182: Bookkeeping For Therapists Behind the Scenes: Gatekeeping vs Alignment

As therapists, we often see bookkeepers as the magicians of our business finances — the ones who keep everything organized, balanced, and under control. I’ve noticed, though, that many of us feel a gap between what our bookkeepers know and what we understand about how money actually works in our own practices. 

In this episode, I talk about some of the defensiveness and gatekeeping that can show up in the financial world — especially around bookkeeping — and how it mirrors what therapists and counselors experience when it comes to how our work is valued and compensated. 

My guest, Sara Walls, has experienced both sides of that story. She started out as a therapist who needed help managing her practice finances and eventually became a bookkeeper who now supports other therapists with their money. Sara actually stepped away from private practice for a while, until she discovered tools like Profit First by Mike Michalowicz and my course, Money Skills for Therapists. Those resources helped her find clarity and confidence with her finances. 

One of Sara’s biggest realizations during that process is summed up beautifully in this quote: 

(00:06:17) “It became clear the more I got into it that what I didn’t know was how much I could actually afford to pay myself, when I could pay myself, how consistently I could pay myself, exactly how much I should be saving for taxes.” — Sara Walls 

In our conversation, Sara shares her journey from therapist to bookkeeper, practical financial habits that therapists and health practitioners in private practice can build, and some helpful ways to make yourself work on your money — especially if you have ADHD or are neurodivergent. 

Reducing Stress and Enhancing Financial Management with Accountability 

(00:02:45) Bookkeepers' Unrecognized Complexity in Accounting Profession 

(00:08:45) Therapist turned Bookkeeper shares financial insights 

(00:19:10) Bookkeepers: Undervalued and Underpaid Professionals 

(00:20:58) Routine Financial Engagement for Reduced Money Stress 

(00:28:44) Financial Co-Regulation for Enhanced Accountability 

(00:30:37) Financial Literacy Training for Therapists 

Establishing Open Lines of Communication & Good Financial Habits for Long-Term Success 

Finding the right financial professional for your practice often means having an honest conversation or even an interview to get a feel for how transparent and open they are when you ask questions, and how they view your roles in the business relationship. Some bookkeepers may hold their cards close as a way to “protect” their value, while some practice owners might not realize just how complex the work of keeping finances straight really is. 

Here are a few ways you can start improving your bookkeeping and financial management skills right now in your therapy practice:  

• Establish a financial routine: Regularly approach your finances, whether it's checking your bank app, updating spreadsheets, or using accounting software like QuickBooks.  
• Systemize & organize: Keep track of your income and expenses in a consistent way. A little automation and delegation can go a long way in helping you stay on top of things. 
• Learn basic accounting: Understanding simple accounting concepts like debits and credits can give you confidence and make your financial decisions much easier. 
• Find assistance & accountability: Work with a bookkeeper who understands the unique needs of therapists and small business owners, and who’s open, transparent, and happy to answer...