A flagship moment on this theme
"So this book came out of an experience with that. And I do think that a lot of people that are entrepreneurs are dealing with that, whether or not they realize it just yet, because as I was dealing with it myself, I. I didn't even know it. I wasn't even aware that I was searching for fulfillment until I hit that point."
Names the fulfillment gap that entrepreneurial clinicians rarely talk about — the disorientation of achieving everything you set out to achieve and still feeling empty, and not even having language for it while it is happening.
Where this is a central topic
5 episodes
Scaling Mental Health Organizations with Ryan Dewey Smith
Ryan repeatedly contrasts affiliation with traditional merger, arguing that affiliation keeps history, community relationships, leadership, and clinical identity intact while traditional M&A causes identity loss in the absorbed organization.
Big Mental Health Stories & Trends to Watch in 2026
Rachel frames the $330B market growth projection as a driver of consolidation and competitive pressure on small private practices, comparing the shift to big-box retail displacing Main Street stores.
Private Equity in Mental Health Care with Dr. Jane Zhu
The central subject of the episode — Dr. Zhu's own research on ownership penetration by state, the leverage-buyout mechanics, consolidation rates, and the downstream effects on clinician autonomy and care quality.
Building Mental Health Practices Without Burnout with Dan King
The entire episode centers on how mental health group practices grow through outside investment and what distinguishes acquisitions that preserve clinical culture from those that erode it.
Revolutionizing the Way Mental Health Practice Owners Connect and Thrive | Kasey Compton of Meet You In Kentucky
Meet You in Kentucky grew from 10 to 150 attendees across several years; Kasey describes the operational failures and adjustments — communication gaps, staffing, energy management — that shaped each subsequent year.
Where this comes up substantially
21 episodes
Interstate Licensure Compacts
Rachel raises the competitive implication: compacts shift the playing field from local to national, meaning local specialty practices may find themselves competing with the full national provider pool.
Making Value-Based Care Work with Josephine Wilton Pt. 1
Solo practitioners and small groups are compared to large hospital systems, with Josephine arguing smaller organizations often understand their financials better but lack resources for the data analysis VBC demands.
Strategy, Not Panic with Jeremy Zug
The MSO and aggregator model was examined in depth, including whether VC-backed companies like Alma and Headway create net new provider capacity or simply reshuffle existing ones, and predictions about insurers eventually acquiring those companies outright.
Welcome to the New Chapter of the Podcast
The pharmacy analogy walks through how conglomerates used VC funding and policy leverage to outcompete independent operators, and Rachel draws the parallel to mental health consolidation underway now.
Advocating for Mental Health Insurance Reform | Lisa R. Savage of the Center for Child Development
Lisa describes how her infrastructure required repeated reinvention as the practice grew, including making her first hire in 2007 and building an internal leadership layer to manage the isolation at the top.
High School Innovators Making a Difference | The Glenelg High School Robotics Club
The conversation covers two years of growth from a one-person prototype to a grant-funded multi-member team, with active discussion of succession planning and how to keep the program running past the founders' graduation.
Healing Together as a Family | Julia Dunn of Olivia's House: A Grief and Loss Center for Children
The episode traces growth from a single rented church basement to two dedicated centers with murals and a national-scale lending library, plus a volunteer model that allows three paid staff to run programs for hundreds of families.
Psychotherapy with Horses | Rosemary Baughman of Courageous Hearts
Courageous Hearts grew from two founders to 20 staff across two properties through incremental contract wins, starting with a $20,000 pilot that expanded into $100,000-per-year state contracts.
Supporting Grieving Kids Through Play and Connection | Brie Overton of Experience Camps
Brie describes growth from 27 boys at a single Maine camp in 2009 to a national program with camps in six states, a growing waitlist at every location, and a new Connecticut site opening in 2025.
The Healing Power of Drumming | Jeff Strong of the Strong Institute
Jeff traces the growth from solo practice to training 2,500 providers by 2009 and then the pivot to online delivery, including how that transition removed providers from the intake loop and required rebuilding the network's role.
Dungeons & Dragons as Therapy? How Tabletop Roleplay Games are Making a Difference | Charlene MacPherson of Nerd Adventure Therapy 20 (NAT20)
Charlene describes concrete plans to expand from solo practice to group practice, add speaking engagements and comic con panels, and eventually launch a nonprofit to fund therapy for underserved clients.
The Intersection of Purpose, Success, and Mental Health | Dr. Ajita Robinson of The Book, The Gift of Grief
Running a group practice as a CEO, the fiduciary responsibility to generate revenue, and building passive income as structural protection are discussed as practice-owner fundamentals.
The Power Of Partnerships In Creating A Safer Community | Katie Cashman of Change the Conversation
Katie traces Change the Conversation from a founder-led organization with no strategic plan to a three-pillar operation with a VOCA grant and a team of five, including the mechanics of their first formal strategic planning process.
A Creative Approach to Grief Support | Jamie Eaton of Living Through Loss
LTL grew from a single 8-week group to multiple group tiers, events, workshops, and retreats by consistently asking what the community needs next rather than following a predetermined program map.
Finding Freedom with Food Through Technology | Dr. Megan Osborne of Peace With Food
The conversation spends meaningful time on the founders' decision not to pursue outside investment, stay small, and keep their clinical practices, framing this as a real choice between mission continuity and growth.
Proactively Addressing Mental Health | Rachael Bevilacqua of Sanare Today
Sanare Today is actively expanding from Pennsylvania into Delaware, North Carolina, New Jersey, and Maryland, using IOP as the platform foundation while layering specialized tracks and new service lines onto that base.
Innovating EMDR Therapy with Online Solutions | Yanick and Benjamin of bilateralstimulation.io
The episode traces bilateralstimulation.io's growth from a free side project to 5,000 therapists to a bootstrapped hardware line, with specific discussion of how they managed the pivot without investor funding.
Welcome To The Mental Health Entrepreneur with Rachel Harrison
Rachel's arc from solo practitioner to six-practice, three-state operator is referenced as context for why she believes in non-traditional growth paths and why she started looking beyond clinical hiring as the answer.
Supporting the ALICE Community | Alison Pidgeon of Move Forward Counseling
Alison explicitly connects her ability to pursue advocacy to the scale her practice has reached, arguing that small practices do not have the same platform for systemic change.
From Personal Passion to Community Impact | Talon and Travis Holleman of R.O.O.T.S
ROOTS grew from 30 to 500+ students in under two years, which the founders described as faster than anticipated and a driver of operational challenges they had not built for.
Who Supports the Crisis Workers with Becky Stoll
Becky frames Centerstone's recent merger as a scale play that creates voice in policy and research, not just size, and discusses the responsibility that comes with it.
Mentions
3 episodes
Mentions
3 episodes
Neurodiversity and Unleashing the Brilliance Within | Erica Whitfield of Positive Development
The travel school concept and the therapist retreat to Ireland represent early-stage attempts to scale the practice model beyond individual clinical work, mentioned as future vision rather than active operational reality.
Mental Health Support for New Moms | Adrienne Griffen of Maternal Mental Health Leadership Alliance
Postpartum Support International's growth from zero paid staff to 60 over 20 years is cited as a reference point for what sustained advocacy can build, not a central topic.
How Neurofeedback Can Improve Brain Health | Mary Ammerman of the Institute for Applied Neuroscience
Mary briefly discusses the tradeoffs of group neurofeedback sessions as a way to reach more clients at lower cost while keeping the practice financially viable.
Looking to go deeper in your own work?
These TSTI trainings build on conversations from the episodes above.