By Sarah Sacks | Psychotherapist & Clinical Supervisor, Melbourne
I don't think I fully appreciated, when I first began working as a therapist, how much of myself I would bring to the work.
Like many people drawn to allied health and the helping professions, I came to this work with a genuine interest in people and a desire to make a difference. I loved the work, and still do.
But somewhere along the way, I began to understand that loving what you do doesn't necessarily mean the way you're doing it is sustainable.
Over the years, I've worked in community health, the not-for-profit sector, and private practice. I've also built and run a group therapy practice, before eventually making the decision to return to working on my own.
Each experience has taught me something different about what it takes to build a working life that feels both meaningful and manageable.
And perhaps the most important lesson has been that sustainability isn't simply about how many clients we see, or how efficiently we manage our time.
It's also about the relationship we have with our work, and with ourselves.
When Being a Good Practitioner Means Doing Too Much
I think many people working in caring professions will recognise the tendency to take on more than is ours to carry.
We want to be helpful. We care about the people we work with. We want to do good work.
And sometimes, without quite realising it, we begin to feel responsible for things that aren't entirely within our control.
We might find ourselves thinking about clients long after appointments have ended, squeezing in another appointment when we're already tired, or feeling uncomfortable about taking time off.
We know the importance of boundaries. We may even spend time helping clients establish their own. Yet holding them ourselves can be surprisingly difficult.
I've come to think that when this happens, it's worth being curious rather than simply trying to become better at saying no.
What makes it difficult to disappoint someone? What do we imagine might happen if we're not available? What does being a good practitioner mean to us?
Sometimes these questions tell us more than another time-management strategy ever could.
The Unexpected Work of Running a Practice
Moving into private practice brings a whole other set of responsibilities.
Alongside our clinical work come decisions about fees, policies, scheduling, marketing, administration, professional obligations and all the practical things involved in running a business.
For many allied health professionals, this is a significant shift. We may have spent years developing our clinical skills, but had very little preparation for becoming business owners.
Building and leading a group practice added another layer of responsibility for me. There were people to support, decisions to make, and the ongoing challenge of balancing the needs of the business with those of the practitioners and clients.
It was rewarding, and I learned an enormous amount. But it also gave me a much greater appreciation of how easily the business of running a practice can begin to take us away from the work that drew us to the profession in the first place.
I think we sometimes underestimate how important it is to give this side of our professional lives proper attention.
A practice that is financially viable, with clear policies and realistic expectations, isn't at odds with being a caring professional.
In fact, I would suggest it's part of what makes good clinical work possible.
Finding a Way of Working That Fits
One of the things I've come to appreciate is that there isn't one right way to build a practice.
What works beautifully for one practitioner might be completely unsustainable for another.
Some people enjoy a full clinical caseload. Others need more space between clients, or want to combine their clinical work with supervision, teaching, leadership or other interests.
And what suits us at one stage of life may not suit us at another.
My own decision to move from group practice leadership back into solo practice was, in part, about wanting to create more space in my life and return to the aspects of the work I most enjoyed.
It meant letting go of things I had invested a great deal in, which wasn't necessarily easy.
But it also reminded me that we are allowed to change our minds about what success looks like.
What Are We Trying to Sustain?
When we talk about sustainable practice, the conversation often turns to burnout, workload and boundaries.
All important, of course.
But I wonder if there's a broader question worth asking.
What is it that we're actually trying to sustain?
Is it a particular income, a certain number of clients, a business we've worked hard to build? Or is it our capacity to remain interested, engaged and emotionally available in the work, while still having a life that feels rich and meaningful beyond it?
Ideally, perhaps, it's some combination of these things.
I think it's easy to become so focused on building a successful practice that we forget to ask whether the practice we're building is one we actually want to work in.
Making Space for Reflection
Whether we work independently or within an organisation, having a place to reflect on our professional lives can be enormously valuable.
For some, this might be clinical supervision. For others, it may be professional mentoring, peer consultation or another form of reflective support appropriate to their discipline.
It's an opportunity to consider not only the challenges we encounter with clients, but also the ways we're organising our work.
Perhaps we're noticing a pattern of over-responsibility, struggling with boundaries, or questioning whether our current workload is sustainable.
Or perhaps we're preparing to move into private practice and wondering how to build something that reflects our values, supports our financial needs, and leaves room for the rest of our lives.
These are questions I particularly enjoy exploring in my own supervision work.
Having worked across different settings, and experienced both the rewards and challenges of running a practice, I know that the decisions we make about how we work can have a significant impact on how we feel about the work itself.
Sometimes we need practical guidance. Sometimes we need a different perspective. And sometimes we simply need the space to think more clearly about what matters to us.
Allowing Our Professional Lives to Evolve
I don't believe building a sustainable practice is something we achieve once and then forget about.
Our interests change. Our circumstances change. We develop new skills, discover different areas of interest, and become clearer about the work we most want to do.
A practice that once felt right may no longer fit.
And that's worth paying attention to.
Perhaps building a sustainable practice is less about finding the perfect balance, and more about remaining willing to reflect on the choices we're making, and to make changes when they're needed.
Because the aim isn't simply to build a practice that works.
It's to build one that allows us to continue doing work we care about, without losing ourselves in the process.
I offer online clinical supervision for ACA and PACFA registered counsellors and psychotherapists, and allied health practitioners across Australia, with a particular interest in supporting mid-career practitioners navigating private practice and professional transitions. If you're considering a change in how you work, or simply want a reflective space to think about your practice, you're welcome to arrange a free 20-minute discovery call.
