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Why You’re Exhausted in Private Practice: The Hidden Work Behind the Client Hour

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Why You’re Exhausted in Private Practice: The Hidden Work Behind the Client Hour

If you’re exhausted in private practice – even with what looks like a manageable caseload – you’re not imagining it. Seeing 20 or 25 clients a week does not mean you’re working 20 or 25 hours. Every client hour includes administrative tasks, financial decisions, emotional labor, and executive responsibility. In this episode, Curt and Katie break down the hidden work behind the client hour and why private practice burnout often comes from the business reality, not just clinical work.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

In this podcast episode: Why You’re Exhausted in Private Practice (It’s More Than Clinical Work)

Private practice is often framed as flexibility and freedom. But the day-to-day reality includes:

Chasing insurance reimbursements
Managing cancellations and no-shows
Updating paperwork and systems
Making hard financial decisions
Supervising staff (for group practices)
Switching from warm therapist to analytical business owner – sometimes within minutes

That cognitive and emotional switching adds up.

Key Takeaways for Therapists on Private Practice Burnout, Mental Load, and Business Reality

“Running a private practice is a never-ending series of tiny, unsexy things you don’t want to do… but if you don’t do them, the whole house smells.” – Curt Widhalm, LMFT

Each client hour often requires 30+ additional minutes of administrative and executive work.
Emotional task-switching (therapist → CEO → supervisor → bookkeeper) drains capacity.
Burnout in private practice is frequently driven by business demands, not just client intensity.
Overfunctioning can show up as under-billing, blurred financial boundaries, or absorbing systemic problems.
Sustainable private practice requires intentional systems and protected CEO time.

“There is a finite amount of resources, and we can’t keep stuffing it in.” – Katie Vernoy, LMFT

Exhaustion is not a character flaw. It’s often a math and systems problem.

The Real Math Behind the Client Hour

If you see:

20 clients per week → expect roughly 10 additional hours of practice management
30 clients per week → that can mean 15+ additional hours

Documentation, billing, scheduling, email, financial review, and maintenance all expand the true workload.

Private practice isn’t just therapy. It’s therapy plus executive functioning.

Understanding the real math of your time (and your actual take-home income after expenses) is essential for sustainability.

Practical Strategies Discussed

Audit where your energy is leaking
Batch executive tasks instead of sprinkling them between sessions
Reduce small irritants that erode patience
Be intentional about sliding scale and unpaid labor
Accept what the job actually requires, not what we hoped it would be

This episode isn’t about working harder. It’s about working with clarity.

Resources on Therapist Burnout and Sustainable Private Practice

Katie’s blog posts on time management:
Curt’s blog post on the real math of private practice revenue:
- The Math is Mathing (But You’re Doing it Wrong): Income vs. Revenue
See below for previous episode on systemic burnout, on sliding scale and pricing

Relevant Episodes of MTSG Podcast

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.

Join the Modern Therapist Community:

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Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

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)

… 0:00
(Opening Advertisement)

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 0:13
Welcome back, modern therapists. This is the 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 practices, the things that go on in our profession. And last week, Shaina Seiber gave us a master class in why we’re all so exhausted. She spoke about the cardigan being on fire at systemic identity level burnout for the very structures of our economy, healthcare, feel like they’re collapsing. If you haven’t heard it, go back and listen to it, but keep a fire extinguisher nearby. Also link to that episode in our show notes over at mtsgpodcast.com. Here’s the thing, once you’ve acknowledged that fire, you still have to go into your office, sit in your chair, realize that your Wi Fi needs to be reset, find out that a client just forgot to pay their session fee. You’re out of tissues. That all of the stuff that just kind of accumulates, and so we’re kind of framing this episode as running a private practice, even with all of the larger macro system stuff that Shaina talked about last week, running a private practice is still a lot like parenting, a lot of just things that come up that you don’t want to have to do all of the time, but you’re the adults in the room. You’re the one who’s running the practice. If building a practice is the shiny part that all of the coaches are trying to sell you on, running the practice is like parenting. It’s a never ending series of tiny, unsexy things you don’t want to do, but if you don’t do them, the whole house smells. So we’re moving from Shaina’s macro systems trauma to micro administrative paper cuts. So, Katie, what do you want to start the episode on? We’ve thrown out a lot of ideas before we hit record. Where do you want to jump in?

Katie Vernoy 2:33
Well, I think, I think the micro paper cuts maybe is underselling what we’re going to talk about here. Because I think there’s the the working title that I’ve had in my head is private practice is heavier than you think. And part of that is, I think, the mental load, or the emotional load of what the work is, but also all the other pieces, chasing down insurance, addressing no shows and cancelations, responding to inquiries, even just being fully present. And I think that at least when I was in community mental health, there was this element of you go into private practice and you’re rolling in beds of money, and it was super easy. And I know we did some episodes on, you know, private practices more than Tiktok would have you believe that we’re not all doing yoga every morning and having a couple of clients a day and making a bazillion dollars, but there’s so many pieces to it that when we are under resourced based on what’s happening in the world, what’s happening in our personal lives, all of those things that that list of things that we have to do, or the unexpected things that we have to do, is way bigger than I think any of us really realize, and it feels so daunting when we’re under-resourced. And so I guess part of this, I’m hoping that there’s some, hey, you’re exhausted, and there’s some obvious reasons why you’re exhausted, because of the of the world and all this stuff, and because you’re potentially underestimating how much your private practice really is requiring of you. And so wanting to do some normalizing, some reality testing, and then my goal is to try to support folks, and whether it’s setting up their their micro systems to support them, or even just trying to better assess and address what it is that we do so that you have that you’re taking care of, taking good enough care of yourself.

Curt Widhalm 4:36
So this is not an episode where we are just going to list out: here’s all of the things that you have to do as a practice owner. We’re going to use some of those to illustrate some examples here. But we want to kind of make sure that this is really about the idea, that this is about kind of the emotional aspects that go into having to have kind of that bird’s eye and global view of ultimately being a small business owner who happens to do therapy. And that being kind of the financial income, but when you’re also looking at, well, who’s the one who needs to go and clean the coffee stain out of the waiting room rug because somebody’s parent or kid knocked something over there that there’s a lot of things that end up developing that also contribute to the ways that we we react. So it goes beyond just kind of the janitor role, but one of the things that really stood out to me in getting this episode ready is just how often in my practice, so I run a group practice, we’re also going to talk about this from kind of a solo practice sort of aspect, but the amount of emotional code switching that has to happen throughout the day. That back when I did agency work, it was really nice to be able to see a client and then do a note and then maybe go to the bathroom or refill my coffee and chat with a co-worker and then go see the next client and rinse and repeat throughout the day, but at various times throughout my career. Now what my between sessions times look like is get the client out the door, answer an employee question about their paycheck or their sick time hours, and then needing to quickly transition into restocking something for our employee break room, and then being able to have to switch to dealing with a client who might be in sort of a crisis type situation, and then switching back to being able to talk to my bookkeeper in the next thing. And so all of those things require different kinds of emotional capacities and different kinds of decision making that ends up needing to have a different touch and a different approach, because some of that is very, very warm kind of wanting to make sure that the environment is safe, to potentially needing to make a kind of cold business owner decision, into needing to be able to look at global financial aspects, that that stuff really wears people down. And through the course of the years that I’ve been running my practice, I’ve been able to better incorporate some of those systems. But the more that I become stressed, the more that I recognize that my systems are largely based on not having to do that kind of emotional switching as frequently.

Katie Vernoy 7:52
It’s interesting, because when I first started really digging into how to run a business and how to decrease the task-switching those types of things, part of it was delegating some of these things. Get a bookkeeper. Have you know someone else, purchase things, you know, whatever it is, right, like anything that doesn’t require your particular set of skills delegated away. And so I delegated a lot of that away. And then I found out that I needed that downtime of buying the Kleenexes or doing some, you know, some of the more administrative tasks. But when you’re talking about the other types of switching, where you’re going from supervisor slash business owner to very warm therapist, I think about that’s kind of how I ended up being raised in community mental health, because I was, at the end, I was a manager, and so there was less clinical work, but it was still trying to put in the empathic, compassionate leader into the decision making, which I don’t know if that makes it any easier, because it’s like, I’m still showing up in the same way, regardless if I’m seeing a client or doing a client complaint or whatever, and talking to a parent or if I’m talking to an employee. But what I found is the more that you became kind of present and bringing the same version of yourself into every arena, there was that emotional toil of the cold, hard business decision, and so it wasn’t okay I’m turning that off, and now I’m, you know, I’m switching. It’s, I’m it’s the same me facing a different decision and feeling heartbroken that I have to stop offering a service, or I need to terminate a client, or when I was working as a boss, I have to do a performance improvement plan, or I have to fire somebody, or whatever it is. Like those, those cold, hard, quote, unquote decisions, I think if you switch, it’s exhausting. If you don’t switch, it’s heartbreaking. And so it’s, it’s, it’s really there’s I go back to, it’s a lot heavier than it looks, because the work itself, the clinical work itself, is so emotionally taxing if you don’t have the resources and all of the things, and then to put those administrative pieces or the business pieces on top of it, it’s just exhausting. It’s just really exhausting. And so when I don’t have resources, it just feels like too much. And so, I mean, I don’t want to keep going to like, Ah, this is so horrible, because I don’t think that’s helpful, but it is a lot.

… 10:38
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Curt Widhalm 10:40
It is a lot, and I think that some of this is just kind of emotional labor. And I think that this is really where I’m framing some of the takeaway for this episode is being able to kind of audit where some of the emotional labor stuff does pop up.

Katie Vernoy 10:59
Sure.

Curt Widhalm 10:59
And some things, you know you’re gonna see those therapists, coaches out there who are telling you to build your practice and delegate things. And that works for some things, but some things are really necessary. I love being the one who has to go and pick up the mail from our mailbox, because it gets me out of the office for five minutes.

Katie Vernoy 11:19
Yeah.

Curt Widhalm 11:20
You know, that is something where that time could be used for any number of high level, you know, executive kinds of tasks that me as the business owner can do. But it’s also literally, if that doesn’t get done by me, I might not leave my office suite for the entire day. So some of this is being able to kind of address that feeling of the always on vigilance that we can develop, and that’s, you know, true, no matter what kind of small business that you have, that you’re constantly worrying about what happens next. There’s no true like clock in clock out time, but it’s being able to embrace some of these tasks as something that does help to reset you. But a lot of the stuff that does come up doesn’t tend to be scheduled. You know, there’s a lot of the unscheduled stuff that pops up. The there’s a plumbing leak in your office. There’s a glitch in the EHR system. A client calls you and says, you know insurance isn’t going to reimburse our sessions anymore. And rather than calling their insurance company, they’re calling you. So you’re spending 15, 20, 30 minutes on the phone trying to walk them through the bureaucracy of the healthcare system while also simultaneously worrying about, well, there goes my income for this, and potentially having to refer somebody out that’s built a trusted relationship with you. So you’re navigating a lot of different levels of potential stressors that are going on here. You know, keeping our parenting theme going through it’s the Hey, our taxes are due tomorrow, and our kid is coming to us because they’re being bullied at school. And it’s not something that you can just kind of drop. But you also know, and you’re calculating in the back of your head, all right now I’m going to be staying up an hour later tonight because I’m not able to get this done now.

Katie Vernoy 13:27
Sure. One of the things that that Shaina talked about in the interview that we put out last week was this idea of burnout being a fawn response, kind of over functioning. And and I think there’s the fawning and the over functioning, and then one of the other obviously one of the other F’s is flopping, right? And so I think what I’ve seen for myself and for other folks that I’ve talked to and worked with is that there’s the over functioning, I get everything done, I’m going to make sure every every need is met right when it comes, and then there’s the flopping of I can’t do anything else, and so I’m barely showing up in sessions. I’m not calling people back, I’m not doing all these pieces. And so everything feels like a mess. My my inbox is overflowing, and I have no idea who needs something from me. And I think that being able to address that with systems in place to not derail everything for an inquiry about insurance, for example. That’s potentially timely but not urgent, whereas a leak in your office maybe is urgent and timely. And so it’s being able to do some prioritization. Shaina called it compassionate prioritization, and sorting through, how do I make sure I’m taking care of myself so I’m not over functioning, but I’m functioning well enough, and I’m not flopping because I’ve run out of gas. And so it’s, it’s hard, because not everyone can stay up that extra hour to get the taxes done after their kids come home bullying, like, that’s, there’s not resources left, whether it’s, you know, kind of actual physical or even mental and emotional, like, there’s, there is a finite amount of resources, and we can’t keep stuffing it in. And so, I have my thoughts Curt but, but when you actually because you seem like you’re indefatigable, but when you actually run out of juice, how do you make those decisions when your capacity is less than what you feel like you need or should be doing?

Curt Widhalm 15:37
So I try to do kind of a ‘fuck it’ audit. Every so often, like what

Katie Vernoy 15:46
I love that we’re a podcast, and I just have to put a little E on this, because we’re now calling it a FUCK IT audit.

Curt Widhalm 15:53
Since we’re already putting an E on it, let’s just lean into the E here.

Katie Vernoy 15:57
All right. All right. The explicit, for those that don’t know what I’m talking about.

Curt Widhalm 16:03
There’s an economy of how many fucks I have to give. And when things are going super well, I can just kind of throw fucks at lots of different things throughout the day, and I can have a teenage client that is super into a new anime, and I can pull things up in between sessions and waste some of my fucks to give on learning something brand new. So that way I can meet a kid in the world that they are. And some days, those fucks get taken away from me and they are put into obligations. And some some weeks or months, it ends up being just kind of constantly taken away. And this can be professionally, it can be personally, usually a combination of both. And every so often, I have to sit down and I have to say, okay, when all of my fucks are taken up, what are the things that are falling behind? What are the things that I stop caring about that don’t get done? And from that list, that’s what I decide, what can be delegated, what what can be offloaded to somebody else, or what are the things to make those things go away? Is this the the parent that is sending too many emails, demanding too many phone calls in between sessions. You know what we do to deal with that on our list, we start scheduling and charging for a parent session at least once a month to be able to deal with those concerns. That that helps to prioritize things, and it moves things off of I’m not wasting my time on this, because bridging from some of what Shaina is talking about and some of that fawning response sorts of stuff, is that when we stop really caretaking ourselves in some of this, when we start to just throw some of this fucks at other problems. We tend to stop billing for stuff that we should be billing for. That’s not just bad business, but that’s essentially paying for somebody else out of our own pocket, with our own time and our own cares to give, and that contributes to our loss of professional agency. So I actually somewhat regularly try to put some time in place as far as what is taking up some of this energy, so that way, I hopefully am not wasting so many of my fucks to give just in being able to pay for other people’s lives at the cost of my own.

… 18:45
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Katie Vernoy 18:46
I think I’m similar. I think I frame it in my head a little bit differently, though. So for folks who frame it similarly to me, maybe I’ll share what I do. But when you’re talking about your fuck it assessment, I look at almost daily, but at least weekly, I go through and I assess, what is it that I need to be doing? What are the most important things? Every once in a while, I’ll do a download of all the things I could do, all the things that I feel like I probably should do, and I sort through them, and I try to decide what are the things that actually are worthy of my attention and that need to happen now, whether it’s a timing issue or whether it’s something that feels more aligned and and in that, I do get more agency from it. You know, when I when I don’t have the time to do it, whether it’s just like I, for whatever reason, I have, like, tons of back to back sessions, and I’m just, I feel like I’m running and running and running, and I don’t have the opportunity to actually think through what it is I’m doing and what, you know the bigger tasks are. Obviously, I need to do progress notes and billing every week. I need to see clients every week. You know, those types of things I don’t, well I do put on the list: Remember to finish up your progress notes, so that I give myself space for that. But I I think that when I’m not able to do that list and refine it down to what is it that I’m going to focus on this week? It feels very chaotic to me, and I know part of that’s the way my brain works. So I’m not saying that everyone needs to do that, and some folks might feel very caged in by a list that gets as draconian as mine does. It’s, you know, oftentimes it’s a couple of things that I focus on at a time. But for me, that gives me enough agency to say I am, when I’m doing these things, I am appropriately spending my time. I’m throwing my energy into something that’s meaningful and valuable in some way. I think about before the holidays, you know, the first couple of weeks in January, I spent a lot of time on something that, right now would seem ridiculous, but it felt very valuable. I went and I completely redid all of my forms because they had gotten bulky and out of control. There was a lot of duplicative stuff. And so I spent, I don’t know how many hours just digging into it. And I I was into it. It was fine. And I feel so relieved that that’s done, because I feel like I’ve cleaned something up. But any other time of the year, because I had fewer clients, I knew that there was updates that I needed to incorporate, so it made sense. Any other time of the year that is not happening. I’m not, in your parlance, throwing any fucks at that. I give myself a particular time of year where I say I’m going to assess and make sure all of my forms are up to date. And being able to allot that time to a task that otherwise is fairly boring to me is kind of how I manage those things. This week, because of it being, you know, the middle of February, I think both you and I were talking to our accountants and doing taxes and stuff. That is not something I normally feel like I want to be doing. Yes, people need to look at their finances. They need to make sure that they’re making what they’re making. They need to assess the expenses all of those things, and sometimes there are reasons to do it more urgently, but this week, it felt kind of good. It felt like it was just like a little house cleaning, because I was like, Oh yeah, I need to tell my bookkeeper, you know what this means and what these these expenses are for. And Curt, you and I are going to sit down and address our expenses too, because it makes sense. But on a day to day basis. In the middle of April, after taxes are done and things are just rolling, it may feel harder to identify what is the thing I need to be focusing on. And I think that assessment oftentimes is, I don’t know what the word is I’m trying to look for here, that assessment can feel hard when there’s no urgency and there’s a lot of demands and you’re already exhausted. And so I think, I think to refine that, I think beyond the fuck it assessment like what matters and what doesn’t, I think there may be some basic principles. And I think I wrote a blog post about this, and I’ll put that at the in the show notes over at mtsgpodcast.com but the things that as a business owner, it makes sense to pay attention to, and one of them is one of the things that you said, which is, make sure that you’re getting paid. I think there’s crisis, I think there are specific things that are pretty helpful. As far as if I don’t have a lot of resources, this is how I decide what gets my attention. And so I’ll put that in the show notes.

Curt Widhalm 23:33
And I think that this is what Shaina was talking about, as far as ways that over functioning can show up. Because if you have a never ending list of things to do, which I also do, and shout out to all of the practice owners with ADHD that can find themselves just overwhelmed with…

Katie Vernoy 23:55
Sure.

Curt Widhalm 23:56
…here is a mountain of a list. And so what’s less, you know, stunning to have to start addressing any of it is going and playing games for a couple of hours. The list will always be there. There’s so much value and potential. And…

Katie Vernoy 24:15
Yes.

Curt Widhalm 24:15
But…

Katie Vernoy 24:16
But, but, I would just want to say, so playing games might actually be fun and give you a little bit of respite. I find that sometimes what I end up doing, if I’m in that space, is I just start clearing my inbox, and it’s my email inbox, and it’s useless stuff. It’s like, oh, I should have deleted this before. And so I spend, I don’t know how long it is, like, I go into this fugue state where I’m just, you know, trying to empty the inbox, and it doesn’t ever really get that much better. And it’s, it’s, it’s stupid stuff that doesn’t actually push the needle very far in getting things accomplished that need to be accomplished. So I just want to acknowledge that there’s, there’s healthier and less healthier ways to kind of dissociate when you’re overwhelmed.

Curt Widhalm 24:58
Yeah. So some of doing this is minimizing the amount of that, switching between empathetic tasks. And you know more, you know kind of, I don’t know, the parlance of the right brain versus left brain tasks. It’s not sprinkling in admin tasks throughout the day, but it’s being able to organize that so that way, it’s not just this illusion of control and this illusion of doing things, but it’s more intentionally attacking what needs to get done. You know, it doesn’t necessarily have to be super rigid, but being able to move out of this over functioning, doing things to do things, but actually doing things to get them done is one of the ways of being able to address it.

Katie Vernoy 25:53
And I want to, I want to add on to that, because I feel like that piece of advice is it’s, it’s it’s accurate, it’s good, and it’s under explained, I think, because I think for myself, if I didn’t allow for some task switching, I would get frozen because I don’t want to do this thing that’s in front of me. I don’t want to finish it, and I can’t move on because I’ve not finished it. And so I think it’s, don’t task switch without thought. Don’t task switch just to distract yourself. And so, I mean, we’ve talked about this before, but like the Pomodoro method, where you have a timer, and so you do 20 minutes, or 25 minutes, or some people have done 50 minutes, whatever it is that you have a timer, and you do the task for that amount of time, and then you task switch, and maybe you do nothing related to work at all, or maybe you do a different task. But to me, I find that if I force myself, if I say I’m going to do something for two hours, unless I get in the groove, that two hours could be torturous of me just beating myself up for not doing the thing that I said I would do at that time. And so I’ve actually gotten a lot more flexible in that, because I was for a long time a proponent of time blocking, and I still think it’s a good idea, and I do think deep work is a good idea, but I do think that there’s that element of being able to address it at the level that you in a way that works, the way that your brain works. Maybe that’s how I’m trying to say it.

Curt Widhalm 27:21
I like the intentionality of what you’re talking about, and I think that with some of what you’re talking about, one of the questions that I ask myself, and I’m encouraging all of our wonderful listeners here, to also look at this, is when we are in those over functioning sorts of states, are we doing it to just kind of save ourselves or save our clients from the larger world that’s going on. That if there’s things like taking on sliding scale clients, you know, in in theory, we agree that we are going to subsidize somebody else’s care with money out of our own pockets, because that’s what sliding scale is. And in return, those clients are going to be phenomenal clients who are going to appreciate the sacrifice that you are making and create no extra issues for you whatsoever. That is the agreed upon trade off, at least in the back of our mind. It is not true in practice, and some of the over functioning that we can do is, here’s a client that just looks so wonderful to me that I am willing to again, subsidize them. And therefore, if I’m willing to make this trade off for them, they must love me so much that they are not going to push back or create any other burdens for me. But…

Katie Vernoy 28:51
Well, I think it’s getting your head around that that’s not the case, right?

Curt Widhalm 28:54
It’s not the case, but it’s that if we start to erode some of the boundaries that we have with clients like this, and I’m not saying that this is necessarily something that they do intentionally, but this is something that does mean that you are taking on some of these systemic pressures yourself, and oftentimes setting yourself up for taking on more than you actually think that you are. And so this can lead to kind of this, I don’t know, hyper normalization, that there is just always something that we have to be doing, and if we don’t, then we’re just going to need to take on something else. So be very, very intentional about where you are really, kind of, you know, showing up and taking on and subsidizing other things in your life, because you might just be trying to fix a bunch of problems by creating more problems for yourself.

… 29:59
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Katie Vernoy 29:58
So there’s a lot we could talk about with that, and we’re getting short on time, and so I want to respond to that a little bit, but we do have other conversations that go deeper into it. We’ve got sliding scale conversations and other interviews that talk about pricing and those types of things. But I think the thing that maybe I want to go to in this point is the little bit of very quick and imprecise math that we did before we hit record, which was looking at how much work is required per client hour. And the way we were looking at it is, if you have like, a 20 plus person caseload, probably you’re spending about 10 hours on kind of practice and client follow up. And so that that ends up being, with the simple math that we’ve put together here, about a half hour extra. So for every hour session, or every 50 minute session, you’re spending an hour and a half. And so when we look at that, and we look at capacity, I think it’s important to recognize, time wise, what that means. So if you have a caseload of 30, most likely you’ve got 15 additional hours of admin and other stuff. You know, I guess at some point there is a scale you don’t have to buy, you know, one and a half times the Kleenex boxes. But but there is, there is a certain amount that every client requires a certain, certain amount, and there’s going to be clients that take more of your time and clients that take less of your time. I think the other piece is that you did a really nice blog post about the math is mathing, but we’re not talking about it properly. I think that there’s a lot of expenses and other things that go into a practice that we don’t think about right away. And if we’re just looking at what money we’re bringing in, it can seem like, wow, we’re making $80,000, $100,000 $150,000, a year. And in fact, we’re actually bringing home a fraction of that because of all of the things that we do need to pay for, whether it’s health insurance or office space or or whatever it is, you know, there’s going to be expenses that are going to eat into that. And so doing the actual math for the money you need to make, and also doing the actual math on your capacity to do the work. Time is is finite, but so is your physical capacity, So is your mental and emotional capacity. And so whether it’s a sliding scale, whether it’s it’s taking insurance, whether it’s whatever it is that you’re doing that’s going to cost more of your time and pay you less of the money. I think it’s important that you factor that in and you make a really clear assessment of it, because if you have no time for rest, you have no time for downtime. And I want to push back on one of the things you said earlier, Curt, which there’s no clocking in and out if you’re not actually setting times where you’re working and not working and you’re kind of always on and available, which I understand, DBT folks, you know sometimes you are kind of always on and available, but if you’re not setting some structure and boundaries around that, not only are you going to feel the moral injury of the work, you’re also going to actually be physically burned out and potentially even physically ill or mentally and emotionally exhausted and potentially ill, because you’ve under estimated how heavy this lift is, and you’ve tried to put yourself, whether it’s over functioning or just underprepared, into a situation that you don’t have all the tools in place for.

Curt Widhalm 33:37
So I think as kind of takeaways is look at where you are just kind of throwing away time or energy. And you know, I think you’ll hear from any number of therapists, coaches, social media influencers, this includes us. But I think getting more into the practical aspects of this is it’s moving beyond efficiency, and it’s actually moving into moving the needle. That you can, you can delegate things, and you should, you know, the stuff that takes up, you know, things in your day, but you should also look at, what are the things that slowly just kind of erode my patience? and get rid of that. If there’s the thing in your office that you know takes away 2% of your just fucks to give, because every time that you walk by it’s it’s the rug that has the one corner that you trip on every single time. Do something about it, so that way it’s done. Or, you know, if you’ve got a group practice so, like I do, have your admin person fix that corner of the rug, have them tape it down. Whatever it is that they do that’s but it’s also…

Katie Vernoy 34:56
It’s also accepting what it is that is, that is necessary. And so it’s get rid of this stuff and stop focusing on the stuff that’s irritating or taking too many fucks. But it’s also accept what actually is the job, which is a lot more stuff than just seeing clients and writing notes.

Curt Widhalm 35:14
And it’s moving a lot of the tasks that fall into more of that emotionally cold like executive type thinking into the same kind of time period. So you’re not necessarily having to forego a difficult conversation with a client about unpaid balances because you’re in warm caretaking mode, and at the end of the session, they’re all up in their, you know, very emotional processing, and you’re needing to be and by the way, your credit card got denied last week. So we’re going to need to address two sessions of billing right now. If you have this in, some of your more CEO time, more of your cold, calculated time where you’re looking at this is my time to look at the finances for my practice. This is the time to reach out to the client about this, not when they’re up in their emotionally fragile state. That’s where we take some of this stuff from, kind of the more analytical approach.

Katie Vernoy 36:20
I think that’s great.

Curt Widhalm 36:24
You can find our show notes over at mtsgpodcast.com. We’ve mentioned a few things that we will include in those. You can also follow us on our social media. Join our Facebook group, the Modern Therapist Group, to continue on with this and other conversations. And until next time, I’m Curt Widhalm with Katie Vernoy.

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