The 4 Things I Would Do Differently If Starting My Practice From Scratch in 2026

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If I were starting my private practice from scratch in 2026, I would do things very differently.

Not because private practice is dead.

Not because AI has made therapists irrelevant.

And not because you need another 47 certifications before you're allowed to charge what you're worth.

Quite the opposite.

I would get much more intentional from the very beginning.

Because the practice you build is going to be shaped by the decisions you make before you ever have a full caseload.

What you train in.

What you charge.

Who you position yourself for.

And who you spend your time around.

After 10 years of helping therapists build premium cash-pay practices, Tiffany breaks down the four things she would do differently if she were starting over today.

And some of them are probably not what you'd expect.

Because if you want to build a practice that is genuinely differentiated in an increasingly crowded and AI-driven marketplace, being another therapist who does another modality isn't enough.

You need depth.

You need a Life First Fee.

You need a niche that creates demand.

And you need to be extremely intentional about whose advice you're listening to.

In this episode, Tiffany explores:

• Why she would invest in a year-long psychoanalytic training program if she were starting her practice today

• Why depth-oriented clinical training may become even more valuable as AI takes over formulaic, standardized approaches to mental health

• Why she would determine her Life First Fee BEFORE looking at insurance reimbursement rates or asking other therapists what they charge

• How to stop setting your fee based on fear and start setting it based on the life you're actually trying to create

• Why your modality, certification, or specialty isn't necessarily your niche

• What R³ — Resourced, Ready, Recognized — means when you're building a premium cash-pay practice

• Why "I work with anxiety, depression, trauma, and EMDR" doesn't necessarily give a potential client a compelling reason to choose you

• The difference between someone who has a problem and someone who is ready to solve it

• Why your ideal client needs to recognize themselves in your language and positioning

• Why Tiffany would stop spending time networking with the average therapist if she were building her practice from scratch

• The rare exception to that rule — and the kind of therapist she WOULD want to build relationships with

• Where your time and attention need to go if you're trying to build a practice around $300, $400, or $500+ Life First Fees

Because here's what changes when you stop asking,

"How do I get more clients?"

and start asking,

"What kind of practice am I actually building?"

You're no longer trying to fit yourself into the existing mental health marketplace.

You're making deliberate decisions about your expertise.

Your fee.

Your positioning.

Your relationships.

And the people you want to serve.

And maybe most importantly, you're no longer allowing the fears and limitations of the average therapist to determine what you believe is possible for your own practice.

Because you don't need to build the practice everyone else is building.

You need to build the practice that supports the life you actually want.

And if you're already years into your practice, don't write this episode off because you're not "starting from scratch."

The same decisions still matter.

Your fee can change.

Your positioning can change.

Your referral relationships can change.

And the people you're spending your time around can change.

You can decide to stop building from where you've been and start building toward where you're going.

If you're ready to do that, email Tiffany at tiffany@leaninmakebank.com with the words "I'm Ready."

Because you don't have to start over.

You just have to start making different decisions.