
In today's podcast, member Ashley and I explore the growth of her Tampa-based private practice, where she’s managing 50 clients and feeling the strain of 32 weekly sessions. We talk through burnout, fee adjustments, and the impact of charging...
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Hi, welcome to the Abundant Practice Podcast. I'm Alison from Abundance Practice Building. I have a nearly diagnosable obsession with helping therapists build sustainable, joy filled private practices, just like I've done for tens of thousands of therapists across the world. I'm excited to help you too. If you want to fill your practice with ideal clients, we have loads of free resources and paid support. Go to abundance practice building.com Links all right, onto the show. Your practice is full. That's amazing. But here's the question. Is it actually the practice you want? Because just being full isn't the finish line. Having the practice you want is inside Limitless practice. You'll spend 13 weeks making the changes you've been thinking about for months, working fewer hours while making more money, creating a schedule that actually fits your life and saying yes or only to clients you love working with. We're going with a cohort model. You'll start and finish alongside other full therapists who are ready for more freedom and joy in their work. And spots are limited because I'm personally running every one on one with every person group call and the accountability check ins that we do each week. Doors close September 23rd at midnight. We start October 1st. Go to the Show Notes to Join Limitless Practice before It Sells out.
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So.
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I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about therapynotes that doesn't typically make it into an ad script. First is that they actually care if you like their platform. They don't only make themselves available on the phone to troubleshoot so you don't pull your hair out when you get stuck. They also take member suggestions and implement those that there's client demand for, like Therapy Search, an included listing service that helps clients find you internal and external secure messaging, clinical outcome measures to keep an eye on how your clients are progressing. A super smooth super bill process, real time eligibility to check on your clients insurance. In my conversations with the employees there at all levels, they all really believe in their product and they want you to love it too. Second, they are proudly independently owned. Why should you care about that? Because as soon as venture capital becomes involved, the focus shifts from making customers happy to making investors happy. Prices go way up. Innovation plateaus. Making more money with as little output as possible becomes the number one focus. With over 100,000 therapists using their platform, they've been able to stay incredibly successful and they don't have to sacrifice Your experience to stay there. You can try two months free@therapynotes.com with the coupon code Abundant. Hey, Ashley, how you doing?
A
Good. How are you?
B
I'm good. I'm good.
A
Talk to you. Yeah. Watch all the videos and it's like, yeah, I'm real, I'm live.
B
You know what would be helpful today?
A
Okay. So, yeah, I was actually. I. Every first of the month, I pretty much try to, like, try to schedule in, but of course it takes, like, by the time, I don't know, 10, 15 minutes pass, there's like, no appointments available. So I kind of got lucky this month.
B
Yeah.
A
And so originally I'm actually doing really well now as far as clients, but I'm just. I think it's more about kind of like looking at where I'm at right now and seeing kind of where do I need to go from here, maybe.
B
Okay.
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So I've been in private practice since January 24th, and that's when I purchased the Abundance package. And so that was really helpful. And my niche is adult adhd. Although I also do enjoy doing adolescence too. And I at a place right now, I think it's just more kind of like looking at where I'm at overall. Of course, the first year was a little bit more of a. I wouldn't say struggle, but it was definitely more trying to figure out my position, like, branding wise, like, who am I as a therapist? And so clients were like, you know, I had enough clients, but was just, you know, it's sometimes ebbs and flows, whatever. Now I'm at a place where I have a lot of clients. I have actually like 50 active.
B
Oh, my gosh. Wow.
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Yeah.
B
How many are you seeing per week?
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So I'm seeing about. Well, this week is heavy. And this is like 32 sessions a week. Yeah. And I do feel the burnout part of it too, like from doing all this. And financially, I know that I. I probably set my fees a little bit low. So I'm like, seeing my cash fees right now. A lot of them are still at 80 bucks a session. So.
B
Are you taking insurance also?
A
I am taking insurance also. Yeah. So I'm taking most. A lot of my clients are actually insurance, too.
B
Mm.
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So, yeah, I guess I'm. I'm maybe to say here I met right now. My website's almost done. Not quite. But I actually, you know, I have that. I have someone who's doing it for me, and she's actually doing a really good job. I don't know, I just feel like I'm I guess reaching kind of like a little bit of a burnout point where like between notes and admin and sessions and then session planning and all of that, I feel like overwhelmed and kind of.
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And do you have ADHD also?
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Yes. Yeah.
B
So, yeah, you add the executive functioning stuff that can also go along with that. Like, it's. That's a lot.
A
Yeah.
B
How many clients do you want to see a week?
A
Ideally more like I put a lot on my plate and I automatically do that. So I would say, actually I'd say ideally five a day. Like five, five days a week. Five a day.
B
Like, so 25.
A
25 would be good. Yeah, I say that. But I also know that, like listening to your videos though too, I probably could go lower than that if I wanted to, but there's something about it that doesn't feel right. Like I'm kind of like struggling there. Like, oh, if I only see four clients a day, when I can see like five or six, you know, I don't know. I think it's just kind of like figuring out. I think five a day I do fine on. Today, for example, I have seven. And it's like, that's where it gets overwhelming. Or I'm waking up and I'm like, oh, my God. Sessions, session after session after session today. So. So I guess it's like figuring out, like with my clients now who are 80 bucks. Like, I. I don't want to. They were at 70 and I give them a raise or I gave my fees a raise to 80 bucks this the beginning of the year. So I don't really want to put them in a. I don't want to raise them in their feet, my fees anymore until like next year, but just kind of like figuring out how to maybe prevent the burnout part of it.
B
Yeah. How. How much is insurance paying you for sessions?
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And it's like some under 100, some over a hundred. Mostly around, I want to say like around 70 to 80 bucks a session.
B
Okay.
A
Blue Cross Blue Shield here is really good. And they pay like 120 a session. But other than that, most insurance companies I have, yeah, 70 to 80.
B
And do you live in a low cost of living area?
A
No, I live in Tampa, Florida, which is a pretty high cost. Yeah.
B
Okay, so you're making low cost of living income for a therapy practice while seeing a ton of people.
A
Yeah, that's what I'm afraid of.
B
Yeah.
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Putting myself into. So, yeah, I don't know if I should just stick with this. Stick this out for the next year. Or if I should, you know, there's anything else. Should I raise my rates? Even though I raise my rates, I feel, I feel bad doing that. My clinical consultant that I see, she's like, oh, I would just start kind of like, you know, spreading them out. Like the ones that are 80 bucks and especially if they've been with you for a while and have a lot of long term clients, then spread them. You know, start like doc. Give them back to like bi weekly or monthly or whatever. Make space for that.
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Yeah, if it makes sense clinically. Or you could have them all go to a group. And with groups, usually you make twice as much per hour and they pay a lot less. Yeah, it's like a win win though. I think the average for groups heard did this survey and like across the US the average amount people are charging for groups is $80.
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So like per person.
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Yeah.
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Yeah.
B
Okay, so that might be a good way for you to kind of bolster your income some. Because this like, I, I don't know how it's sustainable without seeing so many clients with those rates.
A
Yeah, that I know that's kind of like I feel like I'm doing okay. But yeah, definitely not as good as I could be. I'm sure. You know, I was like, my, my new fees that I have for new incoming clients, I have it at 125. Good. So that's good. And I have two of those. And in the beginning I recognized like when I would do the consult calls, it was hard for me to tell them that it was $125 a session. Like I'd find myself kind of like. But also I can do sliding scale. Like it automatically offer that or suggest that. Yes.
B
Yeah.
A
But I feel like at the same time, am I, you know, I can tell it sounds to the client like I am not fully confident in my fees though, because I had, I've had a couple of them. When I first started, when I first put my new fees out, there was 125. A couple of them are like, no, it's okay, I can do the 125. If I'm like, you know what, maybe it is okay for people to do 125. Maybe they are willing to do that on a weekly basis.
B
Yes. And let me look at something real quick. So the household income, the median household income in Tampa is $71,302 per year. That's more than here in Asheville where I'm charging 300.
A
Yeah. Oh, wow.
B
So there's a lot of room for you to go up. I understand the mindset of like I just raised it on these folks. I don't know if I want to raise it again, especially a significant amount, but I would start coming up with a plan to get stair step them up to 125.
A
Okay.
B
So it might be. You talk to them and you say, and we have things in the what to say one course that could. That like different ways of going about that you could just raise it all at once. Usually at that price point. I don't recommend that big of a raise. Like 25. Sure.
A
That seems like a big. Yeah.
B
But at that price point, you know, if somebody's going from 200 to 250, I don't bat an eye. But the folks who are paying 80 are going to be like with that big of an increase often. Now I'll also say we've had lots of students in limitless practice who were taking insurance and people are just paying a copay and then they go to 250. And so yes, some people leave, but also some people make it work.
A
Yeah. Okay.
B
It's getting clear because you have to come at it confidently. So.
A
Yeah, I know that's the hard part.
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You have to do a lot of practicing of saying it out loud. And like 125 is still like below average for income for a therapist per session.
A
Yeah, that's. I mean, it's good. It sounds.
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It's good. Yeah.
A
Sounds kind of crazy.
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I don't want you to feel like squeamish for long about 125. We always get squeamish when we raise it. Everybody does. Even like I've been doing it forever. And when I raised it to 300, I was like, me. So like it's normal to feel some anxiety about it, but I don't want you to feel like you're asking too much at 1:25. And if that means using the anchor of like this is below what the average private practice client is or private practice therapist is making per session. Like if it helps to anchor to that. So like I shouldn't feel bad, then good. Like you've got something to anchor you.
A
Okay. Yeah. When you said 300 per session, I'm like I way. I'm way down there, you know. And here I was thinking 125 was a lot.
B
Yeah. But I mean, I remember when I felt 125 is a lot too. Like, it's just, it's developmentally kind of a part of the process of being in private Practice, I could definitely not have charged 300 when I first started. Not because of my clinical skills, but just because of my money mindset.
A
So Right. Even when I raised it from 70 to 80, I was like, oh, that's sounds like a lot. But then I was kind of worried about losing clients, but every single one of them, like no one blinked an eye. Like they just signed the form and that was it, you know. So. Yeah, okay. Other than that I feel like because before I had a lot of issues in my thinking about my branding because. Or my niche because I was like adult adhd, is that too broad? But lately I've been doing really well with it as far as getting clients who are just seeking ADHD. Be.
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Yeah, it's such an in demand, especially now that people are getting diagnosed whether they're self diagnosing or they're getting diagnosed through a testing psychologist.
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Yeah.
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People are like, this explains everything, you know?
A
Yeah. That's what they say when they come to me is, oh my God, now that I got this diagnosis, this explains everything. This opens up all the doors in my life. So this is the other area I struggled in with that though, in particular. So with adhd, the way I kind of see it is there's two like two major areas. One is like more like strategies and coping, but the other one is more like the emotional, internal, core beliefs and all of that side to it. So I think originally I kind of struggled with. I do, I feel like I do much better as a therapist on the emotional side of it, the deeper rooted beliefs and kind of working with that. So I think I struggled with like should I. In the beginning I was like, should I really drill it down to adult ADHD and just like internal core beliefs or is it okay to leave it as broad as the internal core beliefs and the coaching strategies that kind of go along with it?
B
You know, I mean I think you can do both if you enjoy both. If you want to just focus on one, you could do that. But I think both definitely works because it's more holistic. Right?
A
Yeah. I think people really now I'm finding more and more people are coming to me with needs for both. Like they, they usually, they approach me like looking for ADHD strategies, but then when I explain that part to them, like, oh yeah, yeah, you know, and.
B
As they try to implement strategies that are new to them, all that old stuff's going to come up too. So it's like, I don't know, it would be tough to be like, well, we're only talking about the strategies today.
A
So feelings to yourself. Yeah, yeah. So yeah, right now I've been kind of my. A lot of my referrals have been coming in through like referral sites. So like growth therapy has been really good. So I think what I wanted. That's the other thing what I want to do is because growth therapy is good, but it's all insurance clients and those are the clients that are like mostly 70 to 80 bucks a session. So I think it's also part of it is my website's almost done and so I think part of it is how to get myself out there. That's part how to get myself out there where I'm looking to how to get the cash clients, like where I'm not. Yeah, you know, focusing on the referral sites once my website's done. I know. I listened to one of the videos about how it's like marketing to all, like the doctors, like the physicians, like sending out emails. I don't know if you have any other ideas for how do I get my website out there so people can see.
B
I guess the marketing fundamentals course in there is all about that. We've got Marketing Fundamentals 1, which is about getting your website, building it out in a way that actually works. And it's that and networking. Those are two that everybody needs to be doing. And The Marketing Fundamentals 2 is like all the other strategies that work really well for therapists to get people to their website, essentially because everybody's going to check out your website before they call you. Right. Like nobody's just in this day and age, everybody's checking you out. So that's why your website needs to be really on point. Your copy needs to be really specific. You need to be talking about their daily lived experience. And then your other marketing strategies essentially get people to it so that they're like, oh my God, she's talking about me.
A
So yeah, okay. I did follow your templates on creating the company. Good, good website. So yeah, so that's what I just need to do is to be able to get that website out there so people can see it so I can get those cash clients in. So I'm not stuck at 70 bucks or 80 bucks for you.
B
I would like. Are the majority. Well, I guess what percentage of your clients are getting tested versus self diagnosing?
A
Oh yeah, that's the thing. Like I would say a smaller portion of them than not are have been tested. I get a lot of clients who they come in self diagnosing and then we go over like the criteria and kind of talk about that a lot of times, too. I feel like I can, you know, especially being ADHD myself, I can kind of pick up on all those little nuances, you know, and. But a lot of them just, like, they don't seem to show much interest in getting tested. And even more so, more of them are kind of like a little bit medication resistant. They're more like, I want to do the therapy first and see how that goes before getting on any medication. Yeah.
B
So. So is the, the medication resistant? Is that your favorite flavor of adhd or are you. Do you care?
A
I think I. I work well in both. Okay. Yeah. Yeah. Okay. Actually, I will say in some instances, maybe even more so with the medication resistant because I don't know, I feel like there's like a lot to kind of. I don't know if this sounds crazy, but like, there's a lot to, like, work with. If they're. They come to me and they're like, I really. Some people who come on medication, there's stuff to work on with them, but then otherwise they're good. The ones who don't want medication, there's a little. Usually more to work on with them, which actually I really like to have so much more work to do. Yeah, I guess. Does that make sense?
B
Yeah, I know. Yeah.
A
Yeah. So it's kind of like saying a client with more problems, I enjoy working with, but that's true.
B
Yeah. I mean, we all have our favorites, right? So I think it would be really good for you to network with testers, even though that's the minority of who's coming in. But, you know, the last part of any testing is like, here are the resources. And so become one of their chosen resources for the adults with ADHD and also prescribers. So, like psychiatrists, ARMP is pas, like the psych folks that are getting the majority of these folks, because there are some people who are medication resistant who are going there first. They're not going to take the medicine. They just want to ask their questions. They want to make sure that their self assessment is accurate. And so for the psychiatrist to have that conversation and then be like, I don't know if I really want to take medicine. I don't think I'm going to do it. I don't think I want you to write me the script. Then they can be like, you know, there's this great therapist in town who works with folks whether or not they take medication on the skills and some of the emotional heaviness that can go along with having had ADHD your whole life.
A
Yeah.
B
So to become, like, a preferred referral person for them could be really great.
A
Yeah, that sounds actually a really good idea to do that. Do you think I should, like, this is where I'm kind of like, it's not that big of a deal, but wondering if I should be more like, ADHD for teens and adults, or is it better, do you think, to, like, drill down to a niche of who do you like?
B
Do you have a slight preference for adults over teens?
A
Yeah, like, adults over teens. Yeah, I do prefer adults over teens. Yeah. Okay. Okay. Okay. That's the other thing. I do want to get EMDR certified. I don't want it to, like, blur my. I guess, explore my niche too much, if that makes sense.
B
Yeah, well, they don't really care. Well, sometimes people are looking for emdr, but if people are looking for adhd, they're looking for adhd. And then you have this great tool you can use when you get underneath some of that trauma, you know, like. And you're like, yeah, it sucks to feel like you're in your whole life. Like, we can work on that with this. So I don't think you even need to, like, advertise it necessarily. Like, I wouldn't have it be a part of your marketing. You could. You could have like a. Under your services pages, like, a dropdown about emdr, and you could talk about the circumstances that you see where EMDR can be really helpful for folks with. With adhd. But I don't think it needs to change your messaging.
A
Okay. Okay. Yeah. Because that's what I find, too, is, like, we get to that part, and then they might even ask me about it, like, oh, well, I heard about this EMDR therapy, you know, and so there's a lot of people lately who have been to me with that. So, yeah, that's something I want to do. But, yeah, so that's a good idea. Maybe not like, I'm EMDR and adhd, but instead it's just more of like a. Yeah, hey, when we get to that, this is also what I offer. Yeah. I do find that, though, like, with each client, I. I kind of go all in, which could be a good thing. But we, like. I find that there's always patent. There's always, you know, so much more work to do, like attachment work. And there's also a lot of clients come to me who have adhd, but also, of course, have, like, childhood trauma or sometimes I wonder if people who come through with ADHD seem satisfied with where we're going. But if they. Because what ends up happening is that sometimes it derails and becomes not so much ADHD focused, but now it's like, trauma focused. And I was, you know, I guess that's pretty normal.
B
That's great. I mean, because I think that happens for most of us, you know, like, working with eating disorders. It's never just about the eating disorders. It almost always veers into trauma. Almost. I mean, not almost always. Always veers into anxiety. But I think from your messaging standpoint and your marketing, it is about, like, if most people are coming in because they want, and if your ideal client, I should say specifically, is coming in because they want skills, manage their adhd, then that's where I want most of your marketing to focus.
A
Okay. Because that seems that's what usually happens. It's about the skills. And then it balloons into, oh, we got all this stuff too. Yeah. You know, so. Okay. Yeah, that's true. That's true, too. Because a lot of times they're not even realizing. Because I noticed that when clients come to me, they're not even realizing that, oh, there's so much more that I should be working through. You know, it's just.
B
Yeah. Well, I think it often just takes a little, like, the nudge of, like, here's what I see with a lot of my ADHD clients who are diagnosed late. Like, here are all the stories that they believe about themselves for their whole life.
A
Yeah.
B
And then they're like, oh, my God, me too.
A
Big thing for, like. Yeah, yeah. For those who have been lately late diagnosed, compared to, like, those who have known, like, double lives, you know? Okay. I feel pretty good.
B
Love it.
A
Quick for you.
B
Yeah. I mean, five, six minutes early. I'll take it. Yeah, yeah, yeah. I would just stay on that messaging, go through that Marketing Fundamentals two course. Marketing Fundamentals. One that has the networking section that can give you some really good ideas of who your ideal clients find before they find you so that you can get in touch with them and they can refer to you and make it smooth and easy for your people.
A
Yeah, Sounds good.
B
Awesome.
A
It was nice meeting you, seeing you in person.
B
You too. All right, take care.
A
Thanks. You too. Bye.
B
Bye. Your practice is full. Congrats. But are you secretly stuck in golden handcuffs if you're cribbing in 7pm sessions, glued to insurance panels or just whispering, I can't do this till retirement. It's time for limitless practice. In 13 weeks, you'll work less, make more, and enjoy your business again. Spots are limited. Doors close September 23rd at midnight. We start October 1st. Snag your spot with the link in the Show Notes. If you're ready for a much easier practice, Therapy Notes is the way to go. Go to therapynotes.com and use the promo code abundant for two months free. If you're listening, you probably need some support building your practice. If you're a super newbie, grab our checklist using the link in the Show Notes. I'd love for you to follow rate and review, but I really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.
Host: Allison Puryear
Guest: Ashley
Date: September 17, 2025
This episode dives into the challenges and strategies of growing and marketing a private therapy practice for adults with ADHD, especially from the perspective of providers who have ADHD themselves. Allison coaches Ashley, an early-career therapist in Tampa, Florida, who is experiencing rapid practice growth but is struggling with burnout, fee insecurity, and the transition from insurance-heavy clients to more sustainable, higher-fee, cash-pay clients.
This episode balances practical guidance on fee setting, marketing, and burnout prevention with normalization of the growth pains common in building a private practice—especially for therapists with ADHD working with neurodivergent clients. Allison brings encouragement, humor, and concrete steps while validating Ashley’s anxieties and successes.
“I would just stay on that messaging, go through that Marketing Fundamentals course... find who your ideal clients find before they find you so that you can get in touch with them and they can refer to you and make it smooth and easy for your people.” (23:35)