Lessons from the Leap: Reflections on Ownership, Identity, and “Doing it the Hard Way”
CCP’s Practice Owner Nicole Rea, LCSW, on a solo trip in Cortez, Colorado in February 2023
Have you ever wondered what it would be like to transition from being an independently contracted mental health clinician to owning and running your own psychotherapy private practice? In February 2022, I took the leap and did just that. Here's some of what I've learned along the way.
CCP Practice Owners past & present together at a June 2022 BBQ shortly after the ownership transition
HOW IT STARTED
In late December of 2019, I mustered the courage to inform the then Manager and Owner of CCP, the small private practice where I worked full-time, that I was planning to leave.
Despite being a psychotherapist at the practice for nearly four years at that time providing regular weekly and bi-weekly individual and couple's psychotherapy sessions to clients I loved, the inconsistent pay, lack of tangible benefits, and high self-employment tax burden of being an independent contractor had been causing stress and negatively impacting my mental health, basically since I first started the job, and I knew it was time for a change.
My updated résumé in hand, I imagined returning to a community agency, university, or hospital setting where I hoped to benefit from the increased external structure, more consistent/salaried pay, and access to additional resources that my 1099 role at a sole proprietorship/LLC simply hadn’t been affording me.
Much to my surprise, in response to this news the Practice Owner asked if, instead of quitting, I had considered taking over her role and running this practice, the practice she had created more than 12 years prior, instead. Well, um. Huh. No…I had not.
…I had not.
She told me that she was interested in retiring soon and had already started looking at properties in Florida with her husband. Both of them were eager to escape the harsh Chicago winters and live out a well-earned Jimmy Buffett golden age fantasy in the Sunshine State. Having been born and raised in Florida myself, I understood the appeal. She said she thought I was a good candidate for her job and revealed that she had already been considering reaching out to me to discuss the opportunity before I approached her with the news that I would soon be leaving.
Standing beside her in our small Oak Park office, my head began to spin as she casually continued introducing this monumental and unforeseen possibility in an excited and upbeat tone. We managed just a brief, 5-minute-or-so discussion before the red light on the wall beside me suddenly lit up, indicating that my next client was in our lobby waiting.
Trying my best to put my "therapist hat" back on, I struggled to push aside the swirling thoughts and emotions evoked by this unexpected offer and focus solely on my client for the next 55-minutes straight. Needless to say, with the undeniable mental weight of such sudden new future possibilities dropped upon me and demanding mentally and emotionally to be dealt with, this was a challenge.
Initially, I was flattered to even be considered for this type of responsibility. I wasn’t yet five years out of graduate school, and in my mind at the time, any kind of practice ownership—even if this simply meant one day starting my own practice—felt like a faraway endeavor.
I’d yet to even begin the process of researching what sort of requirements and responsibilities such an undertaking might require. Taking over an existing, established practice was definitely not something I had thought about doing, but the fact that the previous owner, who had also been my mentor, supervisor, manager, and friend for several years, thought that I could handle it was a surprising and motivating endorsement. Whether or not I accepted the offer, I began to realize that, for better or worse, I was developing a new estimation of myself and my potential abilities in the “business world.”
I began talking with friends, family, and my own therapist about the possibility of accepting her offer. Then, less than three months into the introduction of this discussion, Covid-19 hit and the world came crashing down.
CCP’s 2020 “Holiday Party” - held virtually via an online escape room
Thankfully, the practice and our therapists were privileged to be able to make a relatively quick transition to run entirely via remote tele-therapy (a normal enough reality for therapists now, but at the time, a nearly unimaginable pivot).
Talk of my manager’s retirement stymied as we collectively wondered if the practice could even sustain itself virtually as well as how on earth both ourselves and our clients would ever adjust to this bizarre and isolating “new normal.” To address my previously voiced concerns around financial stress and plans to leave, I was offered a newly created position as “Assistant Practice Manager,” which I gratefully accepted given the circumstances.
After about a year in this role, when it finally became clear that the world would somehow continue spinning after all, our practice ownership transfer talks resumed. Still trying to process 99.9% of the grief and trauma of everything that was occurring during that time, it took me several months of stress, excitement, tears, panic attacks, and going fully and completely back and forth on what I thought felt “best” before finally arriving at a decision.
During this time, I resumed talks with friends and family members and did my best to “run the numbers” with the little information I had available to me. I consulted with a variety of lawyers and accountants, with some telling me it would be crazy to take the deal as it was so clearly a bad idea, and others saying it would be crazy not to take the deal as it was such an obviously great and generous offer.
With my head spinning and reality feeling overall pretty objectively unreal, I finally decided to take the leap in late 2021. I said yes and agreed to take over the practice, to be effective February 2nd, 2022.
Welcome table for the CCP Ravenswood office Open House, November 2024
As a complete business novice, I found the next few months of contract negotiations to be brutal and was immediately overwhelmed by the whirlwind of numerous legal and financial requirements for transferring ownership on state and federal levels as well as for assuming full management and day-to-day practical responsibility of the practice.
With no formal business training, I made sure to be transparent about my inexperience from the start, and thus began engaging in a trial-by-fire crash course in federal and state regulations, as well as legal, clinical, and ethical considerations for running and operating an existing group psychotherapy practice in the city of Chicago and the state of Illinois.
Simultaneously, I began speaking with other clinicians at the practice in an attempt to take the temperature of the room, worried that they might not even decide to stick around post-transition, potentially causing the endeavor to fall apart before it even got off the ground.
Fortunately, all but one therapist chose to stay. So in fits and gasps and starts and false starts, we somehow inched ahead, and 100% practice ownership and management officially moved into my hands upon the previous owner’s retirement in February 2022. I was both grateful for and humbled by the opportunity and the trust placed in me as the new team leader.
And while, even then, I anticipated continued difficulties and a steep learning curve ahead, I couldn't have yet imagined just how steep, slippery, and challenging the road was actually going to be.
A steep and icy climb ahead, photographed above the Cliff House in Cortez, Colorado in February 2023
WHAT I’VE LEARNED
A few months into the initial ownership transition, I attended a film event where a friend, known for asking thought-provoking questions, inquired about what I had learned about myself since taking the practice’s reins. I considered the question seriously for a moment and frustratingly found myself without a clear answer. I realized I’d been so focused on my crash course in “learning the ropes” externally and navigating the complex world of small business and healthcare management, that I’d neglected to reflect on my own personal lessons and growth. My friend graciously let it go, but the question lingered in my mind.
Now, more than three years later, after witnessing the practice’s entire original clinical team transition on to other ventures and navigating the hiring and onboarding of a completely new team; surviving an unprecedented, nationwide, healthcare cyberattack that interrupted our ability to bill or collect payment for services; and having managed a transition back to in-person/hybrid sessions from being 100% teletherapy in the wake of an ongoing pandemic while also handling multiple office location closings and openings, an unexpected but necessary major transition in the practice’s various legal and financial structures, and a new office build-out that I’m still working to fully pay off—not to mention weathering a wide variety of other unexpected challenges that have pushed us repeatedly and even still to the brink of bankruptcy—I believe I might finally have some answers.
Lesson #1
Double Check the Foundation Before You Start to Build
Looking back now, there are so many things I wish I’d known to learn before I agreed to take over the practice. I wish that I had known where to look, or what to look for, to ensure that things were set up correctly and running smoothly. I wish that finding help in business under capitalism wasn’t so expensive and soul-crushing. The reality is, we don’t know what we don’t know, and there is no way around some learning curves except through experience and the inevitable mistakes that experience demands.
Though I entered into practice ownership aware of several key areas that I either thought I wanted to intentionally change or continue from the way things were run previously, there were inevitably also some key aspects I wish I had been better informed about from the very start, including:
Choosing the Optimal Business Structure: When I first took over, the practice was organized as an LLC/sole proprietorship. Based on the advice of multiple accountants, I’ve since made the change to S-Corp, and also updated our status to PLLC to comply with state regulations specific to Illinois. This is one area where inheriting a practice was less advantageous than starting my own, as this is a consideration I would have had time to intentionally plan for and determine ahead of time (prior to starting the business) if I were making my own choices and creating things from scratch.
Determining Employment Classification: As I’ve navigated the complexities of practice ownership, I’ve discovered that the choice between hiring independent contractors versus employees has significant implications for both the business and its team members. My informed decision to transition some of our therapists from independent contractors (1099) to employees (W2) in early 2024 stemmed from a variety of legal recommendations, ethical concerns, and personal convictions. However, this change also placed a substantial financial strain on the practice that we were simply not prepared for at the time.
As I’ve learned, it's essential to understand the distinctions between these classifications and how they impact worker compensation, benefits, and overall working conditions, especially in a specialized and highly regulated field like providing psychotherapy as a group of licensed clinicians.
While I found it hypocritical to expect my team members to continue to accept the same working conditions I had previously come to reject due to the stress of the inconsistent pay and lack of benefits, I can honestly say that I understand now why 1099 contracting continues to be so popular in the world of mental health, despite its drawbacks. We are not paid enough. There is a real scarcity issue in mental health compensation, even in more traditionally “resourced” fields like private practice. But more on this soon.
I continue to find it disheartening how prioritizing the holistic and material well-being of team members is so often discouraged in our capitalist society. Especially in the field of “mental healthcare,” this seems to me to be both ironic and sad.Becoming More Financially and Legally Literate: As evidenced above, gaining a strong understanding of financial management and legal considerations is vital for the success of any small business or psychotherapy practice. About a year or so into running the practice, and before the eventual decision to begin offering W2 employment for the first time in the practice’s history, I created this Financial Wellness for Independent Contractors presentation (linked here) for my team in an attempt to support them in benefiting from some of what I had to learn the hard way.
Some additional areas that I wish I’d had more time to familiarize myself with before taking over include small business budgeting, billing requirements, managing revenue streams, and health insurance credentialing. As small business owners, familiarizing ourselves with local and industry-specific regulations in these areas is so important to ensure compliance, minimize potential risks, and protect both ourselves and our team members. That being said, it is a LOT to try to learn, especially in conjunction with keeping up with our other ownership and management responsibilities as well as our own clinical caseloads. Truthfully, had I known just how much I DIDN’T know before stepping into an ownership role, I likely would never have made the move at all.
Lesson #2
It Takes a Village to Wear All These Hats
In 2021, shortly before taking over the practice at the age of 35, I received an adult Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis. After learning more about the disorder while working with a client, I initially sought my own testing due to concerns about my ability to handle the demands of owning and running a small business in addition to continuing my work as a therapist, a parent, and just overall, a human person in the wake of Covid’s onset and capitalism’s inevitable but fiery decline.
While having a name for my experiences and beginning treatment in this area definitely helped in a number of ways, I continued to find myself struggling with task avoidance, particularly regarding things that felt “boring” or tedious to my dopamine-deficient brain.
I learned that my baseline executive functioning skills left something to be desired, and that it takes me a tremendous amount of pointed energy and effort to force myself to tackle and complete some necessary managerial and administrative duties on a regular basis—invariably resulting in future “crash” when I do finally work up the focus and concentration needed. Inevitably, I've made many mistakes in various aspects of the business, particularly in these areas that don't come as naturally to me.
However, through these fumbles, it’s also become clear to me that for a small business to thrive (regardless of the owner’s specific neurotype), there are so many complex and varied necessary tasks involved that it truly takes a village of committed and collaborative-minded others to make things work. It is not a solo endeavor.
In my experience so far, running a small business has required adapting to be able to wear numerous simultaneous hats, including but not limited to: office manager, customer service manager, HR manager, administrative and clinical supervisor, practice scheduler, office janitor, interior decorator, carpenter, IT department, marketing manager, graphic and web designer, SEO expert, insurance expert, billing manager, accountant, and CEO (just to name a few).
While most people would find this level of responsibility challenging, for my ADHD brain, it's become increasingly difficult to manage. On top of this, when I’ve attempted to outsource tasks to experts or rely on team members to help get things done collaboratively, the cost continues to drive up business expenses in an already existing environment of financial uncertainty and scarcity. I wish that I had devoted more time earlier on to developing this village, building the necessary resources to support it, and doling out hats with more foresight and intentionality.
Thankfully, “getting” to try on and experiment with so many varied hats has had the plus side of allowing me to identify and practice more in areas that I’ve really genuinely grown to enjoy, such as creative and relational work. I still love my work with clients more than ever, and have been grateful to expand my practice to include new modalities and populations over the past few years. I now know for certain that, regardless of what happens with the business moving forward, this type of connective healing is the work I’m meant to do.
An additional unexpected delight of the past three years (though not without its own unique and ongoing stressors) was the process of getting to design and establish CCP’s new Ravenswood office location. I spent a full month transforming the previously empty space into a warm and inviting environment for our clients and therapists, carrying furniture up and down a flight of stairs, hauling out trash, cleaning and painting, envisioning color schemes, assembling bookcases, and carting in books and art from home, allowing me to explore my creativity and craft a physical representation of the practice's values.
Ultimately, (re)discovering my passion for creative and relational work has been enlightening, giving me the confidence to focus on my strengths and seek support in areas where I struggle. Learning to accept that it truly takes a community to serve a community (and that community care is where it’s at!) is one of the lessons I am most deeply grateful for today.
Lesson #3
Community Building Under Capitalism is Hard Work
Throughout my journey as a small business owner, I've discovered that my strengths as a “good person” or “good therapist” do NOT automatically translate to being a proficient capitalist or “good business woman.” In fact, these qualities often seem to explicitly conflict with the complicated demands of running any kind of business in today's economy, but especially in the field of mental health.
I’ve learned that building a village is both necessary and expensive. There are not only the relational demands and challenges—transitioning from a peer, friend, or co-worker to being "the boss" has been a steep learning curve, and learning not to take it personally when therapists choose to leave despite caring about and investing in them has been hard.
Then, there are the material and financial challenges. For example, I believe that providing for the basic needs of staff, clinicians, and clients in our offices—such as access to clean water, snacks, Wi-Fi, printing supplies, and other necessary resources —is a fundamental aspect of creating a safe and supportive environment for mental health care. Unfortunately, investing in these “essential” elements might help with relationship building but does not yield significant financial returns, and is as such pretty much actively discouraged by current societal and economic systems.
The flaws in reimbursement methods for traditional mental health and talk therapy are also major and undoubtedly exacerbate these issues. Therapists are either at the mercy of insurance providers' whims and priorities (Google: “clawbacks” or “mental health insurance reimbursement rates”) or we’re forced to place an undue financial burden either on ourselves or on our clients. This delicate balancing act between ethical practice and financial stability is personally taxing, and for me at least, I’ve found myself in a near-constant state of survival mode/existential panic over the last three years that has impacted my own health and relationships in a way that is not healthy or sustainable. (Despite the fact that one of the reasons I agreed to take this position was the promise of finally being able to exit such a survival-based state.)
It sucks, and is difficult, to be responsible for a team of therapists when it materially doesn’t feel possible to adequately reimburse their hard work or provide them the benefits that they want and deserve, all because care work is not financially valued by our culture at large.
Recognizing these inherent flaws in the mental healthcare sector is a crucial first step towards improving (or knocking over and rebuilding) the existing systems. The current options present significant challenges for both therapists and clients alike, compromising the effectiveness of therapy and the overall well-being of practitioners. This negatively impacts (and not by accident) our ability to connect, build sustainable and supportive communities, and collectivize our power. As such, it is a serious issue that needs more attention, awareness, and resources on the national level.
Lesson #4:
Candor Really Is the Greatest Shield Apart from Privacy
Throughout the ups and downs of the last three years, I’ve experienced several deep bouts of clinical depression related directly to the challenges I was facing with the business. It is very complicated to, on the one hand, feel so very deeply proud and grateful and astonished and in awe of everything that has been handed to me and everything that I have worked so genuinely hard to accomplish, while on the other hand simultaneously recognizing how deeply and repeatedly I have failed, am failing, and feeling, at times, like this defines me as an overwhelming and objective failure. (I “know” that it does not.)
A big part of what has helped through this struggle is taking my own advice and giving myself permission to be more open with those around me about my struggles.
Ironically, as a trained mental health therapist, actually talking about my own issues with others does not come as easy to me. Being vulnerable and revealing imperfections as a leader, with the responsibility of ensuring the well-being of my team, clients, and the business, is understandably terrifying and something I actively fought against for some time (as if by showing people the messy reality of my experience I would somehow be letting them, or myself, down). But, as I have gradually allowed myself to be more open (including even through the writing of this post!), I've continued to realize the relieving power of transparency.
As terrifying as it is, I have continued to find time and time again that being candid about the reality of my experiences and the challenges or limitations I am facing has saved me. By sharing my journey, I've found support from others and fostered a culture of trust and understanding within my family and team.
In hindsight, I wish I had embraced this approach earlier. Allowing myself to be vulnerable and honest about my challenges has not only helped me manage the stress of running a business but has also deepened my connections with others.
Enjoying a cookie with my mom, age 4-ish?
Lesson #5 (BONUS LESSON):
As It Turns Out, My Mom Was Right
And finally, in response to the question asked by my friend about more personal awareness and learning now so many years ago: I’ve learned, painfully, obnoxiously, delightedly… that my mother was right. Allow me to elaborate.
When I came out as a queer, bi, poly person as an adult in my early 30s, my mom’s response was perfect (so perfect, in fact, that it's since been validated innumerously by countless enthusiastic responses from strangers and friends alike on social media and dating apps). “So,” she replied to my anxious, over-typed email disclosure directed at both her and my father, “You’ve never done things the easy way. Why start now?” At the time I found this hilarious. And in time, her words have continued to strike a chord, resonating in a way only a mother’s wisdom can.
For me, this has meant in part that I continue to do things in what feels to me to be the “right” way (as per the at times mysterious workings of my neurodivergent mind), instead of just skating by on the bare minimum or conforming to societal standards and expectations for the sake of fitting in.
It’s also meant that, despite decades now of attending my own therapy, processing and healing my own trauma and learning and practicing invaluable coping skills and tools that I’m now so grateful to pass on to my clients, my default reaction in times of stress or crisis is still to internalize, minimize, and pretend that everything is okay. This has led me to at times disregard the lessons above in favor of “trying to figure it out on my own” due to “feeling embarrassed” and “not wanting to burden anyone.”
Doing something challenging alone is almost always “doing it the hard way.”
What I have to remind myself, over and over, including right now, today, is that it’s okay that my default way of being or doing things is different than those around me—and that sometimes, this can even be a strength. I just have to remind myself that I have the choice to do things one way or another, the choice to ask for help or to do it alone.
Now, when it feels like “I don’t have a choice” about something, I know this to be a yellow flag, warning me to slow down and reflect. While the “easy way” may, at times, feel intolerable and untenable, it’s important to remember that there is no one “obvious and correct choice” in how to handle something. And it is always okay and often beneficial and necessary to ask for help.
WHERE WE’RE HEADED NEXT
CCP Team & Families, 2022
Over the past 3+ years, I've navigated a range of emotions, from feeling like an imposter in the early days to grappling with depression, overwhelm, burnout, and longing for the “simplicity” of the past. These experiences have taught me the importance of resilience and self-compassion, ultimately guiding me through the ups and downs of my journey so far.
I don’t regret taking the job, but I’ve also learned that I probably shouldn’t have. There were simply too many unknowns and not enough time to educate myself on everything that would have been necessary to start the job meaningfully prepared. And it’s not only that I’ve come to wonder if I’m a “bad” business person throughout this experience, but that I’ve come to wonder more generally if the entire model of for-profit healthcare is too flawed to be able to ethically exist.
As we approach the end of June 2025, the world remains uncertain, with instability in our country, economy, and world at large leading things, in many ways, to feel less stable than ever before. Even and especially here, reflecting on my journey as a creative, therapist, and business owner, I am grateful for the lessons learned, knowing they have shaped me into the person I am today.
I’ve also learned how important it is to recognize that being a “business owner” is just one small part of my story. Whether it's diving deeper into interior design, pursuing more writing opportunities, or focusing on my role as a parent as my son transitions into high school, I'm open and excited to explore new paths and passions. I look forward to eagerly embracing the growth and connection opportunities ahead.
As I look toward the future with gratitude, curiosity, and a commitment to personal growth, I invite you to join me on this journey.
Together, I believe we can continue to learn, adapt, and create a healthier culture and community where mental health support is both more accessible and less paywalled/stigmatized, ultimately benefiting everyone—clients and therapists alike.
There are so many ways you can help support CCP moving forward. Please feel free to reach out to me directly at nicole@ccptherapists.com or 708.996.0699 moving forward with any suggestions or ideas! 💐
If you are able and would like to contribute to CCP’s mission financially, please visit the donation page on our website here: https://www.ccptherapists.com/donate
Thank you for reading! 🫶🏼