The Practice of Therapy

Gordon Brewer:
Well, hello everyone. And welcome again to the practice of therapy podcast. And I'm so thrilled to have gotten to meet Rachel Barbara and Elfriede and having her on the podcast. We were just chatting here before we started recording, and I think what she has on her mind and a think on for a lot of us is just thinking about how we're doing some pivoting and rebuilding. And so Rachel, welcome to the podcast. Thanks. Yeah, that's great. I'm looking forward to our conversation, so and it's not start out with most everyone. Why don't you tell folks a little bit more about yourself and just kind of your private practice journey and how you've landed, where you've landed?
Dr. Rachel Barbanel-Fried:
I am a clinical psychologist by training. I did my training in Washington, D C, which is where I built my practice the first time. And I did my training actually originally not to be in private practice. I trained to work with kids. I thought I wanted to run a school for disadvantaged youth. I came to this line of study because I really liked working with all the kids who nobody else like working with. I was really intrigued by those folks. And so that's why I did psychology. And then as part of my training, I, I discovered, Oh, I actually like doing therapy. And then it turns out that it's a pretty good life in that I have gotten to build my life to look the way that I wanted to. And so that's kind of, I think, where you and I got excited about talking, cause I really think this is an amazing career choice for people who want to be able to build a life that looks the way they want it.
Gordon Brewer:
Yes. Yes. And I think that's, yeah, that's, you're you're, as they say in the South, you're talking my talk, so that's yeah. So that's great. That's great. So you, you have gone through the process though, of starting and stopping with your practice to not only, you know, just as a mom and all of that, that encompasses, but also just changing locations and moving around. So I know you've got a lot of thoughts about, you know, what it looks like to rebuild. And I think with the you know, the current environment we're in, you know, as we're recording this and in the middle of a pandemic a lot of us are having to do that. And so, yeah. So what are, what have you kind of learned about that so far? I know that's a huge question.
Dr. Rachel Barbanel-Fried:
It is a huge question. So I'll take a stab and see. So the first time I built my practice was in DC and I was like I said, not actually interested in building a practice at that point. I sort of a friend of mine had said, Oh, if you want to sublet for me a couple of hours, that would be great. You know, you can just sort of take what I'm not using. And I had a full time job. I was running a counseling center at a small college and sort of built slowly one by one, you know, I had first one patient, then I had a couple. Then I had, you know, all of my mornings failed. And then I realized I wanted to kind of leave my job and start a practice. So then I built a full time practice in DC.
Dr. Rachel Barbanel-Fried:
And my husband at that point he's a physician and we knew he was finishing his training and we knew we were going to end up somewhere, didn't know where we were. And it happened, happened to be at that time. I w I also got pregnant. And so I closed my practice, sort of not knowing where we were going to land. And we landed in Boston. So came to Boston. You know, luckily had a, you know, he had a job, so we had that, but I knew that I wanted to build my practice again and spent some time talking and thinking and trying to figure out where did I really want to build my practice? What did I want my life to look like at that point? What did I want my practice to look like? I had the benefit of already having had a full time practice.
Dr. Rachel Barbanel-Fried:
So I knew what I wanted it to look like. And I very intentionally picked a place that wasn't near, where I lived and picked a place that was going to be very convenient for people to get to, and really spent time building the practice to look like I wanted it to look like. Right. I'll share with you that I also spent a lot of time interview, you know, sort of informationally interviewing with people. Cause I moved to Boston. Boston is a very institutionally driven place. Everybody wanted to know who are you affiliated with? Where'd you go to grad school? Who did you train with? And I didn't train with anybody here. Right. And so I can't tell you how many people I interviewed with that said, they're not, you're not going to be able to do what you want to do. There's no way you're going to be able to build a practice on your own without having an affiliation.
Dr. Rachel Barbanel-Fried:
And I'm just not kind of the kind of person that like that just, you know, spurred me for further forward. You know, don't tell me I can't do something cause I'm going to do it twice as fast. And so then, you know, I built my practice and then I got pregnant again, which I had to close my practice again and then build it another time. And I've, that's happened to me now three times. So I've been, I have three kids and each time have had the, in some way, I guess it's a real luxury to be able to be very intentional about how I want to build my job and my career to fit my personal and family goals as well.
Gordon Brewer:
Yeah. And I think that's, yeah. You know again, one of the things that I totally agree with you on is I think for anybody going into private practice, I think the one thing we have to really kind of look at as our lifestyle, because that's, that's the major motivation for most of us to go into private practice is that we want the autonomy that it brings. And the flexibility as I shared with you before we got started, my wife is as we're recording, this is in the hospital. And if I hadn't, we hadn't in private practice, there's no way I could have navigated this if I was working for someone else. And so I was just able to, you know, have that flexibility. And so, yeah, so that's that that's huge, you know, one thing you said that I'm curious about is that you had heard from other, I guess, other practitioners in the area there in the Boston area that were really kind of stuck on, Oh, you've got to be affiliated and have a name and, you know, be, you know, have a rubber stamp from this institution or that institution.
Gordon Brewer:
My, do you think that really matters to clients? Are, is that just matter to us in the profession?
Dr. Rachel Barbanel-Fried:
I think that there are certain people who want you to have a pedigree, right. I live and work in, you know, Harvard has a name, right. But Harvard also has a stereotype. So if you are somebody who wants the Harvard stereotype and I actually am now I was credentialed to be a supervisor through Harvard med school. So now I have the pedigree, but if you're the person who is looking for the pedigree, I'm probably not your person anyway. Right. So, you know, I do think that, but I, but I think that people really act from a place of fear. Right. And so I do think that that's what those other clinicians were saying to me. Right. Like they didn't think they could do it so they didn't think I can do it.
Gordon Brewer:
Right, right, right. Yeah. I think that's yeah. One of the things that I think is so important to be mindful of is just, I think a lot of times, particularly not that, you know, I'm, I'm all for education and academics and that sort of thing, but I think a lot of times, for those of us going into private practice, what we get taught in graduate school and in our training, isn't really necessarily true in the real world. I think you know, yeah.
Dr. Rachel Barbanel-Fried:
I mean, who gets, I don't know, my graduate school training didn't include anything about right. And anything about running.
Gordon Brewer:
Right, right. Exactly. Exactly. So, yeah.
Dr. Rachel Barbanel-Fried:
So that's, again, one of the things that I love doing is actually talking with people who, you know mentoring people and supervising folks to build their practice. Right. So fulfilling, if you realize that actually when you have a private practice, you are a small business owner, you're an entrepreneur. What you're doing is creating something other than just helping, which is important and great, but you're really creating some, something of your own vision.
Gordon Brewer:
Yes, yes, absolutely. So as you, as you have gone through this process, several times of kind of ramping down and then ramping back up with your practice what would you say has been maybe some do's and don'ts and what have you found that has really worked well for you? And just for other people that you've worked with and, and going through this whole process. Cause I know you're, you're also helping other clinicians through, through these very, very things,
Dr. Rachel Barbanel-Fried:
Right. So I'm, you know, I'm helping other clinicians. And I think actually my interest in the business side has also like part of what I'm doing now is also working with executives. I have a lot of executives in my practice now I think in part, because I have this interest in work life, life balance in figuring out the piece of business that impacts on our happiness and our life, you know? So I think you have to get, most of us don't come to counseling therapy, psychology psychiatry, because we want to run a business. Right. So you have to get comfortable talking about money and thinking about money. Right. And that is so uncomfortable for so many of us, right. You're not supposed to talk about what money, sex and politics, right. So you gotta get comfortable about talking about all this stuff. You got to get comfortable with talking about all the things that are uncomfortable. And so many of us are trained our, in our, in our clinical training to talk about what our clients are uncomfortable with, but you also have to figure out what are you uncomfortable with? And for many of us, particularly beginning clinicians, it's really uncomfortable to say, this is my fee, right. I'm worth this amount of money.
Dr. Rachel Barbanel-Fried:
Right. And I learned the hard way after getting stiffed about, you know, somewhere around $7,000 by a client who I just really wasn't comfortable talking about money with and then he disappeared.
Gordon Brewer:
Yeah. Yeah.
Dr. Rachel Barbanel-Fried:
Right. And now I'm really good about talking about money. I'm really good about like, talking about, well, what's, what's up with the fee. Why are you, you know, and I actually collect these at time of service, the sort of more typical psychotherapy practice where people bill at the end of the month. Right. You pay your hairdresser at the time.
Gordon Brewer:
Right, right. Yeah, yeah, yeah. Yeah. And you're, you're you're right. I think a big part of the discomfort around money is our own discomfort because I think that that most clients expect to pay us. And you know, if they're and I think most clients know that, I mean, well really any, any business you go into where you're, unless it's banking or something like that, you, you pay at the time that you receive the service. So I think that's you know, I think our money mindset gets in the way of helping us really make our business thrive. Just because we, we hold off on those things. Yeah.
Dr. Rachel Barbanel-Fried:
I think you have to be comfortable with knowing what you do well and knowing what you're not comfortable with. Right. So knowing like what's your lane and knowing when to refer it. Right. So I start every initial intake I say to people, you know, if I'm not the right person, for whatever reason, schedule personality, you know, subject matter, whatever it is that is no skin off my back. Right. I am, my job is to help make sure you get the help you need. So if I'm not the right person, happy to help you get connected to somebody else. Right.
Gordon Brewer:
Right. Right. Yeah. And I, and, and I think because we, it, when a person does that and just really in what you're talking about is just really defining your niche or niche. However you prefer to say that it just makes you a better clinician. If you're working clients that are good fit for you and, and you're a good you know, they're a good, they're a good fit for you and you're a good fit for them. It just makes for much better clinical work as well. Because all of us have had those clients, or we look at our schedule and say, Oh, no, not them today. You know,
Dr. Rachel Barbanel-Fried:
And if we're working right, if you're working and you're, you have your own practice and you spend your whole day, right. We, everybody comes to us because their lives are not working the way they want to. Right. Nobody comes because everything's going smashing. Right. So at the very least, I want to feel like I'm enjoying what I'm doing. Right. And so that doesn't mean that like every single day I'm like psyched to go to work. Exactly. But you know, it means that I feel like I'm doing what I'm good at, which helps me feel like I'm giving people what they need. And it's like a, you know, it's like a happy sort of cycle. Right. Something I was thinking about before that I just wanted to touch on was like, when I was building my practice, I was very intentional and, you know, I sublet first.
Dr. Rachel Barbanel-Fried:
Right. And I thought about how many patients or clients do I need to see in order to cover my expenses. And then that I kept very intentionally that number. And so I tried to build to that number and then I thought, okay, now I want to now I want to cover my expenses in my first two weeks. Right. Then I want to cover my expenses in the first week. Right. Right. So it's a very, you have to have high hard goals if you think about it that way. Right. It is much more achievable. I know that I need two more hours per week or two more hours per day than I can. I'm much more likely to be able to achieve that than if it's just the sort of amorphous.
Gordon Brewer:
Yes. Yes. And I totally agree. And that, it's one of the things that one process I like to help people go through. And it sounds like you do something very similar is that I think you, going back to what we talked about earlier, you start with your lifestyle and, you know, there's for most of us, if we break it down or really think about it, there's a, there's a, there's a number that's associated with that, you know, what is your, you know, what do you need to bring home for you and your family every year? You know, starting that kind of, that big thing. What's, what's your salary. Do you want to pay yourself for the year? And then you work backwards from that to figure out, okay, what does that look like on a daily basis? You know, do I need to see two clients a day?
Gordon Brewer:
Do I need to see five clients in a day? You know, whatever that is. And I think that's, that's, that's a good, that's a great approach because I think one, one of the things, again, this, for me, it seems like common sense, but I think for a lot of people that doesn't doesn't necessarily it may be not, they might not think about it that way, but if you don't know where you're going, how are you going to get there? Yeah. You've got to have a map. If I'm going to go on a trip, I've got to know how I'm going to drive to Boston to see Rachel, I've got to know where to start. I've got to know which, which road to drive down verse to get there. So that's right. That's right. Yeah.
Dr. Rachel Barbanel-Fried:
You know, and I think that, and this is something you and I were talking about before also, right. That this current situation that we're in is another opportunity to take stock. Right. And I've been talking about that with all of the people that I work with, but I've also been really trying to make sure that I am on top of that, of my, in my own life. Right. what works for you and what doesn't. So we are in two separate parts of the country. We have very separate, like different, you know, kinds of experiences in terms of what's happening or what has happened. You know, we shut down pretty fully here in Massachusetts, like from the beginning and now things are kind of reopening. But for a number of different reasons, I have been very clear with folks that I do not actually anticipate seeing people in my office for at least a year.
Gordon Brewer:
Yeah, yeah. Right.
Dr. Rachel Barbanel-Fried:
I for, you know, I just don't think that given what we know, there's so many things we don't know, but given what we do know about the transmission of the virus, I think the anxiety that would come from each of us having to kind of mitigate risk, it doesn't seem that it's worth it, especially because I've had such good results from, you know, using telemedicine. Right. So I have done a combination of seeing people on zoom and doing phone sessions. And one of the things that's really worked for me very well about the phone sessions actually is that I take, I tell people very clearly, I'm going to walk while we're talking. And so for me, that's been amazing. Cause, you know, if you see eight people in a day, you're on your Keester for eight hours.
Gordon Brewer:
Right, right. Yeah. Yeah. That's correct. I love that idea. Yeah.
Dr. Rachel Barbanel-Fried:
And so, you know the fact that I'm walking has really invigorated me. And in fact there have been a couple of ex two examples in particular of people that I was talking with, who after being kind of sheltered in place for a long time were actually quite anxious about getting out, back out into the world. And so I said to them, okay, we're going to do an InVivo experiment. The next time we talk, we're gonna, you're going to walk. Right. So they're walking where they're walking, I'm walking where I'm walking. We're not, we're still on the phone, so we're not near each other at all. We're not, I don't, you know, like different towns. Right,
Gordon Brewer:
Right, right.
Dr. Rachel Barbanel-Fried:
It enabled them to get out and get back into the world. And it's been a really, really useful thing for me to really it's like, I, I kind of don't want to give this up.
Gordon Brewer:
Right. Right. Yeah. Yeah. It's, it's what my experience has been that my priorities about life and what I want in my practice have totally changed since the beginning of March. I mean, just as a result of the, of the pandemic and you know, just other things with my wife's health and all of that sort of thing, it's just kinda like, you know, I had to sit down and just say, okay, what are my priorities now? You know, what is, what do I want my life to look like over this next year? You know, and just really kind of changes and it's drastic, you know, it has just changed. I mean my whole daily routine has changed and I'm sure yours is too as well. You know, one of the, one of the advantages is being able to work from home more so I don't have to commute.
Gordon Brewer:
And so it's you know, that's been a little bit of a park there, but yeah, so I really love I really love this idea though, of just doing an inventory of, of your life and where you want to be in your lifestyle and like it, like you said, a really you're, you're correct. You've got to have that hard conversation about money and about your numbers and be brutally honest with yourself about that I think is, is so important. So yeah, so, well, Rachel, I want to be mindful of your time and I'm so, so glad we we've had this conversation. I'm sure we could, we could talk for several hours about all this stuff and, and that sort of thing, but tell how they can get in touch with you and about your website and your blog and all of that.
Dr. Rachel Barbanel-Fried:
So I had a website it's dr. RBF D R rbf.com. I have a blog that, you know, talking about sort of what we want our life to look like. That has been one thing that is sort of fallen off and that I have not been able to write as much since the beginning of March in part, because other things have come in I've been doing a lot more podcasts and more you know, sort of teaching online. So I am hoping to publish more blogs, but I would love, and people want to check out my blog. I'm on Instagram and Facebook again, dr. RBF. and I would love to, you know, connect with folks if they have any thoughts or questions about what we've talked about today.
Gordon Brewer:
Oh, good, good. And we'll have all the links to all of those things in the, in the show summary and show notes for people as they listen to the podcast. Well, well, Rachel has been so great to get to know you, and I'm so glad, and hopefully we can get you back on again to talk about these things. Cause I think they're just so pertinent and so important. And as you said, especially during the, during this time that we're in and just with the COVID pandemic and all of that, it just that thinking about how do you, how do you regroup and restart and all that sort of thing. So, thanks. Pleasure. Thank you. All right.