The Paradox of Private Practice for Sensitive Therapists

“What is one thing you wish you had been told before going into private practice?”

This question was asked of me earlier this week by a graduate student in a local counseling program.  She interviewed me about being a therapist and why I decided to go into private practice.  While my story is nothing new to you, the conversation with this student got my wheels turning about what exactly drives sensitive therapists into private practice and the unexpected challenges we face once we are in the thick of it.

The decision for a sensitive therapist to go into private practice is often a mix of logic and emotion. 

As one continues to learn what it means to be a Highly Sensitive Person, the importance of crafting an ideal lifestyle becomes glaringly apparent.  We learn that if we are in an environment that supports our sensitivity, we are more likely to thrive and excel in our career, relationships, and life, in general.  Private practice is one option which allows us to do this.

So here we are.  We’ve got our office, our LLC, and our accountant. Holy shit, we are adults now. Legit business people.  We are experiencing the true reality of self-employment.  Somedays we love it and can’t imagine a different life.  We feel the purpose and joy deep within our bones. Other days, we are wondering how the hell we are going to make this work.  How can we survive the ups and downs of entrepreneurship?

What we didn’t expect  

There are many proven factors that will lend itself to being “successful” in private practice.  However, what about happiness, purpose or meaning? As I mentioned in this post, success and happiness do not automatically correlate and may also change over time.

Plus, there is a logical and emotional component to your happiness and security.  Logic propels you to focus on the numbers (gross income, number of clients, reimbursement rates) as that brings you financial security.  Yet, the emotional side, the dreamer, reminds you that success is also about having days filled with contentment, peace, and meaning.

Many sensitive therapists will say they went into private practice with exactly this hope in mind.  They wanted autonomy, to create their own schedule, to be able to practice a modality that might not be supported in agency work, to show up more authentically, or to make a great salary while serving others.

However, I don’t know any sensitive therapist that went into private practice because they wanted to experience the constant uncertainty that comes with self-employment.

Here’s the first paradox…

We went into self-employment because on some deep level, at our very core, we knew we would feel more purpose and joy being our own boss – the creator of our life and career.

Yet, something unexpected happened.  We are in the very structure that–without proper support and boundaries–makes our sensitive brain go on overdrive and eventually self-destruct.

You see, the very thing that we thought would bring us the most happiness is now what brings the most stress to our sensitive brains.

This is why sensitive therapists may feel like they aren’t cut out for private practice.  This is why therapists feel like they have to take insurance even though they have to see more clients than works for them.  This is why therapists get afraid of putting themselves out there or raising their fees.  This is why therapists feel scarcity mindset.

Paradox #1: Our greatest source of joy is also our greatest cause of discomfort.  

And if you are a sensitive therapist, I don’t think that we ever really get immune to those fears.  Because we process things so deeply and explore all outcomes (including the bad ones), we are acutely aware of the risks of being self-employed.   It’s that awareness that can make us really good therapists and really exhausted business owners.

Being self-employed is a gamble.  

I know there are many folks out there who will say it’s not.  There are time-tested and proven steps to make your business thrive.  This is true. It’s a business. And there are folks that study business and know what you have to do to make money and bring in clients.  Period.

But I’m talking about the highly sensitive brain here.  And the highly sensitive brain is different.  It will always be watching, observing, and exploring. The sensitive brain will always be looking out for all possible outcomes.

And one possible outcome that is ALWAYS there, with self-employment, is that you will not be able to make it work.

That doesn’t mean we shouldn’t be in private practice.  It just means we have to build up the muscle that allows us to tolerate this inherent uncertainty.  It means we have to be able to create space and stillness within our busy minds.  It means we must create trust within ourselves to weather the ups and downs with grace and wisdom.

Were I to go to back in time and talk to pre-private practice Arianna, I would tell her this:

“The key to being happy and satisfied in private practice is about your ability to skillfully tolerate the uncertainty and discomfort that comes with the ebbs and flows of self-employment.”

Here’s the next paradox (Oh crap, there’s more?!)

We go into private practice for many reasons, but, ultimately, we have to make money. What makes us money? Clients. In. The. Door.

The truth is…we can’t make clients pick up the phone and call us.  We can’t make our clients stay with us.  We can’t make them pay us. We can’t make new clients look at our website and call us.  We can’t control anything that our clients do.

We guide, we support, we help.  But we do not control them.

We also can’t control the life circumstances that allow a client to be consistent in therapy.  We can’t control if our clients get sick and have to stop therapy.  We can’t control if a client loses their job and can’t pay for therapy.  We can’t help if a client moves away.  We can’t help if a client finds another therapist.  We can’t help if our client decides to switch insurances.  Thus…

Paradox #2: The very measures that define your success in private practice are ultimately out of your control.

I’ve spelled out all these things very clearly because we have to name what is going on inside our head.  I want to take away the stigma that comes with a sensitive brain that worries about this shit all the time.  I want to take away the story that just because we are sensitive, doesn’t mean we aren’t cut out for private practice.

Yet, even though there is much that is out of our control, there is much we can control and I will elaborate on that in just a moment.

Here’s the third (and final, I promise) paradox

Sensitive therapists get overwhelmed because of how our brain works.  We get overwhelmed because we are deeply feeling, we are empathizing, we are processing constantly, and we are seeing all the subtleties of a situation.  This overwhelm can lead us to feel like we aren’t cut out for self-employment.  Your sensitive brain is hyper-aware of all the ways that this private practice dream can go wrong. But do not despair…

Paradox #3: Your sensitivity makes you more vulnerable, but it is also your greatest strength.

If you’ve read about differential susceptibility for Highly Sensitive People, you know that sensitive folks are more vulnerable in stressful environments, but thrive more than non-sensitives in enriching environments.

Thus, this deeply-feeling, sensitive brain of yours makes you (in theory) more vulnerable than others, but it is also what makes you great at being self-employed.  Your sensitivity allows you to deeply understand and connect with colleagues and clients – resulting in loyal customers and referral networks.  It allows you to get inside your client’s heads – which is a great skill for marketing to new clients.  It allows you to express yourself in a way the draws people in – a great skill to have for any type of blogging or content creation.  It allows you to think thoroughly about all outcomes – a great skill for long-term business planning.

You see.  You’re actually perfectly cut out for this.

So, What Can You Do?

Being successful and happy in private practice is about harnessing your sensitive brain to focus on the right metrics.  It’s about gaining confidence in tolerating uncertainty.  It happens by staying connected to your hopes and dreams.

When you focus on what actually brings clients in and makes your income stable, the overactive, overthinking, deeply-processing mind can have rest from considering all the uncontrollable variables.  For example:

Instead of focusing on the ups and downs of your income, focus on holding your money boundaries. 

This means:

  • Do you have a clear cancellation policy that you uphold consistently?
  • Are you clear about how reduced fee fits into your business model?
  • Do you have a solid system for collecting and tracking insurance payment?
  • Do you know where your spending traps are?
  • Are you charging enough to meet all your needs and then some?
Instead of comparing yourself to other therapists, focus on having a clear and consistent marketing strategy.

This means:

  • Have you weighed the pros and cons for different market strategies and decided the key ones that will both reach your ideal client AND allow you to express your voice authentically?
  • Do you have scheduled times where you create blog content and social media content?
  • Do you know what you’re actually doing with your marketing or just throwing stuff out there and hoping it sticks?
Instead of focusing on why clients aren’t calling, focus on retaining your current clients.

This means:

  • Do clients feel like they have a clear understanding of your boundaries, expectations, and policies?
  • Are you getting consistent training or supervision around the main struggles your ideal client faces?
  • Are you offering value to your clients between sessions – either through your social media, sending emails, or recommending helpful resources?
  • Are you asking clients for feedback and looking for ways to improve what you offer to them?
Instead of grasping for new referrals sources, nourish the ones who are the best at sending you your ideal client.

This means:

  • Do you track referral sources so you know the ones who send you the best referrals?
  • Do you send thank you notes or some other systemized way to thank those who send you business?
  • Do you say yes to every coffee date or are you discerning with where to spend your networking time?
  • Do your referral sources get to opportunities to see and interact with the ‘real’ you?
Instead of focusing on what’s not working in your practice, focus on if you’re taking the best care of yourself and living in alignment with your values and purpose.

This means:

  • Do you have regular times set aside where you do not think or talk about work?
  • Do you engage consistently in activities or relationships that are nourishing to you?
  • Do you have some kind of practice that allows you to connect with your mind, body, and spirit?
  • Do you schedule (and take) vacation days? Are you taking sick days when you need them or just powering through?

I specialize in working with sensitive therapists and healers

If it isn’t obvious, I’m obsessed with figuring out how the sensitive brain can thrive in private practice.

I am determined to guide sensitive therapists as they create – and sustain – a successful private practice that brings both stable income and joyful purpose.

If you don’t even know what your money boundaries are…

If you’re convinced you’re not cut out for private practice…

If you are ready to stop obsessing about your business…

I might be able to help.

Let’s teach your sensitive brain to work for you, not against you.


Schedule your free 25-min exploration call 



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