How to Choose Between Going Solo or Starting a Group Practice

By Lisa Reidsema, LMHC • Craft Your Practice™

At some point in private practice, most therapists find themselves sitting with a version of the same question. The caseload is full, referrals keep arriving, and turning people away has started to feel less like a boundary and more like a loss. The idea of a group practice surfaces, sometimes as a whisper and sometimes as something more insistent, and suddenly the decision that felt abstract becomes immediate.

It is worth thinking through carefully, not because there is a wrong answer, but because the two models are not simply different sizes of the same thing. They are different jobs, and the therapist who chooses well is the one who is honest about which job she actually wants.

What Solo Practice Actually Involves

A solo practice means you are the practice, in every sense. Every clinical decision, every administrative task, every policy, every client relationship runs through you, and that concentration of responsibility is simultaneously the model's greatest strength and its most significant constraint.

The strength is control, which in practice means something more specific than it sounds in the abstract. It means you design the schedule before anyone else has a claim on it, set the fees based on your own income floor rather than on what a larger system requires, choose your clients according to your clinical judgment and your own sense of fit, and make operational decisions without consulting anyone or waiting for consensus. When your life demands a pivot, you can make it, and you can make it quickly.

The constraint is capacity, which is equally specific. Your revenue is tied to your hours, and your hours have a ceiling that no amount of ambition can raise. When you are sick or traveling or simply depleted, the practice pauses with you. Growth beyond a certain point requires either raising fees, which has its own ceiling, or adding people, which changes the model entirely.

For many therapists, that ceiling is not a problem worth solving. A well-designed solo practice with a thoughtfully managed caseload and appropriate fees generates a genuinely good income and a workload that can be sustained over a career. The ceiling only becomes a constraint worth addressing if your goals require exceeding it, and not every therapist's goals do.

What Group Practice Actually Involves

A group practice means that you are no longer functioning primarily as a clinician, even if you continue to carry your own caseload. You are also an employer, a supervisor, a manager, and the person who is ultimately responsible for the financial and operational health of a system that other people depend on for their livelihoods, and that responsibility is heavier and more complex than most therapists anticipate before they take it on.

The work expands to include hiring and onboarding, clinical supervision with its attendant liability, payroll and benefits administration, conflict resolution among staff, and the ongoing maintenance of an operational infrastructure that can support multiple clinicians working simultaneously. You carry legal and ethical responsibility for the clinical work of people who are not you. You manage relationships that are more layered and more consequential than anything in solo practice.

The upside is real and worth naming honestly. A group practice can extend your clinical reach far beyond what you could accomplish alone, create mentorship and community that solo practice rarely offers, and generate revenue that is not directly tied to your own session count. For therapists who are genuinely energized by leadership, by building systems, by the particular satisfaction of watching colleagues develop, the group model can be deeply rewarding in ways that solo practice is not.

For therapists who entered the field because they love direct client work, who find administrative complexity draining rather than engaging, and who derive their professional satisfaction from the intimacy of the therapeutic relationship rather than from the work of building and running an organization, the group model frequently produces the opposite of what they hoped for, and the realization tends to arrive after the infrastructure is already in place.

The Question That Clarifies Everything

The most useful question is not which model generates more revenue, though that is worth modeling honestly before any decision is made. The most clarifying question is this: do you want to practice therapy, or do you also want to manage therapists?

Both are legitimate and valuable answers, and neither is more ambitious or more admirable than the other. The problem arises when therapists build a group practice because growth feels like the obvious or expected next step, without honestly accounting for whether they want the job that comes with it. A group practice is not a larger solo practice. It is a different role, requiring different skills, different tolerances, and a different relationship to the work than most therapists developed in clinical training.

Timing and Season Are Part of the Answer

The right answer to the solo versus group question is also not fixed across a career, and recognizing that can reduce some of the pressure the decision carries. A therapist with young children and limited administrative bandwidth may find that solo practice fits this season of her life completely, and revisit the group question when circumstances have shifted. A therapist who is energized by building and leading may move toward a group model earlier and find that it suits her throughout her career. Another therapist may build a group, discover that the management demands have pulled her too far from the clinical work she loves, and scale back without that being a failure of vision or ambition.

What tends not to work is making the decision based on what the next step is supposed to look like, or on a vague sense that growth is inherently better than stability. The practices that hold up over time, in both models, are the ones built around what the therapist actually wants her professional life to feel like, not around an abstract idea of what success requires.

If You Are Seriously Considering the Group Model

If the question has moved from hypothetical to immediate, a few things are worth working through before you commit. Do you understand the supervision requirements your state imposes on group practice owners? Have you modeled the finances honestly, including the real costs of employment, the ramp-up period before associates are generating consistent revenue, and the overhead that comes with supporting additional clinicians? Do you have a clear picture of the clinical culture you want to create and maintain? Do you have the administrative infrastructure, or the plan to build it, that the model requires?

These are not arguments against the decision. They are the questions that make it an informed one rather than an impulsive one, and the therapists who have done that thinking tend to build group practices that are more functional and more satisfying than those who move quickly and figure it out as they go.

If you are working through the earlier decisions of practice building, Launch Lab, Course 1: Private Practice Foundations, covers the structural foundations that any model requires. If you are further along and thinking about growth and expansion, Build and Grow Your Practice, Course 3, addresses that stage directly. craftyourpractice.com/launch and craftyourpractice.com/grow

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