Therapists & Mental Health Practices

You built your practice to help clients, not to manage spreadsheets.

Most therapists start out wearing every hat: clinician, business owner, bookkeeper, HR department. It works for a while. Then the practice grows, the complexity increases, and bookkeeping, taxes, and payroll start taking time that should go toward client care.

Clarke has worked with therapists and mental health practices for over 30 years. Our longest-tenured therapist client has been with the firm for more than two decades. Our average tenure with therapist clients is over seven years. That kind of continuity doesn’t happen by accident; it happens when clients feel genuinely understood.

We know this world. The income constraints of working with insurance companies. The decision of when to hire your first W-2 clinician. The moment a solo practice becomes a group practice and everything gets more complicated. We’ve seen it all, and we know how to help.

I am a new business owner (mental health therapist/private practice). The Clarke team is patient, responsive, thorough, and professional. Very grateful.

-Practice Owner

Support Built Around How a Practice Actually Works

A therapy practice doesn’t run like most businesses, and the accounting shouldn’t be treated like it does. Income comes from a mix of insurance reimbursements and self-pay clients, with all the timing unpredictability that comes with it. You may have W-2 clinicians, 1099 contractors, or both. Owner compensation, practice profitability, and tax planning all look different here than they do in most industries.

We build the accounting around how your practice actually operates, and what clean financial reporting looks like for a practice at your stage.

Ready for a More Organized Practice?

Whether you’re a solo clinician getting systems in place, a growing group practice, or an owner who’s stepped back from seeing clients to run the business. We know where you are and how to help.

Frequently Asked Questions

Yes, and each looks a little different. Solo clinicians typically need organized bookkeeping, quarterly tax planning, and a clean system from the start. Group practices add payroll, contractor management, and more complex reporting. For owners who’ve largely stepped back from seeing clients to run the business, we lean into our partner network and connect you with the right specialists for growth strategy, while we handle the financial foundation. Whatever stage you’re at, we’ve worked with practices like yours.

Earlier than most people do. The best time is before the books get messy: when you’re setting up systems, before you hire the first W-2 employee or 1099 clinician, bookkeeping starts taking time that should go toward client care, or when quarterly estimated taxes start feeling hard to estimate. That said, many practices come to us after a period of rapid growth or disorganization. We can help with that too.

Start with a separate business bank account, basic QuickBooks Online setup, a consistent process for tracking income and expenses, and quarterly estimated tax payments if you’re not on payroll. If you’re bringing on staff, payroll setup is a priority before the first check goes out.

Even solo practices benefit from consistent bookkeeping. It keeps your records accurate year-round, makes tax preparation straightforward, and gives you visibility into what the practice is actually earning, which matters when you’re making decisions about rates, hours, or growth.

Yes. Many practices come to Clarke after periods of rapid growth or inconsistent bookkeeping. We assess where things stand, get records organized and current, and build a clean ongoing process from there.

A W-2 clinician is an employee. You run payroll, withhold taxes, and pay employer-side payroll taxes. A 1099 contractor is self-employed: they invoice you, handle their own taxes, and you issue a 1099 at year-end. The classification has real tax and legal implications and should be made intentionally. We help clients think through the right structure for their situation.

For many therapists, an S-corp election makes sense once the practice crosses a certain revenue threshold, typically somewhere in the range of $50,000 to $80,000 in net profit. At that point, the self-employment tax savings can meaningfully outweigh the added administrative costs of running payroll for yourself.

Our team educates clients on how S-corps work, helps them evaluate the right timing for their situation, and handles the election and setup when the time comes. You don’t have to figure this out alone. It’s one of the most common conversations we have with therapist clients.

Insurance reimbursements come on their own timeline, not yours. Consistent monthly bookkeeping and cash flow reporting give you a clear picture of where the practice stands at any point, so you can make informed decisions about hiring, distributions, or overhead rather than guessing based on what’s in the bank.