The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome again to the podcast and I'm really excited for you to get to know today. Bree Chrisman. Welcome, Bree. Glad you're here.
Brie Chrisman: Thanks so much, Gordon. I'm happy to be here.
Gordon Brewer: Yes. And, uh, we, um, we ran into a few little glitches with our timing before we started, but here we are and we're, yes, we're humans and we're gonna make it work.
So yes, Brie, as I start with everyone, tell folks a little more about yourself and how you landed, where you've landed.
Brie Chrisman: Yeah, thank you. So, I again, am Brie Chrisman. I am the CEO and founder of Bosco. We are an operations agency that supports mental health practices for their operations and backend support.
Really so that they can grow and scale in the way that they want to without burning out, without overloading themselves and really creating the life that they want to. Um, we started, I started the company about five years ago, um, as just a general, um, operations assistant company that worked with all different industries.
It was the middle of the, you know, the first year of the pandemic. Um, and it really. I decided after getting laid off from my job that I could do all the thi, all the things I'm really good at for myself instead of for someone else's, uh, you know, someone else's financial gain and, and professional gain.
So I started in July of 2020 and one of my first clients was a therapist. Um, a wonderful person I still work with and I'm really good friends with today in New York City. Um, and within a couple years, 90% of our clientele was therapists and we decided as a company that we. Loved the mental health industry.
We loved supporting mental health therapists. And so we decided, um, in the, at the end of I think 2023 to go all in on mental health. And since then we have been able to provide education free resources, uh, support from ops, you know, operations, day to day management, all the way up to practice, uh, fractional practice directing, um, with our clients.
And we've really been able to. Make an impact by helping our clients make an impact in their clients' lives.
Gordon Brewer: Awesome. Awesome. Yeah. Yeah. That's, um, just the whole operation side of things people don't really think about. Yeah. And one, one of the things I know that we chatted about before we started that I think is gonna be really interesting to the folks listening is just, um, ways to increase your profit without increasing your work, because that's, um.
That's something that, um, I think all of us, uh, recognize per, especially if you've been in practice for a while, is, is that you can reach a kind of a point to where you just can't do anymore. And Yeah. And just recognizing, okay, but I need to, I would like to earn more, but I just can't do anymore. So, yeah.
Te tell us kind of what you've kind of come up with and the things that you have learned and share with other therapists.
Brie Chrisman: Absolutely. So a lot of times when we think about practice growth, the first thing that people are gonna tell you is you need to add more clinicians. You need to add more clients, you need to do marketing and do Google ads and all of this stuff.
Well, the problem with that is that you are one person. You have 24 hours in a day. You do not wanna be seeing 25, 30, 35, 40 clients in a week. 'cause that's crazy. Um, it's just not sustainable for you, for the people around you. Um, people don't have huge budgets for Google ads. You know, there's, people don't wanna market.
You have enough to do as a practice owner. You know, you're, whether you're a solo practitioner or a group, um, practice owner, you have way too much on your plate. You don't need to be adding more. So something that we always. Try to remind people is that profit equals revenue minus expenses. So there's two parts to that.
So when you're looking at marketing, when you're looking at adding clinicians or adding clients onto your caseload, that's all from the revenue side, that revenue, um, generating side, but that's also. Generating more to put on your plate. Mm-hmm. And so we look at the expenses side and say, okay, how can we streamline things?
How can we help with not only your financial bottom line, but also your time bottom line? Um, and also we take into consideration executive function, decision fatigue, things like that, and really focusing on how you can best use your brain. Because as, as we know, as a business owner, you wear 70 different hats and
Gordon Brewer: Right.
Brie Chrisman: In really specifically where mental health therapists, you are holding so much for your clients and there's so much more of an emotional piece there that you don't, at the end of the day, if you have a couple hard sessions, one hard session, even just a like five or six easy sessions, it's still so much that you're having to process and having all of that business owner.
Things that you have to do on top of that is, can be so strenuous. So we look at, um, a lot of times we'll do an expense audit and look at your bottom line and see what can we cut out, what can we, um, you know, if, if there's software that you're not using or if there's software you're paying too much for, or, um, things that we can shift to a different model.
Um, looking at, you know, how you're spending your day. Are you jumping from. Client to notes, to social media posts to QuickBooks, to emails back and forth, or are you actually budgeting your day and making sure that you are really intentional with your time?
Gordon Brewer: Mm-hmm.
Brie Chrisman: Um, and then really looking at streamlining.
There's not, you know, you can automate a lot of things, um, in a business you can't automate as much in a healthcare business because of PHI. Uh, but there are ways that you can. Streamline your processes, like email templates. My favorite example to give is say you have leads coming in from psych today, my wellbeing, Zocdoc, wherever, um, and you are.
Sending an email, it takes you five minutes to write, like, thank you for responding. This is, you know, the back and forth of scheduling whatever. If you write one of those emails per day, say five days a week, 50 weeks a year, that's almost 21 hours of your time writing that single email. That is insane. And so, mm-hmm.
Like, just, if you think of it that way, 'cause if you're like, oh, well it's just, it takes me five minutes, it's not a big deal, but five minutes times, five minutes or five minutes plus five minutes plus four minutes is a lot of time. And so even just creating a template for that email that drops it down to 30 seconds, um, you think of like 21 hours times, whatever your hourly rate is, that's a lot of money left on the table.
That's a lot of money that, you know, that time could be spent doing something else. Mm-hmm. Um, and really for. For that one email. We'll stay on the same analogy, same example. Um, if you were doing something completely different and then you saw the email pop up on a tab on your browser and you switched to that, you are creating decision fatigue, fatigue for yourself.
So, you know, think of as, I'm sure I'm telling everyone that's listening things that they probably tell their clients all the time, but I know that it's mm-hmm. Really good to hear it from somebody else too. Right. Um, but. You have, you know, a decision picture and each decision you make, you get less and less and less.
And so by the end of the day, if your picture is empty and you need to figure out what's for dinner, that's when you know you're like, I just can't anymore. Mm-hmm. So think about when you're, say you're doing notes and you see that email come in and you wanna jump on it right away. Well, switching from a notes brain.
Wave to writing an email, you're deciding to switch to that tab, deciding what to write, deciding when to send it, going back, trying to get back into that mindset of notes. Mm-hmm. That messes with your executive function so much and so being able to really utilize a template or utilize that time blocking or task batching, things like that really, um, can really help with.
Lowering expenses, and it doesn't seem like that. You think you're listening to this and you're saying, Brie, that that doesn't lower my expenses. But it does. 'cause then you're able to. More efficiently do things and then you're able to stay in the right mindset and all of that, you know, the psychological piece of that, which I don't have to explain to, to the people listening.
Gordon Brewer: Right, right. Well, yeah, and it is a, you know, one of the things that, um, I think is a, a, a low hanging fruit for a lot of people and just being able to, um, increase their, their. Lower their costs, really increasing your revenue. We're not talking about that, but just lowering your costs. Um, if you're spending, if you have to give up, you know, a session with a client to do a lot of those admin, admin tasks, that's, that's a cost for you.
Yes. Uh, cost of your time, absolutely. Cost of your money, those kinds of things. And so I think it's important to kinda think about it in that way.
Brie Chrisman: Yeah. It, it really is. You're right, Gordon. And it. It's something that if you have, like say you don't have a team or you have one or two clinicians, you don't have anybody on the admin business side, and you're like, I don't really need to, I can handle all of it.
Think of it as like in terms of. Hourly tasks, an hourly rate. So if it's a $200 task versus a $20 task, if it's a $20 task that you are doing when you could be doing a $200 session, you should not be doing that task. And it may seem like an added expense to bring on an admin and you know, yes it is.
However. It's also a gain for you, and the return on investment is so much greater if you can pass those tasks off to someone, that you can focus your brain on what you do best, which is the clinical side. Whether it's, you know, if you're large group practice, small group practice, whatever. If you're supervising, if you're leading a team, you can focus on those things and the little tasks, the $20 tasks, the $10 tasks, whatever.
Those can be passed off to somebody else. It frees up your brain. It just creates a really great return on investment, which will eventually increase your profit.
Gordon Brewer: Yeah. Yeah. And I, and I think that's, um, something, um. That I've, I've been working on or reworking or rewriting my private practice startup guide.
And one of the things, uh, that I think is an an important mindset thing is just to think about things in, in terms of the return on the investment.
Brie Chrisman: Yeah.
Gordon Brewer: And, um, yeah. And I think, um. You know, based on, you know, what you're, what you're talking about is to ask yourself, okay, what is the return I'm getting on either this task or what I'm spending money on?
All of those kinds of things to really, um, kind of do that inventory.
Brie Chrisman: Yeah, absolutely. It, it is so important and a lot of times we tell people to do a time audit or a task audit. Mm-hmm. Um, which I'm sure you've recommended to people a lot. Um, and I'm sure a lot of people listening have recommended to their clients.
Um, it doesn't have to be perfect. It doesn't have to be exact, which is having like a, I have a notebook right here. I actually have. On a notepad right here, it says things to pass to Danny, who is my assistant. And so I have this sitting on my desk right now. I made it this morning, uh, because we had a meeting yesterday and she was like, I feel like there's so many things you're doing that should be my job, so I need you to write them down.
Mm-hmm. So we can pass them off. And she's amazing. So she's. You know, she knows me and she's like, no, Brie, this is my job. You have to give them to me. Right. Um, which delegation is hard. It is hard. Yes. Yes. Speaking from experience. And I, Uhhuh will get on my soapbox about delegation, but it's still difficult for me too.
Um. Mm-hmm. But you know, if you just write things down as you, as you're doing them, if you're like, if you're intentionally, if you intentionally have it in the back of your head of. This isn't a task I should be doing. This is like writing an email. You're like, I should not be doing this. This is not what I wanna be spending my time on right now.
That should immediately go on your list 100% of the time.
Gordon Brewer: Yeah. Looking at, look at the, looking at the energy drainers. Um Yes, yes. And going through,
Brie Chrisman: yeah. Going through that, uh, you know, gay Hendrix and the Big Leap, you know that, have you read that book?
Gordon Brewer: I, I'm familiar with it. I've not read it yet. Okay. No.
So
Brie Chrisman: it's, um. I like, I pick out different things in his ideologies and everything, but it's the difference between, um, zone of genius, zone of excellence, things like that. And if you, if it's in your, if it's not in your zone of excellence or zone of genius, you should not be doing it. If it's in your zone of excellence and you're just really good at it, if it doesn't take your specific brain.
You were, you can easily teach it to someone else and delegate it to them. Mm-hmm. Um, and you know, that's when standard operating procedures and, um, task audits, things like that come into play because, and this could be a whole different podcast episode. Mm-hmm. But, um, when you are bringing on, say, your group practice center and you're bringing on clinicians, if you have policies and procedures in place, if you have step-by-step instructions in place, if you have standardized.
Ways of doing things, you can really figure out a way to make sure that one, the standard of of care is excellent across the board, no matter who is seeing them, whether who they're talking to, whether it's an admin person, a different clinician yourself. Um, but as, as any group practice owner knows, it's way cheaper to retain clinicians than it is to constantly hire because mm-hmm.
You know, it can take up to six months or more to get a full-time caseload for that person. And so. You know, it's, it's an in, it's a unique way of bringing people on. 'cause like, I can bring someone on and once they hit a certain number of hours a week, I can just give them more work and they're, you know, they're making money for me.
Um, but obviously it's not the same in the mental health space. You know, you have to make sure that you're vibing with a client. You have to make sure that your client load. Matches, you know, your, your interests, your expertise, and it has to be a good match. And so it does take longer and, um, anytime that we can retain and create those standardized procedures and standard does not mean boring.
Mm-hmm. It can be very unique and can be very your feel. Mm-hmm. Um, but anytime we can do that again, it, it goes back to that return on investment.
Gordon Brewer: Yeah, yeah, yeah. You know, one thing I, I was thinking of as you were saying all of that, Brie, is, um, you know, the part of the problem, uh, with delegating for a lot of people or what they think is a problem is, um, having different tasks that we've done.
Um, as practice owners for several years, and we have just in our mind how to do it and we know how to do it and to explain it or teach it to someone else just seems, um, kind of a big task. So, yeah. What, what, um. What advice do you have or what ideas do you have about, about that particular problem?
Brie Chrisman: Yeah.
Uh, that is not just a therapist issue, that is a business owner or a leader issue in any business, anywhere that's anyone who's ever had to learn to delegate is, is dealing with that. Um, so you're not alone is what I'm saying. Um, what I typically try to do is when I'm trying to teach someone I use. Um, a tool called Loom.
It is a mm-hmm. Video. I'm sure you've used it Gordon, but mm-hmm. For anyone who doesn't know, it's a, it's a video screen recording tool where you can record your screen and record your voice or yourself, um, as like a voiceover, which is great. Uhhuh obviously there's some limits because you can't, you know, go into your EHR and have.
All of your client list and everything on there, because there it is not HIPAA compliant. Um, but for admin things, for business related things, it's really, really great. Mm-hmm. Um, for the stuff that has PHI, I do use a, like a Google doc. Um, if you have or you're, you know, a BAA signed with Google Workspace or whatever, you know, software you're using.
Um, but when I'm doing the task next, it takes maybe 10 to 15 minutes extra for me to write it down as I'm doing it. Um, mm-hmm. Because then it doesn't feel like this big huge task. It feels like, okay, well I'm already doing it. Let me just take a couple extra minutes and write it down. 'cause then you're guaranteed to not miss the step.
'cause you're a actively doing it. You're not just trying to brainstorm, remember all those steps. Right. Um, and you're, you know, especially if you're doing that loom video, you can talk over it and be like, you know, this is how you do it. But also this is a hint and a hot tip that I've learned. And so you can really bring.
Your feel. 'cause if you like to do it a very specific way, that's a really great way to add that in there. 'cause you're already doing it and you're already mm-hmm. In the process of doing it. So it takes way less time. It feels way less overwhelming. Um, but if you have your little, you know, pad of paper and you know what to delegate.
Um, then that is your list of things that you need to create your standard operating procedures for. And I would argue that even if you're not delegating a task, create a standard operating procedure for yourself. Because on those days when you are burned out, you are overwhelmed. You have all of the brain fog, brain fog, and none of the executive function uhuh, you can just pull up that task you've done a hundred times.
I mean, I feel like we've all done it. We've looked and we're like. Where do I start? I don't remember. Even though we've done it so many times. And so just pulling up a step by step, you can get that task done without using as much brain power. And so that's really great. Four days that you're having like a really intense caseload or you know, you're just having a really crap day, you didn't get in a lot of sleep, things like that.
Gordon Brewer: Right, right. Uh, you know, you mentioned the Loom app. The other thing that's nice about it is just you can record your screen as you're doing things. Yes. And so that's, that's a really, really cool feature. Um, you know what, one of the things too, I know I've done that in the past, I know, uh mm-hmm. You know, I think, okay, I need to teach this to somebody else.
And, um, thinking, okay, I don't even know where to start writing this down. Yeah. But like you said, is to be able to just start doing the task and then narrate it as you, as you go through it. And one, one of the benefits too of doing that is a lot of times if you do that. You figure out, oh, here's a shortcut that I didn't even think about.
Yeah. Or here's a, here's a thing that I could be, do di be doing differently, you know? Yeah. As you explain it to, to people. Yeah. And that sort of thing.
Brie Chrisman: Yeah. 'cause you're saying it out loud. The amount of times my team knows and I get made fun of all the time and you know, a very kind way. But they're always like.
My videos are hilarious. Basically, I just ramble and I'm mm-hmm. It's just like, oh, well let's just do this. And it's not a very, like, this is a Loom video on X, Y, Z, and we will be going through these processes. It is not corporate. Yeah. It's like, Hey, what's up? This is what we're doing. Yeah. And the amount of times also that I'm like, oh, wait, oh, I didn't know you could do that.
Hold on. And I like pause it and figure it out and then I uhhuh start recording the video. It's like, okay. Let's, let's regroup and do this again. Right. So it just, it's nice that it captures, you know, it captures that. And that's just how we roll at Bosca. We're very, you know, we're very laid back. We're very, you know, if it we're just very personality, human driven and that's just how I operate.
And, um, but they get a lot of extra content out of my videos because I am, you know. Showing them the process, but also talking through it in a way of like, oh, I've actually figured out you can do X, Y, Z, and it's. You get those, that extra information where you don't get that from like a step-by-step document, like written document.
Gordon Brewer: Right, right, right. And the the other thing too that happens is a lot of times they'll watch it and then they'll have questions like, uh, well, why are you, help me understand why you're doing it that way. It seems like you'd be more, make more sense to do it this way. Mm-hmm. And they, they actually come up with a better way of doing things and so, yeah.
Which is
Brie Chrisman: great.
Gordon Brewer: Yeah. Yeah. Yeah. And so I think, uh, that, I think that. Yeah. That's such a good point is, is that I think the trouble with delegating is, is we have this myth that we tell ourselves that we can only, we can do it the best. Yes. But in reality, a lot of other people can do it probably better.
Yeah. Just as, just as good.
Brie Chrisman: Yeah. We're not always the smartest person in the room. Everyone's brains work differently, which is the beauty of running a business, being in the world. Mm-hmm. Um, and I really find that. When you can get other people's perspectives, it's so much, it's so great. Um, and if they can find a better process, great.
I would love that. Um, and it's the beauty of coming together and making, that's how you can really find success. Mm-hmm. I will say though, too, if you are, you know, using your loom videos or whatever is training, um, if it is a really like tried and true process, you've got it down. It's great. If somebody asks you how to do something, you can just be like.
Go watch the Loom video. Mm-hmm. If you have questions after that, let me know. But that way, if you have a, you know, database, even just a spreadsheet of links of this is how you do these things, they can go to that without bugging you, and you don't have to stop doing what you're doing and go and explain it to them because you've already done it.
So if you, especially for, um, practice owners that are growing a group and growing groups rapidly mm-hmm. You know, group practicing hiring rapidly. Think of how many times you have to explain the same process over and over and over again. You do it once. You don't have to do it again unless you change the process.
And so that cuts down so much time. It also provides a really great onboarding experience for clinicians. And there are studies that show that the better the onboarding experience, the longer they stay. Mm-hmm. And that again, return on investment.
Gordon Brewer: Yeah. Right, right. Yeah. So, um, Bree, I know we need to be aware of our time, but uh, yeah.
I guess, um, one of, I'm, I'm curious as to other areas that maybe people don't think about besides just kind of how they're delegating and automation. What are some other ways that people can really kind of increase their profit, uh, uh, that they might not be thinking about?
Brie Chrisman: Uh, I would say client onboarding is a one of the top processes that we look at.
First and foremost, when we come into a new client's practice, that's the first thing we look at because there are so many times where from lead, you know, when a first lead comes in, or even when someone's looking at your website, looking at your site today profile, we wanna make sure that the barrier to entry is as low as possible.
So that way. You can grab those people that are searching at 1:00 AM that are having, you know, a kind of a spiral moment. Mm-hmm. Because how many times have therapists, you know, anyone listening, you have some, a lead come in from psych today or somewhere at 2:00 AM and then you reach, uh, 2:00 AM on like a Saturday and you reach out to them Monday and they're like, Nope, I'm good.
Thanks. Mm-hmm. Because then they, you know, they get some sleep and they're like, oh, okay, I'm fine. But then guaranteed in a week they're gonna be spiraling again and mm-hmm. I can say that because I've been that person. Yeah. Right. I've been that, that, that client. Um mm-hmm. And so you wanna make sure that everything is optimized from the marketing standpoint.
Um, but once they get into your orbit, once they get into your. Funnel, and it sounds kind of crass when you think of mental health clients as a lead, you know, a sales funnel, but at the end of the day it is. Mm-hmm. Um, and if you can separate the emotion and the personable part of it and really look at the business side, it is a lead funnel and sales funnel.
And so getting those, that's the best way to think about it when you're trying to streamline it. And so. Maybe that looks like, okay. Making sure that your online scheduling is turned on for consults and so they can go through the process, reach out to you, get an automated email or something like that, and automatically book a consult.
Mm-hmm. So that way you capture them in that moment. Um. Making sure they get to the consult, making sure you're sending follow-up emails or confirmation emails. Um, you know, if they're, and this is kind of going back to that standardized process too. If you have it written down and every client gets the same process, you can really see where our clients are falling off.
So if they're falling off after the lead inquiry, okay, do we need to send more follow ups? Mm-hmm. If they're falling off after the consult, let's look at that consult, what's being said? Do we need to do some role playing? Do we need to have a script for that? Um, if they're falling off before their first appointment, you know, they never filled out paperwork.
Okay. Again, do we need to send more follow ups? Do we need to make it a little bit clearer on what the process is, what to expect? And so doing that and having that standardized process will get people through your door and get through the process faster. And it will be really, there won't be any barriers to entry except maybe they're just not a good fit for you.
But if that's the only barrier to entry, you will be able to onboard clients a lot faster. You'll be able to onboard a lot more clients. Um, as long as you're hitting, you know, the audiences that you want to be hitting. Um, which obviously that brings in more revenue.
Gordon Brewer: Yeah. Yeah. That, and, and that's, uh, I think that's a process that people don't really think about much.
Yeah. I is their onboarding process. I know. Yeah. Uh, my good friend Uriah Guilford and I were talking, um, yesterday as a matter of fact, just about that. And one of the things that he's. He's working on. Um, it is just how we can tap into AI to help with that process. Mm-hmm. And so being able to, to look at those different, different ways of doing that.
So yeah. Yeah, there's, so yeah.
Brie Chrisman: It's, it's definitely, I think it's the most important process that a practice can have. If you can optimize that, the rest we can deal with later. But if you can't bring in clients in the door, you don't have a practice.
Gordon Brewer: Sure, sure. Well, Brie, I've gotta be respectful of your time.
What sort of closing thoughts do you have for us today?
Brie Chrisman: Um, really, uh, my advice always is to lead with your gut and ask for help even if you don't think you need it. Because everyone deserves help. Everyone needs help, and that is really, um, what will. Differentiate a solo practitioner that's kind of struggling with profit and bringing clients and someone that is really thriving in their practice.
Mm-hmm.
Gordon Brewer: Yeah. Yeah, totally agree. And I know that's something that I wish I had done early on when I first got started is seek more help trying to
Brie Chrisman: same,
Gordon Brewer: rather than trying to just bootstrap it all myself and trying to figure it out on my own. Yes. And it's, uh, and also just, um. The, the support that you get, the community you can build and that sort of thing is just so, yeah.
So important to, to, to help you thrive and to succeed along the way. Yeah,
Brie Chrisman: exactly. Yeah. Bootstrapping is great up until a point, and then you really need to ask for help. Yeah.
Gordon Brewer: Right, right. Well, Brie, tell folks how they can get in touch with you and, uh, and just a little bit more about your business and what you do.
Brie Chrisman: Yeah, so we, like I said in the beginning, we're an operations agency for mental health practices. So we, um, our services are really to support you in the day-to-day. We have operations assistants that, um, can help with your day-to-day, make sure your processes, like your client onboarding are running smoothly.
We have an HR manager role that can help if you are scaling and bringing on clinicians. It can help you with your payroll, your onboarding, offboarding, all of that fun HR stuff that no one wants to do. Right. And then we have, if you are in that. That place where you're ready to step into a CEO role, step into a leadership role, and you need someone to cover the day to day, we've got fractional practice director services, that's perfect for you as well.
Um, I would love to offer your audience Gordon a, um, 25% off our operations audit. It's a comprehensive audit of how you work, how your practice runs, the software you use. Just basically an all-encompassing, um, audit. And then from that where you get a 90 day action plan, where you get step-by-step instructions on what to do to be able to get your business kind of honed in and get you in a place where you can grow or scale or whatever that looks like for you.
Um, so you can find me@heybossco.com. Um, we're on Instagram, Facebook, LinkedIn, um, and then our website. Uh, and our website has some great resources on. Our blog and we're hopefully by the end of the year gonna be having a digital store up and running for people who are bootstrapping and want to DIY. And so there's gonna be templates and all the fun stuff, workbooks and things like that on there.
So
Gordon Brewer: yeah. Awesome. Awesome. And we'll have links in the show notes in the show summary so people can get to that really easily. So, well Brie, thanks again for being on the podcast. And uh, folks do check out those links and, uh. Brie's a great person, so get get in touch.
Brie Chrisman: Thank you so much, Gordon. I appreciate it.
Gordon Brewer: So glad you were here.
Brie Chrisman: Thank you.