How To Start and Scale a Successful Group Therapy Practice

October 2, 2023   |   Mental Health Professionals

Industry leader shares where to start and what to avoid.

Since 2012 when Maureen Werrbach, LCPC, opened her group practice in Chicago, she’s added over 60 employees and multiple locations. She’s learned a few things in that time and today, she helps other therapists go from solo provider to group practice owner. Through her platform, Group Practice Exchange, she shares the advice, templates and tools she wishes she had when she started.

Together, with a few newer group practice owners, who are still in the trenches of getting started, Werrbach offers what practice owners need to know in those early days of getting started and a few mistakes to avoid. 

Take cues from your mission and vision.

Just because you’re getting more referrals than you can handle, doesn’t mean it’s time to start a group practice. Werrbach has seen many providers hire another therapist because their patient caseload is full. This kind of accidental group practice can fall apart when the owner doesn’t consider the practice mission. Start a group practice because that’s what you ultimately want. Otherwise, you should just refer those extra cases outside your practice.

Start small.

Starting a group practice takes time that most practicing therapists don’t have. Werrbach likes to joke that for most people, the right time to start a new group practice will always feel a little off. “It’s not like any of us have this abundance of blank time to say, this is when I can use my time to start a group practice.”

Instead, Werrbach recommends taking small steps that add up to significant action. For example, build a job description. “If you take one micro step at a time, then a few months down the line you’ll be able to bring on that first employee,” she says.

Take care of the back office business.

Before hiring another therapist, it’s important to have an accountant and bookkeeper to get your books in order and help you project how much you can pay someone. 

An employment attorney can help you identify issues around hiring contractors vs. employees and help you determine what benefits you might be required to offer in your state. Werrbach says, “Consider where you want your practice to be and not where you are right now.”

Outsourcing these administrative parts of your business will save you valuable time. Kelsey Esser, group practice owner and therapist in Columbia, Missouri, says, “You need to be strategic in what you as the owner do with your time. Any task you do for your practice has to be financially and mentally worthwhile.”

Set up standard operating procedures (SOPs)

Start preparing for your group practice by getting all the information out of your head and onto documents or a digital platform that others can implement. Nichole Coyne, LCSW-QS, owner of Higher Ground Wellness in Florida says, “Being organized removes mistakes and helps your team have clarity. Without it, you’ll be asked ongoing questions all the time.”

Identify your ideal clinician.

Many first-time managers make the mistake of hiring based on personality. Building a job description and determining who to hire can help you avoid this.

Consider some of the following:

  • Do you want a single niche or multi-specialty practice?
  • Do you want them to have a specific type of license?
  • Do you want them to work with specific populations?
  • Do you want them to work certain days of the week or hours? 
  • Do you want them to have previous private practice experience?
  • Do you want provisionally licensed therapists you can train under your specific therapy model?
  • Do you want people who are fully licensed and need less hand-holding?

Prioritize self-growth as a leader and business owner. 

The hardest part of owning a group practice is managing people, says Werrbach. There are many resources for growing the business, like those in The Group Practice Exchange. But you can’t easily replicate how to lead and navigate difficult conversations. “Every practice owner is going to have clinicians who are unhappy or who engage in behaviors that upset you. Being able to communicate and manage those issues effectively is likely to be the biggest hurdle you face,” she says.

To develop your leadership, communication and management skills, Werrbach recommends reading. She tries to read at least one a month. Here are two that have been instrumental for her:

Mistakes to avoid when transitioning to a new group practice

In addition to the tips for starting a new group practice, Werrbach has made her share of mistakes and seen the clinicians she coaches make them too. Mistakes are inevitable, but some are worth avoiding.

Overcompensating new employees.

Most people want to be generous with new employees, so it’s no surprise that overcompensating new hires is the most common mistake Werrbach sees group practice owners make. 

It’s hard to gauge actual costs until your new hire starts working for a few months. Sick days, vacation days and benefits all add up.

“When you hire people, you need to make sure you allow yourself enough room for profit,” says Werrback. “If you pay at the top or overpay, it makes it hard to have enough money in the bank to make payroll on top of any additional benefits your state might require.”

It’s much easier to increase pay in the future than figure out how to walk back on overcompensation.

Offering too many benefits

It’s easy to see all the benefits larger companies offer and want to provide similar packages. Don’t underestimate the cost of that, though, warns Werrbach. 

It’s better to start by offering 1-2 benefits you feel are most valuable to you and your business. Then wait at least six months before offering additional ones.

Hands-off management

Many new practice owners unintentionally start out as hands-off managers, says Werrbach. They tend to have fewer rules and expectations because they think it will be easier. Instead, the lack of structure leads to a lack of accountability. It can even mean there won’t be enough profit for the practice to survive.

“Adding more structure later can lead to resentment, so start exercising that leadership muscle from the beginning,” she says. 

Werrbach has coached thousands of clinicians in building successful group practices. Whether you join a group like The Group Practice Exchange or learn from free online resources, getting support from those who have experience makes the transition from solo provider to group practice owner much smoother.


Maureen Werrbach, LCPC, is owner of Urban Wellness – a multi-location group practice in the Chicago area, and founder of The Group Practice Exchange. Her ultimate goal is to help group practice owners learn how to successfully start and scale their businesses to have a bigger impact on their communities.

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