Why only 18% of therapy practices say they're thriving
At a glance
- Practice success rests on five domains: client outcomes, financial health, practice operations, therapist well-being, and client experience.
- In our survey of more than 1,000 therapists, 95% said a practice must do well in all five domains, yet only 18% say they're thriving across them. 48% say they're struggling or just getting by.
- Measurement is a key difference between practices that thrive and practices that struggle. You can't improve your finances, operations, or client experience without knowing how you compare or what good looks like.
- The 2026 Practice Success Report gives you a framework, assessments, and practical ideas to evaluate your practice in each domain and start improving today.
Table Of contents
By Cory Polonetsky, VP of TheraNest Product Management Product Marketing
When you talk to therapy practice leaders about how their practice is doing, it’s interesting what you don’t hear. You rarely hear numbers that explain how well they’re doing on achieving specific, measurable goals. In other professions – even within healthcare, like hospital management – measurement seems to be everywhere. Readmissions rates, length of stay, patient satisfaction scores, and other standardized measures are yardsticks that help an organization know how well they are doing compared to peers. But therapy lacks that kind of objective assessment of a practice.
The reasons for this are many, and topping the list is the type of preparation that therapists receive. After thousands of hours of preparation in the classroom, independent study, and supervised practice, therapists are incredibly well-trained and ready to handle a spectrum of clinical cases. But that preparation includes little, if any, content around business management, technology, operations, finance, billing, payer relationships, hiring, people leadership, payroll, or strategic planning. In short, practice leaders are ready for practice of therapy but haven’t been given all the tools for the business of therapy.
Therapy practices also lack objective measurement because every practice is different. Each is as unique as its founder, with differences in setting, caseload, specialties, therapy methodologies, client mix, and more. These differences among practices make it challenging to analyze, compare, and therefore improve practices. But not impossible. With a well-structured framework for practice success and a set of tools that make evaluation easy, any practice leader can get a new view into their practice health.
At Ensora Health, our mission is simple: help practices succeed. Having worked with more than 100,000 therapists, and having recently surveyed over 1,000 therapists on the topic of practice success, we’re excited to share our 2026 Practice Success Report: The Five Domains of a Thriving Therapy Practice, a practical guide a practice leader can use today to better understand and improve the health of their practice.
Our approach centers on five domains of practice success: client outcomes, financial health, practice operations, therapist well-being, and client experience. In deepening their understanding of the five domains, practice leaders can help ensure sustainable practice success, benefiting themselves, their clients, and if they have employees, the therapists who rely on them.
The five domains of practice success
| Client outcomes | Are clients making meaningful progress over time? How are they doing in achieving personalized goals? |
| Financial health | Is my practice managing revenue and billing well? Are we collecting payments in a timely manner for the work we’re doing? |
| Practice operations | How well are daily operations running? Is my practice as efficient as it should be? |
| Therapist well-being | How well am I managing stress, workload, and burnout? (For group practices) Are the clinicians on my team thriving, not just surviving? |
| Client experience | Are my clients engaged throughout their care? Are they satisfied in their non-clinical interactions with my practice? |
When we investigated the five domains of practice success with our community of therapists, we learned there was near universal agreement that these are the five most important topics that a practice leader must continuously manage to ensure success. 95% of survey respondents told us that a practice must do well on all five domains, yet only 18% say they are indeed thriving across these domains. In contrast, 48% say they are struggling or just getting by.
One key difference between the thrivers and the strugglers is the degree to which they measure their practice. Measurement can be tedious, and most everyone feels discomfort when they hold a mirror up to themselves, but it is a reliable predictor of practice success. How can you be sustainably successful in your finances, operations, and other areas if you don’t know how you compare, or even what “good” looks like for a therapy practice?
In this 2026 Practice Success Report, you’ll find tools to help you understand the five domains of practice success, ways to assess your current performance on each, and practical ideas to ensure your practice does well in every domain of practice success.
We’re already working on bringing you more tools to help your practice succeed. In the meantime, we look forward to hearing from you on how you use the 2026 Practice Success Report to get a firmer handle on the health of your practice and make small changes that can lead to less stress, healthy outcomes, sustainable income, and more joy.
Cory Polonetsky
Vice President, Product Management & Marketing
TheraNest by Ensora Health
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