Mentor's frank advice pivots therapy startup toward profitability

Ciara McEnteggart and Yvonne Barnes-Holmes had built something remarkable in the quiet labs of Ghent University. Their process-based behavior therapy model was delivering recovery rates of 70 percent and higher—compared to the 50 percent industry standard across all therapies worldwide. After five years abroad with their research team, they faced a choice that most academics never have to make: stay in the safe world of published papers and university rankings, or risk everything to put their discovery into the hands of working therapists.

They chose the latter. Both women held PhDs from Maynooth University, where they had first met as student and professor. Barnes-Holmes had become Ireland's most highly cited female psychologist, with more than 160 scientific articles to her name. But neither wanted their life's work confined to the rarefied world of academic citations. "We felt what we were doing deserved to have a place in the world," McEnteggart says, "but if we'd stayed it would have meant continuing to chase grants and move to wherever the money led us." In 2020, they returned to Ireland and founded the PBBT Institute in Dundalk, leaving secure academic positions behind.

The timing was catastrophic. Lockdown arrived almost immediately. They had imagined themselves on planes, teaching workshops in rooms around the world. Instead, they were forced to learn Zoom and move their entire operation online—a pivot that, in hindsight, saved them. The digital model made their training accessible to therapists with full-time jobs across the globe. But the business itself was struggling. McEnteggart spent a year chasing investment and fundraising, pulling her away from the work itself. The company was growing, but slowly, and the path to sustainability remained unclear.

Last October, McEnteggart attended the Entrepreneur Experience at Ballymaloe House Hotel in Cork, where 24 emerging founders are paired with seasoned business leaders for a weekend of intensive mentoring. She worked with Julian Costley, an investor in technology and media, who pushed her to think deeper about every aspect of the business. But it was Frank Madden, founder of the Cork-based automation company that would become Catalyx, who shifted something fundamental in her thinking. In the small group sessions, Madden kept returning to the same point: don't overlook services. If you have the capacity to deliver them, do it.

The message landed. McEnteggart returned to Dublin on Monday morning, blocked out the entire day with Barnes-Holmes, and they began dismantling their business model. They had been so focused on training other therapists that they hadn't fully considered offering therapy directly themselves. Within weeks, they launched two new revenue-generating products. By September, they planned to open a PBBT clinic delivering therapy online through therapists they had directly trained. The shift was profound: instead of chasing investment to fund growth, they would grow through revenue.

The clinic launch is expected to push the business into profitability. More importantly, it addresses a crisis that runs through the entire mental health field. Ninety percent of therapists report some level of work-related stress. Burnout is endemic. But therapists trained in PBBT report something different. They tell McEnteggart: "I used to turn down complex clients all the time. I would never see someone with a particular type of suffering, but now I feel like I can take on any client." The therapy works not just for patients but for the people delivering it.

McEnteggart's confidence as a businesswoman has grown alongside the company. She arrived at Ballymaloe hesitant, still thinking like an academic. "I was a confident academic, but I wasn't a confident businesswoman," she says. "At the start, we did things very conservatively." Now, she understands that a wrong move isn't a disaster—it's just a signal to try something else. The PBBT Institute still owns 100 percent of itself, with no external investors. What began as a leap of faith from the security of academia has become something harder to categorize: a therapy company, a training institute, a clinic, a business that is finally learning to sustain itself.