Dilemmas, Obstacles and Opportunities

Business Dilemmas Peculiar to Therapists

Being a therapist is different from having other jobs. Issues arise in therapy work that would be ignored in other occupations. There can be a belief in therapy circles that these dilemmas can restrict us in seeing a therapy practice as a business. Earning a living is often seen as much less important than the client work and sometimes there can be a negative attitude that suggests that being paid for our services diminishes their worth.

However, for some time now, the profession has been inching towards, well, greater professionalism. There are strict standards of training, the professional bodies have their rules and requirements, state regulation is getting nearer, and still, the perception persists that somehow doing it for free is virtuous while charging a fee is not.

In these articles, I don’t give much space to the clinical side of our work. Lots of more learned and wiser therapists than me do that very well. However, neither do I pretend that the clinical aspects of the work do not impact on the business side, of course they do. And it can be a challenge, to meet the dilemmas peculiar to our work as an opportunity to grow and enhance the lives of ourselves and our clients, rather than seeing them as restrictions and limitations.

What sort of dilemmas am I talking about?

Photo by Stock Unlimited
Photo by Stock Unlimited

Vicarious Trauma

Every day in our work we meet the suffering and pain of our clients. We need to bring some empathy to the space, and empathy assumes some willingness to be open. This is a great gift and can be really helpful for the client, but, means that we may possibly suffer ourselves by entering into our client’s pain.

We need to take care of ourselves, and one way of doing this is to restrict the number of hours we work, and by extension, limit what we can earn.


The issue mentioned most often by therapists is the isolation they experience in the work. Sometimes this is a physical thing, where they don’t see or talk to other therapists. Sometimes it’s an emotional thing, because we don’t talk to those close to us about the detail of our work, whether it’s a positive or negative experience. The nature of a therapeutic relationship is that we interact at a deep level over a long period of time with a very small number of people, which can make it hard when they leave.


Non-therapists find it hard to understand transference, but it is all too present in the therapy relationship, and can continue even after the work has finished. The knowledge of the power of this phenomenon can influence us to be protective of a client in a way that doesn’t really happen in other walks of life, and sometimes this means we might make decisions that are not in our best financial interests.

Marketing Choices

Therapy touches on delicate issues that can be painful for a client. We have choose an appropriate way to market our practices that acknowledges the sensitivity of some of the issues we work with. This means that not all promotional media will be suitable for us.

The Money Dilemma

For all the reasons I set out here, it can be hard for a therapist to make ends meet, and a real challenge to be the major breadwinner for a young family. At the same time, the cost to an individual client of therapy treatment is still relatively high. Often those most in need of our services can be the ones least able to pay. Our awareness of these conundrums can lead us to give more weight to our client’s financial needs than our own.

Are We Really That Different?

Photo by Stock Unlimited

However, there’s a danger that in recognising these limitations, that we see ourselves as somehow destined to be engaged in an expensive and philanthropic hobby. All jobs have their “dirty laundry,” the parts that we would prefer not to engage with, and in my view, for therapists, the financial and business challenges that these dilemmas present are just that. We have a choice about how we see these dilemmas, as walls to restrict our growth, or as a climbing frame to stretch our creative muscles. Could these issues be turned on their heads and produce a surprise gift for us?

My wish is that those therapists who wish to earn a living providing therapy services to their clients should have the information and support to help them to do so. If I can help you with any dilemmas I’d be glad to do so. Please contact me here for your free 20 minute consultation or to make an appointment.

Comments for this post are closed.