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.

Transcripts and additional information for this episode will be available at mtsgpodcast.com!

In this podcast episode we discuss running a private practice during times of 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.

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.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Our Linktree: https://linktr.ee/therapyreimagined

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/

Special Episode: Modern Therapist’s Consumer Guide on Buying Time, LLC

Curt and Katie talk with Bibi Goldstein, of Buying Time, who provides virtual assistant services for therapists. Bibi shares her journey from starting a personal assistant service in 2007 to evolving into a comprehensive VA company. She emphasizes the importance of delegating tasks, using systems like QuickBooks and scheduling software, and maintaining consistent social media presence. Bibi's team provides comprehensive support, including bookkeeping, social media management, and email inbox management. Bibi stresses the importance of regular communication and flexibility to meet clients' needs. Curt and Katie highly recommend Buying Time for its efficiency and quality of service. This episode is part of our Modern Therapist Consumer Guide, where we explore innovative tools and services built for therapists and their clients.

In this podcast episode we talk about how to effectively incorporate business systems and delegate to a Virtual Assistant company like Buying Time, LLC

We talk with Bibi Goldstein about her business philosophy, strategic advice for therapists, and the services offered by her virtual assistant company, Buying Time.

Interview with Bibi Goldstein, Buying Time

0:01:00 - Introduction

0:04:06 - Company Origin Story

0:11:46 - Advice for Therapists on Business Operations

0:16:34 - Social Media Strategy vs. Implementation

0:20:00 - Delegation and Task Management

0:34:14 - Virtual EA vs. Virtual Assistant

0:36:17 – How to vet a potential Virtual Assistance Company

0:40:04 - How to Sign Up with Buying Time

0:43:20 - Contact Information

Curt and Katie Chat – Our review of Buying Time

0:45:24 – Katie and Curt talk through our impressions of Buying Time: We view Buying Time as an exceptional virtual support service that goes beyond typical administrative assistance, offering strategic guidance and practical solutions for therapists and entrepreneurs.

A Special Offer for the listeners of Modern Therapist’s Survival Guide podcast from Buying Time

Buying Time has put together a free Systems Inventory Checklist to help all of us to uncover hidden expenses and optimize spending in your practice. Go to buyingtimellc.com/mtsg to get your free checklist now!

Relevant Links:

• Website: buyingtimellc.com/mtsg

• Email: [email protected]

• Social Media: @buyingtimellc

Credits:

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

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Understanding Sexual Trauma and Hookup Culture in Therapy with Gay Men: An Interview with Michael Pezzullo, LMFT

Curt and Katie chat with Michael Pezzullo, LMFT, about providing affirming and trauma-informed therapy for gay men. We explore common misconceptions therapists hold, the complexities of hookup culture, and how sexual trauma often shows up in subtle and misunderstood ways. We also look at how clinicians can better navigate issues of consent, drug use, and boundary violations when working with this population.

Transcripts and more information for this episode will be available at mtsgpodcast.com!

In this podcast episode, we explore affirming, trauma-informed therapy for gay men

We invited Michael Pezzullo to the podcast to discuss the often-overlooked nuances of working with gay men in therapy. From hookup culture to sexual trauma, Michael breaks down what therapists need to understand to avoid causing harm or misinterpreting client behavior. His perspective emphasizes the importance of clinical humility, cultural knowledge, and a collaborative approach.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Our Linktree: https://linktr.ee/therapyreimagined

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/

Therapy Insurance and Billing Trends for Private Practice in 2025: An Interview with Sanjana Sathya

Transcripts and more information for this episode will be

In this podcast episode, we talk about how insurance is working for therapy right now

Therapists in private practice must make choices between insurance, private pay, or hybrid billing. They all have pros and cons that can shift as

·       Survey insights on therapist billing models

·       Pros and cons of accepting insurance as a therapist

·       Exploring private pay and hybrid models for therapy practices

·       What is out-of-network billing and how can therapists use this model to best effect?

·       How therapists can choose a trustworthy billing service

·       How to future-proof your therapy practices

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Our Linktree: https://linktr.ee/therapyreimagined

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/

Navigating Incel Culture: Therapy Approaches for Manosphere Clients

Curt and Katie respond to all the discussions that popped up about the Netflix series Adolescence and its portrayal of a 13-year-old boy accused of murder. We chat about the complexities of working with clients labeled as "incels." We also explore the importance of understanding the impact of that label (especially when clients are not self-identified as “incels”), internet culture - particularly the manosphere, and the challenges therapists can face when working with clients holding these beliefs.

 Transcripts and additional information for this episode will be available at mtsgpodcast.com!

In this podcast episode we discuss working with clients labeled as

Curt and Katie explore the focus on “incels” in the discussions about the Netflix series Adolescence. We dive into the nuances of understanding internet subcultures and how therapists can effectively work with clients influenced by the manosphere, while also addressing concerns about suicidality, homicidality, and therapy strategies.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Music by Crystal Grooms Mangano https://groomsymusic.com/

Curt and Katie chat with Dr. Robyn Miller, Ph.D., of TheraClosure about professional wills and what therapists need to do to effectively plan for their own incapacity or death. She shares her experience stepping in as a practice executor for colleagues, the trauma that can result when therapists disappear without explanation, and the systems she’s created through her program to provide compassionate and organized transitions for patients. This is a conversation about professional wills, ethical responsibilities, and why planning for the worst brings peace of mind.

Transcripts and more information for this episode will be available at mtsgpodcast.com!

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

Too many therapists avoid thinking about what will happen to their clients if they can no longer practice due to sudden illness, incapacitation, or death. Dr. Robyn Miller joins Curt and Katie to discuss why it’s essential to have a professional will, and how to make sure you’re not leaving your clients without closure or support.

Our Linktree: https://linktr.ee/therapyreimagined

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Curt and Katie chat with Carrie Wiita about authenticity, first impressions, and why traditional business coaching doesn’t work for most therapists. Carrie critiques traditional business coaching models that rely on anecdotal “success stories” and mindset hype, and instead offers a relational, thoughtful, and research-informed framework to help therapists show up in alignment with their professional identities. We also explore the unique challenges therapists from marginalized communities face in marketing, and how systemic issues influence visibility and access.

Transcripts and more information for this episode will be available at mtsgpodcast.com!

Marketing for therapists doesn’t have to feel slimy, manipulative, or one-size-fits-all. Carrie Wiita, a marketing therapist and creator of interpersonal branding, shares how therapists can use their natural strengths, values, and clinical insights to build trust through marketing—without pretending to be someone they’re not.

Our Linktree: https://linktr.ee/therapyreimagined

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Curt and Katie talk with Nate Peereboom, CEO and co-founder of JotPsych, an AI-powered scribe designed to automate therapy notes and save therapists 90–95% of their note-taking time. Jot Psych supports over 30 languages, integrates with many EHRs, and prioritizes security and privacy. In this conversation, we dive into how AI can support clinicians while protecting the integrity of the therapeutic relationship. This episode is part of our Modern Therapist Consumer Guide, where we explore innovative tools and services built for therapists and their clients.

We explore how Jot Psych uses artificial intelligence to ease the documentation burden in therapy practices, while maintaining HIPAA compliance and respecting client privacy.

0:01:07 - Nate introduces himself and JotPsych

0:02:18 - Origin story of JotPsych and why they created the company

0:05:34 - Mission, vision, and values of the business

0:09:42 - Process of using JotPsych and note generation

0:12:08 - Business and clinical considerations for using AI scribes

0:16:14 - Privacy concerns and client consent

0:20:30 - Concerns about data training and potential AI therapist replacement

0:31:18 - Multilingual capabilities

0:31:52 - Quality assurance processes

0:34:49 - Onboarding process for new users

0:40:16 - Where to find more information about JotPsych

0:42:07 – Katie and Curt talk through our impressions of JotPsych: Considerations for choosing JotPsych, paying attention to scope and accuracy in documentation that is produced, how tools

like Jot Psych can serve solo and group practices, the importance of testing AI tools in real-world practice before full adoption

Try Jot Psych with a 10-day free trial and get 50% off the first two paid months.

Visit jotpsych.com/modern-therapist and use code MODERN

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

Music by Crystal Grooms Mangano http://www.crystalmangano.com/

Curt and Katie chat about what happens when legal requirements clash with ethical responsibilities—and how therapists can stay grounded in their values while navigating complex decisions. When you find yourself in a situation where the law seems to contradict your ethics, or even violate your clients’ basic human rights, what do you do? In this deep-dive episode, we explore the tension between law and ethics and the moral courage required to practice in alignment with your values. From post-9/11 changes in APA’s ethics code to current issues like

gender-affirming care restrictions, we explore real-world implications and guide you through a framework for ethical decision-making in the face of legal and systemic challenges. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

Executive orders and nationwide proposed legislative bills that affect mental health have left therapists wondering, “Will my ethics protect me?” This episode and podcourse explores the interplay between laws and ethics, how professional organizations guide therapists when laws and ethics collide and gives a framework for how therapists should proceed. Participants will

learn how to identify potential conflicts, understand their legal and ethical obligations, and develop effective decision-making processes. Topics explored will include risk management strategies, consultation best practices, and documentation considerations in conflictual situations.

·      Where clinical ethics and legal obligations collide

·      How our ethical codes approach this conflict (APA, ACA, NASW, CAMFT)

·      The importance of understanding your responsibilities beyond compliance

·      Philosophical roots: Antigone, Nuremberg, and post-9/11 ethics reform

·      When following the law may cause harm to clients or communities

·      How to protect your license while still honoring human rights

·      What to do when reporting requirements might increase harm

·      How to support trans and gender-diverse clients in states with discriminatory laws

·      Navigating confidentiality, documentation, and advocacy

From Knapp, S., Gottlieb, M., Berman, J., & Handelsman, M. M. (2007). When laws and ethics collide: What should psychologists do?

·   Seek consultation to understand your legal requirements (know what the law is actually asking you to do, even if that means taking the time to consult with an attorney)

·      Clearly understand your ethical obligations (read the language of the ethics code and consult with trusted colleagues)

·      Consider alternatives that allow following the law while upholding your values

·      Contemplate violating the law only if no viable alternatives exist, and if so, limit disobedience to the minimum necessary to fulfill the higher goal

Continuing Education Approvals: Continuing Education Information including grievance and refund policies.

Our Linktree: https://linktr.ee/therapyreimagined

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

Music by Crystal Grooms Mangano https://groomsymusic.com/

Curt and Katie chat with Dr. Loree Johnson about the intersections of reproductive mental health, race, and systemic injustice. Dr. Johnson shared powerful insights about the shame, grief, and medical trauma that many clients face, especially Black women and other folks from

historically marginalized communities. We dive into how therapists can hold safer, more informed spaces for clients experiencing infertility and pregnancy loss, and how systemic racism and historical harm continue to shape reproductive healthcare today.

Transcripts for this episode will be available at mtsgpodcast.com!

We were honored to sit down with Dr. Loree Johnson, LMFT, PhD—an expert in reproductive mental health who brings both clinical expertise and lived experience to the conversation. We explore how therapists can better support clients navigating infertility, pregnancy loss, and trauma, especially clients from marginalized communities.

·    Avoiding the conversation about infertility and pregnancy loss because therapists feel undertrained or uncomfortable

·   Therapists overlook the impact of race, history, and oppression in reproductive trauma

·   Assuming fertility issues affect only straight, cisgender couples

·   Minimizing or misunderstanding the grief associated with pregnancy loss and infertility

·    Mistrust of the medical system due to real, generational harm (e.g., J. Marion Sims, Henrietta Lacks, Tuskegee)

·    Myths of hyper-fertility in Black women and the erasure of infertility struggles in communities of color

·   Disenfranchised grief and cultural stigma around fertility challenges

·   Weathering: the cumulative impact of chronic stress and racism on physical and reproductive health

·   Learn the terminology and processes around fertility treatments and pregnancy loss

·   Create space for conversations around sex, reproduction, and grief—even if it’s uncomfortable

·   Practice cultural humility and intimacy: be willing to be wrong, to sit with pain, and to build trust

·   Acknowledge your own limitations and biases while staying curious and committed to learning

·   Be prepared for these conversations—even if you don’t specialize in reproductive mental health

Our Linktree: https://linktr.ee/therapyreimagined

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

Music by Crystal Grooms Mangano https://groomsymusic.com/