Why Therapists Leave Thousands on the Table (And How to Stop)
- Dec 20, 2025
- 6 min read
Here's an uncomfortable question: How much money would you be making right now if you didn't have beliefs about what therapists are "supposed" to charge? If that number is significantly higher than what you're currently earning, you're not alone—and you're definitely leaving money on the table.
Across Canada, I see therapists with incredible expertise, massive impact, proven results, advanced training, and valuable specializations charging as if they're fresh out of graduate school. They're leaving tens of thousands of dollars on the table annually, not because they lack skill, but because they've internalized the idea that making "too much" money somehow betrays their professional values.
Why do therapists consistently undercharge for their services?
Therapists undercharge because of inherited beliefs that equate profit with exploitation, rooted in patriarchal narratives about helping professions and women's work being undervalued. These money mindset issues—including the martyr narrative, guilt loops, and accessibility traps—create artificial ceilings that have nothing to do with your actual value or expertise.
The solution involves recognizing these limiting beliefs, understanding the difference between revenue and profit, implementing strategic pricing aligned with market rates, and building sustainable profit margins of 30% or higher. Ethical profit isn't the opposite of your purpose—it's what makes your mission sustainable.
Money and profit are probably the touchiest conversations in the therapy world. We need to talk about this far more often than we do, because financial stress empties your cup faster than almost anything else—and you can't pour from an empty cup.
The Money Beliefs Keeping You Stuck
Five Core Beliefs That Limit Your Earning Potential
1. "Therapists Just Don't Get Rich"
This inherited belief sounds like fact, but it's not. The truth? Therapists can absolutely build six- and seven-figure practices. Many don't because they believe they shouldn't. This limiting narrative stops you before you even start.
2. The Guilt Loop: "Profit Means I'm Exploiting Pain"
This belief sounds like: "If I have profit, I'm taking advantage of people's suffering." But here's the reality: you're exchanging valuable expertise, training, and specialization for fair compensation. Your clients aren't traumatized by your fee—they're helped by your skillset.
We often equate fees with ethics, assuming they're somehow connected. They're not. Charging appropriately isn't exploitation—it's recognizing the transformational value you provide.
3. The Martyr Narrative: "Good Helpers Aren't Motivated by Money"
This one sounds noble: "Good helpers should give services for free or do lots of volunteer work." But here's what's really happening beneath the surface: this narrative is rooted in centuries of undervaluing women's work.
The history of volunteerism has always been connected with women. Women's work—including mothering—has never been adequately compensated, creating a cultural assumption that women's labour isn't valuable because there's no compensation for it. It's no coincidence that the therapy field is approximately 90% women and we have significant money issues.
This is patriarchy and sexism woven into the fabric of our profession. A financially secure therapist serves better than a burnt-out or stressed-out one. Your financial wellbeing is essential to your mental health and your ability to serve your community.
4. The Accessibility Trap: "I Should Charge What My Clients Can Afford"
Noble intention, unsustainable outcome. Making decisions about your financial security based entirely on someone else's circumstances isn't a viable business strategy.
Real accessibility means you charge what you're worth and offer sliding scales or scholarship spots where you can genuinely afford to. Undercharging everyone and hoping it works out isn't a plan—it's a path to resentment and burnout.
5. The Growth Myth: "Scaling Will Automatically Fix My Pricing"
Many therapists assume that having a group practice or adding associates will automatically improve their compensation. It doesn't. Having associates actually complicates your money beliefs rather than fixing them.
I've coached numerous group practice owners who are earning less per hour than their associates. Scaling doesn't solve money mindset—it amplifies whatever beliefs you're already holding.
Understanding Canadian-Specific Profit Considerations
Why Your Location and Structure Matter
Provincial regulatory requirements, tax implications, and business structure decisions (sole proprietor versus incorporated) all impact your profit potential. Fee expectations vary significantly by region and province—what works in Toronto differs from rural Manitoba or coastal British Columbia.
You need to understand your specific market, not compare yourself to therapists in completely different regions. Even a $10 fee increase can create thousands of dollars in additional annual revenue.
Revenue Isn't Profit: What You Really Need to Know
The Critical Distinction Most Therapists Miss
Revenue is what comes in. Profit is what you actually keep after expenses. Many therapists focus exclusively on revenue goals without understanding their profit margins and this creates the illusion of success without actual financial security.
You can have a six-figure income without six-figure security if you're not managing profit intentionally. You could have a million-dollar practice, but if you're spending $999,000 annually, you have no profit.
Healthy Profit Margins for Therapy Practices:
Goal: 30% or higher
Reality: Most therapy practices operate at 5-10% profit margins
Calculation: (Revenue minus overhead) divided by revenue
Getting to 30% takes dedication and attention, but it's achievable with strategic planning.
Strategic Pricing: What You Need to Consider
Building a Fee Structure That Actually Works
Your fee structure should reflect your expertise, specialization, training, and the transformational value you provide. Consider these factors:
Your Credentials and Experience: Are you charging entry-level fees with 10+ years of experience and multiple certifications? That's leaving money on the table.
Market Research: What are therapists in your area with similar credentials and specializations charging? If you're significantly below market rate, you're undervaluing yourself.
Your Business Model: Solo practitioners have different pricing considerations than group practice owners with overhead and team management responsibilities.
Your Specialization: Niche expertise commands premium pricing. If you're one of few therapists in your region offering specific treatment modalities, your fees should reflect that specialized knowledge.
The Fee Increase Conversation
How to Raise Your Rates Without Anxiety
Regular fee increases are part of sustainable practice management. Here's how to approach them strategically:
Annual Adjustments: Review your fees yearly, even if you don't increase them every time. This prevents falling too far behind market rates.
Gradual Implementation: You don't need to jump $50 overnight. Plan gradual increases over 12 months if that feels more manageable.
Communication Approach: Announce fee changes 30-60 days in advance. Frame it as an announcement, not an apology. Your language matters: "Effective [date], my fee will be [amount]" rather than "I'm so sorry, but I have to raise my fees."
Existing clients often get grandfather clauses for a transition period, whilst new clients start at the new rate immediately.
The Sliding Scale Question: Finding Your Balance
Creating Sustainable Accessibility
Sliding scales are a personal decision based on your values and financial capacity. If you offer them, here's how to maintain sustainability:
Set a Floor: Establish the absolute lowest fee you can accept and still maintain your practice sustainability. This isn't $20 when your standard rate is $150.
Limit Availability: "I maintain two to three sliding scale spots in my practice" or "I only see sliding scale clients at 10 AM on Tuesdays."
Strategic Scheduling: Use sliding scales to fill time blocks that are harder to book at full rates. Don't offer your high-demand 6 PM spots at reduced fees.
Permission to Say No: Some therapists shouldn't offer sliding scales, and that's completely acceptable. Don't feel pressured if you're not in a position to do so.
Pricing for Group Practice Owners
Your Leadership Has Financial Value
As you move into leadership roles, your fee should increase even if your clinical hours decrease. Why? Your value increases with added responsibility.
Consider these factors:
Price associates appropriately; if they contribute to profit, they should benefit from it
Increase the fees associates charge rather than just adjusting splits
Remember that admin and overhead don't disappear when you scale
Your clinical expertise plus your leadership capacity is worth more than clinical skills alone
Building Long-Term Wealth Beyond Annual Income
Sustainable Profit Metrics to Track
Know your numbers intimately:
Billable hours per week
Average fee per session
Revenue per hour (total revenue divided by billable hours)
Profit margins
Emergency fund (six months of expenses minimum)
Retirement planning (RRSPs, TFSAs, investments)
Quarterly tax planning
Long-term wealth building beyond this year's income
The Truth About Your Value
Your expertise is valuable. Your time is valuable. The impact you have on clients is transformational. When one person improves through therapy, the ripple effect touches their family, relationships, workplace, children, community—everyone.
You deserve compensation that honours that value and allows you to build financial security. This isn't selfish. It's sustainable.
No other industry believes they're selfish for earning appropriate income. Massage therapists don't feel this way. Chiropractors don't. Naturopaths don't. These allied health professionals charge what they're worth without the guilt that pervades our field.
You're leaving money on the table because of beliefs that don't actually serve you. This is your moment to change that.
Ethical profit isn't the opposite of your purpose. It's what makes your mission sustainable. When you're financially secure, everyone benefits.
About The Author
Cecilia Mannella, MSW, RSW, RCC, is a Registered Clinical Counsellor & Registered Social Worker in Abbotsford BC specializing in helping therapists and practice owners build sustainable, profitable practices without burnout. Ready to build a therapy practice that thrives without the hustle? Explore how the Sustainable Practice Framework™ can help you scale strategically while maintaining the clinical excellence and values that matter to you.
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