Most solo therapy practices don’t do an annual review. Year flows into year. Patterns persist that would have been visible in 90 minutes of structured reflection. By year five, things have drifted in ways that would have been correctable in year two.
This is a practical annual review for the practitioner who doesn’t have a business advisor and doesn’t need one. Five sections, 90 minutes, once a year.
When to do it
Pick a consistent month and stick to it. December (calendar year- end), March (financial year-end), or your practice anniversary month — any works. Mine is December. The discipline is annual, not perfect timing.
Section 1: the financials (20 minutes)
Pull out your practice-management tool’s reports plus your bank statements. Look at:
Total revenue. Compare to last year. Up, down, flat?
Sessions delivered. Per month and total. Average per week.
Average per-session realised fee. Total revenue ÷ total sessions. Useful number; usually lower than your published fee because of sliding-scale slots, late cancellations, drop-outs.
Show rate. Sessions attended ÷ sessions booked.
Top operating costs. Rent, software, supervision, CE. What changed?
Net income. Revenue minus costs. Compare year-over-year.
What to ask:
- Is the revenue growth (or decline) consistent with your goals?
- Is the average per-session fee where you want it?
- Are there cost categories that grew without producing value?
- Is your effective hourly rate (net income ÷ hours worked) where you want it?
This section answers: “did the practice progress financially?”
Section 2: the caseload (15 minutes)
Look at the people you saw this year:
Total active clients. Beginning of year vs end.
New clients added. Monthly breakdown if available.
Clients discharged. How many, why.
Average length of work per client. Sessions per client across the year.
Specialisations actually used. Of the work you advertise, what share did you actually do?
What to ask:
- Are you working with the kind of clients you want to work with?
- Are any specialisations under-utilised? (Marketing problem? Real fit problem?)
- Are any client patterns over-represented? (Burnout risk?)
- Is your average length of work consistent with the kind of practice you want?
This section answers: “is the work the work I want to be doing?”
Section 3: the operational stack (10 minutes)
Look at your tools, processes, and time use:
Software stack. What did you pay for? Did each tool earn its keep? Any to drop?
Time use. Of your work hours, what share went to direct client work vs admin vs CE vs marketing? Rough estimate.
Workflow friction. What part of the practice is most annoying? What takes longer than it should?
Storage and records. Are your files organised? Is the backup actually happening? Have you run an export recently?
What to ask:
- What single operational change would save the most time?
- What single operational risk is largest? (Security, backup, vendor stability)
- What needs investment in the year ahead?
This section answers: “is the infrastructure working?”
Section 4: your own wellbeing (15 minutes)
The hardest section. Honest answers required.
Hours worked. Weekly average. Compare to last year.
Vacation taken. Total days off. Compare to last year.
Sleep. Roughly. Better, worse, or same?
Energy at end of work day. Most days, how do you feel? (0–10)
Joy in the work. When did you last enjoy a session? When did you last dread one?
Your own therapy. Are you seeing one? Consistent?
Supervision. Have you maintained it monthly?
What to ask:
- Are you on a sustainable trajectory?
- Are there warning signs from our burnout post?
- Is the practice serving the life or eating it?
This section answers: “can I do this for another decade?”
Section 5: next year (20 minutes)
Based on the first four sections, three specific decisions:
1. One financial change. Fee adjustment, cost cut, new revenue stream, or no change. Be specific.
2. One caseload change. A specialisation to develop, a population to step back from, a referral pattern to build. Be specific.
3. One wellbeing change. Hours cap, vacation commitment, supervision frequency, therapy commitment. Be specific.
That’s it. Three changes. Don’t try to overhaul everything; that fails. Three small intentional changes per year compound across careers.
What not to do in the review
A few traps:
Comparing to other practitioners. Their numbers don’t matter. Your trajectory matters.
Catastrophising small changes. A 10% revenue decline isn’t a crisis; it’s data. Most years aren’t straight up.
Trying to fix everything. Pick three things. Trust the compounding.
Skipping the wellbeing section. This is where most decline gets caught early. Don’t gloss over it.
Doing it with an external consultant who doesn’t understand therapy practice. Most generic business advisors will push metrics that don’t apply.
What practice-management tools should support
A few specific things:
- Year-over-year revenue reports
- Caseload growth/decline visualisation
- Show-rate calculation
- Average session length and fee
- Custom date-range reporting
Most tools have basic reports. MindMaster has the financial side adequately covered; the caseload visualisation is in development.
Sharing the review
A specific suggestion: share part of the review with one trusted person.
- The financials with your CA
- The caseload with your supervisor
- The wellbeing with your therapist
Each of them sees one slice. The integrated view is yours alone.
A close
A 90-minute annual review is the single highest-ROI hour you spend on the practice’s long-term health. The annual rhythm catches drift early, surfaces patterns invisible day-to-day, and forces decisions that get pushed otherwise.
It’s also the rhythm most solo practitioners don’t maintain. The ones who do — even unevenly, even imperfectly — build practices that look different at year ten than the ones who don’t.
For the reports that feed the review, our tool at mindmaster.modoware.com provides the basic data. The reflection itself is yours, once a year, with a notebook and ninety minutes of honest time.