Rachel speaks with Dr. Elizabeth Carr, a clinical psychologist and the founder and CEO of Kentlands Psychotherapy in Gaithersburg, Maryland. Elizabeth leads a team of 20 doctoral and master's-level clinicians and has spent over two decades building a community-focused, financially sustainable practice through some of the most disruptive periods in the history of mental health care. A former Navy psychologist and sought-after speaker on practice management, she recently published a piece on strategic positioning during industry upheaval that is the centerpiece of this conversation.

The mental health practice landscape is shifting in ways that are affecting practices at every size — but not all in the same direction. Elizabeth describes what she calls the barbell effect: solo practitioners, particularly those operating fully virtual, are being squeezed out by venture capital-backed platforms with enormous marketing budgets and SEO dominance, while large practices that over-expanded during the COVID telehealth boom are now sitting on overhead they cannot fill. Mid-sized, community-rooted practices that stayed nimble are finding themselves in a stronger position — but only if their leaders are paying attention to what's actually happening in the market and willing to respond. Elizabeth and Rachel dig into what that looks like in practice: how to read referral data, when to pivot your service offerings, what AI can and cannot replace in clinical work, and why hyperlocal, in-person, relationship-based care may be the most durable competitive advantage a practice owner has right now.

Resources Mentioned

Articles Referenced:

• A Workforce Under Pressure: Preparing the Behavioral Health Workforce for Today and Tomorrow — National Council for Mental Wellbeing (2025): https://www.thenationalcouncil.org/behavioral-health-workforce-under-pressure-preparing-today-tomorrow/
• Telehealth and Hybrid Practice Are Here to Stay — APA Monitor on Psychology (2024): https://www.apa.org/monitor/2024/09/telehealth-hybrid-practice
• Strategic Positioning During Industry Upheaval — Dr. Elizabeth Carr, Kentlands Psychotherapy (January 2026): https://www.kentlandspsychotherapy.com/mental-health-professional/strategic-positioning-during-industry-upheaval/

Connect with Dr. Elizabeth Carr:

• Kentlands Psychotherapy: https://www.kentlandspsychotherapy.com

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast
• Instagram: /thementalhealthevolution/
• LinkedIn: /the-mental-health-evolution
• Facebook: /TheMentalHealthEvolution
• Music by Zach Harrison