Yeah. This is a hard truth. I’ve been around the business of private practice long enough to know many–if not most–therapists never reach their goals in private practice.


They long for a full-time practice. In fact, these therapists will even say it was what they were put on this earth to do.

But unfortunately they stay longing instead of fully satisfied.

And often they even abandon the notion of a full-time practice and move on to other endeavors.

This blog is a wake up call. I’m not trying to scare you. I don’t want you to think achieving your vision as a mission driven, heart-centered healer is impossible.

It’s not impossible at all. In fact, you can definitely achieve your vision in private practice.

But the first reality to face is many therapists don’t and you need to know why.

If you don’t educate yourself on why therapists don’t meet their goals, then it’s going to be that much harder to figure out how to do it.

I’m going to lay it out simply.

It’s from my observations of so many therapists who aren’t where they want to be after years of effort.  

But it’s also from my observations of seeing therapists who are exactly where they want to be after years of effort.

I’m sharing this with you, becuase I want you to have the opportunity and blessing to serve exactly who you want, when you want, and how you want to as a therapist.

This is an absolutely sacred professional opportunity. Use whatever term you want that works for you. But acting as a therapist in private practice is one of the most spiritually fulfilling encounters in life.

And I also want you to earn exactly what you want so that you feel deeply satisfied and supported and abundant in your life so you can continue doing this very important work for as long as you want.

So here’s why most therapists don’t fill their practice:

  1. They don’t acknowledge that their private practice is a business. Period.  If you don’t treat your private practice like a business owner, it is unlikely you will meet your caseload and financial goals. How you serve and heal your clients is a spiritual matter. How you meet your caseload and financial goals is a business matter. I’m not saying it’s black or white, but there’s a difference.
  2. They don’t have a clue how to run a business. Guess what…very few therapists know how to run a business. It’s not a requirement in graduate school to gain competency in business. It should be! But that’s not the real problem. It’s that few therapists devote the time and energy needed into learning how to run a business.
  3. They don’t find mentors or business coaches that understand how to build a practice today. It’s easy to find a professor that you liked in school that built a practice twenty or thirty years ago and has some antiquated tips. But they rarely know what’s involved in building a small business today.
  4. They play the short-game.  Building a small business such as a private practice takes time. You can do it quicker than ever with modern marketing methods, but to achieve a full-time practice that will last for years is a totally different endeavor. Most therapists try for a few months or a year and give up on most of their efforts once they start getting clients. Then their practices die-out and they don’t know why.  It’s a long-game.
  5. They don’t invest in paid advertising. They don’t invest in a website. They don’t invest in search engine optimization. They don’t invest in a business coach. They don’t invest a nice office space. They don’t invest in taking referral sources out to a nice meal. They don’t invest in an accountant. They don’t invest in normal business operating expenses. They try and run a business for free. Big Mistake.

There are other reasons why most therapists don’t fill their practices, but these are the main reasons I’ve observed over the years.

But here’s the great news! Building and running a private practice isn’t a highly complex business model. You already have the service: that’s you as the therapist! You already have the knowledge to offer a great service: that’s your education!

Now all you have to do is not follow in the footsteps of therapists who choose to avoid engaging their practice as a business, avoid learning how to run a small business, avoid mentorship or business coaching, avoid the long-game nature of building a business, and avoid investing in the normal operating expenses to make a practice successful.

You can achieve your vision as a private practice therapist. It’s up to you to decide what you’re willing to do about it.

If you haven’t received our guide on how to start or grow a practice and get 5 new clients this month this is a good time to download it now.



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Keith Kurlander

Keith Kurlander is the founder of Higher Practice, a company dedicated to helping therapists achieve their highest potential in private practice. He has two decades of combined experience in business administration, group facilitation, teaching at the undergraduate and graduate level, yoga instruction and as a licensed professional counselor in private practice.

9 thoughts on “Why Therapists Don’t Fill Their Practices

  1. I received a notice about your blog via Linked In. What a shame so many therapists can’t build their practices to the point it creates the need you are trying to fill. I wonder if it is worse for therapists who don’t take insurance and must market themselves more steadily? I do take insurance and have had a basically full practice for over a year, with openings that come up periodically as folks finish, move away, change job hours, etc., but these are typically quickly filled. The only advertising I do is maintain a presence on Psychology and of course I am listed on the insurance websites.

    I do think you have very good points about remembering that we are small business owners. I am diligent in my record keeping and have an accountant. I have also decided to opt out of insuranc networks that reimburse at unacceptably low rates. I certainly could be better at enforcing my Late Cancel/No Show fee but so far I am pretty satisfied with how my business is going. It certainly is a learning experience the first couple years and it would have been nice to get some better prep in my grad school programs.

  2. Valid points, therapists have to know how to drive a business and not just do therapy. I recognise my obvious limitations in the former.

  3. Mr. Keith,

    I will say you have caught my attention. I am 56 and a student going for my MS in Clinical Mental Health Counseling (just started). This field is new to me (as a professional). I am years away from private practice, but my eye is on that ball. Between family obligations, work, and school I do not know how much time, effort, or money I can put into this at this time, but I am keeping your info on file.
    Thank you,

    James Daniels
    [email protected]

  4. I am in private practice. What kinds of services do you offer, do you charge by the hour?
    Thanks much.

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