The Practice of Therapy

[00:00:00] Gordon Brewer: Well, hello everyone. And welcome again to the podcast. And I'm so happy for you to get to know Tiffany Duffing. Welcome, Tiffany. Thank you so much. Very happy to be here. Yes. And we were chatting a little bit here before we started recording. And I think this is going to be a topic that's really interesting to folks.
Number one, because of her niche, it's she specializes and I'm going to let her tell the story more, but specializes and working with people with GI issues, and then also just We're going to talk about things that she's learned along the way and having a successful group practice. But Tiffany is a start with everyone.
Why don't you tell folks a little bit more about yourself and how you've landed where you've landed?
[00:00:41] Tiffany Duffing: Happy to. So I decided to go into mental health after being in the military and even serving as a military spouse. Saw the impact and the potential of mental health and thought okay This is the way i'm going to be part of the solution a solution And along the way it became more and more apparent that I love health psychology.
I really enjoy Treating clients from that holistic whole body experience where we recognize that all the systems are talking to each other Because that's part of it That's what's happening. So it makes no sense to me, you know, to just treat in a silo and decided to learn more and train more in health psychology.
And that's how I stumbled on gastro psych. And it was through collaboration and consultation with a colleague. Actually, he was, Super pumped. He was loving doing the work and saying how effective they were, the treatments were. And then you started teaching me a little bit more about like brain gut cognitive behavioral therapy and brain gut or like hypnotherapy for GI particularly.
And at first I was a little cautious because I'm like, what's this clinical hypnosis stuff you're talking about. And then as I become much more aware of what the science. You know, says and how helpful it was for his patients. And then my patients that that kind of got us to a point where we were talking about, he knows that I want to be part of a solution.
This is my business partner. And he was already part of the solution. And we thought, instead of just spinning our wheels and working with one patient at a time, let's build a practice. Let's, you know, create something that's not there. There was no national based practice for gut brain therapies. They were just kind of in the isolated university hospital centers, et cetera.
And so we launched AI psychology and now we train, we recruit, train, and deliver gut brain expert care.
[00:02:45] Gordon Brewer: Awesome. Awesome. Yeah. So, I mean you want to say maybe a little bit more about the specialty because I think you know, as you were describing that, I thought about one particular client I've had in the past that, you know, had a lot of trouble with anxiety and it really kind of affected them at at a gut level for, you know, literally, I mean, in terms of just, Gastrointestinal problems went along with their anxiety.
And that's what came to mind for me. Am I in the right ballpark and just thinking about it in that way? It can be the case,
[00:03:22] Tiffany Duffing: yes. So some, sometimes anxiety plays a bigger picture. And sometimes it's a much smaller picture. So there definitely can be GI disturbances that would fall into disorders of the gut brain interaction without prominent anxiety presentation.
But oftentimes we do see anxiety layered in there in a variety of ways. I think of even myself. The moment I get excited or anxious, how do I know? My stomach tells me. You know, and a lot of people can relate to that. But whether anxiety is there or not, these treatments are targeting the communication, the bi directional communication between the brain and the gut.
So especially for someone who's anxious, If let's say, I don't know, ham and cheese sandwich, I hate to, hate to throw ham and cheese sandwiches under the bus, but it could happen where someone gets sick, they ate something bad and now when they see a ham and cheese sandwich, they kind of go, right, they might even get nauseous.
And they haven't actually eaten the ham and cheese sandwich and yet their body responds in the same way because the body's learned and the brain has come up with this self talk. And when we engage in those thoughts, that self talk, it can send messages down to the gut, which can activate systems. Or similarly, the gut can activate systems and send out messages of like threat or fear to the brain.
[00:04:53] Gordon Brewer: Right, right. Yeah. What are some of the other typical kind of clients that you have in your niche?
[00:05:00] Tiffany Duffing: Yeah, so it can be irritable bowel syndrome. IBS is one of the most common ones in the world, but also with our patient population can also be acid reflux, like a hypersensitivity to it. It can even be secondary effects to like Crohn's or colitis.
It can be sometimes it's a bit more vague and there's not necessarily a GI diagnosis, but it could be a six year old who's missing a lot of school because of tummy, tummy upset, you know, and so we can look to educate the patient, but also really importantly educate and provide parent coaching to the parent of the child too.
[00:05:44] Gordon Brewer: Right, right. Well, it's a, it's a fascinating niche. And I think you know, just hearing your story of how you've just built a whole specialty around this, because I think you are the first one I've ever heard of this particular niche. And so, you know, You've grown and you've started a group practice.
And I know we were chatting about, there are lots of things, lots of mistakes that I know I made along the way, and you've learned, learned a lot. So what, what have you been learning so far about just running a practice and the whole business side of things?
[00:06:19] Tiffany Duffing: Sure. Well, the, you know, the thing that you just touched on that sticks out is finding what people need.
We want to bring a service that has value. You know, if you're going to go through all the trouble and labor of creating a business, it needs to be something that brings its weight to the community and the world, not just another replicated service. And so it happened to be with this one, you know, when we looked at, okay, the evidence supports.
These treatments, there's, you know, there's various studies that show how many people have GI distress, but let's go with one of them. 40 percent of the population at some time or another will have a GI disturbance, like a disorder of the gut brain interaction diagnoses. So that's a tremendous amount of people.
Clearly there's a need. And then we weren't exactly sure at the beginning, if we were the first ones that was uncertain. Cause we just. more embedded in the community enough to be sure. But we knew that there wasn't enough because every time a new patient would come to my colleague, they'd say, I've been looking for this for so long.
I didn't even know it existed. And so we had these three tenants, right? There's science to support it. There's a community need for it. And there wasn't enough service. And we thought, okay, this is how we're going to bring value to the community. So I think, For anyone contemplating launching or scaling, you know, a private practice, it's really digging into what do we bring?
How are we unique? How are we going to maintain this highest level of professionalism and service delivery while also growing? You know, and so the lesson definitely was I guess three things come to my mind as part of that one, like allowing yourself to recognize that you don't know everything and that's okay.
It's actually an exciting thing. And instead of it feeling insecure and kind of discouraged, which don't get me wrong, I've had those times too, but kind of going, okay, if. There's all this stuff I don't know that means there's lots of opportunity to learn and it's podcasts like this and you know the numerous other resources on private practices or group practice.
I leaned into those so heavily at the beginning to really like just absorb it all.
[00:08:47] Gordon Brewer: Yes. Yes. What are the, what are some of the I guess maybe one thing I'm curious about is what's the size of your practice now? And, you know, I I think everybody has to find their right size for the type of, Provider they want to be, but what yeah,
[00:09:05] Tiffany Duffing: I don't know what ours will be like.
We haven't found what our ideal will be yet. We're not quite there yet. Our, our focus from day one was to grow thoughtfully and intentionally. So even though there's this massive national need for our service, it was so much more important that we, prepare the training materials, prepare the systems for our staff, our employees, our clinicians, and develop it as we go and only hire as the demand and our leadership bandwidth could allow.
Yeah, you know, and so, Excuse me. So within the first year, we had five clinicians, and that was a really, you know, steady start. And we had a big piece of our business model is that we don't just market to the patients, we market to interdisciplinary providers. Because if we want the world to know that these treatments exist, then that means making sure community, you know, patients and family members know, but it also means providers that might provide a referral that they know about it too.
And so that first year we we had 29 referring partnerships with different providers. And then more recently we have nine clinicians and let's see 135 referral sources. So these are GI's, nutritionists, etc.
[00:10:30] Gordon Brewer: Right. Right. Are you just concentrated in one geographic area, or are you kind of statewide, or how do you, how are you doing that?
[00:10:40] Tiffany Duffing: Well, initially we're based out of Virginia, and the D. C., Maryland, Virginia area was where a bulk of our referrals were coming through, and our initial business plan was brick and mortar business right here in Virginia, and then guess what? COVID happened,
[00:10:55] Gordon Brewer: right? So
[00:10:56] Tiffany Duffing: the five year plan for telehealth department became the immediate business model, and we pivoted and went virtual.
And what we found was the patient population we're serving. They really benefit. to a higher degree to having the convenience of services in their home. And so they were very receptive to us pivoting and going virtual. So although we started in Virginia, DC, Maryland area, now we're in, I'm going to guess 30 States.
It's chronically, you know, change. It might be 35 actually. And so there's still a strong cluster. I think 40 percent of our patients are in this area. But we're beginning to spread as more providers and more patients find out about us, then word of mouth.
[00:11:42] Gordon Brewer: Right, right. Well, that's, that's great. That's great.
So within hiring people, I guess maybe, you know, you mentioned them having kind of the same vision, kind of the same thing. What would you say has been successful for you in figuring out which people to hire?
[00:12:02] Tiffany Duffing: Definitely there's like the pre launch about it and then the in the moment and then retention.
And so, you know, just the proactive advanced planning for it was making sure that our leadership that we defined what is our mission. What are organizational values and because if we don't know what the values are, then how do we know who the ideal candidate is? Or how can we communicate it to them so that they can self select that?
Yes, I can align with those values or no, that's not mine. And so we needed to really define it pretty clearly. And then also being able to have really specific. Goals and accountability along the way of, okay, this is where we're at today. So, you know, maybe our employee manual, just for example, is a few pages, but really it doesn't cover everything it needs to be.
So here's our 90 day, six month and one year goal of how we want to develop it. So we were really intentional with itemizing the good enough for now. But still making ourselves grow and add to and get better along the way.
[00:13:09] Gordon Brewer: Right. Yeah. And that includes
[00:13:11] Tiffany Duffing: like, I'm sorry.
[00:13:12] Gordon Brewer: No, I was just going to say that's really some great foresight.
I mean, just thinking about it in that way.
[00:13:19] Tiffany Duffing: Yeah. And I mean, if I, Expect it, the business to be where it is today. You know, I, two years ago, it probably would've felt like a gigantic lift and I might have ran the other way. . It's just not reasonable to expect we're gonna start off with perfection or such growth.
We need to not, not to say we're perfect yet, 'cause we're definitely not, but Right. We've learned a lot. Yeah. And so, you know, reading the books, listening to the podcast and actually another proactive way that we prepared for the hiring. Was connecting to other like entrepreneurs and other experts in the realm in the area.
And so entrepreneurially DC is my home organization where I get a lot of coaching and mentorship and the, you don't know what you don't know. I find a lot of those in that organization. So that was a lot of the proactive. And then, you know, the, in the moment we created. Systems, we created a ranking sheet of what are the things that matter during the organizational overview meeting.
Cause we have a four part interview and then we also do kind of a resume, a deep dive kind of following the top grading model, although it's much more simplified than that book describes. We're not there yet. And then we also give them a candidate. Web page where they can read about our organizational values, look at what their week might look like, look at some of our employee incentives and benefits, really allow them to experience how it's a mutual interview.
And then, you know, there's more to that, but I won't go too much in depth unless it's something you want me to talk about. And then we have the retention. I think it's super important that our employees know we care about them as humans.
Several of them, mothers with young kids and We want them to know that yes, like we have high professional standards, and we're going to challenge them to learn and deliver expert care, but we know that they also have lives and interests outside of work.
And I think they truly feel that they truly know it which gives them the space and the mental bandwidth to give it all when they're at work.
[00:15:31] Gordon Brewer: Right. Which is
[00:15:33] Tiffany Duffing: huge to meeting the mission. Yeah.
[00:15:35] Gordon Brewer: Yeah. Yeah. So it sounds like a, a really a really welcoming culture and just really people, people it's, I would guess people feel a part, a part of it rather than just working for.
[00:15:49] Tiffany Duffing: Exactly. Yeah. They, when they feel like they're part of that bigger vision, the, when they recognize that they're changing this piece of healthcare, that's hugely satisfying. And if that energizes them, they're on the right team. Yeah. And so we try to talk about that and, and discuss it openly during the interview, because if it's not something that's important to them, it's learning and growing and really changing socially, how this is offered to our country.
If that doesn't drive them, It would be too overwhelming. They'd hit burnout pretty quickly, quite
[00:16:27] Gordon Brewer: frankly. Yeah. Yeah. Well, that's yeah, you know, one, one of the things I've read and heard is, is that people really don't work for a paycheck. They work for a purpose and meaning in what they do.
[00:16:40] Tiffany Duffing: Exactly.
Because
[00:16:41] Gordon Brewer: you can, you can find any job that'll give you a paycheck. But, you know, I think what well, at least in our field, especially, I think most people do what we do because. We have some sort of sense of I'll dare say a higher calling to, to, to what we do.
[00:16:59] Tiffany Duffing: Exactly. Yeah. And it's, then you leave work, even if you've worked so hard and gave it everything you had, you're not empty when you leave.
Perhaps you're full, which is really nice feeling.
[00:17:12] Gordon Brewer: Sure. Sure. So here's a shift gears a little bit. Tiffany, what are some mistakes that you've learned from?
[00:17:21] Tiffany Duffing: Where can I go get my list of them? Let's see some. Oh, definitely one of the biggest ones was thinking that I needed to do it. Right. So, you know, we're fortunate where we have two co founders and directors right now.
And I recognize there's many businesses where it falls on one person. So we're, we're already at an advantage in that way. And yet we were,
Developing the systems, bringing on the right people, keeping the finances staying ahead of all the clinical learning and teaching that, you know, and so over the last three years, we've made it a progressive goal to get to where we can work on the business. And less in the business, which, you know, every entrepreneur coach says that's the goal
[00:18:13] Gordon Brewer: and there's still
[00:18:13] Tiffany Duffing: a work in progress.
So, but that was definitely a mistake is I knew what needs to be done. And, and I knew where to find the answers or how to find them at least. And so it was really challenging to then give it to someone else. And trust that it was going to be done the way I would have wanted it done and sometimes it's about recognizing it doesn't need to be done the way I would have done it.
That's okay. That's great, too. So now we, I, we do have a great admin staff, a clinical support staff, and a wonderful operations lead that works with me on a regular basis and I, I'm fortunate enough where I get to trust her. So delegating has become so much easier.
[00:18:51] Gordon Brewer: Yes. Yeah. And that's a, yeah, that, and I think that's a lesson that I have to remind myself all, all the time is that the importance of, of outsourcing and, and delegating, because in reality, that is the only way you can scale is by taking the, you know, instead of doing it all, you.
divide and conquer. And that's, that's the way that you scale. I mean, it's just absolutely. Yeah. So, and I think, you know, I think people understand, okay, I'm busy. Maybe if a solo practitioner, they think, oh, I've got too many, too many clients now, and I need to have somebody to pass them on to, or have somebody join me in my practice or that sort of thing.
I think we understand that, but I think where. where we drop the ball is understanding that same concept on the administrative side. Yes. Yeah. And like you said, Tiffany, you're, you're exactly right. I think sometimes we're afraid of giving it to somebody else because we think they're not going to do it like I do it, which they won't.
But also being able to accept the fact and understand that number one, they're going to do it their way, but also their way of doing things might be much better than we think it is. Doing it ourselves.
[00:20:20] Tiffany Duffing: Yes. Yeah. It's great to get multiple brains in on a project instead of just one or two. Definitely has been one of the tremendous advantages of our journey is being able to pull in so many different experts or people really that are just willing to learn and grow.
And so, yeah, I've been able to give more away and
[00:20:41] Gordon Brewer: right. Right. So yeah, you know, another thing that I was just thinking about was the importance of getting mentors and coaches to help you along the way. You want to say a little bit about that?
[00:20:55] Tiffany Duffing: Absolutely critical. Right, like that would be the header, the flashing words.
I learned the very beginning of going is, so I'll back up a moment. I have no business training. I actually had never seen myself as an entrepreneur prior to 2007. So it actually was pretty recent. I had no vision of that. And then I started talking to prior supervisors and mentors about their private practices and listening, as I said, to a lot of resources, reading it.
And thinking to myself, maybe I can do this. Maybe. And so I started to share the idea with other people who knew me and believed in me. And, and I noticed how they responded with like an obvious, of course you can do it. So in my mind, I was like yeah, 20%, I probably can do this. I'm not sure. And they were so quick to respond with a hundred percent confidence of course you So it was super critical.
That I shared this fantasy or dream with people that believed in me, cause they clearly saw my capability way before I saw it.
[00:22:02] Gordon Brewer: Right. And
[00:22:04] Tiffany Duffing: so that's obviously a big benefit, you know,
[00:22:06] Gordon Brewer: sure, sure. Yeah. And it's a, you know, I think we can look at something so many times and, and just have blinders on to something that might be obvious to someone else.
And so being able to, you know, and in different ways of doing things, and that's just a cross the board. I mean, I'm not You know, it's kind of like proofreading your own writing, you know, it's somebody else is going to catch stuff that you, that you didn't. So, I mean, yeah, right, right. Yeah.
[00:22:38] Tiffany Duffing: Well, everything,
[00:22:41] Gordon Brewer: right.
If
[00:22:42] Tiffany Duffing: anything, our only expertise really needs to be to know who to go.
[00:22:47] Gordon Brewer: Right.
[00:22:49] Tiffany Duffing: Like, I don't actually need to be smart, but being smart means asking someone else who knows how to do it. Right. Yeah. And that I think is actually the definition of smart, knowing where to find it.
[00:23:00] Gordon Brewer: Right. Right. I totally agree. Tell folks more about how they can find you and Get in touch if they'd like to.
[00:23:08] Tiffany Duffing: Sure, of course. So the easiest way is by going to gipsychology. com. We have, you know, for anyone who's trying to understand or beginning to learn about the brain gut connection, we have a great resources page with some expert videos, explanations, Scientific articles, et cetera.
But we also have the opportunity where visitors can sign up for the newsletter. And then we, we publish it maybe once every four to six weeks, but we try to emphasize. Here's a group that we have coming out, or here's a new scientific study. And here's how it relates to the work we're offering. So try to really hone in on what is our audience need as we try to build awareness for these effective treatments.
So just there.
[00:23:52] Gordon Brewer: Okay, Tiffany, any parting thoughts for folks?
[00:23:56] Tiffany Duffing: Definitely find their community and multiple communities. Preferably, you know, the online communities, the local entrepreneur or small business association groups, and then reach out to that entrepreneur you really admire and say, can I have, can I have a 30 minute coffee break and just have conversation.
Soak it all in.
[00:24:19] Gordon Brewer: Awesome. It was great to have you and hopefully we'll be having another conversation here soon.