What would you do if half your clients didn't show up—and you couldn't do anything about it?
That was Debbie Caudle's reality as a therapist accepting Medicaid clients in 2011. When patients no-showed, she couldn't hold them financially accountable. She and her staff would lose half a day's revenue, just gone. The “guaranteed” government money came with invisible costs that were bleeding her business dry.
So she made a decision most people would call reckless: she dropped Medicaid. Then she dropped insurance entirely.
The result? She lost most of her clients overnight. But the handful who stayed—and every client she's attracted since—changed everything about how her business operates.
When Skin in the Game Changes Everything
Here's what Debbie discovered: when people pay out of pocket for therapy, they show up differently. They're invested. They do the homework. They engage with the process. The quality of her work improved because she was working with people who were genuinely committed to change.
But there was another hidden benefit she didn't anticipate. The insurance model forces therapists to diagnose mental health disorders—even for couples who just want marriage help. That anxiety diagnosis for a 16-year-old? It can follow them into military service applications. That depression label? It might affect disability qualifications down the road.
By going direct-pay, Debbie freed herself to actually help people without the constraints of a third-party system that has completely misaligned incentives.
From Physical Practice to Virtual Powerhouse
Today, Debbie runs a thriving virtual marriage coaching practice from her home. She's worked with clients everywhere from Sri Lanka to New Zealand. She's built a six-month high-ticket program, created self-paced courses, written a book, and produces a twice-weekly podcast—all while maintaining the freedom to decide exactly how big she wants her business to be.
Her secret? She stopped trying to do everything herself.
“You can become the bottleneck in your own business,” she told me. “When I recognized that and said, ‘I need a team and I need to trust that they know what they're doing better than I know,' it changed everything.”
She hired a virtual assistant in the Philippines. Her husband edits the podcast. They brought on someone specifically for YouTube SEO optimization. Each hire freed her up to do what she does best: create content and coach clients.
The Mindset Shift That Unlocked Growth
But perhaps the most powerful insight Debbie shared was about money decisions. Instead of saying “I can't afford that” (which slams the door on possibility), she asks “How do we figure this out?”
That small linguistic shift moves your brain from shutdown mode to problem-solving mode. The door stays open. Options appear. Solutions emerge.
“I've yet to be homeless. I've yet to not have food on my table. I've yet to not be able to pay anybody's salaries,” she said. “And over and over, I've learned that lesson: stop making fear-based decisions about where the money is going to come from. The moment I shift my mindset to ‘we need this and we're going to figure this out,' it always works out.”
What Service Providers Can Learn
Debbie's story isn't just about therapy—it's about any service business where you trade expertise for money. Whether you run a membership site, consulting practice, or agency, the principles apply:
- High-intent clients produce better outcomes (and are more enjoyable to work with)
- Delegation isn't an expense, it's leverage that frees you to do what only you can do
- Your business model shapes your client experience more than you realize
- Success isn't just revenue—it's building a life you actually want to live
As Debbie put it: “At the end of the day, you gotta be able to stand in front of the mirror and like who you are. Which means you gotta have time to show up for your family, your spouse, your friends, yourself.”
Learn more about Debbie's approach to marriage coaching at debbiecaudle.com.
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