Mindset

The Mindset Behind Every Successful Practice I've Seen

Wishful thinking quietly sabotages most practices. The thriving ones share a simple but challenging mindset: engage with reality, not wishful thinking.

Woman with a notebook and coffee sitting by a window in a busy cafe, looking up in thought

This post is the first in a series called "Engage with Reality," highlighting common gaps between how we plan and how things actually work in private practice.

There's a principle that changed how I think as a business owner, and I see it in great private practice therapists: engage with the world as it is, not as you wish it were.¹

When you confuse what you wish were true with what is actually true, you make it impossible to solve real, root problems. You only solve symptoms.

In private practice, wishful thinking shows up in subtle ways:

  • How you plan your schedule: "My day is packed, I hope nothing urgent comes up."
  • How you budget and forecast income: "I'm on track to meet my monthly budget. I hope no clients cancel this week."
  • How you think about your caseload, your energy, your team: "It should be fine to reschedule this client for 5pm... even though their sessions are very challenging."

For me, and many business owners, wishful thinking shows up around my limitations. I don't work as fast as I'd like. My mental stamina isn't what it once was. I'm not a good multitasker. I'm not as good at reading people as I'd like to be. I could go on and on — and I'm not alone.

As business owners, doing it all, the consequences of our wishful thinking don't sit quietly, waiting to be addressed. They insert themselves loudly into our day as problems.

The gap between expectation and reality creates friction—and that friction often shows up in us as frustration.

The mindset shift

See frustration as a signal. It points to a gap between how you expected things to work and how they actually work. Get good at recognizing these moments. When you do, you can stop blaming yourself (or others) and start asking a better question: What's the reality I wasn't accounting for?

Maybe it's a limitation in your plan. Maybe it's a limitation in others. Maybe it's a limitation in you.

That reframe turns frustration into information. And information you can act on.

You're not being pessimistic by accounting for reality. You're being clear-eyed about what it actually takes to do this work sustainably. Adjusting to reality isn't lowering your standards — it's raising your accuracy. It's improving yourself to improve your practice.

¹ This idea comes from Ray Dalio's book Principles. His framing: “Truth—or, more precisely, an accurate understanding of reality—is the essential foundation for any good outcome.”

More from the "Engage with Reality" series:

About the author
Fletcher Dennison, co-founder and CEO of Nesso
Fletcher Dennison

I'm the co-founder and CEO of Nesso. My partner, Will, and I started Nesso after years of hearing therapists say the same thing: nothing prepares you for the business side of private practice. We can't change what grad school teaches — but we can make running a practice easier to learn and manage. Prior to starting Nesso I was SimplePractice's COO, CPO, and first employee.

More posts by this author

Ready to tackle your backlog?

Try for Free
Try new features first, including the EHR
We'll only email you about Nesso. Unsubscribe anytime.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.