Nine Months to $2,000,

Nine Months to $2,000,

Or: Why Group Practice Ownership Is a Terrible Get-Rich-Quick Scheme

This morning, I opened my computer and saw a reminder that made me laugh.

In June of 2019, I paid myself my first salary from Tri Health Clinic.

It was $2,000.

At the time, I was thrilled.

So thrilled, in fact, that I set the very reminder that went off today to remind future me of this momentous occasion.

Not because $2,000 a month was a lot of money. It wasn’t. But because it meant the idea was working.

What makes this milestone particularly funny is that I opened the clinic in October of 2018.

October. November. December. January. February. March. April. May. June.

Nine months.

Nine months before I paid myself anything.

And when I finally did, it was $2,000.

If you’re reading this as a therapist in private practice, you may already be doing some math and realizing that there were probably easier ways to make money.

You would be correct.

The Parts of Starting a Group Practice That Nobody Sees

One of the funny things about owning a group practice is that people often assume the business owner is making a fortune.

I occasionally hear comments that imply group practice owners simply collect a percentage of everyone else’s work and ride off into the sunset.

The reality is a little less glamorous.

Before there were clinicians, there was rent.

Before there were referrals, there was rent.

Before there was revenue, there was…

…you guessed it…

rent.

Commercial leases are not small commitments. When you sign one, you are taking on years of financial responsibility regardless of whether a single client walks through the door.

Then there are the offices themselves.

Six furnished therapy offices don’t magically appear.

Trust me, I know exactly how eye-watering the IKEA and Structube bills can become.

We grew carefully over time. One office became two. Two became four. Four became six.

Every expansion meant another gamble.

Another lease commitment.

Another room to furnish.

Another financial risk taken before there was any guarantee it would pay off.

And that doesn’t even include websites, marketing, software subscriptions, insurance, professional services, administrative support, training systems, or the countless other expenses required to build a clinic.

Many therapists never have to think about these things.

That’s not a criticism.

It’s actually the point.

The Strange Reality of Early Practice Ownership

There were years when clinicians working at the clinic made significantly more money than I did.

Oddly, I was proud of that.

Because it meant the system was working.

It meant clients were finding us.

It meant therapists were building successful practices.

It meant people were getting help.

It meant that something I had poured time, money, energy, and risk into was starting to become real.

The goal was never to build a clinic where I made the most money.

The goal was to build something that mattered.

Something that could help people.

Something that could outlast me.

What Therapists Often Miss About Fee Splits in Group Practice

Therapists can see the fee split.

What they don’t always see is the decade that came before it.

The years spent building referral relationships.

The years spent networking.

The years spent meeting physicians.

The years spent learning Google Ads.

The years spent writing blogs.

The years spent refining intake systems.

The years spent figuring out which marketing strategies worked and which were simply expensive mistakes.

The years spent creating training systems, supervision structures, and processes.

In other words, therapists see the percentage.

They rarely see the investment.

Today, a therapist can join our clinic and walk into a referral ecosystem that took years to build.

They don’t have to pay for Google Ads, design a website, hire an intake coordinator, build physician relationships from scratch.

They don’t have to spend nine months making nothing.

It’s because someone already spent years building it.

The Therapy Market Has Changed

When I opened Tri Health Clinic, the therapy market looked very different.

I opened my practice shortly before the COVID-19 pandemic hit. This was a time of growing acknowledgement that having a therapist was a sign of strength, not a weakness.

Online therapy was becoming all the rage.

Start up costs were lower and waitlists grew with little to no effort.

When I opened my clinic in Kingston, Ontario, the Psychology Today search results for my town produced 5 pages of results.

Today that same search produces over 100 pages.

in 2026, Ontario has more therapists than ever before.

I see private practitioners who previously had thriving caseloads worrying about where their next referrals will come from.

I see clinic owners trying to sell practices that are no longer financially viable.

I see clinicians wondering whether they can afford to stay in the profession.

The reality is that being an excellent therapist is no longer enough to guarantee a thriving practice.

Marketing matters.

Systems matter.

Referral relationships matter.

Business strategy matters.

The reason Tri Health Clinic continues to grow isn’t luck.

It’s not because we’re smarter than everyone else.

It’s because we have spent years investing in the clinic during periods when the return on that investment was uncertain.

What Success Means to Me Now

When I started the clinic, I probably thought success meant making more money (more than $2000 a month, anyways).

Today, I think success looks very different.

Success is that more than 3,000 individuals and couples have received care through our clinic.

Success is that people have better relationships because of us.

Success is that people have better sex because of us.

Success is that clinicians have built meaningful careers here. Built friendships.

Success is that our clinic is continuing to grow during a period when many practices are struggling.

Success is that what started as an idea is now something that genuinely helps people.

That was the dream all along.

And honestly, I feel like we’re just getting started.

A Note to Therapists Looking for Work

If your dream is to own a practice, wonderful.

We need more thoughtful, self-regulated, ethical practice owners.

The profession benefits from people who are willing to take risks and build something meaningful.

But I also hope you understand what you’re signing up for.

I hope you have realistic expectations.

I hope you appreciate the financial risks involved.

I hope, like I did, that you have support around you while you’re building.

Because practice ownership is not simply therapy with better pay.

It is an entirely different job.

And if your goal is simply to do excellent therapy and help people live better lives, don’t underestimate the value of joining a strong group practice.

Especially in today’s market.

There is tremendous value in walking into a referral system, a support system, a training system, and a community that somebody else spent years building.

After all, somebody has already paid the IKEA bill.

And speaking from experience, that bill is no joke.


If you’re a therapist reading this and thinking, “I’d rather skip the nine months to $2,000 part,” I don’t blame you. If you’re a high-quality therapist looking to advance your skills in sex therapy, or an exceptional couples therapist looking for a strong referral base, supervision, consultation, and a community of like-minded clinicians, take a look at the Tri Health Clinic Careers page. We’d love to hear from you.

The Economics of Group vs Solo Private Practice

The Economics of Group vs Solo Private Practice

What Clinicians Rarely See Behind a Successful Group Practice


Why Give Away Part of My Income to a Group Practice?

Many clinicians considering group practice ask a simple question:

Why share income with a clinic when you could keep 100% in solo practice?

On the surface, the logic seems straightforward.

If a clinician works independently, they keep their full fee. In a group practice, a portion of that fee is shared with the clinic.

The math seems like a no brainer; 100% is better than 60%!

However, this comparison assumes that clinical income exists in isolation from the infrastructure required to generate and sustain it.

In reality, running a stable, ethical, and high-quality clinical practice requires a complex system of operations, risk management, financial planning, and professional infrastructure.

Most clinicians never see this work.

In fact, when a clinic is functioning well, clinicians should not see most of it.

At the Tri Health Clinic, a significant amount of work is happening continuously in the background to ensure clinicians have:

  • stable referral streams
  • predictable income
  • legal and financial protection
  • administrative support
  • high-quality office space
  • ethical pricing structures
  • sustainable workloads
  • protection against burnout
  • community of like-minded professionals

If clinicians are largely unaware of how much work is happening behind the scenes, that usually means the system is functioning as intended.

This article aims to briefly pull back the curtain on that infrastructure and explain how the economics of a well-run group practice actually work.


My Personal Experience in Solo Practice

Before founding the Tri Health Clinic, I operated in solo private practice from 2018 to 2019, and prior to that I was in a pseudo solo practice from 2016.

Running a solo practice provides a clear education in the realities of clinical business operations.

During those years I managed:

  • marketing
  • referrals
  • client inquiries
  • website development
  • billing systems
  • payment collection
  • administrative communication
  • financial tracking
  • tax preparation
  • legal documentation
  • office infrastructure
  • client scheduling
  • cancellation management

Even while operating conservatively and carefully managing expenses, I was unable to reduce operating costs below approximately 30% of gross revenue.

This was a time well before the mental health field was as saturated as it is today. For example, Kingston’s Psychology Today search had about 5 pages of therapists, compared to the almost 600 therapists the same search reveals today.

My operating costs din’t even capture the time spent managing the business itself, which further reduced effective income.

Operating a clinic at scale only increases the complexity, costs, and risk associated with these systems.


Calculating Take-Home in Private Practice

I’m sure that you, like me, have run the mental calculations of running a private practice in your mind. You think “okay, take my hourly rate, multiple by the number of clients I’ll see in a week, and consider how many weeks I want to work in a year”.

Even with a generous amount of vacation, the number these mental exercises produce are usually eye-watering.

Cue excitement! Cue mental shopping lists! Cue visions of retiring in Costa Rica at the age of 41!

However, because we have degrees in human behaviour and not in economics, we forget that that figure represents gross revenue, not income.

Running a practice requires investment in several categories of infrastructure.

These include:

  • office space and utilities
  • administrative systems
  • billing and payment processing
  • legal and accounting services
  • marketing and reputation management
  • technology platforms and EMR systems
  • client intake and communication systems
  • financial compliance and reporting
  • policy development and documentation

Many of these costs require considerable risk.

For example, signing a commercial lease often requires a much longer commitment and more legal nuance than the residential lease most of us are familiar with. This is a considerable liability.

Not to mention the considerable up front expenses associated with an office space.

Even if you plan to work virtually, you will need an ergonomic computer set up to protect your body long into your career (think: standing desk, costly office chair, computer monitor set up). Plus a high quality computer and reliable internet connection so you can do your job with minimal interruption.

In addition, clinicians must account for the opportunity cost of time spent managing non-clinical work.

Each hour spent on administrative work (building strong referral networks, managing inquiries in a timely manner), effectively costs the dollar amount you would be making by seeing a client. That’s just not lost income, it’s an expense.

For many therapists operating independently, the financial difference between solo practice and group practice becomes significantly smaller once these realities are accounted for.


The Administrative Infrastructure Behind a Clinic

One of the largest unseen components of a clinic’s operations is administrative coordination.

At the Tri Health Clinic, administrative work includes:

  • managing inquiries in a timely manner
  • coordinating intake appointments
  • responding to any and all client communication
  • managing scheduling systems
  • processing payments
  • maintaining records
  • implementing policies and procedures

Administrative coordination is handled by trained staff who we all love and who specializes in this work. This allows clinicians to focus their professional time on clinical services rather than administrative logistics.

But consider the risk here, as well. What happens if our admin unexpectedly goes off on leave? As a member of a group practice, this is not your concern! Things will continue to operate as normal in the event of an administrator’s leave, because it is ultiamtely the responsibility of the clinic owner to ensure this happens.

As a clinician in a group practice, you will never need to deal with the horrors and administrative nightmare of finding a last minute administrative replacement.

The scale of administrative work, or even the management of an administrator is often underestimated until clinicians experience it firsthand in solo practice. No, thank you!


Financial Infrastructure and Compliance

Might you get a sense of dread or confusion when hearing words like “taxes”, “Canadian Revenue Agency”, “tax deductions”, or “reconciliation”?

Do you feel confident in your ability to accurately categorize and document every single business-related expense you make, forever?

Operating a clinic requires ongoing, detailed financial management.

This includes:

  • bookkeeping
  • accounting
  • financial reporting
  • tax preparation
  • legal compliance
  • financial decision-making
  • assessing financial health of the business
  • choosing how/when to invest in the business

At the Tri Health Clinic, clinicians receive clean monthly associate summaries that simplify financial reporting and tax preparation.

They also receive T4As at the end of every year, uploaded to the CRA for ease of reporting.

Clinicians receive their payment from the clinic via a protected service (no e-Transfered payments here), to ensure no accidents or losses or fraud.

These systems have been carefully chosen and they all provide protection in the event of regulatory review or tax audit.

Without structured systems, financial documentation can become one of the most stressful aspects of independent practice. And finding the right professionals to manage all of this can be extremely pricey.

As part of a group practice, you can trust that this has all been taken care of for you.

Breathe that sign of relief now.


Payment Systems and Revenue Protection

Policies around payment processing are a good example of the kind of high-level operational decision-making that happens continuously within a well-run group practice.

These are not decisions clinicians should have to spend their time making. The goal is simple: clinicians focus on providing excellent care, while the clinic ensures that the operational systems supporting that care are stable, ethical, and financially sound.

For this reason, the Tri Health Clinic requires that all clients maintain a credit card on file. This policy ensures that payments can be processed promptly after sessions and that clinicians are protected from the administrative burden and financial uncertainty associated with unpaid balances.

Credit card processing fees are substantial. Across the clinic, these fees amount to tens of thousands of dollars per year. However, the clinic deliberately absorbs this cost rather than passing it on to clinicians. We consider these fees a necessary cost of doing business in order to maintain a reliable payment system and protect clinicians’ income.

Some solo practitioners attempt to avoid credit card fees by relying on eTransfers or manual payment arrangements. While this approach may reduce transaction costs, it significantly increases the risk of unpaid sessions. When payments are missed, clinicians often have limited practical recourse and may spend considerable time attempting to recover balances.

Our approach prioritizes reliability and clinician protection. By maintaining structured payment systems and absorbing the processing costs at the clinic level, we ensure that clinicians are paid consistently and are not placed in the position of chasing payments from clients.

As a result of these systems, the clinic maintains exceptionally low bad debt rates (under 1%), which helps ensure that clinicians’ income remains stable and predictable.


Referral Stability and Income Predictability

Income stability is one of the most overlooked benefits of working within an established clinic.

Many solo practitioners experience significant fluctuations in referral volume. Look at any therapist facebook group and you will see countless messages to the effect of “is anyone else noticing fewer referrals?”, or “my Psychology Today page doesn’t seem to be working anymore…?”.

When your full time job is seeing clients and marketing is something that happens off the side of your desk (or not at all), you can expect periods of high demand that may be followed by weeks or months of reduced bookings.

Since it was established in 2018, The Tri Health Clinic has gown into one of Ontario’s recognized centres for sex and couple therapy. This was not passive growth; it was deliberate, curated, and took considerable effort, time, and financial investment. Our reputation was established before the pandemic hit and the market became saturated, and this work continues at all times.

Due to the enormous amount of ongoing effort to market the clinic, we receive a large volume of referrals and carefully distribute them among clinicians based on availability and specialization.

This provides clinicians with a more predictable and stable client flow.

This level of investment of time and finances into building a brand is nearly impossible to do while also prioritizing client-facing time. It just isn’t possible as a solo practitioner.

By joining an established, healthy group practice, clinicians benefit from income stability, and thus a significant reduction in financial stress. This peace of mind allows clinicians to focus on clinical work rather than marketing.


Client Fit, Referral Matching, and Burnout Prevention

Solo practitioners often feel pressure to accept most inquiries in order to maintain income stability.

This can lead clinicians to take on clients outside their preferred clinical areas or outside what might be considered their professional “zone of strength.” Over time, carrying a very broad caseload can increase emotional fatigue and contribute to burnout.

Within a team-based clinic, clinicians have the ability to focus more intentionally on their areas of expertise and interest. When a clinician is not currently accepting certain presentations—for example couples therapy, trauma work, or specific sexual health concerns—those clients can be matched with another clinician within the clinic who is better suited to the work.

This structure benefits both clinicians and clients by increasing the likelihood of a strong therapeutic fit.

For solo practitioners, managing this process can be significantly more complicated.

When an inquiry arrives that falls outside a clinician’s expertise, most therapists do not simply decline the request and move on. Clinicians care deeply about the people who reach out to them. Many will spend time responding thoughtfully, conducting consultation calls, reaching out to colleagues, reviewing referral options, and attempting to identify an appropriate alternative provider.

This work is meaningful, but it also carries a real cost.

It requires time, coordination, and often emotional energy as clinicians attempt to ensure that a client who has reached out for help is not simply turned away without support.

At the Tri Health Clinic, this process is built into the clinic’s intake infrastructure. Our intake coordinator manages referral matching and works carefully to connect clients with clinicians whose expertise aligns with the presenting concern.

When the clinic identifies a gap in services—for example, a type of client we cannot currently accommodate—the responsibility does not fall on individual clinicians to solve that problem. Instead, clinic leadership works to address the gap, often by recruiting additional clinicians with the appropriate specialization.

This approach ensures that clients receive appropriate care while protecting clinicians from the logistical and emotional burden of managing complex referral coordination on their own.

It also strengthens the broader professional community by ensuring that clients are matched thoughtfully with clinicians whose training and interests align with their needs.


Pricing Strategy and Market Research

Another responsibility of clinic leadership is determining appropriate fee structures.

As Independent Contractors, clinicians at our particular clinic ultimately choose their own fees. However, the clinic provides the research, data, and infrastructure needed to select a fee that supports a sustainable and thriving practice.

In solo practice, pricing decisions are often made with limited information. Many clinicians start with a quick scan of Psychology Today to see what colleagues are charging, followed by an internal debate that might sound something like:

“I want to earn a reasonable income, but I don’t want finances to be a barrier to helping people.”

“There’s no way someone would pay that much to see me.”

“This fee seems… fine, I guess…?”

The cost of therapy is a source of real tension for many clinicians in the helping professions. I know this well because I navigated the same dilemma when I ran my own solo practice.

At the Tri Health Clinic, we intentionally remove much of this burden from clinicians. The clinic conducts detailed market research on pricing across multiple Ontario cities and across several health professions. We also monitor market saturation, referral patterns, and demand for specialized services.

This work ensures that clinic fee structures remain:

  • competitive within the broader market
  • ethical and appropriate for the services provided
  • sustainable for both clinicians, the clinic, and the people we serve
  • aligned with specialized training and expertise

The clinic also manages how fees are communicated to clients and handles structured fee adjustments when necessary.

As a result, clinicians are not left wondering whether they are charging too much, too little, or when it might be appropriate to adjust their rates. Those decisions are supported by ongoing research, careful planning, and transparent procedures.

Pricing is not guesswork; it is the result of ongoing analysis, careful planning, and a commitment to ensuring clinicians are compensated appropriately for their expertise.


Monitorying the Professional Landscape is Done For You in a Group Practice

Maintaining a healthy clinic also requires ongoing engagement with the broader professional landscape. In mental health, especially, that is changing at breakneck speed these days.

As Clinic Director, I regularly participate in and collaborate with several networks of group practice owners, which provide ongoing insight into:

  • emerging industry trends
  • regulatory developments
  • ethical considerations in group practice
  • sustainable compensation models

These communities offer a perspective that is simply not available when practicing alone. Solo practitioners may consult with colleagues, but the operational realities of running a clinic—and the decisions required to support multiple clinicians—are quite different from those of individual private practice.

Engaging with other clinic directors allows us to compare models, identify best practices, and ensure that the structure of our clinic remains both ethical and sustainable.

It also raises a practical question: who has the time to do this while running a full solo practice?

Monitoring industry developments, evaluating new technologies, and analyzing operational models is a substantial responsibility in itself. At the Tri Health Clinic, this work is intentionally part of my role.

My background in research also informs how these decisions are made. Changes are not adopted based on trends alone; they are evaluated carefully, often through a combination of available research, operational data, and consultation with other clinic leaders.

For example, consultation calls have become a common expectation across much of the therapy industry. However, the available evidence suggests that at best, they offer limited benefit beyond rewarding salesmanship rather than improving clinical outcomes, and at worst they can cause real damage by delaying client’s therapy start date. Because our clinic operates at scale, we have the ability to thoughtfully reconsider industry norms that may not serve clinicians or clients well.

Another example is the rapid emergence of AI-supported documentation tools. Before adopting any technology, the clinic evaluated multiple options, assessed clinician interest, and reviewed privacy and consent considerations. Ultimately, we selected an electronic medical record system that includes AI-assisted note-taking capabilities and developed appropriate consent procedures. Clinicians are free to choose whether or not to use these tools, but the infrastructure and due diligence have already been completed.

These kinds of evaluations take significant time and careful analysis. In a solo practice, it is often difficult to keep pace with emerging tools and trends while also managing a full clinical caseload.

At the Tri Health Clinic, part of my responsibility is to remain ahead of these developments so clinicians can benefit from thoughtful, evidence-informed decisions without needing to invest their own time in evaluating every new trend or technology.


Rethinking the Meaning of a Fee Split in Group Practice

Fee splits are often misunderstood as arbitrary numbers, or even greed on the part of a practice owner.

In reality, fee splits in group therapy practice must balance a complex set of factors, including:

  • clinic health and sustainability
  • clinician income
  • administrative infrastructure
  • physical office space
  • technology systems
  • clinic branding and marketing
  • legal and financial compliance
  • long-term operational stability

When these factors are ignored, clinics may offer unusually unbalanced fee splits in order to attract clinicians. While appealing at first glance, these models can destabilize a clinic’s finances and eventually force difficult corrections such as sudden fee increases, reductions in services, or even clinic closure.

I would ask some very serious questions about any fee split less than 35/65, or even 60/40.

At the Tri Health Clinic, fee structures are calculated deliberately and conservatively to ensure long-term stability for both clinicians and the clinic.

The purpose of this article is to illuminate what a fee split actually represents.

You are not simply “giving up a portion of your income.” You are protecting yourself from substantial financial risk, from the enormous time costs of running a business, and from the operational burdens that can quickly erode both income and professional (and personal!) wellbeing.

You are also investing in a sustainable practice environment designed to support clinicians over the long term.

Most graduate programs in the helping professions do not teach the realities of running a business. In fact, I don’t know if this is ever taught at the training level. Yet when clinicians operate as Independent Contractors, that is effectively what they are doing: running a small business.

And like most businesses, operating independently can be expensive and risky.

Consider the cost structure of many other industries: retail stores must carry large amounts of inventory, pay staff, manage supply chains, and maintain physical storefronts. Compared to many businesses, private practice is already relatively streamlined.

Group practice takes that a step further.

By sharing infrastructure, administrative systems, and operational responsibilities, clinicians are able to access the benefits of a well-run business without carrying the full burden of building and maintaining it themselves.

In many ways, it is an unusually supportive model: clinicians are able to focus primarily on the work they trained for while the clinic manages the underlying business systems that make that work possible.

At the Tri Health Clinic, this model is intentional. Our goal is to create an environment where clinicians can build sustainable careers, avoid burnout, and focus on meaningful clinical work.

Ultimately, that serves everyone involved: clinicians, the clinic, and the clients we collectively aim to support.

If this article helps illuminate the realities of practice economics for even a few clinicians, then it has served its purpose.

Offering unsustainably high splits may initially attract clinicians but can destabilize a clinic’s finances.

This can eventually force clinics to:

  • raise client fees unexpectedly
  • reduce services
  • close entirely

Tri Health Clinic operates with a deliberate focus on long-term sustainability.

Fee splits are carefully calculated to ensure clinicians can thrive while the clinic remains financially healthy.


So… Group Practice vs Solo Practice?

If much of what you’ve read here feels unfamiliar, that is actually a good sign.

When a clinic is operating well, clinicians should not need to spend their time thinking about payment systems, pricing strategy, administrative infrastructure, legal compliance, market research, or operational risk. Those responsibilities should be handled by the clinic leadership working diligently in the background.

At the Tri Health Clinic, we take that responsibility seriously. A significant amount of work goes into building and maintaining the systems that allow clinicians to focus on what they do best: providing thoughtful, high-quality care to clients.

Our goal is simple. Clinicians should be protected from the complexity of running a clinical business, supported by strong infrastructure, and able to build sustainable, fulfilling careers. When those systems are functioning well, much of that work remains invisible.

And that is exactly how it should be.

Why Solo Practice Can Be Risky in Sex Therapy (And What We’re Doing Differently at the Tri Health Clinic)

Why Solo Practice Can Be Risky in Sex Therapy (And What We’re Doing Differently at the Tri Health Clinic)

If you’re a therapist reading this, this post is for you.

If you’re a client looking for care, it’s also for you.

Sex therapy and couples therapy are not casual endeavours. We work with people at their most vulnerable: shame, trauma, desire discrepancies, erectile concerns, infidelity, identity questions, relationship ruptures. These are complex, emotionally loaded, and deeply personal issues.

In this kind of work, drifting is dangerous.

And yet, it happens more easily than we like to admit.


The Quiet Risk of Solo Practice

Many clinicians begin their careers in rich, collaborative environments.

Graduate school. Internship. Hospital teams. Case conferences. Supervisors who push your thinking. Peers who challenge your blind spots.

Then, slowly, especially in private practice, that structure fades…

You rent an office.

You build a caseload.

You get busy.

You stop consulting as much.

You stop attending as many conferences.

You rely more on what you “know.”

And over time, something subtle can happen: you drift.

Not because you’re careless.

Not because you don’t care.

But because isolation changes practice.

Without regular consultation, it becomes easier to:

  • Rely on anecdote instead of research
  • Default to personal beliefs about sex and relationships
  • Over-identify with certain clients
  • Miss your own blind spots
  • Continue using interventions that newer evidence has refined or replaced

In sex therapy especially, the research evolves quickly. Desire models have changed. Pain treatment has evolved. Couples therapy frameworks are continually refined. Neurobiology, pelvic health, LGBTQ2S+ care, trauma integration, online delivery — it’s all moving.

If you’re not actively staying connected, you fall behind.

And when we fall behind, clients pay the price.


Why Sex and Couples Therapy Demands Collaboration

Sex and couples therapy is uniquely vulnerable to clinician bias.

We are human. We all carry our own sexual histories, cultural narratives, religious influences, attachment patterns, and relationship experiences.

If we’re not actively examining those influences in consultation and supervision, they seep into the room.

And with something as taboo as sex — and as emotionally charged as couples therapy — even subtle bias can cause harm.

Clients need:

  • Rigour
  • Evidence-based frameworks
  • Clear case conceptualization
  • Ongoing peer consultation
  • Clinicians who are accountable to something larger than themselves

This is not the kind of work that should be done in isolation.


What a High-Functioning Group Practice Actually Looks Like

There is a difference between “a few therapists sharing rent” and a true collaborative clinical environment.

At the Tri Health Clinic, consultation is embedded in the core of what we do.

We have:

  • Weekly group supervision and case consultation
  • Structured individual supervision
  • Lunch & Learn clinical trainings
  • Ongoing competency-based evaluation
  • In-house training development
  • Shared resources and research updates

If someone has a difficult session, they do not sit alone with it.

They walk next door.

They message a colleague.

They hop on a zoom call with a trusted coworker.

They bring it to group.

They talk about it over lunch.

The hallway conversations matter.

The “can I run something by you?” moments matter.

The humility of saying, “I’m not sure about this case” matters.

That culture protects clients.


Staying Sharp: Conferences, Research, and Provincial Collaboration

Staying current is not a once-a-year CE requirement. It’s a professional stance.

As the Clinic Director, I attend international conferences such as SSTAR (Society for Sex Therapy and Research) and clinical case conferences where leaders across North America gather to debate, challenge, and refine approaches to complex cases.

These environments are rigorous, sometimes uncomfortable, deeply collaborative discussions about best practice.

Beyond that, I helped create the Ontario Sexual Health Network (OSHN), bringing together professionals from multiple colleges across the province to collaborate and consult across disciplines. Sexual health does not belong to one profession. It requires integration: psychology, medicine, pelvic floor physiotherapy, nursing, social work.

We need systems that keep us connected because no single clinician, no matter how experienced, is immune to blind spots.


Later Career Does Not Mean Immune to Drift

This part is uncomfortable, but important.

Experience is invaluable.

Wisdom matters.

Clinical intuition develops over time.

But clinician longevity does not automatically equal evidence-based practice.

In fact, later-career clinicians are at particular risk of isolation if they step away from formal supervision, case consultation, and structured peer review.

If you have not had your work meaningfully challenged in years, that is not a badge of honour.

It is a vulnerability.

The strongest clinicians I know — at every career stage — are the ones who seek feedback, invite consultation, and remain curious.


Why This Matters for Clients

If you are seeking sex therapy or couples therapy, here are questions worth asking:

  • Does this clinician consult regularly with peers?
  • Are they connected to current research?
  • Do they attend specialized conferences?
  • Do they have structured supervision or case consultation?
  • Are they accountable to a clinical framework beyond their own opinion?

You deserve a therapist who is embedded in a professional community, not operating in isolation.


Why This Matters for Clinicians

If you are a therapist considering your next step, consider what kind of environment will keep you sharp.

Do you want to:

  • Carry every complex case alone?
  • Sit with ethical dilemmas without structured input?
  • Rely only on CE credits to stay current?

Or do you want:

  • A culture of consultation
  • Weekly structured case discussions
  • Ongoing training
  • Collegial hallway conversations
  • Shared intellectual curiosity
  • A clinic that invests in your development

In our supervision framework, accountability, documentation, evaluation, and ethical oversight are not afterthoughts. They are embedded in how we operate. 

Because excellence in sex therapy requires infrastructure.


The Standard We’re Building in Ontario

My goal is not simply to run a group practice; it is to raise the standard of sex and couples therapy delivery in Ontario.

That means:

  • Evidence-based care
  • Data-driven decision making
  • Structured supervision
  • Interdisciplinary collaboration
  • Ongoing professional development
  • Humility in the face of complexity

Sex therapy is too important to be casual.

Couples therapy is too impactful to be intuitive alone.

Clients deserve clinicians who are sharp, connected, and accountable.

And clinicians deserve environments that help them become the best in the field.

If you are a therapist who wants to practice in a culture of collaboration, rigour, and leadership in sexual health, I would love to talk.

Ontario needs more clinicians who refuse to drift.


Ready to Practice in a Clinic That Won’t Let You Drift?

If you’re reading this as a therapist, here’s the bottom line.

You do not need to be an expert in sex therapy to join us.

But you do need to be:

  • An experienced clinician
  • Solid in your foundational skills
  • Comfortable with complexity
  • Humble enough to consult
  • Motivated to add a specialty to an already strong clinical base

Sex therapy can be taught.

Clinical depth, integrity, and intellectual curiosity are harder to build from scratch.

At Tri Health Clinic, we train experienced therapists to develop real expertise in sex and couples therapy within a structured, collaborative, evidence-based environment. You won’t be thrown into the deep end alone. You’ll have consultation, supervision, research integration, and a culture that expects excellence.

If you’re at a stage in your career where you’re ready to specialize — and you want to do it properly — we’re building something worth joining.

Apply to work at Tri Health Clinic.

We’re always open to strong clinicians who want to raise the standard of care in Ontario.

How to Spot a Healthy Group Practice (Before You Join a Dumpster Fire)

How to Spot a Healthy Group Practice (Before You Join a Dumpster Fire)

As someone who’s been running a group practice for the past seven years, I’ve developed a bit of an obsession with other practice owners. I joined all the Facebook groups, listened to the podcasts, joined the masterminds. I came for connection and business tips. I stayed because I couldn’t look away.

Because, wow. Some of what I’ve seen in those groups? It’s wild.

There are practice owners who fell into their roles by accident. Some think being a clinic owner means sitting back and collecting 40% of someone else’s labour. Others are so burned out they’re openly talking about shutting down their clinic and getting a “real job.”

And in the middle of all this? Good clinicians just trying to find a place to work where they can do their best work, help people, and not lose their minds.

So, if you’re looking to join a group practice, this post is for you. Here’s what to look out for—and what to run from.

🚩 The Owner Is Constantly in Crisis Mode

The issue:
Leadership sets the tone. If the owner is always stressed out, panicked, or flying by the seat of their pants, the whole clinic becomes reactive and unstable.

What unhealthy looks like:
Every day is a fire. The owner is juggling too many balls, answering every email at midnight, and changing policies on a whim. One minute your intake process is X, the next it’s Y. You never know what’s coming, and neither do they.

What healthy looks like:
The owner is calm, clear-headed, and has boundaries. They’ve built systems so the clinic doesn’t depend on their every breath. They take vacations, they delegate well, and when things go sideways (as they sometimes do), they don’t implode.

Why it matters:
You deserve to work in a place that doesn’t feel like a war zone. A grounded owner creates a grounded clinic. That stability trickles down to you and your clients.


🚩 They Talk Like You Work for Them

The issue:
This isn’t a traditional employment model. Most group practices hire independent contractors. That means you don’t work for them; they work for you.

What unhealthy looks like:
The owner treats you like staff. They make unilateral decisions that affect your practice without consultation. They expect you to be grateful for the opportunity to work there, and remind you of that any time you raise a concern.

What healthy looks like:
The owner sees their job as supporting you. They understand that their role is to keep the clinic alive, support clinicians, and ensure clients are well-served. They recognize that their business exists because of the work you do, not the other way around.

Why it matters:
Power dynamics can get messy. You want to work somewhere that respects your autonomy, values your input, and understands that their success depends on your ability to thrive.


🚩 The Fee Split Is Too Good to Be True

The issue:
Yes, fee splits matter. But how that split is being used matters more.

What unhealthy looks like:
You’re being offered an 80/20 or even 90/10 split. You feel like you’ve won the lottery… until you realize there’s no admin help, no marketing, no supervision, no infrastructure, no support. And a year later? The clinic folds. Or worse, they can’t afford to pay you.

What healthy looks like:
A sustainable split—usually around 60/40 or 55/45—that funds admin, marketing, leadership, systems, and support. The owner can clearly articulate where that money goes and how it helps you do your job better.

Why it matters:
A thriving clinic requires resources. If there’s no money to invest back into the business, the business dies. A healthy split means the clinic can take care of you and itself.


🚩 There Are No Systems (or They’re a Secret)

The issue:
Systems are what keep a clinic running smoothly. Without them, you’re stuck relying on guesswork, micromanagement, or the group chat.

What unhealthy looks like:
Everything is ad hoc. You’re told to “just ask” when you need something. Information is scattered, inconsistent, or gatekept. You spend more time trying to figure out how to do your job than actually doing it.

What healthy looks like:
There’s a handbook. A shared drive. A clear process for everything from intake to offboarding. You’re set up to succeed without needing to rely on the owner for every single detail.

Why it matters:
Good systems mean more time and energy for client care. They reduce burnout, improve outcomes, and signal that the clinic is built to last.


🚩 They Don’t Know Their Numbers

The issue:
Metrics matter. A clinic owner should know whether their business is thriving or floundering.

What unhealthy looks like:
They shrug when asked about retention rates or average caseloads. They have no idea if the clinic is profitable. Or they say things like, “I don’t do this for the money” (which is usually code for: I have no idea what I’m doing).

What healthy looks like:
The owner tracks key metrics like no-show rates, client retention, revenue per clinician, and client outcomes. They use that data to make informed decisions, and they’re transparent about it.

Why it matters:
Financial health = clinic health. If the numbers don’t make sense, the clinic is not sustainable. And if it folds, you’re out of a job.


🚩 They Expect You to Do Your Own Marketing

The issue:
Unless you’re being hired as an associate with a personal brand, it is my opinion that marketing is not your job.

What unhealthy looks like:
You’re expected to build your own caseload, post on social media, or go hustle for referrals. You’re told to “just put yourself out there,” even though the clinic takes 45% of your income.

What healthy looks like:
The clinic has a cohesive brand, a referral pipeline, and a marketing strategy that drives the right clients to you. Your only job is to be a great therapist.

Why it matters:
You should be paid to do therapy, not to market. If you’re responsible for finding your own clients, you shouldn’t be giving up part of your income.


🚩 The Clinical Culture Is… Weird

The issue:
Culture isn’t just about vibes. It impacts everything from job satisfaction to client outcomes.

What unhealthy looks like:
Nobody talks to each other. Or worse, there’s favoritism, passive-aggressiveness, and behind-the-scenes drama. Meetings are skipped, suggestions are ignored, and people seem vaguely terrified of the owner.

What healthy looks like:
The team feels connected. Clinicians attend meetings and actually want to be there. There’s room for feedback, collaboration, and even a little fun.

Why it matters:
Isolation breeds burnout. A strong culture helps you grow, stay regulated, and feel like you belong.


🚩 Clinicians Keep Leaving

The issue:
Attrition tells a story. People don’t flee healthy workplaces.

What unhealthy looks like:
Every time you blink, someone’s gone. The team page is constantly changing. The owner insists it’s just “life stuff,” but you notice no one sticks around for more than a year.

What healthy looks like:
People stay. They grow within the clinic. New hires are excited to join because of the people who are already there.

Why it matters:
In the current mental health market, there are endless options for clinicians to find an environment where they can thrive. People will not stay where they are not valued. A revolving door means instability. It also means you’re probably next.


🚩 The Owner Doesn’t Understand Business Law or Finance

The issue:
A group practice is a business. There are rules. And they matter.

What unhealthy looks like:
The owner doesn’t know what they’re legally allowed to do. They hire people improperly, misclassify contractors, or get caught off guard by tax obligations. (True story: I once saw a clinician use their tax account to fund a trip through Europe dining at only Michelin star restaurants… their clinic promptly folder after because they couldn’t pay their taxes).

What healthy looks like:
The owner is legally and financially literate, or they work closely with professionals who are. They make choices based on facts, not vibes. And they keep themselves (and you) out of legal hot water.

Why it matters:
If they’re not running a compliant business, your job isn’t safe. Full stop.


So… What Should You Ask Before You Join?

Here’s a quick checklist:

  • What’s the onboarding process like?
  • Who handles marketing?
  • What does the fee split cover?
  • Are there written policies and systems?
  • What kind of team culture exists?
  • How long have current clinicians been with the clinic?
  • How are decisions made?
  • What metrics does the clinic track?
  • What happens if the owner is away for a month?
  • Do they understand their legal and financial responsibilities?

Final Thoughts (and a Not-So-Subtle Pitch)

If you’re already in a group practice and half of this list sounds familiar… it might be time to rethink your options.

And if you’re a sex therapist or couples therapist in Ontario? Tri Health Clinic might be the place you’ve been looking for.

We exist to help clinicians thrive. We handle the business stuff so you can focus on therapy. We don’t ask you to market yourself. We invest in systems, in support, and in community. We’re serious about ethical business, financial transparency, and long-term sustainability.

You do the therapy. We take care of the rest.

Interested in joining us? Click here to learn more and apply.

The Hard Truth About Private Practice: Why Joining a Group Might Be Your Best Move

The Hard Truth About Private Practice: Why Joining a Group Might Be Your Best Move

For many psychologists and therapists, the dream is simple: set up a private practice, set your own hours, make good money, and help people.

Seems straightforward, right?

If you’ve worked in the field long enough, you know that private practice today is nothing like it used to be.

The mental health landscape has changed dramatically over the past decade. COVID flooded the field with therapists, universities started pumping out clinicians at unprecedented rates, and now, post-pandemic, the market is shifting again.

Solo private practice isn’t what it used to be, and in many ways, it’s harder than ever before. But that doesn’t mean group practice is the easy answer.

The Fantasy of Solo Private Practice

Many clinicians dream of going into private practice because they assume:

✔ They’ll have total freedom over their schedule

✔ They’ll make more money by cutting out the middleman

✔ They’ll have low overhead costs, since therapy only requires a room, a chair, and a computer

✔ If they’re good at therapy, clients will just find them

Sounds ideal. And maybe 5 years ago, during the pandemic, that was true. But today?

🚨 Here’s the reality of solo practice today:

💸 Overhead is more expensive than you think. Office lease, furniture, monthly software subscriptions, marketing, supervision—it all adds up. Most therapists spend way more than they expect just to keep their business running.

⏳ You will work more hours than you think. Therapy is only part of the job. There’s intake calls, scheduling, chasing payments, admin work, note-taking, networking, and running a business.

📉 Clients won’t magically find you. A good therapist is not the same thing as a good business owner. If you don’t know SEO, marketing, networking, and business strategy, you’ll struggle to stay full these days. Clients will not be able to find you and get the amazing help you can offer.

📑 It’s all on you. No built-in referrals, no IT department, no front desk staff, no one to handle crisis calls when you’re off. You’re running a full-fledged business alone.

For some people, solo practice is still worth it. But for most, the fantasy of “more money and fewer hours” quickly crumbles under the reality of business ownership.

Is Group Practice the Easy Way Out? Not Exactly.

Some people assume that running a group practice is the “easier” path. It is not.

Expanding from solo to group means:

❌ Taking on all the risk (leases, hiring, payroll, legal policies, supervision)

❌ Navigating group dynamics, leadership challenges, and organizational systems

❌ Ensuring quality control—if someone messes up, it’s your license on the line

❌ Keeping your team happy and engaged while balancing business needs

There’s a reason so many group practices fail (and they do fail). It’s not enough to hire good therapists—you have to create a business model that actually works long-term.

A good group practice owner is part clinician, part entrepreneur, part manager, and part strategist. If you don’t get all of those things right, your practice won’t survive.

So no, running a group practice is not easier. But joining one? Especially one with a demonstrated history?

That might be the smartest career move you make.

Why Joining a Group Practice Is Often the Best Choice

Here’s what most therapists don’t realize:

👥 Group practices take on the burden of running a business so you can just do therapy. No marketing, no admin work, no accounting. Just seeing clients and writing notes.

📈 You don’t have to worry about referrals drying up. A well-established group practice already has a referral pipeline. You don’t have to stress about constantly filling your caseload.

💰 The financial trade-off is usually worth it. While a solo practitioner could theoretically keep 100% of their income, they also have way more expenses and unpaid work. Many clinicians in group practice actually make more per clinical hour because they aren’t losing time to unpaid admin work.

🏡 You have a built-in community. Private practice can be shockingly lonely. When you’re in a group, you have people to consult with, learn from, and rely on when things get tough.

🔄 You have room to grow. Want to specialize in a new area? Get supervision? Reduce your caseload and still have financial stability? Good group practices offer growth opportunities that solo practice just can’t provide.

So… What’s the Best Move?

🔹 If you love business, want full control, and are prepared for the reality of running a company—solo practice might work for you.

🔹 If you just want to be a therapist, have a full caseload without worrying about business logistics, and want long-term security and professional growth—joining a strong group practice is likely the better choice.

But don’t just join any group practice.

Find one that is stable, well-run, and values clinician well-being. Look for:

✅ Clear policies and procedures (not just “we’ll figure it out as we go”)

✅ A strong referral pipeline

✅ Fair and transparent compensation

✅ High-quality supervision and professional development

✅ A positive, supportive workplace culture

The Future of Private Practice Is Changing

The days of just “hanging a shingle” and instantly filling your caseload are gone. The market is saturated. Clients have more options. And solo therapists are struggling.

The future of mental health belongs to well-run, high-quality group practices.

If you’re thinking about your next career move, take a hard look at what you want:

✔ Do you want to do therapy?

✔ Do you want stability?

✔ Do you want a full caseload without chasing referrals?

✔ Do you want work-life balance and a professional community?

If the answer is yes, a great group practice might be exactly what you need.

Navigating the Path Ahead: Dr. Bossio’s Reflection on Tri Health Clinic’s Journey in 2023

Navigating the Path Ahead: Dr. Bossio’s Reflection on Tri Health Clinic’s Journey in 2023

 As I stand at the threshold of a new year, my reflections lead me to the core of Tri Health Clinic’s mission—a mission that transcends clinical practice and delves into the heart of human connection. In 2023, my commitment is unwavering: to expand our services, dissolve boundaries, and better meet the evolving needs of the individuals across Ontario. 

A Call for Inclusivity

Our collective journey at Tri Health Clinic is a testament to the power of inclusivity. In the coming year, we aim to broaden our reach, ensuring that our services resonate with the diverse experiences and concerns that define the landscape of Ontario. 

Addressing the Unmet Need: A Focus on Trauma

In the past, our capacity constraints have led to the unfortunate reality of turning away those seeking support for trauma concerns. This year, our focus sharpens—no longer will we allow the unmet need to persist. Tri Health Clinic is preparing to meet the surging demand for trauma-focused therapy, and we invite like-minded clinicians to join us in this critical endeavor. 

Nurturing Relationships: Couples Therapy at the Forefront

The influx of concerns surrounding couples’ therapy speaks to the profound need for guidance in the realm of human relationships. In 2023, Tri Health Clinic is poised to be at the forefront, offering support, understanding, and pathways to healing for couples across Ontario. 

Who Would Be the Ideal Fit?

Tri Health Clinic is not just seeking clinicians; we’re inviting compassionate and skilled professionals who resonate with our vision. The ideal candidate is someone who: 

    • Embodies a deep commitment to evidence-based practices in trauma therapy and couples’ therapy, particularly those with expertise in Emotion-Focused Therapy (EFT).

    • Is passionate about inclusivity, recognizing the unique narratives that each individual brings to the therapeutic space.

    • Nurtures a warm and empathetic approach, understanding that true healing often begins with connection and understanding.

    • Possesses a curious mind, eager to grow, learn, and adapt within a collaborative team environment.

    • Shares our commitment to dismantling barriers and ensuring mental health services are accessible to all.

Elevate Your Practice with Tri Health Clinic

Our clinic is not just a workplace; it’s a haven for passionate clinicians seeking to make a meaningful impact. As we gear up for an exciting year, we are on the lookout for two dedicated trauma therapists and two couples therapists specializing in Emotion-Focused Therapy (EFT). 

Why Tri Health Clinic?

1. Holistic Support:

    • We understand that the best clinicians are those who can focus entirely on their clients. That’s why, at Tri Health Clinic, we handle EVERYTHING from a business admin perspective. Say goodbye to the headaches of paperwork and marketing; let your energy be invested where it matters most—in your clients.

 2. Embrace Evidence-Based Practice:

    • Our commitment to evidence-based practice sets us apart. For trauma therapists, we seek individuals who are passionate about delivering impactful, evidence-based care. Couples therapists, your expertise in Emotion-Focused Therapy (EFT) will find a home in our supportive environment.

 3. Opportunity to Start Fresh: 

    • As we step into the new year, consider this the perfect opportunity to recalibrate your career goals. Start fresh with a team that values innovation, embraces growth, and thrives on mutual support. Join a clinic where your aspirations are not just welcomed but nurtured.

 4. Prioritize Your Self-Care:

    • At Tri Health Clinic, we believe that the foundation of excellent therapy lies in the well-being of the therapist. Joining our team means prioritizing your self-care, fostering a healthy work-life balance, and being part of an amazing team that supports your personal and professional growth. 

Join Us in Transformative Work

As we embark on this transformative journey, I extend a warm invitation to clinicians who resonate with our ethos. If you are someone who envisions a career defined by impactful therapy, inclusive practices, and continuous growth, Tri Health Clinic may be the place for you. 

To apply and learn more about our exciting opportunities, visit our Careers page trihealthclinic.comc/careers. 

Are you ready to make a difference? Join us at Tri Health Clinic and let your journey begin. 

Live passionately, work purposefully, and embrace the extraordinary. 

 

Your partners in transformation, 

Dr. Bossio
Founder & Director, Tri Health Clinic