and seeing how it unfolds.

Finally, I advise against waiting too long. Some therapy clients will simply notice your bodily changes or recognize that you appear tired or sick. By being assertive with how you communicate, you model honesty and humanness in the therapy room.

The main takeaway here? There isn't a perfect communication plan. This applies to both existing and new clients. There does, however, need to be a plan. The more you can concretize it for yourself, the smoother the transition will likely be.

When Should You Stop Taking New Clients?

I also get asked this question all the time. When is it unethical or even just unwise to take more therapy clients? And do you tell clients about your parental leave plans right from the start?

I'll tell you what I did: I stopped taking on new private practice clients around six months, right at the end of my second trimester. When potential clients contacted me for services just before that time, I made it very clear that I was going on maternity leave in about two months. They had the choice to decide if they wanted to work with me (while knowing it would be short-term).

Every therapist will have their own approach to handling this, and you may not know what you want to do until you reach that point. Some therapists take it week by week- that's also okay.

Of course, if you have a full caseload, you may simply decide it isn't worth altering your schedule right now only to change it in a few months. You might even decide to start scaling down as soon as your first or second trimester.

How Do You Decide Your Return Date?

Unlike in a traditional work setting, you won't have a boss or HR representative clarifying your return date. You also won't have the automatic support of coworkers to take over your caseload. It's up to you to choose when you start seeing clients again.

Here are a few options.

Decide a Firm Date to Return

Some therapists work best with this direct approach. You basically choose the day you commit to going back to work, and you give clients that date.

Pros: It can be easier to plan work (and childcare) if you know exactly when you intend to return to work. It can also be relieving for clients. They may be more inclined to stay on with you if they know you're coming right back for them.

Cons: Babies are unpredictable. Hormones are unpredictable. Life is unpredictable. What sounds good in your third trimester may not compute after the baby is here. You may decide that the date no longer works. You or your baby may have health concerns that need more addressing. Having a firm deadline may create stress, and if you change it, clients may feel frustrated.

Decide a Firm Date to Update Clients About Your Status

This is what I did, and it worked really well for me. Essentially, I told clients I would "get back to them" about my plans on a specified date. Then, when that date arrived, I told them my tentative schedule for returning.

Pros: It offers you more flexibility with your business and less pressure to choose your plans before the baby is even here. It gives clients autonomy in deciding whether they want to wait to see you or see someone else.

Cons: Clients may find this method vague, and they will simply opt-out of continuing to see you. Or, they'll agree to wait, only to find another therapist, which may reduce your caseload when you return to work.

Refer Out

You may need to refer some or all clients to your referral network. This is especially pertinent if you have clients with high-risk needs. But it's also ethically appropriate to offer these referrals if you will not be available for contact during your leave.

Pros: You have maximum flexibility when it comes to returning to work. You may feel more comforted knowing your clients are in someone else's hands. This option can be great if you intend to stay at home for an extended time- or if you want to cut your work hours significantly.

Cons: You may decide that stay-at-home life isn't for you. Or, you might want to shorten your parental leave. But if the majority of your existing clients are working with other therapists, it can be jarring once you want to get back into the swing of things. You may need to network and market yourself again to get your caseload up to where you want it to be.

Keep Seeing Some Clients

Maternity leave doesn't necessarily need to be an all-or-nothing limit when it comes to your private practice. Some therapists choose to still meet with a very small, manageable number of clients after their baby is born. This may be a helpful option if you see certain clients just once or twice a month- or if you simply need ongoing money during this time.

Pros: You keep your "toes in the water," meaning that you are still maintaining your therapy practice. You have the chance to earn some supplementary income during this time. Clients may be grateful you're still able to see them. You can enjoy the balance of working while also caring for your newborn.

Cons: Being a new parent is exhausting and life-changing, and you may feel overwhelmed by the prospects of any work right now. Babies, as I've mentioned, can be unpredictable, and this can affect how you feel about your practice. You may resent having to work. You might also be distracted and find focusing on client issues challenging right now.

Advice For Telling Your Clients That You're Pregnant

Whether you have a physical or virtual practice, you can't avoid the elephant in the room forever!

With my firstborn, I felt nervous telling clients about my being pregnant. I anticipated some clients would feel angry or upset. I also anticipated others would be happy but also scared about what would happen to them after I stopped working. I also worried about how my leave might affect my business.

Here's the thing: we can't accurately predict how our clients will react. A few clients may seem to have no real response whatsoever. Others may be crushed by the news.

Commit to When You're Going to Do It

I found it helpful to commit to a specific week to tell existing clients that I was pregnant. When I had my firstborn, I was working in both an agency and private practice. That meant telling several clients all in one week.

I won't sugarcoat it: it was stressful and heavy. But it was also relieving to just get the news out there.

Once you know you're taking some parental leave (and have an idea of how long it will be), it makes it easier to share these plans with clients.

Validate All The Feelings

Therapy clients can experience immense transference toward their pregnant therapists. From feeling abandoned to wishing you were their mother to imagining you having sex to conceive the baby, there is a lot that comes into this dynamic.

Some clients will be open with their feelings. Others will be far more guarded about their mental health. But it's still important to maintain an open dialogue about the pregnancy.

No matter your orientation- and whether you work with eating disorders or depression or divorcing couples- you should still anticipate some complex feelings arising in your practice.

Anticipate Slips and Regressions

Strong reactions don't just happen right after you tell clients you're pregnant. They keep unfolding as the weeks progress.

And as clients observe you getting closer to their due date, they may start acting differently. This is where relapses, withdrawal, and anxiety symptoms often emerge.

How you intervene with these experiences largely depends on your theoretical orientation and style of work. But my best advice is this: don't ignore it. Don't pretend it isn't happening. Model being courageous enough to talk about what you observe.

Decide What You Want to Disclose to Therapy Clients

Around the third trimester, clients may ask you lots of questions about your pregnancy. Are you having a boy or girl? What names are you thinking? Have you been throwing up a lot? What hospital will you be delivering at?

They may also want to give you tips, especially if they are parents. Some of these conversations are part of friendly banter. Other questions may be more indicative of transference reactions. You can generally tell the difference based on your rapport with the client.

However, I recommend thinking about what you want to share well in advance. There's no right or wrong answer here (and it will often vary based on the client). Therapists need to decide what's appropriate for them to divulge.

As for me, for most clients, I did reveal the sex of my firstborn (we didn't find out the sex in advance for my second). I did not share names. I was minimal about my symptoms when clients asked. I did not share any details about hospitals or labor.

Checklist For Existing and New Clients Before Your Due Date

Have you updated your professional will?

Have you reminded existing clients about your last day of work?

Have you set boundaries about communication during your maternity leave?

Have you updated your email/voicemail to reflect that you are out of the office?

Do you have a plan for how you will handle emergency phone calls?

Have you discharged clients with a relevant discharge summary?

Have you submitted all necessary insurance claims?

If you are in a group practice, have you reminded your colleagues and bosses?

If you are in a solo private practice, have you ensured all your confidential information is safe?

Have you updated any treatment plans that need updating?

Are you telling potential clients that you are on leave- or are you eliminating contact through your private practice entirely right now?

The Baby Is Here! Now What?

Whether labor was smooth or tumultuous, your bundle of joy has arrived! Even though you're a therapist who logically knows about prioritizing support, rest, and good coping skills, it can be difficult to put those priorities into practice with a screaming newborn!

Those first few weeks can be insane, and they may challenge everything you ever thought you knew about yourself. Here's what helped me.

Self-Care Still Matters

It's cliched, but it's true. Just like you would tell any client to take care of themselves during this time, you need to apply that advice to yourself. Pregnancy is rough, and giving birth is unlike anything else. Furthermore, having a baby is a total game-changer, and you ideally want to spend time being fully present with your new family.

For me, self-care included lots of reading (often when the baby was sleeping or nursing), taking walks (often with the baby strapped onto me), and spending time with loved ones.

They say that a day will often move slowly, but a week will move fast- I have found this to be very true. Even though it can be hard to maintain a schedule, grounding yourself with some semblance of a routine can be helpful at this point.

Tap Into Your Support System

Seriously. Postpartum is gnarly!

I also recommend connecting with other therapist parents during this time! Parental leave can be lonely, and it helps to have a team of other therapist friends who "get it."

Additional Resources/Recommendations That Helped Me

In this section, I'll go through some of the items that were helpful for me. Keep in mind that everyone from your mother to your doctor to your Starbucks barista will want to dish out good advice and well-intentioned tips when it comes to your pregnancy.

Take everything with a large grain of salt- what works for one therapist (or even one person) may not have the same positive impact on you.

Books

And Baby Makes Three: Even though my husband and I are both therapists, we did NOT anticipate how much having a child would impact our relationship. We definitely struggled during that first year. This book is BLUNT, but it's also validating and helpful- it's similar to other Gottman books, but it has some very applicable reminders for expecting and new parents!

What to Expect the First Year: It's a classic, and your mother probably read it back in her day! Basically, it's a really good reference guide for all those anxieties you face as a first-time parent!

The Whole-Brain Child: I love Dan Siegel, and understanding the neuroscience of children and attachment has helped me be a better parent (and therapist).

Postpartum and Baby Supplies

ErgoBaby360: We have gotten so much mileage from this one item. My firstborn never napped in the crib/bassinet, so we did a LOT of babywearing that first year. My second also loves the carrier. The structured lumbar support reduces back and neck strain. I never trusted myself to do those other wraps!

Haakka Breast Pump: I have MULTIPLES of these! I MUCH prefer this manual pump over the two electric ones I've owned. I use it on one side while the baby feeds on the other side. It helped me build a freezer stash and avoid electric pumping. Results may vary based on your supply and letdown.

Boudreaux's Butt Paste: I don't know how the magic works, but it literally clears up the worst of diaper rashes almost automatically. I will be a customer for life.

Pack' n Play w/ bassinet insert: Used this for both babies for safe infant sleep! You can drop the bassinet to the ground when your little one is big enough. It can then be used as a play yard or another crib.

General Life/Organization/Management

Asana: I use Asana to manage everything for work/personal/life! Free!

OurGroceries App: We've used this forever to merge shopping lists. It syncs with your and your partner's or your family's smartphones. Free!

Professional house cleaning: I never outsourced this task until my maternity leave. It's undoubtedly one of the best investments I've ever made for my mental health. My family and I would probably get rid of A LOT OF THINGS before getting rid of this.

Final Thoughts

Private practice therapists, social workers, and other mental health professionals have unique considerations when it comes to going on maternity leave. Figuring all this out can be overwhelming (and even discouraging), but it shouldn't surprise you.

Having your own private practice requires maintaining due diligence. This work starts before you begin your leave, and it continues as you progress through your pregnancy.

Likewise, as a small business owner, you are responsible for managing your workload and time off. Preparing for parental leave in advance can give you the flexibility you need for taking care of yourself- and your growing family.

Best wishes!