Why Therapists Struggle to Help Themselves: Building a More Intentional Private Practice

 The skills that make therapists exceptional clinicians don't always translate easily when they're making decisions about their own businesses. Why?

In this episode of the Therapist Incubator Podcast, Liz explores why private practice often feels so much harder when we're the ones making the decisions. Rather than offering another list of business strategies, she invites listeners to slow down, challenge assumptions, and approach their practices with the same curiosity they bring into the therapy room.

Drawing from years in business leadership and marriage and family therapy, this conversation explores how perspective influences decision-making, why we often solve the wrong problem, and how asking better questions can lead to more intentional business choices.

Whether you're building your first private practice or reevaluating an established one, this episode offers a different way to think about the business you're creating.

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. Hi everyone, this is Liz with the Therapist Incubator, which is part of the Liz David Collective. If you've been part of the Therapist Incubator over the past several months, you'll know that we're taking a little bit of a hiatus for the summer before we reopen the group in September. And honestly, I think it's a healthy pause. One of the things I've learned over the years, both in business and in therapy, is that growth doesn't always happen because we keep adding more information. Sometimes it happens because we finally have enough space to think about the information we've already been given. Over the past several months, we've had some incredibly thoughtful conversations inside the incubator. We've talked about referrals, private pay, documentation, AI, networking, websites, burnout, paperwork, taxes, pretty much everything that comes with owning a private practice. But as I was thinking about this break, I realized something. The conversations themselves have probably been more valuable than the topics. Because almost every time someone brought a business question to the group, something interesting happened. Nobody immediately started handing out answers, and instead, we started asking questions. What are we actually seeing? Like what information do we have? What assumptions are we making? Has this happened before? Could there be another explanation? Here's the thing: sometimes by the end of the discussion, the original problem wasn't even the problem anymore. And I kept thinking, we as therapists do this all day long with clients. We're trained to slow conversations down, we're trained to stay curious, we're trained to resist jumping to conclusions. Yet somehow, when it comes to our own business, many of us lose access to those same skills. So while we're taking a break this summer, I thought this would be the perfect opportunity to continue some of these conversations, but in a different way. Not through another business podcast, not through another here are five things you need to do this week. There are plenty of people doing that. And many of them are doing it really well. So instead, I want this podcast to become a place where we simply think together, where we look at common business challenges through a different lens. Not because there's one right answer, but because better questions usually lead to better decisions. That's really what this summer series is about. So over the next few episodes, I want us to explore some of the patterns I've noticed, not only in private practice, but in the way therapists tend to think about their business. And I hope that by the time we come back together in September, you'll have something much more valuable than just another checklist. I hope you'll have a different way of approaching the questions that come with building a practice. So let's start with something I've wondered about for years. Why is it that therapists, people who spend every day helping others navigate incredibly complicated situations, why do therapists often struggle to help themselves when it comes to their own businesses? Because I don't actually think it's a business problem. I actually think it's something much more interesting than that. When I first started private practice, I remember feeling like every decision carried enormous weight. Should I accept insurance? What should I charge? Which EHR should I use? How should I write my website? Should I niche? Should I stay general? Should I spend money on directories? Should I hire someone? The questions go on. Every decision felt permanent. Honestly, every decision felt expensive. Every decision somehow became connected to whether I was going to succeed. And I noticed something in myself that I had seen in hundreds of other therapists. The more uncertain I felt, the more information I collected. Maybe you've done this too. You spend three weeks researching scheduling software, you read 40 opinions about private pay, you compare website platforms, you join Facebook groups, you watch YouTube videos, you buy another course, you download yet another free guide, you ask multiple colleagues what they think. At some point, you've gathered so much information that making the decision actually becomes harder instead of easier. What's fascinating to me isn't that therapists seek information, because we're lifelong learners. Of course we do. What's fascinating is that we often assume the problem is a lack of information. But is it? Let's imagine a therapist notices their referrals are slowing down. Immediately the mind starts working. My website must be outdated, my SEO probably isn't good, or I need to sign up for another directory, or maybe I need to lower my fee. Everyone else seems busier than I am. What am I doing wrong? Within a day, we've created a dozen possible explanations. By the end of the week, we've updated our website, we've changed our Psych Today profile, we've rewritten our biography, we've signed up for yet another networking event, and we started wondering if we picked the wrong career. Now let's pause. Because here's what I find so interesting. If a client walked into your office and described that exact chain of thinking, would you immediately help them redesign their website? Probably not. We'd slow things down. We'd ask questions. Questions like, how long has this been happening? What changed? Has this happened before? What evidence do we actually have? Other questions like, could there be other explanations? Is there anything we're overlooking? As a therapist, you wouldn't assume the first explanation was automatically the correct one. Yet somehow, when the business is our own, we lose that curiosity. Why do you think that is? I don't think it's because therapists are bad at business. I think we're simply too close to the situation. Think about your clinical work for a moment. Have you ever had a session where you could clearly see the interactional pattern that your client couldn't see? You could almost predict what could happen next, right? You're not smarter than your client. You simply weren't inside the interaction. So you had perspective. Then let's think about our own relationships. Have you ever found yourself halfway through an argument before realizing, oh, I'm doing the exact thing I help clients stop doing? Let's be honest, we've all had those moments. Knowing something intellectually isn't the same as being able to see it while you're living inside it. So guess what? Our business, it works the same way. They're personal. Every consultation feels personal. Every cancellation feels personal. Every negative review feels personal. Every slow month, yeah, feels personal. And guess what? Once something feels personal, our thinking naturally narrows. Before becoming a therapist, I spent over 20 years working in commercial real estate, in leadership, and in operations. And one lesson came up over and over again. Whenever something wasn't working, people wanted to fix the most visible problem. Comments like, we need another employee, or we need updated software, or we need a different vendor, or we need a new process. And let's be real, sometimes those solutions were exactly right, but surprisingly often they weren't. Because the thing everyone wanted to fix wasn't actually causing the problem. It was simply the symptom everyone could see. Years later, after becoming a therapist, I remember laughing because I realized families do this too, couples do this too, organizations do this too. Businesses do it too. Human beings are incredibly good at identifying symptoms, but we're much less consistent at identifying what keeps those symptoms going. Quite honestly, that's one of the reasons I love the way marriage and family therapists have traditionally been trained. Because many of the influential thinkers in our field encouraged us to become more cautious about our first explanation. Someone like Salvador Minucin wasn't simply interested in identifying who appeared to be struggling. He became curious about the larger picture. What patterns are repeating? How did everyone influence everyone else? What happened before the problem? And what happened afterwards? What maintained the pattern? Questions like those completely changed how problems were understood. And the more I've owned businesses, the more I've realized those questions, they work remarkably well here, too. So let's get back to that question about referrals. Maybe referrals are slow, but what else has changed? Maybe you're burned out, but is it your caseload? Or is it your documentation process? Or your schedule or your inability to say no? Maybe you're frustrated with networking, but is networking actually the problem? Or are you attending events that don't fit your personality? Or were you expecting networking to produce referrals after one meeting? Maybe you're comparing yourself to extroverted clinicians when that's simply not how you build relationships. Do you notice what we're doing? We're not solving the problem yet. We're just trying to understand it. I know that sounds obvious, but I think it's something therapists forget when we're working on ourselves. We become incredibly solution focused before we become curious. One of the things I hope this podcast encourages is the idea that slowing down, it's not wasting time. Sometimes slowing down is what prevents us from solving the wrong problem. That's different. And honestly, I think our profession needs more spaces where we can think this way. Not because strategy isn't important. Strategy absolutely matters. Let me be clear: marketing matters, pricing matters, operations matter, AI matters, documentation matters, all of those things matter. But strategy without understanding often leads us to copy someone else's business instead of intentionally building our own. I've seen therapists ask, what should I charge? That's not actually the first question. I've heard therapists ask, should I accept insurance? Maybe, maybe not. I've heard therapists ask, which EHR is the best? Again, maybe that's not the first question. A better first question might be, what matters most to me? What kind of practice am I trying to build? What constraints do I actually have? What assumptions am I making because everyone else seems to be doing something differently? You'd notice those questions don't immediately produce answers, but they almost always produce better decisions. And that's really the philosophy behind the therapist incubator. The goal has never been to teach therapists how to build my practice or their practice or any practice. The goal has always been to help therapists become more intentional about building their own. Because there isn't one correct business model, there isn't one correct fee, there isn't one correct marketing strategy, and there isn't one correct schedule. Two therapists can make completely different decisions and both can be incredibly successful. The difference isn't usually the tactic. It's whether the tactic actually fits the business they're trying to build. So as we wrap up today, I don't want to leave you with homework. I'd rather leave you with a few questions. When was the last time you became genuinely curious about your own business? Not critical, curious. Where have you been looking for another strategy when what you may actually need is another perspective? What assumptions have quietly become facts in your mind? What business decisions have you been trying to solve quickly that might actually benefit from slowing down? And finally, if another therapist came to you describing your exact business situation, what questions would you ask them before offering advice? I know it sounds trite, but yes, those same questions might be the ones worth asking yourself. Thanks for spending time with me on this today. And I hope you'll join me for the next episode where we're going to explore an idea that quietly shows up in almost every business challenge I've ever seen. Because it continues to visit how the problem isn't the problem. Because more often than not, the thing we're trying to fix isn't actually the thing that's driving the struggle. I'll see you next time.