Welcome therapists and group practice owners! I’m Nicole McCance, a psychologist turned business coach for therapists. I scaled my group practice to 55 therapists and multiple 7-figures in just three years, and leadership (without being your team’s “friend”) was one of the hardest roles to step into.
When you move into group practice ownership, your identity starts to change. You’re no longer just a clinician. You’re an employer, a decision maker, and the person setting the tone for the entire practice. Many practice owners feel pressure to lead well, stay human, and keep their team happy, all at the same time. That balance can feel confusing, especially when you genuinely care about the people you work with.
This conversation is about CEO leadership for group practice owners and how to lead with clarity, fairness, and confidence while still being yourself.
P.S. Not a huge fan of reading blogs? (I’m more of a podcast girl myself.) You can listen to my podcast episode all about this topic by clicking here or by watching my YouTube video below!
Why Leadership Feels So Unclear for Group Practice Owners
Most therapists were never taught how to be employers. I know I sure wasn’t!
Graduate school didn’t cover leadership, management, or how to navigate team dynamics. As a result, many practice owners rely on instinct and good intentions when they start leading others.
That often shows up as:
- Wanting to be liked by your team
- Feeling unsure whether you’re doing a good job
- Avoiding hard conversations longer than you should
- Making decisions based on connection rather than clarity
Leadership can feel super isolating because feedback doesn’t flow the same way it does with clients. You won’t always hear reassurance that you’re doing things right, and that uncertainty can make it tempting to overcorrect or overgive.
Leading Your Team Without Becoming Their Friend
It’s totally natural to want strong relationships with your team. Connection builds trust, and trust supports retention. The challenge arises when leadership and friendship start to overlap in ways that create confusion or inconsistency.
As an employer, your decisions carry weight. Team members notice who gets opportunities, recognition, and access. Even small gestures like coffee, gifts, or extra flexibility can be interpreted through a leadership lens.
This doesn’t mean you need to become distant or overly formal (that would be boring!). It simply means your leadership choices need to be grounded in fairness and clarity.
How to Think About Boundaries in Group Practice Leadership
You’re allowed to be warm, approachable, and human. At the same time, your decisions should be tied to role expectations and performance instead of personal closeness.
Hot Tip: A helpful mindset shift is remembering that leadership isn’t about removing connection. It’s about creating consistency so your team knows what to expect.
Rewarding Performance Without Creating Favouritism
One of the most common questions I get from group practice owners is whether it’s okay to reward high performers differently. The short answer is yes, when it’s done intentionally.
Performance-based recognition helps reinforce the behaviours that support your practice. It also creates clarity around expectations.
Use KPIs to guide recognition!
Key performance indicators help you anchor decisions in something objective. These might include:
- High client retention
- Strong engagement in meetings
- Consistent follow-through on responsibilities
- Contribution of ideas or leadership within the team
When recognition is tied to performance, it becomes so much easier to explain and easier to repeat fairly.
How to Handle Hard Conversations as a Group Practice Owner
Avoiding difficult conversations is one of the fastest ways leadership stress builds. But it happens often because let’s face it, difficult conversations feel yucky.
But performance issues, boundary concerns, or policy gaps are best addressed early and directly.
1. Keep Performance Conversations One-to-One
Any conversation related to performance should happen privately, either in person or on Zoom. Group settings are never the place for individual feedback.
Once you understand the situation, you can decide whether a system or policy needs to be updated to prevent the issue from repeating. Systems support clarity and reduce emotional load for everyone involved!
2. Ask the Right Leadership Question
When an issue comes up, pause and ask yourself:
- Is this a people problem?
- Is this a leader problem?
- Is this a systems problem?
More often than not, the answer actually points back to systems. If something isn’t written down, trained, or clearly communicated, it doesn’t truly exist.
Leading With Attunement Instead of Control
This one is super important for group practice owners to remember! The best leaders are observant.
They notice energy shifts, engagement levels, and subtle changes in team dynamics. Because leadership is truly less about pushing and more about responding.
One of the most helpful metaphors I’ve come across is thinking of leadership as sailing rather than rowing. When you pay attention to what’s happening in your practice, you can adjust course without exhausting yourself.
Your job isn’t to force outcomes, it’s to guide the system so it can support growth naturally.
I know this can feel hard at times, but remember to be kind to yourself. You’re still a baby boss!
Stepping Into CEO Leadership With Confidence
Leadership is a skill you grow into. You’re allowed to learn as you go, reflect on mistakes, and refine how you show up over time.
When your decisions are grounded in fairness, performance, and clear systems, you don’t need to second-guess yourself as often.
If you’re building or growing a group practice, remind yourself that leadership is part of the work. You’re developing a skill set that wasn’t taught to you, and that takes time.
Want more support with leadership, systems, and sustainable group practice growth? Follow me on Instagram and listen to the Business Savvy Therapist podcast for more advice!
Your Business Bestie,
Nicole
