Bookkeeping and payroll for mental health professionals in private practice

Call or Text: (661) 646-9745

How do I know if my session fee is too low?

The market range is worth knowing, so here it is. Private-pay session fees commonly land somewhere around $100 to $200, and specialty work such as psychological testing, forensic evaluation, or prescriber visits often runs higher. Those figures shift with your region, your license, and your niche, and they change over time, so treat them as a starting point you verify in your own market.

Knowing the range still leaves your question open, because a fee that is fine for one practice is thin for another. What decides it is what your practice costs to run, what you need the practice to pay you, and how many sessions a week you can hold without burning out.

Start with your own numbers. Add up a full twelve months of practice expenses, including rent or home office costs, your EHR and other subscriptions, liability insurance, license renewals, CEs, consultation, bank and card processing fees, and professional help. Then decide what you need the practice to pay you over the year, before whatever you set aside for taxes, which is a conversation for your tax preparer. Add those two figures together and divide by the number of sessions you can realistically deliver in a year. Twenty-five sessions a week across forty-six working weeks comes to roughly 1,150 sessions. The result is your floor per session, and anything above it is breathing room.

Now compare that floor to what you actually collect rather than what you charge. Divide collected revenue for a month or a quarter by the number of sessions you truly delivered. Sliding-scale slots, late cancels, no-shows, and processing fees all pull the average under your posted rate, and it is common for the real average to sit noticeably below the number on your website. Private practice bookkeeping exists to surface exactly that gap.

The trap I see most is setting fees by what colleagues charge. Your colleague may have a paid-off office, a spouse carrying the insurance, a smaller caseload, or costs nothing like yours. Their number tells you about their practice. Yours has to cover yours.

Keeping the arithmetic honest is what full-service bookkeeping gives you every month. Real expense totals, real collected revenue, and a clear view of your average per session, so you are deciding from facts instead of a feeling.

The fee decision belongs to you. My job is making sure the numbers underneath it are true. If you would like to walk through what your practice actually costs and actually collects, book a consultation with me and we will look at it together.

Helping the People Who Help Others

Let's Start With
a Short Conversation

Tell me where your books stand right now, even if the honest answer is that nobody has looked at them in a year. I'll ask a few questions and give you a clear idea of how I can help.

More Questions

What's the difference between catch-up and clean-up bookkeeping?

Catch-up is for books that were never done, meaning months or years with nothing recorded. Clean-up is for books that exist but cannot be trusted because things are miscategorized, unreconciled, or duplicated. Both end the same way, with accurate current books and a monthly rhythm going forward.

Read answer

What kind of practice fits AD Keeps The Books best?

Mental health practices with one to about ten people, anywhere in the country. Solo therapists, psychologists, LCSWs, addiction counselors, psychiatric nurse practitioners, group practices, telehealth practices, and ABA providers. If you want your books current and a bookkeeper who already speaks your language, you're the fit.

Read answer

How do I know if my group practice actually makes money on each clinician?

Take what each clinician actually collected, subtract everything you pay them, then subtract a fair share of overhead. What is left is what that seat contributes. Run it person by person, because a practice-wide margin can look fine while one seat quietly loses money.

Read answer

I've been running my practice through my personal checking account. How do I untangle it?

This is the most common thing practice owners tell me, and it is completely fixable. The fix has two parts, opening dedicated business accounts for everything going forward, and sorting the historical mix so the practice's real activity gets recorded properly.

Read answer

I'm a good therapist and my books are a disaster. How normal is that?

It is extremely normal. Clinicians spend years training for the work in the room and almost no time learning bookkeeping, so the money side is usually the part that slips. Catch-up work has a clear beginning and a clear end, and it says nothing about your skill as a clinician.

Read answer

What do you deliberately not do?

Four things stay outside my scope. Tax return preparation, insurance billing and credentialing, payroll system setup, and clinical or legal advice. Naming those lines up front means everything inside them gets my full attention.

Read answer

AD Keeps The Books is Aretha Dirden, a bookkeeper who spent more than 15 years as a licensed nurse in mental health before taking over the books for the people doing that work. She handles monthly bookkeeping, catch-up and clean-up work, and payroll for therapists, psychologists, counselors, and clinical social workers in private practice, and she does the work herself for every client. Based in Lancaster, California, serving practices nationwide. QuickBooks ProAdvisor certified.

  • Intuit ProAdvisor Gold badge
  • Intuit ProAdvisor QuickBooks Level 2 Certified badge
  • Intuit ProAdvisor QuickBooks Payroll Certified badge

© 2026 AD Keeps The Books LLC