Can Your Practice Survive This Economy
If you have been staring at an empty schedule wondering what went wrong, I need you to hear something first: it is not just you.
I don’t think a week goes by these days without a post in a Therapist Facebook community that is started by a therapist, desperate for solutions, being met with dozens of responses, mostly supportive with a touch of commiseration. Slow referrals. Clients canceling. Phones quiet in ways they've never been before. Therapists with 10+ years in practice saying this is the worst it has ever been.
But not everyone is struggling, and the therapists who are doing better than hanging on have something to teach even if they don’t know it.
What Therapists Are Actually Reporting
The phone is quiet, and it's not seasonal.
One of the most common challenges, especially for new therapists is that new client inquiries have slowed or stopped entirely. Years ago a basic, stock photo filled website with Psychology Today was enough to keep your practice mostly full, but now even therapists who have navigated summer lulls, economic downturns, and referral dry spells for over a decade are saying this feels different.
Insurance doesn't fix it.
16 years ago when the practice I run started, getting on panel with insurance was the ‘safe’ route. Now that’s just not the case. Whether you’re working with the platforms, fully cash pay or insurance heavy, nothing feels particularly safe these days. We’ve accepted insurance, but also have a robust system of cash paying clients as well. I think that blend makes for the most stability, which is what I teach in the Own Your Practice Challenge Replay but if you haven’t built that way it may take some adjusting to get it right. Why? Because deductibles have gone up. ACA subsidy cuts have made premiums unaffordable for clients who previously had coverage. Copays that used to feel manageable now compete with groceries and gas. Even our office has noticed more declined credit cards than ever.
Therapists are seeing what every other service-based business is seeing, consumer spending contracting at the middle. People are making hard choices. Therapy, even when people value it deeply, is losing to rent, food, and utilities. The K-shaped economy is real: a portion of the population is spending freely; a larger portion is cutting everything non-essential. If your practice is not positioned to serve the segment that is still spending, or structured to weather the segment that is not, you’ll feel this squeeze more than most.
VC platforms and AI are taking market share.
Last year I went on record, sharing that the VC backed platforms, including BetterHelp, Headway, Alma, Grow, Rula, are coming for returns on their massive investments of the past 8 years. The tens of thousands of dollars that they invested in pulling therapists has made it challenging for practice owners to keep staff and the marketing dollars don’t fit in any therapist’s budget. When you add in the AI of it all, it can feel like a pointless battle.
But a few people are doing fine. What's different about them?
This is where it gets interesting. My favorite author, Malcolm Gladwell wrote a book called The Outliers about the people and situations that defy the expected path and why. And the truth is, there are practices that are growing, waitlisted, or at minimum, holding steady. And they do tell a story.
• A defined, difficult-to-replicate niche (not just "trauma therapist", a specific population, modality, or lens)
• Active community referral networks built on relationship, not just directory listings
• Revenue that is not entirely dependent on individual sessions
• Systems and visibility, a consistent content presence, a clear offer, an email list
None of these are accidents. They are decisions.
What This Moment Means for You
External pressure does not create structural problems in your business. It reveals them.
The practices feeling this most pressure right now are the ones that were built around assumptions that no longer hold:
that a Psychology Today listing would always fill the caseload,
that referrals would keep flowing from existing networks,
that one-on-one sessions would always be enough to sustain the revenue the practice needs.
Those were reasonable assumptions for a while. They are not reliable assumptions anymore.
The practitioners who are weathering this built something the slow season can't dismantle. Not because they worked harder, because they built differently.
This is not about blaming practitioners who are struggling. It is about naming what is true so you can respond to what is real.
When I came on as a fractional exec, a Director of Operations, I did so because the CEO of the practice wanted to close her clinical caseload and needed a path to keep getting paid. At that time we had 1 nearly 6 figure contract and she wanted a raise. We also noted that nearly 80% of our insurance revenue was from ONE company. Even before the widespread notices about insurance audits and clawbacks we knew that this kind of dependence was dangerous. So we built out a menu of services and suddenly between our existing reputation and showing up consistently online, suddenly the requests were coming in. Now we have multiple 5 and 6 figure clients on retainer.
You do not have to wait for the economy to recover, the algorithm to favor you, or the VC platforms to implode. You can build a practice that does not depend on any of those things. But it requires a structural shift, not a hustle upgrade.
If you are reading this and recognizing your own practice in the thread above, it’s time to take action.
Start with showing up. You cannot compete dollar for dollar with the VC platforms, but you can compete video for video IF you use social media to get the momentum building. The Visible Therapist System is a no-overwhelm content system for practice owners who know they need to be findable but don't have time to become content creators. This is how you build a referral pipeline that works while you're in session.
Get in community. Not just Facebook groups, which can be great for support and vent sessions, but in collaborative spaces. There are many co-working spaces for private practice owners and some of the best aren’t unaffordable, but I am starting one that is free.
Once a month, I host The Round Table, which is a free live event where practice owners can ask questions, get unstuck, and think through what's actually going on in their business with other practitioners who get it.
No pitch. No fluff. No powerpoint. Just a room full of practice owners who are done waiting for things to go back to normal and ready to build something that works regardless. Sign up today.
This is not a bump in the road that you should ignore, but it also doesn’t have to be the end of the road either. Need a little boost? Check out the Peace and Profit for Therapists podcast where you’ll find 30 minute microdoses of MBA level business development support.