Ethical Practices: New Therapists and Group Contracts
Picture this: you're fresh out of grad school with a framed license on the wall and a laptop that still smells new. Maybe you’ve been there, perhaps you ARE there now. On your first real leap into private practice, nobody talks about the mountain of contracts and 'splits' waiting for you, or how your shiny idealism collides with capitalism. I remember my first contract negotiation: I thought I was just picking out an office plant, not dissecting the fine print on session expectations or admin support. It’s a strange new freedom, plus a market that seems to get more crowded by the week. So, let’s cut through the noise. Let’s talk candidly about what those contracts actually mean, how to keep your ethics intact, and the red flags no one warns you about.
Private Practice: Chasing Autonomy in a More Competitive Market
You probably entered the mental health field dreaming of autonomy. The flexibility to set your own hours, work from home, and create that perfect work-life balance everyone talks about. And yes, that flexibility is real, but it comes with a catch that nobody prepared you for.
The landscape has shifted dramatically. What used to be a straightforward path into private practice has become competitive, where your clinical skills are just the entry ticket. The real game? Marketing yourself like a business owner, because that's exactly what you are.
The Old Rules Don't Apply Anymore
Remember when therapists could simply create a one-page website, join Psychology Today, and call it a day? Those days are gone. Today's expectations are higher, and economic changes are adding another layer to the mix. You're not just competing with seasoned practitioners anymore; you're up against fresh graduates from programs like Yorkville and other institutions that are graduating mental health therapists at a much faster rate.
The irony? Most therapy programs still don't prepare you for the business realities you'll face. They'll teach you about psychology theory, but don't really explain how to negotiate an independent contractor agreement or what constitutes a fair revenue split. This gap leaves you vulnerable when you're sitting across from a practice owner, trying to decipher contract terms that could define your career trajectory.
The Marketing Reality Check
Today's private practice toolkit needs to include comprehensive marketing strategies. Research shows that marketing and networking are now vital parts of success in private practice, not just optional extras. You need a social media presence, content creation skills, networking abilities, and business acumen that most clinical programs overlook.
This isn't about becoming a marketing guru overnight. It's about understanding that your clinical expertise means nothing if potential clients can't find you or don't understand how you can help them. The therapists who thrive aren't necessarily the most skilled clinically; they're the ones who've learned to communicate their value effectively.
Caseload Expectations: The Hidden Pressure
Here's something they don't tell you upfront: Many private practice contracts include minimum caseload requirements. These typically range from 5 to 15 sessions per week, depending on the practice structure. But here's the thing: these numbers are often negotiable.
The key is asking the right questions. Are these targets or hard requirements? What happens if you can't meet them? Can you negotiate based on your other commitments? Many new therapists accept these terms without question, not realizing they have leverage.
The Flexibility Paradox
You entered private practice seeking work-life balance, but the reality is more complex. Yes, you can set your own schedule, but you also need to fill that schedule with paying clients. The flexibility is real, but it comes with the responsibility of running a business, even if you're working under someone else's practice.
Programs often neglect the business realities, leaving knowledge gaps for new therapists. You'll need to understand tax implications, how to conduct successful consults, client retention strategies, and professional liability issues. These aren't just administrative tasks; they're the foundation of your professional life as a therapist.
The Competition Factor
The mental health field has become increasingly crowded, which is both beneficial and challenging. Good because it means reduced stigma around therapy. Difficult because it means you need to try harder to differentiate yourself in ways that go beyond your degree.
Your clinical skills are your baseline. Your business acumen, marketing savvy, and ability to build genuine connections with referral sources will determine whether you thrive or struggle. The therapists who succeed understand that they're not just mental health professionals; they're entrepreneurs in the helping profession.
This isn't meant to discourage you. It's intended to prepare you for the reality that autonomy in private practice requires more than just hanging up a sign.
Split Decisions: Decoding Fee Agreements, Red Flags, and Ethical Dilemmas
When you're evaluating split agreements in private practice, the numbers on paper don't tell the whole story. That 50/50 split might look reasonable until you realize what you're actually getting, or more importantly, what you're not getting in return.
The Real Cost of Fee Splits
Let's be honest about the math.
"By the time you take 50% off of your hourly rate then you take off your income tax and all that fun stuff you've really got very little left."
This reality hits especially hard for new therapists who are still building their caseloads and learning the ropes.
The problem isn't just the percentage; it's what that percentage represents in your independent contractor agreement. Research shows that comprehensive contracts should clearly outline splits, expectations, administrative support, and supervision. Without this transparency, you're essentially working blind.
Decoding What Support Really Means
A 50/50 split should come with substantial support, but some clinics use buzzwords without delivering substance. Here's what to dig deeper on:
Supervision frequency: Weekly or biweekly supervision is standard for new therapists. If they're offering supervision "once every three months," that's not ethical for a 50/50 split
Team meetings and peer support: Quarterly meetings don't cut it when you're paying half your income for support
Administrative support: Are they handling all billing, scheduling, and client communications, or just some of it?
Professional development: Does the clinic invest in your training and continuing education?
Virtual-Only Clinics: A Major Red Flag
Here's where things get particularly questionable. Some clinics offer 50/50 or 60/40 splits for virtual-only practices with more minimal overhead costs. When there's no real estate, limited admin support, and infrequent supervision, what exactly are you paying for? This represents unclear or one-sided splits that new therapists should approach with caution.
For virtual arrangements, you can expect significantly better fee payment terms, typically around 60/40-70/30 in your favour, unless they're providing exceptional value through training, marketing, or comprehensive support systems.
The Experience Factor
Your contract should evolve as you do. A split might be fair when you're new and need intensive supervision, but what happens later when you're more independent and experienced?
This is why it might be prudent for therapists to negotiate progression clauses upfront. Ask directly: "If I don't need supervision anymore, and we aren't getting peer support/marketing support, etc., will you reduce the split?" Many clinics may not be accustomed to this conversation; however, it doesn't mean it shouldn't be happening.
Ethical Framework vs. Business Model
There's an inherent tension between professional ethics and profit-driven business models. Some clinics prioritize building "seven-figure practices" at the expense of fair compensation for their therapists. This creates an unsustainable cycle; therapists leave when they realize they have more experience and don't need to give up half their hourly rate, forcing clinics to constantly recruit new talent. This, in the long run, isn't really helpful to the latter either.
An ethical framework should guide these arrangements. Fair splits reflect the actual support provided, not just market positioning or what the clinic would like to be making in profit.
Questions You Must Ask
Before signing any agreement, get specific answers to these questions:
What does my split include, and what additional costs am I responsible for?
How often will I receive supervision, and is it included in the split? Is peer support included, and if so, how frequently?
What administrative support is provided, and what tasks remain my responsibility?
Are there minimum caseloads, and how are referrals allocated? If I don't meet this expectation by the time allotted, what will happen? What help will I receive in meeting this expectation in terms of marketing support?
How will the split adjust as I gain experience and require less supervision? If I bring clients to the practice, will I gain a break in the split, as I am bringing more clients to the practice?
Finding the Sweet Spot
Caseloads, Client Fit, and the Art of Saying No (Without Guilt)
When it comes to caseload policy in private practice, the numbers can feel overwhelming at first glance. Most contracts include minimum caseload clauses ranging from 5 to 15 sessions per week, with 8 to 15 being the most common range. But here's what many mental health therapists don't realize: these numbers are often negotiable, and you should absolutely advocate for what works for your situation.
The reality is that caseload expectations vary dramatically between practices, and there's no regulatory standard keeping things consistent. Some forward-thinking practices recognize that therapists often juggle multiple gigs, as this is often needed to obtain a full caseload these days. Maybe you're building your own practice while working part-time elsewhere.
The Art of Negotiation: Questions You Must Ask
Before you sign anything, dig deeper into what those caseload numbers actually mean. Are they targets you should aim for, or hard requirements that could get you penalized? This distinction matters more than you might think. Caseload expectations are diverse and should be openly discussed rather than accepted blindly.
You also need to understand what support the practice offers to help you reach those targets. Are they providing marketing support? Do they have established referral sources from doctors' offices and other networking opportunities? If a practice expects you to maintain 12 sessions per week but offers zero marketing assistance, that's a red flag worth noting in your private practice toolkit.
The Reality Check: Building Takes Time
Here's some real talk that might ease your mind: building a full caseload takes longer than you think, especially in today's economic climate. Lack of OHIP coverage also makes building a caseload slower and more competitive, and many therapists put unnecessary pressure on themselves, thinking they're doing something wrong if their calendar isn't packed immediately.
The market reality is that while there are plenty of therapists available, the issue isn't a lack of need; it's accessibility. People need therapy, but unlike medical doctors who are covered by OHIP, therapy often comes out of pocket. This economic factor significantly impacts how quickly newer therapists can build their practice.
Additionally, it’s also tough out there. New therapists are coming out of school with a lot of debt, and then often have to pay $1000s in specific therapy modalities after the fact. So, the need to cover these and other costs, while trying to live and pay their bills, is a big stressor. As a result, finding it slower than expected to build a caseload can cause new therapists to panic and be more prone to signing contracts with group practices, feeling like they have no other option but to agree to the first offer they receive. I hope this will be avoided by raising awareness.
Client Fit: Where Ethics Meet Business Sense
This is where things get serious from both an ethical and practical standpoint. Client fit and the ability to say no are critical to ethical practice, and this should be contractually protected. Unfortunately, some practices treat therapists like interchangeable parts, shuffling referrals without regard to expertise or training.
Consider this scenario: you're handed a client with severe OCD, but you have no specialized training in evidence-based OCD treatment. This isn't just uncomfortable; it's potentially harmful to the client and puts you in an ethically compromising position. For example:
If a therapist finds themselves in a situation where they work a 60/40 split with no marketing support, no clinical meetings, and no training opportunities, all while being expected to take on cases outside their area of expertise. This combination should raise immediate concerns about the practice's approach to ethics and professional development.
Your Rights as an Independent Contractor
The CRPO's primary concern is public protection, which means they care about competent care delivery. When practices assign clients to therapists without providing them with the necessary training or expertise, it crosses the ethical lines that regulatory bodies take seriously. Your client information consent process should include clear communication about your areas of specialization and competence.
Your autonomy as an independent contractor exists for a reason. You should be able to decline referrals that fall outside your expertise without fear of retaliation. This isn't about being picky; it's about maintaining professional standards and ensuring clients receive appropriate care.
Remember, if you're bringing clients to the practice through your own referral sources, there should also be room for negotiation on splits.
In Summary, don’t rush to sign the first contract you’re offered. Know your worth, notice red flags (especially in splits and expectations), and ask the questions that nobody is typically thinking of. Your ethics, peace of mind, and work-life balance are worth it. At the end of the day, you're an independent contractor, not an employee.
If you’re a new therapist and need support, please reach out to me at charlottelaws.rp@gmail.com. I also offer periodic webinars on this topic in more depth, so please follow me on Instagram @charlotte.laws.rp for upcoming dates.
