The Practice of Therapy

Gordon Brewer
Well, you know, when I started thinking about this particular episode, I'll be quite honest part of it is, is I had a little bit of break in the interview schedule. And so I wanted to get another episode out. And so I thought this would be a good opportunity to delve into a topic that I've been thinking about, and just really, from listening to other people in the sight craft network, and also just other people in general, just around this whole idea about how our practices change over time. You know, one of the things that when I started my private practice back in around 2000 2005 2006, somewhere in there, I haven't, I can't keep up exactly when I started my private practice. Because I started part time, I was still working for an agency at the time, and was mainly working with children and youth and their families. And so my private practice really focused on adults, and particularly marriage, marriage and relationship issues, which was a different niche than I was in, in the, in the agency that I was working for at the time. But when I started into private practice, you know where I am now, looking back, I never would have dreamed that I am where I am now. And so one of the things that I would say is, when you start into private practice, one of the things you can expect is that it will evolve. So for example, I went from a solo practice into a group practice, and I never really thought I would get into group practice. But what I figured out along the way, was that that was kind of, as we like to call it a low hanging fruit, for really taking my practice to the next level, and also creating more income for myself within my practice. And so back in that, around 2014, I was supervising a person for licensure, and they were needing extra hours for their to get their, get their hours in for their licensure. And so I had gotten to the point where I was starting to get pretty full with my practice. And so I brought, it was Amy at the time, Amy on as a as a person within my group. And so really kind of it was informal group, we were really just kind of operating independently. But one of the things that we were doing is just sharing resources. At that particular time we were sharing the cost of an office, we were just sharing, you know, I was giving her referrals, and she would give me referrals. But we were really operating pretty independently at that time. And so later it kind of evolved into starting group practice officially. And so I formed an LLC, that's Kingsport counseling. Kingsport counseling associates, P LLC, which is not to go down too far down on a rabbit hole is just made professional, limited, limited liability company. But anyway, formed a group. And so I brought on some other clinicians, brought them on as contractors. And one of the things that I learned through that process, which again, that's a good segue into, maybe some of the some of the mistakes that I made along the way, was is that as a contractor, I was actually loot having them as contractors, particularly what I was paying them, I was losing money, and didn't really realize it at the time. But one of the things that I learned over time was that mistake I made was is that I was kind of picking what I was paying them to kind of arbitrarily trade early, without really knowing my numbers. So the stakeholder number one that I would say that I learned from is not spending time on the front end, when I started my group practice are really understanding my numbers. And two things about that is that one is having an understanding of what you need for yourself. My friend Casey Compton and on a recent podcast episode that she did with Whitney Owens at the y's practice podcast, she talked about referred to it as lifestyle congruence. In other words, what is it that you need monetarily to maintain the lifestyle of your practice and also your personal life? And so that's something that I think people need to put some thought into on the front end of really understanding what it is that you what is going to fit for your lifestyle. There's really no Perfect style of perfect size practice, I think you have to build your practice based on what is going to work and fit for you. I know for me, in my practice, I've made a decision to kind of keep my practice small. Some would consider probably a small to mid sized practice, I've got six clinicians working for me plus an admin person. And so that would be considered probably a small to mid size practice. But I made that decision, just because I knew what my bandwidth was at the when I made that decision. And so I didn't want to just go create a large practice. Beyond that, so I think and also just really fit with my lifestyle. And that, you know, when you take on more people, when you take on more things and enter practice, you have to outsource more. And you have to really be aware of your time commitment to all of those things. Now, the other thing kind of related to lifestyle congruence is thinking about how you tend to go about accomplishing tasks and doing things within your practice. You know, typically, when a person starts out into private practice, the one asset they get the most of is their time, depending on how you started. And one of the things that in those early stages, it makes sense to do some bootstrapping, and other words, doing a lot of the, the work on your own, in terms of getting your systems and processes in place in terms of marketing, in terms of making appointments. You know, all of the things that are involved in setting up a practice, doing those on your own is, is make sense to do it in those beginning stages when you've got more time. But as you grow, and you start taking on clients, or taking on patience, that's when your time factor kind of comes in your time becomes much more valuable at that point through seeing clients. And so one of the things that I made a mistake of is trying to maintain candidates solo practice mentality, and also just that beginning bootstrapping mentality for too long. You know, I wish I had outsourced more sooner. And that was one of the mistakes that I made and that I tried to be the the every one person for my practice, and it got overwhelming. And what ended up happening is I started noticing that things were falling through the cracks, I would forget to do things, I was missing things along the way. I would, I would finally get around to returning phone calls and people had already scheduled with somebody else. So those are the kinds of things you have to take into consideration. So one of the things that pieces of advice I would give, and things that I've learned along the way or mistakes are made is to outsource sooner. In other words, find the people and the resources, you need to take on some of the tasks that you don't necessarily need to be doing yourself. One one particular area is hiring a virtual assistant to handle your appointments are making the appointments and doing your intakes for you. That is time, time and money well spent, in terms of hiring someone training someone. And there's a lot of different ways you can go about doing that there are several companies out there that offer virtual assistant services. In fact, shout out to my friend, Uriah, Guilford, and productive practice. He's got a ton of resources there about hiring people and being able to outsource in productive and meaningful ways. Also, I'll put make sure that we get a link here in the show notes. Uriah put together a directory for for mental health providers that covers everything from consultants to virtual assistants to electronic health record systems, but it's a pretty comprehensive directory to help you find those resources that you need. So I'll point you to that and make sure you've got the link here in the show notes.

The other thing that I would say that I wish I had done sooner was to not do too much stuff alone. In other words, not get some consulting not get some coaching Earlier on, I tried to figure out too much on my own. Now, again, when I first started back into, into private practice back in 2000 2005 2006, there weren't as many folks like me around back then as far as people that really taught private practice skills and business building, and private practice entrepreneurship. There weren't that many of us around. So got a lot more resources there around. But I will say that, every time I have I have invested my time and money into coaching, and into consulting with other people that are, quote, unquote, experts in the whole private practice realm, it has pushed the needle forward for me. So if you're interested in doing some consulting with me, I'm available, you can just go to practice of therapy.com. And just click on the link up there that says Start consulting. And there's three different ways I do that are actually two different ways. One is in the group context. So I've got two different levels of that I've got the practice launch Club, which is really geared towards those people just getting started in private practice. And it is, it is a, I have a community of folks, and we get together twice a month to have both office hours, and also a mastermind group that's a little bit longer and a little bit more comprehensive. And there's also connected with the practice launch club, a set of lessons that I've put together, just around some of the basic skill building on starting a private practice. So that's, that's available for folks. Again, you can find links in the show notes for that, and also the URL is practice of therapy.com/practice launch club. And you can find out more about that. The other group that I have is the group practice focus group on, you know, I've got their name group in there twice, but But anyway, it's a group practice focus group. And that is really specifically for those clinicians that have maybe smaller group practices, but are also insurance based. And so we've got that, that code, the current cohort has already started. And so we won't be I won't be taking enrollment for that till later in the year. But you can check into that and reach out to me about that, and I can get you on the waitlist for that. But you can. Again, you can go to practice of therapy.com/focus Group to learn more about that. And the other way you can get some help from me, is just do some individual consulting with me, and I've got different consulting packages that offer for people. And with that, what we do is we spend some kind of a some intensive time together to really define your define your goals, the areas that you're struggling in, set, some key performance indicators of how we're going to change things, what we're going to do differently. KPIs is another is the acronym for that. But we figure all that out and look at your strengths, areas, you need to grow and put a plan together. And so that's, again, there's, I've got a package around that. And you can check that out by going to practice of therapy.com and just click on that link that says, Start consulting. And you can find out more about all of that. So the other thing that I will mention here that we've already kind of hit on a little bit, is really kind of knowing your financial side better, you know, one of the game changers for me, and my practice was, again, a hard lesson I had to learn was when I was I had hired some contractors and I had set the fees that I was going to pay them the contractors, the the fee split, so to speak and not know don't take the split in the wrong context there. Because I know in some of the ethical codes, it mentions fee splitting, but what I'm talking about is hiring someone and you your practice collects the fees for the sessions. And then you give to the contractor a percentage of that as their payment for being a contractor with you to what I mean by fee splitting, not paying somebody to give you referrals, which is another type of fee splitting that is unethical, and we don't do that. But anyway, with the with the fee splits that I originally had come up with. Quite frankly, the big mistake I made is I came up with the percentage arbitrator arbitrarily, I just picked a number that I thought sounded fair thought, okay, I can do this. And so it was a fee split, that was way too high. And so when I actually ran the numbers and started doing a deep dive into what my costs were, what I was bringing in what I was paying out to them, I was having to subsidize that through the clients that I was seeing. And so it was not what they were doing, the contractors were doing was not making a profit. And so if you don't know this already, you have to make a profit in your practice, and you it's okay to make a profit, because that's the only way that you can stay open. And so not only do you need to make a profit as the owner, but also what's your, what's your clients, excuse me, what's your clinicians, if you're in our group practice, produce also needs to make a profit, otherwise, you're not going to be able to keep paying them, and you're not going to be able to keep them on your payroll. So again, knowing your numbers understanding that whole financial side of things. And one of one of the resources that I want to point you to here and there's there's actually two, one is the book by Mike McCalla wits called profit first. And it came out probably about 10 years ago, I guess now. And it really kind of was a game changer for me and understanding the power of allocation. In other words, the Profit First is exactly what it means is that you take your profit off the top, rather than what is left over at the end. And I'm not going to go into that a whole lot here. But check out the book. And also coming out in May, is Julie Harris's book, Profit First for therapists. So I would suggest writing profit first. But if you want to wait till Julie Harris's book comes out in May, it's specifically for therapists, and particularly the types of percentages you need to think about for your practice. And also, Julie goes a lot into the money mindset. And also in that book, she, she uses me as a case study. So again, learned a lot from my mistakes around, you know, how you structure the financial side of your practice. But, you know, one of the things for a lot of us is, is money is an emotional issue,

in that we have certain money mindsets. And I would say, the thing that I learned the most is not make financial and money decisions based on emotion, and needs to be made on the data. And looking at that. So that was something I learned the hard way. And I don't want you to go about it that way. The other thing too, that that whole kind of learning from our mistakes did is it prompted me to put together the course money matters in private practice. And Julie Harris collaborated with me on that in the in the updated version, which we're getting ready, Julie and I have already talked about in this year, we're going to update updated again, but the the original course is out there, it's available, money matters and private practice. And you can find that at practice of therapy.com/money matters. So I would come in that that particular course to you. And then the other the other thing, the last thing that I would say, of things that I've learned along the way, is when you start a group practice, make sure you hire the right people, and also set expectations for those people. one story in particular that I'll share with you as odd. I had hired someone. And this has been a few years back, I had hired someone that really came with high recommendations when I checked out their references and all of that sort of thing. They were well thought of and that sort of thing. But once I got them into the practice, and they started working, it was a disaster. And I won't go into a lot of the details around that. But part of it, I blamed myself for a big part of it is that I didn't didn't hold them accountable for some things and I didn't set the expectations on the front end. I was a little maybe a little too trusting. I'm a very giving person which is okay and that's a good virtue to have is to be giving a generous person but I was overly so with this particular person and I kept them on way too long, longer than I needed to and stuff or financially for that they suffered financially for that, and it just was a drag it on too long. So setting expectations on the front end with the people, you hire and really defining what it is that they will be doing and how you expect them to do it. And all of that sort of thing goes a long way. And also, you know, I think when when you hire somebody is having a trial period. I know now, with the way that I do things is I've got like a 90 day tribe trial period with people to see how they work out. And if they're not working out, it's very clear on the front end, that if things aren't working for them, and they're not working for the practice, then we need to figure out something different. So again, setting your expectations, not letting problems drag on too long, not burying your head in the sand around things that are happening. I know in my focus groups, what's one of the things that we've been talking about is just what to do when you're having to change things in your practice, and having those hard conversations? Well, I think if you set that expectation on the front end, that it's okay to have those hard conversations with people, it's gonna go better for you in the long run. So again, hiring the right people setting expectations and not letting problems go on unchecked, once you recognize that they're there. I know for folks that have maybe been listening to the podcast for a while. This is not new information for you. But I think it's always good to revisit these things. You know, first of all, as you always hear from me know your why around your practice, know what, know what your lifestyle congruence is, in other words, does your practice match the lifestyle you want to keep and both across the time that you devote to your practice, but also the income that you're getting from your practice that needs to all line up for yourself. Also, to being very aware of the financial side of things, knowing what is profitable, what your breaking, even points are, knowing, knowing your numbers well, is goes a long way, with with having a successful practice. The other thing is, making sure you've got the right people and that you're creating a culture within your practice that not only helps people thrive, but also helps your practice thrive. Again, kind of the bottom line is, is if you're not making a profit in your practice, is not going to be able to be sustained. And so having some honest conversations with yourself, and with others about money in your practice just goes a long way, long way in making your practice successful. The other thing too, and just thinking about the title of this episode, the evolution of private practice and the mistakes I've made. One thing to recognize, too, is that the way you start out in your practice is probably not going to be the way you keep it going. And again, think of mistakes that you make as learning opportunities. Rather than getting stuck in the mud with just putting yourself down and getting getting to buried, buried in the mud, so to speak, around mistakes that you made, just count them as learning, learning experiences. Pick up and keep moving. I think the other thing too, I'll just kind of close out here with this, this idea around things around the evolution of your practice is being consistent, persistent and consistent with what you do. I think being able to get into some routines, having the right systems and processes in place, being able to you know, also know when to if something's not working, being willing to let go of that. And the other thing too, and I know Sorry, I'm jumping around here that I needed to mention again and just put some highlights around is knowing when to outsource and not trying to do too much on your own. Not only what you physically do and as far as the time you put into your practice, but also getting the support of others getting the support of people you outsource to but also reaching out to others to get some coaching and some help with how you're doing things along the way. Every time I've done that my practice has grown by reaching out to others, getting some consulting and coaching