The Practice of Therapy

[00:00:00] Gordon Brewer: Hello everyone and welcome again to the podcast and I'm really looking forward to you getting to meet and hear from Gary Katz. Welcome, Gary. Glad you're here.
[00:00:09] Gary Katz: I'm so glad to be here. Thanks for having me.
[00:00:12] Gordon Brewer: Yes, and so Gary, as I start with most everyone, tell folks a little more about yourself and how you've landed where you've landed.
[00:00:20] Gary Katz: Yeah, well I'm a licensed clinical social worker and the owner of this practice. But and before that I was a teacher for about 20 years and a rabbi. And so for me, the name of the practice, the Center for Intimacy Recovery, and it really, you know, that's basically what my life has been about, is trying to recover or find and have intimacy with other people or with myself and what I've learned in the process in.
Some messy and sometimes painful ways as well, not always gracefully, is that the only way I'm able to have real intimacy with other people at whatever level is being sought, whether it's romantic or friendship or family or you know, collegial. The only way I'm able to have intimacy at whatever level it is, is by first having intimacy with myself.
So like, and by that I mean you know, really knowing myself and even being willing to look at the parts that for many years I didn't even know were there or didn't wanna look at.
[00:01:23] Gordon Brewer: Right.
[00:01:23] Gary Katz: 'Cause if I'm not gonna look at them, I'm, I'm not gonna let you see them either.
[00:01:27] Gordon Brewer: Mm-hmm.
[00:01:28] Gary Katz: Right. So that kind of, you know, has been my lifelong experience.
Mm-hmm. Personally and, it drove me to my first career of teaching kids. I felt like that's a way to help them learn about themselves. And it led me to my second career, which is this, which is, you know, psychotherapy and helping both clients to heal, to know themselves, and then to be able to share that with others in their lives, and also to train staff to do that.
So in creating the practice. It was, it's kind of all revolves around that idea. So both the clinical work certainly is about helping clients to have intimate relationship with therapists and then with themselves and then with other people in their lives. But it's also kind of been my guiding light for how I structured the business too.
[00:02:19] Gordon Brewer: Right, right. Yeah, it's it's fascinating and, and Gary, you have multi-locations and so and we were kind of ta talking just a little bit before we started recording that. It was really during the, the pandemic, it's always crazy to me how we mark time now by COVID and, and all of that. Right.
But but you, you, you really recognized what were the things that you enjoyed the most and one of those was the business side of running the
[00:02:48] Gary Katz: practice? A hundred percent. Yeah. I mean, I never really did business before. I. Like I said, I taught in schools, did programming, summer camps and stuff like that.
So, and I always felt as a man kind of inferior than the men who were in business, like in Wall Street or attorneys or, you know, whatever. I. And so when I started my practice, first of all, I had no training. And I also didn't really, you know, I spent some time as in COVID, probably like five, six years into having the practice really thinking about like, as you know, demand grew for support, for mental health, for people, and business was growing.
Part of the way that I brought bring intimacy into the practice is by, you know, every person in the practice has three hours of supervision a week. It's like, kind of like a teaching hospital, so to speak. Mm-hmm. Where, you know, I want lifelong seekers and lifelong learners as therapists. So in the pan, early in the pandemic, we were all so isolated and not knowing what's happening fully.
That weekly group supervision felt like such a special place. Like we were able to see the same people every week, and I hired a few more people as the knee grew. And I was like, if I, what am I doing here? Am I just gonna keep hiring and dilute this connection? I didn't wanna do that. So it made me take some time to think about what do I want to do?
How do I wanna, what do I wanna do? And also what do I wanna do with my time and how do I wanna structure the business as well about that? And so I came up with three things that I really like to do and that my PA I'm passionate about, which is working with clients teaching, which I taught for 20 years formally.
But, so teaching new staff, you know, and supervision and like you mentioned, we just said. You know, the development of creativity in the business and stuff, and so that led me to really stop doing the thing I didn't wanna do. So,
[00:04:45] Gordon Brewer: mm-hmm.
[00:04:46] Gary Katz: You know, initially I did all the consultations and that was fine, but as it grew I couldn't do them all.
And I would squeeze them in between sessions, which, you know, is a lose lose type of thing.
[00:04:56] Gordon Brewer: Mm-hmm. So hiring
[00:04:57] Gary Katz: someone to do certain things, hiring them to do the payroll, hiring them to handle things that, so that would free me up to be able to do the things I really love, which is, you know, and so it also.
Changed how I hire people. So I went from hiring one more, two more at a time and sticking 'em in the group. And I don't want the group to get too big because the people were having this really special connection. So what I did was I hired a pair, like a second, entirely second parallel staff. So we would meet on Thursdays for group supervision, and I hired a whole new set of people that I met on Wednesdays in group supervision.
Kind of like at that time, the pandemic. In the pandemic, they were doing pods like who you socialized with and mm-hmm. For safety. And so it allowed each. Sub staff or staff to have a smaller and more intimate experience. They get more attention in group supervision. They get to know their coworkers instead of having a larger thing.
And that, so it's, that's what I mean by it drives how we build out the business. Not just the clinical piece, but the business structure too.
[00:06:03] Gordon Brewer: Right, right. Yeah. So it, it, the, one of the things that a theme I hear there that I hear a lot is that really the big game changer was when you were willing to start outsourcing a lot of the things that you were doing in order to grow, in order to, to build what you've got.
[00:06:21] Gary Katz: Yeah. Yeah. And so as we start to grow into other states, it's the same idea, which is to create smaller. Small units of staff in each state, but they all meet like once a month. I have a whole staff training. I'll bring someone in and do, you know, but I, each therapist has the supervisor and they have a small staff that they interact with where they feel connection and hopefully like collegial relationships and sometimes friendships and, and get more better supervision too, because they're having a smaller, more intimate experience.
Right,
[00:06:56] Gordon Brewer: right. If, if you were to maybe give some guidance for people that are thinking about maybe starting to scale their practice or they're trying to maybe go from solo to group or any of those number of ways that you can do that, what would you say would be a good approach for them?
[00:07:18] Gary Katz: Yeah, that's a great question.
I was just having this conversation with two friends of mine who are solo practitioners and they, and were asking me about who they could send to for sup, like to like, if they're seeing a couple and they need one of the people in the couple to get individual therapy or you know, and I was like, you could send them to me or someone else, but why don't you hire someone you know?
And I think zero to one is much harder than one to five. So, you know, it's a, it's a mindset. Like I mentioned before, I worked in education for 20 years. I spent several years wondering what else I could do, but not knowing what it could be. 'cause I only knew a very, you know, narrow work experience. And so I'm so glad.
Like, I don't regret, I mean, I love teaching, but I. I wouldn't trade being in private practice for anything. Mm-hmm. And so like, my guess is for most people, like myself, there's a, there's, it's right, we're in the therapy business, it's always emotional. So what are the emotions and the feelings that are coming up around.
Wherever you might get stuck. So if it's hiring one person, treat it like you would your ther, you know, your regular therapy issues, like process it with someone, a supervisor, a bus, a the, a group practice supervisor or someone. It's always driven by emotion. Mm-hmm. You know, so like fear or self-worth or insecurity.
So, you know, am I gonna be, you know. I don't know how to file a, a, something with the state to do to pay somebody. I don't know how to do a payroll. I don't know. Like, will I be able to give them enough work? What if they don't work out? I don't like to fire people. These are all things that you're not inventing the wheel someone has and many people actually have gone through.
Right. So can I formed? I joined one and then I formed another group. I actually have another one I'm gonna go to right after we finish. Of group practice owners who are all figuring it out. So we don't have to like, invent the wheel, we can like share our knowledge. Mm-hmm. So find places or people to talk to, just like if you had an emotional problem or a problem in your relationship as a professional therapist, you would hopefully go to therapy to get so again.
Mm-hmm. Get business therapy help, you know, like, I think it's, and just be in touch with the feelings that are coming up that are limiting your dreams. I, I had a friend. Who owned a toy company, and I remember when I first started my practice having coffee and she said, Gary, like you only have a finite amount of potential for your income because you're working on an hourly basis like an attorney who charges by the hour.
She, if she gets a bigger demand and she succeeds, she can just call the factory at that time, I think, and it was located in China and say, I need another 600,000. Dolls and then she gets 'em. Mm-hmm. And she can make more money. She has unlimited possibility for income. And it really made me think a lot. I was like, oh yeah, right.
Plus I was also working ridiculous hours and that's kind of what led me to think if I hire someone else, I could still make money when I take off. Mm-hmm. But I was scared to, you know, what if I hire the wrong person, how do I know they're good? Da dah, dah, dah. I trust them. My reputation of their, like all these fears came up.
So I had to really face the fear at each and every step.
[00:10:41] Gordon Brewer: Right. Right. Yeah. And I think that's a, one of the things that I think people struggle with and is, like you said, is that, that there's stuff that we, we know we don't know, but there's also stuff that we don't know. We don't know. And so I think, you know, that's the thing that kind of holds people back.
Okay. What if I get into the weeds here, but like you said, there are plenty of other people that have done exactly the same thing and they've, you know, they've, they've. Come out. Okay.
[00:11:12] Gary Katz: Yeah. And there's even great podcasts. That could be resources too.
[00:11:15] Gordon Brewer: Yes. Yes. Yeah, that's an idea. Somebody, that's a great idea.
Someone should do that. Yeah. Yeah, yeah. So, yeah. Well that's, yeah, it's yeah, it's, it's interesting how our mindset can kinda get in the way of, of things, and I think one of the. The big things too is not, not only worried about giving up some of that control in order to scale or in order to grow, you have to go from instead of the one-to-one way of providing services to the one to many.
Yeah. And the way you do that is by bringing on more people.
[00:11:53] Gary Katz: Yeah. And you have to learn how to do things that you don't know how to do, which is hard. Mm-hmm. So it's, you know, it's, it's like, when I was in the education world, it was very common. A really good teacher would get promoted into an administrative role.
Their training is not to be an administrator. They might have the natural skill or maybe they learn their training is to be a wonderful educator. And so the same thing happens here. Really good therapists. Their practice really. They blossom and they get bumped into semi either fully administrative, which I don't think anybody wants, or very few people mm-hmm.
Love the clinical work or they get this quasi administrative clinical position and it's, and so that was also something I would say, I actually learned that recently. I, or I heard it again and it landed a little more this time, which is I have to stop running my practice like a therapist and I have to start running it like a group practice owner.
[00:12:46] Gordon Brewer: Yes. Yes. Which to
[00:12:47] Gary Katz: me, and I'll just to be candid with you and with all the, whoever's listening, like that's my biggest challenge at the moment, which is mm-hmm. And for a while it's like I still wanna carry a full caseload to clients, and actually I do. And I, I generally carry a larger than most caseload, but.
I have to have time set aside with, you know, for supervision of staff, for meeting with my clinical supervisor, for meeting with the administrators who do like the paperwork, the intakes, the consultations, the bookkeeping, marketing. Like I have to make time for that. It's not gonna get done. Right. And so, you know, that goes back to like also like how I, you know, what, how do I want to structure my practice?
Some of it I want to hand off 'cause I don't wanna do all that, but so I have to. Mm-hmm. So. I regularly, I, you know, to me it's like a, my relationship to how I work is like any relationship that has ups and downs. Sometimes I'm doing better. Mm-hmm. Sometimes I'm not, you know, I, and then also I think learn.
I think many therapists, we are caretakers. You know, maybe we're trained by our parents and as an older sibling, or taking care of even of our parents, not even our siblings. Mm-hmm. So we've learned somewhere to take care of people, which can make it hard to say no.
[00:14:10] Gordon Brewer: Mm-hmm.
[00:14:11] Gary Katz: And that's something else I think is really important, is learning how to say no, whether it's to staff or to clients, right?
Like I, one of the reasons I get into stress, a stressed out space is. Sometimes my heart goes out to a person who reaches out for therapy. And I feel for the pain that they're in. And I agree to take 'em on as a client when maybe that's not the best thing. If I'm thinking in the bigger picture of where I need to allocate my time.
[00:14:37] Gordon Brewer: Mm-hmm.
[00:14:37] Gary Katz: Or if I have a, a, a colleague who I have a really good relationship with 'em, they're like, Gary, I want you to see this person, not your staff. Or if I have a treatment center that often sends us people I want to give them. So like, it's really challenging. And if. We're healers or people pleasers.
Yes. Or caretakers and saying no. Like there's a book called The Disease to Please, which is all about people pleasing and it has this quiz and it at the beginning that you can self take and see where you fall out. And also what type of people pleasing you at the first time. I did it with my staff 'cause we use it.
We use that, some of that, the work from that. It's a wonderful book. We use it in with some of our workshops with clients. And so in 20 20, 20 21, I had the staff take it in group supervision. I shared my score and I was like. The highest score of the staff. It was embarrassed. Actually one person who was scored higher than me, who is my sister, so I was like, oh, we were trained a certain way, but it was a little humbling and embarrassing that I scored higher than my tire staff.
[00:15:42] Gordon Brewer: Yeah,
[00:15:42] Gary Katz: fast forward about three and a half, four years later, we just did it this past month with, because we have a lot of new staff, so we did it again as a training. My staff, my or my score went way down and I shared that with the staff. Like, wow. I had like a, I don't remember the first number, like 17, 18, and now I had a four.
And someone asked me what did I do? What do I think changed that? And I, I, it caught me off guard, but I think part of it was being a boss. Employer. Mm-hmm. You have to say no. It's like being a parent. The average mother or father says no a hundred times a day. Mm-hmm. And the kids storm off and everybody like, you know, Johnny's mom lets him go hang out with his friends all night.
Why? You're the only one who, like, you have to tolerate that. Right. And I think you have to tolerate the big picture needs over the, sometimes the individual needs as an employer and also with clients too. Mm-hmm. I think that can be challenging and I think. I would encourage any therapist who's wants to develop their practice, whether it's marketing it, whether it's hiring is like you're gonna have to lean in and look at your own relationship with saying no.
[00:16:50] Gordon Brewer: Yes. Yes. And, and that's yeah, I think it's, yeah, it's funny because that's just the whole thing that's come up for me lately, just in relationships and just in, in work and, you know, just doing all the stuff. I for those that are familiar with the Enneagram, and I'm, I'm an Enneagram too, the helper, and so we're just.
We're just so prone to people pleasing and making sure we take care of everybody else's needs rather than our own. And mm. It's yeah. And so I think becoming more and more aware of that is such an important, important piece of running a practice.
[00:17:27] Gary Katz: Mm-hmm. Yeah. I don't know. I never did the Enneagram.
I should find out what my score is. 'cause people were, yeah. And I should also know what the scores mean. 'cause I've had a number of Yeah. You know, colleagues like you or clients even. Yeah. It's a way to be, it becomes a way to be known. To know oneself. Right.
[00:17:44] Gordon Brewer: R Right, right. Yeah. The, the, the thing I, not to get us too far off on a tangent.
The, the big thing I love about the Enneagram is, is it's not doesn't really focus on behavior as much as it looks at internal motivations for things and how we approach, approach and see the world and, and, you know, interact with it in that, based on that internal. Internal, yeah. Motivation. Yeah. Kinda of like the framework
[00:18:10] Gary Katz: that we see that we organize inside, and also that we see things and, yeah.
Yeah. Yeah.
[00:18:15] Gordon Brewer: It's, yeah, it really gives a great, great, great job of, of explaining the lens through which we see the world. So, I mean, it's just, yeah, pretty, pretty fascinating stuff. But well, Gary, one, just to shift gears a little bit tell folks a little bit about how you've got your practice structured in terms of.
Who are the people in leadership and then, you know yeah, just how that works. I know you mentioned having the small groups or pods of people that are working together and developing those relationships, but Yeah. Yeah,
[00:18:47] Gary Katz: that's a great question. So what I did is I, like, we had one supervision group. I ran it.
I met individually with everybody, you know, six employees or so. Then when I hired that second staff, I no longer had time. Well, I wanted to work with clients and not just only do supervision. So it may, I could no longer I. Do individual supervision for everyone, and I feel very strongly about having a certain quality of training and therapists.
I don't wanna have, just a therapy mill doesn't feel right to me. I, I don't think to anybody, it feels right. So, right. That led me to realize I need to hire someone who can do supervision and. You know, I was given just the greatest gift of meeting and then hiring, and now working with the most wonderful person and clinician, Nancy Truama, who's our clinical director.
And she slid in and met with every single person individually, every single therapist. And it's so rare that like they all just feel. So like she's beloved to everybody. You know, sometimes you get lucky with a hire. Mm-hmm. And sometimes you don't. And so, that's kind of how we structured that. And so she and I would run both group supervisions through each two hours a week.
And they had about six people in each. And then as we continued to grow and like I mentioned we're, we start the, we're based out of New York. If you're in the New York City area, you really get inquiries from New Jersey and Connecticut too. So we got people licensed in those states, especially now that we were virtual.
It wasn't an issue before. When we worked in an office, people would come from New Yorker, I mean Connecticut and New Jersey into the office. So the New York license covered that. But as we started, as virtual work went up, 'cause of the pandemic, the just the shift as a result of the pandemic. So we needed to get people licensed in multiple states.
So like nowadays, somebody who. Licensed in New York will often be licensed in New Jersey and Connecticut too, which again, it's a hassle, right? Mm-hmm. Like, you know, that like
[00:20:52] Gordon Brewer: yeah,
[00:20:52] Gary Katz: you know, the fact that licenses generally are state by state and in our new reality, you know, it's hard. And then thinking, you know, thinking about wanting to expand to other places.
Think my thought processes process was, well, since it's by state, I'm gonna look at the largest markets, right? Like, how many clients can you get from Rhode Island, the smallest state compared to how many can you get from, let's say Texas or Florida or California, which are the most popular states. So
[00:21:24] Gordon Brewer: we
[00:21:24] Gary Katz: hired people licensed in those states as well.
[00:21:27] Gordon Brewer: Wow.
[00:21:28] Gary Katz: And, and that's kind of how been our, how we've been expanding. And so we have a few therapists in each of those states and the goal, and then, so that started to grow the practice and then I realized that if my, my plan was if those smaller groups continue to develop, I want to have, I. A similar structure where Florida will have its own smaller staff and a supervisor.
Texas will have its own smaller staff and a supervisor California will. So that's kind of where we're at right now, is as we're expanding those staffs. The goal the goal is I hired a number of people who were not. New graduates but had had experience already. Even some of them had experience supervising or they just, I just thought they would make quality supervisors.
And so the goal is to train them how we work and what we work in and train 'em to be supervisors so then they can each run one of those smaller pods, so to speak, one of those smaller staffs. And my hope will be is that as each one develops into its own staff and has its own supervision group, that that's the way I can stay connected and.
On, on top of things by being in each group supervision. So for example, if we had one. Let's say we had five supervision groups. One that met every morning, let's say Monday through Friday. Every day I'd have a two hour supervision. I'd get to know each staff member, get to hear how they think, how they conceptualize cases.
I wouldn't be the primary per person because they'd have a more direct individual supervisor, but I'd also be able to teach them the way we work around intimacy too.
[00:22:59] Gordon Brewer: Mm-hmm. Yeah. That's great. That's great. That's fascinating how you've structured that and just really kind of thinking progressively about expanding out and offering.
Tell I, I know we're, you know, we've gotta be mindful of our time, but tell folks a little bit more about your niche and your practice and how they can get in touch with you.
[00:23:20] Gary Katz: Sure. You know, as the name is intimacy, so people often think that means sex. And I would say that a large part of our practice is, is about sex.
But it's really about getting to know each yourself and then other, allowing others to know you and how to be present to know others. So people come for that. And then they come for the things that get in the way of being able to have intimacy with ourselves. So, you know, whether it's you know, we all develop strategies that are protective of our heart.
That as, mm-hmm. We go through life, it gets banged up, scarred, cut, nicked, damaged, wounded, bruised. Our hearts are so tender and so strong at the same time, so we look at a lot of strategies that people develop ranging from I. More avoidance strategies, like I'm gonna isolate is extreme, or I'll be a prickly porcupine and then wonder why nobody wants to hang out with me or be in a relationship with me.
Or I will be focused on keeping everybody happy. I. Then I still feel empty at the end. Like all those strategies with, you know, without shame, without judgment, and helping to unwind them so that the person can actually take the risk and have the courage and feel strong enough to take the risk to get close to other people.
Right. A significant part of our practice also deals specifically with people who use relationships or sex as a way to avoid intimacy. Whether it's compulsive sexual behaviors or, or addiction, or whether it's jumping from relationship, you know, I found the one again, you know, who's gonna fix me?
[00:24:53] Gordon Brewer: Mm-hmm.
[00:24:53] Gary Katz: And then we also have a, and, and then the impact I. So if somebody's had secretive or compulsive sexual behaviors and has betrayed a partner, we work a lot with the other side of that relationship, the person who's been betrayed and has experienced what we call betrayal trauma. Right? So we work a lot with those, with couples or individual.
And then we also do like traditional sex therapy, you know, with
[00:25:16] Gordon Brewer: mm-hmm.
[00:25:17] Gary Katz: People whose bodies are not responding the way they want or discrepancies of desire in a couple. Or discrepancies of how they want their sex life to be. Differences like that. Mm-hmm. Whole variety. So that's really all we focus on and we have a lot of groups.
People that are partly psychoeducational so people from any state can participate.
[00:25:40] Gordon Brewer: Mm-hmm.
[00:25:41] Gary Katz: And we have a couple intensives as well, which are focused either on trauma, they're virtual or like, you know, sexual behaviors that are problematic. And we have couples intensives too to help couples, you know, reconnect or develop deeper intimacy.
[00:25:58] Gordon Brewer: Awesome, awesome. Tell folks your website and how they can get in touch with you.
[00:26:02] Gary Katz: Website is the best way to get in touch with me or the practice. And it's intimacy recovery.com. That's intimacy recovery.com. And my email is my name, which, if they're, I. They probably can see you on what they're looking at.
If they're listening to this, which is Gary Katz, G-A-R-Y-K-A-T z@intimacyrecovery.com, and I invite, you know, clinicians and non-clinicians, I always invite people to reach out. I'm happy to chat via email or even on the phone whether it's like a business development question or practice a clinical or a clinical question or a personal, you know, like I really feel that.
I really feel that we as colleagues should show up for each other, you know? Mm-hmm. And to spend one or two times talking with somebody and it feels like a way of giving back. So I'm always, I invite people listening to Please reach out.
[00:26:56] Gordon Brewer: Awesome. Awesome. And we'll have links in the show notes and the show summary for folks.
And Gary, this has just been a pleasure to talk, chat with you and hope we can get connect again here soon.