Persistence Without Panic: How to Follow Up Without Feeling Pushy

There is a distinct and familiar emotional pattern that follows the act of asking for something: a rush of adrenaline during the send, then a long, quiet dip while waiting for a response. When psychologists request a rate increase or initiate a contract renegotiation with an insurance company, the high-stakes ask is often followed by an emotional crash—something between dread, doubt, and fatigue. The silence on the other end begins to throb. Days pass. And the question quietly arises: Do I follow up? Or do I just… let it go?

For many clinicians, the answer feels charged. Following up stirs anxiety—not about the content, but about how one will be perceived. There is a reflexive fear of seeming pushy, aggressive, difficult. The very idea of persistence begins to feel morally suspect.

So they hesitate. They wait longer than they should. They talk themselves into giving the system more time, even if it’s already been more time than it should have taken. They back away—not because the request was invalid, but because the silence was uncomfortable.

This is where self-advocacy, even when technically begun, begins to unravel. Not in the drafting, not in the request itself—but in the follow-through.

And it’s precisely here that psychologists need a new framework: one that separates persistence from panic, professionalism from passivity, and self-respect from perceived confrontation.

The Fantasy of the Single Ask

Most psychologists don’t like repeating themselves. They are trained to be precise, thoughtful, and clear. Their interventions are calibrated. Their insights are timed. In clinical work, saying something once—at the right moment, in the right way—can change everything.

But administrative systems are not like therapy.

No one in provider relations is waiting to be moved. No one is taking notes on nuance. No one is reading between the lines. If your request is seen at all, it is likely seen quickly, briefly, and filed away. The idea that one clear, well-crafted message is sufficient is a fantasy rooted in the clinician’s own standards—not in institutional reality.

Systems respond not to elegance but to repetition. Persistence is not rudeness. It is the minimum threshold for visibility.

Why Therapists Hate the Follow-Up

The follow-up email is where many clinicians freeze. Not because they lack the words, but because it feels like crossing a line—an invisible one, woven from internalized fears about being too much. Most therapists are trained to dial themselves down: to be non-intrusive, to track others’ needs, to prioritize relational ease. Following up feels like the opposite. It can stir fears of rejection, fears of being labeled, fears of not being taken seriously—or worse, being taken seriously and resented for it.

And so, many therapists delay. Or worse, they interpret the delay in response as a message: They didn’t answer, so they must have decided. The silence means no.

But in most cases, the silence doesn’t mean no.

It means nothing.

It means the system is slow, or chaotic, or distracted. It means your request is one of many. It means your follow-up is not rude—it’s necessary.

And it is your right to be remembered.

Persistence Is Not Pressure

Let’s clarify something: you are not begging. You are not escalating. You are not making demands. You are following up on a professional inquiry that has received no response.

If the roles were reversed—if a client didn’t show up for an appointment or failed to return a required form—you would follow up without shame. You would send a reminder. You would name the timeline. You would assume they forgot, not that they were rejecting you.

This is the same.

To follow up on a rate review is not to become overbearing. It is to hold the system accountable to a reasonable communication standard. The content of your request doesn’t become less legitimate just because it’s uncomfortable to revisit.

In fact, consistency often increases legitimacy. A provider who follows up at steady intervals, without reactivity, without aggression, is more likely to be taken seriously—not less.

The Emotional Energy of Waiting

One of the hardest parts of persistence is the psychological toll of suspended expectation. The in-between state—after the ask, before the answer—is depleting. It quietly siphons mental bandwidth. You find yourself checking your inbox more often. Wondering if the silence is meaningful. Rereading what you wrote. Imagining the worst.

This is natural.

But it’s also optional.

You do not need to stay in that suspended state. The moment you decide on a follow-up schedule—on timing, language, and tone—you free yourself from the drift of waiting. You place the uncertainty into a structure.

Structure reduces anxiety. It converts rumination into motion.

You don’t need to follow up today. But you do need to know when you will.

A Script Is Not a Demand

For those who freeze at the thought of “being pushy,” let’s reframe the tone. A follow-up doesn’t need to be an argument. It can be brief, clear, and kind. It might sound like:

“Hi [Name],
I wanted to follow up on my rate review request sent on [date]. Please let me know if additional information would be helpful. I look forward to hearing back and appreciate your time.”

That’s it.

You don’t need to re-argue your case. You don’t need to add more rationale. You don’t need to escalate—unless you’ve followed up multiple times with no response.

Persistence is not about increasing volume. It’s about maintaining presence.

What to Expect (and What Not To)

Most provider reps will not respond to the first message. Some will not respond to the second. Many will only respond after a third message, or a phone call. This is not because your request was offensive or inappropriate. It’s because response is not automatic. It must be prompted.

That’s not your fault.

And it’s not a reason to stop.

Keep your tone steady. Keep your intervals professional—perhaps 10 to 14 days apart. Note each follow-up in a tracking log. And remember: your job is not to make them say yes. Your job is to remain present until they say something.

Ethical Consistency, Not Aggression

Persistence, when done ethically, is a form of professionalism. It says: I am invested in this request. I am willing to hold the thread. I am committed to the process.

It also says: I respect myself enough not to abandon a valid ask just because the system is slow or unresponsive.

There is a difference between insisting and holding steady. One demands. The other waits and returns, waits and returns, waits and returns—until clarity is achieved.

And clarity, not compliance, is the goal.

When to Let Go

There may come a point when you’ve followed up multiple times with no meaningful response. At that point, you may decide to escalate—to a supervisor, to a formal provider dispute, or to a professional association. Or you may decide to disengage, to drop the request, or to reassess your participation with the payer entirely.

But that decision should come from clarity—not exhaustion.

Letting go after persistence is informed. Letting go before persistence is resignation.

And resignation has no place in sustainable clinical practice.

The Long Arc of Professional Voice

Most therapists will not learn to follow up gracefully on their first try. It will feel awkward. Maybe even shameful. But every time you do it, you deconstruct a little more of the training that taught you to avoid tension at all costs. You widen your tolerance for being seen as firm. You loosen the grip of the belief that self-respect equals selfishness.

Eventually, follow-up becomes just another part of the job—like charting, like scheduling, like billing. But until then, it’s an edge.

A meaningful one.

And like most edges in therapy, it’s where the work happens. Not just with clients.

With yourself.

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.

No One Teaches You How to Ask for More—But You Can Learn

There is a moment—a small but strangely charged moment—when a psychologist opens a blank document to begin drafting a letter to an insurance company. It isn’t clinical documentation. It isn’t a referral note, or a client summary, or a thoughtful reflection on attachment patterns. It’s a letter about money. A request for reconsideration. A rate review. An ask.

And everything goes quiet.

The words do not come. Or rather, they come in a sudden, apologetic rush: “I understand if this isn’t possible…” “I hope I’m not overstepping…” “I realize you’re very busy…” The tone is deferential, the posture low. The request, buried in the fourth paragraph, is diluted by qualifiers and disclaimers and justifications. It reads more like an apology than an assertion.

This is not an issue of writing skill. These are competent, literate professionals. It’s not about not knowing what to say. It’s about not knowing how to be while saying it.

Because no one teaches therapists how to ask for more.

Not in graduate school. Not in internships. Not in supervision. If anything, most training environments quietly discourage it. You’re praised for being flexible. For staying late. For “taking one for the team.” You’re expected to work through lunch and apologize for needing time off. You’re groomed for generosity, not advocacy.

So when the time comes to speak up—not in the abstract, but in a direct, professional request for more—the skill isn’t there. The confidence isn’t there. The template isn’t there.

But the stakes are.

And that’s where the freeze begins.

The Legacy of Good Behavior

Therapists are, by and large, people who’ve excelled at being good. Often from a young age, they learned to sense what others needed and to provide it—quickly, seamlessly, and with minimal disruption. Many entered the field because helping came naturally. Others arrived through hardship, driven by insight or necessity. But nearly all were rewarded, again and again, for being thoughtful, accommodating, and agreeable.

In clinical settings, these traits translate beautifully. Empathic attunement. Tolerance for ambiguity. Relational safety. But in administrative and institutional contexts, the very same traits become liabilities. Because in those environments, clarity is currency. Ambivalence is ignored. Good behavior is exploited.

And so, when a therapist finds themselves needing to assert something—when they need to name a limit, request a change, challenge a status quo—they often hesitate. Not out of incompetence, but out of conditioning. They’re used to absorbing, not asserting. They’re used to adjusting to others’ expectations, not recalibrating them.

They’ve learned that being liked keeps them safe.

And asking for more doesn’t always make you liked.

But it’s still necessary.

The Fantasy of the Automatic Yes

In nearly every consultation group or practice workshop, there is someone who asks, “Is there a way to do this that doesn’t feel aggressive?” And the answer, of course, is yes. But underneath that question is another one, unspoken: “Is there a way to ask for more that guarantees I won’t feel uncomfortable or be seen differently?”

And the honest answer is no.

There is no way to ask for more—whether it’s money, time, respect, or space—without risking something. You may be seen differently. You may feel uncomfortable. You may not be granted what you asked for.

But the greater risk is not in the asking.

It’s in the silence.

The fantasy that good work will be automatically rewarded, that effort will be recognized without expression, that fairness will arrive without invitation—these are soothing myths. They keep many therapists from ever picking up the pen. But they also keep them underpaid, overextended, and quietly resentful.

No one teaches you how to ask. But they also never warned you what happens when you don’t.

Writing as Psychological Exposure

What makes writing a rate request letter so uniquely difficult isn’t the content. It’s the identity shift. You are, in that moment, stepping out of the role you know—warm, receptive, reasonable—and into a position that feels sharp-edged. You are the one naming a need. You are the one initiating the conflict, however mild. You are the one possibly disappointing someone.

This is exposure therapy.

It activates the same parts of the self that tremble when saying no, when disagreeing, when setting a limit. The fear isn’t just rejection—it’s rupture. Disconnection. Being misunderstood. And for many therapists, who have built their entire professional lives around understanding, that fear is intolerable.

So they soften. They delay. They erase the draft.

But writing is also where something new can begin. Because putting the words on paper is a form of self-recognition. It forces precision. It refuses ambiguity. It says: I’m not asking because I’m greedy or needy. I’m asking because this is what the work requires.

And eventually, if done well and often enough, the exposure fades. What once felt bold becomes routine. What once felt impossible becomes just another part of running a practice.

Learning the Ask

The good news is that asking can be learned.

Not all at once. And not without discomfort. But it can be done.

It begins with clarity: What, exactly, are you asking for? Not just “more” or “better,” but a specific change. A dollar amount. A policy shift. A reconsideration.

It continues with structure: What’s the rationale? What data supports your request? What value do you bring? What precedent exists?

And it ends with tone: Respectful, direct, unembellished. Not overly warm. Not hostile. Just professional.

None of this requires a personality transplant. It doesn’t require becoming someone who thrives on confrontation or delights in bureaucracy. It simply requires moving through the initial discomfort long enough to reach the other side of it.

And then doing it again.

Why It’s Worth Doing Badly at First

No one writes a perfect request letter the first time. And many therapists, trained in exactitude, hate this. They want the message to be airtight. They want every word to land. They want to avoid the sting of misinterpretation.

But perfectionism is just another form of avoidance.

The truth is, your first request letter doesn’t need to be brilliant. It just needs to be sent. It can be short. It can be a little clunky. It can feel weird. What matters is that it exists—that you chose to make the request instead of swallowing it.

Most institutions are not expecting eloquence. They’re expecting professionalism. Timeliness. Specificity.

If you hit those marks, the letter has done its job.

And the next one will be easier.

Reclaiming the Right to Ask

At its core, the discomfort around asking for more is not about language. It’s about permission.

Therapists, for all their training in empowerment, often forget to grant it to themselves. They wait for cues. For consensus. For someone else to name what’s reasonable. But the nature of negotiation is that you name it first. You define what’s sustainable. You decide what this work is worth.

That’s not arrogance.

That’s ownership.

So yes, it may feel strange to write that letter. It may feel unnatural to follow up. It may feel awkward to press for clarification or to restate your request.

But you are not doing this to be liked. You are doing this to be clear.

And clarity, even when uncomfortable, is never unprofessional.

It’s the beginning of everything that follows.

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.

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.

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.

It’s Not Greedy to Know Your Breakeven

There’s a curious silence that falls over many psychologists when asked to name their breakeven. Not their fee, not their average reimbursement—but the number beneath it all, the one that determines whether the practice they’ve built is sustainable or simply propped up by borrowed energy and denial. It is the number that doesn’t lie. And for many, it is the number they do everything to avoid.

Ask a psychologist what they charge and they’ll tell you—perhaps a bit sheepishly, perhaps with precision. Ask what they’re reimbursed by a particular panel and they’ll likely have a rough sense. Ask what they need to earn per session in order to cover their costs and keep the lights on, and you will often see hesitation. Not because they don’t care. But because the very act of calculating that figure feels dangerous.

To name your breakeven, after all, is to admit you have one.

And that is where the trouble begins.

The Psychology of the Breakeven

Psychologists are taught to work with precision, to honor nuance, to respect complexity. But when it comes to their own business models, many operate on gut, habit, and a kind of inherited cultural guilt. There is a persistent, half-formed belief that if you’re really good at what you do, the money will work itself out. That if your intentions are pure, your practice will thrive. That if you have to do this kind of math, maybe you’re not cut out for this kind of work.

Of course, none of this is true. But belief and knowledge are not the same.

Knowing your breakeven doesn’t mean you’ve become transactional. It doesn’t signal that you’ve commodified care. It means, quite simply, that you’ve stepped into the truth of what your work actually costs. That you’ve made visible the invisible scaffolding that allows your clinical presence to exist. That you’ve chosen, deliberately, to work within reality.

There is no shame in that.

And yet, for many, there is.

The Guilt of Being Precise

There is something almost indecent, in certain clinical circles, about knowing your numbers too well. To be financially organized is to risk being seen as calculating. Detached. Less authentic. Less committed. The mythology runs deep: the best clinicians don’t track their hours. The real healers offer sliding scale without a second thought. The truest therapists say yes first and figure it out later.

These are stories, not ethics. But they wear the clothes of ethics so convincingly that many psychologists internalize them as truth.

The result is a strange kind of professional schizophrenia: a practitioner who operates with extraordinary attunement inside the therapy room, but who dissociates when it’s time to reconcile the books. Someone who can help clients reframe the most complex cognitive distortions—but cannot apply the same insight to their own narrative about money.

There is no villain in this story. Only inheritance.

But like all inheritances, it is ours to accept—or not.

Why Knowing Isn’t Greedy

Greed implies excess. Hoarding. A willingness to take more than one’s share.

Knowing your breakeven is the opposite of greed. It is the refusal to pretend. It is the practice of enough.

To know your breakeven is to look directly at what it takes to do your job well, and to acknowledge that these inputs—time, energy, risk, skill, space, supervision, technology, presence—are not free. That they never were. That they never will be.

It is to understand that the space you hold for your clients must also be held for you—financially, practically, structurally. Not because you are fragile, or selfish, or demanding. But because you are human.

A practice that does not meet its breakeven is not a practice. It is a slow act of self-erasure.

And no amount of clinical virtue can cover that up for long.

The Cultural Pressure to “Just Make It Work”

Psychologists, particularly those in private practice, often carry the invisible weight of social idealism. They are told, implicitly and explicitly, that their work exists at the intersection of vocation and charity. That they are here to help. That wanting stability, let alone prosperity, somehow contaminates that mission.

This creates a pervasive pressure to “just make it work.” To accept contracts that don’t cover overhead. To avoid raising fees. To subsidize systemic dysfunction with personal depletion.

And when the numbers don’t add up? Many don’t revise the system. They revise their expectations. Fewer vacations. More clients. Longer hours. Deferred retirement.

They become, slowly and with great devotion, the kind of therapist who survives instead of thrives.

It does not have to be this way.

The Power of Naming

Naming your breakeven is not an act of finality. It is an act of orientation.

It allows you to say: This is the floor. This is what it takes to keep this practice alive, to keep this care ethical, to keep this work sustainable. It allows you to make decisions with clarity instead of confusion. It gives you a reference point—not for greed, but for integrity.

Because integrity is not just about doing the right thing by your clients. It is about doing the right thing by your practice. By your future. By the version of you who still wants to be doing this work in five or ten years, not because you’re stuck, but because you’re still inspired.

And that version of you? They need you to know your breakeven now.

Rewriting the Narrative

What if financial clarity wasn’t something to hide?

What if it was part of your professionalism?

What if knowing your breakeven was simply the psychological hygiene of practice ownership—the same way you wash your hands, update your license, or lock your filing cabinet?

What if, instead of whispering about money in the hallway after peer group, we spoke about it plainly, intelligently, as stewards of our own labor?

What if knowing what you need was not seen as self-indulgent, but as self-respecting?

The myth that money and meaning exist in opposition has done more to stunt the health of this field than most administrative burdens ever could. And nowhere is that more visible than in the way psychologists struggle to calculate, to say, and to accept what their work actually costs.

To know your breakeven is not to sell out. It is to opt back in—to your own viability, your own longevity, your own capacity to do the work not just now, but sustainably, with care, for years.

It is a quiet kind of professionalism. A small but necessary act of clinical stewardship. And in a field that has historically rewarded self-sacrifice over sustainability, it may just be the most radical thing you do.

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.