The AAMFT Blog

Your Private Practice Vision for 2025

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

Your vision is the heart and soul of your private practice—it’s the why behind everything you do. It’s like the GPS for your business decisions: no vision, no clear direction. Instead, you’re left - winging it, chasing random ideas, and maybe even wondering, "How did I end up here?" But here’s the secret sauce: your vision isn’t some rigid thing you set once and never touch again. It’s alive and ever-changing because, hey, life happens! The best part? Your business is meant to fit into your life, not the other way around.

So, as 2025 approaches, let’s shake things up a bit. It’s time to dream bigger, ditch what’s not working, and craft a vision that feels like a hug for your soul and a rocket for your business. And, this isn’t just for 2025, you can circle back here anytime you feel stuck, drained, or overwhelmed because your vision is what can give you the fuel to move forward and create a private practice you love. Let’s break it down step by step.

Step 1: Permission to Dream Big (and I Mean Big) 

Okay, first things first—let’s get rid of the idea that you’re stuck with what you’ve already built. Just because it worked for you last year (or kind of worked, or maybe didn’t work at all) doesn’t mean it’s your forever plan. You’re allowed to change your mind. You’re allowed to want more, less, or something completely different.

Sound like something you tell your clients also? I thought so.

Close your eyes and imagine your dream practice—no rules, no limits. What does your ideal day look like? Who are you working with? How are you feeling at the end of the day? Let yourself go wild here. You don’t have to commit to anything yet; this is just about seeing what’s possible. So go ahead, give yourself permission to dream, even if it feels a little scary or out there.

Step 2: Check In with Your Body (Yep, Your Body!)

Your body is smarter than you think. It’s constantly sending you signals about what’s working and what’s not. Take a moment to reflect on your practice as it is right now. What lights you up? What makes you want to hit the snooze button on Monday morning?

Notice where you feel energized and where you feel drained. Is there tightness in your chest every time you look at your calendar? Do you feel a spark of excitement when you think about a certain client population? These physical clues are like a cheat sheet to help you figure out what’s really going on beneath the surface.

Step 3: Have a heartfelt celebration!

You might be wondering why I want you to celebrate and from the heart. Too often we reflect, and we move on to fixing things. Before you fix or change a thing, take that information you got from your body and celebrate all the learning and the wins. We bet you can find that something did work for you, even if it was imperfect.

Step 4: Identify What’s Not Working (and Imagine What Could Be)

Now that you’ve tuned in, and celebrated, it’s time to get real about what’s not working. Is your schedule too packed? Are you spending hours on admin work that makes you want to scream? Maybe you’re attracting clients who aren’t your ideal fit. Whatever it is, name it. Call it out.

Then, here comes the fun part: ask yourself, what would better look like? Maybe it’s working fewer hours, focusing on a specific niche, or finally hiring someone to handle the stuff you hate. Whatever "better" looks like, this is your chance to start dreaming up solutions.

If you’ve ever had that feeling of wanting to burn the whole thing down, take a breath and consider making some smaller changes first. With small changes, you can start to find the breathing room you need for a clearer vision.

Step 4: Find Your Dream Team (or Tools) 

Spoiler alert: you don’t have to figure this out alone. Whether it’s a coach, a mentor, a tech tool, or even your best friend cheering you on, support makes all the difference. Who do you need in your corner to make this vision happen?

Our culture loves to tell us that we can figure these things out on our own. But that keeps us isolated and often in a traumatized state. Just like your clients reach out to you, you might need to reach out to someone too to help you take your vision and make it a reality.

Maybe it’s a business coach to help you strategize, a virtual assistant to take admin off your plate, or a therapist to help you tackle imposter syndrome. Identify the tools, resources, or people who can help you bridge the gap between where you are now and where you want to be.

Examples of Re-Visioning Your Private Practice 

We have helped hundreds of thousands of therapists to create a vision for their private practices. We bring this topic up now because the landscape of Marriage and Family Therapy is changing as tech companies and AI come on the scene. Private practice is needed now more than ever, but your vision is what helps you stand out and be seen by the people who need you most.

In recent months we have been seeing more group practice owners switch to solo practices because their bodies were telling them that it wasn’t physically sustainable to carry the group practice work. We have seen solo practitioners move to intensive-only models, no longer seeing weekly therapy clients, and instead focusing on services that get the highest clinical outcomes. We have seen hybrid practices successfully negotiating a better fee from insurance companies. We have seen therapists take a month off from work, save for retirement, and have a schedule that isn’t the traditional therapy schedule but one that allows them to show up to their kids’ events and family gatherings.

The options are endless, if you give yourself the time and space to create from your heart, with your body’s wisdom. 

Your private practice vision isn’t just a business exercise—it’s your chance to design a life and business you love. Remember, your vision is allowed to grow and change just like you do. Give yourself the freedom to dream, tune in to what’s working (and what’s not), and don’t be afraid to ask for help along the way. 2025 is the year to create a practice that lights you up, supports your life, and feels oh-so-aligned. Let’s make it happen!

We’ve created a cool tool for you to use with a custom report on how you can make more and work less in 2025. This tool will show you the areas that need some support so you can bring your vision to fruition.

Check them out below so you can start making more and working less in private practice!

- Make More, Work Less (Solo Practice) Calculator

- Make More, Work Less (Group Practice) Calculator

Post-Election, Holiday Stress and A New Year: A Systemic Look at Using Self-Compassion to Manage Our Anxiety in Stressful Times

Written by: Vanessa Bradden, LMFT

Strengthening family connections during the holiday season and in trying times is essential. Yet, it can become complicated by the pressures of gift buying, election results, and goals for the new year. Additionally, we may be coping with the loss of a loved one or loved ones and other significant life pressures like the loss of a marriage or a job. For many of us, this can cause great distress, made worse by the prospect of having to attend various holiday parties and family gatherings.

While these difficulties are real for many, hope is not lost if we take the time to understand ourselves better and the limitations of being human. As marriage and family therapists, we know that it is possible to overcome some of our stress and build better familial relationships (even if only small gains are made) by using Family Systems Theory alongside self-compassion and compassion for others. This approach helps us better understand our relationships and offers stress management tools. By focusing on kindness to ourselves and others, we can create a supportive environment for everyone during challenging moments.

Family Systems Theory is the foundation of the Marriage and Family Therapy (MFT) profession. When applied correctly, it becomes a valuable tool for therapists and clients, aiding in self-understanding, particularly during stressful situations. By utilizing systems theory, clients can develop a broader sense of compassion for themselves and others. Compassion not only fosters empathy but also encourages positivity toward those around us. Ultimately, it helps us manage the tension and anxiety often accompanying the holiday season.

Let's be honest: holidays can evoke many emotions, especially regarding our family of origin. Regardless of the complexities within your family tree—ranging from playful banter to deep-seated emotional wounds—everyone has triggers that can be activated by family members, irrespective of age or stage in life. Family gatherings can cause us to revert to unhealthy behaviors we prefer to avoid. Murray Bowen, a pioneer of family systems theory, aptly notes that families profoundly influence their members' thoughts, feelings, and actions, often making it seem like individuals live under the same "emotional skin." Family members seek each other's attention, approval, and support while reacting to needs, expectations, and upsets.

Our shared emotional history complicates the process of breaking free from established roles and negative patterns learned during childhood, yet it also connects us through shared experiences. So, what does this mean as we approach an already stressful time of year?

One approach to the season's difficulties is to cultivate self-compassion, which, in turn, allows us to have compassion for others. To do so, we need to understand our role within our family of origin, its influences, and how we contribute to its dynamics. For example, suppose you are the eldest sibling who took on a parental role. In that case, you might find it difficult to view your younger siblings as independent adults, which can lead to infantilizing behavior. Conversely, younger siblings may struggle to appreciate your support, resulting in misunderstandings and unnecessary resentment.

Engaging in sensitive discussions within family dynamics can often trigger anxiety, leading to hurt feelings and a pervasive sense of injustice that is hard to resolve. If political concerns dominate your thoughts this year, this may heighten the family's reactive tendencies. However, if we can take a step back and view these dynamics through a lens of compassion for ourselves and others, we are more likely to respond with empathy rather than contempt. At a minimum, it can prevent escalating something unlikely to be resolved. In the best-case scenario, this approach can facilitate personal growth and enhance our relationships,

Self-compassion can be a powerful tool in managing anxiety. If used properly, it will lessen the intensity of negative feelings that can come up when we are with our families over the holidays and beyond. 

Here are several ways it helps:

1. Reducing Self-Criticism: When feeling anxious, it's common to engage in harsh self-criticism. Practicing self-compassion encourages kindness toward oneself, helping to combat negative self-talk. By treating ourselves with the same understanding we would offer a friend, we can reduce feelings of inadequacy and shame.

2. Normalizing Feelings: Self-compassion allows us to recognize that anxiety is a common human experience. When we understand that others also struggle, we break the isolation that anxiety can create. This normalization can lessen our feelings of being alone in our distress.

3. Encouraging Mindfulness: Self-compassion involves being present with our feelings without judgment. This Mindfulness helps us acknowledge anxiety without becoming overwhelmed by it. Rather than suppressing or avoiding these feelings, we learn to accept them, which can reduce their intensity.

4. Promoting Emotional Resilience: We build resilience when we approach our anxiety with compassion. This resilience allows us to face challenges with greater strength and flexibility rather than feeling defeated by them.

5. Enhancing Coping Skills: Self-compassion encourages us to explore helpful coping strategies when faced with anxiety. Instead of resorting to avoidance or negative behaviors, we're more likely to engage in healthy behaviors such as seeking support, practicing relaxation techniques, or pursuing activities that bring joy.

6. Fostering a Positive Mindset: Practicing self-compassion can help shift our perspective from fear and anxiety to hope and possibility. This shift can lead to a more optimistic outlook, reducing feelings of helplessness.

7. Building Healthy Relationships: When we practice self-compassion, we're often more compassionate toward others, which can strengthen our relationships and create a supportive network, which is vital during anxious times.

In essence, self-compassion provides a powerful antidote to anxiety's harshness. It allows for a gentler, more supportive internal dialogue that fosters healing and growth. By cultivating self-compassion, we can navigate anxious moments with greater ease and grace.

MFTs are uniquely trained to work with family dynamics and are an excellent resource for those struggling with complex familial relationships. AAMFTs therapist locator is a great place to find an LMFT in your area.

Be kind to yourself this holiday season, and remember that everyone has anxious thoughts and feelings, even if we can't see them.

Sliding Scales and Accessibility in Private Practice

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

Therapists are helpers at heart. We got into this work because we genuinely care about people and want to make a difference. We all believe in the power of therapy and its impact on not just the individual but also the family and the legacy left by each person we work with. Therapy is something that we want everyone to have access to, but how do we do that within the current context of our healthcare system?

The Truth No One Wants to Admit: Being Underpaid Can Impact Clinical Outcomes

Fees that don’t lead to a livable wage, inconsistent income, and the creeping dread of burnout don’t exactly make for a thriving private practice—or a happy, healthy therapist. And a burnt-out therapist does NOT lead to great clinical outcomes. Therapists who are struggling to live on an unlivable wage also often do not have access to consultation, training, rest, or sustainable caseloads. And yes, all of these impact clinical outcomes.

Bridging the Gap in the Healthcare System

The current landscape of mental health care in the United States is a challenging one for therapists and clients alike. Insurance companies, which are supposed to bridge the gap between care and affordability, often make it harder for both parties. Therapists are grappling with clawbacks—where insurers retroactively recoup payments for services already provided—and steadily declining reimbursement rates. These practices not only undervalue the work of mental health professionals but also discourage many from accepting insurance altogether. As a result, clients seeking affordable care are left navigating a shrinking pool of in-network providers, while therapists face increased pressure to balance accessibility with their financial and professional sustainability. This cycle perpetuates a broken system where both clients and clinicians pay the price.

For years, mental health has been underfunded and overlooked, leaving therapists to play the role of superhero—minus the cape, plus the student loans. The truth is individual therapists can’t fix systemic problems like inadequate funding or insurance barriers. Yet we’re often left holding the bag.

What’s the takeaway? We shouldn’t be the only ones patching the holes in a broken system. Advocacy and systemic change are where the real magic happens.

But what do we do at an individual level? How do we keep helping without helping ourselves into exhaustion? Let’s dig in.

Sliding Scale Fees in Private Practice

Ah, the sliding scale: the DIY solution therapists often turn to when we want to make therapy more affordable. Essentially, it’s a fee structure where clients pay based on what they can afford. Seems simple, right?

Sliding scale fees might seem like the hero we need, but they can come with some sneaky ethical dilemmas. For starters, charging different client's different rates for the same service can make things feel a little… wobbly. Imagine a client paying full price finding out someone else gets the same care for less—awkward, right? It could create feelings of unfairness or even erode trust in the therapeutic relationship.

Plus, therapists are human, and let’s be real—there’s a chance you might subconsciously invest differently in someone paying less versus someone paying your full rate (even if you don’t mean to!). Could resentment arise in the therapeutic relationship if you hear about something that infers to you that the client could pay the fee for therapy? We think it could.

This variability can conflict with the ethical principles of fairness, transparency, and maintaining the value of therapy. The result? Sliding scales can unintentionally slide right into murky territory, making it essential for therapists to tread carefully and consider alternatives that feel fair and aligned with their values. Sliding scales are not always the knight in shining armor they appear to be.

The Ethics of Using a Sliding Scale

AAMFT emphasizes fairness and transparency. If you’re using a sliding scale, it better be clear, consistent, and above all, ethical. This means that if you choose to use a sliding scale you need to remove bias from your process, so that every person that comes through your door gets the same access based on the same factors.

In a CPH Insurance Avoiding Liability Bulletin it was mentioned by Richard Leslie, “My view is that a "sliding fee scale” is unnecessary, unwise and problematic." Most sliding fee scales used by nonprofits and other entities base the fee on the financial condition of the patient. In order to properly implement such a policy, entities must ask for certain information and perhaps supporting documentation, like tax returns. Most private practitioners do not want to get into that kind of detail in their practices. Psychotherapists usually establish fees that they are comfortable charging and stay with those fees until they decide to raise their fees. Physicians and other practitioners likewise establish a “usual and customary fee” and typically do not change their fee for different patients. If the patient can’t afford the fee, he or she can be referred elsewhere."

Sliding scales aren’t a no-no, but they’re not exactly a “yes-yes” either.

Let’s think outside the sliding-scale box and explore some fresh alternatives that keep therapy accessible without leaving therapists feeling like overworked superheroes.

First up, there’s the Privilege-Based Sliding Scale. An example of this would be the Green Bottle Method created by Alex J. Cunningfolk. This spin on the traditional sliding scale puts the power in your clients’ hands. Instead of awkward financial disclosures, clients self-select their fee based on their resources, privilege, and ability to pay. It’s judgment-free, transparent, and as a bonus—way less paperwork for you! This approach empowers clients while taking the emotional and administrative weight off your shoulders. Yet, what will you do if you find that this process doesn’t lead to a sustainable wage? Or, if clients that appear to have more financial privilege are consistently self-selecting for a sliding scale, while clients who are struggling do not?

Then there’s Group Therapy, the ultimate win-win solution. Group therapy gives clients a built-in support system, reducing feelings of isolation while being budget friendly. For therapists, it’s a great way to maximize impact without burning out. Pro tip? Market it as a unique, collaborative feature of your practice—because group therapy is seriously underrated and underutilized.

Another option is Tiered Service Models, which are like a buffet of therapy offerings. You can create a range of options: lower-cost services such as workshops, self-guided programs, or one-off consultations for budget-conscious clients, while reserving your one-on-one sessions for full-fee clients. This approach not only protects your time and energy but also gives clients more ways to access your expertise.

You can also choose to Give Back, as our AAMFT ethics mention, and improve accessibility, changing the system from within through lobbying, advocacy and volunteering at a government level to affect change.

And sometimes, you just have to pass the baton. Build Advocacy and Referral Networks by connecting with nonprofits or other clinicians who offer sliding scale or low-cost options. It’s okay to acknowledge when a client’s needs fall outside your financial or professional capacity. Bonus points for getting involved in advocacy efforts to push for systemic changes like better insurance reimbursements and increased mental health funding—because real change happens when we shift the system, not just our individual practices.

Finally, there’s the all-in strategy of Lower Fees Across the Board. While it might sound like an easy fix, it comes with a big red flag: burnout. If you decide to reduce rates for all clients, make sure you’ve got a rock-solid self-care plan and a realistic client load. Remember, being a therapist isn’t about self-sacrifice—it’s about sustainable care for both you and your clients.

Redefining Accessibility and Sustainability

Sliding scales aren’t inherently bad, but they’re not the only (or always the best) solution. Whether it’s privilege-based models, group therapy, or tiered services, there are plenty of creative ways to balance accessibility with sustainability.

And let’s not forget the bigger picture: systemic change is the real game-changer. So, while you’re doing the amazing work of supporting your clients, don’t forget to advocate for a system that supports you, too.

because at the end of the day, the best therapy happens when both client and therapist are thriving.

Celebrating Pioneers - LGBTQ+ Advocates in Family Therapy

Written by Ivonne Harting (She/Her) LAC, LPCC, MFTC, NCC

Diversity has always existed; it’s an intrinsic part of the human condition. Why is understanding diversity crucial in today's society? There isn’t a single person on Earth who is exactly like another. Yet, we often choose to rival our differences instead of rejoicing in them. Although we recognize the importance of support and acceptance as a society, hesitation still exists. Fortunately, we have made significant strides in celebrating diversity, particularly within the LGBTQIA+ community, which has relied on brave pioneers to advocate for our rights and illuminate the battles we face.

In honor of LGBTQIA+ History Month, I want to highlight one such pioneer: Dr. Deborah Coolhart. She is a prominent voice in family therapy, especially known for her work with trans and gender-expansive youth. Dr. Coolhart has made significant contributions to gender-affirmative therapy, centering the needs and voices of LGBTQIA+ youth in family therapy practices.

Dr. Coolhart emphasizes the critical importance of support—especially family support—in fostering positive mental health outcomes for LGBTQIA+ individuals. In her work, she discusses how dysphoria affects not just the mental health of trans masculine individuals, but also their physical and relational well-being. She states, “Because your dysphoria gets in the way of you…it affects everything.” This highlights the profound impact body dysphoria can have on a person’s identity and daily functioning. Addressing dysphoria through gender-affirming practices in therapy is essential, as it not only validates the experiences of trans individuals but also creates an environment where families can learn to support their loved ones effectively.

Dr. Coolhart’s work resonates deeply with me, especially as I reflect on my own experiences as a queer therapist. I remember the fear I felt when contemplating coming out to my family. Growing up in Venezuela—a society that lacks inclusivity regarding anything outside of heteronormativity—having a safe space that normalized discussions about gender and sexuality would have been life-changing. Such an environment would have allowed my family to understand my experiences from a different perspective and receive psychoeducation on how to support and accept me. This is what I believe our current society needs more of: education—not just about tolerance and acceptance, but about love and empathy. Community workshops and educational programs can play a vital role in fostering this understanding.

The progress we have seen in our field is monumental! We have transitioned from homosexuality being classified as a disorder in the DSM-I in 1952, to professionals like Dr. Coolhart advocating for and researching gender-affirming care, driving positive change in family therapy. It is clear that there is nothing we need to change about gender-diverse individuals. Conversion therapy is not the answer. Inclusion is. Let history be a reminder of how far we’ve come and where we are yet to go. Let’s continue to find ways to contribute as professionals, fostering environments that celebrate diversity and support all individuals in their journeys.

With love and pride,

Ivonne

Disaster Resources

Millions of people are reeling from the heartbreak left behind by Hurricanes Helene and Milton. In the Carolinas, Helene left entire communities submerged by floodwaters and cut off from aid with people waiting to be rescued with no access to food, power, or fuel. In Georgia and Tennessee, damage from downed trees and flooding have left neighborhoods unrecognizable. In Florida, cars are buried in sand and homes have been gutted by the massive storm surge. Rescues are underway in Florida as the extent of damage and deaths from Milton are still unfolding. Hurricane Milton knocked out power to more than 3 million customers, flooded barrier islands, tore the roof off a baseball stadium and toppled a construction crane. Many are missing, possibly unable to leave their location or unable to contact family where communications infrastructure is inoperable. AAMFT will shortly release information on its partnership with the Red Cross letting AAMFT members know how they can help by volunteering in the impacted areas.

Following are ways for you to donate, volunteer, or get resources on helping families navigate this challenging and life-changing time.

• Make a donation to the Red Cross here for hurricane relief.

Resources and Information

Disastershock: How to Cope with the Emotional Stress of a Major Disaster has a systemic, trauma-informed, and evidence-based foundation, making the manual an excellent resource for MFTs. This resource was produced by AAMFT members who serve on the board for the Institute for School-based Family Counseling and are part of the Disastershock Global Volunteer Team, which has members from 16 countries.

From AAMFT’s Family Therapy Magazine

Helping Families Cope with Disasters

An Overview of the Red Cross and Disaster Mental Health

Systemic Therapists on the Frontlines of Climate Change

Attending to the Whole System: Eco-Informed Family Therapy

Tips for Parenting During Times of Crisis

• Model calm and control. Reassure children that they are safe and so are the other important adults in their lives.
• Talk with your children about crisis events. Take some time and determine what you wish to say. This is especially true since new information will unfold each day. Provide brief, accurate, and age-appropriate information. Don’t dwell on the scale or scope of the tragedy, particularly with young children.
• Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that their lives will not change. Upper elementary school children will be more vocal in asking questions about their safety and what is being done. They may need assistance separating reality from fantasy.
• Understand what your child is asking. Difficult questions that children ask may be spurred by curiosity or feelings. Rather than plunging into an immediate answer, learn what motivates the question. Ask, “What made you think of that?” or “What ideas do you have?” Once the meaning of a question is known, it is easier to answer effectively.
• There may be questions we cannot answer. Rather than invent a response, it is more helpful to say, “I don’t know,” or “I’ll try to find out.”
• Acknowledge, validate, and accept your child’s feelings. He or she may be feeling confused, frightened, or even excited. Listen calmly and reassuringly as they express their thoughts and feelings.
• Limit the amount of your child’s television viewing of these events. If they must watch, watch with them for a brief time; then turn the set off. Young children should not be allowed to watch TV coverage of the event, as they are too young to process what they are seeing and hearing.
• Maintain a “normal” routine. To the extent possible, stick to your family’s normal routine for dinner, homework, chores, bedtime, etc. Children feel secure when routines are calmly followed.
• Spend extra time reading or playing quiet games with your children before bed without the television or news radio on. These activities are calming, foster a sense of closeness and security, and reinforce a sense of normalcy.

First Responder Toolkit: A free app for those deployed to emergency response events

Red Cross Disaster Mental Health Volunteers

From AAMFT: MFT Volunteer Opportunities with the American Red Cross

Red Cross Volunteers

Trauma Informed Care: A downloadable, comprehensive, and free guide to TIC

Psychological First Aid: A downloadable, comprehensive, and free guide to PFA

SAMHSA Resources by Disaster Type

SAMHSA Disaster Response Helpline (call or text): 1-800-985-5990

SAMHSA Disaster Response Overview

Doing What Matters in Times of Stress: An Illustrated Guide (from the World Health Organization). A stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day is enough to practice the self-help techniques. Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.

Pan American Health Organization: Mental Health and Psychosocial Support in Emergencies (MHPSS). Health emergencies, natural and socio-environmental disasters, armed conflicts, and various migratory phenomena may cause severe suffering in affected populations. The psychological and social effects of emergencies can be severe in the short term, but they can also affect people in the long term. Protecting and improving people's mental health and psychosocial well-being is therefore a priority in emergencies.

Disaster Preparation

AARP offers tips on how to protect your important papers and property:

Protect Your Important Papers and Property

Information on preparing your office for an emergency:

8 Tips on Preparing your Office for an Emergency

Be prepared before the next storm. The Red Cross offers tips on “How to Prepare for a Hurricane”

Tips for a flooded office

Ways to donate and help

How to help those impacted by Hurricane Helene: Charities, organizations to support relief efforts

Pet Rescue

For those interested in helping pets impacted by the hurricane, a Virginia-based pet rescue organization is receiving cats and dogs from flood-impacted states and is in need of donations to care for the influx of arriving pets. Learn more in “Cats and dogs from flood-ravaged North Carolina find hope in Fairfax”

Homeward Trails: Donate

Hiring for Group Practice

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

We recently received a question from a group practice owner in practice since 2013. They are known in their community as one of the top private practices in their county and in the past never had an issue with finding and retaining great clinicians. Yet recently they have noticed a change in the landscape for employment options for therapists and they asked “Since you are in the of the ‘business’ of mental health, am I the only one seeing this or are other brick and mortar therapy offices struggling as well? I fear that if places like mine go out of business what will there be for therapists to return to if they tire of the online platforms?”

Many years ago, therapists who wanted to work in private practice settings had the option of either starting a private practice themselves or joining one. Fast forward to today where therapists can now work for online mental health tech companies, creating a work-from-home option usually as a contractor but sometimes as a W2 employee. To acquire therapist labor, they offer sign-on bonuses, promises of providing clients and working as little or as much as you would like, and do some of the administrative work of being on insurance panels.

So now that there are more options than ever before, how do you as a group practice owner stand out, hire and retain great staff so you can continue to provide great clinical outcomes to your clients?

First, we want to say that this group practice owner is not alone. Many group practice owners have found hiring to be more challenging because of the landscape of multiple options for clinicians. We want you, the group practice owner to be more agile so you can continue serving your community, clients, and staff. Being a group practice that offers clients to a clinician is no longer enough of a draw for hiring. Let’s look at what you want to be clear about when showing what you offer to potential new hires so you can create a private practice that truly thrives.

Stand out In WHO you serve

Many tech companies take a serve-all approach. We believe that group practices that serve within their scope and expertise, will find they get better clinical outcomes, reduce the burnout of their staff, and be known for the good work they do. Group practices that stand out in who they serve have not only a great benefit to the client but also to the clinician.

The focus on who you serve will influence trainings, supervision, and overall culture of the group practice. For example, one of our coaching clients is highly specialized in divorce and mediation. They focus on hiring therapists interested in working with couples and those who want to gain special training in divorce and mediation. Their therapists benefit from the specialization and can really hone their skills in this area.

Stand out in HOW you serve

Some group practices choose to stand out in how they serve their communities. Again, this is a benefit to the clinicians they hire because the clinicians get a more specialized approach in their supervision and trainings. We know of practices that focus exclusively on IFS or EMDR. You appeal to clinicians who want to really develop their skills with the modalities that are of focus in the group practice. Other options for clinicians don’t typically offer this kind of focus. They provide the clients, but not necessarily expert case consultation or training.

Stand out in WHAT you offer to your staff

To run a group practice, you need to pay your staff well. As one of the lowest-paid master's degrees, group practice owners have an opportunity to shift the narrative and value their staff’s well-being. When you take care of your clinicians, you are also taking care of their clients. We would much rather see a well-rested, low-stressed therapist than one that is overrun with clients and burning out.

So, what are some things to consider offering clinicians who you want to hire beyond just paying them? Let us help you stand out even more as the best option for therapists when it comes to choosing their private practice setting options.

Health Insurance - This is beyond what many tech employers offer clinicians, but it is necessary for your clinician’s well-being that they have access to health care.

W2 vs 1099 - By the federal definition of what constitutes a 1099, it is very rare that group practices can hire a 1099. If you do hire a 1099 contractor, you are outsourcing your business to another business. What does this mean for you? It means you have no say in how the therapist provides treatment. You cannot provide anything for them to do their job either, think about laptops or office space. As a 1099 contractor, the therapist is responsible for using their own resources to take on the work you provide. But with a W2 you do have more control, and not in a sense of abusing power, but to work together to create better clinical outcomes for clients. W2 status protects the therapist with labor laws and is in that therapist’s best interest.

Vacation & PTO - We all need breaks, but often if you are a therapist, taking a break means you don’t get paid. If you aren’t saving up for vacation or sick leave, it can be financially disastrous for many. This is why so many therapists never take time off even though that leads to massive burnout. As the group practice owner, you can support your staff by setting aside part of their pay for vacation and sick leave. It can be such a relief for clinicians to not have to worry about how they will cover this expense. This means your clinicians are more likely to take time off and your clients benefit too, because again, we love a well-rested therapist.

Supervision and Training - In other private practice settings you will not find this offered to clinicians. Clinicians are expected to seek out these things on their own. Value your knowledge and the collective knowledge of your team by offering supervision and training. Not only does this improve clinical outcomes, but it can improve group practice culture, clinician confidence, and satisfaction as well.

As a group practice owner, you aren’t here to create a practice that just churns people through the therapy door. You genuinely care about the outcomes of the clients and the satisfaction and joy of your clinicians. It may take some financial planning and support, but standing out from other options is your best bet to attract the right kind of clinicians who value the work that you do.

Need more support on your group practice? Check out our free training library where we have training exclusively on group practice financials.

National Hispanic Heritage Month: Embracing Diversity in Marriage and Family Therapy

Written By Julian Crespo, Ph.D., LMFT. 

As we celebrate National Hispanic Heritage Month from September 15 to October 15, it's impossible not to reflect on the rich multiplicity of Hispanic cultures. This annual observance provides marriage and family therapists an opportunity to consider the profound influence of Hispanic heritage on our field and society as a whole.

The Hispanic community defies simple categorization. It's a composite of cultures, traditions, and identities shaped by centuries of mestizaje – the blending of Indigenous, European, African, and other ancestries. This intricate history has fostered a wide array of perspectives on individual and family identity formation. Some Hispanic families celebrate their indigenous roots as a cornerstone of their identity, while others may emphasize their European heritage. Many embrace a fluid, multifaceted identity that honors all aspects of their lineage.

For marriage and family therapists, this diversity within Hispanic cultures is a wellspring of insight. It underscores the need for tailored approaches to therapy, even among seemingly similar cultural groups. Each family brings to the therapeutic space its unique historical narrative, cultural values, and identity constructs. Additionally, the multifaceted nature of Hispanic populations can significantly enrich and foster inclusivity in the United States. As therapists, we can draw valuable lessons from how Hispanic cultures have navigated complex identities and histories. This knowledge can shape our approach to working with all clients, helping us develop more inclusive and culturally responsive therapeutic practices.

Many Hispanic cultures, for instance, place great importance on strong family bonds, respect for elders, and collective decision-making. These values offer fresh perspectives that contrast with more individualistic approaches. By integrating these diverse worldviews, we can broaden our therapeutic toolkit and better serve a wider spectrum of clients.

Furthermore, the richness and complexities of Hispanic cultures can inform and nurture marriage and family therapy practices to adopt a critical stance. They push us to examine our assumptions and biases, encouraging us to create epistemological spaces where the profession can grow in multiple directions.

Take, for example, the concept of familismo – the strong identification and attachment to nuclear and extended family – prevalent in many Hispanic cultures. This concept prompts us to reconsider our understanding of family systems, encouraging us to look beyond the nuclear family and consider the roles of extended family members and close friends who may be considered family.

Similarly, the diverse spiritual and religious practices within Hispanic cultures can expand our approach to addressing spirituality in therapy. From indigenous spiritual practices to syncretic religions like Santería, these varied belief systems remind us of the many paths people take to find meaning and healing.

The linguistic diversity within Hispanic communities offers another valuable lesson. It highlights the importance of not just literal translation, but cultural interpretation in therapy. This insight can inspire us to be more attentive to the nuances of language and communication in all our therapeutic interactions. 

As we mark National Hispanic Heritage Month, let's embrace these lessons from Hispanic cultures. Let's use this richness and complexity to foster more inclusive, culturally responsive, and critically reflective marriage and family therapy practices. In doing so, we not only better serve our Hispanic clients but also enrich our field as a whole, creating space for multiple perspectives and approaches.

National Hispanic Heritage Month serves as a powerful reminder of the invaluable contributions Hispanic cultures make to our society and our field. It challenges us to continuously expand our understanding, question our assumptions, and strive for truly inclusive and effective therapeutic practices. In honoring Hispanic heritage, we also honor the diversity of human experience and the myriad ways families and individuals construct their identities and relationships.

World Alzheimer's Awareness Day: Understanding and Reducing Stigma

By Vanessa Bradden, LMFT,

Founder and Clinical Director at Lakeview Therapy Group

Did you know that September 21st is World Alzheimer's Day? It is a day intended to increase our understanding of Alzheimer's and other forms of dementia and diminish the stigma associated with it. Globally, more than 55 million people are living with dementia, and it is estimated that 10 million new cases are diagnosed each year. The number of people with dementia is expected to increase to 139 million by 2050.

Most of us have been affected directly or indirectly by dementia and know that it is a painful, often lonely journey. Receiving and processing a dementia diagnosis is a significant life transition that needs more attention. It is grief work for the patient and the loved ones around them. And like any loss, it is not a linear process. There is denial, anger, bargaining, depression, and acceptance, which oscillate depending on the day. The feelings associated with such a loss can be paralyzing, overwhelming our ability to cope well.

As marriage and family therapists, we understand that the patient is part of a more extensive system – family, friends, and co-workers. We also know that stigma is an obstacle, imposing shame and making it harder to focus on what needs to happen to adapt and keep a good quality of life. The stigma around dementia can result in premature outcomes if we decide that patients cannot do anything on their own because they have dementia. We all benefit when we encourage diagnosed individuals to use as many capabilities as possible, if they are safe.

Stigma and Its Impact 

 For those directly affected by Alzheimer's and other forms of dementia, life changes in ways that are scary and unpredictable. The progressive nature of the disease can alter parts of our loved ones who were once vibrant and productive members of their families and communities. It is a startling moment when you realize someone you know and love is struggling with pieces of their ability to remember things you experienced together or, even more alarmingly, your name and who you are to them.  

Fear of the unknown is difficult for all of us. However, if left unchallenged, it perpetuates stigma around the disease, making it hard for everyone to get proper care and support. Raising our awareness about Alzheimer's disease is one of the best ways to deflate the stigma that negatively affects patients and their families. 

Stigma is a significant concern facing patients and families living with dementia. Many report feelings of abandonment, isolation, and infantilization. Our fear of dementia can cause us to back away from someone when they need us the most. For some, it is a fear of not knowing what to say or do, or more selfishly, an inability to cope with the changes that will happen over time. Either way, it further worsens feelings of loss.

Reducing Stigma 

Marriage and Family Therapists are the pioneers and leaders of systemic therapy. We think that the individual is more than the sum of their parts, and we value finding strength-based solutions rather than those that enforce stigma and isolation. We believe nothing happens in a vacuum, and effective treatment comes from looking at the broader context of what is happening with the individual and those closest to that person. With staggering numbers projected for the future of Alzheimer's, it is crucial to reduce and even end its stigma.  

Educating yourself and those around you about dementia is one of the most effective ways to reduce stigma. Be direct and factual about what is happening. Being direct can help set expectations for others while also empowering ourselves as advocates of our lives. Being open and honest with others can help people better understand what you are facing and take the pressure off them not knowing what to say or do to help you.  

How Marriage and Family Therapists (MFTs) Can Help  

Marriage and family therapists (MFT) have a unique skill set and know how to work with individuals, couples, and families. They support everyone in the family system, making processing loss more manageable. Grief work is complex, and there is no easy solution. Each person's experience is essential; tensions can run high in the family, and old wounds can get triggered. Working with an MFT provides an added level of support for everyone. 

Medical Advances Give Us Hope 

While we search for a cure for Alzheimer's disease, we must hold onto hope. The National Institute on Aging (NIA) is the leading agency supporting and conducting Alzheimer's disease research, and their unyielding support continues to push researchers toward more effective prevention and treatment protocols for dementia. 

September is National Suicide Prevention Month

Join AAMFT for a conversation on suicide prevention

Each September, the United States observes suicide awareness and prevention. The nationwide observance aims to raise awareness about suicide, identify ways to prevent suicide, and remember the lives lost to suicide.

In the U.S., someone dies by suicide every 11 minutes. Suicide can impact anyone—people of all ages and backgrounds. The White House World Suicide Prevention Day proclamation underscores this, noting that in 2023, nearly 50,000 Americans died by suicide, and in 2022, over 10 million seriously considered suicide. In 2022, suicide was the second leading cause of death for young people aged 10 to 14 and 25 to 34, and the suicide rate for veterans was 50 percent higher than for anyone else.

On September 24 at 12:00 p.m. Eastern, we invite you to a special LinkedIn live panel discussion titled “Understanding Suicide Prevention: Community, Signs, and Support.”

Hosted by AAMFT Board President Silvia Kaminsky, this critical session will feature insights from AAMFT members Dr. Marie-Nathalie Beaudoin and Dr. Katherine M. Hertlein, along with Dr. Lisa M. Horowitz of the National Institute of Mental Health. Together, they will explore the significant impact of family dynamics on mental health and discuss practical strategies for suicide prevention.

This session will provide expert insights into the warning signs of suicide; help you understand the support systems that can prevent crises; and insights from top professionals about the role of marriage and family therapists in mental health advocacy.

This event is essential for anyone interested in the latest approaches to mental health and wellness, especially in recognizing the crucial role families play in prevention. Whether you're a professional in the field, a student, or simply an advocate for better mental health practices, your participation is valuable.

Save the date and join the conversation that matters. Let's empower our communities with the knowledge to support and save lives.

REGISTER FOR THIS LIVE EVENT HERE

The Private Pay Private Practice

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.

The landscape of private practice has evolved rapidly since we have been coaching since 2010. We now have tech companies and directories that therapists can work for, online therapy software and companies, laws shifting for providing therapy across state lines, insurance companies that are changing how they do billing and so much more. Yet, even with these changes, the options for structuring your private practice remain to be - private pay, insurance-based, and hybrid.

Private pay practices have a cash fee and do not involve third-party payors in their practice at all. They may provide a superbill, but it is up to the client if they allow a third-party payor’s involvement. Insurance-based practices that exclusively take insurance are often working with billing companies or software to communicate with third-party payors. With many tech companies showing up in the therapy space, some of them are supporting these billing processes, negotiating fees, and managing the claw backs. Lastly, a hybrid practice is one that has a combination of both private pay and insurance provider involvement.

Is one of these options better than the other? Not necessarily. The key is choosing a structure that is profitable and sustainable for you. Profitable meaning that it provides a decent living wage for you and anyone you hire. Sustainable meaning that you can do business without it negatively impacting you, your clients, and your community. You want to look at doing this work in a way that allows for excellent outcomes, ethical practice and that doesn’t burn you out physically, emotionally, or spiritually.

There is no moral high ground for taking insurance. The variance from therapist to therapist shows us that not one single private practice is the same. We all have different circumstances and privileges at play when determining our private practice structure. What is most ethical is to choose that which is best for the client and for the therapist.

That said, many cannot afford to take insurance exclusively or in a hybrid model. If you have longed to be independent, not involving insurance companies in the therapeutic relationship, we want to explore how to make your private pay practice a possibility.

Pillar 1:  Solid Systems for Private Pay

It’s time to ditch the hustle culture and really look at how many hours you can healthily give to your business, beyond your direct client work. Working nonstop is not what will get you a private pay practice. First start with honoring your energy and time and give to the practice what is sustainable for you. Having systems in place is what will help you find flow in working in your private pay practice. Some of the key systems every private pay practice needs are a consultation and onboarding process, financial plan, business plan, marketing systems, and self-care systems. All of these systems work together to make private pay more easeful in your practice.