Starting a Private Practice is the show for therapists who want a practice that holds up: good clinical work, real fees, and a business that does not quietly run on your unpaid hours. This one is not a success story interview. It is Kelly and Miranda talking through what they are watching in the profession right now, starting with health insurance.
The reason to hear it: a lot of clinicians took insurance specifically to be accessible. That logic breaks when the people you wanted to reach no longer have coverage. Kelly and Miranda walk through what actually changed, why therapists have been quietly bending their billing to make the math work, and what it looks like to build access on something sturdier than your own subsidy.
What You'll Hear
00:00 What we are watching in July of 2026
05:20 What actually happened with the subsidies, and who let it happen
07:06 2.6 million people, two very different explanations
09:48 Doctors building around the system: cash pricing, membership models, in-house labs
11:06 The quiet math problem: when therapists bend billing to make care work
12:08 Letting the deductible write the treatment plan
16:54 A better care model, not a cheaper version of a broken one
17:30 Counting who has their hands in the pie
19:17 What happens when you hand your practice to people who do not do the work
22:37 Intensives, extended sessions, and tracking your own outcomes
25:11 Why therapists are already built for a cash-pay world
29:30 More people are looking for us, not fewer
32:44 Drain versus groundswell, and how to tell which one you are in
35:09 Stockholders, platforms, and deciding where you give your labor
About Kelly and Miranda
Kelly Higdon, LMFT and Miranda Palmer, LMFT are the co-founders of zynnyme and the co-hosts of this show. They have been business partners since 2010 and have reached 100,000+ clinicians with trainings, coaching, and a lot of unglamorous spreadsheet work. Kelly brings the operational side; Miranda brings the tech and marketing side. Both of them still think like clinicians first, which is why the business advice here never asks you to trade clinical integrity for revenue. Kelly uses they/them pronouns.
Reach them at zynnyme.com, or start with the free training library at zynnyme.com/free.
Resources Mentioned
Free training library: https://www.zynnyme.com/free
Platform Contracts Exposed: https://www.zynnyme.com/free/platforms
Ditching Insurance and Platforms: https://www.zynnyme.com/free/ditching-insurance
Private Practice Under Pressure: Ethics, AI, and the Fight to Keep Therapy Human: https://www.zynnyme.com/free/private-practice-under-pressure-ethics-ai-and-the-fight-to-keep-therapy-human
The AI Policy Every Therapist Needs, with Dr. Maelisa McCaffrey: https://www.zynnyme.com/free/the-ai-policy-every-therapist-needs
RedBud Surgery Center, Austin, Texas: https://redbudsurgerycenter.com/
Dr. Elisabeth Potter, MD: https://www.drpotter.com/
Are Third-Party Credentialing Platforms a Lifeline or a Trap? https://www.zynnyme.com/blog/are-third-party-credentialing-platforms-a-lifeline-or-a-trap-a-deeper-look-at-the-ethics-and-sustainability-of-alma-headway-and-grow-therapy
Alma, Headway, and the Big Question: https://www.zynnyme.com/blog/alma-headway-and-the-big-question
What to Ask a Recruiter Before Signing a Therapy Platform Contract: https://www.zynnyme.com/blog/what-to-ask-a-recruiter-before-signing-a-therapy-platform-contract
All episodes: https://www.zynnyme.com/podcast
Business School for Therapists: https://news.zynnyme.com/business-school/
Want the Kind of Support Kelly and Miranda Talk About?
Business School for Therapists is our flagship program for therapists ready to build a practice that supports the life they actually want. It is a blend of live coaching and self-paced curriculum, plus a community of clinicians who normalize niching, real fees, and clinical depth. Twenty years in, it is the work we wish someone had handed us when we were spending our own weekends figuring this out. Learn more: zynnyme.com
Listen, Subscribe, and Leave a Review
Apple Podcasts: https://podcasts.apple.com/us/podcast/starting-a-counseling-practice-with-kelly/id1398391639
Spotify: https://open.spotify.com/show/7K8TQ13vJL4L3IvtWLLXV3
Stay Connected
Website: zynnyme.com
Blog: zynnyme.com/blog
Instagram: instagram.com/zynnyme
LinkedIn: linkedin.com/company/2456942
Pinterest: pinterest.com/zynnyme
Facebook: facebook.com/kellyandmiranda
