The Practice of Therapy

Dr. Carlos Garcia: Hello, I'm Dr. Carlos Garcia, and I am the guest today on the practice of therapy podcast. And today we're going to be talking about some of the both ups and downs that you face when you're a practice owner or starting your own practice, some of the challenges that tend to come through, but also some of the amazing successes that you can have along the way.
Gordon Brewer: Well, hello everyone. Welcome again to the podcast. And I'm so happy for you to get to know today, Dr. Carlos Garcia. Welcome Carlos.
Dr. Carlos Garcia: Thank you. Thank you, Gordon. It's such a pleasure to be here with you today.
Gordon Brewer: Yes, and so Carlos is in Tampa, Florida
Dr. Carlos Garcia: Tampa counseling and wellness.
Gordon Brewer: Yes, perfect. Yeah. Tell a little bit about more about yourself and how you've landed where you've landed.
Dr. Carlos Garcia: Yeah, sure. So I'll give you the quick and the quick part of the story. So actually after high school, I was in the military for about six years serving in the United States Marine Corps.
And then I actually transitioned into work as a fireman and paramedic for about another six, almost seven years before I decided to go back to school and get my doctorate degree in psychology. So It's always been a passion of mine. I also struggled a lot with my own mental health in my 20s and 30s, so that was sort of the, the big push.
I saw the ways that therapy could have such a profound impact in shifting someone's life, and sort of knew from that point on that that's what I wanted to do with my life. So coming out of my graduate program, Graham. I actually went and did a little bit of consulting work in corporate America and then came back to Tampa in 2017.
Got my license, and then a couple years after that started my own practice. So we now have a small practice here in Tampa with several other clinicians that work with me, and we have an amazing team and we provide just like the, you know, just really best and most amazing services to our community and, you know, mental health and wellness.
Gordon Brewer: Oh, it's awesome. And, and thank you for your service on just, you know, to our country and then just in the, you know, in the first responder arena. Yeah. Yeah. So, yeah. So yeah, I'm guessing like most of us that are in private practice, the learning curve on how to run a practice was a pretty big one because I know as, as people have heard from me you know, we get a lot of great clinical training and learn that whole side of things, but running the business side of a practice is a totally different thing.
Dr. Carlos Garcia: Yeah, it's sort of you're just like taking the hits and learning as you go, right? It's, it's. It has felt at times like you're just kind of walking in the dark with your hands out in front of you to kind of figure it out. You know, I think there's a lot of beautiful learning that happens in that way, Gordon, that we may not get in a classroom, for example, if we were taking sort of a business course.
You know, I'm, I'm. Keenly aware of that because just here recently, I was asked to speak at a for a class over here in, in, at the University of South Florida for folks that were about to graduate with their doctorate in business. And it was profound to see how. I had this sort of level of experience and knowledge that was derived from walking through the dark from hitting the bumps on the road that some of these folks haven't even been introduced to yet.
So, so I think there's, there's, you know, really cool piece to that, but yeah, it's also a challenge. It's also a challenge because you're asked to sometimes, Learn, you know, whether it's you know, how to create budgets or how to do marketing or how to network You know things that you haven't maybe had to explore in the past so yeah that that there's such a growth that you know comes from that.
That's beautiful I had I got really lucky gordon. Because of my veteran status here locally we have the air McDill Air Force Base. So there's a lot of veterans in our community. And one of the programs that was available for veterans was a sort of three month course for veteran entrepreneurs.
So I got to come in and, and, you know, meet with them once a week. Kind of learn a few things about how to develop a business, scale a business. And so that was really, really helpful. So I have this really, really amazing facility that is in downtown, it's called the entrepreneur collaborative center,
Gordon Brewer: and so
Dr. Carlos Garcia: they have a lot of free resources there that are funded by the County.
You know, if you wanted to take a class on sales, if you wanted to take a class on, you know, how to create a a business plan, they have those, those things. So, so the, the researchers were out there. It was really a matter of going out there and, you know, how much of that did I want to learn and then be able to come back and implement in my own practice and my own business.
Gordon Brewer: Right, right. Yeah. So what were, what were some of the things that I'm trying to think how the best way to ask this question, what were some of the things that you felt like were I guess, pivotal in helping you grow your practice and just kind of what, oh, This is finally, finally, finally on the right track kind of thing.
Dr. Carlos Garcia: Yeah God, there's, there's so many. Yeah yeah, I, I think the one that it's, it's sticking out for me the most and, and you know, I don't know if a lot of other Folks experience a challenge around this but around budgets and finance. I've never been a numbers person and so even in the first couple of years of my practice, you know, am I tracking the right data?
Am I looking at the numbers correctly? And so there was a big learning curve there for me. And just one of those places where i've been challenged throughout, right? Because You know, you want to get out ahead of that stuff early on in the practice, right before, you know, you're making mistakes that are costing you deep in the pocket.
And so, you know, if I had any advice for anyone out there, if that's a place where you feel challenged, you know, maybe take some classes on, on or some courses on QuickBooks or, or budgeting or whatever it is that that's really going to help you in a really, really powerful way in the long run. Cause you know, here we are, we're.
Still kind of looking at like, you know, what's the best way to track all of all of the data, the numbers that we need to not just from a revenue perspective, but incoming calls. And where are those calls coming from? And, you know, are we you know, are we converting? I hate using terms like that. like, are we converting the calls that are coming in?
How long are they staying? And, and really more from a perspective of like, how can we use that data to better our services to, to be better for our clients and for our community. So all of that is really, really important. And if you're not a numbers person, well, you know, make sure that early on you bring someone on.
In your team that that is, you know, right, right.
Gordon Brewer: Yeah, it's a, yeah, that's something that people hear from me all the time is the importance of knowing your numbers
Dr. Carlos Garcia: and
Gordon Brewer: just, but like you said, you know, is that's a, that's a very broad term, knowing your numbers, but what numbers are we looking at and that kind of thing.
And you mentioned some really good things to think about is, you know what, what are the things that I think a lot of people don't think about? think about is just client retention and making sure that people are, are staying and completing their therapy and that, that sort of thing. Yeah,
Dr. Carlos Garcia: absolutely.
Yeah. You, you know one of the things that I chose to do at my practice, Gordon, and, and, you know, I'm kind of talking from my like owner hat here, but also, you know, this, the, the therapeutic compassionate part of me. I. I felt very strongly. Let me just back up here a minute. I think that when our field started to adopt the medical model.
There was some, some really great shifts and then some shifts that impacted our field in a pretty negative way. For me, I'm not a big believer in the fact, you know, these sort of manualized, I know there's a lot of value in that but for me, it's about like the human sitting across from me and the healing that they need to do less about how many sessions do I have to give you and what prescriptive treatment do I need to give you?
Right. And so For me, it was very important that if I was going to hire staff to work at my practice, that I wanted to have what I, what I call sort of brand alignment, right, are, are the therapists that also work here work sort of in the ways that I do with, with that model of belief that we're not just going to do a quick fix, that this isn't sort of solution focused therapy, although that has its place and its value that we're really here to provide a different service.
And that's, we want to get you, okay. of your hurt and pain and whatever is showing up for you so we can help you heal and move through that. So I decided to hire a lot of interns and postdocs that were going to work under me for a period of time, and that was sort of my way of knowing that the services we were going to have here were going to be consistent.
So in that is, is coming back to your point that the client retention I think when clients know that they are there to do deeper work and that there isn't some, you know, set amount of sessions that, that, that's going to relieve their suffering, if you will,
They're, they're sort of in it for the long haul.
I think that that's a part of the messaging that contributes to a client that stays longer is that first conversation up front about like, what, what are we really doing here? I mean, Yeah, I'm happy to give you some strategies and techniques to fix the problem that's going on right now, but right, this has a deeper root to it.
And I invite you and encourage you, what if we were to, you know, take a look at that and show you not only how to heal, but how to develop some, some different coping strategies and some different ways of being in the world so that later on down the road, if this were to ever arise again, You know what you have to do right and you feel confident in your ability to do that.
So, for me That's a big piece that goes into client retention,
Gordon Brewer: right? Right. Yeah, and and and unfortunately, I think part of part of the whole medical model of mental health has been driven by insurance. And I don't know whether you're accept insurance in your practice or not, but I know for my practice that's something that we do.
And, you know, that's a, that's something to be, again, on the business side of things of being able to be aware of. Okay. You know, insurance rates and what you can collect per session and all of those kinds of things and how, how it fits in. But I totally agree with you is that it should be therapy should be driven by what the, what the client needs or what the patient needs rather than what.
Some chart says they need
Dr. Carlos Garcia: Absolutely. Yeah, I wholeheartedly agree. And you know, I I know that people fall sort of everywhere along the spectrum you know, my experience has been Not only through my own therapy as a patient, but now as a clinician Is that when i've sort of given or allowed the space for my clients to explore?
You know, whether it's previous attachments you know, from this sort of psychodynamic lens object relations, you know, what are, what are the impacts of those, those early experiences in our lives that mold the attitudes that we then carry about ourselves and others in the world? I've noticed that inevitably where we arise is that anxiety decreases, that depression decreases.
The, the thing that they're coming in to work on is, is. You know, again, either healed or move through it in a in a very powerful way. And because that's been the brunt of my experience is how I've wanted to continue to work. Now, as a business owner, that incurs a huge challenge because a lot of the marketing, you know, That we have to do and the advertising is it's sort of on us.
It's it's not, you know, given over to to the insurance companies. And so you know, that's a real challenge for anybody that's trying to run a practice. That's, you know, self pay. But something that. You know, when I sit with, you know, having more clients and maybe a higher revenue or continuing to do this work in a way that feels truly aligned and for the clients, I just keep coming back to, well, we're going to stay self pay and do what we got to do to make ends meet in other ways.
Gordon Brewer: Yeah. And I think that's I know that was a decision that was a hard one for me to make in my practice, you know, because obviously self pay is easier, there's less, less headaches and stuff. But then you think about, you know, in parallel to that, are the needs of your clients and just looking at the demographics of my area where we're, you know, here in the, in the, an Appalachian culture surrounded by a large rural area with the socioeconomics is much different than other parts of the country.
And so, yeah.
Dr. Carlos Garcia: All of those things need to be considered.
Gordon Brewer: Yeah. Yeah. Sure does. Sure does. Well, the, the other thing that you mentioned a little bit ago, and I think this is something to, for people to think about is as you grew your group practice the recruiting of therapists. and how you went about that.
And, and this is something that I think is becoming more and more a way to think about it is bringing, bringing those new folks in and, and bringing them up, so to speak, and in your ways of doing things.
Dr. Carlos Garcia: Yeah, we've navigated this multiple different ways. We've, you know, have brought on at times people that are already licensed.
We've had good and bad experiences you know, bringing in whether it's sort of interns or postdocs or at a student practicum level that, you know, and then they kind of move through the process. And, you know, there's been positive and not so great experiences there as well. What I can say is yeah, it's a process, right?
We've tried bringing people off from doing an advertisement or post on indeed. Sometimes on social media. We have several, Also partners in the community and other universities in the area or in Florida or outside who we've developed good relationships with, who are always willing to send us, you know, students and interns.
So there's lots of different ways to make that happen. I think where the where the focus needs to be. Is in the sort of interview process. And what I mean by that, Gordon, is an interview process that allows either you as the owner or as the group or as the team to identify what's going on.
Individuals that are aligned to the vision of the organization and the method in which we work. Right. For example, a small example would be we meet every two weeks as a team for our supervision slash consultation meeting. Right. We discuss cases, right? And so I've, I've experienced at times, most of my team, you know, if we had to label it, are psychodynamic, they're integrative, right?
They, they, you know, they're, they're, they're going to focus on relationships that are interpersonal, attachment based. And we've had folks that are very solution focused kind of CBT and, and you can tell that there is, They just don't feel like comfortable, or they feel like this isn't the space for them, right?
Like, it's very nuanced, but you can sense it. So part of what that meant for us is I don't just want to be the only person interviewing this person. I want my administrative team to interview them. I have two, two young females that work for us in our administrative team, both part time. They're looking to get their degrees later on, but I have such a deep trust in them because they're like, they're so passionate about what we're doing here at Tampa Counseling and Wellness.
And so their opinion to me matters just as much as the opinion of anyone else. We also have the person interview with one of our sort of somebody that just finished their practicum or their internship so that they can ask questions about what that process was like for them. And then I'll have them sort of interview with, with me and maybe another clinician.
So all of those touch points allow us to see like, is this somebody that's going to be a good fit here? Not only from a clinical perspective, but, but for our team, right? Is this somebody we want to be around weekly? Is this, and so I, you know, it's been a really great tool for us, I think. And, you know, you still get some that kind of slipped through the cracks.
I mean, people always. Putting their, their best foot forward, but it really gives you a good feel for the person you're bringing on. And that's, what's truly helped us bring them the most aligned folks to our organization. Right,
Gordon Brewer: right. I love, yeah, I love that process. And I do do a similar thing in hiring when I'm bringing people on is, you know, I want to get, get kind of a second opinion or other eyes on it of, you know, being able to pick up on things that I might not.
Not see or be biased to or that kind of thing And I
Dr. Carlos Garcia: think that the bigger sort of lesson in all of that gordon has been for me knowing that I don't always have the best idea on the team I don't have the best way of doing things and that was something that you know when you're a solopreneur like myself And someone that comes from this model of like take charge, right?
Like that's what the marine corps taught me take charge and you lead the way You I had to really like delegating was a real challenge. Learning that other people had ideas that sometimes were better than mine or ways of doing things that were much better. So I think the bigger lesson there is like sometimes you got to get out of your own way and let people You know, give them the confidence to take charge and do things because sometimes That is where the value really comes
Gordon Brewer: right right and to add to that I think in delegating and that's been a you know, been a learning curve for me as well because you know, but Well, you like most of us that go into private practice, we have a sense of ambition and we, you know, they're good work ethic and all of those kinds of things.
And we want to, we have, you know, okay, this is the way I want to do it. And the thing about it is, is if you do it all, then you can't You will never grow. It's it's, you absolutely have to have the ability to delegate and outsource to have any sort of growth. And I think recognizing too, that I might delegate this to someone to know, they're not going to do it exactly the way I would do it, but they're going to do it in their way and it's going to be just successful.
Yeah.
Dr. Carlos Garcia: Yeah, it is really truly about surrendering in that process sometimes. And I think another thing that goes along with that, Gordon, is you know, for me with my staff, it's always been a conversation that I house right up front about this is our practice. The second that I hired someone new on the practice several years ago, cause I was on my own for the first couple of years, I went into the website and changed all of the, my, and I, to we and our, and so even when young practicum students or interns are coming here, I tell them, you know, this might just be the place where you come and train for a couple of years, or you can make this your home.
And what I mean by, by that, when I tell them that is like, you know, you Bring your creativity, bring your passion, make this a place that's yours as well. Bring in new services, right? Find where we can grow all together as a team in a way that we could all benefit. Right. I think when you plant that seed early on and someone that's still in a, in a sort of supervised role they really take ownership of their time here.
They, they, they develop a deeper sense of confidence of like, Oh, yeah, my opinions and my thoughts and, and, and the things that I bring to the table are, are really acknowledged here and sometimes implemented. And so that really helps the cohesion of our team as well.
Gordon Brewer: Right, right. Yeah. One of the things I don't remember where I heard it, but I remember just thinking about, you know, and is around team building and that sort of thing.
But, you know, people, people don't necessarily people don't work for a paycheck. They work for a sense of purpose and feel like they're contributing in some way. And so the more that you can do, just like you mentioned, Carlos and giving people ownership and giving them a stake in it. They're going to be happier.
You're going to be happier and it's going to be a much more successful practice.
Dr. Carlos Garcia: Yeah. And all of that is the sort of trickle effect the ripple outward because when you have therapists that are engaged. When you have therapists that don't feel burnt out, when you have therapists that come to work and want to be here, the level and quality of their work directly relates.
And so now you have these, like, amazing therapists just really showing up for their clients in this really powerful, beautiful way. And and like I get emotional about it, but you know, often in these team meetings, I'm I'm hearing these therapists and their work with their clients. And it's like I'm I'm moved to tears because it's so beautiful the work that's happening, right?
And so it's it's beautiful to see that it's a ripple. It's a ripple outward, right? And these clients are then going out there and right. They're better for their families and and and you know, in their world. And so it Yeah, he is just amazing to see. Yeah,
Gordon Brewer: it is. And it's I've always said it is that this this work that we do is very noble.
And I would say, you know, just drawing on kind of my own faith tradition to really kind of holy sacred work as well. Not, not to push any sort of religious agenda or anything, but that, you know, it's people come and hand to us some of the heaviest things in their lives and to have someone there to listen and to hear it in a non judgmental, affirming kind of way.
I think that's where healing, that's where healing resides. Yeah.
Dr. Carlos Garcia: That's it.
Gordon Brewer: I mean,
Dr. Carlos Garcia: I mean, That's it. Yeah, that's that really speaks to me, my friend. Yeah. Yeah. I'm just reflecting here recently on a client, you know, just came in and was finally at that point where they shared something that they had been holding sort of deep agony and shame around for years and years and years and hadn't told anyone.
And, you know, I just sat there in, in, in, like, in an all. And again, this is not as like, almost like a spiritual, like, wow, like, wow. To be graced the, the honor that another human being has given me. The trust that they have given me in that moment was like I didn't even need any other kind of payment or paycheck Like like to be sort of given that it was such an honor.
And so I think the word sacred is very appropriate here that doesn't happen in too many other spaces in our lives, right? I was just sharing with one of my young clinicians who was feeling really positive about some some work that he's done with a client and I sort of just said like You know, if nothing else, right?
We don't have to get tripped up. And what's what am I doing with this client? Which way are we moving? What's the treatment plan? It's just sitting back and recognizing that you are a safe and loving and compassionate place from which they can go into the places in them where they hurt or have shame to find the healing to do the work right in our presence in loving presence.
And like, if
Gordon Brewer: nothing else, you've
Dr. Carlos Garcia: done it
Gordon Brewer: all. Yeah, that is that you're exactly right. That is the key. I think that's the key to therapy is is just creating that safe space and being able to just kind of take in and hear the pain that people are going through and. And them knowing that it's okay. Yeah.
Dr. Carlos Garcia: Yeah. Yeah. And, and you know what? Here we are, right? And nothing changes. And I, I still think you're an amazing human being and really that, that, that, that space. Yeah. Yeah.
Gordon Brewer: Yeah. Yeah, well, Carlos, this is, this is great stuff. And I know we, we could probably talk all day about those things that we're passionate about.
But any parting thoughts that you have and on all of this?
Dr. Carlos Garcia: Yeah, I just you know, this, this last conversation that we were just having, it feels like that's kind of where we always arrive, you know, whether it's, you know you know, as therapist or you know, sometimes I've noticed that healing happens in a lot of different places.
You know, sometimes it happens on a yoga mat. Sometimes it happens in meditation. Sometimes it happens, you know, doing some somatic work. Sometimes it happens in the therapy office. Sometimes it happens with a pastor. I, I think that it's Right. Like, what are we embodying as those presence in the life of others?
Right. If we can embody love and compassion and, and knowing that we're sort of all in this together thank God we can, we can all help to heal each other just through our own work on ourselves sometimes. And so if we can keep doing that, then we can start to shift the way that many of us show up in the world.
And you know, what, what can that mean for us as a society? And, and as, you know, as, as a world. Yeah. So yeah, that that's sort of my party thought. Let's continue to do the work on ourselves so that we can be beautiful vehicles for others to do their
Gordon Brewer: work because it's, it's important work. It really is. Yeah,
Dr. Carlos Garcia: absolutely.
Gordon Brewer: Well, Carlos, thanks again for being on the podcast. Tell folks real quickly how they can get ahold of you and get in touch if they'd like to.
Dr. Carlos Garcia: They can, they can find me on Tampa counseling and wellness dot com. Those are also on Facebook and on Instagram. They can find me at drcarlosagarcia on Instagram.
I post a lot of content about, you know just. Life and the ups and downs of life and a lot of beautiful things there. And here now I just launched a new website in 2025, which is drcarlos. com. And that's if people want to connect with me there, they can find my book on there. And also a lot of my.
Speaking stuff is on there as well.
Gordon Brewer: Awesome. Thanks again, Carlos. And I'm sure we'll be in touch again.