On therapist compensation, insurance reimbursement, professional values, and what happens when the people closest to us become the easiest ones to blame.

Anyone familiar with Scream knows that a ringing telephone can become a rather unsettling thing. A perfectly ordinary conversation begins, someone asks a seemingly harmless question, and before long, you’re examining the windows, checking the locks, and wondering which familiar face might be hiding behind the mask.

Horror has taught us to look for the villain nearby, perhaps somewhere inside the house or among the people we know. Lately, I’ve been watching a different kind of horror story unfold within the mental health profession. There are no masked figures lurking outside the window, at least none that I’ve encountered during payroll, but there is a growing suspicion about who deserves to be cast as the villain.

An Instagram reel recently caught my attention. A therapist was reacting to compensation offers for associate-level clinicians working in group practices. One arrangement appeared on the screen: a 50/50 split.

If you’ve spent much time in therapist circles online, you probably know where these conversations tend to go. Someone points out that a practice might collect $100 for a session while the therapist receives $50. Someone else questions why the practice should retain half the money when the clinician is the one providing therapy. Before long, the discussion becomes about exploitation, professional worth, and whether group practice owners are profiting unfairly from the labor of their clinicians.

I understand the frustration. Therapists invest considerable time, money, education, emotional energy, and professional responsibility into becoming clinicians. Many enter the field carrying student debt, having spent years earning supervised experience, and having accepted compensation that barely reflected the complexity of their work. By the time someone becomes licensed, they’ve often spent years being told that helping people is its own reward, as though landlords, grocery stores, and student loan servicers accept professional fulfillment as currency. They do not, unfortunately.

Yet as I watched the discussion unfold, I found myself wondering whether we had become so preoccupied with identifying the villain that we had stopped questioning where the threat was actually coming from.

The group practice owner is an obvious suspect. After all, owners determine compensation arrangements, control organizational resources, and make decisions that directly affect their employees’ financial lives. Sometimes those decisions deserve serious scrutiny. But what if some of the financial pressures we’re experiencing originate somewhere beyond the walls of the group practice? What if therapists and practice owners are both responding to conditions created by institutions with considerably more influence over the financial landscape of mental healthcare?

Perhaps we’ve been searching every room of the house while overlooking where the calls originate. Unlike the familiar horror-movie warning, this time the call isn’t necessarily coming from inside the house. Sometimes it’s coming from much further upstream.

When a 50/50 Therapist Pay Split Becomes a Judgment About Someone’s Values

There is something psychologically interesting about how quickly a compensation percentage can become a moral assessment.

A 50/50 split appears on a screen, and the arithmetic seems relatively simple. If a group practice collects $100 for a therapy session and pays the clinician $50, the remaining $50 must be going somewhere. If we imagine that money disappearing directly into the owner’s pocket, the arrangement can feel obviously unfair.

The difficulty is that the money retained by a group practice is not automatically profit. That remaining revenue may support billing, insurance credentialing, administrative staff, employer payroll taxes, workers’ compensation, clinical supervision, employee benefits, office space, electronic health records, marketing, compliance, and the infrastructure necessary to operate a healthcare organization. It may also help sustain the practice during periods of inconsistent referrals, rising expenses, or delayed insurance payments.

The amount a practice charges for a therapy session is not necessarily the amount an insurance company reimburses, either. A private-pay rate, billed charge, contracted insurance allowance, and actual collected revenue can represent very different numbers. Even the meaning of a compensation percentage can vary depending on whether it is calculated from billed charges, expected reimbursement, or actual collections.

None of this tells us whether a particular 50/50 therapist pay split is fair. It tells us that we need more information before deciding what the number represents.

In The Myth of the Scrooge McDuck Practice Owner, I explored the financial realities that tend to remain invisible when people imagine group practice ownership as an elaborate exercise in collecting passive income from other therapists’ labor.

I’ve learned that there is an enormous difference between the revenue an organization generates and the money actually available to distribute. I’ve also learned how easily group practice owners can spend years paying themselves less than their responsibilities might otherwise warrant, redirecting resources toward clinicians, benefits, infrastructure, and organizational stability.

I’ve made those decisions myself, sometimes thoughtfully and sometimes because I confused personal sacrifice with responsible leadership. Neither experience should be romanticized. A practice owner’s willingness to reinvest in an organization does not create an obligation for therapists to accept inadequate compensation, just as an owner underpaying themselves indefinitely is not necessarily evidence of a healthy business model.

The question, then, becomes more interesting than whether a particular percentage sounds generous or exploitative. We need to understand what the compensation arrangement actually provides, what it costs to sustain, and whether the resulting distribution is fair to the people whose work makes the organization possible.

I Was a Therapist Long Before I Became a Group Practice Owner

My perspective on therapist compensation did not begin when I became responsible for payroll.

Long before I founded Storm Haven Counseling & Wellness in Temecula, California, I was navigating the professional journey that many therapists know intimately: graduate education, supervised experience, licensure requirements, clinical responsibilities, and the strange expectation that someone preparing to enter a profession dedicated to human wellbeing should somehow be willing to sacrifice their own along the way.

During my journey toward licensure, I worked without compensation while earning a portion of my clinical hours. I was gaining valuable experience, certainly, but I was also contributing actual labor to an organization while trying to build a professional future.

Then, when I became licensed, I received a whopping $100 per month raise. I wish I were inventing that detail for comedic effect. It would make a decent bit in a workplace satire, perhaps somewhere between the breakroom pizza party and the inspirational poster reminding everyone that teamwork makes the dream work.

Those experiences contributed to my growing awareness of how our profession sometimes treats aspiring clinicians. We spend years emphasizing ethics, professional responsibility, client welfare, and the therapeutic relationship while participating in systems that have not always extended those same values to the people preparing to become therapists.

My commitment to changing that culture developed during my years working in the nonprofit sector, well before I owned a group practice. When I eventually founded Storm Haven, I wanted pre-licensed clinicians working within the practice to receive compensation for their work. I did not want someone’s need for supervised experience to become a reason their labor was treated as disposable.

That commitment has never meant believing every organization can offer identical compensation or that all training environments operate under the same legal or financial structures. It has meant recognizing that ethical professional development requires attention to power, labor, supervision, financial vulnerability, and the ways people can be exploited when advancement depends upon someone else’s approval.

Years ago, Alyx and I explored these concerns on our Therapists Off Script podcast. In Seasons of a Therapist: Path to Licensure, Part Two, we discussed the associate experience and the realities of entering the profession. Later, in Navigating the Shark Infested Waters of Mental Health: Be the Battleship, we examined professional obstacles, predatory practices, and the importance of approaching our careers with intention rather than simply accepting whatever conditions the field places before us.

These were conversations I cared about before becoming an employer, and they remain important to me now.

I share that history because I think we sometimes assume changing professional roles means changing allegiances, as though becoming a group practice owner requires abandoning the experiences, values, and concerns that shaped us as therapists.

Certainly, ownership changes the responsibilities we carry. It introduces financial interests, institutional power, employment obligations, and decisions that directly affect other people’s livelihoods. Those differences matter, and responsible leadership requires acknowledging them. But becoming an employer did not erase the years I spent on the other side of the employment relationship. If anything, it gave me another perspective on how deeply interconnected these problems actually are.

Following the Money Upstream: How Insurance Reimbursement Affects Therapist Pay

Imagine two people standing beside a river, arguing about why there isn’t enough water reaching their portion of the landscape. One believes the other is taking too much. The other insists they’re trying to keep the surrounding ground from drying out. They study the water immediately in front of them, measure what each is receiving, and begin assigning blame, yet neither has walked upstream to see what is happening to the flow before it reaches them.

That is increasingly how I experience conversations about therapist compensation within insurance-based mental healthcare.

Group practice owners make meaningful decisions about compensation, benefits, staffing, and how organizational resources are distributed. Those choices matter, but the financial resources available to an insurance-based practice are also substantially influenced by reimbursement arrangements that individual therapists and practice owners may have limited power to change.

Insurance companies establish contractual reimbursement rates, determine claim-processing requirements, and create administrative systems that practices must navigate to receive payment. Clinicians and administrative teams spend time responding to denials, correcting claims, verifying coverage, obtaining authorizations when required, and satisfying documentation expectations.

All of that work consumes resources that might otherwise support compensation, benefits, supervision, or additional clinical and administrative services. Even practices genuinely committed to paying therapists well must account for what their insurance contracts actually reimburse and what it costs to collect those payments.

This becomes particularly frustrating when healthcare systems emphasize the importance of mental health access while maintaining financial and administrative structures that can make providing that access increasingly difficult.

Mental health parity protections exist because mental health and substance use disorder benefits have historically required scrutiny regarding how they compare with medical and surgical benefits. The U.S. Department of Labor’s guidance on mental health parity explains federal protections involving financial requirements, treatment limitations, and other health plan practices.

But meaningful access involves more than the existence of insurance coverage. It also depends upon the availability of clinicians, the feasibility of participating in insurance networks, and whether reimbursement supports sustainable care.

When those structures are inadequate, the consequences move downstream. A group practice struggles to maintain staffing and benefits, a therapist wonders why compensation has not increased, and a client struggles to find an available provider who accepts their insurance. What began as a reimbursement problem becomes a workforce problem, an access-to-care problem, and eventually a source of conflict between people who may have more overlapping interests than they realize.

Practices can negotiate with insurers where possible, challenge payment problems, and make decisions about which contracts remain financially viable. Yet those efforts do not guarantee that an individual practice can fundamentally change the reimbursement landscape.

When the larger system remains stubbornly unresponsive, frustration tends to look for somewhere else to go. Often, it lands on the person standing closest to us.

The Psychology of Turning Each Other Into the Problem

As therapists, we spend considerable time helping people understand that the most visible conflict is not always the entire conflict.

A couple may argue about unfinished household chores while navigating deeper concerns about fairness, emotional labor, trust, or whether their needs matter. A family may identify one member as the problem while overlooking the larger relational patterns in which everyone participates. Someone experiencing chronic stress may find their frustration settling on the nearest available person, even when the conditions creating that frustration extend well beyond the immediate relationship.

We know how to explore these dynamics in the therapy room, yet there is something profoundly human about how difficult it becomes to recognize similar patterns when our own financial security, professional identity, and sense of fairness are involved.

Money is rarely just money. It represents housing, food, independence, stability, opportunity, and the ability to imagine a future without constantly calculating whether we can afford it.

For therapists, compensation can also become entangled with professional worth. After years of education, training, supervision, licensure, and emotionally demanding clinical work, receiving an inadequate paycheck can feel like another institution communicating that our labor is less valuable than we believed.

For practice owners, financial pressure may carry a different emotional weight. Payroll is not an abstract business expense when other people’s livelihoods depend upon it. A denied claim, unexpected operating cost, or insufficient revenue can create consequences extending beyond the owner’s individual financial circumstances.

These experiences are not identical. Employers hold authority and financial responsibilities that employees do not, and that difference in power cannot simply be dissolved through a conversation about shared struggles. Nevertheless, financial vulnerability can shape how people interpret one another’s intentions.

A therapist asks for higher compensation, and an overwhelmed practice owner may hear an accusation that they’re greedy, exploitative, or insufficiently invested in their team. An owner explains financial limitations, and the therapist may hear that their work is not valued, their needs are inconvenient, or the organization’s wellbeing will always matter more than their own.

The conversation can begin to resemble a familiar relational cycle. One person raises a concern, the other becomes defensive, the first feels dismissed, and the second feels unfairly characterized. Each response makes sense from inside that person’s experience, yet the interaction becomes increasingly organized around protecting oneself rather than understanding what is happening.

Sometimes those interpretations reflect genuine problems within the working relationship. Other times, they are influenced by accumulated experiences, unmet expectations, and pressures neither person has fully articulated. Recognizing the pattern does not mean treating employers and employees as equally powerful or equally responsible. It means understanding how a financial problem can become a relational one, and why resolving the conflict may require more than deciding who is right.

The Seduction of the Bigger Percentage: Group Practice vs. Private Practice

Compensation conversations become even more complicated when we introduce the growing number of professional arrangements available to therapists.

A clinician working within a traditional group practice may see an opportunity advertising a substantially higher percentage of collected revenue through an independent practice arrangement or technology platform. The appeal is understandable. More income can mean reduced financial anxiety, greater independence, more flexibility, and the freedom to create a professional life that better fits one’s circumstances.

Therapists should absolutely have those options, but comparing compensation percentages without considering the underlying structures can be misleading.

In Docking at Storm Haven: A Guide to Joining a Group Practice as a Therapist in California, I explored what therapists may want to consider when evaluating a group practice opportunity. Compensation matters enormously, but so do the structures surrounding it, including supervision, administrative support, benefits, professional community, autonomy, and expectations.

An employee position and an independently operated practice do not necessarily carry the same financial responsibilities, tax obligations, legal protections, or business risks. Depending on the arrangement, clinicians may receive employer-supported benefits, payroll tax contributions, administrative assistance, credentialing support, referrals, and clinical consultation. Alternatively, they may assume more of those responsibilities themselves in exchange for greater autonomy and a different financial arrangement.

A 70% offer may genuinely be more advantageous than a 50% offer. It may also reflect a fundamentally different professional relationship in which expenses and responsibilities have shifted rather than disappeared.

This is part of what I explored in Thinking About Going Solo? What No One Tells Therapists About Group Practice, Private Practice, and the Cost of Every Choice. Leaving a group practice may allow therapists to retain more of the revenue generated by their clinical work, but it can also mean taking on financial risk, administrative labor, business infrastructure, and decisions that previously existed outside the therapy room.

Employment classification matters too. Particularly in states such as California, organizations cannot simply choose whether someone is an employee or independent contractor based on which designation makes a compensation package more attractive. Applicable legal requirements and the actual working relationship determine what arrangements are permissible, while pre-licensed clinicians have additional supervision, registration, and employment considerations.

Yet those distinctions are rarely visible in a social media post comparing two percentages.

When the Platform Promises to Make Everything Easier

The same questions arise when considering technology platforms that promise easier insurance participation, reduced administrative responsibilities, greater autonomy, and potentially more favorable reimbursement arrangements.

Some platforms offer meaningful advantages. They may make it easier for therapists to establish independent practices, accept insurance, and spend less time managing administrative work. Those benefits deserve consideration, particularly when traditional practice structures have not adequately supported clinicians’ financial or professional needs.

At the same time, I think our profession needs to examine what happens when therapists become increasingly dependent upon infrastructure controlled by organizations whose long-term business interests may not always align with their own.

A platform’s financial arrangements, contractual conditions, referral systems, fees, and technology may evolve as its business model changes. The convenience of an arrangement today does not guarantee that its terms will remain equally advantageous in the future. Sometimes the teeth of a business model become visible only after people have organized substantial portions of their professional lives around it.

That possibility does not make every platform predatory, nor does it mean traditional group practices are inherently more ethical. The relevant question is whether we understand the arrangement we’re entering, what we’re receiving, what we’re giving up, and who controls the infrastructure surrounding our work.

I explored some of these tensions in You Can Build the Hearth, But You Cannot Make People Gather Around It, particularly the relationship between compensation, community, professional independence, and values-based group practice ownership.

Ultimately, a percentage can tell us something important about compensation, but it cannot tell us everything about the professional future we’re choosing to build.

Sometimes the Call Really Is Coming From Inside the House

Of course, anyone who has watched enough horror movies knows that dismissing the possibility of danger inside the house is rarely a particularly wise survival strategy. Sometimes the person behind the mask really is someone familiar, and the same is true within our profession.

Some group practices genuinely exploit clinicians. Some owners prioritize personal profit while expecting employees to absorb inadequate compensation, excessive workloads, poor leadership, or unpaid responsibilities. Others rely on the language of community, professional development, or shared mission to justify practices that deserve legitimate criticism.

Those experiences do not disappear because insurance reimbursement is complicated. A therapist does not owe an employer gratitude for meeting basic employment obligations, nor should they be expected to subsidize an owner’s vision through uncompensated labor or acceptance of problematic workplace practices.

Likewise, an owner’s personal financial sacrifice should not become a moral debt that employees are expected to repay through loyalty, silence, or acceptance of conditions that do not meet their needs.

I’ve become increasingly aware of how easily even well-intentioned leaders can blur those boundaries. When you care deeply about the organization you’ve built, its survival can begin to feel inseparable from your identity. You know how much work happens behind the scenes, how many difficult decisions must be made, and how frequently you’re trying to balance competing needs with limited resources.

It can be painful when someone interprets those decisions as evidence that you don’t care, but caring about an organization does not make every decision correct. Good intentions do not automatically create fair outcomes, and values-based leadership requires more than believing ourselves to be values-driven. It requires examining how our decisions affect other people, remaining open to criticism, and taking responsibility for the authority we hold.

People can care about an organization and still leave it. They can appreciate their colleagues and still need more financial security. They can recognize the value of community without deciding that community should replace income.

Looking upstream should never become a way of avoiding accountability downstream. We cannot follow every financial problem back to an insurance company and pretend there is no responsibility for what happens closer to home.

But we also cannot assume every practice owner is wearing the mask simply because they happen to be the person standing closest to us when the phone rings.

Sometimes the problem genuinely originates inside the organization. Other times, systemic pressures and organizational decisions compound one another. Understanding the difference matters because accountability should be directed toward the people and institutions actually responsible for the harm.

The Cost of Making Each Other the Villain

There’s another consequence to these increasingly adversarial conversations that concerns me. When therapists begin assuming group practice owners are inherently exploitative, and owners begin assuming therapists care only about compensation, we lose access to the possibility of understanding one another.

The therapist becomes a productivity measure or a financial demand, while the practice owner becomes a percentage retained from a session. Neither person is allowed to remain particularly human.

Social media can intensify that reduction. The sharpest statements are often the easiest to circulate, and a complicated conversation about reimbursement contracts, labor laws, operating expenses, employment protections, and professional values is considerably harder to compress into a thirty-second reel.

A villain makes the narrative easier to understand: the greedy owner, the entitled employee, the soulless corporation, or the therapist who supposedly cares more about money than clients. But when we apply those narratives indiscriminately, we risk overlooking important differences between exploitation, competing interests, poor leadership, and systemic financial constraints.

More importantly, we risk losing potential allies.

Therapists have firsthand knowledge of what inadequate compensation, administrative burden, and unsustainable clinical expectations feel like. Group practice owners may have direct experience negotiating reimbursement contracts, maintaining insurance participation, navigating payroll and employment requirements, and advocating for resources needed to support clinical services.

Those perspectives are different, but they can inform one another. We do not need to pretend employers and employees always share identical interests to recognize that they may have overlapping reasons to challenge larger systems.

If we become so focused on unmasking one another that we overlook the institutions shaping our shared professional environment, we may find ourselves fighting over the consequences while the underlying conditions remain remarkably undisturbed.

What Happens When We Stop Fighting Only Downstream?

One of the things I continue to wonder is what might happen if more of our professional frustration were directed toward changing the conditions that make sustainable mental healthcare so difficult to provide.

Advocacy can begin with how insurance companies determine reimbursement, how provider networks are maintained, how claims are processed, and whether mental health parity protections are meaningfully upheld.

Professional organizations such as the California Association of Marriage and Family Therapists (CAMFT) and the American Association for Marriage and Family Therapy (AAMFT) provide opportunities to participate in broader professional advocacy. Clinicians and practice owners can support legislative efforts, communicate with policymakers, raise concerns about problematic insurance practices, and contribute their experiences to discussions about the actual cost of providing mental healthcare.

For group practice owners, advocacy also happens within the organizations we lead. We can examine compensation structures, communicate more transparently about employment arrangements, negotiate reimbursement where possible, challenge problematic payer practices, strengthen clinical and administrative support, and make thoughtful decisions about how available resources are allocated.

For therapists, advocacy may involve asking informed questions about compensation, benefits, employment classification, supervision, administrative expectations, and professional autonomy. It may mean evaluating opportunities according to personal values as well as immediate financial gain, participating in professional organizations, or speaking openly about workplace practices that deserve improvement.

None of this should become another unpaid responsibility that exhausted clinicians are expected to carry simply because they entered a helping profession. Advocacy takes different forms, and not everyone has the same capacity to participate.

Sometimes meaningful change begins with someone recognizing an unfair arrangement. Sometimes it begins with an owner reconsidering a longstanding policy. Sometimes it involves collective organizing, legislative engagement, or professionals from different roles deciding that a problem deserves more attention than another argument in an Instagram comment section.

The goal is not to eliminate disagreements between therapists and practice owners. It is to recognize which problems we can address within our organizations, which require broader professional advocacy, and where collaboration might accomplish something that mutual suspicion cannot.

We Can Build Something Better Without Pretending the System Is Fine

When I founded Storm Haven, I wanted to create something that reflected the values I had developed throughout my years in mental healthcare.

I wanted a place where therapists could practice thoughtfully, receive meaningful support, continue growing professionally, and remain human while doing work that asks so much of them. I wanted the organization’s values to exist beyond the website, the mission statement, or whatever polished language we might use to describe ourselves.

Years later, I’ve learned that maintaining those ideals inside the realities of insurance-based group practice ownership is considerably more complicated than imagining them.

Sometimes I wish I could offer more than the practice can sustainably provide. Sometimes I have to make decisions that someone else may reasonably experience as disappointing. Sometimes I have to examine whether my own expectations, assumptions, or ways of leading are contributing to the very tensions I’m trying to resolve.

And sometimes I look at the larger mental healthcare system and wonder how we’ve collectively accepted so many arrangements that make it unnecessarily difficult for people to do meaningful work and earn a sustainable living.

I don’t believe the answer is to ask therapists to want less, nor do I believe it is to ask group practice owners to absorb unlimited financial risk, sacrifice their own wellbeing, or operate organizations that cannot remain sustainable. I think we need a more expansive conversation about what it actually takes to create workplaces where clinicians are compensated fairly, clients can access care, and the organizations supporting that care can continue functioning.

I keep thinking about that Instagram reel and the conversations surrounding it. The therapist reacting to a 50/50 split is asking an important question about professional value, while the group practice owner explaining operating expenses may be trying to answer an equally important question about sustainability. Neither perspective, by itself, tells us the entire story.

Perhaps this is where our professional training becomes particularly relevant. We spend our working lives helping people recognize relational patterns, explore the influences shaping their experiences, and question whether the most obvious explanation is necessarily the most complete one. Yet when our own financial security and professional worth are involved, it can become remarkably tempting to identify a single villain and call the mystery solved.

Real life rarely offers such convenient endings.

Sometimes the threat really is coming from inside the house, and we have a responsibility to confront it. But sometimes the people inside are arguing about who left the door unlocked while the larger systems controlling their resources remain remarkably undisturbed.

We may occupy different positions within the mental healthcare system, but we do not have to mistake the person standing closest to us for the source of every problem we’re experiencing. Perhaps that is the plot twist worth considering this spooky season. We’ve been so busy trying to unmask the villain standing across from us that we haven’t always considered who else might be on the other end of the line.

Maybe it’s time we traced the call.

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About the Author

Jennifer Hyatt, LMFT, is a psychotherapist, clinical supervisor, writer, and builder of spaces where psychology, creativity, community, and the beautifully complicated business of being human can meet. She is the founder of Storm Haven Counseling & Wellness, a values-driven group psychotherapy practice in Temecula, California, as well as the creator of The Nerdie Therapist, where she writes and speaks about psychotherapy, clinical leadership, private practice, and the systems surrounding the work.

Jennifer is also the founder of The Nerdie Matters Collective, a community created around connection, creativity, and gathering beyond traditional professional spaces. She is the author of The Understory: Going Beneath the Surface in Psychotherapy, a therapist’s guide to the hidden ecosystems beneath symptoms, stories, and the roots of change, and co-creator of Thread & Tether, an archetypal card deck designed by therapists for therapeutic exploration, reflection, storytelling, and meaning-making.

Across these different creations runs a similar thread: Jennifer is interested in what happens when we build places where people are invited not merely to fit in, but to belong, contribute, create, question, and imagine what might grow next. Much of her work lives at the intersections of neurodivergence, depth psychology, nervous system awareness, archetypes, symbolism, relationships, storytelling, and the systems in which therapists and clients are trying to do deeply human work.

Want to Go a Little Deeper?

Some ideas fit neatly into a blog post. Others have roots that keep traveling underground.

The Understory is where I explore what lives beneath the more visible parts of being human: psychology, neurodivergence, relationships, identity, archetypes, symbolism, folklore, pop culture, the nervous system, and the strange and beautiful business of becoming more fully ourselves.

If something here gave you a thread you are not quite ready to put down, come find me in The Understory. We’ll follow it a little farther.

Disclaimer

This article reflects the author’s professional experiences and perspectives and is intended for educational and reflective purposes. It is not legal, financial, employment, or tax advice. Therapist compensation structures, employment classifications, supervision requirements, and practice operating expenses vary by jurisdiction, organizational model, and individual circumstances. Readers should consult appropriately qualified professionals regarding their specific situations.