PATRICK CASALE: Hey everyone, you are listening to the All Things Private Practice Podcast. I am your host, Patrick Casale, here in Asheville, North Carolina, nice 75-degree day in the middle of November. 33 degrees tomorrow, because we live in the mountains, it makes no sense. I want to talk a little bit about today, possibilities, when they don't feel possible, and how you can work through that to get to the other side. We get into a lot of situations in life that are hard. We become therapists for a reason, we get into the helping field for a reason. But there are a lot of times where when we're going through some shit, there does not seem like there are going to be possibilities in the future or you can't see them, right? It's just no clarity. What comes after this?fe. I haven’t gambled since: Asheville, North Carolina in:
I went to school at night, got my master’s, got my graduate degree in clinical mental health counseling. Again, I'm like, “Okay, cool, cool, cool, cool,” I’ve been watching a lot of Brooklyn Nine-Nine lately, “I think I can go into a community mental health job.” I was offered a position starting at like $40,000. I was like, “Oh, my God, I've made it. This is it, right? This is the pinnacle of what I can do with this degree.” I did that for several years, worked at a lot of startups, helped to create programs and got them off the ground, I found myself in the really glamorous middle management positions all the time, where you can't please your administrators and your staff never have enough support. I was just like, “Oh, I am so burnt out from this.”
It was constant crisis work, on call all the time, answering emails, answering phone calls, text messages. I couldn't get away from it. Again, there were no other possibilities. I didn't know what else I could do. I thought about stepping away from the profession plenty of times. I could go back to bartending, I could go back to doing anything. I just couldn't do that anymore. There's a lot of guilt and shame that comes up with those thoughts and emotions where it's like, “I went to school for this. What the hell is wrong with me?” But it's really a broken system. I mean, community mental health agencies exist for a reason, and we are able to support our most vulnerable populations, but they're massively underfunded, like we all know, and it's exhausting, and we don't have enough support, or resources, and you're always asked to do more with less, and it's almost applauded. Self-care is talked about, but it's laughed at, like, “We should practice self-care, hahaha. Oh, you want to put a PTO request in? Denied. We don't have enough staff.” It's just bullshit.
I think we believe as therapists, and counselors, and social workers that that's the path, that's the end all be all. We either become community mental health therapists and burn ourselves out, or we go maybe get a PhD, and we're professors, and that's the extent of it. Private practice ownership is very rarely talked about, especially in grad school programs and community mental health agencies. It's almost taboo as if you can't make it. It's not going to be successful. You can't work for yourself and hell, none of us get business training, right? We don't know what the hell we're doing, how do I start something out that I have no clue. It feels so overwhelming, and you convince yourself that it's just not possible, not for me, at least. I can't do that. Nobody would hire me. How do I even get clients? That's a big risk. I'm really comfortable with this really shitty salary and terrible benefits, because I know when I'm going to get paid, and I know that I have two and a half weeks off a year, and I'm barely ever able to take.
Again, another message that says this is not possible, at least not for you. When I decided to finally leave, there was a last straw moment that I'm not going to go into right now. I was like, “I'm going to start a private practice, and I don't know what I'm doing.” I found lists online, some of the Facebook groups, and I was like, “I'm just going to do this. I don't know if it's going to be successful, but I've got to try.” I was scared shitless. I didn't think it was going to work. Again, major imposter syndrome, who's going to hire me? Who's going to call me? Am I ever going to get phone calls? I don't know what I'm doing, and you stumble along the way, and you make mistakes, and you fail.
I remember a night where I had three back, to back, to back, no shows, I didn't have their cards on file, I didn't really have a policy in place, not at least one that I was comfortable enforcing. I just sat there in my office. I was like, “Yeah, I've got to pack up shop. I don't know how to be a business owner, I can't do this, I have to go back to my community mental health job tail between my legs.” The last thing my program manager told me at my exit interview lunch was, “You'll be back in 30 days, nobody ever makes it on their own, so we'll keep your job waiting for you.” I was like, “What the fuck?” I just remember having that be so motivating for me to be like, “Yeah, I can't do this. I'm never going back there, because I cannot let her win or the system win.” It was kind of petty, but it's also created momentum, and fueled the fire, so to speak, to never allow that to be my reality.
I realized in that moment I just have to reshape my policies. This doesn't mean that this isn't going to work. It just means that I have to be more intentional, I have to get really clear on boundaries. What I did was create a policy, had all of my clients sign it, go over it with them, explain, “Hey, this is the policy. I'm going to charge your card full fee if you don't show up, if you late cancel.” All that stuff, because we have to treat our businesses like businesses, and therapists don't do a good job of that. We really struggle with the money piece, we struggle to enforce policies, we have bleeding heart syndrome a lot, and I'll talk about that in future podcast episodes. Anyway, private practice was then the mountaintop. I felt really good. I got really full, I developed a reputation within the community as someone who did good work with clients, especially men who were struggling with addiction, lo and behold. I think our ideal clients are versions of us, and that was it. That was the end of possibilities for me.
I remember back then, like two or three years ago, must have been three now, that I saw a link in one of the Facebook groups for the Not Your Typical Psychotherapist conference that Ernesto Segismundo holds every year. I was looking at it and I was like, “Oh, my God, all these therapists doing all these outside of the box things, these innovative ideas, different ways to work, different streams of revenue.” I convinced myself I should go to that conference. It was in California at the time. I then decided to talk myself out of it, “I don't have anything to offer, I don't have anything in common with them, I’m going to feel really out of my league.” It was fear-based, it was scarcity mindset-based. Imposter syndrome fueled the fire. Again, no other possibilities, but private practice.
I'm not saying private practice, for those of you who want that to be your long-term and your reality, and that's going to be your career for the rest of your lives. There's nothing wrong with that, but as someone with ADHD who can't sit still, and I have this complex when I feel like I've mastered something that I need to do something different. I'm sure a lot of you can relate. I thought, “What else can I do?” I have been helping therapists in Asheville for years, build their businesses, their practices, help motivate and empower them, and really try to instill some positive thinking and courage to take the leap, start their businesses, and they would all tell me, “You should do this for a living; you are really good at this. You're really good at leading, you're really good at instilling confidence.” I would say, “Hell, no, not me.” There’re other private practice building coaches out there and they have good reputations. Some of them live in my city and have massive followings. Why would anyone hire me if they exist?” I talked myself out of it again.
Again, putting an end to any possibility, because I didn't believe that there was anything else that I could do. How else can my skill set apply to other ventures, because I don't have the ability to think outside the box right now? It was very much like tunnel vision, can't see the forest for the trees, so to speak. One day during COVID, being trapped in our houses, and going a little stir crazy, and trying to figure out what can I do with all this energy, I decided to put the idea out to the world like, “Hey, I'm going to start a private practice building and coaching business.” I had held myself back from that for so long, but when I tend to put things out to the world, like most of you probably do, imperfect action, right? I didn't have the conceptualization of what this was going to look like. I didn't know anything. I just knew I had the idea that I could help other therapists do this, and that came really naturally to me.in. Started two in August of: of those in: t pretty busy. We've got like:
There's a lot of therapist’s Facebook groups out there that maybe don't do that good of a job of that. It's kind of shaming, and also, I really want to support people through their journeys and allow them to self-promote, and talk about the cool stuff that they're doing. A lot of groups don't do that, and that's okay, to each their own. That's a good point of this, is like authenticity and showing up the way you want to show up is then going to allow you to attract the clients that you want to attract, whether that be in your private practice, in your coaching businesses, in anything that you do. The way you show up is going to attract the clients or the people who are drawn to your personality, but if you're not able to put yourself out there, and feel exposed, and vulnerable, and insecure, and just walk through it, and work through it, and feel that discomfort, it's going to be really hard to attract people who are really enjoying or appreciating what you're putting out there and recognizing that, “Oh, this person's done the work. They know how to help me or support me.”
But again, I'm going to use this term, that was the end of my possibilities. Okay, I've got a Facebook group, I do some coaching courses, and I've been on some podcasts of other people. This is cool. This feels surreal. I am waiting for this to end and it hasn't yet, and now that I've started a podcast, I've also started a group practice, because I was getting so many phone calls as a therapist, I had to refer out so often. I thought, “Why don't I refer in and hire some really cool fucking people.” Right now we've got 11 therapists. I started my group practice less than a year ago. We have a psychiatric provider, and I'm really trying to pay people well, because I want to empower them to know that this is possible, and if they want to go out on their own, great. I want to support that journey for them too, because we need good therapists who want to do good work, who don't feel burnt out all the time.
The last couple of years have been really challenging for therapists. Burnout is at an all-time high. I think people are making a mass exodus from community mental health jobs because of that, and they want autonomy, freedom, flexibility, and the ability to do things on their own without always feeling like they have to be productivity-based, and that they can work outside the box. I've met so many cool therapists over the last year because of COVID, and COVID’s been destructive, and damaging, and devastating. But it's also led to so much connection for people with people they would have never met.
I know therapists that are doing walk and talk therapy, or equine therapy, or incorporating Tarot or dream analysis, or Eastern medicine or practice, and it's so cool to see how we are practicing so differently and really stepping into personality, and belief, and value system too. It's really important, I think to recognize that in private practice and small business, we need to be marketing within our value system and being authentic to that point to say, “This is what I believe, this is the stand I'm going to take.” If these are the things I think work, really walk that walk, and you've got to be able to back it up too. I don't know what the future holds. All I know is that 15 years ago, this was not possible. All I know is that a year ago, this was not possible. All I know is that I've been limiting myself and preventing myself all of my life. I think a lot of you can probably relate to that, convincing yourself that you're not good enough, you don't have enough to offer, you're not competent enough, whatever the case may be. Those self-limiting beliefs exist.y for me. I said, my goal for:
I am a humble person. It's really hard for me to kind of take in and soak in the accomplishment. But I'm like, “Holy shit. This is real, this is a reality, and now I've got to structure it and figure out how this is going to operate, and what this is going to look like.” But again, in perfect action. I didn't know the steps, I didn't know what I wanted it to look like, I just had the idea, and by putting the idea out to the world, it kind of creates this fire. It's like, “Okay, here's the motivation that you need to really start to put the pieces in place.” I think a lot of us go into default perfectionism mode, and we have to perfect everything we're going to do before we put it out to the world, and that can paralyze you, and prevent you from doing something for years. It did for me, and I talked with a lot of other people who it does the same thing to, where it's just like, “I have to have this perfect before I can launch my website, or my podcast, or my private practice, or my coaching business, or my course, or whatever.”
Please try to do yourself a favor, put it out there. If you have a goal, if you have a dream, if you have an aspiration, even if it feels like a pipe dream, and it's like out of reach, just put it out to the world, put it out on your Facebook page, put it out in a positive supportive Facebook group, put it out to friends, and colleagues, and partners. It doesn't have to be perfect, and it never will. If you can get out of your own way possibilities start to open up. You can start to see differently, and see that there are other options and ways to make money, and ways to enjoy life. Not all of you are going to want to be a therapist for the rest of your life, and that's okay. I know that can bring up shamefulness. It does for me too, as I think of my transition out of the profession and more into a coach, consultant, speaker, etc.
But I think about it as helping the profession in a different way, helping support a movement for therapists to finally believe in themselves, and stop cutting themselves off at the knees, and start to charge what they're actually valued and worth. I know it's hard to quantify worth, but you have master's degrees and thousands of hours of experience, and a lot of student loan debt most likely. Start moving into the headspace that you're allowed to charge money and help people simultaneously. That will be a future podcast episode for sure.
Anyway, thank you for listening to my story, thank you for tuning in, and following, and subscribing. If you like the podcast, please download it, subscribe, and share. I'll be releasing new episodes every Monday. Lots of guest interviews with experts in the field, really looking forward to the stuff that we've got going on right now, and you can find me at allthingspractice.com, you can find me at the All Things Private Practice Podcast, the All Things Private Practice Facebook group. I have coaching courses, individual private practice coaching, a lot more, and retreats that will be happening all over the world. Thank you so much for listening and I will see you next Monday.