The Practice of Therapy

Gordon Brewer
This episode is brought to you by blueprint health. blueprint health is a measurement based care platform for mental health providers. You can find out more about them by going to practice of therapy.com slash blueprint health. And also this episode is brought to you by therapy notes therapy notes.com, the leading Electronic Health Record system for mental health providers in private practice there who I use in my practice, check them out at practice of therapy.com slash therapy notes.

This is the practice of therapy podcast with Gordon Brewer, helping you to navigate your private practice journey.

This is episode number 199 of the practice of therapy podcast. Hello, everyone. I'm Gordon Brewer, glad you've joined me and glad you've joined me for a kind of this special episode. It's hard to believe that we're approaching episode number 200. And I'm looking forward to you hearing that one next week. And I'm going to be joined by a special guest at least special to me, and that is Rachel bond and she's my virtual assistant and she does all the behind the scenes things for the podcast. And so what you're gonna get to hear from, from her and just us our conversation just about kind of the evolution of the podcast, and, and all of that. But in this particular episode, I'd like to just kind of share with you maybe a little bit of my backstory, but also just share with you the things some some more things that I've learned just about being in private practice, and maybe some things to think about just in your own practice and our mindset and all of those kinds of things. And you know, and by part of this was just kind of kind of the catalyst for this, I guess you could say is that, here it is, as I'm recording this the beginning of a new quarter, or the last quarter of 2021. And so I pulled out my full focus planner, my new new one for this particular quarter. And part of the process of when you switch planners from quarter to quarter, you do a quarterly review. And so we just kind of thinking back over this last quarter, but also thinking back to the beginning of the year. And even farther back than that is when I when I first started the practice of therapy and just how that came to be. But I'm just so glad you're with me on this journey. And thank you for listening in to kind of my thoughts and just kind of sharing what I've learned. I've been in private practice now for over 20 years now I started started my private practice probably in around 2005 2006. So it's, it's come it's come a long way since then. So but had been doing it part time prior to that. And just just thinking I want to just kind of share with you my thoughts on what some of the things I've learned so far. But before we get to that, and just kind of my thoughts on that, I'd love for you to go over and check out the new course that I've got out. And from now until October 15, you can still take advantage of the pre launch price of this course. And it's gone using Google workspace as a practice platform. For those of you that have been listening for a while you know that I'm a big fan of Google workspace, I've got another course that's out there called Google workspace for therapists. And this new course really piggybacks on that. But during the pre launch, you can get it at a much discounted price. And if you go to practice of therapy.com slash g w s platform, you can check it out. And I'm putting the finishing touches on that the probably 90% of the content is up there, but we're gonna, I'm gonna be adding some more to it over the next week or so. And really finish it out until I'm ready to update it. And then speaking of updating,

you know, if you enroll in the course you have lifetime access. So as things change with Google and things change over time, you get access to all the updates as they come. I just recently updated the Google workspace for therapists course. I spent a lot of time in 2021 working on that and getting it updated. So those updates are there for that course. And then If you bundle the courses, you'll see a little pop up that will come up over that. If you bundle this, this course with Google workspace for therapists, you can get a discount for that too. But for now, all the pre launch is available practice of therapy.com slash g w s platform. So I invite you to check that out. And also before we get to this particular episode, and just me thinking about some things that I've learned and some reflections about private practice and some things maybe to consider in your own practice, I'd love for you to listen in on our sponsors, aren't we've got our wonderful sponsors of the podcast, therapy notes, therapy notes calm or you can get to them at by going to practice of therapy.com slash therapy notes, be sure to check out blueprint health also in the old care more about them here. But they are a measurement based care platform. So before we get to my thoughts on some things that I've learned and things that maybe think about in your own practice, take a listen to our sponsors. You know, as your practice grows, the systems and processes you have in place will keep your practice running smoothly. That's why it's important to have an Electronic Health Record system that is specific to mental health providers. Therapy notes is a complete practice management system. With everything you need to manage patient records, schedule appointments, meet with patients remotely, create rich documentation, and Bill insurance all right at your fingertips. Their streamlined software is accessible, wherever and whenever you need it. There are who I use in my practice, and that I mentioned that they are one of the top rated EHR for mental health providers, their support is also second to none. So be sure to check them out at practice of therapy.com slash therapy notes. And be sure to use the promo code Gordon, just g o r, d o n, and you can try them out for two months for free. That's therapy notes.com. And this episode is also brought to you by blueprint health. You know, one of the best ways to serve clients in your practice is through measurement based outcomes. In fact, more and more third party payers, aka insurance companies are demanding measurable outcomes. And with more and more emphasis on good mental health, having a way to measure your outcomes just make sense. Introducing blueprint, the measurement based care platform that administers scores and charts, hundreds of symptom rating scales, to give clinicians deeper insights into treatment progress, ultimately, by helping helping behavioral health providers to grow top line, practice revenue, increased clinician satisfaction, and deliver more effective care. So be sure and check them out by going to practice of therapy.com slash blueprint health. And by going to that URL, you can also get your first month free. Again, that's practice of therapy.com slash blueprint health.

Welcome again, folks to the podcast and thank you for joining me in this special episode, Episode Number 199. And, you know, it's it's interesting, the journey that I've been on as I reflect back and, you know, even you know, I think a lot of times, we do a lot of reflection around the, the the first of the year, but here we are at the end of the third quarter if you track those kinds of things, the beginning of October, and so just three months left in the year. And so I think it's always a good idea to kind of go back and look at things and as I mentioned earlier, I've been able to do that with the help of my full focus planner. And it has a lot of prompts in it and really a quarterly review that I use in just really looking back over things that I've accomplished things I'd like to accomplish just goal setting and that sort of thing. But anyway, for those of you that maybe you're newer to the podcast, I wanted to share maybe a little bit of my backstory and how just kind of how the practice of therapy came into being. You know, I really Really my dream of going into private practice really goes way back to when I was in undergraduate, I went to Mars Hill University and it was really my freshman year, I was really trying to figure out what I wanted to major and I had really thought originally that I was going to go into pre med and that was my goal was to become a doctor, a medical doctor, and, and all of that, but one of the things I ran into was just that chemistry kicked my butt. And so I really started really thinking, Okay, is this really what I want to do? Do I really have what it takes to become a doctor? Probably in reflecting back on what I knew then versus what I knew. Now. I wish I had pushed myself to that, but I really don't regret the core of the, the, the course the course of life that I've been on since then. But you know, part of part of the story around that was, I had got there was a movie that came out and I'm really dating myself here. They came out the year, it was over Christmas break. I remember my freshman year of college. So the movie ordinary people again, I'm date dating myself a good bet was came out in 1980. And I had to go back and do a little research on it. But it's basically a story about a family, the Jarrett family. It's has the some pretty heavy hitting actors in it, at least in my mind. You have Donald Sutherland and Mary Tyler Moore and Judd Hirsch and Timothy Hutton, and also Elizabeth McGovern, fo, for those of you that are Downton Abbey fans. But the gerrits are an upper middle class family in the in a suburb of Chicago, and they're trying to return to normal life after an accidental death of their oldest teenage son buck, and an attempted suicide of their younger surviving son. And he was paid by Timothy Hutton. His name was Conrad and Conrad had recently tert returned home from a format stay at a psychiatric hospital, and is really kind of feeling very alienated by his friends and family and sees, sees a psychiatrist Dr. Berger, who is played by john Judd hearse. And so the story just kind of talks about what the family is going through prior, you know, after this tragedy that occurs in their family, and particularly the mom's attempts to kind of cover up her emotions and deal with all of her grief and that sort of thing. But there's a particular scene in this movie where Conrad is having a crisis. And he found out that one of his friends, again, the his friend that is played by a friend that had been he had met in the psychiatric hospital had committed suicide. And so he's dealing with this crisis. And in the particular scene with Judd Hirsch, Conrad has kind of like this breakthrough moment where he realizes that he's never really dealt with the trauma of his of his brother's death. And the fact that he survived he was having a lot of survivor's guilt around all of that. But it was during that movie, yeah, that sorry, for the long story here. That really I had just this aha moment about wanting to become a therapist of thinking, wouldn't it be really cool to be able to work with people and help people in that way. And so that was really when the seed was planted for me.

You know, as far as becoming a therapist later in life, and so I went back to school, and I declared my major in psychology. And it kind of went from there. Now I took some detours along the way, before actually went back to graduate school, I graduated from college. And then again, this is a whole other story that I could go down a rabbit trail on, but I actually became a funeral director because I was working part time at a funeral home during my senior year of college and so I got really interested in that whole business. And so I did that for several years before I went back to graduate school. But anyway, all through graduate school, I had kind of this, this idea that I wanted to go into private practice eventually and that was kind of my dream and just had this idea. You know, this character played by Judd Hirsch. Dr. Berger, in wanting to be like him one day, having my own office and being able to see clients one on one and being able to help them with with trauma and being able to help We'll work through the difficulties in their life. And one of the things about it, hopefully, as I'm sharing this kind of story, this backstory, hopefully is getting you to maybe think about your own story about why you wanted to go into this profession to begin with, why you wanted to go into clinical work, become a therapist, become a social worker, psychologists, marriage and family therapist, licensed professional counselor, whatever you are within this particular profession, because that's an important piece to keep in mind. As you move through just thinking about going into private practice. What is your inspiration? What is your why, as I like to call it, because I think one of the things that happens, as we go into this, and we get busy with the business of running a practice and that sort of thing, we can lose sight of that. And we can really get to a place where we're maybe feeling a little burned out. I know, I've gone through some ups and downs around that. And this is hard work, I think that is noble work. And just to borrow some words, from my faith tradition, this is holy work, to some degree. And I think we need to all be reminded of that. And particularly, as we've all experienced over this last year, just with a lot of the struggles with COVID, and just the anxiety that that that has created for people, and just even for ourselves, just the anxiety that's created, created for ourselves of just not knowing and really being afraid, in many ways, it's really caused, I think, a lot of us to really be really reflective on our own mental health and our own well being around all of that. So anyway, My point being is, is that, I think it's good to always go back and get grounded in that, you know, the other thing that I've learned along the way, and just thinking about private practices that private practice isn't for everyone, I think one of the things that you have to have there for yourself is a sense of wanting to feed the creative side of yourself. And I think we all can do it in different ways. But as I have, you've heard from me before, one of the things that you have to have in order to be successful in private practice is a bit of an entrepreneurial spirit. And in other words, a bit of a willingness to accept a challenge or be challenged by that bad things. part of the fun for me, if you will about running a private practice is the fact that I get to dabble in the business side of things and learn that. And that's really what inspired me to start the practice of therapy when I started it back in 2016, which again, it's hard to believe that I've been doing this that long, I started the podcast in 2017. And so here we are up to 199 episodes, getting ready to do our 200th episode. And I hope that I keep can keep this going for another few years. But part of the reason for starting the practice of therapy is really wanting to share the things that I've learned about being in private practice, because

it's not stuff that we learned in graduate school, very few of us have had any sort of business courses or learned anything about the business side of running a private practice. Even when I went to work for an agency, I was kind of shielded a little bit from that because somebody else handled kind of the administrative side of things. Now, I got into that when I was a supervisor and had to be aware of like, census says, and making sure that the people that reported to me kept a certain number of caseload hours and that kind of thing. But other than that the business side of things really wasn't something I learned. But when I made the decision to kind of jump into private practice, I had to learn a lot. Number one, I had to learn about the financial side of private practice. And that was one of the things that inspired me to create the course, money matters and private practice which is, is still available and you can access that at practice of therapy.com slash money matters. But that's a whole course that I put together just to really teach people about the financial side of private practice. And one of the one of the things that I learned along the way was when you go into business, you need to have some money. I need to kind of back that up. A lot of traditional businesses do it through investors. In other words, they get people to invest money for some sort of return on that investment. But I think for a lot of us, when we go into private practice, we want to be self sufficient with that. And that's what i what i was able to do. So I started out in private practice, just doing it part time, I was still working for the agency at the time, and started my private practice, and then later, left the agency. But I was also working another church related job that was, was very much a part time job I was, at that time, I was the coordinator for Episcopal Appalachian ministries. So it's a regional ministry that was located here in the Appalachian region, just kind of dealing with social issues throughout the Appalachian region, particularly the coalfields of Appalachia and that sort of thing. So I was able to do that it was the coordinator for that. But that provided some income that took the pressure off of me as I built my practice. So that would be one thing that I would say that I've learned. And it was a good lesson to learn, in that I didn't jump into private practice full force until I knew that I had enough money in reserve, to kind of back myself up as I built my practice. So I spent a year just taking everything pretty much everything that I made from the practice, and saving it away so that I had a reserve, knowing that if something were to happen, that I didn't see any clients are wasn't able to get any income from my practice, I had a buffer there that could, could protect me through that. And so that would be one thing that I always encourage people to do is to have at least three to six months of your income and expenses saved away in your practice before you jump into it full time. It just takes a lot of pressure off yourself. Now, one of the things too, that I've learned over these last, there's the last this last year is that there is more than enough business for all of us. And it's a matter of being able to put yourself out there and being able to market your practice in a way that people can find you. And that's really all marketing is, is just making sure that you've got a website that is performing well. You are networking with the right people as far as people that are going to send you referrals. And also if you are if your insurance based being on the right insurance panels, because that's kind of a built in referral network there for you if you are on insurance panels. So being able to, as you build your practice, being able to have that financial buffer, as you bring in those income sources that are going to continue to build your practice. The other thing that I've kind of learned along the way is is that when I first started my practice, I really made my systems and processes really much more complicated than many debate. So one of the things is, is keep it simple.

Don't make it overly complicated for yourself. And I think one area that people can do that is they get start getting worried about regulations such as HIPAA, state requirements, and all that sort of thing. I think it gets ingrained in us. When we were in graduate school, you don't want to do anything illegal or unethical. But I think that that the fear around those particular issues can hold us back. Not that I'm saying that you put that stuff aside, but don't make it over. overly complicated for yourself. You know, like, for example, with HIPAA. The bottom line to HIPAA is is that we protect client information, personal information about our clients. That's something we do anyway in our in our profession. So just being able to do that in a way that you know that you're protecting stuff. So you encrypt your equipment, you encrypt your storage of documents, that sort of thing. You make sure that you've got be a AES with business associate agreements with any third party application that you're sharing your information on. So for example, with Google workspace, you can get a BA from them to be able to store client records on the Google Drive, or if you're using an Electronic Health Record system like therapy notes, they have a BA. So you're doing good, just kind of those common sense things to protect patient information. So don't make it overly complicated for yourself. Again, you can find lots of resources of that I've got, there is a blog post that I'll probably go in and update here soon. But it's just HIPAA anxiety, in private practice, a blog post that I did a few years ago, just about HIPAA, and just not making it overly complicated for yourself around those issues. The other thing, too, that I think I've learned along the way, and maybe a little bit of a mistake that people make, is that they're reluctant to really invest in things that are going to be a better use of their time. One of the things that I think a lot of people want to do when they're initially starting their practices, and even I see people that have been in practice for a long time, they end up doing too much of the work, that isn't a good return on their time investment for themselves. So an example of this is, as you grow your practice, and it starts reaching kind of this critical mass, you're, they're still returning phone calls to clients, they're still scheduling clients, all of those kinds of things. Where that could be a better a better use of their time would be to outsource those things. That's usually one of the first places when I do consulting with people, and usually when people call me about doing some consulting, is that they're starting to get overwhelmed in their practice. And they're realizing that how they're doing things isn't running as smoothly, and they're having to spend just a lot of time on administrative things, the more you can outsource your administrative functions, and that would be things like setting appointments, returning client calls,

even your records, like insurance claims, and all of that sort of thing. It's much better to outsource those things they had to try to continue to do, do them yourself. I think it's a good idea to bootstrap and do those things yourself in the initial stages, when you're not seeing a lot of clients are not having to worry about a lot of that because you've got the time to do it. And you also kind of learn the workings and the nuts and bolts of all of those systems and processes. But once you reach a critical mass, and I would say if you're starting to see 10 or more clients per week, in your practice is time to start outsourcing. And so that's a good return on your investment. The other thing too, is making the investment and getting some help, not only with outsourcing things, but I think in consulting, not that I'm necessarily pushing consulting with me, but just getting consulting with anybody. People that have had the experience and to be able to do those consults with them, is a very important piece. I know every time that I have done that, when I have reached out and like become joined a mastermind group or a focus group or done individual consulting with either people within our profession or outside of profession, it has just been such a huge benefit. And I've nearly always gotten the return on the investment of the money I invested in doing consulting. So that would be something that I would encourage you to look into. Particularly if you're starting to feel a little bit overwhelmed and feeling a little bit tired in your practice, so to speak. Look at maybe doing some consulting to see how you can learn how to work more efficiently and learn learn to work smarter in your practice. The other thing and this is tied to this is one mistake that I people see people see make is just a little bit about their money, money mindset within their practice. They're reluctant to invest in their practice and put money into things that are going to bring a good return on their investment. A small example of this would be to put some money into advertising or promoting your practice. And one way to do that is I think about like Psychology Today profile or other directories of putting the money into that if you were to get you know, for example, Psychology Today profile costs about $30 a month if you get just one new client from putting your money into that, you're going to get that money back. And so think about return on investment when you think about spending your money or not. Also, as I mentioned, just with outsourcing your return on investment of your time, putting, putting your time where you're going to be

being able to spend your time in ways that actually bring you income rather than then not getting income. You know, another question that I get from people a good bit about it, and that is just thinking about ways to diversify your income. You know, when we're working in traditional therapy practices where we're spending our time, one on one with people either, as you know, like, for me, as a marriage and family therapist, I see a lot of couples, but also individuals. That's a good, you know, getting paid for that time is a good return on the investment of my time. But one of the things about that is, is that their cap, particularly in a solo practice, there's a ceiling to that there are only so many clients, you can see in one day, there are only so many clients you can see in a week. And so you can reach a limit in that, and being able to preserve time for yourself by not taking on too many clients. And one of the things that you will want to think about doing is how to diversify your income. In other words, if you want to increase your income within your practice, just saying more clients does bring in more income, but it might not be a good, again, return on your investment of your time. And so kind of a natural, next logical step for a lot of people is in being able to start a group practice. And one of the things about that is again, that's not great going into group practice might not be for everyone, I think you have to be able to have a bit of an app, some document around leadership, you have to enjoy working with others, just within kind of an employee, employer employees setting, you could also hire contractors, but you have to be able to be willing to be dependent on other people, but also being able to lead in such a way that is going to make it worthwhile for people that you might bring into your practice a whole lot to say about starting a group practice more than I can cover in this particular episode. But I do we do have a free webinar that's still out there. And it's just on solo to group practice. And if you got a practice of therapy.com at the top of the page, there should be a banner that comes up for you to register for that free webinar. And the webinar will give you a great overview about what it means to go into group practice and what it takes. And then if you really want to dive in deep, we do have a course that's there. There is a course that I partnered with my friend Dr. David Hall on called group practice outfitter. And in this course, we just kind of walk you through the the nuts and bolts in the A to Z of starting a group practice. So that's there, but I would say go watch the webinar. First. It's a, it's a free on demand webinar when I say on demand. In other words, you pick the time that you want to watch the webinar. And that'll give you a way to kind of dip your toes into that. And even if you already have a group practice, I would encourage you to watch the webinar because there's some information in there. And just some tidbits that David and I share about the the ups and downs of running a group practice and things you might want to think about. So I commend that to you. And again, you can get to that by just going to practice of therapy.com. And also there's a URL practice of therapy.com slash group. And that'll get you in in there to, to see the webinar and register for that free webinar. So again, thinking about being able to diversify your income. The other place that ways that you can diversify your income is by creating products and services that are just kind of an add on to your traditional therapy services, or even just like what I've done with the practice of therapy are related to what we do and so the creating online courses, I've done a lot of that there's also different products that you might want to create such as hands handouts and clinical tools that maybe you've developed. One of the things I'm excited about is one of my, one of my clinicians here in my practice, is wanting to create a parenting course. And so we're going to be working together to put that online. And she'll be able to benefit from the income from that course, once we get it up there. And also, I'll benefit in for in my practice, just from income from that as well. And so it's a win win situation. But thinking about different ways to diversify your practice. Again, I'm thinking about putting together another course just on that whole whole concept of being able to think about what it takes to diversify income within a private practice. But group practice is one way to do it, but also creating products and services. And so one of the things about that to prevent burnout, I think, is being able to feed that creative side by creating these things within your practice that are going to bring excitement and meaning and that sort of thing within your practice.

The other thing too, and I'm kind of circling back to where, where I began in this particular episode, before I close this out, is to really evaluate what it is that you need from your practice, not only need in terms of your emotional needs, or spiritual needs, or that sort of thing, but also your fiscal fiscal needs. In other words, how much money you need to make from your practice, to create the lifestyle that you want to create for yourself. So many times I think people create practices, where they are. They are working for their business, rather than the business working for them. And so I think it's always good to kind of evaluate that, and look at how you can work smarter rather than harder. And again, this ties back into your why what is it that prompted you to go into private practice to begin with? What is it that you're wanting to get out of your practice? What is it that you need to sustain yourself, and the lifestyle that you want to keep for yourself, and your practice should be feeding you with that, rather than the other way around. And so I think that's something that we have to evaluate, over and over again, one of the things I'll just mention in this particular episode, because I know it's coming up, is killing at camp and one of the talks that I'm going to be doing in killing at Camp is really thinking about what is your right size, practice? What's the right size practice for you. And it might be that just being a solo prep, not just being that sounds kind of diminished. But being a solo practitioner, might be the perfect size for you might be that you just want to work part time with your practice. But also, quite honestly, it might be that being a private practice owner isn't what you want to do. Is it something that you want to put the work into? Is it something that you want the headaches of so to speak, and so seeking out somebody else that will hire you as an employee in a private practice might be a good place to start. Being in private practice doesn't mean you have to be the owner, you can be an employee or a contractor with another private practice. So I like to put that out there for people as well. Also just thinking about what are your goals around growth and just your values and what your mission of your practice is, because I know that that has been a big motivator for me. And just in my own journey of being able to think about why I started a private practice to begin with, is that I wanted to provide within my community, a premier, a mental health provider option for people other than just public mental health. And I feel like we've done a pretty good job of that, at least based on the calls that we've gotten so far, and what we hear from people and just being able to be a leader in our community in this field. And so the feedback I'm getting so far is that we're accomplishing that. So again, thinking about your why about why he wants your practice to be what you want to provide to your community. All of those things are things I think we have to keep ourselves grounded in, in order for our practices to be successful. So I think that was allotted probably enough for this episode. Thank you for listening in to this and, you know, again, I want to reiterate that what you're doing is as a therapist As a counselor, social worker, psychologist coaches, this is important work. And now more than ever, you are really in a great field. And I'm so proud to be in this field to be a provider in the mental health field. And hopefully you have a sense of that pride as well in the work that you do, because you're doing something that is making a huge difference in people's lives in the world. And I don't want any of us to lose sight of that. And so thank you for what you do day in and day out and helping people. It's something that I feel a great sense of calling for. And something that I feel is important to make our world better. So kudos to you for being in this field. And thank you again for just being with me on this journey. And just learning how to, hopefully this, this podcast and the resources I've got are support to you. So thanks for joining me, particularly in this episode number 199.

Well, thanks again, folks for joining me for this particular episode. I'm so glad you're with me on this journey. And I hope that you will tune in again to future episodes, be sure to come back for episode number 200. It's a special one, and I'm really looking forward to you getting to know Rachel as I've gotten to know her and just some more reflections on the on the episodes we've had and things that we've learned along the way and just putting this podcast out every week. Be sure and check out the Google workspace as a practice platform course. And you can get to that at practice of therapy.com slash GW s course gdb s platform excuse me Jedi GWS course will get you to another course of mine, Google workspace for therapists. But either either one, take it out, do take advantage of the pre launch of the Google workspace as a practice platform course that I've got out. And also be sure to check out our sponsors for the podcast. I'm so happy to have them as partners in this journey therapy notes and you can find out more about them at practice of therapy.com slash therapy notes, and also blueprint health, their measurement based platform for your practice and really making sure that you're doing great clinical work. And you can find out more about them by going to practice of therapy.com slash blueprint health. So thanks again, folks, for being with me on this journey. Be sure to take time to follow us wherever you might be listening to the podcast. And leave us a review. I love hearing, hearing honest feedback from the podcast and love hearing from folks. So take care folks have a great rest of your week or weekend. Whenever you might be listening to this.

You have been listening to the practice of therapy podcast with Gordon Brewer. Please visit us at practice of therapy.com for more information, resources, and tools to help you in starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide and practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered. It is given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person

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