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NOTES FROM THE EDITOR

Reality Check 2025

This week I had an impromptu coffee chat with my friend Andrea from Liquid Cents Bookkeeping.

We both work with therapists in private practice, so naturally, we ended up talking about the industry and some of the changes we’ve been seeing in 2025.

Both Andrea and I noticed a dip in private pay leads for our clients over the past year. Today, I want to share what I’m seeing with you too.

But first, let me say:
If you’ve seen a drop in private pay leads, you are not alone.
This is the market reacting to what’s happening outside of it.

Here are my three main observations:

1. The "White Collar Recession" is real.
   It's not a widely talked about topic, but we've been in the midst of a "white collar recession" for over a year. A 2024 Vanguard report showed that hiring for employees earning over $96,000 has fallen to its lowest level since 2014. That means the pool of people who can comfortably invest in private-pay therapy has shrunk.
   ​
2. The post-COVID therapy boom is over.​
   During COVID, therapy demand skyrocketed and many practices filled up without much marketing.
   But that era is over.
   Today, practices need real ​marketing infrastructure​ in place to generate leads consistently. Unfortunately, many practice owners haven’t made that adjustment yet.
   ​
3. AI is changing traffic and SEO.
   The rise of no-click search results (and AI-driven browsing) means a lot of therapy websites are seeing big drops in traffic and fewer appointment bookings as a result.

I also posted about this topic on LinkedIn recently, and got even more insights: competition, oversaturation, and mental health tech companies with giant marketing budgets are also squeezing the market.

Despite this, I'm still very optimistic about your ability to attract private pay clients. Here's why:

This is not the time to give up on private pay clients altogether.
Yes, having insurance clients can help your cashflow and it's a good source of revenue. But if you want more freedom in the future, keep on networking, learning about marketing, and get into the habit of working on consistently generating new leads.

Want to share your perspective on private pay?

Just hit reply, I'd love to hear from you!

📰 And now to the news!

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NOTEWORTHY

Higher Diagnoses For Publicly Insured Kids

A new study found a sharp rise in mental health diagnoses among children with public insurance.

BUSINESS AND PRIVATE PRACTICE

An AI Question That Misses The Point

Instead of fearing replacement, this article argues therapists should focus on how AI can complement human care.

It’s a smart take that aligns with the idea of using tech to enhance your work, not compete with it.

INDUSTRY NEWS

The Global Decline In Youth Mental Health

A major global study shows worsening mental health trends among young people.

If your practice serves teens, young adults, or families, this data reinforces the urgent need for skilled human-centered care.

FINAL THOUGHTS

The market is tougher — but you are tougher.
Stay visible. Stay consistent. Stay human.

Private pay isn't dead.
It's just evolving. And so can you.

See you next week,

Avivit