by jennbossio | Jul 10, 2025 | Advocacy, Therapy, Training
If you’ve been following my recent posts, you know I’ve been sounding the alarm about something that’s hard to ignore: clinical psychology is at a critical juncture. The market is saturated. Therapy is in demand, and everyone wants to do it. That should be a good thing, right? But here’s the problem: when it comes to what we actually do as psychologists, there’s very little that differentiates us in the public eye from social workers, psychotherapists, or counsellors, despite our years of training, research expertise, and clinical skill.
And that’s not just a branding issue. It’s a professional identity crisis.
Most clinical psychologists in Ontario work in private practice, doing one-on-one therapy. But when our day-to-day looks identical to the work done by those with far less training, how can we justify the length, cost, and intensity of our education? And more importantly, how can we ensure that the field of psychology survives and thrives in a crowded, competitive landscape?
It’s time we stop underplaying what we’re capable of.
What Makes Psychologists Different From Other Therapists?
Here’s the thing we forget: we’re not just therapists. We’re diagnosticians. We’re researchers. We’re scientists. We’re case conceptualization machines.
We are trained to understand not just what a client presents with, but why and how that should inform the course of treatment. We’re taught to read research critically (not just quote it from a slide deck) and to integrate complex evidence bases into our clinical work. That is not a universal skill across the mental health professions.
And yet, as a field, we’ve let that go quiet. We’re not stepping into positions of influence, consultation, or thought leadership in the way we could be. And we’re losing ground to professions that are simply better at marketing, regardless of whether their approach is scientifically sound.
Need an example? Let’s talk about EMDR…
EMDR is treatment that’s exploded in popularity, largely because it’s easy to market and sounds revolutionary. But when you actually dig into the research (which, again, most psychologists are trained to do), the evidence tells a different story. Multiple meta-analyses have shown that EMDR is no more effective than other established treatments for PTSD, like Cognitive Processing Therapy or Prolonged Exposure. The “bilateral stimulation” component, often touted as the secret sauce, doesn’t appear to add any benefit beyond what you’d get from exposure-based therapy alone. And yet, EMDR is everywhere. Precisely because many clinicians and clients don’t have the research literacy to question its claims. This is where psychologists should shine: translating science into practice, and helping the public—and our colleagues—separate evidence from hype.
Why Prescription Rights Matter
Here’s where I see a path forward: clinical psychologists should be able to prescribe.
Psychiatrists are overburdened and hard to access. Family doctors are often uncomfortable with psychopharmacology and are flying blind when it comes to complex mental health cases (and that doesn’t even touch on the complete lack of time that GPs have to deal with it properly in their practice). Meanwhile, psychologists—the very professionals most skilled in diagnosis, assessment, and and case formulation—are sidelined when it comes to medication.
We could be the bridge. We should be the bridge.
Imagine a model where psychologists are trained in psychopharmacology through a postdoctoral master’s program (as is already the case in some U.S. states). We’d be uniquely positioned to prescribe with a level of diagnostic clarity and caution that many prescribing professionals simply don’t have time for. Our deep understanding of evidence-based psychological treatment would allow for a nuanced, integrated approach; one that prioritizes both medication and therapy, not one over the other.
And for those who think psychologists would never go for more schooling… have you met a psychologist? We’re exceptional students. We love learning. Many of us would leap at the opportunity to return to school for something that actually excites us and helps us better serve our clients. In fact, I’d argue a lot of us are bored in private practice, precisely because we’re underutilizing the full scope of our training.
How To Get Prescription Rights as a Psychologist?
So what would it actually take for psychologists to gain prescriptive authority in Ontario? In short: legislative change, regulatory oversight, and the development of standardized training pathways; likely in the form of a postdoctoral master’s degree in psychopharmacology, as has been done in several U.S. states. And this kind of professional expansion isn’t unprecedented! We would not the the first!
Optometrists, for example, fought for and won the right to prescribe medications related to eye care, dramatically expanding their role in patient treatment. More recently, pharmacists have gained prescribing privileges in many provinces, especially for minor ailments and chronic conditions, recognizing that their expertise in medication can meaningfully improve access to care.
Psychology is arguably even better positioned for this kind of evolution, given our diagnostic scope, depth of training, and understanding of both the biological and psychological underpinnings of mental illness. The infrastructure isn’t impossible. it just requires the will to build it.
The Field Is Shrinking (and We’re Letting It Happen)
Psychologists are being outpaced in every direction. Social workers are doing therapy. Psychotherapists are doing therapy. Even occupational therapists are doing therapy. And many of them are excellent at it! Our silence around what we could offer on top of one-on-one therapy is costing us our place in the mental health ecosystem.
This isn’t just about professional identity or job protection. It’s about stepping up during a mental health crisis that’s overwhelming our systems and leaving too many people behind. Psychologists are uniquely trained to assess, diagnose, conceptualize, and treat complex mental health conditions, and yet we’re not using those skills to their full potential. Why? Because we’ve been boxed into doing the same therapy as everyone else—just with more debt and more years of school behind us.
Meanwhile, the public is desperate for better care. Waitlists for psychiatrists stretch months (sometimes years). Family doctors are expected to manage mental health with 10-minute check-ins and minimal training. And evidence-based treatments often get lost in the noise of trendy modalities and slick marketing.
This is where we come in. We have a responsibility—not just to ourselves, but to the public—to do more. To speak up. To lead. To integrate what we know into systems that desperately need it. Expanding our scope isn’t about professional ego. It’s about public health.
If we want to protect the future of our profession, we need to act now.
We need to differentiate ourselves, not just in rhetoric, but in scope.
We need to fight for prescriptive authority; not to become mini-psychiatrists, but to offer something better: a hybrid, science-informed, psychologically grounded model of care.
Where Do We Start?
I know there are barriers. Regulatory hurdles. Funding questions. Training logistics. But the first step is raising our voices.
Let this be a rallying cry: to the Ontario Psychological Association, to our peers, to the students we’re training—our profession has more to offer than we’re currently allowed to give. Let’s fix that.
Let’s stop disappearing into the crowd. Let’s lead.
If you’re a fellow psychologist who feels this too—reach out. Let’s collaborate, consult, or just brainstorm how we can move this profession forward together.
Dr. Jenn Bossio is a Clinical and Health Psychologist, the founder and director of the Tri Health Clinic—Ontario’s largest sex and couples therapy practice—and a passionate advocate for system-level change in mental health care. Based in Kingston, she was named Business Person of the Year (2025) and recognized as one of the Top 40 Under 40 (2024). Jenn is committed to redefining the role of psychologists in a rapidly evolving health care landscape.
Read my recent blog posts:
by jennbossio | Jul 9, 2025 | Therapy
Recently, I wrote a blog post in response to the CPBAO’s proposed changes to registration standards for psychologists in Ontario. These changes, brought to light by the Ontario Psychological Association (OPA), include potentially removing the doctoral requirement for psychologists and eliminating the four-year supervision requirement for psychological associates. The proposals appear to be aimed at improving access, addressing workforce shortages, and responding to interprovincial mobility concerns.
When I posted about this on LinkedIn, I didn’t expect the level of traction it received. The response was pretty incredible. It’s heartening to see how many people care deeply about the future of our profession and the integrity of psychological services. But I was also surprised—genuinely—by some of the responses.
A number of commenters enthusiastically agreed with the proposed changes, especially those who are already registered psychotherapists (RPs) or psychologists from other provinces. Their argument? That they shouldn’t have to re-do a Master’s degree or repeat training to become registered as a C.Psych. in Ontario.
I understand where that frustration comes from, but I was left scratching my head because that argument completely misses the point.
Why Do You Want to Be a Psychologist?
The question isn’t how hard it is to become a psychologist. The question is: why do you want to become one? And what are you going to do with it?
If your goal is to do excellent therapy, you already have so many relatively low barrier options! Registered Psychotherapist, Social Worker, even Nurse Psychotherapist. These professionals are delivering vital, life-changing care across Ontario every day. They are not “less than.” In fact, they form the backbone of our mental health system. They can open private practices, charge what they believe their services are worth, and deliver evidence-based care.
So if you’re seeking to become a psychologist purely to have more letters after your name, to charge more, or because of perceived prestige, I’d argue that’s a misalignment. Clients don’t generally understand the difference between a psychologist, psychotherapist, or psychiatrist anyway. The public is not walking around saying, “I need a psychologist.” They’re saying, “I need help.”
So if you want to become a psychologist, are you actually planning to practice like one?
Because what differentiates psychologists is not just the volume of our training, it’s what that training qualifies us to do. We are meant to be the providers who:
- Offer comprehensive treatment planning
- Handle diagnostic complexity
- Supervise other clinicians
- Lead teams
- And, I would argue, provide prescriptions, with proper training, to alleviate the immense pressure on family physicians and psychiatrists (but I’ll say more on that in a moment)
Instead, many psychologists in private practice do the exact same work as every other therapist in the province. Excellent therapy, no question, but not differentiated. That’s not a problem in and of itself, but it does create a blurry professional identity.
Which brings me to this: the system needs a reimagining.
We should be taking cues from the dental model. Think:
- Psychotherapists = Dental hygienists: they provide the bulk of patient-facing care.
- Psychologists = Dentists: they diagnose, supervise, oversee, and intervene when needed.
This doesn’t devalue anyone. It clarifies roles. It makes sure everyone is practicing at the top of their training.
And right now? We’re not doing that.
We’re seeing more and more people wanting to become psychologists—but fewer people asking what the system actually needs psychologists to be.
So here are my questions, and I genuinely mean them as an invitation for reflection, not criticism:
- Why do you want to become a psychologist?
- Are you planning to use the full scope of what psychologist training enables you to do? And if so, how?
- And most importantly: how is our College—and our professional association—working to help us define and differentiate the role of psychologists in Ontario’s already saturated mental health marketplace?
Because if we don’t define it, we’ll continue to drift. And eventually, we’ll become indistinguishable. In a field where we already require thousands of hours of training, we should be demanding more clarity, not less.
A Cautionary Tale: When Psychologists Don’t Differentiate
In a hospital setting I worked in years ago, I witnessed firsthand what happens when psychologists refuse to differentiate themselves.
We were working with a highly complex patient population. Exactly the kind of clinical setting that calls for psychologist-level training: complex assessment, diagnostic clarification, treatment planning, and supervising interdisciplinary care. I suggested that the psychologists prioritize the most challenging cases, handle diagnostic clarification, and coordinate care across the broader team.
Instead, they insisted on running group therapy—a service already being delivered beautifully by other therapists on the team. The psychologists seemed to believe that their extra years of education made them better at the same work. But they weren’t offering anything different. They weren’t leveraging their training to fill a unique role, like taking on the more complex cases, coordinate care across the team, or using their research skills to monitor patient outcomes. That could have been the contribution that set our profession apart. Instead, they buried themselves within the team hierarchy, inadvertently sowing tension and diminishing the value of their scope.
Instead, they doubled down on trying to out-therapist the therapists, as though having more years of education made them better at delivering the same services. It didn’t. It just created confusion, tension, and, frankly, resentment. It damaged the team dynamic and, worse, set our profession back in the eyes of our colleagues.
Psychologists are not just therapists with more training. We are trained to take on different responsibilities. When we don’t do that, we create redundancy, confusion, and frustration—both within teams and across the system.
It’s Worst in Private Practice
This lack of differentiation is even worse in private practice. Across Ontario, psychologists are largely working in isolation, doing therapy that’s often indistinguishable from what RPs, social workers, and other providers are offering. We’re rarely conducting diagnostic assessments. We’re not embedded in health care teams. We’re not coordinating care across providers. We’re just…doing therapy. And while that therapy may be excellent, it doesn’t reflect the full scope—or justify the extended training—of our profession.
As a result, we’re losing relevance in a saturated marketplace. Clients don’t understand the difference. Physicians don’t know when or why to refer to us. We are slowly but surely shrinking our role in the bigger picture of health care—and hurting the system’s potential for integrated, evidence-based mental health care in the process.
If we want to remain essential, we need to stop blending in. We need to lead.
It’s Time to Reimagine the Mental Health System
This isn’t just about who does what—it’s about designing a system that works. Right now, Ontario’s mental health care system is full of dedicated professionals. But it lacks a clear structure for how those professionals work together.
As I said above, we need a dentist-style model:
Psychotherapists and Social Workers = the hygienists and dental assistants: they provide the vast majority of care and do it well.
Psychologists = the dentists: they diagnose, supervise, create treatment plans, and step in when advanced intervention is needed.
This doesn’t mean one role is better than the other. It means each role is practiced at the top of its scope—with clear coordination and leadership.
And here’s my big-picture argument: psychologists should be leading this structural change.
Why I Think Prescription Rights Are the Future
If we’re serious about solving the mental health crisis, we have to face a tough truth: therapy alone isn’t always enough. The research is clear—combined treatment with therapy and medication yields the best outcomes for many disorders.
Right now, the only people with prescribing authority are family physicians and psychiatrists—both of whom are overworked and inaccessible. Psychologists, with our diagnostic training and clinical knowledge, are the obvious next step in expanding access to medication responsibly.
This already exists in multiple U.S. jurisdictions and is well-supported by research. But we can’t credibly fight for prescribing rights if we’re simultaneously lowering the training bar.
You can’t argue you’re ready to prescribe while also arguing that you shouldn’t need additional education to join the profession. That’s just not how credibility works.
What Needs to Happen Now
If we want psychology to have a meaningful role in the future of mental health care, we need to do more than maintain the current standards—we need to clarify and expand them.
We need to protect the depth and rigor of psychologist training.
We need to position psychologists in system-level leadership roles.
We need to prepare the profession for scope expansion, including prescribing rights.
And yes—we need to contact the CPBAO, the OPA, and our MPPs to advocate for a system that uses every professional to their fullest potential.
Let’s make sure psychologist training isn’t watered down or misused. Let’s make sure it means something.
If you haven’t already, contact:
The CPBAO: info@cpbao.ca
The Ontario Psychological Association: membership@psych.on.ca
Your MPP: https://www.ola.org/en/members/current
Dr. Jenn Bossio is a Clinical and Health Psychologist, the founder and director of the Tri Health Clinic—Ontario’s largest sex and couples therapy practice—and a passionate advocate for system-level change in mental health care. Based in Kingston, she was named Business Person of the Year (2025) and recognized as one of the Top 40 Under 40 (2024). Jenn is committed to redefining the role of psychologists in a rapidly evolving health care landscape.
by jennbossio | Jul 7, 2025 | Advocacy, Therapy, Training
As a clinical psychologist, clinic director, and lifelong advocate for evidence-based care, I want to sound the alarm on a concerning development in our profession. The Ontario Psychological Association (OPA) recently sent out a message to its members about proposed changes by our regulatory college that could profoundly reshape what it means to be a psychologist in this province.
Below is the full message from the OPA Board of Directors:
IMPORTANT MESSAGE TO MEMBERS FROM THE OPA BOARD OF DIRECTORS
We are writing to inform members about a proposal we recently became aware of under consideration by the College of Psychologists and Behaviour Analysts of Ontario (CPBAO). This proposal, which was brought to our attention in May, has reportedly been passed by the CBPAO council and recommends a revision of the educational and training standards required for registration as psychologists and psychological associates in Ontario.
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By way of background, the Office of the Fairness Commissioner (OFC), which oversees registration practices for regulated professions in Ontario, rated the CPBAO as ‘medium to high risk’ in its 2022 and 2024 assessments. The most recent report cited concerns related to frequent appeals to the Health Professions Appeal and Review Board (HPARB), labour market shortages, and the under-representation of racialized individuals among PhD registrants. Recommendations included more flexible pathways for internationally trained psychologists and regular review of HPARB outcomes.
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We understand that the CPBAO proposal outlines several potential changes aimed at addressing the concerns raised by the Office of the Fairness Commissioner (OFC), which may include:
- Changes to program accreditation standards,
- The removal of the doctoral standard for psychology,
- The removal of the 4-year period of supervision required for registration among psychological associates.
We acknowledge the OFC’s concerns and understand the government’s emphasis on improving interprovincial mobility. Differences in registration requirements across provinces, coupled with Canada’s Free Trade Agreement, have created challenges including a rise in professionals with varied titles, training, and qualifications. This variation has led to public confusion and underscores the need for greater consistency and alignment across the profession.
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The OPA is committed to discussing the identified issues with key stakeholders to further understand and advance appropriate alternatives. We recognize the need to expand the psychological workforce and address the Fairness Commissioner’s concerns, however we believe there are more thoughtful and effective ways to do so, without increasing confusion or compromising the safety of psychological services to Ontario residents. We are also committed to fair and inclusive access to psychology training and are proud of the progress underway. We believe there is a path forward for retaining standards, addressing OFC’s concerns and maintaining the integrity of the profession.
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Simply revising or removing standards will not appropriately address challenges related to diversity, access, or the costs associated with mental health care; rather, it risks eliminating safeguards that protect Ontarians, while significantly eroding our professional reputation as experts in the field of mental health assessment and treatment. Like physicians and nurse practitioners, psychologists and psychological associates hold the protected act of diagnosis and require training that reflects this responsibility.
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Since becoming aware of this proposal, we have been actively engaged in clarifying the facts, conducting outreach with key stakeholders, and developing materials to support the maintenance of the current appropriate registration standards. We are pleased to share that our advocacy efforts have facilitated meaningful connections and dialogue with stakeholders similarly devoted to upholding the overarching registration standards for psychology in Ontario. At the same time, we recognize that continued vigilance and advocacy will be necessary. We remain committed to promoting adherence to best practices in training, education, and supervision to ensure that psychologists in Ontario continue to be recognized for their high standards of competence and professionalism. As discussions around mobility and regulatory modernization continue, it is essential that any changes occur in partnership with key stakeholders, including the OPA. We look forward to continuing this important work.
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Please be assured that we will continue to update the membership.
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The Ontario Psychological Association and the Board of Directors
This proposal passed by the College of Psychologists and Behaviour Analysts of Ontario (CPBAO) has sparked serious concern among Ontario psychologists. As outlined by the Ontario Psychological Association (OPA), the proposed changes could significantly lower the educational and training requirements for registration as a psychologist or psychological associate. These changes may include:
- Removing the doctoral degree requirement for psychologists;
- Eliminating the four-year supervision requirement for psychological associates;
- Altering accreditation standards for training programs.
These proposals appear to be a response to pressure from the Office of the Fairness Commissioner (OFC), which is advocating for increased access to the profession and improved interprovincial mobility. While access and fairness are essential goals, this approach is fundamentally flawed.
There Is No Shortage of Therapists
Let me be blunt: there is no shortage of therapists in Ontario. Since the creation of the College of Registered Psychotherapists in 2015, the mental health landscape has been flooded with competent, hardworking professionals, adding many psychotherapists to the existing field of social workers and nurse psychotherapists. These individuals provide the bulk of mental health services, and they are doing valuable, often life-changing work.
But here’s the reality: none of these professions are authorized to perform the controlled act of diagnosis. Nor do they receive the advanced, in-depth training required to manage complex clinical presentations, supervise other clinicians, or lead interdisciplinary treatment planning. That is the role of the psychologist.
If the goal is to allow easier movement across provinces or create faster pathways to practice, then aspiring professionals already have options. One can obtain a master’s degree and become a psychotherapist with far fewer barriers. The suggestion to dismantle the rigorous standards of psychology in the name of mobility is not only short-sighted—it’s dangerous.
Psychologists Are the Dentists of Mental Health
Think of it like this: in a dental office, you have dental assistants (technicians), dental hygienists (primary care providers), and dentists (diagnostic and treatment leaders). Dental hygienists provide most of the routine care, but it is the dentist who diagnoses, develops treatment plans, and supervises the entire process.
Psychologists play the same supervisory, diagnostic, and consultative role within the mental health system. Our training prepares us to assess the full clinical picture, understand differential diagnoses, supervise and support the work of others, and lead the system in evidence-based care.
To remove these responsibilities—or to water down the standards needed to attain them—is to risk collapsing this entire structure. We would no longer have a class of highly trained clinicians to lead the system forward. We would instead flatten the profession into a sea of generalists with minimal differentiation in training and expertise.
Prescription Rights: The Next Logical Step
Rather than weakening psychology’s entry requirements, we should be expanding our scope of practice to include prescription rights—a logical and evidence-based solution to our mental health crisis.
Research consistently shows that combined treatment using psychotherapy and medication is the most effective intervention for conditions such as depression and anxiety (e.g., Cuijpers et al., 2020; Thase, 2013). Psychologists are already experts in evidence-based psychotherapy. With additional training, they can—and should—become prescribers.
This model is already in place in several U.S. jurisdictions, including New Mexico, Louisiana, and the Department of Defense, where prescribing psychologists have been shown to provide safe, effective, and accessible care (DeNelsky & Garb, 2006).
Currently, however, medication for mental health conditions in Ontario is typically managed by:
- Family physicians, who may lack the time, training, or continuity of care to prescribe appropriately.
- Psychiatrists, who are in such short supply that waitlists can stretch for months or years. When accessed, these appointments often last just five to ten minutes.
In this climate, prescribing psychologists could dramatically improve access, continuity, and treatment quality—especially for patients with complex, treatment-resistant conditions. But this will never happen if we simultaneously reduce the educational requirements for entering the profession.
Granting prescribing rights demands high standards. It requires advanced diagnostic knowledge, pharmacological training, and strong clinical judgment. If we allow psychology to become a low-barrier profession, we are effectively disqualifying ourselves from the very future we should be moving toward.
What We Risk Losing
Lowering entry standards won’t make our system more equitable. It won’t address psychiatric shortages. It won’t improve patient care. Instead, it will:
- Undermine public trust in the title of “psychologist.”
- Confuse patients and referral sources.
- Reduce the profession’s ability to lead, supervise, and innovate.
- Widen the gap between our current scope and the future we should be fighting for.
Ontario needs more highly trained psychologists—not fewer. We need to invest in more doctoral-level training programs, create financial supports for students from underrepresented backgrounds, and expand the career opportunities of psychologists by evolving the scope of practice. That’s how we address workforce shortages without compromising care.
What I’m Doing—and What You Can Do
I’ve already written to my MPP to express my concerns. I urge all of my fellow psychologists, trainees, and clinic directors to do the same. Let your MPP know that these changes are a step in the wrong direction—and that Ontario deserves better.
In the meantime, I will continue to advocate for a system where psychologists are positioned as clinical leaders: experts in diagnosis, treatment, supervision, and—eventually—prescribing.
This is not the time to shrink our profession. This is the time to grow it into what Ontario’s mental health system truly needs.
References:
- Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A. (2020). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. The Lancet Psychiatry, 7(6), 491–505.
- Thase, M. E. (2013). Combining psychotherapy and pharmacotherapy for depression: Psychodynamics, cognitive-behavioral therapy, and the sequence of treatment. Biological Psychiatry, 73(1), 47–53.
- DeNelsky, G. Y., & Garb, H. N. (2006). Prescription privileges for psychologists: A dangerous precedent. Professional Psychology: Research and Practice, 37(2), 219–227.
If you would like a template to email your MPP or help getting involved, don’t hesitate to reach out.
Dr. Jenn Bossio is a Clinical and Health Psychologist, the founder and director of the Tri Health Clinic—Ontario’s largest sex and couples therapy practice—and a passionate advocate for system-level change in mental health care. Based in Kingston, she was named Business Person of the Year (2025) and recognized as one of the Top 40 Under 40 (2024). Jenn is committed to redefining the role of psychologists in a rapidly evolving health care landscape.
Read my recent posts here:
by jennbossio | Jun 27, 2025 | Jobs, Therapy, Training
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.
by jennbossio | May 15, 2025 | Therapy
Let me say the quiet part out loud: consults are a waste of everyone’s time. And worse, they’re hurting access to mental health care.
As a clinical psychologist, a clinic owner, and someone who gives a damn about getting people the help they need when they need it—I’m begging fellow therapists to stop offering free 15-minute consultations. Not just because they’re annoying (which they are), but because they’re actively working against our mission as mental health care providers.
Let’s break it down.
1. Consults delay care. Full stop.
In private practice, one of our greatest strengths is flexibility. No long waitlists. No red tape. We can move fast when people are struggling—which is exactly what they need. But the consult model throws a massive wrench into that process.
You know how this goes. A client reaches out. You offer a consult. They don’t respond for a few days. You send a Calendly link. They’re busy for two weeks. You finally meet. You talk for 15 minutes. Then they might book an intake three weeks later.
That’s a month of waiting. For someone who might be in crisis.
Research is clear: delayed treatment leads to worse outcomes. Symptoms get more entrenched. Motivation drops. Risk increases. Every day someone sits in limbo is a day we’re not doing our job.
Research consistently shows that delays in initiating mental health treatment can exacerbate symptoms and lead to poorer outcomes. A meta-analysis indicated that longer durations of untreated illness are associated with brain changes in individuals with various mental health disorders, emphasizing the importance of early treatment .
📌 Wang, P. S., Berglund, P. A., Olfson, M., & Kessler, R. C. (2004). Delays in initial treatment contact after first onset of a mental disorder. Health services research, 39(2), 393-416.
2. Consults don’t predict fit. They predict performance.
We like to tell ourselves that consults are for “ensuring a good therapeutic fit.” But let’s be honest—what are they really measuring?
Who’s got the best phone voice.
Who seems the friendliest in 15 minutes.
Who can sell themselves as the “right” therapist.
Even worse: consults open the door to unconscious bias. Clients are more likely to choose someone who looks like them, talks like them, or presents in a familiar way—rather than the person who’s actually best equipped to help. This creates a ripple effect that disproportionately impacts therapists from marginalized backgrounds and narrows access to diverse, skilled care.
This isn’t a job interview. It’s therapy. And research doesn’t back up the idea that short consults lead to better outcomes. In fact, most predictors of therapeutic success come after therapy starts—things like early alliance, feeling understood, and session consistency.
If clients want to try out a therapist, they can do that the real way: by booking a first session.
The strength of the therapeutic alliance is a robust predictor of positive treatment outcomes. However, this alliance typically develops over the course of therapy, not during brief initial consultations. A comprehensive review suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcomes, independent of the variety of psychotherapy approaches
📌 Manubens, R. T., Babl, A., Doran, J., Roussos, A., Alalu, N., & Gómez Penedo, J. M. (2023). Alliance negotiation as a predictor of early treatment outcome. Journal of clinical psychology, 79(8), 1740-1751
3. Consults create unrealistic expectations for clients.
We’ve unintentionally trained the public to believe they should shop around with consults. And it’s not their fault—we built this monster.
But here’s the thing: no other healthcare provider does this.
Dentists don’t offer to peak into your mouth for free.
Doctors don’t block off time to pitch themselves.
Optometrists don’t take unpaid phone calls to explain how great they are.
So why are we doing free labour under the guise of client empowerment?
We need to shift the narrative. Educating the public is part of our job. That means being clear that the first therapy session is the consult—a full, billable hour (or two) designed to build connection, explore goals, and decide if we’re a good match. And if we’re not? We refer. We adjust. We support the next step.
But doing unpaid emotional labour as a marketing tool? That’s not it.
Brief consultations can inadvertently allow unconscious biases to influence client choices, potentially leading to preferences based on perceived similarity rather than clinical effectiveness. An experimental study found that racial match influenced perceptions of therapist credibility and working alliance, mediated by perceived similarity
📌Meyer, O., Zane, N., & Cho, Y. I. (2011). Understanding the psychological processes of the racial match effect in Asian Americans. Journal of counseling psychology, 58(3), 335.
4. Intake IS Treatment
Here’s something I tell clients and supervises all the time: an assessment is interventional. It’s not just a formality or a box to check before the “real work” starts. The very act of telling your story—of putting words to your pain, your patterns, your history—is therapeutic.
Why? Because the more we tell our story, the less power it has over us. That’s why the first session can feel so heavy. It’s supposed to. And because it’s hard, it’s also incredibly important.
So yes, there’s a cost to booking a full intake. But it’s a cost that comes with value. You’re not just sampling a vibe—you’re getting real clinical attention, real insight, and real momentum. Even if it turns out the fit isn’t quite right, that session still moves the work forward. And if you have to do more than one intake to find the right person? That’s not a failure. That’s a commitment to getting the care you actually deserve.
Intake isn’t what you do before therapy. Intake is therapy.
5. Consults are bad for business (and burnout).
Let’s talk brass tacks for a second.
Free consultations are unpaid time, often offered by therapists who are already overbooked, under-boundaried, and under-maybe even compensated. For those of us running group practices, free 15-minute consultations also create a cascade of issues—confusion around scheduling, inconsistent onboarding, and unnecessary admin strain.
You know what’s better for everyone? Clear systems. Direct scheduling. Compassionate onboarding policies that trust therapists to assess fit once therapy starts, and trust clients to advocate for themselves if something’s not working.
When you respect your own time, your clients benefit too. Because you’re not resentful, rushed, or stretched too thin to offer the care they came for in the first place.
Here’s the alternative to free consultations
Let’s stop centering consults and start centering access.
What if instead of offering 15-minute calls, we:
- Made it easy to book online.
- Had Intake Coordinators to help guide clients to the best-fitting therapists for their unique needs.
- Had transparent bios and fee info on our websites (why does no one list their fees, already?!).
- Offered first sessions with the explicit framing that they’re about mutual fit.
- Trusted clients to choose again if the match isn’t right.
What if we moved faster? Trusted our clinical skill? Cut out the delay?
The TL;DR
Consults are:
- Unnecessary
- Unsupported by evidence (!!!)
- A scheduling mess
- Bad for business
- Not in service of the client
- Not supportive of therapists
Let’s stop doing them. Let’s build something better.
Want help figuring out a better intake process for your solo or group practice? I consult with clinicians and clinic owners across Ontario. Reach out—I’d love to support your vision.
by jennbossio | Nov 1, 2024 | Consultation, Sexual Health, Therapy, Training
As a clinical psychologist specializing in sex and couples therapy, I’ve seen firsthand how essential thorough assessments are in guiding treatment and achieving successful outcomes. When clients come to us, often grappling with sexual dysfunction or relationship difficulties, there is a natural inclination to focus solely on these immediate concerns. However, without a comprehensive assessment, we might miss underlying mental health issues that profoundly impact their intimate lives and relationships.
Understanding the Bigger Picture
One of the most important aspects of my work is to look beyond the presenting problems. Many times, clients may be struggling with conditions like depression or PTSD, which can significantly affect their sexual health and relationship satisfaction. It’s not uncommon for someone dealing with a mental illness to experience decreased libido, difficulties with arousal, or challenges in maintaining an emotional connection with their partner.
When clients are unaware of these underlying issues, they might feel frustrated that their efforts in couples therapy are not yielding the desired results. “I went to couples therapy for so long, but things haven’t gotten better! We must truly be doomed,” is a sentiment I’ve heard too often. This frustration can lead to a sense of hopelessness, which is why a thorough initial assessment is vital.
The Importance of Diagnosing Mental Health Conditions
Mental health stigma remains a significant barrier to effective treatment. In my practice, I’ve diagnosed individuals with depression or PTSD, and recommended pausing couples therapy to prioritize personal therapy. However, the reaction is often one of disbelief: “You think THIS is depression? This is nothing! ” This reluctance to acknowledge and address their mental health can prevent clients from making the progress they seek in their relationships and sexual lives.
Depression, for instance, is not just about feeling sad. It can manifest as irritability, lack of motivation, and disinterest in previously enjoyed activities, including sex. PTSD can lead to emotional numbness, avoidance behaviors, and hypervigilance, all of which can severely disrupt intimacy and connection with a partner. Addressing these conditions head-on is crucial before, or in tandem with, focusing on sexual and relational issues.
A Bio-Psycho-Social Approach
Assessment is the cornerstone of effective therapy. By identifying and addressing mental health issues early on, we can tailor our therapeutic approach to better meet the needs of our clients. This might mean integrating individual therapy with couples therapy or coordinating care with other healthcare providers to ensure that clients receive comprehensive support.
In practice, this approach has shown me that when clients begin to manage their mental health effectively, improvements in their sex lives and relationships often follow. They start to see the connection between their internal experiences and their external interactions, leading to more sustainable changes.
Personal Reflections
Reflecting on my journey as a psychologist who sees clients and who trains other therapists, I realize how vital it is to advocate for a deeper understanding of mental health within the realm of sex and couples therapy. Mental health stigma not only hinders individual well-being but also impedes the potential for fulfilling and healthy relationships. By fostering a compassionate, open, and non-judgmental space, we can encourage clients to acknowledge and address their mental health needs.
At the Tri Health Clinic, we believe that everyone deserves a fulfilling and healthy sex life and relationship. But achieving this often requires us to look beyond the surface and understand the deeper issues at play. Comprehensive assessments are not just a procedural step; they are a compassionate approach to ensure that our clients receive the most effective and holistic care possible.
A Call to Action
For mental health professionals and clients alike, recognizing the importance of mental health in sex and couples therapy can lead to more effective and satisfying outcomes. If you or someone you know is struggling with these issues, don’t hesitate to seek a thorough assessment and comprehensive treatment. Prioritizing mental health is the first step toward a healthier, more fulfilling intimate life.
Let’s continue to break the stigma and foster an environment where mental health is addressed openly and compassionately, paving the way for better relationships and overall well-being.
