Julia Nepini’s journey from a private practitioner to a collaborative leader is a testament to the transformative potential of self-discovery and growth within the mental health field. In the quest to build a thriving practice, Julia emphasizes the critical distinction between treating the profession solely as a job and cultivating an environment beyond clinical work. Her approach reflects a commitment to nurturing a values-driven team that prioritizes support, collaboration, and individualized care.
Julia’s insights into the challenges of the mental health profession, her dedication to financial stability, and her innovative use of the Enneagram as a tool for team cohesion all contribute to her unique approach in creating a professional environment that values personal growth and work-life balance. In this episode, we delve into the multifaceted facets of Julia’s journey, offering valuable insights and lessons for therapists, business owners, and anyone seeking to create a fulfilling and supportive work environment.
Meet Julia Nepini 
Julia Nepini is a clinical and forensic social worker who owns a group practice, Compassionate Counseling Company, and the consulting business, Compassionate Consulting Company, where she helps clinicians start, expand, and diversify their practices. She is also the host of the Compassionate Climb, a podcast that discusses the challenges of success in business while maintaining integrity.
From Private Practice to Collaborative Leader
Expanding from private practice to a group setting has been a transformative journey filled with stages of growth and self-discovery. This topic holds immense importance as it delves into the pivotal decisions therapists and business owners face along the way. The process often begins with the solo practitioner donning multiple hats and managing every aspect of the practice. As clients start pouring in, the question of expansion becomes an enticing prospect. However, this journey is riddled with challenges, including defining growth limits and how time is best spent.
For Julia the decision to expand was driven by the desire for a more collaborative and team-oriented environment, reminiscing about the camaraderie of previous work experiences. This expansion was not undertaken lightly but was a deliberate effort to create an environment that addresses the shortcomings of past workplaces. Looking back, the journey has been a profound one, marked by trials, errors, and personal growth. The process has uncovered strengths and areas for improvement, ultimately leading to the creation of a highly rewarding and fulfilling professional environment.
Building a Thriving Practice: Julia’s Emphasis on Culture and Collaboration
The distinction Julia emphasizes is indeed crucial when embarking on the journey of expanding a practice. She poses a fundamental question: do you want a practice where professionals come in, perform their tasks, and leave at the end of the day, or do you want to foster a culture that goes beyond mere work? For Julia, the latter was the intentional choice. Recognizing the significance of professionalism, she also acknowledged the unique personalities, backgrounds, and experiences that each team member brings to the table.
Julia’s approach to hiring, done in clusters to cater to community needs and referral trends, evolved over time, driven by feedback from team members and peers. Maintaining accessibility and connection with the team is a priority, with regular one-on-one meetings and a clinician engagement survey to gauge the team’s experiences, goals, and well-being. The practice extends beyond clinical work, with bi-weekly consultation groups, community service, and team-building activities, creating a thriving, collaborative, and fulfilling professional environment that encourages personal and professional growth.
Balancing Autonomy and Support: Julia’s Insights on Mental Health Practice Dilemmas
Julia’s perspective sheds light on a common dilemma faced by many in the mental health field. She rightly points out that a solo practice can be isolating and may not suit those who lack an interest in the business side of things. Her insights resonate with those who’ve been through community mental health settings, where a lack of flexibility, limited control over client assignments, and the pressure to meet specific numerical targets can be discouraging. Additionally, she highlights the shortcomings of some group practices that may lack the necessary touch points, opportunities for collaboration, and a positive work culture that extends beyond the therapy room. Julia’s comments underscore the importance of finding the right balance between autonomy, support, and a nurturing work environment in mental health.
Nurturing a Values-Driven Team
Julia’s perspective on financial motivation highlights her commitment to creating a work environment that goes beyond the pursuit of money. She acknowledges the importance of financial stability and the value of fair compensation but emphasizes that money is not her primary driving force. She demonstrates her dedication to paying her team well, although she admits to initially overcompensating, which required a difficult conversation about adjusting compensation due to business projections. The outcome of this adjustment led to the departure of one clinician who had plans for a solo practice but reinforced the commitment of the rest of the team. This lesson served as a valuable reminder for Julia to clearly communicate the unique benefits of being part of her team, which extend beyond the clinical hour. Julia’s approach prioritizes a supportive and holistic work experience over financial gain, a perspective that has attracted and retained a team that values the same principles.
The Enneagram’s Role in Julia’s Group Practice
Julia’s take on the Enneagram highlights its significant role in enhancing the team’s dynamics and individualized support within her practice. She introduces the Enneagram to her team members after they’ve joined, finding it a valuable tool for expediting getting to know one another on a deeper level. Understanding each team member’s Enneagram type allows her to tailor her approach when working with them. By identifying clinicians with similar Enneagram numbers, Julia fosters connections, encouraging mutual support and understanding based on shared motivations and fears.
This knowledge also plays a vital role in incentivizing good work, as she recognizes that different Enneagram types have distinct preferences for how they feel acknowledged and appreciated, whether through financial rewards or verbal recognition. Julia’s approach to integrating the Enneagram into her practice has been transformative, contributing to a supportive and dynamic work environment where individual needs and work-life balance are consistently addressed through ongoing touch points, written self-assessments, and reciprocal performance reviews, ensuring each team member feels valued and understood.
Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini Gordon Brewer Julia Nepini
Okay, go for it. Hi,
I'm Giuliana piney and I am thrilled to be on the practice of therapy podcast where we're going to talk about team building today in group practice.
Well, hello, everyone, and welcome again to the podcasts. And I'm really looking forward to hearing from Julia lupini. To welcome Julia,
thank you so much for having me. Gordon, I am equally excited to be here with you.
Yes. And Julia and I got to be and be together in person at the y's practice conference back in. Back in Oh, God, I guess October, I guess. Yeah. And in beautiful Savannah. And, and so it was a great conference, and really got to meet a lot of great people. So but, Julia, as I start with everyone, why don't you tell folks a little more about yourself, and how you've landed where you've landed.
I am a licensed independent clinical social worker, my practice is in southeastern Massachusetts. We are an insurance based practice of 20 clinicians called compassionate counseling company. And we really serve the whole family, individual couples family therapy, as well as groups. And it's a great team. I'm very proud of them. And I also do private practice consulting. So I help clinicians start expand and diversify their practices. I was doing that unofficially for all of my colleagues. And it ended up making so much sense to just do that officially. And I love it, it is some of the most rewarding work I've ever done. And then I have a podcast called the compassionate climb where we discussed the challenges of being successful in business while maintaining integrity. It's not as easy as it sounds. So that's been a fun journey as well. Oh,
that's awesome. And I think I think your journey kind of parallels mine and tour as far as the consulting piece, because same thing people started asking me and that sort of thing. So decided to put my shingle out on that in that business there. But But, yeah, why not? I mean, it's a Yeah, so. So Julia, I know one of the things that's really important to you and important to me as well, it's just thinking about how we build, particularly for those of us in group practices. How do we build a culture that is going to be fun for people to be in, but also something that's sustainable? Absolutely.
Yeah, this is a great topic, because it's happened in stages for me, and I think it's so important for people to really give this some thought. So at the outset, it's is private practice for me, business ownership, wearing those hats doing a lot of the things ourselves. And then from there, there's very oftentimes that question, Should I expand, if we're lucky, we get full very fast, it can be hard to say no. And we only have so many clients that we can see. And so we hit this glass ceiling and have to decide kind of where that cap is and how we want to be spending our time. And so for me, that was group, I had worked at a group practice, I had worked in community mental health and private practice was very lonely. And I missed a team environment from the hospital that I had worked in, and the team from community mental health, and that consultation and collaboration. And so I made the decision that I was going to expand, but I did this very conscientiously. And I wanted to do everything in my power to ensure that if I was going to expand, I was going to create the type of environment I would want to work for. And that I was able to provide a lot of the things that was lacking, and a lot of places that I had worked previously. And so at this point, reflecting back, I can confidently say that I have done that it has not been without challenge, trial and error. And it has definitely been a journey for me personally, in terms of really opening me up and identifying clearly my strengths and the things that I can improve on. But it's been one of the most rewarding things I've ever done.
That's yeah, and that's, I think that's true for a lot of us that go into start group practices, we want to create the kind of place that we didn't have when we were maybe most of you know, it's interesting. Most of us in private practice have also worked in agencies and you, you learn very quickly that just I think, for a lot of people is just not sustainable. That sort of thanks. So, yeah, so I'm curious what, what, what was the culture that you were looking for that you couldn't find and what is that for you now?
Yeah, so One distinction, I think is important for everyone to make when they are expanding, do you want the type of practice where people are going to come in, do phenomenal work, and then they leave at the end of the day. And that's that? Or do you want to intentionally create a culture where it goes beyond just the work, that you also have opportunities to collaborate beyond that. And it was very intentional that I wanted the ladder. And I recognize that it's so important to maintain professionalism. But for me, I wanted to view my employees and my team members as just that they are people, they are obviously clinicians, but they are also unique in their personalities and their previous experiences and what they bring to the table. So when I hired, we kind of did it in clusters. And so it was to really try to meet the needs of the community, the number of referrals that were coming in the issues that the majority of clients were coming to us with. And so a lot of it came in time, it wasn't necessarily a pre planned thing, I knew that there were certain things that I needed to have systems that I could replicate meetings, touch points. But we've added in a lot of extra things as time has gone on, because of feedback that we've received from the team members themselves through our interview process, learning from our peers. And so I guess I can kind of go into that. So I Yeah, we try to have some level of connection with the team, I want it to be accessible and available. And so at a minimum, I meet with every team member at a minimum minimum of once a month. And so that is an opportunity to discuss the big picture, but also how they're doing. And so I created a survey that kind of goes along with that, that I administered to everyone. And it's a clinician engagement survey. And so we go into not only what is their experience, then in the practice, and why did they decide to work here as opposed to somewhere else? Because I recognize they can go into practice on their own, they can work other places. Why here? And then in addition to that, it's what are their long term professional goals? And how can we help them achieve that? What is their typical level of stress in any given week, and the main source of that stress rating, their work life balance and things that we can do to assist with that balance, and then reading the quality, I guess, or areas that we can improve? When it comes to the team meetings? Do they find them helpful, and how we can improve that we do your consultation group, so bi weekly, we have divided the practice in half, because we've grown so big, and so they rotate and they present cases, and somebody will take notes. And so it's a great opportunity to present cases, we discuss challenging cases and share resources. But we always make it a point to talk about wins, client wins, professional wins, personal wins. And then it's just evolved from there. We do a lot of community service. So we're very involved in the community. We've done fundraising events, we have collected donations around the holidays. And then we have done gathering. So we always do a fall gathering where our partners and kids are welcome. People have brought their pets, we always do a holiday party. And then we've also done some fun team building things like escape rooms and paint nights. And so it's not a requirement to participate. But everyone is encouraged. And I really feel like it's enhanced the relationships. Right,
right. Yeah. So what did you What have you learned so far about why people want to work at one place, as opposed to another?
Great question. Most people have experienced what I have, they are either not interested in the business side. And solo practice is really not for them, because they recognize that it would be isolating. Or they've had an experience in community mental health, where they didn't like the fact that they didn't have flexibility in their schedule. They didn't have a lot of say in terms of the clients that they were seeing. And they didn't like that pressure of certain numbers that needed to be hit. And then when it comes to maybe other group practices, there weren't as many touch points and opportunities and a culture, that positive work environment that went beyond just everybody working collectively, but maybe beyond just the therapy room.
Right. Right. Yeah. And what's interesting about what you said with all of that, you never said anything about what people get paid. You know, and I think that's, that's significant. And you want to say some more about that. Yeah.
So I am not someone who is inherently financially motivated, I recognize that money is important, I know that it's a necessity. And I recognize that there is value. However, it is not something that is a driving force. And so for me, I definitely wanted to ensure that I paid my team well, I am actually someone who will own that I made the mistake of paying everyone too well in the beginning, and I had to have that dreaded conversation. Unfortunately, my projections were off. And this is the state of the business. And if we keep going this way, it's not gonna look good. And I had to scale back. And I am grateful to say, we lost one clinician whose plan was solo practice, it just expedited that process for her, which is understandable. Everybody else stayed and is still with us today. And we've obviously grown exponentially from there. So that was a huge lesson for me. But I think what you're talking about is I had to get so clear about all the things that I was offering by Pete being a part of this team that went beyond just the clinical hour, and all the things that I'm speaking to really seem to matter to the people that have found us and come on board and state. Right,
right. Yeah, that it's interesting, same, same exact thing for me when I first opened, started my group practice, I started them as contractors. And I, you know, not knowing my numbers, and I just picked up picked the figures that I will give him this percentage, big mistake. And I had to do the same thing, those hard conversations, you know, about, okay, this isn't sustainable. So we're gonna, we're gonna have to regroup. But it was the best decision I may have ever made. And it and it also, like you said, Julia, it really changed the whole culture of, of our workplace and the people that are on board and
sharing that because you feel so isolating, and like you're on your own island when it happens, and we can be our worst critics. And these are hard conversations to have. So I'm grateful. I'm not alone. But I also feel for you during that time, and I'm glad to be bounded. Yes.
That was, yeah, so I learned a lot from that. And I guess when I asked that question, or made that point about the money, I think what is significant to me is people do not work for money. They work for meaning and purpose. And that's Yeah, and I think that's, that's what's got to be in the forefront when you think about hiring people. And also just thinking about why people want to come to us as, as a private practices or progroup practices. But also, that, you know, money, money is important, and people do need to be paid fairly, and that, that sort of thing. And that's exactly, but the big thing is, is that they are really like you've figured out is they are looking for an environment and a place that they can find meaning and feel like what they're, what they're doing is making a difference.
I couldn't agree with you more. And the beauty of it is that when someone commits to your practice, and they are aligned with the mission and your value system, and there is that transparency and the open communication, they are incentivized as time goes on for the great work that they're doing. And it's so incredible to be in this position now. So I hired my first employee may 2021, we're recording in October 2023. So in a very short time, we've grown so much and to be in a position now where not only are we offering medical, dental and vision and paid time off and reimbursement for CES, we provide a lot of in house trainings. Now. We're going to be adding a retirement plan at the end of the year, and it just grows, there's just more that we can do to reinvest in the business and the team. And if people buy in for more than just that initial rate that is listed in your job posts, there's a potential for so much more. Right. So that's been my experience so far. To get here. Right,
right. Yeah. So we're just thinking to about the, when we think about the culture of our practices, what have you found how interviewing people and finding the right people? What have you found has been an important piece and you for you with that process?
The Enneagram
Okay, all right, got
it. In a valuable tool, so I don't introduce that until somebody has already come on board. But to introduce that, once they have it expedites the process of getting to know one another, it helps shift my approach and working with them. I have multiple clinicians that are similar numbers and finding those connections, and they go to each other for support around things because they know who is going to get it and shares the same motivations and fears. And I can also say that it's helped me to incentivize good work, because someone who's an Enneagram, three, achiever is going to be very different than an Enneagram, eight, let's say the challenger in terms of what is it that's going to make them feel that they are acknowledged and appreciated, and for some, it is financial, or like, the tangible fruits of their labor, for others, it's going to be more verbal, and you know, a to is going to want appreciation and acknowledgement, and it has just been so transformative. So that's one thing. But I would also say, really understanding the person in contact. So what is it that they are specifically looking for? Can we meet that, and maintaining the work life balance conversation throughout, it starts with their schedule, and it starts with the types of clients they want to see. And then as they change and evolve, and if they're with us for a period of time, they're gonna go through different phases, that we can continue those touch points, and not only verbally having a conversation and meeting, but opportunities for them to put that in writing. So when we do our performance reviews, I obviously provide that for them, but they get to rate and review themselves, and they get to reiterate me or whoever their supervisor is, so it's always reciprocal. And when I have asked them how they feel it's supported and understood and valued. And that's really, yeah,
yeah, it is it is. So it with your growth, that's another thing is, is that being able to have the right systems and processes in place to support that growth, you want to say some things about that.
Yeah, it's important one of many, not one, the best thing that I did was pick a solid electronic health record, and phone, text, and fax, and email, and all of those things that could grow with us. But then it's also been staying fluid with policies and protocols. So did I have my employee manual complete, when I hired my first clinician, no. But I did have a template. And I continued to add to it. And it is a fluid document that is ever changing and evolving. But you're all collaborative in contributing to that. And when we have a situation that comes up, we come together, we handle it, and then we come together as a team, and what can we learn from this? And is this something that should be in the policy? So I think that that is so important, but I don't want that to discourage people, if they really feel like expansion is right for them. There are several things that you should have in place, and there are other things that can come in time.
Yeah, you want to what are some other things that you can think of besides you know, you know, Electronic Health Record system, that kind of thing? What are other things?
I think the structure, so the organizational structure, that is a piece that is going to come with time as you hire more people, and depending on their licensure level, and the populations that they serve, and how much support they feel that they need, hiring for leadership positions and adjusting titles and getting better at delegating. I also think the other piece is in the unigram has helped with this to identifying people's strengths and capitalizing on it. And then knowing what their goals are for professional development, and are those things we can offer within their time and the practice. So that's another piece that's come in time is regularly checking in around those things, providing those opportunities, seeing it through.
Yeah, and then there's the whole marketing piece of being able to fill up their caseload. And
so I would say that has never been an issue for us. But it is primarily because we are an insurance based practice. And I would say I came from a hospital that is in the same city that our practices located and I had worked there for eight years, and I had form relationships with the doctors and the psychiatrist and the nurses. And so that really helped to fill my practice and then it just grew from there in terms of community and reputation. That is an additional challenge for a private pay practice for sure. But I think that's really been a saving grace for us. Not to say that marketing is still not important. So we have a mailing list for referral sources. We have a mailing list for clients where we're providing practice updates, but also some valuable resources and tips we post regularly on social media, we do blog posting. So yeah, that's a piece that I probably did not anticipate the time investment and the expense. And the importance of to be at the forefront of people's mind as time goes on. Because even though we have enough referrals for therapy, we want our groups to be full. Or if one of our clinicians is offering a training, we want to make sure that enough providers are coming in. And those marketing efforts are invaluable with that. Right,
right. Yeah. So take a little bit of a turn here. My practice is also insurance based. So I think that does, the advantages is that you've got a built in marketing source. And we've really had to put very little effort into marketing our practice. But how was it that you made that decision? Because I think, as we hear the kind of the buzz in most of the kind of the private practice world is to not be insurance based. But I'm curious as to how you came to that decision and why you went that way.
It was never a question for me. So the geographic location, and the area that I have worked throughout my entire career as a social worker, is very disenfranchised. And I knew that if I did not offer insurance, we would be missing a significant portion of the population that is really in need of services. And so it was important to me and part of my mission, that not only are we providing a safe, compassionate place to heal, but that it's accessible, and it's affordable. So what we've done is gotten creative with some of our other offerings. And so I am trained in forensic mental health. So Divorce mediation, parenting coordination, Guardian at litem, or parenting evaluations. And so that's been a service that I've been able to offer the groups. So we do provide some that are obviously, for people that have a diagnosis and are looking for support with their mental health. But then others are just strictly support groups, or we've done workshops, or we provide trainings. And so we've tried to get creative with ways that we can offset some of that because as you know, insurance companies pay what they pay and we are contracted rate and the increases are not existed. And a lot of my negotiation requests have been denied. And I don't want the clinicians to have to be at the mercy of that completely. And so we've got,
yeah, yeah, I love that. Because I think that's been been true for my practice as well. It's just really looking at at at the number really, in a way it's looking at the numbers in a different way. Yeah, absolutely. And the truth of the matter is, when I switched from contractors, to, to, you know, employ having employees, I became much more profitable, even with the lower insurance rates and that sort of thing. So, yeah, yeah, that's
helpful for people to hear, because someone can tell you, but if they haven't actually come out on the other side and have the numbers to back that up, it can be hard to make that jump.
Right. Right. Yeah. And I think it's you and like you said, to think that decision, a lot depends on the demographics of your area. To some degree, I think it also depends on kind of your own personal convictions about offering to use insurance, for clients to use insurance. And all of those things play a factor in that, but I think one message I'd want the audience to know is, is that if you're insurance based, it is very doable, and it is, it is profitable. So yeah, yes.
And I will also say on the other end, that in my consulting work, I have found myself really working with my clients to determine their value system and what is the motivation driving whatever their inclination is to be insurance based or private pay, and really acknowledging that you can make one choice and that can change you can opt to be on insurance panels, but be selective. There are so many opportunities now where cost doesn't have to be a hindrance. And if you are private pay and you do the math correctly, you can still offer reduced rate you can provide super bills there is reimburse the fi there's menta so there you can go either way. I think it really has to start with what's your value system, what type of practice and population do you want to serve? How important is accessibility and you still can find ways to creatively do that if your private pay? Yeah, I'm Mine has been opened for sure. Yes.
Right. Right. Yeah. And yeah, and I agree with every bit of that, because I think that, you know, there's a little bit of a bias, at least in private practice towards being solely private pay. And it is it is simpler, but
you can avoid a lot of headaches. But I am here to say, there are things that you can be doing at the outset and throughout that make insurance much less of a barrier
route, right? Absolutely. Well, Julia, I've got to be respectful of your time, what sort of parting parting thoughts do you have for folks?
So one thing that I would love to offer that's free and available on my website, and I'm happy to share in the link is two quizzes that I created. So if someone is listening, and they're considering starting a private practice, but the idea overwhelms them, and they'd like to gauge where they're at in terms of assessing their readiness, that is one and then the other is are you ready to expand to group practice and develop a team. And so I really took all the steps that I went through considerations, pros and cons, and then coupled that with my consulting, and I actually have all of my new console tees do that survey, because it's such great information to have to really hone in and focus on what would be the most valuable things to pay attention to throughout our process. So right,
yeah. And how can folks get in touch with you? Compassionate
consulting company is the consulting business. And so it's just compassionate consulting company.com that counseling practice is compassionate counseling company, and we are on all of social media and the links are on those pages. And I'd love if people would give a listen to the compassionate climb. I'm really proud of it. And the conversations are exactly what I was looking for. I wanted to find like minded people that share some of my values, compassion, integrity, and be able to talk about some of the challenging aspects aspects of business, but maintain hope and optimism and we can balance out those values and still be successful. So
yeah, absolutely. Absolutely. Well, Julie, I'm glad you are on the on the show here and we'll have links in the show notes in the show summary for folks to connect with you easily and thanks again for being here.
Thanks for having me, Gordon. I appreciate you and all you do
Being transparent… Some of the resources below use affiliate links which simply means we receive a commission if you purchase using the links, at no extra cost to you. Thanks for using the links!
Julia Nepini’s Resources
Compassionate Consulting Company
Compassionate Climb Podcast
Compassionate Consulting Company on Instagram
Compassionate Consulting Company on Facebook
Compassionate Counseling Company
CompassionateCounselingCompany on Instagram
Resources
Use the promo code “GORDON” to get 2 months of Therapy Notes free.
Try Jotform
Instagram Mental Health Templates
Mental Health Wear
The Practice of Therapy Podcast Workshop
The Practice of Therapy Community
Focus Groups
Listen to other great Podcasts on the PsychCraft Network Today!
Google Workspace (formerly G-Suite) for Therapists Users Group on Facebook
The Course: Google Workspace for Therapists
Follow @PracticeofTherapy on Instagram
Meet Gordon Brewer, MEd, LMFT
Gordon is the person behind The Practice of Therapy Podcast & Blog. He is also President and Founder of Kingsport Counseling Associates, PLLC. He is a therapist, consultant, business mentor, trainer, and writer. PLEASE Subscribe to The Practice of Therapy Podcast wherever you listen to it. Follow us on Instagram @practiceoftherapy, and “Like” us on Facebook.