How Much Do Therapists Actually Make? A Realistic Breakdown by Practice Size

“How much can I actually make in private practice?”

It’s one of the most searched — and least clearly answered — questions in the therapy world. And for good reason: most income conversations stop at session rates and ignore what really matters. We've set out to clearly answer this here, read on for the actual numbers.

Revenue isn’t just about:

• Your hourly rate
• Or how “full” your caseload is

It’s about structure.

A solo private practice, a small group practice, and a large group practice can all charge the same session rate — and still produce very different income.

This post breaks down what therapists actually make at three stages:

• Solo private practice
• Small group practice (≈5 clinicians)
• Larger group practice (≈20 clinicians)

And shows you how to calculate revenue realistically — not aspirationally.

How to Calculate Therapy Practice Revenue (The Simple Formula)

At its most basic, revenue looks like this:

Sessions per week × Average session rate × Weeks worked per year

But to make this realistic, you also need to account for:

• Cancellations and no-shows
• Admin time
• Supervision and management (in group practices)
• Insurance vs private pay mix
• Time you’re not seeing clients

We’ll keep the math conservative on purpose.

Scenario 1: Solo Private Practice (You Only)

Let’s start with the most common setup.

Assumptions

• 18 sessions per week
• Average rate: $140/session (mix of private pay + insurance)
• 48 working weeks per year

Annual Gross Revenue

18 × $140 × 48 = $120,960

What This Means

• This is gross, not take-home
• You’re doing clinical work and admin
• Your income ceiling is tied directly to your time

Many solo therapists fall in the $90k–$130k gross range depending on:

• Rate
• Caseload
• How consistently they work

You can raise rates or add sessions — but both have limits.

Scenario 2: Small Group Practice (≈5 Clinicians)

Now let’s look at a small group practice where you still see some clients but also manage others.

Assumptions (Per Clinician)

• 20 sessions per week
• Average rate: $140/session
• 48 weeks per year

Per clinician annual revenue:
20 × $140 × 48 = $134,400

Practice Gross Revenue (5 clinicians)

$134,400 × 5 = $672,000

Owner Take Depends On Your Split

Let’s assume a 60/40 split (clinician/practice):

• Practice share (40%): $268,800
• From this, you cover:
  • Admin
  • Billing
  • Software
  • Marketing
  • Your own salary/profit

Many small group owners land somewhere between:

• $140k–$220k personal income, depending on overhead and structure

At this stage, income starts to decouple from only your sessions — but systems matter a lot.

Scenario 3: Large Group Practice (≈20 Clinicians)

This is where the model truly shifts from “practice” to “business.”

Assumptions (Per Clinician)

• 22 sessions per week
• Average rate: $145/session
• 48 weeks per year

Per clinician annual revenue:
22 × $145 × 48 = $153,120

Practice Gross Revenue (20 clinicians)

$153,120 × 20 = $3,062,400

Practice Share (40%)

≈ $1.22M

From this, you pay:

• A full admin team
• Billing + operations
• Leadership roles
• Marketing + growth costs

Owner income at this level varies widely, but many well-run practices net:

• $300k–$600k+
  depending on efficiency and leadership structure.

At this size, your income is no longer limited by your calendar — it’s limited by operations.

Why Two Practices With the Same Revenue Feel Very Different

Two practices can generate the same gross revenue and feel completely different.

What changes the experience:

• How organized intake and follow-up are
• How much unpaid admin work leaks into your time
• How predictable cash flow is
• Whether you’re reacting or operating intentionally

Many therapists make less than they expect not because they charge too little — but because systems are doing invisible damage.

What Actually Moves the Needle on Revenue

Across all practice sizes, revenue grows fastest when:

• Inquiries don’t fall through the cracks
• Follow-up is consistent
• Admin time is controlled
• Billing is clean and timely
• You’re not the bottleneck for every decision

More sessions help. Better systems help more.

Final Thought

Therapists can build six-figure incomes — and beyond — but the path looks very different depending on structure.

Understanding the math is empowering.
Building the systems to support it is what makes it sustainable.

If you’re thinking about your next stage — solo, small group, or scaling larger — clarity around revenue is the first step.