Finding Your Niche: Amy Graham on Building a Private Practice Around Speech Sound Disorders
"I have so much respect for SLPs in the schools because I don't know how you do it. It's stressful as it is with just speech sound disorders."
That line from Amy Graham, owner of Graham Speech Therapy, lands differently when you understand the path behind it. Amy spent years bouncing between school positions, rehab facilities, contract work, and other clinicians' caseloads before narrowing her entire private practice to one thing: speech sound disorders. Not speech and language broadly. Not pediatrics generally. One subspecialty, pursued with the kind of depth most clinicians never have the runway to develop.
Her story on Clinic Chats is a masterclass in how specialization can become both a clinical advantage and a sustainable business model, especially for SLPs who want to build something small, intentional, and entirely their own.
The Long Road to Specialization
Amy's career didn't start with a plan to specialize. After grad school, she wanted to go medical. Acute rehab was where her heart was during externships. But the jobs weren't there in the late 1990s, and a wedding was coming, so she took what was available: a school position down the street.
She's grateful she did. Schools forced her to assess and treat everything that walked through the door, and that broad exposure eventually clarified what she actually loved. Speech sound disorders kept pulling her back.
But she didn't rush the pivot. She worked part-time on-call at a rehab facility. She contracted at other clinicians' practices. She filled in for SLPs on maternity leave, picking up mid-caseload and running assessments for months at a time. Each role added a layer of experience, and each layer pointed her more firmly toward SSDs.
"It took me a while to go ahead and just make that my specialty and the one and only thing that I treat," she says. That patience, the willingness to let a career marinate before committing, is something worth sitting with.
Building a Practice That Fits Your Life
When Amy started having children about fifteen years ago, she stepped away from all of her jobs. She kept her credentials and state licensure current, but she wasn't actively seeking clients. They found her anyway.
Families in her community knew she was an SLP. Parents would reach out about kids who didn't qualify for school services because it was "just a lisp" or a single sound error that wasn't impacting academics. Informally, one or two clients at a time, a private practice took shape around the families who needed her most.
For roughly ten years, Amy maintained this low-key rhythm. She wasn't the breadwinner, which gave her something invaluable: time. Time to take CEUs specific to her clients. Time to read the research. Time to go deep on assessment techniques and treatment methods without the pressure of a full caseload demanding breadth.
When her youngest started full-time school, Amy made it official. LLC. Website. Graham Speech Therapy. She converted the main-level office of her home into a therapy room with French doors, and she hasn't looked back.
Today she runs about twenty sessions a week, primarily 30- to 45-minute blocks, two and a half days of direct client time. The other two days are dedicated to the work clients rarely see: report writing, quarterly taxes, certification renewals, and all the administrative tasks that come with being a sole practitioner.
Private Pay, Instagram, and the Power of a Niche
Amy is private pay only, and she's made it work by building something most SLPs overlook: a reputation so specific that families seek her out rather than the other way around.
Her Instagram following, which grew large enough to catch the attention of the Clinic Chats team, started as a straightforward SEO play. She wanted to show up in Google searches so self-referred families could find her. But the audience that actually showed up was other SLPs, hungry for the kind of clinical knowledge Amy was sharing.
"I began to get all these messages from other SLPs saying, 'I've never heard of this. I didn't learn this in grad school,'" she recalls. The tipping point was therapy videos. She started recording sessions, with parent permission, and posting clips that showed what evidence-based treatment for phonological disorders actually looks like in real time.
"People really wanted to see examples of how to put all these things that we know on a meta level into a therapy session. Like, I know these are evidence-based treatments for phonology, but what does that look like?"
That question, the gap between knowing a method exists and knowing how to implement it, turned out to be enormous. Amy's willingness to show her clinical process openly created a following that now generates both referrals and a secondary income stream through consulting. SLPs pay her hourly rate for 15- to 30-minute collaboration sessions via FaceTime, walking through specific cases and getting targeted guidance.
Why Assessment Tools Matter More Than You Think
Amy's best-selling product is an oral facial exam, a structured checklist-style assessment she originally built for herself because she needed something practical and interpretable.
The gap she identified is one most speech therapy clinicians will recognize: graduate programs teach you that you should do an oral facial exam as part of an SSD assessment, but they often don't teach you how to interpret the results or what to do with what you find. Amy's tool includes additional pages explaining how to interpret findings, when to refer to another specialist, and how specific observations connect to differential diagnosis.
She's since developed a case history form built on the same principle. A child with a lisp might present identically on the surface, but the underlying cause could be developmental, motoric, or myofunctional, and each demands a different treatment approach. Her case history pulls in red flags for childhood apraxia of speech, feeding and eating history, and sleep patterns that might indicate myofunctional issues.
"There are so many red flags that we can get from parents that can kind of clue us in," Amy says. Good documentation starts before the first session, and the right questions up front can change the entire treatment trajectory.
What SLPs Starting Out Should Know
Amy's advice for anyone considering private practice is disarmingly simple: make it what you want to make it.
She credits lurking in Facebook groups like SLP Private Practice Beginners for a year or two before launching, absorbing questions and success stories until the idea of going independent stopped feeling impossible. Her husband pushed her toward entrepreneurship for years before she was ready. The regular-paycheck anxiety was real.
What finally made it work was permission, mostly from herself, to build small. No employees. No brick-and-mortar overhead. No insurance billing headaches. Just a converted home office, a focused caseload, and a schedule that respects her family's boundaries.
"I know I definitely lose clients because I don't accept insurance and I don't work after school hours," she says. "But since I'm just a sole practitioner, I had to make that sacrifice."
The tradeoff is sustainability. Four years in, Amy has a practice that fits her life, a growing reputation in her subspecialty, and the clinical depth that only comes from choosing to go narrow instead of wide.
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Transcript
Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant. Our featured sponsor this week is Therapy Marketing Kit, the perfect solution to creating professional marketing materials for your business.
Kadie: Today I have a guest that I'm super excited about named Amy Graham. You might know her if you follow all the speech pathologists that are active on Instagram. Amy is the owner of her own private practice called Graham Speech Therapy, and she specializes in speech sound disorders. Amy, thank you for joining me. How are you doing today?
Amy: I'm doing well. Thanks for having me.
Kadie: I'm excited to hear how you began, not only in private practice, but also how you started to develop your blog and followers. So can you take us back after grad school? Where did you start in the field?
Amy: After graduate school, I actually really wanted to go into the medical setting, into hospitals. I really loved my externships, working in acute rehab. And so I was looking for something in that arena, and it just was not available back in the late 90s, early 2000s. That's been a while ago, so I'm not sure what the job market is now. And I was getting married, so I needed a job to make money fast. So what was available to me was a school position in my local public school that was actually just right down the street from where we were living.
Amy: And so I took that, and I'm so glad I did, because it's kind of shaped why I specialize in speech sound disorders, in working with pediatrics. So that is where I started, and I stayed there for a few years. And the nice thing about schools, and I hope this is even an encouragement to SLPs who feel like maybe they don't necessarily want to go into the schools, but that's where the opportunities are. The nice thing about that is that you are kind of forced, in a way, to assess and treat everything that comes across your desk or your speech room. And so it kind of pushes you outside of your comfort zone, and it can be a little overwhelming because we can't specialize in everything.
Amy: And I think sometimes parents expect that SLPs, we just know everything about all the things within our scope of practice, and we just can't. I mean, we can know a little bit about a lot when you're in the schools. And so it's really hard to specialize. But at the very least, it kind of pushed me to figure out what I did love, because you have to kind of treat it all. And what I did love was speech sound disorders, but it took me a while to go ahead and just make that my specialty and the one and only thing that I treat.
Amy: I worked part-time on call at a rehab facility while I was working in the schools. I've worked for other people's private practices. I have worked as a contractor as well, which was a great experience because I would basically go fill in for SLPs on maternity leave. And so I would kind of have to go into schools for two, three months at a time, fill in, pick up where somebody else left off. At one point, I was doing just assessments, and I loved that. And that's kind of one of the reasons that I developed my oral facial exam that I sell. So yeah, that was kind of where I started anyway, was in the schools, and I'm glad that I did.
Kadie: So it sounds like you dabbled a lot to kind of find exactly what you wanted to do. And like you said, that kind of background in a school, I was the exact same way. Wanted to go medical. No one would hire someone without experience, and then your school background actually can benefit you because you just have to see anybody and everybody, like you said. At what point did you say, I'm going off on my own now?
Amy: Well, it was funny. What happened was I started having babies, and so I decided that I did not want to really work outside of the home. And I had my kids, and that was, oh, 15 and a half years ago. So I actually quit all my jobs that I was doing, and I decided to just take it as it came. And so people around me and in the community knew that I was an SLP, and so I would have people contact me and say, well, could you just see my child for this and that? And they don't qualify for school services because it's just a lisp, or they just have this one sound error, and it's not impacting them academically, but they still need therapy.
Amy: So I got a lot of people actually asking for my services that way. And so really just kind of informally, I kept up all of my credentialing and all of my state licensure so that I could do that, but it was just kind of gradual. That was kind of who sought me out were families that had kids with speech sound disorders who may not have qualified for low-cost services elsewhere. And so I did that for quite a while. Basically for like 10 years on and off, I just had a client here and there.
Amy: The nice thing about that is that I didn't have the pressure of being the breadwinner, so that was a huge blessing so that I could kind of take it easy and just take maybe one or two clients on the side. So I didn't have to work to make ends meet, but I did have the time to investigate and take CEUs specific to my clients. And so that really helped me start to specialize and really have a love and really understand that, even just specializing in speech sound disorders, I can't hardly keep up with the research and the literature and the methods and the assessment techniques and all that.
Amy: I have so much respect for SLPs in the schools because I don't know how you do it. It's stressful as it is with just SSDs. When my youngest child, who is now 11, when she started going to full-time school, that's when I started to get really back into the workforce and I started working part-time at their school just to kind of get my feet wet for working more hours. But then I was still keeping up this private practice on the side and I actually decided to make it official while I was at their school and just go in with a website, make it an LLC, Graham Speech Therapy, and just kind of go for it and just see what happens.
Kadie: That actually reminds me of an awesome way I found for private practice beginners to create their marketing materials quickly and getting their brand known in the community ASAP. Therapy Marketing Kit creates custom marketing materials such as brochures, flyers, postcards, and more that are unique to your business. With professional templates and content written by an SLP, you can skip the exhaustive back and forth part of the design process. Listeners can use code CLINICNOTE and get $20 off any of the kits on Therapy Marketing Kit's website. That's therapymarketingkit.com.
Amy: I just started getting a lot of requests for services for families who needed speech therapy. I got to the point where I had to pick one or the other because two part-time jobs was too much because I did not necessarily want to work full-time at that point. I had to pick one and I had to pick the one that I loved and the one that has my name on it. I started that probably, that's been almost four years ago now. That's how long I've been doing this private practice.
Kadie: Wow. Now, do you have a brick and mortar location or do you still go to families' homes?
Amy: My situation might be a little unusual in that I work out of my home. Yeah, I do. I work out of my house. We converted our main level office into my therapy room. We have French doors off the side and so parents can come in or they can stay outside in the living room. It was kind of like, well, let's see how this goes and we'll just do it in the office and then we'll maybe go to brick and mortar, but honestly, it's been such a wonderful way to do this that at this point, I don't think I plan on expanding and hiring more SLPs and having a brick and mortar. I think I just want to do me and right now that is just working out of my little office here because I don't have the big overhead, so I don't necessarily have to charge maybe as much as other SLPs around and I just love it. It's been great.
Kadie: No, it sounds like the perfect fit and your story is unique, but not unlike too many of us who become a mom and your family comes first and so if it's the perfect balance for your family, then yeah, stick with it. Are you private pay only then?
Amy: I am private pay only. That was another thing that took me a while to figure out if I wanted to stay that way. And if I could even maintain a part-time caseload with private pay. Actually, that's where my Instagram following has kind of helped and the fact that I'm kind of getting more of a name that I specialize in speech sound disorders. So I do have people seeking me out for my expertise. I've created this niche practice that has helped in that I have people seeking me out. So I have been able to maintain a part-time caseload. I have 20-ish sessions a week, which is about all I want to do at this point. And so I haven't found that I have needed to start accepting insurance.
Amy: There are things that you can do though for those SLPs out there if you don't want to have to deal with the headache of insurance. If you can accept credit cards, which I think you should because it just makes it so much easier, almost most of my clientele pay with either credit cards or their health savings account cards. And so if you accept credit cards, you can take those as well. We even have that's how our insurance is set up. We have a health savings account and I pay for my kids' therapies and different medical appointments with that. So that has made it a real convenience for a lot of families too.
Kadie: How do you take that payment, do you use Square?
Amy: I use Square. Yeah, that's what I started out with. I know there are other ways to do that. I just so far it's worked for me and I've been happy with it.
Kadie: So you touched briefly on your Instagram following and of course, that's how I found you because it is quite large. So how did that happen? Did it just kind of take off with some of your blogs and materials that you sell?
Amy: I think it must have. Honestly, the reason I even started this business account, because I have a Facebook page and an Instagram, I won't do Twitter. I'm too old for that. I can't handle it. I do Instagram a lot. When I started to do that, it really was just to kind of see if I could build up my search engine optimization, getting people going to my website so that I would show up on Google searches for families who were searching for speech therapists. Because when you're private pay, most of your clientele is going to be self-referred. And how do most parents find anything? They Google it. And so I knew I needed to show up on a Google search. So that's how it started.
Amy: But then I found out that as far as followings go, I was getting more following from SLPs. And then the more I started posting about what I was doing specific to speech sound disorders, I began to get all these messages from other SLPs saying, "I've never heard of this. I've never done this. I didn't learn this in grad school." Which kind of in a way surprised me because I felt like I must have had a really good SSD course in graduate school because I felt like I got all the basics that I really needed to get me going in grad school, but it sounds like a lot of SLPs have not.
Amy: And so I just found that sharing particular aspects of assessments that we might be missing or treatment methods that other SLPs aren't trying that are really evidence-based, if I started posting on that, I just got more and more of a following. And then some of the other influencers in our little corner of Instagram started sharing my stuff. And I found that what people really wanted to see was examples of how to put all these things that we know of on kind of a meta level, as far as, okay, I know that these are evidence-based treatments for phonology, but what does that look like in a therapy session? Or, I know that I have to get the kid to say this sound, but how do I do that? Like what does that look like in real life?
Amy: And so that's when I started asking parents' permission to record our sessions or parts of our sessions if I felt like, oh, this would be a good one to show other SLPs. And so I started recording and posting, and that was really what seemed to give me that uptick in followers. It was all the therapy videos that I've been posting.
Kadie: Definitely, like you said, I think people want to see how other therapists implement. So smart. And you're doing the therapy anyway, so I guess it doesn't take too much extra work. Do you feel like as you've increased it's requiring more and more work or not necessarily?
Amy: What's funny is what has taken up more time is all the direct messages that I get from people just asking questions. Like, I need help with this client. What do I do here? That is what has taken more time. Unfortunately, I get so many in a day. I will get a dozen a day now from really specific cases. And if I can't immediately direct them to like, okay, take maybe this continued education course, or give them a quick, okay, try these three things, then I have started providing, at my hourly rate, just over Instagram really or FaceTime or something, more of a kind of a collaboration Q&A time. People just pay my hourly rate and then they get me for 15 minutes, 30 minutes, whatever it takes. I've done that a few times and that seems to be helpful. But yeah, what's taken more time is really answering the questions from all the SLPs. The filming itself is easy because I always have my phone right there next to me. And as I'm in therapy, I think, oh, this is a great technique, maybe I'll get this. And the child is really cooperative right now. So I just one click of my thumb on my phone camera and I'm recording.
Kadie: That is so funny that it's more so the messages and you're really not having some sort of approach of posts. It's just your therapy.
Amy: Yeah.
Kadie: Is there any words of advice as far as someone who's starting off in private practice? How do you think they should get started?
Amy: I think everybody is going to be different and what they're looking for and why they're going to want to go into private practice. Some people are just really business-minded and I've got friends like that who have these huge successful practices. And if that's what you want to do, go for it. But for people like me, if you're just like, I just kind of want to be a sole practitioner, I want to do my own thing and work with who I want to work with, then I would recommend the reason I kind of started it. Actually, my husband was the reason I even considered it. When I first got out of grad school, he was like, you should just do your own private practice. He's the one with the entrepreneurial spirit, even though I'm the entrepreneur in the family. He always was like, just do it, just go for it. And just considering not having a regular paycheck freaked me out. And so I just couldn't do it before the point where we didn't necessarily need my income.
Amy: But what I did was I started just following and lurking on some Facebook groups that are super helpful, like SLP Private Practice Beginners. They're super helpful. Really helpful. I was on there for probably a year or two before I even considered doing it myself. And I would just go on there and see what kinds of questions people were asking. If I had a question, I would do a search and just see what popped up. There is amazing information. Jenna Castro was the one who leads that, and I know she has some courses on starting private practice. It's just phenomenal information.
Amy: And I think what I took away from just being on that Facebook page is that you can make it what you want to make it. If you want to build and you want to have employees or you want to have contractors, you can do that. And I know SLPs who started even around the same time that I did four years ago and they've got huge practices that are flourishing and they bill insurance and they have it all. And then there's other people like me who are like, no, I just wanted to be my own sole practitioner and I do my own billing and it's kind of just it is what it is. And you can make it what you want to make it. But I think that was what was really helpful is just finding a group of people on that Facebook group who were kind of doing what I wanted to do and to hear their frustrations and their success stories and that kind of inspired me just to go for it.
Kadie: Now you said that you have developed a few things that you sell. Do you primarily sell off your website or are you on Teachers Pay Teachers?
Amy: I primarily sell off of my website more. I have items on TPT as well. But since I usually have just links that go right to my site. I just sold another one. Sorry if you heard that little cash register. But I primarily sell off of my website. And my oral facial exam is what has kind of taken off. Hopefully I'll be doing maybe a presentation or two in the near future about how to do or how to use an oral facial exam to help with differential diagnosis.
Amy: I just found that so many SLPs, you learn that you should do one, right? You have to do one in order to help with the diagnosis or the assessment of SSDs. But a lot of people didn't know how exactly to do one, or if they did, they didn't know what to do with the results or how to interpret them. And I needed an easy checklist-style assessment for myself. And so that's why I made one just for me. And then with the social media following, I just asked if anybody else was interested in that. And come to find out, they were. A lot of people needed that because mine comes with a whole list of additional pages on how to help you interpret particular things. If you see certain things, how to help you know if maybe this child needs a referral to another specialist and that kind of thing.
Amy: So that's primarily what I sell. And I also have, just recently, I started doing a case history because I found out that a lot of people don't realize there are so many, the umbrella of speech sound disorders, you see a child with a lisp but that doesn't tell you much about the underlying issue and why that child is lisping. Is this a developmental issue? Is it a motoric issue? Is it a myofunctional issue? There are different reasons that a child could have the same exact speech sound issue, but you're going to need to know how to treat it because all three of those issues you're going to treat differently, or you should be treating differently.
Amy: And so that's why this case history that I also developed and that I'm now selling is so important, because there are so many red flags that we can get from parents that can kind of clue us in to maybe thinking of if the issue might be childhood apraxia of speech. There's a lot of great research that has come out in the last couple of years about early signs of the types of babbling or absence of babbling that kids are doing, the types of consonants that they're using as toddlers. And so those can be red flags for children who will likely be diagnosed with CAS down the road.
Amy: So I've kind of incorporated all those kinds of questions for parents into my case history and also things like feeding and eating and sleeping history because those can give you big red flags for myofunctional issues as well. And so those are kind of the two main things right now that I've been selling on my site.
Kadie: Wow. Okay. Well, thank you. And you can go ahead and share your site just so people can find it directly if they're listening.
Amy: Great. So it is at grahamspeechtherapy.com. Graham is spelled like the cracker, G-R-A-H-A-M. And you can find all of the things I sell there as well as on TPT.
Kadie: Thank you. And you do blogs. How often do you try to upload a blog to your site?
Amy: Well, I've actually kind of been getting back into it. I took about a year off just because I had been so busy with this other social media of just creating my products and I was doing a lot of guest blogging for people. But I'm going to try and get up, I think, a new blog post every quarter. I was going to say every month and then I just know myself, it probably wouldn't happen. Ironically, my blog posts are often inspired by my Instagram posts because I post every so often, like every fourth post, I'll post some kind of tip or something that I think SLPs should know about a particular aspect of speech sound disorders. And so inevitably that kind of spurs me on to write more in a blog post. I think my last blog post was inspired by one of my Instagram posts. I'm going to try to get back into it a little more regularly, so hopefully once a quarter.
Kadie: How about your biggest struggle throughout maintaining your business while also having children in the home? I imagine that can be challenging at times.
Amy: Yeah, I think the scheduling was the most challenging initially because it was hard to figure out where to draw those lines. Okay, well, my kids are home. Am I going to, since I work out of my own home, am I going to make that family time or am I going to say, all right kids, well, I've got five clients this evening, so deal with it. I think that can be different for everybody because depending on the age of your kids and the needs of your kids, you can make either one work.
Amy: I think the trickiest part was actually limiting myself because I'm the one who's like, okay, if I'm going to make this a go, I'm going to make it a go and I'll be willing to see clients whenever I can see clients and I'm just going to make this work. I quickly found out that I just could not do that and it was at the expense of my family. I just limited and I only see clients now two and a half days a week. I have the other two days where I'm doing a lot of office work and paperwork and report writing.
Amy: And I think that's the other thing too that I don't think a lot of clients understand is that there's so much more that goes into private practice than just face-to-face therapy time and those contact hours, especially if you're a sole practitioner. I'm dealing with quarterly reports and taxes and keeping up with all the different certifications that I need. And so I am my own secretary. And so I think limiting when I see my clients has been a huge benefit because then I do kind of build in that family time of, well, my kids are home from school so I don't see anybody after 3:30 in the afternoon. I begin at a certain point in the morning and I won't see anyone past that time.
Amy: I had to limit myself and I know I definitely lose clients because of that. I think the two biggest reasons I lose clients is because I don't accept insurance and I don't work after school hours. And I get it, that it's super frustrating for parents. But since I'm just a sole practitioner, I had to make that sacrifice. And so far, I've had parents who have taken their kids out of school to come see me. It's kind of like a regular dentist appointment for them, or they get a letter from me that it's necessary and their school will let them out. And so there are ways around it.
Amy: We have a big homeschool population so I'm fortunate that that's the case. I have a lot of clients who have more flexible schedules as well. That's the nice thing with speech sound disorders. I see a lot of preschoolers who aren't necessarily in school all day long.
Kadie: Yeah, and I totally understand what you're saying with some people might not be as excited with a scheduling limitation or whatever it may be, but you still have 20 clients a week. I think that's still a really great number. And yeah, fitting it into two and a half days all before 3:30, I'm pretty impressed. Do you do 30-minute sessions usually then?
Amy: Primarily, I do 30- to 45-minute sessions. Most of my kids couldn't handle more than that. It's a lot. We work really, really hard in therapy too, especially with speech sound disorders. It is a very intensive therapy that we do, just because most of the time I'm using those principles of motor learning, so we're getting a ton of trials. Yeah, most of my therapy sessions are 30 minutes.
Kadie: Well, I really appreciate you joining me today and I love that your stance is fairly simplistic as far as the business goes, but yet you have so much knowledge and are sharing that with other SLPs with your social media presence.
Amy: Well, thank you so much. I really appreciate that.
Kadie: Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a 5-star review for Clinic Chats to help other SLPs find our podcast. Please email me at kadie@clinicnote.com. That's K-A-I-D-E at clinicnote.com.