Leadership Evolution for Therapy Practice Owners: From Scarcity to Strategic Growth
- 4 days ago
- 7 min read
When "I Don't Know What I'm Doing" Is Actually Normal
Look, when I started my group practice 17 years ago, I had no idea what I was doing. Like, zero idea. I was full of optimism and spit and vinegar, totally on a mission—but I didn't go to business school, I wasn't an entrepreneur, and I'd never done anything like this before.
Sound familiar?
Here's the thing nobody tells you: starting your practice with no strategy is completely normal. In fact, that passionate, purpose-driven energy is what gets you through those early years when you're basically just making it up as you go.
What Is Leadership Evolution and Why It Actually Matters
Leadership evolution is how you grow through different identity phases as a practice owner. From that passionate-but-strategic-less beginner to an informed, strategic leader. And here's the part that might sting a little: your practice can only grow as much as you're willing to grow as a leader.
The revenue ceiling you're hitting? It's probably not about needing more associates or raising your fees. It's about which phase of leadership you're currently stuck in. When you shift your mindset from scarcity to strategic abundance, your practice follows.
You're Probably in the Scarcity Phase (And That's Okay)
After about five years of running my practice and dealing with associates leaving, putting tons of energy into marketing only to watch it walk out the door, investing in mentorship that didn't pan out. I hit this wall. I moved into what I call the scarcity phase, and I'm not proud of that version of myself.
I started hoarding everything. Knowledge, systems, processes. It all became like top secret. I had this fear that if I shared too much, people would take it from me. And looking back now, I can see it was rooted in childhood poverty stuff, my own personal triggers around not having enough.
It didn't make me a good leader. I made decisions from fear instead of abundance. I behaved in ways that made everything proprietary when it probably shouldn't have been.
The Helper vs. Business Owner Paradox
Here's where it gets really uncomfortable for us: the battle between wanting financial success and feeling guilty about making profit.
I was living in this paradox of having my social work values—generosity, giving back, helping the community—while also wanting to make payroll, employ people, and actually have some profit left over. But there was so much shame and guilt around wanting that "extra." Like somehow wanting profit made me a capitalist pig.
You might be feeling this right now. That discomfort with charging what you're worth. The guilt about making "too much" money as a helper. The fear that business focus will compromise your clinical integrity.
I get it. I lived there for years, and it was miserable.
The Mirror Moment That Changed Everything
What shifted me out of scarcity was honestly kind of brutal. It got mirrored back to me. I was in a business partnership at the time, and my business partner was also living in scarcity. When I saw her behaviour, it hit me: Oh my god, I'm behaving the exact same way.
And I realized this wasn't sustainable. It was not business-wise, but for my heart and my soul. I wanted a sustainable space to be in.
So I made a conscious decision to shift into abundance. I started embracing different perspectives, bringing in more feminist ideology around sharing power and recognizing that making profit doesn't make me a capitalist pig.
Here's what the research actually shows: when women make money, especially through business ownership, the community benefits way more than when men make money. We buy more local, we collaborate, we get involved in nonprofits—we do things that are community-driven and relational.
That reframe changed everything for me.
Next time you're making a fear-based decision, ask yourself: "What would I do if I believed there was enough for everyone?" This simple question can start shifting you from scarcity to abundance.
Stop Outsourcing Everything You Think You're Bad At
Around 2018-2019, after I bought out my business partner, I noticed this pattern: I was outsourcing everything I believed I wasn't good at. I Didn't know how to do websites? Paid someone. Overwhelmed with SEO? Hired it out. Didn't want to spend time on business cards? Delegated it.
And what happened is I lost track of the process. I couldn't see the big picture of my own practice anymore.
So I made this decision that people thought was crazy—I took it all back. Every single thing. And I decided to learn how to do it myself before I would ever outsource it again.
The Question That Levels Up Your Leadership
I had to have a serious intervention with myself: Why was I asking "Who can do this for me?" instead of "How do I learn this?"
Listen, if you have a master's degree, you can learn how to design a business card. You can learn Canva. You can understand how your website backend functions. That's not rocket science compared to grad school, right?
When I took everything back for about a year and learned it all myself, something amazing happened: I could see the entire picture of my practice. I knew where to turn the lever for growth. I became much more informed as a leader.
Nobody understands your practice as much as you do. Nobody knows the purpose that you feel in your heart and soul that drives you to do this work. And when you outsource everything, you're kind of selling yourself short.
Before you outsource your next task, spend two weeks learning the basics yourself. Watch tutorials, play around with it. Then when you do delegate, you'll actually know what "good" looks like and can direct the work strategically.
From Stuck at $500K to Seven Figures
Here's what happened with this shift: we were stuck around $500-600K a year in revenue for a while. But when I stepped into that strategic leadership role knowing the entire thing, having my fingers in all the pieces—we made a huge leap to seven figures.
It wasn't about having more associates. It wasn't just about increasing fees. It was the leadership that I showed up with.
I started hiring differently too. Instead of looking for people with all the skills already, I hired for passion and vision and mission—and then trained them. Because skills can be taught through courses and mentorship, but alignment with your values? That's way harder to develop.
Where Are You in Your Leadership Journey?
If you're wondering which phase you're in, here's a quick check:
Passionate Chaos (Years 0-5): You're driven by purpose but learning as you go. Lots of energy, not much strategy yet.
Scarcity Mindset: You're hoarding information, feeling defensive about profit, making fear-based decisions.
Mirror Moment: Something reflects your limiting beliefs back to you. You decide it's time to shift.
Taking Back Control: You're learning your business inside and out before delegating. Getting strategically informed.
Strategic Abundance: You're leading from vision, making confident decisions, and your practice reflects your evolved leadership.
The truth is: you cannot stay the same leader you are today for five years and expect your practice to grow. Your business growth is directly tied to your leadership growth.
Having Grace for Who You Used to Be
Let's be real about something: there will be phases of your leadership that you're not proud of.
Times when you made decisions from fear. Moments when you weren't the leader you wanted to be. Periods when shame drove your pricing or scarcity made you hoard instead of share.
That's not failure. That's part of the process. You kind of have to have those times in leadership to get to the other side where you can learn from what hasn't gone well.
The key is having a ton of grace for who you used to be, while knowing this isn't where you're going to stay.
You Get to Decide What Leadership Looks Like for You
Here's the freedom part: you can run your practice in whatever way you want to. There's no perfect book out there written specifically for therapy practice owners. Trust me, I looked for years.
You decide what your leadership evolution looks like. You decide where you want to go and who you want to be. That's the beauty of business ownership. You're not constrained by anybody else's definition or expectations.
FAQ: Leadership Evolution for Therapy Practice Owners
Q: How do I know which leadership phase I'm in? A: Look at your decision-making. Are you making choices from fear or abundance? Are you hoarding information or sharing openly? Your honest answers will show you where you are.
Q: Is it normal to feel shame about wanting profit? A: Absolutely. This is especially common for women therapists and social workers. That shame is rooted in gendered expectations that weren't designed for business ownership. Profit fuels your mission, it doesn't compromise it.
Q: Should I really learn everything myself before outsourcing? A: Not everything but, understanding the basics of key business functions before delegating gives you strategic oversight. You become a better leader when you know how all the pieces work together.
Q: What if I'm stuck at a revenue ceiling? A: Revenue ceilings are almost always tied to leadership identity, not lack of associates. The ceiling usually breaks when your leadership evolves to the next phase.
Your Practice Is Waiting for You to Evolve
If you're recognizing yourself in any of these phases, especially scarcity, I want you to take a breath. You're exactly where you need to be right now.
Leadership evolution isn't about being perfect. It's about conscious growth. It's about looking in the mirror, seeing where you are, and dreaming about where you want to be.
Your practice can only scale as much as you're willing to evolve as a leader. And the beautiful part? You already have everything you need to make that shift.
Ready to evolve your leadership and scale your therapy practice sustainably? Building a practice that serves your life (not consumes it) starts with one decision: choosing to grow. Let's talk about creating sustainable growth that honors both your purpose and your profit.
Cecilia Mannella is a therapy practice business coach with 25 years of experience as a mental health practitioner and 18+ years building group practices in Canada. After growing her own practice from solo therapist to seven-figure group practice, she helps licensed therapists scale sustainably using the Sustainable Practice Framework™—without sacrificing their values or burning out. Let's talk about creating a practice that serves your life, not consumes it. Book a FREE Consult where we can dive deep into your business.
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