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, and one of the biggest reasons we were able to do that was retention. We weren’t constantly replacing people, and that made a huge difference in how we grew.
Most practice owners focus all their energy on hiring (and I get it, hiring feels like growth), but if you’re losing therapists as fast as you’re bringing them on, you’re stuck on a treadmill. I want to walk you through exactly how I approached retention in my group practice, because it doesn’t require a massive budget, and it starts with something a lot of people overlook.
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 watch the video below!
Why Therapist Retention Matters More Than Hiring in Your Group Practice
Hiring is only half the equation. Every time a therapist leaves, you lose their caseload, their client relationships, and the time you invested training them. You also take a hit to team morale, because the therapists who stay notice when people keep leaving.
When I look back at how we grew, retention was actually the bigger growth lever. Keeping one great therapist for three years did more for the practice than cycling through three okay hires in that same time. And the bonus is that retention is a lot cheaper than constantly recruiting!
How to Build a Group Practice Culture That Keeps Therapists Long-Term
I like to think of culture as the background music of your practice. It’s not what you say in your policies, it’s how you show up, your energy, and how your team feels when they walk in (or log on). Values are the lyrics. Culture is what people experience, and values are the words that guide it.
Define Your Practice Values (and Actually Use Them)
My three values were:
- go above and beyond
- stay ahead of the curve
- work hard play hard
These weren’t just words on a wall. We hired by them, we gave feedback by them, and when someone wasn’t aligned, those values gave us a shared language to talk about it.
Your values should be specific enough that you could use them in a hiring interview or a performance conversation. If they’re too generic (like “be a team player”), they won’t actually help you make real decisions.
Make Psychological Safety Your Number One Priority
There’s a book called The Culture Code by Daniel Coyle that shaped how I led my team in a big way. The biggest takeaway was that psychological safety is the number one reason people stay in any organization, above pay and above perks.
And something that really surprised me about this is that vulnerability creates trust, not the other way around.
I started sharing first in team meetings, whether it was something I was struggling with in the business or a mistake I’d made, and that openness gave my team permission to do the same. The whole dynamic of our team shifted after that.
Hot Tip: If you’ve already lost a therapist and you’re figuring out how to handle it, read my blog on what to do when a therapist leaves your group practice. It covers how to manage the transition without losing more of your team.
Who Should Enforce Your Cancellation Policy?
This is the part that makes all the difference, trust me. Your admin is the bad cop. Your therapist is always the good cop. Even if you’re in solo practice (and especially if you have a group), please don’t be the one having this conversation with clients.
You’re protecting the therapeutic relationship and the brand. If the therapist is also the person enforcing fees, it gets awkward fast and can damage the trust you’ve built.
If there’s something in your business that feels emotionally sticky, that’s your signal to remove yourself completely, delegate it, and put a process in place. The best part is you won’t even know it’s happening.
Hot Tip: If you don’t have admin support yet, read my blog on why your group practice needs an admin and send me a DM on Instagram saying “ADMIN CHECKLIST” and I’ll send you my list of tasks that should be delegated to your admin.
4 Ways to Retain Therapists in Your Group Practice Without Raising Pay
You don’t have to overpay to keep great therapists. Here’s what worked just as well (and sometimes better):
- Offer supervision and mentorship. Therapists want to grow, and supervision is one of the most underrated retention tools. When someone feels like they’re learning and developing, they’re far less likely to look elsewhere.
- Invest in training. We brought in outside experts for 40-minute training sessions during team meetings and it cost about $200 each time. That’s a tiny investment compared to the cost of replacing a therapist, and free training was one of the biggest perks our team talked about. (We’d order food too, which doesn’t hurt!)
- Run 90-day check-ins. I sat down with every therapist every 90-days to ask how things were going, what they needed, and whether anything felt off. As we grew, my clinic manager took over the alternating check-ins so every therapist still got that face time. These conversations caught small issues before they became reasons to leave.
- Balance structure with flexibility. We had clear manuals and processes (therapists actually love knowing what’s expected), but we also stayed open to feedback. If someone on the team had a better idea, we tried it. That balance made people feel respected, not micromanaged.
Hot Tip: Building a strong team starts with your very first hire. If you haven’t read it yet, check out my blog on who your first hire should be in your group practice.
When Should You Let a Therapist Go?
This is the part nobody wants to talk about, but if someone is hurting your culture, you need to let them go quickly. I call them a “culture cancer.”
I once kept a therapist who wasn’t a good fit for almost two years because I was avoiding the hard conversation, and in that time I lost three other therapists who were great. The bad fit was driving the good people away.
When a therapist does leave (whether you initiated it or they did), handle it with confidentiality and grace. Our approach was simple, we would say something along the lines of “So and so has left the practice, and we wish them the best.” No gossip, no details, no drama.
And something else I want you to hear is that you may outgrow some of your early hires as you scale, and that’s completely okay! It’s totally normal.
The therapist who was perfect when you had three people on the team might not be the right fit when you have fifteen. That doesn’t mean either of you did anything wrong. It just means you grew.
Hot Tip: A strong admin is one of the best retention tools you can have, because they take the operational weight off your therapists (and off you). Read my blog on why your group practice needs an admin if you don’t have one yet.
Build the Kind of Group Practice Therapists Never Want to Leave
Retention isn’t about throwing money at people or adding flashy perks. It’s about creating a practice where therapists feel safe, valued, and like they’re actually growing. Define your values, lead with vulnerability, invest in your team’s development, and don’t be afraid to protect your culture by letting go of the wrong fit.
Want more strategies for growing your therapy practice? Follow me on Instagram and listen to the Business Savvy Therapist podcast for strategies and real talk about scaling a 7-figure group practice without burning out.
Your Business Bestie,
Nicole
