I'm a good therapist and my books are a disaster. How normal is that?
It is extremely normal. Most of the practice owners who reach out to me open with some version of that exact sentence, and almost all of them apologize while they say it. You do not owe me an apology, and you do not owe yourself one either.
Think about the training. Years of graduate coursework, supervised hours, diagnosis, treatment planning, ethics, licensure exams. Somewhere in all of that, nobody sat you down and taught you how to build a chart of accounts or reconcile a merchant deposit. Then you open a practice and get handed a business bank account, a payment processor, an EHR, a software subscription with a hundred settings, and a stack of receipts. That gap is a training gap. It has nothing to do with how good you are in the room with a client.
There is a practical reason it slips too. Clinical work takes everything you have. After a full day of sessions, notes get written because a real person depends on them. The books have nobody sitting across from them waiting, so they wait, and then a few months pass and it starts to feel too big to open.
When someone tells me their books are a disaster, it usually looks like one of a few familiar things. Personal and practice spending mixed in one account. QuickBooks connected in a burst of motivation and never categorized after that. A spreadsheet that stopped in March. Deposits landing in the bank with no record of what they were for. None of that is unusual, and all of it can be sorted out.
I spent more than 15 years as a licensed nurse in mental health, so I know firsthand how consuming the clinical side is. Bookkeeping for mental health professionals is what I do now, on purpose, so clinicians do not have to carry it themselves.
The important part is that getting current is a project with a start and a finish. Catch-up bookkeeping means gathering your statements and access, working through the missing months in order, reconciling every account, and handing you back books you can actually read. From there, steady monthly bookkeeping keeps you from ever repeating the climb, and your records stay ready for whoever prepares your tax return.
If you are behind and tired of thinking about it, book a consultation with me and we will look at what exists and lay out the way forward.
Helping the People Who Help Others
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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
Should my associates be W-2 employees or 1099 contractors?
Classification is not really a preference you get to pick. It turns on how much control the practice has over the associate's work, and associates who see the practice's clients on the practice's schedule often land on the employee side of those tests. The call belongs with employment counsel and your tax professional, and I make sure the books and payroll records match whichever answer is true.
Read answerWhat is a healthy overhead percentage for a practice?
Common guidance puts overhead under roughly 32 percent of revenue for a lean solo practice, with group practices running higher. Treat that as a starting reference to verify, since the number that actually helps you is your own, tracked month after month.
Read answerWhat has to happen before January so contractor 1099s are easy?
Almost everything. Collect a W-9 from every contractor before the first payment, record payments by payee all year long, and review the totals in December. Do that and January is nothing more than paperwork.
Read answerWhat should an addiction counseling practice's books account for?
Separate income by the kind of work behind it, since individual sessions, groups, assessments, and education programs earn very differently for the time and space they use. Your books also need a consistent way to record sliding scale fees, payment plans, and partial payments, plus clear tracking of group revenue and unpaid balances.
Read answerWhat does it actually cost to run a therapy practice?
Established solo practices commonly run somewhere between $1,500 and $5,000 a month in overhead, and lean virtual practices often come in well under that. Those figures move around and are worth verifying. The number that matters most is your own, and your books can tell you exactly what it is.
Read answerWhat's different about bookkeeping for a psychologist who does testing?
Testing behaves like a second business inside the same practice. The engagements run long, the money often arrives on a different schedule than the work, and materials cost real money, so testing revenue and testing costs belong in their own categories.
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