Why I'm Moving Away From Open-Ended Therapy

I used to believe good therapy came with an open-ended container

Throughout my education, licensing, clinical training, and countless conversations with other therapists, I've been taught that good therapy is open-ended and client-led. While I am a huge advocate of client-led sessions, I’ve come to realize that an open-ended therapeutic container can place a surprising amount of dependence and pressure on both the therapist and the client.

I’m going to put my therapy business owner hat on for a second so you can see what I mean.

In order for me to make a pre-tax salary of $90,000,* seeing an average of 15 clients per week (a typical caseload for a private practice therapist), I would need to charge an average of $115 per session. This assumes I take zero breaks and a client never cancels.

There’s an industry standard assumption that clients will miss 20–30% of scheduled sessions. I’m going to use 30% to account for my own cancellations as well. One client paying $115 per session over 52 weeks represents roughly $6,000 of annual revenue (pre-tax). Each client, then, represents about $6,000 of my income each year. My livelihood relies on how consistently my clients attend therapy and how little time off I take. That dependence doesn't sit well with me.

I find this calculation upsetting. The math is remarkably simple. The business model is too.

I’m questioning the classic private practice model and exploring what I need financially in order to best support my clients, the work itself, and my own survival too.

I’m Uncomfortable with a Business Model Built on Dependency

There are many schools of thought around the efficacy of brief versus long-term therapy. But when my income depends on how many clients I see each week, and those weekly sessions become my annual income, I have to wonder how that financial reality shapes my clinical intuition about what works best.

A mentor once asked me what my resistance was to long-term therapy. I remember hearing the question as though there was something wrong with my clinical judgment for not wanting to work with someone indefinitely without consciously choosing to recommit to the relationship over time.

I now understand that what makes me uncomfortable isn't long-term therapy itself. It's the possibility that, over time, both therapist and client can become dependent on the relationship in ways that may no longer serve the work. I want to build a practice that regularly asks whether therapy is still the best place for someone to be, rather than assuming it should simply continue.

And I also live in a world where I need to earn an income. I don't want to pretend that financial reality doesn't exist or that it has no influence on how I design my practice. Instead, I want to build a model that supports my clients, honors the work, and allows me to earn a sustainable living.

Reimagining the Therapeutic Arc

In the coaching landscape, packages for ten sessions at an upfront cost are relatively common. It's one reason some fully licensed therapists choose to move into coaching. The financial model is simply different. And this doesn’t mean the full payment is due at the beginning of sessions. There are opportunities for payment plans and collecting fees that can support a client’s financial needs.

I want to hold onto my license. It’s important for me that I do therapeutic work and I can call my work therapy. Maybe in the future that will change, but I don’t want my decision to be because I can’t earn an income in the way that works best for me and my clients.

I’ve landed on this 6 month arc. I’ve seen in my own work the value of spending TIME cultivating a cadence and a relationship with a client. In therapy terms, we call this rapport and joining. This means there needs to be enough trust and stability in the relationship for both client and therapist to show up authentically and that takes time. Then I thought about my capacity and desire for pauses or breaks. I realized that if we had a container of 6-months, there is plenty of time to build trust and do meaningful work. And when the container comes to a close, we have an opportunity for a break, a pause or an ending, that feels more natural because it’s been pre-determined. This isn’t about rushing someone through therapy, it’s about allowing seasonality and natural time for integration, for perspective to land, for acknowledgment of the work that's already been done rather than assuming there's always more work to do.

Knowing something won't always be available changes the way we relate to it. We become more intentional, more present, and perhaps more grateful. You know when you have a deadline and suddenly you begin showing up more fully because the end is in sight? Think about the final stretch of a marathon, the last bit of energy you find before you finally get to rest.

I want to normalize pauses, turning inward, and time to steep in the unknown. Ultimately, I want clients to leave believing they don't need to work with me.

My Vision for Future Work

As I continue building my practice, I'm becoming less interested in following the default model and more interested in building one that reflects my values. I want a practice that invites intentionality, honors a client's agency, respects my own need for rest and creativity, and acknowledges that time and money inevitably shape the work. I'm motivated by two things: building a sustainable life in this profession and practicing therapy in a way that creates the conditions where I can best support healing.

If you're curious about how this philosophy shapes my approach to marketing, I'll be writing about that next. When it's ready, I'll link it here.

-Molly

*I’m aware there are infinite ways to do this math, but I wanted to provide a concrete & simple example