On Selling Out

I have practice-building clients who deal with immense guilt when they leave the under served population with whom they’ve been working.

Maybe they don’t like the day to day realities of working in the methadone clinic or community mental health agency, but they feel badly leaving because some of their clients are really working hard and making great progress.

Unfortunately, these practice-builders are burned out from dealing with lots of systems, unclear or overly rigid rules and high turnover rates in their jobs.

Sometimes they are also struggling with low compliance and high no show rates on top of the bureaucratic BS. I’ve heard stories of denied vacation time, decreased pay and abusive bosses. I’ve experienced some of those things myself. Being a therapist is difficult and when you don’t have systems that support you, it can be untenable.

For those of you exploring the idea of private practice currently in these agencies, I dedicate this blog post to you. Thank you for doing the work you do and please know that there are others who will fill your shoes once you’ve moved on to the much easier world of private practice.

Off the Path

In my MSW program, there was some unchecked shaming. If I had followed the path encouraged by faculty and adopted by many of my peers, I would be doing macro-level work with communities in need.

Incidentally, I would probably suck at this work because I can work myself into a `this-isn’t-right’ tizzy while waiting for very slow systemic progress. I would probably become a pretty toxic person in that environment. Toxic people don’t make great changes from the inside, FYI.

In my program, the mention of private practice or even clinical social work was met with disdain and discussion about “the worried well.” Unless you were planning to work with folks in the CPS or DJJ system, then it was okay.

Here’s what programs like mine didn’t seem to get: helping the woman addicted to crack who wants to be a good mother to her kids and get a job that sustains her family isn’t any better than helping the depressed stay-at-home mom whose husband is an executive. Both these women are deserving of support, love and a beautiful life as she defines it.

The under served woman has fewer resources and fewer options by far. The woman with more resources can probably go to whomever she wants once she gives herself permission to seek help. These women may be a best fit with different therapists. That is okay. That doesn’t make one therapist good and the other bad. Neither therapist is more virtuous. Neither therapist is more competent.

Burned Out?

If you are in an agency and you’re burned out, you aren’t doing your best work. You don’t have to feel guilty about that; it’s a professional hazard that happens to every single one of us in our career.

You don’t have to stay burned out. It doesn’t serve you, your clients or the system. We make up excuses because when we’re burned out, it can be difficult to get motivated to change. That’s okay. Hang out in the contemplative stage for a while. You’ll get where you need to be.

For your consideration: A burned out therapist who resents the system because s/he has been in it too long is probably less effective than the eager new grad who wants to make a difference.

Despite the fact that it requires wearing so many hats, working with the under served is often seen as “entry level” in our profession. Some of us hang out in these jobs because they are comfortable enough or because we are scared. That’s not choosing your population; that’s settling for them. No one wants to feel like you’re settling for them. Your clients don’t deserve that.

If your ideal client is a part of the under served population, explore ways to serve them outside of the bureaucracy that makes you miserable. Look into grants, see if you can accept Medicaid as a solo provider or if you need to contract with an agency. Maybe volunteer with this population instead.

One practice-builder is doing community gardening in an under served neighborhood which feeds her soul in a few different ways. Just see what’s out there. Not out of guilt, out of love. If these are your people, work with them in a way that works for you. If these are not your people, make room for the providers who want to work with them.

This article was adapted from blog post published on the Abundance Practice-Building Blog.

Woman feeling burned out photo available from Shutterstock

On Selling Out

Allison Puryear, LCSW, CEDS

Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different cities and wants you to know that building a private practice is shockingly doable when you have a plan and support. You can download a free checklist to make sure you have your ducks in a row here. Get in on the conversation in the Abundance Practice-Builders Facebook Group.


APA Reference
Puryear, A. (2015). On Selling Out. Psych Central. Retrieved on October 27, 2020, from


Scientifically Reviewed
Last updated: 18 Jul 2015
Last reviewed: By John M. Grohol, Psy.D. on 18 Jul 2015
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