A Letter From the Other Side of the Door

There is a particular romance attached to opening a group practice.

It usually arrives dressed as freedom.

More space. More clinicians. More impact. More income.

The dream suggests that once you stop doing everything alone, the weight will distribute itself. That expansion will feel like relief. That leadership means less strain and more ease.

Here is the truth from the other side of that door.

You are not wrong for wanting this.

And the picture you were sold was incomplete.

This is not a warning.

It is a lantern.

The First Myth: Growth Automatically Brings Relief

The Physics of Expansion

Growth has weight.

When you add clinicians, you add nervous systems. When you add offices, you add logistics. When you add insurance panels, you add a language that does not belong to the soul of the work but still must be spoken fluently.

In the beginning, vision carries you. Later, gravity returns.

You are no longer only a therapist who owns a business. You become a container.

A container for clinicians’ doubt and burnout.

A container for client crises that land sideways through your team.

A container for systems that fail at the least poetic moment.

Your body notices before your mind does. Tight jaws. Shallow breath. Shoulders that never quite drop.

If your nervous system does not expand alongside the practice, something else will give.

The Second Myth: Hiring Means You Stop Being Alone

Leadership Is a Different Kind of Solitude

This one surprises almost everyone.

You will be surrounded by people and still feel alone in a very specific way.

There are concerns you cannot pass downward.

There are tensions you cannot process sideways.

There are decisions you must metabolize alone before they ever leave your body.

This is not poor leadership. This is leadership.

Depth psychology would call this an initiation. The Steward. The Holder of the Center. The one who carries responsibility without being able to discharge it freely.

If you do not build places where you are held, mentorship, consultation, honest peer relationships, your shadow will quietly take the wheel while you believe you are being generous.

The Third Myth: If You Care Enough, the Systems Will Work Themselves Out

Care Is Not Infrastructure

Therapists are good-hearted people. That can become a liability if no one names it.

You will care deeply.

It will not be enough.

Insurance companies do not respond to devotion. Payroll does not run on intention. Burnout does not care how values-aligned your mission statement is.

Clear policies reduce resentment. Defined roles reduce triangulation. Predictable processes calm nervous systems.

Structure is not cold. It is protective.

Without it, chaos takes the job and never clocks out.

Structure is the vessel that allows magick to stay.

The Myth No One Warns You About: Visibility Is Fragile

When the Algorithm Sneezes, Everyone Catches a Cold

There is a special exhaustion that comes from doing everything right and still watching the floor give way.

Months spent learning the language of search engine optimization. Algorithms. Rankings. Keywords that feel nothing like care, yet decide whether someone finds you when they are desperate and searching late at night.

The work pays off. You climb. You show up. The phones ring.

Then a single moment shifts it all.

A one star review from someone you have never met. No record. No contact. No context. Just a public mark that drops your rating and quietly unravels weeks of careful visibility.

No appeal. No nuance. Just math pretending to be truth.

Storm Haven, home of The Nerdie Therapist, recently experienced this firsthand. And then something else happened.

Our community rose. Clients, colleagues, and people who have been impacted by our work reflected back the care we pour in every day by offering an outpouring of five star reviews. In the middle of the fog, their voices became a beacon. A reminder that algorithms measure visibility, not meaning.

The ripple does not stop with you.

It touches schedules. Hours. Projections. Livelihoods.

Leadership means swallowing the panic so others do not have to taste it.

The Seasonality Trap No One Mentions

Saving All Year, Spending All at Once

You plan. You save. You do the responsible thing.

Then the holidays arrive.

Cancellations increase. Insurance payments slow. The calendar thins in ways that look gentle and feel brutal.

You dip into savings not because you failed, but because you planned responsibly.

Rent still comes. Payroll still runs. Benefits still matter. The nervous system does not care that January will likely recover.

This is the part no one glamorizes.

The Scrooge Duck Illusion

When Everyone Thinks You’re Fine Because the Lights Are On

From the outside, group practice ownership looks like abundance.

From the inside, it often looks like restraint.

Requests arrive when the account is low. Raises. Software. Expansion. All reasonable. All well intentioned.

There is an assumption that the owner is swimming in profit, cheerfully diving into coins like a cartoon tycoon.

The reality is quieter.

A responsible group practice owner often makes less than they would in solo practice. Not because they failed, but because they chose stewardship over extraction.

They reinvest.

They buffer payroll.

They absorb risk so others do not have to.

The Tension No One Wins: Wanting More and Being Boxed In

When Everyone Is Right and the Math Still Fails

Your therapists want to make more money. They should.

The cost of living has increased. Life is heavier. Wanting financial stability is not greed. It is survival.

And then there is the ceiling.

Insurance reimbursement rates that have not meaningfully increased in years. Contracts written by entities that will never sit with trauma or hold the emotional labor of this work.

The practice owner stands in the middle.

You want to pay your people more.

You run the numbers again.

You already know the answer.

Good intentions do not override reimbursement caps. You cannot generosity your way out of a broken system without breaking something else.

Usually yourself. Sometimes the practice.

The Quiet Moral Injury of Leadership

Being the Face of a System You Did Not Create

You believe in fair pay. You advocate constantly. You hold the values.

And you also hold payroll, rent, benefits, reserves, and the responsibility of keeping the entire ecosystem from collapsing.

“I wish I could” becomes a recurring phrase.

Not because you do not care.

But because the math is already holding its breath.

This is not a failure of leadership. It is the cost of holding a broken middle.

The Grief No One Prepares You For: Loving People Who Leave

When Mentorship Is Not a Contract

There is another grief rarely named.

You pour time into someone. You mentor them. You advocate for them. You watch their confidence form and their voice sharpen.

And then they leave.

Sometimes to grow. Sometimes to open their own practice. Sometimes to pursue a dream that looks remarkably like the one you once held alone.

It hurts.

Not because they are wrong to go.

But because the investment was real.

When Success Looks Like Loss

The Paradox of Good Leadership

If you are doing this well, people will outgrow you.

They will take what they learned and build something of their own. The container worked.

And still, there is grief.

You lose shared history. You lose imagined futures. You lose rhythm.

This is not betrayal. It is developmental.

The shadow is hardening. Convincing yourself you should never invest that deeply again.

The work is grieving cleanly without rewriting the past as a mistake.

Integration Instead of Armor

Letting Endings Mean Something

Healthy leadership sounds like this.

“I am sad you are leaving, and I am proud of what you are building.”

“This mattered, even though it changed.”

Group practices are incubators whether we name them that way or not.

The grief is proof you cared.

The letting go is proof the work worked.

The Truth Under All of It

Opening a group practice means your nervous system becomes part of the infrastructure.

You absorb volatility. You translate chaos into continuity. You hold steady while numbers fluctuate and people count on you.

This path is not for everyone.

And it is deeply meaningful for those who choose it with open eyes.

Not because it is glamorous.

But because it asks you to become more human, not less.

The storm is real.

So is the refuge you are building.

And neither exists without weather.

And I want to be clear about something.

I did not write this from a place of regret. I wrote it from inside the work.

Knowing all of this, I would choose a group practice again. Not because it is easier or more profitable, but because I believe in what happens when care is held collectively, when clinicians are mentored with integrity rather than isolated, and when communities are built to outlast any one person.

Naming the weight is not a lack of appreciation. It is how I take responsibility for holding it well. This work costs something. And it gives something back that cannot be measured on a spreadsheet.

A Note on What Comes Next

This article names the realities that are often left unspoken. The weight. The constraints. The grief. The responsibility that comes with holding a system together.

What it does not fully answer is how people continue to do this work without hardening, burning out, or disappearing inside it.

The next article, What Actually Sustains Group Practice Owners, explores that question directly. It looks at peer leadership circles, financial transparency without shame, nervous system care for those who hold others, and meaning that outlasts metrics.

These two articles are meant to be read together. One names the weather. The other names what makes it possible to keep holding the light.

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Written by Jen Hyatt, a licensed psychotherapist at Storm Haven Counseling & Wellness in Temecula, California.

Disclaimer:
This piece reflects lived experience and personal perspective as a group practice owner. It is not intended as legal, financial, or business advice. Every practice operates within its own financial, clinical, and regulatory context, and outcomes may vary based on location, structure, payer mix, and individual circumstances. Readers considering opening or running a group practice are encouraged to consult with appropriate legal, financial, and professional advisors when making business decisions.