Most therapists didn’t enter the field out of a love for business, and most graduate programs don’t pretend otherwise. Travis Heath, PhD, host of the Psychotherapy.net podcast Therapist Confidential, says the show has had a complicated relationship with the idea of business, and he is candid about how often he wrestles with where private practice fits inside a neoliberal, late capitalist system he’d like to see change. That tension is what makes his conversation with John Clarke, LPCC, so useful. Clarke is one of those rare clinicians who genuinely enjoys the business side of the work and finds real creativity in it.
Clarke is a trauma therapist, a private practice consultant, and the founder of Private Practice Workshop, where he has helped hundreds of therapists build and grow their practices. He opened his first practice in 2013 after five or six years in community mental health, including juvenile justice work in San Francisco and East Oakland, the foster care system, and school-based work with elementary school students. Today his clinical work draws on Internal Family Systems, EMDR, and somatic approaches, and he hosts Going Inside, a podcast on trauma therapy. In their conversation, he and Travis discussed fees, marketing, and the quieter skills that make therapy worth paying for.
Can therapists run an ethical business and still earn a good living?
Clarke believes they can, and he has designed his practice around that belief. Coming from nonprofit work, he initially found it hard to reconcile community mental health with a private practice office, especially in a city like San Francisco, where the gap between wealth and poverty is stark. His solution was a fee structure in which clients who can pay the full fee do, which allows his group practice to also offer sliding scale and pro bono sessions.
Owning his schedule has had another benefit. Because Clarke doesn’t work a 40-hour-a-week job, he has time for community projects, including consulting for a nonprofit that takes San Francisco kids surfing for the first time. He is also working with an incarcerated individual at a prison outside Sacramento on a peer-led program called Taming Trauma, which helps incarcerated people work through the traumas behind some of the behaviors that led to their incarceration, with attention to systemic oppression. “The private practice is the reason why I can go do that stuff,” he says.
That’s why Clarke asks therapists to start with a vision for what they want their life and work to look like. Many clinicians eventually reach a point where they have a full caseload of 20 or so clients a week and find themselves asking what comes next. Clarke enjoys helping therapists answer that question, and he believes the answer is much easier to find when the vision comes first.
When should you start a private practice?
Clarke’s advice is to start before you feel ready. New clinicians are still learning to be in the room, finding a modality, and adjusting to the role, so a business can feel like one thing too many. But if you wait until you feel ready, he says, you may be waiting a long time, so he encourages clinicians to identify the bare minimum they’d need to try private practice and see whether it fits.
He also believes it has never been easier to start. Electronic health record platforms now handle scheduling, insurance billing, getting paneled, and video sessions in one place, which wasn’t the case when he opened his first practice. Large therapy platforms can also serve as an entry point, though Clarke has real concerns about how those platforms treat and pay therapists, and he sees many clinicians use them to get started and then transition away.
Travis took a similar leap around 2008. He started with a single client in a mentor’s office she let him use for free, with no website and a full-time academic job that covered his salary and benefits. Eight years later he realized he had more clients than he could take, and when people asked how he’d built it, his honest answer was that he did decent work over a long enough time frame that referrals followed. He acknowledges that isn’t very inspiring advice for someone trying to pay rent this month.
Do you need a niche to market a private practice?
A niche helps, but Clarke points out that it can take more than one form. One option is a personal brand, where the niche is essentially you, and everything from the colors and fonts on your website to the copy and a short homepage video helps prospective clients get a feel for who you are. He notes that many people choose a therapist based on vibes, and in smaller markets a strong personal brand can be more than enough.
In urban markets like San Francisco, a narrower focus on a modality, a symptom or diagnosis, or a population (like teens) may be necessary. Therapists often worry about being either too general or so specific that they get pigeonholed, but Clarke says those fears rarely come true. A brand is a living thing that evolves with you, so it only needs to be specific enough.
His own practice shows how this works in layers. The umbrella is trauma, which is enough for some prospective clients to choose him over a therapist who does many different things. Underneath that, they may see that he offers IFS, somatic experiencing, and EMDR, and some clients will be looking for exactly that, while others will simply connect with him personally.
What is a therapy website actually for?
In Clarke’s view, a therapy website has one job: getting people off the website and onto a call. It only needs enough information to spark interest and make a prospective client want to talk with you. Many therapists overbuild their sites trying to say everything at once, when all they really need to do is open the door.
The initial consultation has an equally simple purpose, which is deciding whether you’re aligned enough to book a first session. Clarke sees therapists overthink that call or try to do too much, when it simply requires listening, answering basic questions, and saying either “I think I can help you” or “I don’t think I’m the right person, but let me send you some names.” The skills that matter most here are the ones behind a good intake and a strong therapeutic alliance, not a sales pitch.
He also wants therapists to know that saying no is as powerful as saying yes. “When you say no, it just means you’re clearer and clearer on who you help,” he says. Each referral out sharpens your sense of your ideal client and keeps you working in what he calls your “zone of genius.”
How can therapists market themselves without feeling salesy?
Travis pushes back on the idea of personal branding, and the exchange is one of the most useful parts of the episode. He sees personal branding everywhere and worries about what happens when a person, not a company, is the brand. When a business fails, he points out, the business failed, but when you are the brand, a slow stretch can start to feel like a personal failure.
Clarke shares some of those caveats and suggests using your own reactions as a guide. Think about the people you trust online and what makes them feel authentic, then think about the ones who feel scammy or salesy, because both give you useful information. When therapists tell him they hate email marketing because of promotional spam, he asks what it would look like to write a short, heartfelt letter instead, perhaps something you realized in your work or on a morning walk that might help someone living with trauma, OCD, or another struggle.
He also reminds therapists who feel stuck that sharing their ideas isn’t really about them. He once told a clinical psychologist friend, who had been sitting on ideas for a YouTube channel for years while wrestling with imposter syndrome, that holding back meant keeping his wisdom from people who could use it. When Clarke started Going Inside, his test was simple: if it helped one person, it would be worth it.
Clarke does draw a line. He has seen newly licensed therapists start Instagram accounts for their practices featuring honeymoon photos, drinks in hand, or revealing outfits, and he doesn’t think that’s the way. Therapists need to stay professional and consider what their online presence might evoke in clients or shut down, which is where legal and ethical considerations come in.
Travis ended up with a reframe that may help other skeptics. Especially at his career stage, he acknowledges that he is already branded whether he wants to be or not. The real question, he says, is how to find a preferred relationship with these systems and decide, with some intentionality, how he wishes to be known, and Clarke adds that the impression you make on people is already your personal brand, even if it doesn’t have a website yet.
How much should therapists charge?
Clarke’s short answer is: more than you’re comfortable charging, especially for clients who can afford it. He admits to having a chip on his shoulder about this. In a graduate school class meant to introduce students to the profession, a panel of burned-out counselors told his cohort they’d be exhausted, unsafe, and earning $13 an hour forever. Yet, he refused to believe that therapists couldn’t help people, earn a good living, and run an ethical business at the same time.
He puts it plainly: “I don’t know why my hourly rate should be half of what my attorney’s is when he solves problems in my life, and I solve problems in clients’ lives.” At the same time, he acknowledges a real difference, because psychotherapy has roots in social work and social justice and pays attention to systemic issues. His resounding message is to do what works for you ethically, morally, practically, and financially, and to reject the narrative that being a helper means being a martyr.
Travis offers a different model that fits his own circumstances. As a department chair at San Diego State University, he works on what he calls a radical sliding fee scale, and some of his clients pay as little as $5 a session. He is clear that he’s in a privileged position not everyone shares, and both he and Clarke agree that therapists deserve to make a good living, even within a system neither of them loves.
How do you know if a therapy session was worth the fee?
Money can make every session feel like a transaction, and both clinicians remember that feeling from early in private practice. When clients handed him cash at the end of a session, Clarke says, he’d wonder whether what he had just done was worth it, and as a new therapist he had never been handed $125 for anything. Travis describes the same one-for-one feeling, where it seemed he had to prove the hour was worth what the client paid.
Clarke now asks the clinicians in his group practice how they evaluate a good session. If a session is only worth the fee when a client has a breakthrough or stays sober, he asks, is it worth less when a client relapses or a couple decides to divorce? The longer he practices, the more he comes back to the absolute essentials of psychotherapy.
A recent experience as a client made this concrete for him. In his first session with a new therapist, the therapist simply listened and was so present, attuned, and patient that Clarke realized how badly he needed to be heard. “Our presence matters so profoundly more than the technique or the training,” he says, and Travis has found similar footing by thinking in aggregate, feeling solid in his process over time, including the moments when it isn’t working and needs adjusting.
Why does slowing down matter in therapy?
Travis has noticed something therapeutic about slowing down over the past year, and he suspects part of the reason is how fast the world now moves. Notifications, constant demands, and pressure to do a hundred things at once can overwhelm people on many levels. In sessions, he has found himself staying with a single thread for an entire conversation, when earlier in his career he would have moved on much sooner.
Clarke connects this to what Peter Levine calls the trauma vortex, where too much happens too soon and all at once. The more time we spend in the healing vortex, he explains, the more healing takes place and the more a client’s window of tolerance expands. He recently drove past a Silicon Valley billboard advertising a product “for the relentlessly impatient,” and he says clients bring those values into the room because they are simply in the water.
That is part of why he likes to explore clients’ values directly, sometimes using a motivational interviewing values assessment. If all he does in a session is help a client slow down and be with their thoughts, feelings, and sensations, he says, he seldom goes wrong. His own recent therapist gave him the feeling that there was nowhere to go and all the time in the world, and he wonders where else in life people get to experience that.
Frequently asked questions about therapy fees and private practice marketing
How much should a therapist charge in private practice?
There’s no single right fee, but John Clarke encourages clinicians to charge more than they’re comfortable charging, especially for clients who can afford the full rate. He also stresses choosing a fee that fits you ethically, practically, and financially. Some therapists, like Travis Heath, PhD, use a sliding scale to serve clients across a range of incomes.
Do therapists need a niche to get clients?
A niche helps, especially as a personal brand, a modality, a symptom or diagnosis, or a population. Clarke finds that a personal brand can be enough in smaller markets, while urban markets often call for a narrower focus. Either way, the niche only needs to be specific enough, and it can evolve over time.
What should a therapy website do?
According to Clarke, a therapy website’s main job is to move prospective clients off the website and onto a consultation call. It should include just enough to spark interest and help people get a sense of who you are. The consultation then determines whether you’re a good fit for a first session.
Why does presence matter in therapy?
Clarke has come to believe that presence matters more than technique or training. Slowing down, listening closely, and letting clients lead can be deeply healing, especially for trauma survivors whose agency was taken from them. For him, it is the core of what makes a session worth the fee.
Keep learning
The full conversation with John Clarke is available on Therapist Confidential, where he and Travis also talk about neoliberalism, burnout, and what raising young children has taught them about curiosity. It’s a thoughtful listen for anyone building a practice or rethinking how they show up in the room. If you’re earlier in the process, Gordon Brewer’s episode on building a sustainable private practice is a good companion.
Growing a practice also means continuing to grow as a clinician. Psychotherapy.net offers on-demand CE built around real therapy demonstrations, so you can learn from master clinicians in session on your own time.
Editor’s Note: This article was developed from a conversation originally featured on the Psychotherapy.net Therapist Confidential podcast. AI tools assisted with transcription and editing, and all content was reviewed by the Psychotherapy.net editorial team.
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