Patterns and Mindsets That Are Lowkey Draining Your Private Practice

I have been thinking about this topic a lot lately, not just in my work-life, but in my life as a whole. I have some big new things in my life right now (new work, new baby), and yet sometimes I find myself in this very familiar old place as far as my thoughts and feelings. I saw a quote on Instagram as I was scrolling the other day and it got me thinking. I can’t find it again, but it went something like this:

If you are feeling angry, resentful, or exhausted it means that somewhere in your life there is a healthy boundary that you haven’t set yet.

When I read that, it just hit me right where I live. For me, if I’m feeling any of the above emotions, it’s because I’ve put an important need aside, and reeallllly buried it down so deep, often so deeply that I don’t even realize it. And I do this (like we all do) because of internal messages and mindsets that are very old, but still very much alive and kicking! Messages that tell me that my needs are bad, wrong, or that they aren’t going to be met anyway so why bother, or that I don’t deserve them, etc. etc.

I also really liked this quote because it reminded me that it is squarely on me (and on each of us) to recognize and set these boundaries (and just to clarify before we go on, I’m talking here about day-to-day work-life stuff, not about extreme situations, such as domestic violence, which are much more complex, and not the subject of this article). It’s one thing to recognize that you are stuck in a mindset that is draining your business, it’s another thing to actually do something about it.

Things we do to get in our own damn way

It got me thinking about my own private practice, and ways in the past that I have felt angry, resentful, or exhausted, and about my consulting clients and how they have generally come to me because they have felt these feelings as well. Here are some of the common things that private practice clinicians do that cause them to feel drained, resentful, angry, and exhausted, see if you find yourself in any (or all!) of these or if any of these surprise you:

  1. You charge your clients too little, scrimping by while your clients are thriving, getting job promotions and going on vacations.

  2. You avoid conversations about money with your clients.

  3. You continue to stay on insurance panels out of fear that you won’t get referrals if you go off (rather than out of a considered choice or preference to stay on).

  4. You don’t uphold your own cancellation policy.

  5. You let your sessions run over time.

  6. You take phone calls/emails/texts and don’t charge for them (even though it says in your policy that you do).

  7. You see more clients than you want to see.

  8. You see clients at times of day that you don’t really want to be in the office (e.g. evenings, weekends, early AM, after school hours).

  9. You are seeing clients that aren’t a good fit for you or that you don’t enjoy working with.

  10. You don’t have enough support (e.g. other therapists, consultation, your own therapy).

Maybe each instance by itself doesn’t necessarily feel like a big deal, but over time these add up and can lead to burnout. For more on this, see my other post The Little Actions That Lead to Big Burnout.

So what makes us engage in these behaviors? And why, even though they might seem like small things if it’s “just one client” or “just once a week”, might it be crucial to examine the behavior more deeply?

When old mindsets set up shop in your new business

As a therapist, of course you know the following, but it bears repeating:

We develop ways of coping with adverse situations in our earlier lives, and those ways of coping get deeply hardwired, and we bring those ways of coping into our adult lives, and we use these methods of coping, even though they may no longer continue to serve us.

Mostly because we don’t even realize what we are doing. Sometimes even when we do realize it, change is just really frigging hard. Coping in new ways takes insight + time + support + repetition +more time + patience + experience + more support….you get the picture. It’s not easy (and it’s obvi not a simple math equation).

Here are some mindsets that contribute to the behaviors above. See if you can identify with any of these:

1) “I’m not enough”

  • “I’m not a good enough therapist to charge the market rate.”

  • “I’m not competent enough, I need to do more training before I can go off insurance.”

  • “If I have a conversation with my clients about money, I’m going to find out that they actually don’t think I’m worth the money, so I should just not bring it up.”

And a zillion more ways “I’m not enough” can manifest. All of them are harmful to your business. One related mindset, which is kind of a buzzword these days, is “Imposter Syndrome”. Which is “I’m not enough, and one of these days people are going to finally realize that, and bad things will happen, so I must act super competent to defend against the bad things”. There are so many ways of arriving at the “I’m not enough” conclusion. Not just from adverse life experiences, but also by messaging we get from the larger culture, especially if you are a part of a marginalized group.

2) “I should make myself small, and not take up space”

  • “Who am I to start a private practice? People in my agency might think that I think I’m better than them.”

  • “I can’t pursue that big idea I have. Who do I think I am? I should just stay in my lane.”

  • “I can’t charge the market fee because people will think I’m being greedy.”

This is another one that is strongly correlated with social messaging you receive if you are a member of a marginalized group. But certainly not limited to that. It’s about feeling like you aren’t as deserving or worthy of space as other people are.

3)“I should avoid conflict at all costs

  • “I can’t raise my fee because my clients will get upset with me.”

  • “I can’t go off insurance because my colleagues will think that I’m a sellout and that I just want to work with rich people.”

  • “I can’t have a conversation with my client who keeps no-showing about paying my fee because they will get mad and not want to work with me anymore.”

This is similar to not taking up space, but a slightly different flavor, usually more having to do with fear of being abandoned if you are disagreeable, or fear of angry retaliation.

4) The “scarcity” mindset

  • “I can’t start a practice in [insert name of densely populated area here], there’s too much competition there, I won’t get enough referrals.”

  • “I have to take these clients that aren’t my best fit because I might not get other referrals.”

  • “If I go off insurance there won’t be enough referrals coming in.”

The scarcity mindset is all about operating from a place of fear of “not enough,” versus a trust in the abundance of the universe.

5) “If it’s not perfect, I can’t get started”

  • “I need to have _______________ (the perfect office, the perfect website, the perfect business card, the perfect paperwork) before I can start seeing clients.”

  • “I can’t write this blog post because I don’t have all the answers” (ahem, that’s certainly not a thought I had writing this post, or anything).

This is a biggie for me, and for many folks. In order to get anything done creatively, and to start a business we have to allow ourselves to do things imperfectly. To be human. But this is so tricky because, as I reminded us in the beginning, we developed this particular mindset as a way of coping with some adverse set of circumstances in our life: “be perfect and you will be loved.” So there’s no easy flip to switch here-with this one (or with any of the ones I’ve mentioned here).

6) “Other people’s needs are more important than my own”

  • “I can’t ask my client to move to an earlier time slot, even though I really want to be home in time to put my kid to bed.”

  • “I have to keep working with certain clients that I don’t enjoy.”

As therapists there might be sort of a selection bias here-meaning our population is sort of skewed towards being very empathic and concerned with the needs of others. That’s why we got into the field, after all. However, there’s a point at which this becomes detrimental to us and our work.

THIS IS DEFINITELY NOT AN EXHAUSTIVE LIST! It may be an exhausting one (ba-dum-ching!) but there are certainly other mindsets that can drain us and sabotage our practice, for sure. Also the above mindsets all directly or indirectly link to one another.

Alright, I see myself here, so now what?

If I had a solution for you like “meditate and journal every day for 2 weeks, and then you’ll have it all figured out”then I’d be a) a liar and b) probably really rich. But I can say a few things.

1) We can’t heal from what we don’t know about ourselves. So if you can identify yourself in any of the above, ask yourself how things came to be that way? See if you can develop some understanding (and more importantly) compassion for the person (and maybe it was a very little person at the time) who came to develop this mindset as a way of dealing with some difficult shit. And then see if you can start to attune to different ways this shows up for you in your business. When you did or didn’t take that client, or have that money conversation, was one of these mindsets at play?

2) Take a look at your current business model, the way you are running your practice, and see if there are ways in which you are treating yourself unkindly. Are there some boundaries that you need to set? The list in the beginning is a good place to start. Basically, ask yourself this: are there are the places where you said you were going to do one thing, but you actually are doing another? That’s usually a good indicator that some sort of mindset is at play.

3) Get yourself some support. It’s important to have people in your life-be it peers, colleagues, friends, your life partner, a therapist, your supervisor, your 12-step group, you name it-or all of the above-who know what you’re working on. People who are supportive-truly supportive, not just cheerleaders-can help reflect back to you where you are growing, and where you are still facing some challenges.

4) Find out more. There are some amazing folks doing amazing work out there on all of the above topics. There is Nicole Lewis-Keeber who is a business therapist that has made understanding how trauma and business relate her life’s work, and is amazing. There is Allison Puryear who is a therapist business consultant, like myself, and her whole deal is about abundance, and it’s brilliant. And then there’s Brené Brown (who is a juggernaut, and probably needs no introduction because she even has her own Netflix special now), on the topic of bravery and taking up space (and a zillion other things). And so many more, but you get the idea.

I hope this article is a helpful start to your reflection. If you have thoughts, please share them below!

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Melissa KellyComment