What happened when I stopped seeing clients for therapy? How to evolve a business in adversity

Welcome to the Business of Psychology podcast. Today is a bit of a different episode for me because I wanted to be honest with you about some decisions that I've made recently that are really personal, but that resonate a lot with decisions that I help some of my coaching clients to make, because it's rare that we go into private practice without some complicating factors happening in our lives.

Full show notes for this episode are available at The Business of Psychology

Episode Links:

Episode 19: How psychologists and therapists can use an ideal client avatar to co create and market their services

Episode 103: Why you should specialise – old gold that is still important

Episode 128: Who are you helping? Three ways to specialise your psychology or therapy practice

Episode 152: Thinking differently about your practice: A tool to put the client first

Links for Rosie:

Substack: substack.com/@drrosie

Rosie on Instagram:

@rosiegilderthorp

@thepregnancypsychologist

Evolve and Thrive Mastermind

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Our next cohort is starting in January 2026, and it's a small group, six-month coaching experience. The early bird rate finishes mid-December, so if any of that sounds good to you, make sure you check out the details over at psychologybusinessschool.com and book your free call with me now to secure the best price.

Shownotes

What happened when I stopped seeing clients for therapy? How to evolve a business in adversity

I've spoken a bit here, and a lot more on my substack, about how I originally went into independent practice really because my children have additional needs. I wasn't aware of that at the time; all I knew was that nursery didn't work and that we didn't have other childcare options available to us. But looking back, nursery didn't work for the same reasons that school is very challenging now. And that was the beginning of me having to learn to evolve and adapt and be a clinical psychologist in a different way, and that's been very much the purpose of my business and what I love to help other people do too. So it felt only right that I should share with you about some of the recent evolutions that have had to be made in my business, my thinking behind it and the kind of strategy that I use every time I have to make a big change in my business. Because it has happened so often that I have developed a bit of a framework for thinking about it and helping my clients through it when it happens to them too. So, I thought it might be useful to share what's happened, but also my framework for thinking through and strategizing my way through those difficult moments that often lead to a change or an evolution in the business.

Firstly, I want to acknowledge that there's a lot that I love about independent practice, and I am so grateful that I have this profession that enabled me to set up independently when the NHS wasn't going to work anymore. But it's a paradox because I also felt extremely sad about leaving the NHS. It was 2018, I was very young, I didn't feel anywhere near experienced enough to go into independent practice at that time. So, to an extent, my first journey into independent practice involved a big evolution of identity in and of itself, and I guess that's a context for many of us. Many of us feel a big wrench when we leave the NHS or when we even start to think about potentially leaving our public sector roles. So, I guess independent practice starts from that place for me, and for me it's always held this kind of paradox of opportunity and excitement alongside sadness and loss. I know that that's the case for very many of us in independent practice, and I suppose what I hope is that what I'm going to share today helps me and you, if you find yourself in this kind of situation, to use an actionable framework to find the opportunities and the excitement, even when maybe you wouldn't have chosen the situation that you find yourself in.

What's been going on in my business

I'll let you behind the curtain a little bit in what's been going on over the past few years in my business, the harder bits perhaps. As I mentioned, I have children with additional needs and sometimes it's difficult to get those needs met by anybody other than me. I think if you've navigated the SEND system in the UK, then you'll know exactly what I mean by that. A few years ago, my children really couldn't cope with school, so suddenly I found myself needing to go back into the role of being the primary carer all of the time, and there was no space for my independent practice. It was very sudden, I hadn't anticipated that my children would struggle to that extent, that they couldn't be in the school environment. I'd never in my life met anybody that had a child that didn't go to school. I knew it happened for teenagers, I did not know that it could happen for five- and six-year-olds, but it really did. And in fact, it was a problem that lasted for more than a year as we tried to find flexibility and find ways of making school accessible and suitable for them. I should say that compared to a lot of families, we were very lucky. We’re in a lovely school with an amazing SENCO and a really compassionate and strong head teacher who have been flexible in ways that I do not think are normal in mainstream primary schools. They've bent over backwards to support us and that is not the story that I hear from a great many families that I work with. So, just to check my privilege on that one, I know how lucky we've been. But it still took a really long time to help the children recover and to find the adaptations that we could make to make some sort of school more accessible to them. We did get there, but it took all of me to do it. And so in a real hurry, and I'm not proud of how I handled it, because I don't think that I handled it in an optimal way whatsoever, I had to close down my clinical practice. It wasn't the first time it had happened, it happened to many of us in COVID as well, but it felt much more rushed, much more traumatic than that, because I went from expecting that I would be seeing my clients for years to come. I was really excited about the premises that I had, really excited about establishing a service in my local area, and all of that just ended really abruptly when I had this realisation that I'd had to cancel more clients than I'd seen in a week. And I can't overstate how painful it is to know that you're not being the psychologist or therapist that your clients need. As soon as I had that realisation, I knew the only ethical thing to do was complete closure and to hand people over in the best way that I could to other professionals in the area. But it was brutally painful and I still feel waves of trauma thinking about it and talking about it, so that's all I'm going to say about that. It was forced, it was hurried, it was crisis driven, it was not what anyone would hope for.

So the practice stayed closed for probably at least 18 months, if not two years, while I just focused on recovering my children. I kept Psychology Business School going, because although there were parts of me that thought let's just retreat from professional life entirely, financially I didn't really have that option, or it would've been extremely difficult for us if I had chosen to do that. But I think more for me, I needed to feel that connection to my profession and to my colleagues and hopefully as anyone who's done coaching with me will know, I really enjoy immersing myself in somebody else's practice and somebody else's struggles, and solving the problems that come up in other people's businesses was the kind of relief from the rest of my life that I needed, and it also meant that I didn't lose contact with the mission that we have as mental health professionals and my professional values. So it was important for me to keep that going during that really difficult period, even though it was also extremely difficult, and I would find myself snatching hours of work at ungodly times to try and keep things going. I don't regret it, I feel like that sustained me during that period. Including this podcast - getting feedback from this podcast, talking to the amazing people that I've interviewed for this podcast during those dark times was extremely restorative for me in what was a really difficult moment. So, I'm so grateful that I did have that to fall back on during that time.

And then things started to get a bit easier. We found those accommodations in education that allowed my kids to feel safe outside of the house and learn outside of the house, maybe not for whole days, but for long enough to give me a bit of professional time back. And we made the decision to hire somebody to help my son in the afternoons when he isn't at school, to give him and me that sense of security, that he could be safe with someone else while I could focus on some client work. For me, that meant the building blocks were back in place; I could open up the clinic again and start taking on a caseload of therapy clients. And I was really excited to do that. I love working with people who are struggling in pregnancy, I love my hyperemesis work. And I don’t know how this happens, but I often talk to people who are worried about their marketing, about this kind of mystical way in which people who have similar experiences to you will kind of gravitate towards you. If you are out in the world at networking events and you are talking about personal experiences that you have, don't be surprised if you suddenly start to get clients who have some of those experiences too. And so another type of work that started coming to me were parents adjusting to diagnoses that their children had been given. Often that would happen as the result of a difficult birth, which is something I already did a lot of work with, but I was also starting to see people who had children who'd newly been diagnosed with neurodevelopmental conditions and wanted some space to reflect on how that might impact them and family life moving forward. I found that work deeply fulfilling. I hadn't really anticipated it, but it fit really well with the model that I use in therapy most, the acceptance and commitment therapy model, and often would logically follow on from EMDR trauma work that I'd been doing with them anyway, so it felt like a really good and fulfilling fit. And I just attracted dream clients during that period. I would like to say I took a bit of my own advice, I went back to my marketing frameworks, back to basics, looked at the customer journey, and I did intentionally market to get the kind of clients I like to work with. And it worked beautifully; I really enjoyed the clinical work that started to come my way. And it only lasted about 10 months, and you can probably hear the sadness in my voice about that. I really enjoyed the work that I was doing, but I guess there were signs from fairly early on that the situation maybe wasn't as sustainable as I had thought that it was at the beginning. The help that we had for my son, she was the most wonderful young woman, but she had health problems and actually it became obvious that perhaps this wasn't going to be a long-term arrangement and perhaps it wasn't going to be as reliable as I needed to have a full caseload. At about six months in, she handed in her notice. As any parent of an autistic child will know, it is not easy for children like mine to make attachments, to have somebody new in the house, to adjust to different routines, so when she handed in her notice, and because she's a wonderful human being who I have nothing but warmth and admiration for, she gave us just over three months of notice. So I had time to think; what do I want to do with this situation? Am I going to hire somebody else, try and keep this status quo going, or am I going to take this as an opportunity to change and pivot and maybe accept that things aren't going to follow the pattern of independent practice that I have previously enjoyed? As you can probably tell, I decided to go for the latter option. I just couldn't face the thought of bringing somebody new into our house and making that work again. I don't think it would've been the right thing for my son either. He already has to adjust to one-to-ones changing in the school setting, there’s nothing I can do about that, and there's going to be a lot of it in his life. I just didn't want to keep doing that to him at home as well. I know that it's a real privilege to even have a choice about that. I reflect all the time on the fact that if I had a normal job where I was employed by someone else, there would've been no choice. It would've been a mad scrabble to try and replace this person as quickly as possible so that I didn't have to miss a day in the office. I am so lucky to have work that means that I can still make an income even if I'm not able to see lots of therapy clients. So I took that privilege decision and said, you know, we're not going to replace this person, I'm going to go back to providing that care in the afternoons. But that meant that once again, I don't have those building blocks in place that creates the security that you need to work with people in their most vulnerable moments. And so this time slowly, ethically, with supervision and support from my peers and a proper plan, I decided to close the practice again. And this time probably for a lot longer, because this time I have intentionally decided that for the time being, I'm going to use my skills in a different way.

The strategy and framework I use to make a pivot into an evolution

I wanted to let you in a bit on the strategy behind that and the framework that I use to think about how to make a pivot in the business into an evolution rather than just a loss. Because there is loss here and I wouldn't want you to think that I'm not acknowledging that. I feel sad about it, of course I do. But I have also found things to be excited about and projects that I'm really excited about and feel professionally fulfilled by moving forward. And that's the joy of independent practice that we get to do that. So I want to share with you how I started to think about doing that so that if you are in this situation, you can do that too.

Go back to the basics

The first thing that I did was really go back to the basics, pull out my customer personas that you will know all about if you've been following this podcast. For anybody that hasn't, a customer persona is basically a deep dive that we do on the kind of person that we really want to help, our ideal client, if you like. We usually have between three or five of these to represent the diversity of the client group that we work with, and they're really useful documents because if we do them properly (I’ve linked to the podcast episode where you can learn how to do them properly) they should answer questions like; what are the real priorities of this customer? What is it that's keeping them awake at one o'clock in the morning? What other solutions have they tried to try and solve their problems? Where do they go when they're looking for help? Who do they ask for support? All of those deep questions that we need to really understand why our clients come to us and how we can best support them. So the first thing I did was go back to those customer personas and to revisit the core values of my business, like why do I do the things that I do? And think about how I could design the stuff I do in the business to best align with those values in the new constraints that I found myself in. The thing that came up from that work was that I really enjoy going deep with people. I don't enjoy, and I've tried it before and I've done it successfully, but it didn't feel great for me having things like courses with loads of people going through them but not very much interaction from me - that's not really professionally fulfilling for me. So I knew that. I know that I really love going under the hood of people's businesses in Psychology Business School, I like to know my coaching clients' businesses inside out. I like to have time to really understand where people are at and do that deep work with my coaching clients, and I feel the same about my clinical work. I don't really get much fulfilment out of putting lots of short videos on Instagram. I like creating long form content for people and I like doing deep work with people where I really get to know them well and help them solve the problems in their lives. That's a challenge when you've got limited capacity, but it's a good thing to know about myself as a professional.

So I started to think, how can I do this without doing tons of one-to-one work? Because while I've made the decision to close my clinic, I also realised that I couldn't see one-to-one coaching clients anymore either, because although coaching clients are not usually vulnerable, they still require you to show up when you say that you're going to show up. It's really not right to mess people around. And while I can be pretty reliable for a few hours in my week, across the whole week, it's not enough for as many coaching clients as I have been seeing over the last few years. There just wasn't enough protected time that I could be sure I could offer everybody a slot that would be safe from the slings and arrows of life as a SEND Parent. So again, I made that ethical decision that I wasn't going to be able to do too much of that either.

What meets the needs of these customer personas and meets your needs?

So I started thinking, what could I do? What would meet the needs in these customer personas and meet my needs? And the tool that I use to do that is called the Value Proposition. This is where we think about our customers' pains,, the things that they want to get rid of when they come to us, the things they want to gain when...