Is Insurance Burning You Out? Finding Freedom and Fulfillment in Private Practice

Audrey Schoen, LMFT
June 28, 2024
Is accepting insurance as a therapist burning you out? It doesn't have to. Learn how to build a practice that supports you and your clients.

Deciding to transition from accepting insurance to a private pay practice is a significant professional and personal choice.

Maybe you've been contemplating this leap for a while. You see the benefits – more control over your schedule, less paperwork, the freedom to truly tailor treatment to client needs. There's also a strong pull to remain accessible, to keep our services available to everyone who needs them.

This internal battle, I hear it all the time. I've spoken to countless clinicians who feel stuck in a cycle of accepting insurance while simultaneously struggling to make ends meet. The paperwork, the limitations on session lengths and treatment approaches, the constant battle for fair reimbursement – it all chips away at the very thing we came into this profession for: to make a real difference in people's lives.

Fear and Uncertainty: The Emotional Cost of Accepting Insurance

The truth is, by constantly compromising your own well-being, you're sacrificing the quality of care you can offer your clients. When we are exhausted, under-resourced, and frankly, a little resentful, are we really at our best to serve our clients?

So, what's holding you back from taking the leap to private pay?

Fear is a powerful emotion, and it can definitely hold us back. We worry about what our clients will think.

It can be a hard truth to face. Some clients might choose not to follow you. That's okay. It's part of the process of defining your niche and attracting the ideal clients who value your expertise and approach. 

The clients who truly cannot afford your rates may need to be referred, or you have the option of offering reduced fees on a case-by-case basis. 

The clients who truly value your expertise and the impact you have on their lives will find a way to work with you, even if it means going out-of-network.

Recognizing Your Value

Then there's the imposter syndrome.

I want you to really let this next bit sink in…

Your unique skills and approach to therapy are exactly what your ideal clients need, and you cannot put a price on the transformation they will experience working with you. 

The private pay model allows you to set your own rates based on what you need to earn to be well and keep doing this work long-term. 

Your ideal clients will also be willing to invest in their own well-being, knowing that a private pay model allows for a more personalized and focused experience.

Planning for Success: Building Your Private Practice Life Raft

Of course, letting go of the insurance safety net doesn't mean diving headfirst into the unknown. It's about creating a life raft – a solid plan that considers your unique circumstances. There's a whole spectrum of possibilities here and you can create a plan that will work for you and your clients.

The key is to prepare. Do the financial legwork, figure out your income needs, and create a plan that feels secure for your risk tolerance. A single mom with financial commitments will likely need a different approach than someone with a supportive spouse.

The biggest emotional hurdle you might face is the counter-intuitive idea of seeing fewer clients while potentially earning more. It can feel strange to consider working less, even if the math supports it. We're wired to feel like "more is better," and the idea of working less can trigger feelings of guilt or fear.

This is where self-compassion is key. Recognize that taking time for yourself is not selfish, it's essential for long-term sustainability. It's a shift in mindset, sure, but it's a shift that can free you from the constant feeling of needing to do more, see more, just to make ends meet.

Setting Boundaries and Prioritizing Your Well-Being

You cannot fix a broken system with self sacrifice. The current insurance system has its flaws. When you leave insurance you are setting boundaries and prioritizing your well-being despite the broken system. 

What's more, you're setting a powerful example of self care for your clients. Wouldn't you want them to advocate for their own needs too?

Think about what private pay could mean for you. Finally being able to save for retirement, taking that overdue vacation, or simply reclaiming some personal space to recharge. Maybe it's not about grand gestures, but simply having the bandwidth to be fully present with your family after work.

Giving Back on Your Terms

If you are worried about your ethical commitment to service, remember, "giving back" can take many forms. 

The point is, you get to define what "giving back" looks like on your own terms, and it can't come from a place of exhaustion and financial strain.

Ultimately, taking the leap to private pay is a personal decision. But if you're feeling burnt out, undervalued, and ready for a change, it's a path worth exploring. It's about reclaiming your power, your time, and your financial security. It's about showing up for your clients as the best version of yourself, and that's something we can all get behind.

This shift is about creating a practice that aligns with your values and goals. Your journey towards a fulfilling private practice starts with acknowledging your own needs and taking courageous steps towards a balanced professional life. Trust in your abilities, embrace the journey, and remember—you deserve to thrive as much as those you help.


This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.

About the Author
Audrey Schoen, LMFT

Audrey Schoen is a premium-fee licensed marriage and family therapist in California and Texas. She is also the founder of Balanced Private Practice where she equips therapists with both lifestyle and business tools that allow them to prioritize their needs, increase their income, and show up fully in both their personal & professional lives. Outside of her callings as a therapist and coach, Audrey is an engaged mother of two and a LEO spouse. Learn more about Audrey at balancedprivatepractice.com