What Nobody Tells You About Starting Your Own Therapy Practice
Or Why Leaving a Group Practice
Might Cost You More than You Think
This is part two of an ongoing series on the real economics of private practice.
If you have not read part one yet, start here: Private Practice Therapist Salary: The Costs Behind Solo vs. Group Practice
Thinking About Starting Your Own Therapy Practice?
The decision can look deceptively simple from the outside. You may be comparing the percentage you keep in a group practice to what you could make on your own and wondering if leaving would give you more freedom, more income, or more control.
But that comparison rarely tells the whole story.
This is part two of an ongoing series on the real economics of private practice. If you have not read part one yet, start here: Private Practice Therapist Salary: The Costs Behind Solo vs. Group Practice.
In the first post in this series, I broke down what a group practice actually pays for and why the percentage you keep is not the same thing as what you net. If you have been wrestling with the question of solo vs. group practice, that post gives you the financial foundation. This one gives you the rest of the picture.
Because here is what that breakdown does not capture: the weight of what it actually takes to build and sustain a practice from the inside. And what it actually costs you when you walk away from one that is working.
Starting your own therapy practice is not only a question of income. It is a question of infrastructure, risk, support, sustainability, and how much of the business you are prepared to carry yourself.
What I Learned the Hard Way About Starting My Own Therapy Practice
Owning a group practice will require you to become someone who is comfortable with constant change.
The moment you feel like you have a system dialed in, something shifts. A clinician is out on medical leave. A payer changes their reimbursement rates. A policy updates. A tool you built your workflow around stops working the way it used to.
Ownership is not a problem you solve once and maintain. It is a living thing that grows and changes on its own timeline, whether you are ready or not.
The best analogy I have found is parenting. The second you finally get your baby's nap schedule figured out, they are old enough to drop the nap entirely. You do not get to stay in the stage that finally felt manageable. You just get better at adapting to the next one.
If operational uncertainty genuinely rattles you, that is worth taking seriously before you make the leap. It does not mean you cannot do it. It means you will need to actively build that muscle, because the practice will demand it of you anyway.
The owners I have seen struggle most are not the ones who lacked clinical skill or business knowledge. They are the ones who wanted stability or growth without understanding the necessary ebb and flow of both.
The goal of a mature business, similar to parenting, is not to get it perfect early. The goal is to keep adapting and improving long enough to reach the stage where all of those early growing pains actually make sense. Where you have a more independent, sustainable practice with delegation and reliable systems that can function without you in every room at once.
That stage exists. And it is worth the chaos it takes to get there.
This is one of the parts of starting your own therapy practice that does not always show up in income calculators or percentage comparisons. The business keeps changing, and you have to keep changing with it.
What Is Actually at Stake When You Leave a Group Practice
Here is the part of this conversation that does not get said enough.
When a clinician leaves a well-run group practice to go independent or to join a platform, the question they are usually asking is: what percentage do I keep?
That is the wrong question.
And I say that not to be dismissive but because I have watched people make significant career decisions based on a surface comparison that left out most of the actual costs.
In part one of this series, I walked through what the group practice percentage actually funds.
A well-run group practice often provides the infrastructure that makes clinical work sustainable. Credentialing. Billing. Denial management. Intake coordination. Marketing and SEO. Supervision and consultation. Liability and legal infrastructure. The referral pipeline that keeps your calendar full without you spending unpaid hours building it.
When you leave, you are not keeping that percentage. You are taking it on.
A Note About VC-Backed Therapy Platforms
If you are considering leaving for a VC-backed therapy platform, I want to be especially direct with you: what looks like a higher take-home in the short term often comes with rate controls you did not negotiate, payer access you do not own, and a support system that is designed to route you away from humans when something goes wrong. I have written separately about the platform question here.
The comparison has to be honest. And the honest version includes what happens to your income when a payer drops off a platform overnight, what happens to your caseload when you lose referral infrastructure, and what it actually costs in time and money to build everything from scratch that a good group practice was quietly doing on your behalf.
A Better Question to Ask Before Starting Your Own Therapy Practice
Instead of asking: what percentage do I keep?
A more useful question is: what infrastructure am I buying back?
Group practice percentage is not a tax. It is a trade.
Less business risk. More clinical focus. More support. More sustainability. More long-term growth. And if you find the right practice, a community that actually has your back.
The clinicians who thrive in group practice are the ones who understand that the split is not what they are giving up. It is what they are buying. The infrastructure, the referrals, the billing system, the person who answers the phone when a client calls in crisis and you are in session, the supervisor who notices when a case is getting heavy.
Is Starting Your Own Therapy Practice the Right Move?
There is no single right path.
Starting your own practice may be the right move for some clinicians. For others, staying in a group practice, joining a different team, or choosing a hybrid model may better support their clinical work and personal capacity.Solo practice, group practice, W-2, 1099, and hybrid models can all work depending on your season, your values, and your goals.
But make decisions based on the full financial picture, not just the surface percentage.
A good group practice is not taking your money. It is building the structure that makes your work possible, ethical, compliant, and sustainable. And it is carrying a weight that is much heavier than it looks from the outside.
I am still carrying it. And I would not trade it, because I believe in what we are building.
If You Are Thinking About Starting Your Own Practice
Talk to someone who has done it. I offer professional consultation for clinicians thinking through exactly these questions. Whether you are considering going out on your own, evaluating a group practice, or trying to understand what your current arrangement is actually costing you, I am happy to think through it with you. You deserve clarity and not a sales pitch.
Get educated on the business side. If you are serious about private practice in any form, I recommend the Practice of the Practice Academy as a resource for therapists building sustainable practices. I am an affiliate because I believe in the content.
Consider whether a community might be the right fit. If you are a licensed clinician interested in what a well-run, specialty group practice looks like from the inside, we are building something at The And Way Therapy that we are proud of. Contact us here for more information.
Whichever path you choose, make it a real choice. Not a default. Not a reaction to a frustrating week. A choice made with the full picture in hand.
You deserve that.
Kelsey Blahnik, LCSW-S
Founder, The And Way Therapy
OCD and Trauma Specialists | Austin and Dripping Springs, TX | Virtual Across Texas and Florida
If you are a clinician thinking through what sustainable practice looks like and want to explore whether The And Way Therapy might be a fit, reach out to The And Way Therapy
Learn more about LCSW supervision with us
If you enjoyed this article, check out Private Practice Therapist Salary: The Costs Behind Solo vs. Group Practice.
FAQs About Starting Your Own Therapy Practice
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Therapists should consider more than the percentage they may keep. Starting your own therapy practice means taking responsibility for billing, credentialing, marketing, referrals, legal and ethical infrastructure, scheduling, intake coordination, and business risk. For some clinicians, that independence is worth it. For others, a well-run group practice may provide support that makes clinical work more sustainable.
For many clinicians, insurance paneling can take months and may involve confusing portals, repeated documentation requests, and limited communication from payers. This is one reason some therapists turn to credentialing platforms or therapy billing platforms for support. However, therapists should understand what they are giving up in exchange for convenience, especially when it comes to rates, billing control, and long-term practice ownership.
But the bigger question is not just what a therapist earns.
It is what they actually keep after business expenses, taxes, marketing, billing, consultation, legal support, technology, and unpaid time are accounted for.
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There is no single right answer. A group practice may offer referrals, billing support, consultation, supervision, systems, and community. A solo private practice may offer more independence and control, but it also requires the clinician to build and manage the business infrastructure themselves. The better choice depends on your season, goals, capacity, and tolerance for business risk.
A therapy platform may give therapists access to insurance clients through the platform’s payer relationships, but that access is usually tied to the platform’s terms. If the platform changes rates, removes billing options, drops a payer, or changes how certain session codes can be used, the therapist may have limited control. That does not mean platforms are always bad, but they should be viewed carefully and strategically.
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A group practice may provide credentialing, billing, denial management, intake coordination, marketing, SEO, supervision, consultation, liability support, systems, and a referral pipeline. These supports can reduce the amount of unpaid administrative and business work a therapist has to carry alone.
However, therapists should be cautious about building their entire private practice income around a platform they do not control. Independent insurance panels, professional credentialing support, strong billing systems, and thoughtful practice infrastructure can create more long-term stability. The goal is not to avoid every platform, but to make sure the platform is not the foundation of a practice you cannot afford to lose.
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Leaving a group practice can cost more than expected because therapists are not just leaving behind a percentage split. They may also be leaving behind billing support, credentialing, intake coordination, marketing, referrals, supervision, consultation, systems, and administrative help. When a therapist starts their own therapy practice, those responsibilities either become unpaid labor or new business expenses. A higher percentage can look appealing, but the real question is whether the therapist is prepared to replace the infrastructure the group practice was providing.
Written by Kelsey Blahnik, LCSW-S
Kelsey Blahnik, LCSW-S, is an author, clinician, and creator of The And Way model. She is an advocate committed to bringing peace and justice into our politically divided world. With extensive experience in behavioral health, including work with substance abuse, unhoused individuals, and veterans, Kelsey has witnessed the impact of division on communities. She is the owner of a thriving online group therapy practice, The And Way Therapy, and author of the book The And Way: Assertive Peacemaking in a Divided World.
Outside the therapy room, you’ll usually find her reading, hiking, or enjoying matcha.
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