The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome again to the podcast, and I'm so thrilled to have back with me on the podcast, my good friend Avivit Fisher.
Welcome Avivit Glad you're here.
Avivit Fisher: Thank you so much for having me. We were just talking about how it's been a long time, so
Gordon Brewer: Right.
Avivit Fisher: So happy to hear, be here again.
Gordon Brewer: Yes. And so for folks that might not know you, Avivit uh, tell folks a little more about yourself and how you got into this space of working with therapists around marketing.
Avivit Fisher: Yeah, I mean I've told this story quite a few times, but I love telling it uh, I'll repeat it. I started working with therapists in about 2017. And like everybody else who ends up in the mental health space, almost everybody that I meet, I ended up there because of personal reasons. In 2015 the apartment building where I lived with my family burned down.
And subsequently I was looking for, help to process it and to cope with it. But I didn't really understand what I needed. So when I started looking for how to get over a house fire emotionally I couldn't really find anything online. And then I saw the gap between. How therapists presented themselves then it was 2015, 16 and what people were actually looking for.
And I saw an opportunity to close this gap. So, and kind of, help both. The therapists attract more clients and also help people find the right therapist for them. So I've been working with therapists ever since. I've been helping them with, uh, marketing strategy, um, with the, also with digital marketing and so on.
And since then. My own business, right strategy has evolved more into business growth. Helping therapists either transition from insurance to private pay, launching a private pay practice, and also scaling their private pay practice. And this is basically, uh, my sweet spot. I help them. Kind of differentiate themselves and stand out among other therapists, position themselves within the market with a very strong brand message and put together a marketing system.
That they can own that can attract the type of clients that they enjoy working with, that they're a good fit, and most importantly those who can pay their fees. Right. So that's a little bit about me.
Gordon Brewer: Yeah. Yeah. And I know when we before we started recording part of, uh. What we're we started talking about, which I think is, uh, you know, this topic comes up a lot for people and there's really two topics we want to try to maybe try to get to if we can.
Just about with the advent of AI and just things like, um, better help and Talkspace and all of that, of being a private pay clinician. But one of the things that I always tell people, when I do consulting with them and they're trying to make this decision mm-hmm. Between going kind of insurance based or going private pay.
Or even having a kind of a hybrid model, which I think is a good sweet spot for a lot of people, is you really have to make the decision about. Where you want to put your energy with mm-hmm. With all of this because and you're, you're, you're the expert in this in that for. Private pay clinician, you're gonna have to devote a lot of time and a lot of energy into marketing your practice in a way that helps you stand out and also reaches your your ideal client versus.
An insurance based practice where you don't really have to do a lot of marketing, but you, the payoff the downsize is, is that there's a lot of work that has to go into credentialing and finding the right insurance companies to get on their panels with and then be willing to have them dictate to you what you get paid.
And so that's the downside. And then filing claims and following up. So I guess maybe the question is, is in your working with people that want to go private pay, what's the approach they really need to think about and the mindset they need to have around that?
Avivit Fisher: So, that's a very good question, and especially it becomes a little bit tricky when it's a hybrid model.
So from. Operationally right from the point of view of insurance based practice. Those practices, they can go wide. You know, they don't even necessarily need to have a very strong niche because they accept insurance. So they're, their whole approach is focusing on volume. So the more people you get to your practice, the more leads you get to your practice, the more the higher probability that your caseload is gonna grow.
With private pay, that's a little bit of a different mindset, and that's something that a lot of people don't really recognize right away. The mindset is you need to filter down the people. So the volume is not the approach, it's the targeted. Quality leads that you can generate. That's the approach because you know the motivation for insurance clients is to find a provider within the insurance, right?
So they need to find somebody who takes their insurance. And so that's the main motivator, the motivator for private pay clients. Those are the ones who are looking for the best fit, so they're looking for the best therapist for them. So all your marketing and messaging needs to signal that you are the best therapist for a particular group of people, for a particular audience, and this is when nicheing comes into play and so on.
Gordon Brewer: Mm-hmm.
Avivit Fisher: Particularly when we have headway, when we have Alma. Those are the platforms that can, you really bring a lot of people to you. They can just send you leads. So the broader you are in terms of your expertise and, and, and, uh, and uh, experience. Uh, actually I think that's the, be the, that's better.
So when you transition from insurance to private pay, you kind of need to shift that mindset of being. All inclusive to being very deliberate and filtering who you are trying to attract.
Gordon Brewer: Yeah. I think it's, uh, yeah. And that's, uh, again, the thing that people have to weigh for themselves
Avivit Fisher: mm-hmm.
Gordon Brewer: Is okay, do you want to attract clients that are only gonna. Use their insurance and you're gonna have to go a higher volume with those number of clients,
Avivit Fisher: right?
Gordon Brewer: In order to probably get the, meet the financial targets that you're looking for yourself. Mm-hmm. Um, versus. Smaller number of clients that are also willing to pay you a higher premium for your services.
Right. And so, yeah. And it's, uh, yeah, and there's no, I don't think there's any right answer, but you do have to approach it much differently and really get. I think I do a lot of kind of soul searching on the backend about what it is that you want your practice to look like, what you want your practice to be.
Yeah.
Avivit Fisher: Yeah. You're completely correct. And in, uh, when it comes to soul searching, you have to actually name the trade-offs, right? If you are going, uh, the insurance route, then the trade off would be lower reimbursement fees, right? And in exchange for not having to do some, invest in marketing so much, not having to actually invest in business growth as much and strategy.
So all, so you can focus more on your clinical work, right? When you go the private pay route, you have to actually, um, you know, the trade off is the volume, obviously. But the upside is the premium fees. You know, being a little bit on your own terms and you are more independent in terms of, how you structure your future, how you structure your mm-hmm.
Your business future and financial future and so on. So it really depends on, I think it depends a lot on personality of a, of a, of a therapist to make this decision.
Gordon Brewer: Yeah. And I know a lot of, um, I've talked with, hundreds of therapists over the, over the years on, on this podcast, and one of the things I think you have to really kinda start with is, you know, what is your, what is the life's life?
Lifestyle you wanna maintain for yourself.
Avivit Fisher: Mm-hmm.
Gordon Brewer: You know, what is it that you need financially in order to make it worthwhile, in order to get the return on your investment of your time and your money? And, um, really approach it from a business standpoint of what that could look like. There are people that are.
Their financial situation might be that they don't have to work full-time mm-hmm. Or see that many clients. And so those are great people to really think about having a, a cash-based practice. I know one of, uh, you know, one of my therapist he's very, very much, a person that caters to a certain type of client.
Right. And that's how I, why I connected with him because he has, he kind of works with, you know, he works with other therapists and he works with people that, um, I. I've gone through different life transition things like I've experienced. Mm-hmm. And that's why I sought him out. And the thing about it is, is that I pay, he doesn't take insurance.
And so mm-hmm. That's okay with me because I can afford to pay that. And so that's the, I guess that's kind getting to what you're looking at or finding, finding those kinds of clients.
Avivit Fisher: Right. So you, I guess you connected to what he was saying, his messaging and the way he positioned themselves. Out of curiosity, how did you find him?
Gordon Brewer: It's, it is funny. I, I found him through word of mouth as much as anything. Right. Um. Just that. Uh, and, and also as people know, I've got a lot of church connections and so there were some church connections there. And so, and I knew his background and kind of knew him personally. So that was how I found him or how, just knew about him ahead of time really.
So, um, he didn't really have to market to me to find me, but yeah. But I knew about him. I mean, he was, he was, um, was known and trusted. And so that goes back to the marketing piece is making sure that people know who you are, that you build credibility with people and trust, know that whole know, like, and trust thing.
Avivit Fisher: Yeah. And, and it's a good thing that you bring it up, word of mouth. I work, when I work with my clients. One of the first strategies we go to is outreach and networking. Mm-hmm. And the interesting part about it is that the more specific you are in your message, when you, when, when we define the message, when we say specifically, I work with these type of people, helping them in this way.
And that's why I, and here are the reasons why I'm the best fit for them. When you reach out, even to other therapists, to colleagues, it's much easier for them to remember you and refer to you. So mm-hmm. As opposed to reaching out and saying, I, I have availability, can you send me any more clients? And like, having sort of a generic note.
It's no wonder why you heard about him word of mouth, because he built a reputation in as a certain type of therapist. So that's. That's a good thing to remember. Yeah.
Gordon Brewer: Yeah. And if it, and if we think about it, just thinking about the niche or niche or however we wanna say that if I go to my doctor, my general practitioner, and there's a particular specific thing that I need help with, he's gonna send me to a specialist,
Avivit Fisher: right.
Gordon Brewer: With, in that, in that. In that area. And and so I think being able to specialize really goes a long way in helping people market. And you're also gonna be, you're also as a therapist gonna be much happier because you're working with your ideal client in that way.
Avivit Fisher: Yeah you are. And it's, uh, there's many reasons to feel happier.
Mm-hmm. Um, there, there are ways you work with people that you really, truly enjoy and find meaningful meaning and satisfaction in working with them professionally. You also, once you build your caseload and reputation, you also can be less burned out as a result because your caseload doesn't have to be so full like an insurance therapist.
And you can plan financially better I think. So there's a lot of upside definitely to being a private pay.
Gordon Brewer: Sure. You know, one of the things, a question that gets asked, and we talked about this a little bit before we started recording, and I'm hearing this question a lot just to people that send me questions or, you know, just respond on Instagram or whatever, you know how there, there's a lot of anxiety that people have in, in private practice about, using platforms like Better Help Talkspace. Mm-hmm. I would categorize them as tech companies that have gotten into the mineral health space. Right. And a lot of people are saying, well, you know, it's gonna get me clients, do I drink the Kool-Aid and, and do that? But also they think, well, I worry about competing with those platforms and that I'm not not gonna be able to.
Get clients because those platforms are there or they're stealing my clients or however they wanna praise that. What have you learned about that, or what do you kind of, how do you kind of think about that?
Avivit Fisher: So I have. Observed a lot. What, what's been happening in the market for the past couple of years, and not only tech companies, but also AI changed a lot of things.
So there's
Gordon Brewer: Yes.
Avivit Fisher: I ha So I know some therapists lose sessions to people because they had a great chat with a chat GPT about how they're feeling. And the thing that I came out with is private pay practices. Cannot compete with those companies and they should not compete with this, with these companies.
They're in a completely different category. So pro those companies. The whole point of those companies is creating access to therapy for people at an affordable rate, right? So they're uh, offering affordability and access, right? A private pay practice cannot compete on access, on affordability.
It's just they will lose. So they need to compete on quality and. Personalization and I coin it being human on purpose kind of thing. Mm-hmm. You have to think about it. I don't compete with them. I can't win because they have different budgets. They have, you know, they have a monopoly in many ways, but the way I can position myself as a premium level of care and have a very strong message there.
This will attract clients that will not go to Talkspace, that would not go and look for for a therapist through headway. They want somebody who they can connect with. They want somebody who makes them feel like they're getting the best of the best, and this is how you need to think about it. It's.
Premium of level of care. It's different. It's, mm-hmm. And, and, and. Mm-hmm. That's the mindset that you have to adopt right now, in my opinion.
Gordon Brewer: Right. Yeah. So, yeah. And, and I, I agree with you totally. Is that the other thing too is that, that what, at least what I'm seeing in my practice, because we offer both telehealth and we also have.
In person, far in away. More and more people are wanting to come in person.
Avivit Fisher: Yeah.
Gordon Brewer: Because they recognize being on a screen, you lose something. And I think, um, again, that's a very specific kind of client as opposed to maybe a client that's busy and doesn't want to drive to the office, that kind of thing.
And so that's a different category of, of client. And so, um, yeah.
Avivit Fisher: I completely agree with you. And funny, I mean, it's not related. I have a friend who just opened a yoga studio and she's seeing that people are really enjoying the connection, the human connection, the coming mm-hmm. The personal care, uh, and all the obviously yoga studio is a different experience, but I'm seeing that also if, when I observe my own behavior, I'd rather go to a doctor's office.
Than seeing a doctor on screen. I had to see a doctor on screen on screen. Yes, it's convenient, but I don't feel like, I don't feel like. I'm being checked properly.
Gordon Brewer: Right, right. Yeah, exactly. Exactly. Yeah. And so I think that's a big, um, selling point, so to speak, for having a, you know, a cash pay practice.
The other thing too, just as a side is that. Cash pay practices as far as operationally are much easier to run than an insurance based practice. And I just know that from my own experience, because I'm really, my practice uses kind of a hybrid model, and that was a, that was a. That was a big decision I made whether to accept insurance or not, or
Do a hybrid model. And I think you could do, I think you can do both profitably, uh, but you have to, again, you have to have a different mindset about it.
Avivit Fisher: Yeah, that's right. And I, I'll tell you more. I keep hearing, I don't know if you hear that, but I hear like, oh, you know, people can't afford therapy right now.
Why would the people pay for therapy out of pocket? Mm-hmm. There, there's this fear among therapists that people would not pay out of pocket. And to that, I just, I just observed other, other, vertigo, other industries, and I'm looking around and I'm seeing that, for example, there are more and more medical spots popping up.
None of them take insurance. All of them are cash pay. That's only an indicator that people pay for what matters to them. People pay mm-hmm. For things that they feel that they, you know, get. Can get value from and they can significantly improve their lives.
It's a sim for somebody, it's skincare.
For other people it's mental health. But the challenge becomes for therapist is to communicate how to the audience that they're trying to attract, how, what value you can bring to somebody by working with them. Mm-hmm. Um, and I think that once people. Recognize it and know it. They will.
Yeah. They pay. They pay the fee. Right,
Gordon Brewer: right. Yeah. So Avive, I know we have to be mindful of our time, but tell folks that are interested in working with you, the ways to go about the different ways in which you help people.
Avivit Fisher: Wonderful. Uh, the easiest way to find me is to go on my website, red strategy.com, with, uh, red, with two Ds.
There is actually a lot of resources and information there. I, I recently created a whole library, a glossary of terms, uh, marketing terms for private pay practices, so you can find everything there. I also wrote a brief that goes deep into the topic of. Private pay practice in 2026, so you can download it, that's completely free.
And you can always schedule, um. A call with me. It's, um, cre, uh, it's strategic direction call. That's what I call it. We sit for 60 minutes and we'll look through really look under the hood of your private practice. So that's the easiest way to find me to work with me and to really, uh.
Look through all the resources that I created in the last 10 years of working with therapists. I have a lot of insight and I really understand what, what the, what you, what therapists and private pay specifically need.
Gordon Brewer: Yes. Yes. And, and, um, Avive has always been one of my go-to people for marketing in private practice.
And so I can, a, I can actually recommend her. So that's, that's always a good, always a good thing. The other thing I'll say about Avive is that she just has a great way of just really listening well and understanding what. What therapists are needing for their practice. So we'll have links here in the show notes and the show summaries to for people to access all of that easier.
So what's next on the horizon for you? Avivit
Avivit Fisher: I do, I want to champion the private pay therapy practice. Mm-hmm. Uh, model. Mm-hmm. I believe in it very strongly, I believe in being human on purpose. Mm-hmm. Even though I do work with AI and I also understand the AI tools, but I do think that therapists will become.
Much more valuable in the future, and I wanna be there for you. Yeah. That's awesome. Thank you so much for Yeah, again, having me over. It's always such a pleasure talking to you. I feel like we just, yeah, we're just chatting. So
Gordon Brewer: Yes. That's, yeah, that's how I try to do this. So, but uh, yeah, and also I'll mention too, um, Avive has a great email newsletter that comes out and she's got, it's just packed full of great information.
So when you get to her website, do sign up for that because, um. It's great stuff, so thank you Avi. Yeah, go ahead.
Avivit Fisher: Thank you. It's called Therapy Business Brief. Yeah, and it comes out every Friday in the afternoon.
Gordon Brewer: Alright. Alright, I'm sure we'll be talking again here soon. Thanks again, Avivit
Avivit Fisher: Thank you.
Appreciate it.