Why Self-Advocacy Feels So Awkward for Therapists—and Why You Should Do It Anyway
There is a particular kind of dread that creeps in when a psychologist, after years of training in nuance, containment, and empathic attunement, sits down to write an email not to a client, not to a colleague, but to an insurance company. The dread isn’t about wording, exactly. Nor is it about clarity of thought. It is about identity—about the strangeness of being in the position to ask for something, rather than offer it. It is the discomfort of assertion in a professional culture that has elevated deference to a near-spiritual ideal.
Therapists are trained to make room for others. To bracket their needs. To keep themselves out of the frame. And in doing so, many develop a working style that makes self-advocacy not just unfamiliar, but emotionally threatening. When it comes time to request a rate review or negotiate a contract, even the most seasoned clinicians can find themselves flooded with a kind of muted panic: What if I’m being inappropriate? What if I’m seen as difficult? What if this isn’t how I’m supposed to behave?
The question is not whether therapists struggle with self-advocacy. The question is why they struggle, and what it costs them not to try.
The Inherited Posture of Deference
Clinical training programs, almost without exception, teach aspiring psychologists to deprioritize themselves. In supervision, students are praised for their capacity to listen, to contain, to hold complexity without inserting themselves too visibly. These are good skills. But over time, they often harden into something less adaptive: a professional posture of self-effacement, where even basic boundaries start to feel like breaches of ethics.
This posture is not accidental. It is deeply rooted in the history of mental health care, which emerged from disciplines—medicine, social work, clergy—that emphasized self-sacrifice as moral virtue. The archetype of the helping professional was someone who gave more than they asked, who served without complaint, who absorbed the distress of others without needing reciprocity.
That legacy, while no longer explicitly taught, remains embedded in the culture. It shows up in the therapists who apologize for canceling sessions when sick. In the clinicians who feel guilt when quoting their full fee. In the providers who haven’t raised their rates in ten years because “some of my clients wouldn’t be able to afford it.”
And, most perniciously, it shows up in the therapist who hesitates to ask an insurance company to review a reimbursement rate that has remained unchanged for half a decade—not because they don’t know how, but because they’re not sure they’re allowed to want that.
When Containment Becomes Self-Suppression
The therapeutic stance is built on a paradox: to be fully present with someone else, you must first be secure in yourself—and yet you must be willing to temporarily set that self aside. This is not a problem in the room. In fact, it is what makes psychotherapy possible.
But outside the clinical hour, the continued suppression of self becomes maladaptive. When psychologists begin to manage their professional relationships—especially with institutions—using the same stance they use in therapy, the result is not therapeutic neutrality. It’s disempowerment.
Institutions are not clients. They do not benefit from your containment. They benefit from your silence.
When a psychologist avoids asking for a fair rate out of fear of being too assertive, what they are doing—often unconsciously—is using the therapeutic frame in the wrong context. They are bringing an ethos of empathic deference into a setting that requires negotiation. And they are hoping, quietly, that their restraint will be noticed and rewarded.
It almost never is.
The Therapist as a Conflict-Averse Entity
Psychologists, as a group, are not known for their love of confrontation. There are exceptions, of course—those with activist spirits, those trained in systems thinking or policy advocacy—but the average clinician in private practice did not go into this work because they enjoy pushing back. They went into this work because they care about people.
The internal narrative that develops from that orientation often sounds like this:
- “I don’t want to be one of those providers who’s always complaining.”
- “I should be grateful to be in-network at all.”
- “Maybe I’m just not cut out for the business side.”
These are not thoughts. They are defenses. They protect the therapist from the discomfort of cognitive dissonance—between what they give and what they receive, between what they tolerate and what they know is unsustainable.
But the cost of those defenses is cumulative. Every time a therapist ignores that inner signal—that quiet but persistent voice that says, this is not okay—they weaken their own sense of professional integrity. Not the kind of integrity that deals with ethics codes and licensure boards. The deeper kind. The kind that whispers, You know better. You know this isn’t sustainable. Do something about it.
What Self-Advocacy Actually Is (and Isn’t)
There’s a reason this guide does not begin with scripts or tactics. It begins with groundwork—the psychological foundation necessary to withstand the unease of asking for something, especially when asking goes against the grain of your training.
To be clear: self-advocacy is not arrogance. It is not entitlement. It is not an abandonment of clinical values. It is the basic act of naming what is needed to sustain your practice—out loud, to the people and systems that shape its viability.
To advocate for yourself is to refuse to participate in your own depletion.
That’s all.
It is not dramatic. It is not revolutionary. But for many psychologists, it is deeply uncomfortable—because it challenges the belief that good clinicians are always agreeable, always flexible, always willing to absorb whatever the system hands them.
They are not. And they should not be.
Why You Must Do It Anyway
The emotional awkwardness of self-advocacy will never fully disappear. But it is not a sign you’re doing something wrong. It’s a sign that you’re growing out of a professional role that was never meant to contain all of who you are.
You are not just a provider of services. You are the architect of a practice.
You are not just a helper. You are a knowledge worker whose time and expertise carry real economic value.
You are not just an advocate for others. You are the only person who can advocate for yourself.
And the uncomfortable truth is: if you don’t, no one else will.
That email you’ve been avoiding? That call you’ve postponed? That letter you can’t bring yourself to send? It matters—not just because it might lead to a better rate or fairer contract, but because it reorients you back to agency. It reminds you that you are not at the mercy of systems. You are a participant in them.
And while your power may be limited, it is not zero.
Self-Advocacy as Ethical Practice
There is one final point to make, and it may be the most important.
Psychologists often define ethics as adherence to external standards—confidentiality, informed consent, scope of practice. But ethics also live in the day-to-day decisions that shape whether your work is sustainable.
If you build a practice that cannot support your needs, you are not being ethical. You are being avoidant.
If you accept contracts that underpay you to the point of resentment, you are not being generous. You are being complicit.
If you continue to engage with systems that harm you without ever voicing objection, you are not being collaborative. You are being silent.
And the field doesn’t need more silent practitioners. It needs clinicians who are willing to name what’s broken—not just in their clients, but in their contracts. In their workflows. In their expectations of themselves.
That naming begins with a single, awkward moment: a message, a call, a sentence that says, “I’d like to discuss my rate.”
It will not feel comfortable.
But it will feel true.
And in the long arc of your work, that matters more than comfort ever could.
About the Editor
Cody Thomas Rounds is a Clinical Psychologist-Master based in Burlington, Vermont, specializing in psychological assessment and collaborative care. He serves as Editor-in-Chief of PsycheAtWork Magazine, founder of the Learn.Do.Grow educational platform and the PsycheAtWork YouTube channel. In addition to publishing, he offers consultation and supervision for psychologists and creates practical therapist resources designed to support ethical, sustainable practice.