The State of Therapy: Surviving Debt, Burnout, and Systemic Issues in Private Practice
So, you’re dreaming of private practice? Maybe you’re fresh out of grad school, heart full of empathy and anxieties, or maybe you’re a seasoned clinician who can recite insurance scripts in your sleep and wonders, isn’t there a better way? You’re not alone. The urge to build a counseling business that honors your skills and safeguards your sanity is driving scores of therapists to take the plunge… but if you’ve peeked under the hood of our profession, you know it’s anything but straightforward.
There’s hope, humor, and a whole lot of insight in reimagining what therapy can look like for both clinicians and clients. That’s exactly what Kelly and Miranda dive into.
Ready to challenge the status quo, shake off some dusty old beliefs, and get a real-world roadmap to a thriving, outcome-driven, feel-good (for everyone) practice? Let’s go!
Lesson 1: The System Might Be Broken, But You Don’t Have To Be
Let’s rip off the Band-Aid: the mental health system isn’t just gently creaking at the seams; it’s falling apart on therapists, new and seasoned alike.
As Miranda puts it, “This system is really broken, like it's clearly not working. And then you say actually this system is working perfectly… what it's meant to do, which is increase shareholder profit.” OOF.
Insurance profits rise, therapist pay stagnates, and new grads are thrust into under-resourced circumstances with debt up to their eyeballs and only the shakiest roadmap to clinical outcomes that matter.
But here's where it gets real: it’s not all about ‘green’ therapists making rookie mistakes. Kelly notes, “We actually see it in every space, people that have been licensed for 10, 20, 30 years that actually don't know how to get great outcomes in private practice.” Cue collective nervous laughter.
Takeaway:
It’s not you. It’s the culture, the training, the business incentives, not personal inadequacy, that’s set up to trip us. That knowledge is a relief and a call to action: you get to (and must!) design something different.
Tip:
Give yourself permission to challenge systemic norms. There’s no gold star for endless hustle in a broken system.
Lesson 2: Training is Basic, So Go Beyond It
Miranda and Kelly pull no punches about grad school prep: “The training I do feel is…basic, what we get in grad school. Sometimes you can find some grad programs that are more specific… But…you have a lot more online universities that don't even really provide the practicums. The clinicians have to find them on their own.”
And, let’s be honest, supervision is a crapshoot: “It's like a burnt-out person training a burnout person training a burnout person.”
So what do you do when the learning stops at ‘don’t be worse than nothing’ and ‘termination planning’, but you want to help clients radically transform?
Takeaway:
You’re going to have to seek out practical, skills-based, ongoing training that can’t be found in syllabi or chaotic internship placements.
Tip:
Invest in post-grad clinical trainings that feel alive, outcome-focused, and relevant to your practice (think: EMDR, trauma work, niche-specific workshops, not just what’s required for CEUs!). But beware of going $150K into debt for a fancy degree, Miranda warns, “There is no graduate program, in my humble opinion, that is worth six figures in this particular profession.”
Lesson 3: Outcomes Matter More Than Paperwork
Ever been told, ‘If people keep coming back, you must be doing something right’? Miranda hits the nail on the head: “If what I was doing wasn't working, then sort of like, what was the point?”
But outcomes in counseling are deeper than session attendance or ‘hanging in there’. Instead, it’s about:
Checking in about distress (“What is the distress level? How is it between at the beginning and the end of the session, in between sessions?”)
Talking about goals and desired change (Did your grad school even teach you to ask about the “miracle question”?)
Courageously checking if things are working (Not just assuming silence means satisfaction.)
Miranda shares, “We teach people how to have a conversation on the phone, how to actually, like, plan for their first session, how to move into that with confidence…how to get good outcomes and how do you create a dynamic that...everybody who comes in to see you gets your highest and best?”
Takeaway:
Clinical outcomes are everything. And it’s totally learnable, even if your supervision never taught you.
Tip:
Build feedback loops into your sessions (use session ratings, feedback forms, and direct outcome tracking). If clients drop out unexpectedly, don’t blame yourself, but also don’t ignore, get curious about what wasn’t working and how you could create more safety and clarity next time.
Lesson 4: Attunement With Clients and Yourself
The typical mental health culture overvalues self-erasure, ‘taking yourself out of the room’, and warns against ‘countertransference’. The result? “It’s a very dissociative work…you learn to dissociate if you're not, if you don't already know it,” Miranda points out.
But sustainable private practice and transformative client work have to be rooted in your own clarity. As Kelly observes, “A lot of our training is about attuning to the clients, but not utilizing our own kind of compass…coming back to our knowing of, like, no, I know, like, who I really love working with. I know how to help them. I know…how long this takes. Right. Coming back to our knowing, I think it’s a huge piece of that.”
Takeaway:
Self-attunement isn’t selfish. It’s necessary for solid therapy and happy business-building.
Tip:
Set aside time for personal reflection: What kinds of clients light you up? What modalities feel alive in your hands? Where are your boundaries actually serving your wellbeing (and thereby enhancing your clinical work)?
Lesson 5: Supervision, Abuse, and the Importance of Safety
If you’ve ever felt stuck in a harmful work situation, you’re not alone. Kelly shares, “The whole system that they're in is oppressive, it's unethical, illegal, you know, like…what do we do? We tend to find that a lot of clinicians are like, there's something wrong with me…I am…broken. But it's really that they're in a system that is not working at all.”
So, if you’re experiencing these frustrations, it is NOT your personal failing!
Takeaway:
Toxic work environments and bad supervision aren’t a rite of passage. They’re wounds you can choose to heal from and ultimately leave behind.
Tip:
Learn your labor rights, know what to expect in good supervision, and trust your gut if something feels off. If possible, connect with peers outside your workplace for perspective and validation.
Lesson 6: Licensure is Not a Magic Bullet (But It’s Complicated)
Many see licensure as the ultimate professional badge of safety, for clients and clinicians. But Miranda gets honest: “Does licensure, does that really create a safety net for clients?” Kelly confesses, “I have a lot of issues with this. I have not unpacked this for myself.”
There’s value in the process, but it isn’t an infallible shield. It can be “a safety net and it can also be the tie that binds. It really depends on what you want to do and what you're creating, right?”
Takeaway:
Licensure is a tool, use it intentionally, but don’t buy into the myth that it alone determines your worth or effectiveness.
Tip:
On your journey, be thoughtful about licensure requirements, but also remember: your impact comes from skill, integrity, self-awareness, and the systems you build around you.
Lesson 7: Build Feedback Muscles (Even When It’s Awkward)
If you’re sensitive to feedback (hi, most therapists), you’ll resonate with Kelly’s honesty: “With having rejection sensitivity stuff, right? …I was never taught how that feedback can create a cycle of excellence. Right. And so we don't know how to fail.”
Learning to seek and respond to feedback is the ultimate secret sauce, not just for clinical work, but for growing a resilient business.
Miranda describes a group practice owner who tells new hires, “Hey, we're gonna be tracking your outcomes…when you start, your KPIs are going to suck. I know that, and I want you to know that, and I want you to know that you're not doing anything wrong by the fact that your KPIs will not be good and they will get better over time.” What a relief!
Takeaway:
Welcoming and responding to feedback on your clinical work, your systems, and your business practices is the skill that changes everything.
Tip:
Practice asking clients for input (What felt helpful? What didn’t?). Reflect with colleagues, and reframe mistakes as an invitation to grow. Sustainable success is built on iteration, not perfection.
And Finally: You Can Change the System (or at Least Your Slice of It)
Miranda encourages, “Can you create something that's actually sustainable for these individuals? Can we maybe even, as individuals and guides for that next generation…help to direct people?”
Private practice isn’t just an escape from the broken bits. It’s a chance to design a system that’s fair, supportive, innovative, and alive - for you, your clients, and maybe the next generation of clinicians, too.
Takeaway:
You are allowed to build the career you want. There are tools, communities, and programs to help you actually do it.
Tip:
Ask yourself: “What would it take for this to feel sustainable for me, year after year?” Then, reach out for the guidance and structure to make it real.
Ready for Your Next (Best) Step?
Let’s be real: building a private practice can feel daunting, especially when the way it’s always been done doesn’t actually work for you or your clients.
But change doesn’t have to be lonely, and you don’t have to reinvent the wheel! Kelly and Miranda are leading the way with Business School for Therapists, a step-by-step program that helps you build not just any private practice, but a sustainable, profitable one, rooted in self-knowing, clinical excellence, and a business model that lets both you and your clients thrive.
If you’re ready to do things differently, ready for clarity, support, and maybe even a little joy in the process, check out Business School for Therapists.
You deserve a practice that honors your skills and your life (and yes, you really can build it). Your clients (and your future self) will thank you!
Want more insights, free tools, and unfiltered real talk? Check out all that Kelly and Miranda offer at zynnyme. Here’s to redefining what’s possible: one confident, embodied therapy business owner at a time.
