Same Pattern, Different Place: Therapy Sessions and Business Growth

What happens when the work looks right… but nothing is actually changing? 

In this episode, we unpack a real conversation from the Therapist Incubator that started with a clinical dilemma and expanded into something much bigger. 

We explored what it looks like when: 

•  clients show up but don’t fully engage 
•  progress feels inconsistent or surface-level 
•  therapists begin to question their effectiveness 

But instead of staying in the clinical lens, we zoom out.
 
Because the same pattern shows up in business.
 
You can be:  

•  busy 
•  consistent 
•  doing “all the right things” 

…and still feel stuck.
 
This episode walks through:  

•  how therapists get pulled into roles that aren’t theirs to carry 
•  why activity can create the illusion of progress 
•  how systems quietly shape both clinical work and business decisions 

We also touch on the real-world realities of practice building, including:  

•  navigating licensing challenges across states 
•  building referral networks 
•  managing paperwork and liability 
•  reducing operational friction through simple systems 

This is not a “what to do” episode.
 
It’s a how to think episode.
 
And if you’ve ever found yourself working harder while things stay the same…
this one will likely feel familiar.

About the Therapist Incubator

The Therapist Incubator is a professional learning space where clinicians explore the real operational challenges of building and sustaining a private practice. Through collaborative dialogue and systems thinking, participants examine the business, structural, and relational aspects of practice ownership.

Learn more about the incubator at:
www.thelizdavidcollective.com

Transcript

SPEAKER_00 0:00

Welcome back to the Incubator Podcast. Hello again, this is Liz with the Therapist Incubator, a part of the Liz David Collective. As a reminder, these recordings are meant to serve as a learning record, a way to walk back through the conversation in the order it unfolded, so you can revisit what we discussed, you can look up anything that feels worth exploring further, and continue to think about how these topics intersect with your own practice. As a reminder, this isn't meant to tell you what to do, it's an opportunity to listen to how decisions are being worked through so you can consider what fits for you. Our most recent session was one of those that I think a lot of therapists quietly experience. But we don't always say out loud. We covered a mix of clinical work, business realities, and operational things that, on the surface, don't seem connected. But when we zoom out, they actually are. And that's what I want you listening for in this episode. Not just what we talked about, but what's underneath it? Because the question I want this episode to answer for you is what am I hearing? Why does this matter? And what can I do with this right now? Before we got into the clinical conversation today, we actually started by revisiting something we've been talking about over the last few sessions: setting up Google business pages. And what was interesting about what that was was that we didn't actually solve it because we didn't. There was still some confusion, there was still some frustration, and some of us saying, I'm not sure how it's going to land. But here's the key. We were able to talk through it. We were able to throw out ideas, challenge each other's thinking, and try to solve our problems from a few different angles. And here's the thing: I wanted to name that because that's actually part of the point of this space. It's not just about getting the right answer, it's about having a place where you can bring something that's not working or that's not clear and think through it with other people who understand the system you're operating in and the challenges that you're facing. And even when it's not resolved, you end up leaving with more direction than you had when you walked in. So just keep that in mind as you're listening to the rest of this episode. The beauty of a space like the incubator is an opportunity to discuss in real time with others who are trying and experimenting with the same things that you're going through. As usual, we started the session talking about headaches of the week. And what was really cool was that the headache this week was actually a chance to talk about a case. We started with a situation that I think is more common than many of us would admit. Two couples, both engaged, both showing up, both saying they want change, but the clinician indicated that progress isn't really happening. There are small shifts, sure, but the same patterns keep coming back. Resentment seems to still be there. Communication is still breaking down. And the tension with those clinical discussions became: if I know I'm not being effective, but they want to stay with me, what do I as a clinician do? I want to slow this down for a second because if you really think about it, it's not just a clinical question. That's a responsibility question. Because on one hand, you have, I don't want to just take their money if nothing is changing, but on the other hand, you have they don't want to leave. They feel comfortable and they like the relationship with their clinician. And in the middle of that, the psychotherapist is feeling like they're spinning their wheels. The beautiful thing about being able to talk about this as a headache of the week was that there were some things that came up that are worth highlighting. The first was this idea that the couples weren't not working because they were showing up, they were doing the assignments, they were participating, but they were doing it in a way that was very surface, kind of like they're checking boxes, doing the things that's supposed to help without actually engaging with the deeper emotional work underneath it. And then this really important pattern came up. They seem to be keeping score. I did this, they did that, we're even now. And guess what? When it evens out with the couple, they're typically going to look at the therapist to decide what it means. And quite honestly, to be the tiebreaker. And that's where something subtle but really important starts happening. A clinician ends up shifting from being a facilitator to being the tiebreaker. And once that happens, the pressure in the room is going to change. Another headache that came up was clients who come to session with an expectation that they should be leaving the session feeling better, more resolved, more connected with their intention and their purpose. And the question that came up was when that doesn't happen, why isn't therapy working anymore? And what's really interesting is as a therapist, we can start to feel how easy it is to start trying to prove that therapy is working. We start trying to highlight the good moments, to show the progress, to meet the expectations of our clients. And again, that's where you can feel yourself start to drift. Now, here's where I'm inviting you to zoom out. Because this is not just about clinical work. We're talking about systems. And guess what? This is a very similar pattern to what shows up in business all the time. You have people who are posting content, joining directories, trying new platforms, doing all the things they've been told to do, checking all those boxes, doing as they were told, handling their homework, but nothing's actually moving. So the system looks active, but it's not effective. And then what happens? We start looking outside of ourselves. Tell me what to do. What platform should I use? Why isn't this working? Which is the same as a client saying, We did our part, now you have to tell us what this means. It's outsourcing the outcome. And then there's this piece that I think is the most important. It's the illusion of work. You can be really busy, you're really engaged, you're networking, you're committed, you're posting, you're writing, you're updating. But guess what? We're still potentially avoiding the part of the process that actually creates change. And when that happens, the system, it's going to often try to pull you into doing more. You got to work harder, you got to fix more, you got to carry more. And guess what? That can be true in session or in our business. As the conversation continued and we started to shift into the business of therapy, we started talking about things like licensing, networking, paperwork. And as usual, I don't want to skip over that because it matters. We talked about licensing delays when we're trying to actually get our license done and we're not getting feedback from the states that we're working with. Or maybe it's unclear requirements. And what about the challenges of trying to expand across states? It's not just annoying, it's actually impacting your decision making, it's impacting your growth, and it's impacting your access to clients. Here's the thing: it's the same with paperwork. Most therapists seem to be pulling forms from different places. They use templates from platforms. They're hoping that their paperwork is just good enough without really knowing where their exposure is. And then when you think about it on the operational side, we actually started talking about something really simple but powerful: templates. Think about it, emails that you send all the time, client communications, follow-ups, billing reminders. Those templates aren't intended to remove personalization, but it's to remove friction for you as a business owner. Because rather than recreating the same thing over and over again, you can build off of something that you've already done. Because that's being able to reclaim some energy that you don't get back. So here's what I want you to do this week. Think about the things that we were talking about today and pick one situation, one client, one decision, or one part of your business that feels stuck. And run it through these three questions. First question is am I seeing movement or just activity, busy work? Are things actually changing? Or am I repeating the same effort and calling it progress? The second question I'd invite you to ask yourself, what role am I being pulled into right now? Am I the facilitator? Or have I stepped into fixer, referee, decision maker? Because once you take the wrong side, the system, it's going to reorganize around it. And the third question would be: where might I be overfunctioning? Am I working harder than the client? Am I trying to create clarity where something or someone else is avoiding it? Or am I adding more effort because something isn't moving? If you only do one thing this week, don't fix everything. Just notice one moment where this is happening and pause long enough to ask: what actually belongs to me here? And what doesn't? This session was one of those sessions that reflects life in a real practice. Here's the thing: it's not ideal. It's not a textbook, it's real. And if you're listening to this and thinking, yeah, I've been there, you're not off track. You're in it. And the work is not doing more, it's actually just being able to see the system you are in more clearly. And quite honestly, deciding how you want to show up inside of it. That's going to be true with clients and with business. And we'll continue to build. Until next time. Take care.