Building a Sustainable Business That Works for You
- 4 days ago
- 7 min read
Written by Rebecca Rae-Hodgson, Chronically Resilient Occupational Therapist
Rebecca is a neurodivergent and chronically ill Occupational Therapist who supports other neurodivergent and chronically ill health professionals to understand themselves so they can thrive. She also develops and delivers trainings, and creates graphics and resources through her online persona, The Chronically Resilient OT.
The journey of building a business does not have to be a relentless climb. True sustainability comes from designing a business that honours your unique capacity, values, and life circumstances. It is not easy, but it is possible.
I hope my personal and professional experience building a private practice as a neurodivergent and chronically ill Occupational Therapist can help others see what might be possible for them too.
This blog post describes three key pillars for building a sustainable business that works for you. It offers insights and actionable steps for fellow neurodivergent and/or chronically ill health professionals, particularly sole traders or those who are self-employed and navigating similar challenges.
My journey: From burnout to a redesigned business
After qualifying as an Occupational Therapist six years ago, I worked part-time in a couple of roles but found that traditional employment did not provide the flexibility I needed to accommodate my disabilities and work sustainably. This led me to start my private practice, Chronic Resilience: Lived Experience Occupational Therapy, three and a half years ago, where I initially focused on providing telehealth and in-person support for neurodivergent and chronically ill adults. I started slowly, alongside a part-time employed role, building my business until I was able to leave the employed role and focus solely on the business. I was having an amazing time supporting clients, creating graphics and worksheets, writing blogs, developing and delivering training, presenting at conferences, and doing things that I love.
However, even while doing what was lighting me up, I kept finding myself in a state of autistic burnout and experiencing chronic illness flares, as I was constantly working beyond my capacity. Seeing even six clients a week was pushing me beyond what was sustainable. I now realise my capacity is more realistically closer to seeing two to four people a week alongside some project work. A significant change in my business was necessary for me to continue working at all.
This necessity sparked a major business pivot. At the start of 2026, I transitioned away from one-to-one client work to focus on supervision, mentoring, and training for other health professionals. The idea was to create a ripple effect. By focusing on supporting other health professionals, I could indirectly have an impact on their caseloads and make a bigger difference while working within my energy limits.
Three key pillars for a sustainable business
When reflecting on what has been crucial for this successful pivot, I came up with the following three pillars:
Key pillar 1: Designing for your real capacity
Understanding and respecting your genuine capacity is the foundation of a sustainable business. It's about moving beyond what you think you should be doing and honestly assessing what you can do, allowing for fluctuations in energy and capacity. Of course, this is not an easy thing to do!
One of the challenges is that my desire to take on new and exciting projects clashes with my limited energy reserves. I see clients two days a week and no more than two clients on any one day. Project work happens flexibly as capacity allows. The mental load of seemingly simple tasks, like context switching between different emails, is significant and must be factored into my workday, along with many other factors. This is further complicated by capacity that fluctuates unpredictably, so you may need different levels and kinds of support on different days.
So, what are some potential action points to help you design for your real capacity?
Honour your limits: Acknowledge that your capacity is not static. It fluctuates. The goal is not to force yourself to do more, but to build a business that can adapt to these fluctuations. Reframe your ideas of productivity, celebrate the wins, and try to apply some self-compassion. What you are doing is difficult!
Embrace “OTing yourself”: Apply the principles of occupational therapy to your own life and business. Consider the person, you, the occupation, what you do, and the environment, where you do it. What are your energy levels? What are your support needs? How can you modify the environment, such as your business structure, work tasks, or physical environment, to fit and support you?
Make the invisible visible: Be open about the hidden costs of your work. Have an email signature or automatic reply that makes your response times clear. Presenting at a conference might look impressive, but it comes with a significant cost in terms of preparation and recovery time. Sharing these realities helps to normalise the need for rest and realistic expectations. I have written about and created resources around the planning, doing, and recovery stages of attending something like a conference and how complex this actually is. Making this side of things more visible is so important, as what people often see is just the highlights, not the substantial effort and recovery required.
Key pillar 2: The power of authenticity and saying no
One of the most profound transformations in my journey, and a core value of mine, has been embracing authenticity. This means showing up as myself, not a persona, and making unapologetic choices that serve my wellbeing. For me to be able to support others, I need to support myself. As the saying goes, you cannot pour from an empty cup!
Being selective about what I say yes to and becoming more confident in saying no is an ongoing learning process, and I am getting better at it. Realistically, I just don’t have the resources to do everything, so I need to make sure that what I do say yes to is values-aligned and within my capacity.
Clients and supervisees have shared that the most valuable aspect of our work together is the feeling of being seen, understood, and not judged. This comes from being authentic and having a shared lived experience, the understanding that struggling does not equate to being lazy or weak, but is a result of navigating systems not designed for brains and bodies that work differently.
Potential action points that support authenticity and saying no:
Define your “no”: Sustainability often means saying no. No to ways of working that lead to burnout. No to expectations, both internal and external, that don't serve you. No to forcing yourself into systems that don't fit. For example, I removed my phone number from my website because unscheduled calls are disruptive for me. Email is my preferred method of contact, and I only had my phone number listed because I thought it was the “professional” thing to do. Remember that “no” can also be a complete sentence, and you don’t need to justify or overexplain.
Create your schedule around what actually works for you: Are you a morning person, or do you work best later in the day? Can you set your hours around supporting these patterns? For me, I don’t see clients before 11 a.m., as I take a long time to get going in the morning.
Find your people: Create or find a community where you can be your authentic self. For neurodivergent and chronically ill health professionals, this is particularly vital. Supervision can be a space not just for clinical questions, but for being truly honest about the challenges of staying well in this work. Peer support and/or peer supervision can be hugely useful as well. You might also find a support or peer group outside of being a health professional, for example, one based on a special interest.
Share your story when useful: Your lived experience is a powerful tool. Sharing parts of your journey, where appropriate, can validate others’ experiences and foster a profound sense of connection and self-compassion. The goal of sharing is to support others’ self-understanding and ability to advocate for their needs.
Key pillar 3: Financial stability and confident decision-making
Financial pressures can make it feel impossible to make necessary changes. For me, gaining access to a disability pension provided the financial safety net I needed to pause most of my income-generating activities for three months and restructure my business. While I acknowledge the privilege of having access to this financial support, financial planning is a critical component for any business owner.
Potential action points that support financial stability and decision-making:
Know your numbers: You don't need to be an accountant, but understanding your income, expenses, and what you need to earn to feel secure is crucial. This knowledge empowers you to make decisions with confidence. It can also help you determine what to say yes and no to.
Explore diverse income streams: Relying solely on one-to-one client work can be precarious, especially with fluctuating capacity. Consider creating products or services that are not directly tied to your time, such as:
Digital resources: Downloadable PDFs and graphics can create a small income stream that helps cover business overheads.
On-demand training: Creating prerecorded courses requires a significant upfront investment of time and energy but can provide a scalable income source over the long term. I currently have two on-demand training courses that are live, where I have used recordings from live training sessions.
Hybrid models: Combine on-demand learning with live group sessions. This allows clients to learn at their own pace and uses your valuable live energy for higher impact activities like Q&A and application discussions. This is a goal of mine for the future and not something I have done yet!
Support: Knowing what support you need in business is important too. Maybe it’s a virtual assistant, a partner who cooks for you, a bookkeeper, a support worker, or a fellow neurodivergent business owner you can call on as needed. Maybe it’s not a person, but a tool, system, or piece of equipment. Whoever or whatever it is, find the support that works for you.
Building a sustainable business is an ongoing experiment. It requires continuous reflection, tweaking, and the courage to design a way of working that is not just successful on the outside, but genuinely life-giving on the inside.
If you’d like support figuring out how to make your business work for you, you can find out more about me and contact me through my website.
Read more from Rebecca Rae-Hodgson
Rebecca Rae-Hodgson, Chronically Resilient Occupational Therapist
Rebecca, otherwise known as The Chronically Resilient OT, is a neurodivergent and chronically ill Occupational Therapist, her core value in private practice is Making a Difference. She combines her clinical knowledge and lived experience to support others through mentoring, supervision, blogs, worksheets and trainings and is passionate about educating health professionals to improve support for a larger number of people. Current special interest areas are neurodiversity affirming practice, the wellbeing of neurodivergent health professionals, values exploration and sensory processing. She lives in New Zealand and loves board games, books and gentle nature walks.
