The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome again to the podcast, and I'm really looking forward to you getting to know today Martin Altman. Welcome, Martin. Glad you're here.
Martin Altman: Hey, thank you.
Gordon Brewer: Yes. And so Martin and I were just reminiscing before we started, uh, recording and we have met, actually met each other at, uh, one of our mutual friend's, uh, Whitney Owens, who does the Wise Practice Conference every year and has the Wise Practice podcast.
So shout out to Whitney on this episode. But, um, Martin, as I start with everyone, uh, tell folks a little more about yourself and how you've landed where you've landed.
Martin Altman: Yeah. Man, I, where to start's a little bit of a awkward question there in my mind. I I like to say that I, I started becoming a therapist.
I graduated 2011. Just did various forms of, you know, work out in the field, and then realized that, while I was doing private practice, realized that I, I was someone with ADHD. And suddenly light bulb started going off for me and, uh, had someone ... Actually, it was Whitney that asked me, uh, "Who are you good at working with?"
And, uh, in, in considering that and asking like, "Where have you had the most success in your work? What kinds of clients have you had the most success with?" I realized, oh yeah, they're all either people with ADHD or, or some form of autism in their thinking, and that, it, that just became who I related the best to and, and did the best work with.
And so I decided let me, uh, let me point all of my efforts that way. Uh, let me market that direction. Let me get trained as much as possible in that direction and, and, and here we are.
Gordon Brewer: Yeah, yeah.
Martin Altman: Actually, that was about eight years ago that happened. Yeah. All right.
Gordon Brewer: Um, and
Martin Altman: I started tailoring that.
Gordon Brewer: Yeah.
Uh, and I think that's so important. People hear on this podcast and others as well just the importance of developing a niche so that you'd get to kind of stand out. And I think, like you discovered, what happens is, is you find the things that you're most passionate about and that's your niche. Yeah.
Because if you try to do a niche that you're not passionate about or even though you might have a know- a lot of knowledge about, that's gonna come through eventually, that you're just, yeah, just don't enjoy working- Totally ... with those folks. Yeah. But so- Yeah,
Martin Altman: and I think with ADHD it's especially important because if I'm not interested in something, you know, good luck getting me to do it.
Gordon Brewer: Right. Yeah. So yeah, so as you made that discovery about yourself and, uh, recognizing that, what have been, um, I guess this is a really broad question, but what have been some of the key takeaways for you in just being a therapist and what it m- has meant for, you know, attention during sessions and all that kind of stuff?
Martin Altman: Oh, yeah. Oh, so you're asking about the experience of being a therapist with ADHD, right? Right. And
Gordon Brewer: the collecti- Right. Yeah.
Martin Altman: Yeah, yeah. Good question. What was the question again? No, I'm playing. Yeah.
No I definitely see the impact. Um, what I will say is that as a creative person I'm the kind of ADHD, as most people are, that, that tends to be very creative and somewhat artsy, and I feel like I, I operate on about two or three different levels at the same time. Mm-hmm ... and if I sit down with a client who's like that as well, it's a lot more interesting to me, um, and it helps me kind of understand what they are probably thinking as well.
I feel like I'm always sort of running a creative backlog or a creative backstory, uh, script- Mm-hmm ... behind, uh, what I'm thinking or saying. And then also, and this is, I think, key for the therapist, uh, the ADHD person tends to be very sensitive to rejection and always really careful about how they are presenting.
Gordon Brewer: Mm-hmm.
Martin Altman: Um, and so I think that honestly plays right into some of the skills that therapists have to learn how to do.
Gordon Brewer: Mm-hmm. Mm-hmm.
Martin Altman: Um, we can be, uh, hypervigilant about that or, or, or very, uh, very rigidly protecting our, our image sometime for the client to make sure that they understand, "Hey, I am, I'm here.
I'm, I'm listening. I'm being compassionate." And I think we're also extra sensitive to more subtle nuances in the expression of the client that other people might not be.
Gordon Brewer: Right.
Martin Altman: Yeah, I think- That's how we've survived as ADHD-ers- Uh-huh ... you know, for since, you know, kindergarten or before, that's how we've survived the social setting- Mm-hmm
is to be extra aware of potential threats to our personhood.
Gordon Brewer: Yeah. What's a b- A- as you have kind of, uh, and, and maybe you don't do this, but I, you know, one of the things that I've always said about being a good therapist is being able to give ourselves some grace to do a little bit of self-disclosure about our own struggles and just different life's, life experiences and that sort of thing that are relatable to people.
What have you found with that?
Martin Altman: I do way too much of it.
But I usually find too that after I build up a, a, a lot of rapport with a client and I've gotten to know them a good bit and we're talking, you know, 10, 12 sessions in sometimes, uh, as I start to disclose more of, my own sort of experiences here with ADHD, that really sen- it tends to hit home.
Gordon Brewer: Mm-hmm ...
Martin Altman: it tends to be really helpful for the client. And sometimes I'll, I'll even get a couple of questions like, "Okay, tell me more about that," you know?
Gordon Brewer: Mm-hmm.
Martin Altman: So it's, it- I always wrestle with that because as, as a therapist, you know, we're told, "Don't do that," very often. And I don't think anybody should be that, necessarily that blank slate, but also like I, I find that I have to sort of in my mind justify why I'm doing it.
Uh, and to measure, measure it to make sure I don't do it too much.
Gordon Brewer: Right. So what, what sort of, uh, tricks and tips and that sort of thing have you learned just with, um, knowing yourself well and just the neurodiversity and that sort of thing?
Martin Altman: Yeah. So one of the things I picked up a long time ago, I like to model it for clients.
I, I teach them, you know, this happens to help me a lot in, in the sessions, is I'll repeat back, I repeat back, under my breath, what's being said, what's being said, while it's being said, while it's being said. And so i- it's not something as audible as what I just did, but I may- Mm-hmm
just like in my mind repeat the last few words so I make sure that I actually got that, that it- Mm-hmm ... didn't just hit me and my, creative dopamine burst makes it seem irrelevant to me, uh, but that- Mm-hmm ... I actually spend a little bit of time with each word that comes my way. Um- Yeah ... as much as possible I like to take a lot of notes.
And, uh, many times I'll write down something the client said or I'll write down two or three points that I wanna make sure I, I go over with them, um, so that I, uh, I, I've got it, you know, fresh in front of me and I'm, I'm certain to return to it.
Yeah. Um, beyond that it's kind of just about knowing yourself, I think.
Gordon Brewer: Yeah. Um,
Martin Altman: and then trusting yourself. As, as our good friend Aaron Poztrat from Shrink Think says- Yeah. Yes.
Gordon Brewer: Yeah ...
Martin Altman: you tru- trust yourself to do the right thing in the moment.
Um, to trust myself rather than being motivated by the anxiety to- Mm-hmm ... to go back and- t- to trust yourself to i- when the situation arises to do the right thing, and to be motivated by trusting yourself rather than the anxiety of the moment.
Gordon Brewer: So as you, as you made the, um, as you made your way into private practice and you not- kind of identified the niche that you wanted to be in, how did things change in your practice for you?
Martin Altman: It became less drudgery. Uh-huh. Mm-hmm. Yeah. Um Uh, I used to think that, "Oh, yeah, anxiety, you know, just walking around, basic anxiety. Uh, yeah, certainly I can treat that." And I, I guess I can, um, it just, it's not as interesting to me if it also has... un- unless it also has ADHD mixed in. Depression, you know, uh, kind of the same thing.
Like, I can coach this person into feeling better. But if, if there's not that level of neurodivergence in there, I'm not gonna be as interested. Potentially not as effective, possibly. But it's just going to be a lot better if that's mixed in.
Gordon Brewer: Mm-hmm.
Martin Altman: So once I sort of embraced that and realized that I can take this element of myself and bring it into the therapy space it, it was a scary kind of transition because I didn't know if I was ever gonna get clients.
Mm-hmm. But then you find that there's a lot of people out there that are looking for that. Mm-hmm. And it's a pretty, um, it's a pretty good s- resource once you sort of build a name for yourself in, within that niche. Does that make sense? All
Gordon Brewer: right. Yeah, it does. It does. Yeah. And I think that's, um, like we, we've said already, I think people connect with that because it's genuine. So, um, as you structured your practice, how have you done that in a way that kind of helps kind of your style- ... and that kind of thing? Yeah.
Martin Altman: So I tried hiring an assistant. I- Mm-hmm ... I tried that for a while.
Had in, in one situation, had a just great, uh, relationship with an assistant who was able to, to keep me scheduled and to keep all the billing and everything done. Um, then i- it's been really rough once that person had to transition out. It's been a little bit rough to try to stay on top of those things myself and other efforts- Mm-hmm
you know, to bring someone in. So I'd still love to have an assistant but that was a huge, I think, key piece to keeping myself- Mm-hmm ... on board. Um- Yeah ... and, and to keep myself, you know, productive and profitable. Mm-hmm ... other than that, I'm relying a lot, too, on, uh, the schedule yourself feature, uh, in my- Mm-hmm
EHR, where- Yeah ... a, a person can log on to my website, they can go through that to get to my EHR to schedule their own appointment.
Gordon Brewer: Uh-huh.
Martin Altman: Um, and then, you know, I think anybody I wind up spending a lot of time, uh, texting people about appointments. You know, like they're- Mm-hmm ... they're asking me, "Hey, can I get an appointment in?"
And I'm, I'm replying back to, you know, all the possible times, and I'd love to have everybody able to go schedule their own appointment- Mm-hmm ... but it doesn't typically work like that. Right. You- Right ... like- Yeah ... w- which is fine. You know, I get it. If I was,
Gordon Brewer: Mm-hmm ...
Martin Altman: the client to that therapist too, I would think I would want that more individualized service even on the scheduling end.
Sure.
Gordon Brewer: Sure. Yeah. Well, you know, I think, uh, uh, one of the things I've learned, um, in just working with people and, and just my own experience in private practice, I think a lot of times people wait too long to outsource things that are things that, um- They may be doing themselves. The part of it is, is you feel like you can do it better than somebody else that you hire or all of those, all the different reasons.
But I think that's one, you know, having somebody do the scheduling is one really low-hanging fruit and being able to make your, your practice not only more sustainable but also more profitable in a way because our money is made with our bu- as I like to say, butts in chair, and that's how we- Yeah ... yeah, kinda, kinda do things.
Yeah.
Martin Altman: Yeah. Yeah. So, so important to have that flow.
Um, and then multi s- several streams flowing into that, you know, uh-
Gordon Brewer: Right ...
Martin Altman: i've gotten in with a, uh, an EAP that I love that sends me a lot of clients. I use Headway. Headway sends- Mm-hmm ... a good portion of clients. Um, then, you know, I've been able to market myself online all the social media platforms, a website, to be able to get all of that, putting myself out there, even using a lot of AI channels recently to try to put myself- Mm-hmm
out there as findable and, market myself as a hopefully pretty skilled person.
Gordon Brewer: Yeah. Sure, sure. Yeah, I know you mentioned AI, and I think that's been hu- a huge game changer for us in a lot of different areas. And, um, one, one in particular of having, uh, AI admin staff you know, a kind of a, a shout out here to my good friend, uh, Uriah Gilford, who's also good friends with that.
We have a little consultants group that gets together with Whitney and Uriah and Allison Pidgeon. And so one of the things that, uh, Uriah's been working on is having a, um, an AI, AI-powered administrative assistant that does the scheduling and all of that kind of stuff, and it's just amazing what can be done with all of that.
Martin Altman: Yeah. And frankly, I kinda hate it. Yeah, I, I know it.
Gordon Brewer: I know it. I know it. Yeah. I get it. Yeah.
Martin Altman: Um, and, and I have more of a, I guess it's more of a personal distress for it 'cause I'm from a county that's literally being taken over right now in pursuit of a data, data center. Down in South Georgia where I grew up there's this- I
Gordon Brewer: get it
Martin Altman: massive, like, lots of stuff going on. I won't get into the politics of it, but like-
Gordon Brewer: Mm-hmm ...
Martin Altman: yeah. I love- Uh-huh ... the easiness that it brings. I hate some of the environmental impact that-
Gordon Brewer: Yeah, very good point. Yeah. Very good point. Yeah, and I think that's something we're gonna have to weigh out over time, and I think, too, I think ultimately where we'll land is people want to have that human touch as opposed to- Yeah
just something, artificially gene- generated or whatever. But yeah.
Martin Altman: Yeah. I think the other piece there is that because I work with a lot of ADHD people, like probably 80, about 80% of my caseload is someone who qualifies as having ADHD. That means, too, that I work with a lot of computer engineers, computer programmers- software engineers and-
Gordon Brewer: Right ...
Martin Altman: so many of my clients are like, "Oh my gosh I'm not gonna have a job next month." So I'm experiencing this sort of like fallout of- Yeah ... uh, within AI- Yeah ... of A- A- AI is taking my job. Um, not- Right ... me personally, but those... That's what I'm hearing from many clients.
Oh,
Gordon Brewer: right.
Martin Altman: And so with all that said, I'm actually quite hesitant to use, um, AI in my, in my business, even though I know inevitably I, I will wind up using it more, but- Mm-hmm ... I'm definitely not, not there yet.
Gordon Brewer: Right. Well, that's fair. Even working- That's, uh, yeah ...
Martin Altman: absolutely.
Gordon Brewer: Yeah. Yeah. That's, uh... Yeah. It's, uh...
A- and I th- I think we, uh, I know that we didn't intend for this episode to be about AI, but I think- ... I think, uh, the fu- you know, the full potential of it is yet to be found, and so I think it's- Yeah ... gonna be... Yeah, it's gonna be interesting, interesting stuff for sure. So yeah, so- So I'm a little bit
Martin Altman: of a loose cannon sometimes.
It's Friday, and I've done like a bunch of
Gordon Brewer: stuff. So, yeah. Oh, oh, yeah. Yeah. I get it. I get it. I'm the same way. I have a... i've not been diagnosed with ADHD, but I notice that I have a lot of those tendencies- Sure ... as far as getting, getting easily distracted, especially if it's something I find interesting or whatever, but yeah.
Yeah. So what, uh, yeah, I guess to get back, kind of a little bit back on topic, what, what sort... when you hit with your cli- with your clients with this, you know, the whole neurodiversity thing what do you find that most people tend to struggle with or come to you for help with most of the time?
Martin Altman: Yeah. Um, it's really interesting. I, I found this before I was treating ADHD, and also n- now that I kind of specialize in that. A lot of times people want skills. That they'll come in and they're, they're wanting skills because that's kind of what I think even an AI chatbot or, or the Google would tell them that, okay, this is what needs to happen.
More often than not, though, uh, we wind up, you know, pursuing like that healing therapeutic alliance. The clinical relationship becomes what's actually effective. I think one of the biggest things that, that people come in for is like organizational kinda life skill level stuff. And the thing about ADHD, and this is kinda sort of the, the magic bullet is that- It's generally emotional hijacking that causes the distraction.
And this is where Ed Hollowell, uh, who wrote ADHD 2.0, who I, I love that book. It's most of what I do comes from that book. Mm-hmm. He talks about, um, emotional hijacking, meaning that the what's called the default mode network hijacks the ability to focus on something, and the result there is, is rumination and brooding and spinning off.
And, and, uh, the distraction comes from not being able sometimes to manage the emotion that I have around the thing. Mm-hmm. And therefore, it's hard for me to focus on doing the thing. Or if I'm trying to do my spreadsheet at work and there's something going on at home that's a high conflict, all I can think about is that.
I can't focus on the spreadsheet I'm trying to do at home.
Gordon Brewer: Mm-hmm. Yeah. Yeah. No, I bet-
Martin Altman: And it doesn't have to be negative stuff. It can be, like, really, like, positive, like, Mm-hmm ... inspirational, happy, feel-good stuff too that can really hijack our focus- ... um, because we feel strong emotion towards the thing.
Gordon Brewer: Yeah, I think that that's a really interesting thing is is that there's that whole self dialogue around what's happening that- Yeah ... gets in the way, yeah. Yeah.
Martin Altman: Yeah. And how much bandwidth does even the dialogue take up? Usually a whole lot. With- Mm-hmm ... ADHD too, there's a separation from the relationship with the self.
Like, the, the key part of ADHD is that I have worried so much or I have, oftentimes kicked myself so much, beat myself up so much that I don't have much of a relationship with the person inside my chest, what I want, what I feel, what my dreams and goals and visions are. Mm-hmm ... you know, and, and I may lay that down for someone else or lay that down for what my boss wants me to do and never actually, you know, connect here.
Mm-hmm. There's not a lot of, um, kind of slow it down, connect on a deep level with myself kind of energy. It's more like- Right ... in the moment, s- more spastic, uh, meet the demand at the time.
Gordon Brewer: Yeah. Yeah. And I, I think of that self-awareness would be, be pretty huge.
Martin Altman: Yeah. Yeah.
Gordon Brewer: Yeah. Yeah.
Martin Altman: Um, we see that in relationships a lot of times where-
...
Martin Altman: Where the one partner lays down what they want just entirely for what the, the non-ADHD partner wants.
Gordon Brewer: Mm-hmm.
Martin Altman: And then you can go through decades like that sometimes and kind of realize, oh, I don't quite know who I am because I've not been- Mm-hmm
actually paying attention to the person inside my chest. Right.
Gordon Brewer: Yeah. What sort of, uh, grounding stuff do you find helpful for people?
Martin Altman: It really comes down to, Understanding when it's happening again, you know? Mm-hmm. So, so you could answer all the time. Yeah. Right. But, but really, like, uh, Hollowell talks about this too in his book, is this awareness of I'm doing it again.
Oh, there it is. Mm-hmm. I'm doing it again.
I am letting myself spin. I'm letting myself get too far down the rabbit trail.
Gordon Brewer: Right.
Martin Altman: Um, uh, and that awareness means that you can realize, now that you're aware that you're doing it again, you can realize, oh, my brain is going too fast right now. I need to s- to slow myself down.
Gordon Brewer: Mm-hmm. Mm-hmm. Um,
Martin Altman: this is where I like to use, uh, the example of an upside down bicycle.
Gordon Brewer: Mm-hmm.
Martin Altman: And, and I sometimes if I teach this, I'll actually bring a bicycle to the, the- Yeah ... the demonstration. But a upside down bicycle, the handlebars and the seat are on the ground between us, and then the wheels are sticking up.
If I take the pedals and I spin them, the back wheel might go 80 miles an hour. Mm-hmm. Now move that inside your head, and the, the speed that your brain is going right now at this moment is the speed of the back wheel. Mm-hmm. And then you realize my thoughts and my feelings are what's pedaling that wheel.
Mm-hmm. What are the thoughts I need to come off of? What are the thoughts I need to turn down, I need to- Mm-hmm ... reduce energy flow to?
Gordon Brewer: Yeah. Yeah. And I, I would think that takes an incredible amount of practice to be able to do that.
Martin Altman: It does. Yeah.
Gordon Brewer: Mm-hmm.
Martin Altman: And, and a lot of people are just not developed to the point that they can do that yet.
Gordon Brewer: Yeah.
Martin Altman: And so- Yeah ... it's a long, slow process of helping people, number one, say, "Oh, I'm doing it again," and number two, find ways to calm themselves down to the point that they- Mm-hmm ... feel like they're at the control panel. They're at the executive function level that they can control where their energy goes.
Gordon Brewer: Martin, this is fascinating stuff, and I wish we had more time to, to talk about all of this, but any parting thoughts? And also tell folks how they can reach out to you if they'd like to and learn more about your work.
Martin Altman: Yeah. Yeah. I think, uh, parting thoughts would be if you are someone with ADHD or living with someone with ADHD or with autism you know, don't give up on yourself.
Keep investing in yourself. Keep exploring, learning doing what you can to get an idea for how to control this. With ADHD in particular, we talk a lot about taking back control.
And, uh, there's thankfully, you know, ADHD 2.0, the book by Ed Hollowell, has, uh, so many pointers on how to take back control.
Um, so highly recommend that. Yeah. I can be reached through, largely through my website, which is www.stillwatercounselingatl.com.
Um, I'm also on, uh, Instagram, Facebook, Psychology Today, I think Therapy Tribe. I think I'm still on Therapy Tribe, Oh, okay. Okay ... and several other platforms. You Google me, you'll find me.
Martin Altman, LPC.
Gordon Brewer: Awesome. Awesome. And we'll have links here in the show notes in the show summary to Martin's things. So, well, Martin, thanks so much for being on the podcast. Oh, and I wanted to mention on Martin's podcast, he's got a lot of blogs there that are really helpful- I do, yeah ... kinds of- On the website, yeah
kinds of things. So yeah, wanna shout out for that, but yeah, hopefully we can have another conversation here soon, Martin, and I'm sure we'll see each other at different conferences and stuff in the future.
Martin Altman: Yeah. Thank you, Gordon. I appreciate it.