The Ups and Downs of Practice Ownership
The Ups and Downs of Practice Ownership
By Laura Kietell, DQCS
Licensed Clinical Social Worker | Owner, Thrive Counseling Services
When people tell me they dream of owning their own counseling practice, I usually smile and say, “There are days when it’s the best job in the world, and days when I wonder what on earth was I thinking.”
Practice ownership is often viewed from the outside as freedom. You set your own schedule. You make the decisions. You build the culture. You answer to no one. Well… mostly.
The truth is that owning a private practice is a lot like riding a roller coaster. The highs can be incredible. The lows can leave you questioning every decision you’ve made. Most days fall somewhere in between.
The Ups
Creating the Culture You Believe In
One of the greatest rewards of ownership is creating a workplace that reflects your values.
When I started Thrive Counseling Services, I wanted clients to feel like they were walking into a living room rather than a medical office. I wanted clinicians to feel supported rather than micromanaged. I wanted a place where people could be authentic.
As an owner, I get to make those decisions.
If I want slippers in the office, we can have slippers in the office. If I want a therapy dog curled up beside me during sessions, that’s my choice. If I want to prioritize client care over maximizing profit, I can do that too.
Watching Others Grow
There is something deeply rewarding about watching interns and new clinicians develop confidence. You remember what it felt like to sit in that chair for the first time, wondering if you knew enough to help anyone. Years later, seeing someone you’ve supervised become a competent, confident clinician is one of the most satisfying parts of the job.
The Flexibility
Practice ownership offers flexibility that many traditional jobs do not. Need to attend a horse show? Want to take a day off for camping? Need time to work on a book, grant application, or new project? While owners don’t necessarily work less, we often have more control over how we structure our time.
The Downs
The Buck Stops With You
When something goes wrong, there is no supervisor’s office to walk into. You are the supervisor.
You are the HR department. You are the compliance officer. You are the problem solver. If payroll is due, that’s your responsibility. If the internet goes down, that’s your responsibility.
If a clinician quits unexpectedly, that’s your responsibility. And if a complaint arrives in your inbox on a Friday afternoon, that’s your responsibility too.
Everyone Thinks They Know How You Should Run Your Business
One of the more surprising aspects of ownership is how many people will offer opinions about how you should run your practice. Current employees. Former employees. Consultants. Insurance companies. Licensing boards. Family. Friends. People who have never owned a business. Sometimes the advice is helpful. Sometimes it is not. Learning to listen without allowing every opinion to derail your direction is an important skill for owners.
The Emotional Weight
Many practice owners care deeply about both their clients and their staff. That means decisions often carry emotional weight. You worry about your clinicians. You worry about your clients.
You worry about whether you’re making the right decision. You worry about finances. You worry about growth. You worry about regulations changing. And occasionally, you worry about all of those things before breakfast.
Success Can Feel Lonely
This is something that isn’t discussed often. As a practice owner, there are times when you have no peers inside your organization. Your clinicians have colleagues. Your staff have coworkers.
But when difficult decisions need to be made, ownership can feel surprisingly lonely. Many owners discover they need outside support systems—consultation groups, trusted colleagues, mentors, or fellow business owners who understand the unique challenges of leadership.
What I’ve Learned
After years of ownership, I’ve learned that running a practice is not about perfection. You will make mistakes. You will occasionally trust the wrong person. You will implement policies that need revision. You will have days when you wonder if everyone else knows something you don’t.
Then you’ll have a day where a client succeeds, a clinician grows, a grant gets approved, or a problem finally resolves itself, and you’ll remember why you started.
Practice ownership is not easy. It is not always fun. It is not nearly as glamorous as some people imagine. But for those of us who love building something meaningful, it can also be one of the most rewarding journeys we ever take.
The secret is understanding that both the ups and the downs are part of the job. You don’t get one without the other.
About the Author
Laura Kietell, MSW, LCSW, DQCS, is the owner of Thrive Counseling Services in Cheyenne, Wyoming. She works with individuals and couples across the lifespan and provides clinical supervision for therapists working toward independent licensure. Her approach emphasizes steady, grounded care and creating a space where clients can slow down, feel understood, and make meaningful changes.
