The Business of Therapy: Surviving Economic and Industry Disruptions
Curt and Katie chat about how therapists can adapt to the changing business landscape of private practice, including fewer client inquiries, economic challenges, and increased competition. We share practical strategies for maintaining a sustainable therapy practice, improving marketing efforts, and building strong referral networks.
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Transcript
Show notes are created in collaboration with otter.ai and ChatGPT.
In this podcast episode we discuss running a private practice during economic uncertainty
We’ve heard a lot about the real-time challenges that therapists are facing in a changing business landscape. With a drop in inquiries, increased financial pressures on clients, and greater competition from virtual and AI-based services, private practice clinicians are feeling the pinch. We explore how to adapt your business model, rethink marketing strategies, and prioritize networking and flexibility to weather the storm and build a more resilient practice.
What is the current state of private practice therapy businesses?
- A drop in referrals and inquiries: Therapists are seeing fewer new client inquiries, especially compared to the pandemic boom.
- Economic pressures on clients: Some are requesting fee reductions or shifting to less frequent sessions, even when practices are technically full.
- Rising competition: Therapists are competing not just with other clinicians, but also with VC-backed platforms and AI services.
“If you’re looking to stand out, stand out as you are, and be able to express that, either online, through marketing, through your website or truly in person with referral partners if you’re going to be having an in person practice.” – Katie Vernoy, LMFT
What can private practice therapists do to navigate the current business climate?
- The need for adaptability: Offering in-person and virtual options, adjusting your fee structure, and being flexible can help retain clients.
- Business evolution: It’s more important than ever to regularly assess your practice’s expenses, operations, and marketing strategy.
- Standing out in a crowded market: Specializing in specific modalities (like DBT or EMDR) and diversifying your service offerings (e.g., walk-and-talk therapy) can help.
- Networking and community support: Building strong referral networks and staying connected with colleagues is essential in today’s climate.
- Sustainability for therapists with additional needs: Flexibility can also support therapists who are neurodivergent or living with chronic illness.
Key Takeaways from this podcast episode for therapists
- Monitor your referral trends and be proactive about filling client gaps—even if your caseload seems full.
- Adjust your practice model as needed—offering hybrid sessions or reduced fees may help sustain your income.
- Reevaluate your expenses and time investments (marketing, admin, documentation) for a more efficient practice.
- Stay current and visible by evaluating SEO, trying Google Ads, and maintaining a strong online presence.
- Network consistently—both online and in-person—to build a robust referral stream.
- Don’t be afraid to evolve. Practices that are nimble and responsive to change are more likely to succeed long-term.
“One of the things that I have found from successful practitioners is being willing to make changes, being willing to offer more evening or weekend clients, or being willing to expand into a new area of your practice that makes your practice more robust, and adding to what you’re doing.” – Curt Widhalm, LMFT
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Relevant Episodes of MTSG Podcast:
Recession-Proofing Your Practice
Managing Chronic Pain and Illness: An interview with Daniela Paolone, LMFT
Topic: Marketing and Branding
AI Therapy is Already Here: An interview with Dr. Ben Caldwell
Topic Artificial Intelligence
Making Sense of Insurance Billing and Client Referral Services for Therapists
Meet the Hosts: Curt Widhalm & Katie Vernoy
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Modern Therapist’s Survival Guide Creative Credits:
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Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
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Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that go on in our field, the things that go on in our practices. And we’ve been hearing from a lot of people in the therapist community, some of our listeners, saying, Hey, are you running into the same problems that we are? It seems like we are receiving less inquiries into our practice. The referrals seem to be going away. And we wanted to spend some time talking about what might be contributing to that, and maybe walking through this episode with some practical advice beyond just kind of lamenting. No, your referral sources haven’t just decided to ghost you. So Katie, just from the start of the episode, and I’ll kind of reflect on my practice here just a little bit when you answer your question. But have you run into the same problem that many other people are saying, that I used to get 10 inquiries a week. Now I’m lucky if I get two.
Katie Vernoy 1:17
I never have had a practice where I get 10 inquiries a week. I have, you know, chronic medical stuff. I’ve got some other things, so I purposely keep my practice smaller. And right now I’m actually full so I’m not having to face that question. I don’t know that I’m seeing fewer referrals. What I am seeing are clients who are needing, potentially a fee reduction. Clients who are, you know, shifting the cadence of their sessions. Some are actually increasing because of what they’re going through, and I think, in the background the chaos of what’s happening. But there are some that have decided to decrease or or finish treatment, partly, I think, because of what’s going on economically. So, I guess my answer is things are mixed, but I do have some ideas for folks who have fewer referrals, because I’ve had some moves that I’ve made recently that I think have helped to keep my practice full even during this time. So I’m looking forward to this conversation. I also want to make sure in this episode that we’re talking about just the shifting business landscape overall, and some things I think are wise to do right now, even if it’s separate from the referral issue. So I think let’s start here, but I want to make sure that we touch on a lot of different things, because so much I feel like is possible right now and is potentially shifting. And so a lot of folks, I think, started the their practices, when everything was online, there was a huge upswell of need and time and potentially reserved financial resources because folks were in lockdown during the pandemic. And so I think that this is a very big shift back to, I think, probably more like when you started your private practice, where the economy was kind of all over…
Curt Widhalm 3:10
In the middle of the great recession when I started my private practice?
Katie Vernoy 3:14
Yes, yeah.
Curt Widhalm 3:15
Back to those days
Katie Vernoy 3:17
Back in those days.
Curt Widhalm 3:19
I think, much like you, I, for my personal caseload, have not seen a shift in the number of inquiries to me. I’ve noticed it with some of the newer therapists in my practice, especially some of the associates that work for me. So I think at that level, there is definitely a lot of economic stress that you’re referring to that things have drastically changed here at the beginning of 2025 and we have done episodes in the past about recession proofing your practice. That when you’re starting in the middle of a recession or a recession is about to be acknowledged that it’s very hard to have done all of the prep work when you’re first getting started out.
Katie Vernoy 4:03
Oh, absolutely, absolutely.
Curt Widhalm 4:05
And so we’ll link to some of those other episodes in our show notes, but just briefly in talking about some of the bullet points around that is needing to be more flexible in how you work with especially cash pay clients when it comes to their ability to afford coming into therapy. It might be working on a reduced frequency. It might be being more flexible with what your per session fee is in order to be able to help them, if it means getting people regularly in might be at a lower hourly price, but it might be better for your practice and your treatment overall, by sliding your scale down a little bit for those clients.
Katie Vernoy 4:49
And I think that the the zeitgeist during the high times that we recently experienced, I think largely went to charge. A very high fee, hold strong, do not slide your fee, because that is somehow, I mean, at some points it even felt like a moral failing if you lower your fee. And I think the nuance of the conversation that was missing at that time, clients have value in a lot of different ways. And I’m, I hate the sound of this, because it sounds so mercenary. But yes, per hour fee, like, What’s your average fee, the number of client sessions you have, and you divide the number, you know, the total amount of money that you make for the month, and you divide it by that number, you want that to be as high as possible, or as close as possible to the number that will get you what you need for to live, to have the profit you want, those kinds of things. And there is a lot of resource and time that goes into getting new clients. There is also the hard facts that even if you have a very high per session fee, if you only have a few sessions, you’re still making a whole lot less. And so when we look at what do I need to make per month, and how do I want to make sure that I’m keeping the clients I have because it’s a lot cheaper to keep clients than to try to find new clients. I think the sliding fee makes a bit more sense even and in a business status. And certainly I think oftentimes it makes sense clinically for folks who truly need a reduced fee and want to be coming weekly or every other week, and shifting your fee to help them afford that provides clinical opportunity. And it also makes business sense, even though I think that goes against what folks have been saying for the past few years.
Curt Widhalm 6:54
I went to grad school. I started grad school around 2005 and as I mentioned earlier in the episode, ended up starting my practice, kind of great recession era. And one of the big things that was happening then, it continues to happen now, it feels like a lot of success has happened now is our profession’s efforts to get the public to embrace therapy. Hey, we need more people to come to therapy. We need more people to come in. And that really seemed to be something where a lot of the barriers to getting into therapy during COVID and the immediacy afterwards, where people weren’t spending their time commuting, they could telehealth. In that this is where I had non therapist friends sending me memes from The Onion that said therapist knows this whole gravy train of clients ends the second the vaccines announced and and it feels like there is kind of some truth to that, that as people have integrated back into more or less a I hate to use the word regular, because it doesn’t seem to fit…
Katie Vernoy 8:11
Not fit for right now, but I know what you mean, regular lifestyle, right?
Curt Widhalm 8:16
That some of the ease of getting into therapy, even with such options as online therapy, that there’s more competition for more people’s time now. So if you’re somebody who was starting out your practice in 2020, 2021, that was not normal. That was not normal folks as far as the number of people coming in. But I think that this also segues into the next point is that there is a lot more competition in just the virtual space of doing online therapy with people. And we’ve talked about this in our long, long in the past, Therapy Reimagined conference presentations and some of our previous podcasts around my practice made a very strong shift into we’re going to focus on people who want to be seen in person. Well, we’ll see the people who also want to be seen online. We think that we can benefit in that space, but I’m really only competing with the people who are in my building and down the street for clients where, if you’re working online, you’re competing with everybody whose jurisdiction is the same as yours.
Katie Vernoy 9:34
And with the Interstate Compacts and the ability to get some practicing privileges in other states. We’ve got folks all over the country potentially who are vying for clients within the same jurisdiction.
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Katie Vernoy 9:52
I want to add on to your point about being in person. I actually really like being in person. I think probably, at least half of my practice is in person, in addition to the ones who come in or or I see virtually. And so the flexibility that I think, being able to offer that, that that feels more important now than ever. If someone wants to be able to see you virtually or in person, I added some walk and talk. There’s other folks who do intensives in addition to their regular sessions. I think you do that right with the EMDR stuff?
Curt Widhalm 10:30
Yes.
Katie Vernoy 10:30
So having a flexible entry point with clients so that they get what they need. And we talked about this, and I think the episode’s called Beyond Reimagination, you know, and talking through how to make your practice more flexible. The point I’m trying to make is, if we are rigidly only providing telehealth therapy for specific lengths of time, I I have half sessions, full sessions, coaching calls and at times intensives. I’m not doing those yet, but I I’m interested in looking into them. If we’re only doing one hour once a week or 50 minutes once a week, telehealth, we will get clients. But there are clients who want some different flexibility and who also want to be able to seen, be seen in person. And so yes, you decrease your competition if you go in person, because it’s only the folks who are local who can see people in person. But you also decrease your competition if you differentiate how you offer services. And some of that is the flexibility I was just talking about. But you also, with your practice, went into DBT and some other and EMDR and some other elements that are, I think, pretty, not even recession proof, I think they’re AI proof, that that provide additional possibility for folks who want to come in to be seen in a practice.
Katie Vernoy 11:02
And that was a very intentional choice that we made in our practice. And we were you and I were talking about that in our Therapy Reimagined 2021 conference…
Katie Vernoy 12:19
Yeah.
Curt Widhalm 12:20
With everybody at that time saying, AI is not going to be a thing. Some of these online platforms, okay, but I’m I’m special. I’m going to be very specialized in what I do, but I’m going to do it online, and I’m going to do it on my schedule. And you and I had talked about this in our presentation at that time. That was, be really good at what you do, be flexible to the clients, like you’re just describing. And this is what five years of work has led to, as far as our practice, not necessarily seeing huge dips in inquiries at this time, but it’s being able to make yourself really be in the work, to make yourself stand out. And I think that that’s the part of the competition with some of the AI, some of the online stuff is that, if things have always been easy, and this is your first rodeo of really having to compete against advertising with everybody else, you’ve got to put in the work to be able to actually now stand out. The field is more crowded. The online platforms are not as easy. There’s more people and companies on Psychology Today. Rula is managing a lot of people’s profiles and practices, and they’re putting up people’s pictures and then saying, Oh, you reached out to this one. They’re not available for sessions, but we’ve got other people in our network. And is it icky and unfair and everything else? Absolutely.
Katie Vernoy 14:01
Yeah.
Curt Widhalm 14:01
But it’s but it’s also happening.
Katie Vernoy 14:03
Yeah.
Curt Widhalm 14:04
And the things that you can do are to really develop yourself, to kind of make it to where you’re competition proof in some of these ways. And it might mean doing something like I did with my practice, which is working with very specialized, very complex presentations. We talk a lot in our treatment team meetings around there is a lot of work that we have to do in sessions, and we all love the work that we do, but it is compared to some of the worried well clients that come in, they’re sessions that involve 50 minutes of work. It’s not just kind of sitting down and listening to people talk, but it’s a lot of very engaged work, and it’s tiring.
Katie Vernoy 14:56
Oh yeah.
Curt Widhalm 14:57
And our business is stable?
Katie Vernoy 15:01
Yeah, I have a different practice than you, and I’ve found some similar success because I think I have also helped myself to stand out. And I don’t work with the worried well, but I don’t work with the very high intensity, complex presentations that you do. I stand out based on niche and authority, and a lot of the times the folks I’m working with are people who are referrals from my network. They are potentially related to the career work I do or the referrals that I get from attorneys. And so my my jumping off point that sometimes helps me get clients that others don’t, I’m willing to write reports for court. I’m willing to sit with people that have high intensity jobs, high influence, and hold my own with them. And I think that’s where a lot of folks sometimes get imposter syndrome, those types of things. And so to me, I think if, if you’re looking to stand out, stand out as you are, and be able to express that, either online, through marketing, through your website or truly in person with referral partners if you’re going to be having a an in person practice.
Curt Widhalm 16:27
I want to highlight something that you’re saying here, and you use the word willing, and I think that that’s one of the things that I’m seeing in some of these musings. I want to use this positive word here. Some of these musings about the state of where referrals are, but one of the things that I have found from successful practitioners is being willing to make changes, being willing to offer more evening or weekend clients, or being willing to expand into a new area of your practice that makes your practice more robust, and adding to what you’re doing. And I think some of these musings are trying to do more of the same. It’s not evolving as a practice that is something that makes it to where we have to adapt. And I think that those of us who had practices well before the pandemic recognized, okay, we’re adapting into the pandemic, and it’s a skill set and a long term kind of idea that does make it to where there’s nothing static about what we do, and things are going to continue to change. And if you can embrace that, that’s where this willingness to add something new into your practice really does benefit you.
Katie Vernoy 18:00
And I think the the idea of willingness is a good one. And I’m already hearing in my head some of the objections that I’ve heard in other musings around, what if you have X or Y going on. And for me, one of the ones that really comes up that resonates and feels very valid is the idea of chronic illness or neurodivergence or those types of things when therapists…
Curt Widhalm 18:27
Or the other chronic illness, which is having children.
Katie Vernoy 18:32
Very true, very true. But I think the idea that if I have chronic illness or neurodivergence or those types of things, I may not be able to do what you’re talking about, Curt. I think through the way that we had a Daniela Paoloni come on and talk about chronic illness, and potentially we’ll have someone come on again soon, because that was quite a while ago, but that is the the way that her practice was able to survive was she works with other folks with chronic illness, and they and she’s very flexible, and she’s there her clients are flexible with her. And so it’s something where digging deeply into who you are and providing the flexibility that clients, potentially like you might need, helps to solve some of those problems. Because I think too many folks get either tied to some rigidity, only a 24 hour or 48 hour or 36 hour or 72 hour cancelation policy. There’s if somebody says they’re going to be telehealth or in person, if they do the opposite, then it’s a cancelation. It’s not a whatever. And there’s a lot of us who need that flexibility, both for ourselves and for our clients. And so being able to have that willingness to have a schedule that’s a little bit messier, a little bit more rescheduled without charging, those types of things may also be a way to stand out that allows for you to have a practice that works. Virtual and flexible scheduling is great for folks with chronic illnesses and/or kids, and so leaning into that isn’t bad. I think there are definitely still limitations that keep people from being able to have as full of practices as they would like because of these other limitations or other responsibilities. But I don’t feel like there’s no hope. I feel like there there are a lot of ways that we can build practices for ourselves in order to meet the moment and take care of our own financial needs. Obviously, not talking for everybody, but I think a lot of us have things that we can do if we’re willing to lean into them. I think there’s a lot of folks who created online practices for the worried well, and if AI or someone making a couple of bucks on a insurance platform or a large group platform, if they can do what you do, that competition is going to be really hard to to face.
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Curt Widhalm 21:16
Katie has made it known on the podcast several times over, including in this episode, her feelings about the size of the caseload that I carry. And…
Katie Vernoy 21:28
Your caseload is way too big.
Curt Widhalm 21:32
Some of the things that have really worked for me is even when my caseload is full. I have taken advice that Casey Truffo, who’s been around for very long time, about building private practices. Some of the advice that I had read from some of her writings back when I was first getting started out is, no matter how busy you are, continue to look for where your next five clients are coming from, and I think that that has been something that has served me well, is no matter how full Katie feels that my caseload is, part of being able to really make it to where the ebbs and flows are a little bit less risky, is continuing to put in the work to craft and grow your business. And while I imagine many of the people with the musings are not having full time case loads where they’re actively working on building waiting lists or building referrals within their group practice, like I am, but it is something where the focus on the business aspects of your business is continuing to evolve, knowing some of the trends, knowing how SEO changes are going to affect you, doing some of the research into what is actually working within my marketing plan. If I’m seeing that, hey, the number of inquiries into my Psychology Today profile is going down. Evaluating is that the one that I should be relying on, or do I need to be doing other things?
Katie Vernoy 23:18
Well, and I think online marketing is it’s tough. Because SEO, Google ads, those types of things were really great for folks who wanted to focus on online marketing, but as we’ve mentioned here and elsewhere, we don’t have the marketing budgets to be able to compete with BetterHelp and Grow and Alma and all of those, and so trying to get a big enough bump beyond those things, either you have to throw a lot of money at it. There are potentially some different mechanisms to optimize keywords. Potentially it’s differentiation things that those folks are not marketing, although they constantly change, and maybe they’re going to be marketing, you know, psychedelics or things that we haven’t thought of yet to to counteract. But, but the other thing too, when you were talking about the business elements of it, there’s another strategy that we haven’t even mentioned, and that is assessing and addressing your expenses, whether it’s time or money expenses, because oftentimes people will spend a whole bunch of money on their Psychology Today profile or on one of the other things, and they don’t take the time just to go out to coffee with a colleague. And so the money spent on that $5 cup of coffee, or depending where you go, that $10 or $2 cup of coffee.
Curt Widhalm 24:59
Who’s your two dollar coffee guy?
Katie Vernoy 25:01
I’m thinking, I’m thinking Middle America, but that maybe I’m wrong. And then there’s the, you know, $30 bucks a month for these directories. Are they worth it? Probably. But you have to assess that. There’s also different things that I’ve done to try to streamline my documentation. There’s things that I’ve done to try to decrease costs that don’t make sense. It’s a comprehensive look at how your business is working, because things continue to ebb and flow. Are you spending a whole bunch of money on SEO or on Google AdWords, and are they actually bearing fruit, or are you just getting almost to the point that you’re competing with the really large VC backed companies? And so to me, assessing all of your expenses is another way to make your business sustainable in the current market, because you may have less revenue, but that does not mean that you have to have significantly less profit.
Curt Widhalm 26:04
Really competing competition is what we’re talking about. There is a lot more providers now than there have been five years ago, and it’s testament to some of the efforts that we were putting in 20 years ago as far as saying more people should be therapists, there should be more therapists. Careful what we wish for, I guess is what it comes down to in the in the practice competition space. But really, with some of the online stuff, what you’re describing is it’s a David versus Goliath issue when it comes to some of the VC backed companies having the marketing budgets of a small nation someplace that goes against your worries of, oh, it’s costing me $30 or $50 new clients to be able to come in, as well as looking at a lot of the established practices that have been out there and are maybe in a more privileged starting place, as far as being able to weather some of the tougher changes that go on when the economy goes sideways and upside down and then back up and sideways again. And that’s just a Tuesday in 2025 America.
Katie Vernoy 27:27
Yes.
Curt Widhalm 27:29
But I think the takeaway that I want to give is that this is where we have to continue to evaluate what’s working and then make shifts. And it’s not a set it and forget it, type profession. That there’s a lot of things that we can do. We can specialize and we can focus, and that helped, and it helps, and that might be 4% help, but you have to be able to let go of the things that used to work and continuously look at what you’re doing with fresh eyes and be willing to let go of your creature comforts in order to actually run a business.
Katie Vernoy 28:13
And just remembering that your competition is not only or not really other therapists, it’s these big VC backed companies, it’s aI therapists. It’s, you know, other types of chat bots, self help chat bots and coaches. And so I haven’t done this assessment as recently, but I found that by and large, my referrals are more from other therapists than other types of professionals. Now, I do get a lot of referrals from other professionals and other opportunities, but coming together as a community and identifying how do we work together? How do we help those referrals keep flowing? How do we specialize? How do we meet the needs of our communities? Those things are all really important, and isolating at home behind your computer isn’t going to necessarily take you the full distance, and whether that network is virtual or in person, I think we have to grow our networks at this point, there’s, there’s no other way, I think, for therapists to really sustain. So it does not have to be an in person, get out and go put on pants and grab a coffee. It can be virtual, but you have to have a network at this point.
Curt Widhalm 29:38
We would love to hear your thoughts on what’s working for you. Also your thoughts on the show and some of the best places to do that is follow us on our social media. Comment. Give us feedback. Follow us in our Facebook group, the Modern Therapist Group, to continue on with this and other conversations. You can find our show notes over at mtsgpodcast.com and until next time I’m Curt Widhalm with Katie Vernoy.
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