Episode #772: Will the Money Anxiety in Private Practice Ever Actually Go Away?

Summary

Abundant Practice Podcast Summary
Episode #772: Will the Money Anxiety in Private Practice Ever Actually Go Away?
Host: Allison Puryear
Guest: Rebecca Smith
Date: July 4, 2026

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Episode Overview

This episode tackles one of the most persistent worries for therapists in private practice: the anxiety surrounding variable income. Host Allison Puryear and guest Rebecca Smith, both seasoned practitioners, walk listeners through practical systems and emotional strategies to deal with financial unpredictability in private practice. They answer a listener’s heartfelt question about whether money anxiety truly disappears—or if therapists simply get better at handling it over time.

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Key Discussion Points and Insights

1. The Listener’s Question: Income Anxiety in Private Practice

[00:48] Rebecca reads the question:
A listener shares, “I've been in private practice for two years and I still feel a low grade anxiety every time I look at my bank account—even in the months where I'm doing fine financially...How do therapists actually get comfortable with income that fluctuates? And is that anxiety something that eventually goes away or do you just get better at managing it?”

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2. Systems for Dealing with Fluctuating Income

Allison's Approach: Pay Yourself a Predictable Salary

[01:24] Allison:

• Pays herself the same amount each month, regardless of income variability.

• Calculates her yearly average, then pays herself a bit less to build a buffer.

• Uses the “Profit First” method, directing all income into a single account and then distributing it out to expense and owner accounts.

• Builds reserves for slower months (e.g., summer slump).

• Gives herself a bonus with surplus funds at year’s end.

  Notable Quote (Allison, 02:29):

  “So all my money goes into one bank account. Nothing comes out of that bank account except for when I’m paying myself or dispersing it to various bank accounts...then I'll give myself a little bonus.”

Rebecca's Approach: Using Budgeting Software

[03:38] Rebecca:

• Uses YNAB (“You Need A Budget”) for detailed business budgeting.

• Keeps separate budgets for business, family, and her child’s allowance.

• Organizes business expenses in virtual categories without opening multiple bank accounts.

• Prioritizes seeing exactly where money goes: into taxes, payroll, rent, etc.

• Both she and Allison agree on “shoving” money in different places to manage income dips.

  Notable Quote (Rebecca, 05:07):

  “Look at your money all the time. Be in it, be active with it, know what's there, and plan accordingly.”

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3. The Emotional Side: Facing Anxiety Head-On

Exposure to Finances as an Emotional Practice

[05:15] Allison & Rebecca:

• Both admit to experiencing anxiety when checking accounts, even when finances are OK.

• Allison recalls periods of avoidance (“ostriching”) and how confronting reality often reduced anxiety.

• Reference to “money dates,” a weekly practice encouraged by Lindsey Bonham (moneynutsandbolts.com) for building comfort with money.

  Notable Quote (Allison, 05:45):

  “The only way to get over that low grade anxiety is a little exposure therapy—going in, like having a money date every week.”

Normalize and Separate Business and Personal Finances

[07:06] Rebecca:

• Strongly advises separating business and personal accounts for clarity and peace of mind.

• Helps distinguish between “is my practice okay?” and “is my family okay?” financially.

  Notable Quote (Rebecca, 07:18):

  “If you don’t, you better do that, y’all. Immediately. Today. It really helps your tax guy. But also...it protects you.”

The Reality: Does the Anxiety Disappear?

[08:18] Shared insight:

• Both Allison and Rebecca agree: anxiety may lessen with experience, but it rarely disappears completely.

• Cyclical, predictable fluctuations (like summer slumps) become less distressing as they’re recognized as normal.

• It’s more about learning how to manage, rather than eliminate, the anxiety.

  Notable Quote (Rebecca, 08:18):

  “I don’t think it goes away. I don’t. It has not gone away for me yet, but I just am like, oh, yeah, that’s...it goes away in the months that it feels great. But in the summer slump, I still feel like, oh, man. Like, this doesn’t feel good.”

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4. Tactical Takeaways and Additional Tips

Choose the System That Works for You

• Both “Profit First” and dedicated budgeting software are valid, customizable options (10:41–10:54).
• The key: commit to a system and stay actively engaged with your finances.

Mindset Check

[10:54] Allison and Rebecca:

• If anxiety is high, consider if you’re charging enough.
• Scarcity mindset and undercharging can fuel ongoing stress.

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5. Resources and Next Steps

• Free Worksheet: Allison offers a worksheet with her favorite financial resources for therapists (get via podcast show notes or social DM, 11:06).
• Financial coaches: Lindsey Bonham at moneynutsandbolts.com, “Profit First for Therapists” (book).
• Budgeting Tools: YNAB (“You Need A Budget”), Profit First methodology.
• Banking: Always maintain separate business and personal accounts.

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Notable Quotes & Memorable Moments

• “Look at your money all the time. Be in it, be active with it, know what's there, and plan accordingly.” — Rebecca [05:07]
• “The only way to get over that low grade anxiety is a little exposure therapy—going in, like having a money date every week.” — Allison [05:45]
• “Does it go away or are you just better at managing it? ...I don’t think it goes away. I don’t. It has not gone away for me yet, but I just am like, oh, yeah, that’s...it goes away in the months that it feels great.” — Rebecca [08:18]
• "Are you charging enough if you're that anxious about it?" — Allison [11:00]

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Timestamps for Key Segments

• Listener’s Question: 00:48
• Allison’s Approach to Salary: 01:24–03:36
• Rebecca’s Budgeting Method: 03:38–05:07
• Facing Anxiety / Emotional Work: 05:15–07:06
• Separate Banking Importance: 07:06–07:59
• Does Anxiety Disappear?: 08:18–09:17
• Reassessing Fees & Mindset: 10:54–11:06
• Financial Resources Worksheet: 11:06

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Final Thoughts

The consensus: Income anxiety in private practice is a companion that rarely disappears entirely, but with the right financial systems and a willingness to confront your numbers regularly, it becomes much more manageable. Experience brings predictability and self-trust. The key takeaways center on adopting predictable pay structures, actively engaging with financial data, separating business and personal finances, and continually reassessing your rates and mindset.

"Really be in it. Exposure therapy. Get in there." — Rebecca [10:41]

Transcript

[A]

Foreign.

[B]

Welcome to Ask Abundance. Y' all ask the questions about having a fun and thriving practice. We answer them. We have a worksheet for you today so you can bring this answer into your life. If you want support in your practice, we have you covered with on demand or one on one support. Links for the worksheet and support are in the show. Notes can't get enough Ask Abundance. Check out our YouTube channel for the entire library. Hey. Hey. Welcome back to Ask Abundance. Today I'm joined by Rebecca Smith. Rebecca is a limitless practice grad who came aboard Team Abundance. She's got a premium fee private pay practice in New Orleans and she's great at helping Abundance therapists imagine what's possible for them. She's going to give us today's question.

[A]

Thanks, Allison. This one says, I've been in private practice for two years and I still feel a low grade anxiety every time I look at my bank account. Even in the months where I'm doing fine financially. I spent so long in agency work with a predictable paycheck that I don't think I've ever fully made peace with the variability of self employment income. Yeah, yeah, yeah. How do therapists actually get comfortable with income that fluctuates? And is that anxiety something that eventually goes away or do you just get better at managing it?

[B]

I love this question. Okay, before we dive in, I want to thank our sponsored therapynotes. I've talked about them for years. I know their features by heart, but what truly sets them apart is that they genuinely care about your experience. It's not just about troubleshooting. They actively implement user suggested features like secure messaging, clinical outcome tracking, and their AI notes feature. Therapy fuel. Everyone at TherapyNotes believes in the product and wants you to love it too. Plus, they're independently owned, which means no venture capital and no pressure to prioritize investors over customers. This independent allows them to keep their prices fair, to focus on innovation and prioritize customer experience. With over 100,000 therapists already on board, they've proven you don't have to compromise success for quality. If you're ready to see for yourself, you can try TherapyNotes free for two months with the code [e-mail] all right, so I think the first thing that comes to mind for me is what I do as somebody who has had a variable income since 2005 is I pay myself the same amount every single month or every single month.

[A]

Your variable income can drink now, Alison.

[B]

It can.

[A]

It's so old.

[B]

But every two weeks I pay myself the same amount, because I figured out the average of what I make over the year. And I go a little bit under there, just in case, and then I pay myself the same amount. Because I too, am somebody who needs predictability. So that means I use profit first. So all my money goes into one bank account. Nothing comes out of that bank account except for when I'm paying myself or dispersing it to various bank accounts. Yeah, but sometimes that gets. Certain bank accounts will get bigger just because I made more than I paid myself. And that covers me during slower times. So, like, you have a summer slump, you can accommodate that. So I'm somebody who absolutely needs predictability. Cause I'm, you know, I've got stuff I gotta do. I got stuff I gotta pay for. And if at the end of the year I've got this big, like, extra money, then I'll give myself a little bonus.

[A]

That's nice.

[B]

That's one way to handle it.

[A]

Mm. Yeah, that's. That is so interesting. Cause that's not how I handle it. But I also feel happy about how I handle it. So my. My method is. I love my budgeting software. I use ynab. You need a budget. And I have. So in the budgeting software, you can create multiple budgets. So I have my family budget. My kid has one for his allowance. There's like $4 in it. It's very cute. And I have a business budget that is like a separate tab. It's a whole budget for my business. When I open it up, there's like. Here's like, the section where I like, dole out quarter. It's very similar to profit first without multiple bank accounts. But I can see this is where I'm. This is where I'm paying into the S Corp payroll. This is how I'm distributing. This is paying for my office rent. And so one of the ways, depending on the amount of variability, essentially you and I are both saying shove money in places where you can't get it yet so that you can. You can, like, pay yourself in different ways during slower months or. Excuse me, Even if you can't actually pay yourself what you want to pay in that month. If it was a bigger dip, you at least know for a fact that I know my taxes are saved for. I know my office is paid. I have it all there. And so I think that, like, tldr. Look at your money all the time.

[B]

Right.

[A]

Be in it, be active with it, Know what's there, and plan accordingly.

[B]

Yeah, I went into like, here's how to Organize it. But the emotional piece of this is every time this person is looking at their bank account, they're getting anxious, even when it's fine. And I, I have 100% been in phases of my life when I was in that same position to the point where I would want to ostrich just like stick my head right in the sand and just not look at it if I could avoid it. And sometimes I've done that and it's been to my detriment. And sometimes I've done that and I've looked at it and been like, oh, I've been stressing for nothing.

[A]

Oh, it's okay.

[B]

Dang. So I think the only way to get over that low grade anxiety is a little exposure therapy going in, like having a money date every week. This is something Lindsey bonham [e-mail] it's fantastic. She is a. She no longer is a therapist, but she helps therapists manage their money. Not like a financial advisor, but like, here's how to budget, here's how to think about your money and make sure you're putting into retirement. Those kinds of things. So go check her [e-mail] but I think she talks about a money date every week. And just like, you know, getting tea, getting a glass of wine, whatever your thing is, it's going to help you regulate your nervous system a little bit and make it as pleasant as possible to just look at it, just be with it. And at some point, I think you're gonna see, okay, this is what I usually make. And, like, that's enough. Or it needs to be. And I need to, like, adjust things so that that's enough. And then you're not in this space of scarcity of like, oh, but I needed to make this. It can be more of a. Okay, I have enough over. Sometimes it's looking at it over the course of a month or three months, but getting used to looking at your money so that it doesn't have that zing every time.

[A]

I agree. And I think too, I definitely assumed that this person already had separate banking for their business and their personal stuff.

[B]

Great point.

[A]

If you don't, you better do that, y', all.

[B]

Immediately today.

[A]

Yeah, for sure. It makes everything so much easier. It really helps your tax guy. But also it protects you in a way of, like, what you're saying as you're like, I'm paying myself means I am literally moving it from bank account A to bank account B. And bank account B is for Groceries, bank account A is for my office rent. Like, those are very different things. And so feeling like, is my practice okay financially versus, like, am I. I okay, or was my family okay financially? Should. We should kind of try to get some separation there.

[B]

Yeah, definitely. There are a million reasons to separate it out, not the least of which is you have a lot more clarity and what is happening in your business expenses and your business income. And that's really important to know and understand as a business owner. Yeah.

[A]

I think that the ending part of the question is that, does it go away or are you just better at managing it? Maybe. And you and I might be in different places because I still feel like I'm just better at managing. I don't think it goes away. I don't. It has not gone away for me yet, but I just am like, oh, yeah, that's. It goes away in the months that it feels great. So I don't have that whole, like, if it's fine, I'm fine. But in the summer slump, I still feel like, oh, man. Like, this doesn't feel good. But I also know that that's normal for my business. That's actually not an indicator of, like, poor networking or something.

[B]

Yeah.

[A]

For marketing, it's. Oh, it's June.

[B]

Right. Here we are.

[A]

Happens every month or every. Every year. And so the managing, it comes with experience and it comes with. It comes with, like, getting elbow deep in your finances, knowing what's normal.

[B]

Yeah. And I think that's why I ended up shifting to paying myself the same amount every month, because it calmed that anxiety. Because when I transfer money from my, like, income bank account into my owner's compensation bank account, there's plenty in there already to. On the. In the months where we have less revenue, there's already plenty in there. So when I add the smaller amount of money into it, the total amount of money in there is still big enough. You know what I mean? So it's like my anxiety kind of is like, oh, no, I'm good.

[A]

You know, this is a good reminder to me to. I bought profit. I bought the book Profit First Therapist. I was like, okay, Alice, this is my. This is my indication. It's probably time.

[B]

Yeah. I've been doing profit first for over a decade. I think when the original first came out, I started using it. And it's not for therapists. You need to get profit first for therapist, the book. Because it's different. It's all different than what? You're not going to have your overhead unless you have a group practice, your overhead is not going to be nearly as much as, you know, the steel industry or whatever else that the more general book can speak to. Yeah, absolutely.

[A]

And if you don't want to put it into actual physical. I know one of the first things is like here have 15 bank accounts. You can also do it in budgeting software too. To. There are lots of ways, but really be in it. Exposure therapy.

[B]

Yeah. Just get in there. And there's clearly some money stuff to work on too. Some scarcity.

[A]

Yeah. Are you charging enough if you're that anxious about it.

[B]

True.

[A]

Maybe that's one of the things that needs to shift.

[B]

Good point. That's a really good point. Today's free worksheet is going to be some of my favorite financial resources. So if you're listening to this on the pod, then you can go to the Show Notes to access that. If you're on social, you can just hit the word or dm, the word sheets or worksheet and I will send it to you. All right, see you next week. 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. I hope that helped. Please get in touch with any of your questions for Ask Abundance. If you're listening, you probably need some support building your practice. If you're a super newbie, grab our free checklist using the link in the show, not 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.