I was in the middle of a session when it hit me.
My client was mid-sentence—something important, something vulnerable—and I realized I was thinking about payroll.
Not fully. Not consciously. But there it was, humming in the background like a browser tab I forgot to close. Did I submit that invoice? Is the new contractor's paperwork filed? What was that insurance thing I was supposed to follow up on?
I caught myself, refocused, and finished the session. But afterward, I sat in my chair for a long time, feeling like a fraud.
This was the work I'd trained years to do. The thing I was supposedly good at. And I couldn't even be fully present because my brain was running a business in the background.
That was the day I realized I had two brains. And they were terrible at sharing.
The two brains
Here's what nobody told me in grad school: running a private practice means becoming two completely different people.
There's Clinician Brain. This is the one you trained. It's present, empathic, focused on the person in front of you. It thinks in sessions, breakthroughs, and human connection. It's why you got into this work.
Then there's CEO Brain. This is the one nobody trained. It thinks in revenue, capacity, systems, and risk. It notices that your collections are slipping and your schedule has gaps. It wakes you up at 3am wondering if you should hire, expand, or raise your rates.
Both brains are necessary. Neither is wrong. But they cannot run at the same time.
When CEO Brain intrudes on clinical work, you lose presence. When Clinician Brain intrudes on business decisions, you make choices based on guilt instead of sustainability. And when both run simultaneously—which is most practice owners' default mode—you do everything at 60% and burn out doing it.
The accidental CEO
Most practice owners I know didn't sign up to be CEOs. They signed up to help people.
The business part was supposed to be a means to an end—a way to do the work on their own terms. Maybe escape a toxic agency job. Maybe have flexibility for family. Maybe just stop having a boss.
But somewhere along the way, the business became its own organism. It needed feeding. It had demands. And suddenly you weren't just a clinician with a practice—you were a CEO who also happened to see clients.
The problem is, you never learned to be a CEO. There was no training for this. No supervised hours. No internship in "figuring out health insurance" or "managing your first contractor."
So you wing it. You context-switch a hundred times a day. You answer emails between sessions, think about scheduling during dinner, and lie awake running mental P&L statements.
It's exhausting. And it's completely unsustainable.
What switching actually looks like
The solution isn't to kill one brain or pretend the other doesn't exist. It's to learn to switch between them deliberately—with clear boundaries, defined time, and actual transitions.
Here's what works for me.
Clinical hours are sacred. When I'm with clients, I'm only with clients. Phone is on airplane mode. Email is closed. My to-do list is in another room—literally, not metaphorically. The business will survive for 50 minutes without me. It always does.
CEO time is scheduled. I block two hours every Thursday morning for business work. That's when I deal with finances, systems, strategy—all the stuff that used to bleed into every other hour. If a business thought pops up on Tuesday, I write it down and tell myself: "Thursday." Most of the time, that's enough to let it go.
Transitions are physical. This sounds almost silly, but it changed everything. Before my clinical day starts, I take a short walk. Even five minutes. It's a reset. It signals to my brain: we're in clinician mode now. Same thing at the end of the day—a walk to signal that work is done. No more lying in bed doing mental billing.
I write things down immediately. The anxiety about forgetting a business task was half the problem. Now I have a single notebook where every CEO-brain thought goes the moment it appears. Not to act on it—just to capture it. Once it's written, my brain releases it. It knows the thought is safe and waiting for Thursday.
The guilt problem
Here's the part nobody wants to talk about: many clinicians feel guilty about CEO Brain.
They feel like thinking about money is somehow dirty. Like wanting a profitable practice makes them less caring. Like the time spent on business is time stolen from the "real" work.
I used to feel this way. Deeply.
And then I watched what happened to the clinicians who refused to engage with the business side. They burned out. They undercharged. They couldn't set boundaries. They closed their practices within a few years because they couldn't make it work financially.
Meanwhile, the ones who embraced CEO Brain—who treated business as a skill worth developing—were the ones still helping clients a decade later. Still loving the work. Still sustainable.
CEO Brain isn't the enemy of clinical work. It's the protector of it. A well-run practice is what allows you to show up fully for clients. The billing, the systems, the strategy—all of it exists so you can do the work you love without the whole thing collapsing around you.
There's nothing to feel guilty about. There's a lot to feel proud of.
The identity shift
The hardest part of this isn't the tactics. It's the identity.
For years, I thought of myself as "a clinician who happens to have a business." The business was incidental. Almost apologetic.
Now I think of myself as "a clinician and a business owner." Two hats, both legitimate. Neither one diminishing the other.
That shift sounds small. It wasn't. It meant I could read a business book without feeling like a sellout. It meant I could have a conversation about profit margins without cringing. It meant I could hire help—actual help—without feeling like I should be able to do everything myself.
Your clinical training taught you one way to think. Your practice is asking you to learn another. That's not a failure. It's growth.
Both, not either
These days, I don't think about payroll during sessions.
Not because I've eliminated CEO Brain—I've just given it a proper home. It has its time, its space, its notebook. It knows when it's welcome and when it's not.
And in return, Clinician Brain gets to be fully present. No background hum. No half-attention. Just the work.
The goal was never to choose one brain over the other. It was to learn that you're both—and that both have a place.
You trained for years to be a clinician. Now you're learning to be a CEO too.
That's not a contradiction. That's the whole job.
