Therapists leave group practices for reasons an owner can often change. Two come up in what therapists and owners write: pay a clinician cannot see or trust, and a caseload that was promised and never arrived. The research adds one an owner may not expect. In one trial, staff stayed longer where their work was monitored and the monitoring was presented to them as support.
This matters because a departure costs more than a recruiting fee. A practice that loses a clinician loses the clients who leave with them, the months it took to fill that caseload and the next hire's ramp. The guide to what a therapist hire costs works through that arithmetic.
How common is turnover in mental health teams?
Common, at least in public mental health. A study of 42 teams in a national demonstration project found mean staff turnover of 81% over the study period, with a standard deviation of 46 points, so teams differed widely. Higher turnover went with lower fidelity to the care model at 24 months (Woltmann and colleagues, Psychiatric Services, 2008).
A private group practice is a different setting, and its turnover is probably lower. The shape still holds: when clinicians leave, the work the practice built around them leaves too.
What do therapists say makes them leave?
Kate Walker, a Texas supervisor trainer, names opaque pay and unmet caseload promises among the reasons counselors leave group practices. On pay she writes that "the lack of transparency about where that money goes creates significant tension" (Kate Walker Training, October 17, 2025). A clinician who cannot see how a paycheck was worked out assumes the worst about it.
The caseload side looks different from the owner's chair. Jennifer Contarino Panning, who has about ten employees, remembers a round of hiring this way: "And so I had all these people starting, and it was so hard to get them clients" (Heard podcast, September 2, 2024). A new therapist hired on the promise of a full caseload who is still waiting for clients months later has a reason to look elsewhere.
Does recognizing your best clinicians keep them?
Not on its own, in the one study here that measured it. A prospective study in a publicly funded mental health system found that burnout predicted leaving and that openness to new practices predicted staying. It also found that more professional recognition predicted more turnover (Beidas and colleagues, Administration and Policy in Mental Health, 2016). The authors do not claim a mechanism. One plain reading is that recognition marks a clinician as someone other employers want.
That does not mean praise drives people away, and the study did not test rankings or awards. It is a reason not to count on recognition alone to keep someone.
Can measuring clinicians help keep them?
It did in one trial. A statewide trial in home-based child welfare services followed 153 providers on 21 teams for 29 months. Staff stayed longer where the new practice came with ongoing fidelity monitoring that was presented to staff as supportive consultation (Aarons and colleagues, Journal of Consulting and Clinical Psychology, 2009).
The trial did not compare supportive monitoring with monitoring framed as oversight, so it cannot say the framing alone did it. It does show that being measured did not drive staff out when the measuring came as help. For an owner, the practical reading is to send each clinician their own numbers first, as help with their own work, and not as a ranking posted beside everyone else's.
What to do this week
- List every clinician hired in the last year, the caseload you discussed when you hired them and the caseload they carry now.
- Show each clinician how their pay is worked out, line by line, and answer the questions it raises in writing.
- Look at every report that names a clinician and ask who it is addressed to. Send each clinician their own numbers before anyone else sees them.
- Take down any ranking of clinicians, and keep recognition for the work rather than for a position on a list.
- Ask each clinician hired in the last year what would make them stay another year, and write down the answers.
Sources
- The role of staff turnover in the implementation of evidence-based practices in mental health care, Woltmann and colleagues, Psychiatric Services, 2008.
- Why counselors are leaving group practices and what comes next, Kate Walker Training, October 17, 2025.
- Building a group therapy practice for college students, with Dr. Jennifer Contarino Panning, Heard podcast, September 2, 2024.
- A prospective examination of clinician and supervisor turnover within the context of implementation of evidence-based practices in a publicly-funded mental health system, Beidas and colleagues, Administration and Policy in Mental Health, 2016.
- The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect, Aarons and colleagues, Journal of Consulting and Clinical Psychology, 2009.
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