Only 7% of Therapy Practices Track What They Say Defines Success, New Ensora Health Research Finds

Reviewed by clinical experts at the American Counseling Association and the American Physical Therapy Association, the 2026 Practice Success Report surveyed 1,124 mental health and rehab therapists across five domains of practice health. Just 18% call their practice thriving.

BIRMINGHAM, Ala., Aug. 6, 2026 /PRNewswire/ -- Therapy practice leaders agree, almost universally, on what a successful practice needs: client outcomes, financial health, practice operations, clinician well-being, and client experience. Ninety-five percent say all five matter. Just 7% actually track all five. And only 18% say their own practice is truly thriving, according to new research from Ensora Health. Those findings come from Ensora Health's new 2026 Practice Success Report: The Five Domains of a Thriving Therapy Practice.

By the numbers

The five domains of practice success: client outcomes, financial health, practice operations, clinician well-being, and client experience.

• 95% of therapy practices agree all five domains matter.
• 7% of practices track all five.
• 18% of practices describe themselves as thriving.
• 19% of practices track client experience, the domain they rank first in importance and first in self-rated performance.
• 68% of practices have no reliable way to learn why a client stops treatment early.

Source: 2026 Practice Success Report (Ensora Health, 2026)

The five domains come from our work with more than 28,000 practices. Drawing on that experience, we partnered with industry leaders and conducted research to identify what successful practices have in common, then refined the domains against the responses of 1,124 practicing therapists, with review from clinical experts at the American Counseling Association (ACA) and the American Physical Therapy Association (APTA). The result is a picture of practice health across five dimensions: client outcomes, financial health, practice operations, clinician well-being, and client experience.

"We are excited to partner with Ensora Health on the newly released 2026 Practice Success Report due to the company's strong commitment to helping therapy practices," said ACA CEO Brian D. Banks. "We think this will be a tremendous value-add to our members because we continue to hear from so many of them about how challenging and complex it is to manage a successful therapy practice, especially in this day and age. This is a great resource based on research that details five domains of practice success, which are what set thriving counseling practices apart."

The tracking gap

Across the five domains, what practices believe and what they measure don't line up. Practices rate client experience their most important domain and their strongest, yet only 19% track it. Even financial health, the most-tracked domain, is monitored by just 38% of practices.

• 62% of practices track one domain or none.
• Practices tracking at least one domain report fewer missed billing opportunities (31% versus 44%) and less uncertainty in treatment decisions (31% versus 41%) than those tracking none.
• 81% of practices, thriving and struggling alike, say one clear view across all five domains would help them.

What the data reveals about practice success

• Client outcomes: Just 21% of therapists have a steady, reliable way to see how their clients are progressing.
• Financial health: Financial health is the domain fewest practices call a clear strength, at just 9%, the lowest of all five.
• Practice operations: No-shows and late cancellations are the top operational headaches, named by 47% of practices, yet only about 20% have a defined process to get ahead of the issue.
• Clinician well-being: There's a gap between what owners believe is in place and what clinicians feel day to day. 58% of owners say formal after-hours policies exist, compared with 37% of clinicians.
• Client experience: 68% of practices have no reliable way to learn why a client stops treatment early, which means a meaningful signal about their experience of care goes unheard.

"What struck me was the distance between what practice owners believe is in place and what their clinicians experience day to day. Owners generally want to know how their people are doing. They lack a reliable way to see it. That pattern repeats across all five domains, which is why measurement matters more than adding another policy," said Cleopatra Booker, PsyD, a licensed clinical psychologist and advisor to Ensora Health.

What separates Thrivers from everyone else

The 18% of practices that call themselves "Thrivers" aren't excelling in just one area; they've built a clearer view across all five domains and act on what they see. Thrivers are about twice as likely to feel confident in how clients experience their care (55% versus 27%) and are far more likely to follow up when a client leaves treatment early (44% versus 26%). That follow-up habit is the difference between a practice that learns why clients leave and one that absorbs the loss without ever knowing the reason.

"Physical therapy by nature is patient centered and focused in its approach to providing care. That's not a bad thing, but there is no way to give outstanding medical care without understanding the business aspects that facilitate providing that care. When clinicians can rely on a framework that measures and leverages the successful methods they use and allows them to multiply their clinical impact, that is a powerful tool that benefits the clinicians as well as the patients," said Dr. Drew Contreras, PT, DPT, Vice President Strategy and Innovation, American Physical Therapy Association.

Low-lift by design

None of this calls for a new tracking system or more paperwork. In The Practices Pulling Ahead, Ensora Health's 2026 survey of more than 500 rehab therapists released last month, documentation time adds up to nearly five years over a 30-year career, an administrative burden the same survey tied to near-universal burnout in the field. The habits in this report are built to take minutes, not hours: one metric, tracked on a set day each week.

Cleopatra Booker, PsyD, a licensed clinical psychologist and advisor to Ensora Health, will present the 2026 Practice Success Report: The Five Domains of a Thriving Therapy Practice at APA 2026 in Washington, D.C., in a session titled "Unlocking Success: Your Essential Private Practice Health Check Framework." The session takes place August 6 at 2:30 p.m. and August 8 at 10:30 a.m. at The Exchange, Booth #539, Walter E. Washington Convention Center, Level Two, Hall D. Attendees can also find Ensora Health's TheraNest team at Booth #341 throughout the conference.

The full Practice Success Report includes domain-by-domain breakdowns, the five financial benchmarks every practice owner should know, additional practice leader perspectives, and low-lift action steps for each of the five domains. The report is available at https://insight.ensorahealth.com/practice-success-report.

Ensora Health will publish the Practice Success Report annually and expand the framework toward practice-level measurement as the underlying data matures.

About the research

The 2026 Practice Success Report was conducted by Ensora Health between May 19 and June 9, 2026. The survey comprised 32 questions completed by 1,124 licensed therapists across the United States, approximately two-thirds in mental and behavioral health and one-third in rehab therapy (speech-language pathology, physical therapy, and occupational therapy), and has a margin of error of ±2.9 percentage points at the 95% confidence level. Respondents reported on the practice in which they work and were not restricted to Ensora Health customers; of the 1,124 respondents, 100 were recruited through the research panel UserInterviews.com.

About Ensora Health

Ensora Health is the only software and services company purpose-built for practice success across the full spectrum of therapy, serving mental health, behavioral health, physical therapy, occupational therapy, and speech-language pathology providers under one roof. Trusted by more than 200,000 individual providers and 28,000 practices, Ensora delivers practice management, EHR, e-prescribing, payments, revenue cycle management, and documentation through its two flagship products, TheraNest^® and Fusion. Ensai℠, Ensora's AI, is built into both, taking documentation and administrative work off clinicians so they can be present with the people in front of them. Learn more at ensorahealth.com, read our blog, and follow us on Facebook, LinkedIn, YouTube, and Instagram.

Ensai℠, TheraNest®, and Fusion are trademarks of Ensora Health.

Media contact

Stephanie Wright
Senior Communications Manager, Ensora Health
[email protected]
(614) 499-6291

SOURCE Ensora Health