Why Psychologists Struggle to Think Like Business Owners (And Why That Has to Change)
There’s a certain flavor of unease that arises in the psychologist who opens QuickBooks for the first time and realizes—with no small measure of dread—that she is not just a therapist, but a business. It is not a dramatic unease, not the breathless kind that grips in moments of crisis, but something subtler: a quiet friction, an internal tension that accumulates between one’s professional identity and one’s financial obligations. She was trained to listen, to reflect, to contain. She was not trained to set prices.
And yet here she is, price-setting.
It is one of the more peculiar features of modern psychological training that so many of its graduates arrive in private practice woefully unprepared for what private practice actually is. Most doctoral and master’s programs are steeped in ethics, theory, diagnostics, and supervision, yet remain strangely silent on the practical demands of running a practice. This is not simply an oversight—it is a cultural position. The very phrase “private practice” is often delivered with a mild sneer in academic settings, a subtle rebuke embedded in tone. To be a clinician in an agency or an academic center is to be of service. To work privately is to risk being seen as self-serving.
This attitude, unexamined and often unspoken, leaves its mark. Many psychologists enter private practice in a posture of apology: sorry for charging a full fee, sorry for turning away a sliding scale client, sorry for wanting weekends off. They build beautiful, caring, ethically sound clinical containers—and populate them with the economics of guilt. The business side of practice becomes not just uncomfortable, but morally ambiguous. A necessary evil. Something to keep quiet about in peer consultation groups.
But what if this discomfort is not inevitable? What if it is a symptom, not a virtue?
The Inheritance of Self-Neglect
Psychology, as a profession, has inherited a tradition of self-neglect. The earliest clinicians were often volunteers, clergy, or institutional caretakers. They worked without pay or for minimal compensation, their status granted not by earnings but by sacrifice. The modern psychologist, especially in the United States, is a strange hybrid of healer and healthcare provider, wrapped in layers of licensure, legislation, and insurance bureaucracy. Yet the internal narrative remains stubbornly archaic: help first, and let the money work itself out.
This would be quaint if it weren’t so corrosive. Ask any seasoned therapist about their least favorite part of practice and you’ll likely hear the same answers: billing, fees, cancellation policies, insurance paperwork. Not because these tasks are particularly difficult, but because they feel vaguely shameful. They draw attention to the reality that therapy, for all its human depth, is also a commodity.
What makes this realization so difficult for many psychologists is that it threatens their self-concept. To think like a business owner is, for many, to risk feeling like a fraud. It raises old and thorny questions: Am I doing this for the right reasons? Have I sold out? Have I become one of them—a profiteer, a hustler, someone who trades in pain?
These are not trivial fears. But they are misplaced.
The Ethical Imperative of Financial Clarity
In truth, to run a practice well—to understand its financial architecture, to price services responsibly, to set boundaries around time and energy—is not to abandon one’s ethics. It is to enact them.
Financial clarity is clinical clarity. If you are undercharging, overextending, or quietly absorbing the costs of systemic dysfunction, your clinical work will suffer. Not all at once, and not obviously—but subtly, like a low-grade fever that dulls your focus and drains your stamina. A therapist who dreads reconciling invoices or tracking payments is not, in that moment, available to the work. Their attention is split. Their body remembers what their role denies.
It is a profound act of professional integrity to charge what your services require to remain sustainable. Not what you wish they cost. Not what you think your clients can afford. But what they do cost—overhead, time, liability, continuing education, supervision, taxes, and yes, rest. You cannot advocate for client boundaries if you chronically violate your own.
And yet, so many psychologists struggle to internalize this. They grasp it intellectually—many could teach an entire seminar on professional boundaries—but struggle to apply it to money. Something about money remains disorganizing. It feels contaminated. Unsafe. Perhaps even unethical.
This is where the role of business owner must be reimagined.
Ownership Without Exploitation
To become a business owner is not to become a capitalist caricature. It is not to wear a suit or memorize sales funnels or optimize for profit above all else. It is, quite simply, to take responsibility for the ecosystem you inhabit.
Business ownership, at its most ethical, is a form of stewardship. It asks: What do I need to thrive, and how can I structure my practice to deliver that—without extraction, without burnout, and without self-erasure?
This framing does not require abandoning your values. It requires honoring them more fully.
If you value accessibility, you build a practice that includes intentional pro bono work or a limited sliding scale—not one that covertly undercharges every client in the name of egalitarianism. If you value quality care, you ensure that your practice model allows you to rest, consult, learn, and stay present. If you value fairness, you start by being fair to yourself.
To think like a business owner is to widen the lens. You are not just a technician delivering services hour by hour. You are an orchestrator of systems—clinical, financial, logistical—that make healing possible. When those systems are weak or neglected, your work degrades. When they are strong and ethical, your work shines.
The Cost of Not Thinking This Way
The alternative, frankly, is untenable. A psychologist who ignores their business infrastructure will inevitably collapse under its weight. They will blame themselves for problems that are architectural. They will resent their clients for financial realities that should have been negotiated upstream. They will carry the silent burden of martyrdom and call it professionalism.
This is not noble. It is unsustainable.
What’s more, it feeds the very dynamics psychologists claim to resist: inequity, powerlessness, scarcity. A burnt-out clinician cannot offer excellent care. An underpaid therapist cannot build longevity. A disorganized practice cannot model containment, no matter how insightful the interpretations.
And so, the shift must begin—not with spreadsheets or software or marketing funnels, but with a new narrative.
A Narrative Worth Replacing
The old story goes like this: If I’m good, I won’t have to ask. If I’m kind, they’ll treat me fairly. If I’m selfless, the system will reward me.
The new story is quieter, but sturdier: I am allowed to name what I need. I am allowed to build a structure that supports me. I am allowed to think like a business owner—because I am one.
This shift won’t happen all at once. It may begin with something as simple as reading an explanation of benefits. It may take root in a spreadsheet. It may flicker to life in the discomfort of quoting a fee without apology. But it will grow—if you let it.
Because the real question isn’t whether psychologists can think like business owners. It’s whether they’re ready to stop pretending they aren’t.
And that’s not a mindset shift.
It’s a reckoning.
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.