Navigating Leadership Challenges in the Therapy Practice
Leading a group therapy practice isn’t just about managing the business side of things — it’s about navigating the deeply human work of supporting your team, making decisions with limited data, and staying aligned with your values even when it’s uncomfortable.
As group practice owners, we’re constantly balancing emotional nuance with structural responsibility. We’re hiring, onboarding, managing performance, handling conflict, holding accountability, and still somehow trying to sleep at night.
Here’s what we’ve learned (and are still learning) along the way:
The Evolution of Leadership Style
Most of us didn’t step into leadership fully formed. In the early days, decisions are often driven by fear: fear of losing a good admin, fear of taking on someone else’s workload, fear of rocking the boat.
But over time, something shifts. We stop making decisions just to avoid pain and start making them to build alignment. We learn to stop tolerating “mostly right” because we realize it’s still not right. And we learn to build margin — in our systems, our teams, and ourselves — so that losing one person doesn’t collapse the entire structure.
Difficult Conversations Are a Leadership Skillset
Avoiding hard conversations is a surefire way to create more problems. High-performing but misaligned employees don’t fix themselves — and pretending everything is fine only reinforces the problem.
Whether it’s someone bypassing admin protocols, showing up dismissively in team meetings, or just coasting, clarity is key. And here’s the truth: being clear is being kind. There’s no need for cruelty, but there is a need for courage. If you’ve been rehearsing the same conversation in your head for a week? It’s probably time to have it.
Build a Framework for Making Decisions
One of the biggest shifts in sustainable leadership is creating a consistent process for how you think — not just what you do. Having a decision-making framework helps you avoid the emotional reactivity spiral that can come with tough calls.
Ask yourself:
Is this a stylistic difference, or a values misalignment?
What’s the risk to the team, to the business, to the client experience?
Is this a debrief-after situation, or is it time to step in and lead decisively?
The more transparent and grounded your process is, the easier it becomes to model and communicate to your team.
Accountability Isn’t Antithetical to Kindness
Let’s bust a myth: holding people accountable doesn’t make you a jerk. It makes you a leader. The discomfort that comes with being direct is often what creates long-term safety — because your team knows you’ll tell the truth, even when it’s hard.
It’s not about being punitive. It’s about being honest. And if someone can’t meet expectations despite coaching, support, and structure? Letting them linger is often more harmful to them and the team than helping them exit gracefully.
Insight Without Action Is Just Reflection
You can know something’s wrong. You can feel it. You can even talk about it in supervision or process it with peers. But insight alone doesn’t change your practice. Acting on it does.
If your gut says something is off, pay attention. Document. Ask clarifying questions. Create space for conversation. And then move. The longer you wait, the more you reinforce the misalignment.
Leadership in a therapy practice is nuanced and complex — and you don’t have to do it alone. Inside the Living Practice membership, we dive deep into topics like this every week. From real-life scripts to leadership reflection tools to systems that actually support your team, we’re building a community of people leading with both structure and soul.
🎯 Listen to Tara (and Nicole Brewer) talk all about this topic here.
About the Author
Dr. Tara Vossenkemper is a gently-candid consultant who’s been in the trenches of group practice ownership since 2017. With a hearty blend of depth, irreverence, and a solid dash of humor (or so she hopes), Tara helps practice owners navigate the can-be-messy process of hiring, culture-building, vision generating, people-y issues, and all the other things that keep you up at night. When she’s not consulting, she’s probably wrangling her animals or homeschooling her kids—because why not add more chaos to the mix?
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