Profit with Purpose: A Values-Driven Framework for Running a Thriving Therapy Practice

By Kate Fish, LMFT, PMH-C

There's a phrase I've been sitting with for a while now: profit first.

If you've spent any time in the private practice world, you've probably encountered Mike Michalowicz's Profit First — a cash flow management system that flips the traditional accounting equation on its head. Instead of Revenue − Expenses = Profit, Michalowicz argues the formula should be Revenue − Profit = Expenses. In other words, you allocate profit before you spend, building financial health into the bones of your business rather than hoping something is left over at the end of the month.

For therapists specifically, Julie Herres — founder and CEO of GreenOak Accounting and author of Profit First for Therapists — has done the remarkable work of translating this framework into our world. Julie leads the country's largest accounting firm serving mental health private practice owners, and she's been a trusted financial partner of mine at Graceful Therapy for nearly seven years. Her book takes Michalowicz's concepts and applies them with precision to the realities of our field: insurance reimbursement cycles, clinician compensation, group practice scaling, and the unique cash flow rhythms of a therapy practice. If you haven't read it, put it on your list.

I'm grateful for the Profit First framework. It has brought real structure and sustainability to how I steward the finances of my practice. And yet — if I'm honest — something about the phrase profit first has always created a small tension in me. Not because I think profit doesn't matter. It absolutely does. But because, as a values-driven leader, I never want the language of my business to outpace the heart of it.

So let me tell you what I actually believe.

People First, Profit With Purpose

The foundation of how I lead is this: take care of your people, and they will take care of your clients. When clinicians feel supported, valued, and seen — when they work in a culture that honors their wellbeing as much as it honors client outcomes — they show up differently. They bring their whole selves. They do their best work. The quality of care in a practice is inseparable from the quality of the culture inside it.

This means investing in your employees isn't a nice-to-have. It's the strategy.

And profit? Profit is what makes that strategy possible over the long haul. Without financial health, there is no mission. Without margin, there is no longevity. A practice that ignores profitability eventually can't serve anyone — not its clients, not its clinicians, not its community. Financial stewardship isn't at odds with values-driven leadership. It is values-driven leadership.

So when I say profit with purpose, I mean this: profit isn't the destination. It's the fuel. It's what allows me to meet my personal and family goals, to keep Graceful Therapy's doors open, to pay my team well, and to stay in this work for the long term. The Profit First system provides an excellent framework for that stewardship — not because profit is the most important thing, but because without it, none of the important things are possible.

Vocation As The Compass

Theologian Frederick Buechner wrote that vocation is found at the intersection of the world's deep needs and your own deepest gladness. That idea has been a north star for me since long before I opened Graceful Therapy. It's the question I return to again and again as I make decisions about how to grow, what to build, and who to become as a leader.

The needs of my community are real. Access to quality mental health care remains deeply inequitable. Clinicians need mentorship, ethical leadership, and sustainable workplaces. Practice owners are often doing it alone, without the business formation they need. Those are genuine needs — and they happen to sit directly at the intersection of my skills, my training, and the work I care most about.

That's not an accident. That's vocation.

Running a profitable practice isn't separate from that calling. It's what allows me to show up fully in it — to say yes to the work that matters, to invest in the people around me, and to keep building something that lasts.

Blessed To Bless

Underneath everything I've described is a deeper conviction: we are blessed in order to bless others.

Generosity isn't an afterthought in how I run my business. It's the point. The profit, the platform, the practice — all of it is meant to give more than it takes. That looks like equitable hiring practices. It looks like an Equity Internship Program. It looks like showing up at the capitol to advocate for the mental health workforce. It looks like building a consulting practice not to grow my own platform, but to help other practice owners do this work well, with integrity, without burning out.

The goal was never to accumulate. The goal has always been to steward.

What This Means For You

If you're a practice owner reading this, I want to offer you a reframe: being profitable is not selfish. It is responsible. It is how you stay in the work. It is how you serve your community over decades, not just years. It is how you pay your people well, give generously, and build something that outlasts you.

You don't have to choose between people and profit. The best practices I know hold both — with intention, with structure, and with a clear sense of why they're in this to begin with.

That's the kind of leadership I'm here to help you build.