Making Therapy Work When the System Feels Broken
So, you’re dreaming of building or growing your private counseling practice. Maybe you have that change-the-world energy that got you through grad school, or perhaps you’re just trying to escape the endless parade of insurance claims, clinical note headaches, and shifting regulations that seem to come from nowhere (shout-out to those surprise memos from your licensure board on Friday afternoons).
Whatever brought you to the brink of entrepreneurship or expansion, you’re absolutely not alone, and if you sometimes wonder, “How do I even choose where to focus when everything feels so… everywhere?”, Kelly Higdon and Miranda Palmer are here to assure you: The world is a hodgepodge right now, and your feelings matter.
Their conversation on the most recent Starting a Counseling Practice Success Stories podcast episode doesn’t sugarcoat what’s happening in the mental health field, but it also offers genuine wisdom and a few belly laughs. Ready to learn from their lessons, get some practical tips, and feel less alone on the road? Buckle up!
Lesson 1: The Mental Health Field Is a Real-Time Hodgepodge (And That’s Okay)
Can we be honest for a minute? There’s no single headline dominating the mental health world right now. Kelly admits, “as we were talking prior to this recording, we had hit record because we want to remember our ideas. We were talking about how this is like a hodgepodge of an episode, that there's not this, like, one theme that we can just focus on because we think that how we're feeling mirrors what's going on for our clients.”
Sound familiar? You’re not wrong if you feel like you’re at a drive-in movie with “six things playing all at once, and all six were coming in through the speakers”, as Miranda puts it.
The takeaway: You do not need to choose just one issue to care about. You’re allowed to hold multiple concerns: insurance changes, economy shakes, changing clinical laws, AI creeping into documentation, and the big existential ‘what does my career mean?' questions.
Tip: Give yourself permission to pause, refocus, and simply be with what’s in front of you. When everything feels urgent, remember you’re not obligated to fix it all today.
Lesson 2: Navigating Regulations, Rights, and the Realities of Practice
Have you ever asked yourself, Is it more dangerous to keep my license if I’m told what I can and can’t say in session? If so, you’re in eminent company.
Kelly shares about a conversation with a social worker serving indigenous teens, where new federal rules suddenly restrict critical conversations: “They can't discuss gender. They can't discuss safe sex. And they work with teens who are getting pregnant very early in their teen life.”
The struggle is real: Do you stay? Do you go? Do you have the resourcing to fight the fight?
And Miranda echoes the tension for marginalized clinicians: “I feel unsafe, like, literally physically unsafe because of their particular marginalization, because of their… queerness and where they live in particular, that… I don't know if I could put all of this energy into building something and then feel like I need to flee the country.”
Takeaway: Regulatory change, ethics, and your own rights will come up (sometimes all at once). The landscape can shift by zip code, grant status, or even the whims of your licensing board.
Tip: Know that it’s normal to have one foot in fight for systemic change and the other in ‘run far away.’ You don’t need to resolve this tension immediately. The skill here is presence: “Holding the polarization... being present to what's in front of me until I know within myself what I need to do next.”
Lesson 3: Befriending Your Own Fear and Feelings (The Real Business Skill)
Therapists are taught to move clients through evidence-based protocols, but Kelly and Miranda want you to pause before hustling into fix-it mode. As Miranda puts it, “can we be with our emotions without like jumping past them?... Can we actually like be with the sensation in our body? Can we be with the fear? And maybe if we're with the fear and we befriend it and we're... with it, maybe it dissolves and resolves.”
Sometimes, the true work is just to acknowledge the knot in your shoulder, the flush of anxiety, or the dread as you open your inbox. Like Kelly says, “There are no words or thoughts. It's all just sensation. And I don't have to figure it all out, but I do feel better as I feel physically or energetically... move through me.”
Takeaway: The wisdom of practice isn’t always found in swift solutions or rapid business pivots. Sometimes, it’s about sitting with the feels - confusion, fear, anger - and letting them teach you before you leap into strategic action.
Tip: Next time you’re spiraling about insurance, marketing, or licensure - try asking, “Where is this sensation in my body? Can I be with it for a minute before I tell myself a story about what it means?”
Lesson 4: The Good, The Bad, and the Ongoing Soap Opera Of Insurance
If you’re starting or scaling your practice, chances are insurance is the small elephant in your waiting room.
“UnitedHealthcare was calling out this association for their cynical contract negotiations…” Miranda recounts, as Kelly wonders aloud, “Where does the money go? Because it's not going to the providers that we're seeing now…”
If you’re in a state where insurance pays well and on time, celebrate it! As Kelly says, “We would love to hear about [it]. I want to celebrate you, first of all.”
But if not, you’re not alone. Contract terms, clawbacks (where insurance “asks for money back because I didn't do a good job of documenting”), and late payments are real struggles.
Miranda’s advice: “The laws in [some] state are... taken care of.” For example, Texas’s Prompt Pay Act and Illinois’s strong insurance legislation mean some clinicians have positive experiences. “If you submit your documentation, they need to be able to reimburse in a timely manner. And they can't be asking for money back, you know, 18 months or three years later for no fault of your own.”
Takeaway: Insurance isn’t one-size-fits-all. The nuances of your state laws, contract details, and reimbursement rates can make or break your financial health.
Tip: Hold back a small percentage (10–20%) of your insurance income in a separate clawback account. That way, an unexpected repayment request won’t torpedo your practice finances overnight.
And always ask: Who’s paying for that shiny new coaching course or mastermind recommending a particular insurance-adjacent program? “Pay attention also to who pays those sources,” Kelly cautions.
Lesson 5: Multiple Streams of Income (Is It All Gravy?)
Raise your hand if you’ve heard, “Just juggle a bunch of side hustles!” as the path to sustainability. Kelly and Miranda are not fans of the gig economy for therapists. “It shouldn't be that you are... side gigging your way like the gig economy of like $5 here, $20 there. Like it doesn't work for most therapists.”
Actually, research says you’re 33% more likely to succeed with a startup if you have a single solid source of income. “If you are trying to piecemeal together six streams of income... the odds of any one of these things working... is 33% less.”
Build stability first (one offer that truly works) and then add extras “because it’s fun and it’s what you want to do,” not because you’re scraping together rent every month.
Takeaway: Focus on making your main service sustainable before chasing after shiny, scattered money pots.
Tip: Evaluate your current offer: Is it profitable, enjoyable, and serving your clients well? If not, build your foundation before venturing out.
Lesson 6: The Tech Tsunami, AI in Therapy
Just when you thought insurance couldn’t get any more complicated, along comes AI. Kelly share about startups like ONOS Health, with insurance giants behind it, promising to eliminate manual reviews and let the AI will determine what is right for the client.
Miranda’s reaction is pure gold: “We're going to hand that over to a bot. I mean maybe it'll do better. But... they're like hey, we're going to save money by doing this right?”
Faster care decisions? Sure, maybe. But where does that leave nuanced care, relationship, and clinical judgement? The concern is, as Miranda puts it, “That's the part that, where I go, yeah, I'm out. Like there's no way.”
Takeaway: The robots are coming, maybe not to take your place, but to make decisions about care and reimbursement. Stay curious, stay aware, and advocate for the human heart of therapy.
Tip: Keep up with tech trends, but don’t let them distract you from the core work: providing real, effective therapy.
Lesson 7: The Power of Doing Your Own Thing and Doing Good
Despite all the stress and drama, there is hope. More and more therapists are finding clinical joy and sustainability not by leaving the field entirely, but by leaving traditional weekly models. Intensives, longer sessions, somatic work, and neurodiverse-friendly frameworks are helping therapists (and their clients) thrive.
Kelly notes, “It's taking the income that I have and thinking like, is this my highest and best?... The Clinicians that are doing really well are aligning the services with their neurotype, their energy, their gifts, their. Their joy.”
Miranda adds, “The outcomes are freaking stellar... And this is a freedom again, back to a privilege because... she was already private pay and she didn't have to worry about insurance coming in and saying, you can't do that.”
Takeaway: Innovation flourishes when therapists design their practices around their unique strengths and preferences and refuse to be boxed in by the way things have always been.
Tip: Give yourself permission to experiment. If weekly 50-minute sessions don’t work for you, try intensives, groups, or workshops. Build a practice that fits your life, not someone else’s legacy.
Lesson 8: You Matter. No Matter What the System Says
Here’s your friendly reminder from Kelly: “Whatever you decide, you are a valuable human. You are important in this world. You matter. Regardless of what an insurance company tells you, regardless of what clients tell you, regardless of, you know, what this field is saying or how you might be feeling right now, we hope that you can hold... the good that is within you when you're faced with the stuff and the gunk of the world out there.”
Miranda closes it out: “It's therapists, for the most part, we are called to this work. It's not a willy nilly decision that somebody made because they heard that they can make a lot of money. We invest a lot of time and energy because we wanted to help people, we wanted to do good work.”
Takeaway: Your work matters, and your unique path is worth protecting, even when the field feels chaotic.
Tip: Don’t make every decision from fear. Seek clarity, resources, and community. Trust your intuition, not just your anxiety.
Here’s to Your Hodgepodge (and Your Magic)
If you sat down with this podcast and found yourself nodding along, feeling seen in the chaos and inspired by the reality check - know that you’re part of a community inventing new pathways through an ever-changing field. Whether you’re starting out, scaling up, or considering a leap into innovative clinical models, your mess and your magic are both welcome here.
Ready to Choose Your Own Adventure?
Redefine what success means for you, regularly!
Sit with your feels before you zoom into solutions.
Learn your state’s insurance laws; protect your practice from surprises.
Build your main business strong before adding side hustles.
Experiment with innovative clinical formats.
Remember: You matter, just as you are.
If you loved this conversation, want more deep dives into running a private practice, or have a topic you wish Kelly and Miranda would tackle on the podcast, drop them a note at help@zynnyme. And if you hated it? Let them know that, too. They’ll keep talking, in private, but they do care about your feedback!
Here’s to building a counseling practice that actually works for you. Chaos, courage, and a little bit of hodgepodge: all welcome here.
Resources from the Episode:
More on intensives, insurance, and practice-building at ZynnyMe
