Episode 71

Episode 71: Balancing Chronic Health Conditions & Entrepreneurship [featuring Hillary Bolter]

Do you dream of entrepreneurship but hesitate whenever you think of the “what ifs” around health care and being able to work for yourself? 

Are you working for yourself now while struggling with a chronic health condition and wondering how to keep to it all together as you try to find balance between business and health?

Do you ever worry about what the heck you would do if a chronic health condition were ever to appear for you?

Well, this episode is for you.

I talk with Hillary Bolter, therapist and motivational interviewing expert and trainer, about the effect that chronic health conditions have on entrepreneurship.

Top 3 reasons to listen to the entire episode:

  1. Understand that chronic health conditions don’t always have to put a stop to your entrepreneurial career.
  2. Learn how to create space for healing and self-care by shifting your processes and accepting help when needed and available.
  3. Identify ways to reshape your professional and personal lifestyle and habits to accommodate for substantial life changes without stopping you from following your passions.

So, if you find yourself facing difficult, sometimes unexpected, major life changes due to chronic health conditions, know that you are not alone. 

It can painful and challenging, but it is not necessarily impossible to make adjustments to your process to help you continue your entrepreneurial journey. This is a tricky and very personal issue to navigate, so it’s encouraged that you seek support, ask for help, and be open to change. 

And make sure to give yourself time, patience, and kindness as you navigate through these life transitions.

A Message From Hillary:

Hi, I'm Hillary Bolter, MSW, LCSW, LCAS.

I am one of those folks that inherently thinks I have great ideas and solutions for people upon first encounter (Enneagram 1!). I’m ready to jump in and FIX! When I began my MI learning process, I realized just how essential MI was going to be for my energy, effectiveness, and longevity in the helping profession!

I have been a member of the Motivational Interviewing Network of Trainers (MINT) since 2011. I am a Licensed Clinical Social Worker & Addiction Therapist and absolutely delight in helping individuals, groups, and organizations learn the essential skills of Motivational Interviewing. I have worked as a helping professional for 20 years, ranging from working in wilderness therapy to community mental health, providing in-home & school-based services, as a therapist with specialties including working with anxiety, trauma, addiction, and veterans.

Check out Hillary's 12-hour hybrid live and self-paced virtual workshop on the Foundations of Motivational Interviewing: micenterforchange.com/beginner-foundations

Save a spot for a FREE Motivational Interviewing Masterclass on Hillary's Website: micenterforchange.com


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Mentioned in this episode:

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I would also like to thank The Receptionist for iPad for sponsoring this episode. As you prepare for the new year as a private practice owner, one area of your business where you might be able to level up your client experience is from the moment that they enter your office and check in with you. For many private practices, the client check-in process can be a bit awkward and confusing. Clients often enter into an empty waiting room. And chances are you're wrapping up a session with someone else, so there's no way of knowing when they arrive. With a visitor management system like The Receptionist for iPad, you can provide clients with a discreet and secure way to check in for their appointment while instantly being notified of their arrival. What's more, The Receptionist offers an iPad list check-in option where clients can scan a QR code to check in, which negates the need for you to buy an iPad and stand. Go to thereceptionist.com/privatepractice and sign up for a free 14-day trial. When you do, you'll get your first month free. And don't forget to ask about our iPad list check-in option.

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PATRICK CASALE: Hey everyone, you are listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale, joined today by my friend and colleague, Hilary Bolter, an LCSW and motivational interviewing expert, extraordinaire really, all things motivational interviewing.

But we're going to talk today not so much about motivational interviewing, which was our original topic a couple of months ago, we're going to talk about being entrepreneurs who have chronic health conditions or health conditions that impact us in terms of how we adapt, evolve, and change in terms of how we run our businesses, and the emotional toll that it can take, and the physical toll as well. So, we're going to be really real today about our recent throat surgeries that we've both had and our recovery processes.

So, Hillary, I appreciate you being on and just being willing to be really vulnerable about your experiences that you've had and and how it's impacted you going forward. And I just appreciate the willingness to do that.

HILLARY BOLTER: Absolutely. Yeah, that's one of the things that you and I have connected over as entrepreneurs, business owners, and folks struggling with the various health things that crop up and having to do surgeries and it's vulnerable. It's a vulnerable place to be.

PATRICK CASALE: Yeah, I think that's an understatement. You know, we were talking before we started recording about our own recovery journeys and the complications that come with them. And I think it's even more… I mean, it's challenging in general. Like, no matter what, if you have surgery, your body is recovering, there's a trauma process, there's going to be a process where you have to heal and it takes a toll.

But when you're a business owner and the business depends on you being available, and present, and capable, it is an extra layer of complication.

So, for those of you out there with chronic health conditions or health conditions that you're going through that are impacting your ability to show up the way you want to show up, it's really fucking hard.

HILLARY BOLTER: It is really hard. And I actually was thinking like, I left agency work six, seven years ago in top health and younger than I am now, right? It was earlier and without really thinking about this kind of grown-up real-world part of health insurance. And when you're sick and not working, you're not getting paid. All those pieces. And I had a health crisis about five years ago that brought me into this first wave of vulnerability around, wow, how do I keep working and maintaining my business while also taking care of myself.

And then I had this second wave with the thyroid cancer diagnosis in the spring, and subsequent surgery, and treatment that kind of brought it around a second fold. So, there's so much, I think, we could say about this process. I appreciate your naming the vulnerability and naming the trauma that we're going through around our own processes, while we're also trying to hold space and employ other people and keep things running.

PATRICK CASALE: It's quite a juggling act. And you know, for myself, you know, I can't say my… what's the word I'm looking for? Disorder, disorder, condition, whatever I want to call it is as significant as having cancer, because I think having cancer, you know, you hear that word and you're like, "Oh, fuck." Like, "This is scary."

And, you know, I got diagnosed with a very rare throat condition that impacts 0.001% of the population and people over 65. So, I'm one of the lucky 35-year old's who got diagnosed with that, there's no answers, there's no understanding as to why there's no long-term projections in terms of quality of life. So, it's very challenging.

ll come back, just [CROSSTALK:

And within three months it came back, like even more significantly, and I had to then be facing the choice of, do you try endoscopic surgery, again, knowing that it wasn't successful? Or do you go with the open surgery route, which is significantly more impactful and invasive, and the complication risk is quite high? And I kept putting it off, as most people would, in a lot of ways. And I was like, "When do I have two months of my life to recover from this?" And [CROSSTALK 00:04:49]. Right, exactly.

I run multiple businesses, my business is my voice, and I was having a lot of grief and anticipatory grief of like, your voice is being impacted, and what it meant to feel like that could be impacted and also lost, and the risk factor of your vocal cords being impacted, and your voice shifting and changing, and all of the stuff that comes with it.

And, of course, that is what happened. Like, I told you before we started recording, one of my vocal cords got damaged. So, like it's not working anymore. I'm going to have to have vocal cord surgery now. And your capacity and your abilities are significantly diminished. And you have to adapt, and evolve, and figure out like, what does this next chapter of my career look like knowing that my capacity is no longer what it was?

And it's really, really hard to come to terms with. And I think there can be a lot of emotion in that like, anger, grief, sadness, frustration, like, sometimes acceptance. I guess I don't know if I've got there yet.


PATRICK CASALE: I'm trying, you know, it's just really, really hard.

but like this [INDISCERNIBLE:

I mean, it goes on and on and on. And that takes up so much mental and emotional space. And our business takes up so much mental and emotional space. And for me, almost always, my business is a tremendous resource. I love it. It brings me joy, it brings me energy, it has my creativity going, it's like tremendous resource for me.

During this cancer journey, my brain just wasn't all there. As much as I tried to show up and keep working, it was just like a part of me had left the room. And it was so much more effort to keep working through that all. I'll just say, just this last month I feel like I'm back. And I thought I was going to be back like once I go, I was like, "Surgery's done. I should be better. We're done."


HILLARY BOLTER: Yeah, let's see, my surgery was at the very end of September.

PATRICK CASALE: So, we're looking at October, November, December, January, right? So, about four and a half at this point in time, and just now feeling like you're kind of coming back into a place where you feel, I don't want to say good, I don't know, maybe like, taking more and just able to move through the day without a lot of extra exhaustion.


PATRICK CASALE: It's amazing. Like, the build-up for people who are struggling with situations like this, you know, you're doing research on where you should get care if you have the privilege and ability to do so. I fully recognize that I do have good health insurance, which was quite helpful. But like, you're second-guessing your decisions, too. I almost canceled my surgery the night before we were in Georgia. Like, "I'm just going to cancel this." Like, "I don't want to do this." Like, "I don't want to deal with the recovery process."

And I just knew that it was going to get worse and it was going to get worse. And it was the right time to do it. And I had to really displace a lot of my life. Like, it was really weird to have this surgery the way that I had it, because there was this build-up to October 27 of like, "Your light stops as of today, in this way, because everything has to be done, and wrapped up, and completed by this date."

And it was really strange to have that countdown. And in August it was like, "Yeah, that's in like 60 to 90 days." And then like September, it was like, "Okay, it's like 40 days." And then you're there and there's just a tremendous amount of overwhelming anxiety and pressure. Even as mental health professionals, we know all the skill sets like, but that doesn't make a difference, because the reality of the situation is like the unknown is fucking scary, right? Like-

HILLARY BOLTER: Right so, yeah.


And my wife was like, "You're not dying." I know, but this is the major surgery and I'm scared, because they're going to cut my throat open and like, it's just scary. And it's just been a process.

HILLARY BOLTER: So vulnerable. Yeah, part of you is thinking, "I could die." And you're living with so many realities and not knowing what it's going to be until it happen, right? I thought the surgery recovery was going to be the worst. You know, I was told, "Oh, it's about a four-week recovery." And two weeks, two and a half weeks after the surgery, I flew to Chicago, attended a conference. I was on the elliptical there, in the, like, conference room, I was like, "This is amazing."

And then, I got back home. And it was like my body caught up with or you no longer have a thyroid. It kind of took about six weeks for the shit to hit. Like, I think maybe I had enough thyroid hormones in my body. So, I didn't anticipate that it actually was like, November, December, that I was going to feel worse than I ever had.

"Oh my God, I feel [CROSSTALK:

I didn't have that experience. Like, my recovery has been challenging the whole time where I was on the couch or in my bed. And for those of you who know me, I don't sit still well. So, like, I couldn't do anything. I couldn't eat anything. It was liquid, liquid, liquid, which is just miserable when you wake up. And it's like, you can have jello or bone broth for breakfast. You can also have jello or bone broth for lunch, and dinner, and snacks. And like, I [CROSSTALK 00:12:05].

HILLARY BOLTER: …hamburger.

time and it was not [COSSTALK:

HILLARY BOLTER: There's the creativity, you're like, "How am I going to be creative."

PATRICK CASALE: Yeah, well, you know, here's the thing that I struggled with, and I'm still struggling with. I'm someone who doesn't like to have restriction on my ability to create and feel like when I'm creating, like you said, when you're in your business, I feel really good. Like, that flow state, that creativity process, connecting with other people, I feel great about that. And I couldn't.

And I kept trying to force it during this recovery, where I was like, my mind is saying, "Yes, you had major surgery, this is your body's job right now is just to rest, and heal, and watch Lord of the Rings 300 times." I'm like, "It's fine."

But like, the other part, irrational side of my brain is saying, "But you're being lazy, you're not using this time effectively. Look at all this time you're spending laying on the couch or on your bed, you could be doing X, Y, and Z or figuring out X, Y, and Z." And I was like, "This is fucking crazy." Because I know, I don't have the capacity. And I should not be doing these things.

But it was so hard to kind of work through that. And that just feeling of like, despondent, of being like, I'm being useless. And in reality, it's like that's exactly what you need to be doing.

HILLARY BOLTER: Right, you need that rest. Also, your brain wants that excitement and nourishment from the flow and the joy that you get from your work. And it's cut off from you, for now, like, in those periods. And yeah, you said the word despondency. And I was like, I definitely, definitely felt a lot of despondency, and missing that, and a fear that would I ever get it back? Would I ever have my brain back and be able to find that trainer flow that used to come so easily?

And thank goodness, I actually was just training before you and I talked, and I said to the group, I was like, "I feel so good being back in the saddle. And I am so… I mean it's like these little things. I've run these classes for forever. And it's like I'm just a new person again. And then. Like, a new delightful trainer, like, "Oh my God, I love this." I'm like discovering it all again, and it's bringing me a lot of joy.

And I was terrified that I wouldn't have that. And I was stuck in so many ruts around, like, frustrated with myself for not being able to do the things that I… like, before my surgery. So, I had cancer diagnosis in April, late April. And for those of you that don't know thyroid cancer is a very slow-growing cancer for the most part. And so, I had the privilege of taking some time to explore, research, interview surgeons, or a whole thing. And I took time to do that. And more things unfolded, I learned later that had metastasized, the bigger surgery, blah, blah, blah.

But all during that period, I couldn't really focus like I was used to focusing, but my brain was saying, "You should be able to, you're not having surgery yet. That's not until the end of September. You got time, you should focus, put your videos out, work on the..." And I would sit down and I tell my admin, like, "I will do this today." Or "I'll do this this week." And time and time again, I would say, "I'm sorry, I didn't get to it. I couldn't get to it."

And all these things stacked up, but I kept kicking him down the road. And it was so hard, I was being hard on myself. And also, right, that other thing of saying like, yeah, actually rest is exactly what I should be doing. Or of course, I'm having a hard time focusing. But it's the inner turmoil that eats up energy, expectations, and desires versus ability inside.

PATRICK CASALE: Absolutely. Yeah, yeah. You know, I had very similar experiences where I kept thinking, what if I never get this creativity back? What if I can never get the spark again? And you go into like this depressive state after surgery, I think it's all the trauma, all the worry, all the anxiety, the recovery, everything is hitting you, you're low energy, you go into this depression, and it's like, there's darkness everywhere. It's just, I don't think I can be creative, I don't think I'll ever be able to do the thing ever again.

And for someone like myself,:

So, if you can't do these things, who are you? There's a lot of identity and existential crisis wrapped up into this. And I would get these sparks of energy. And then, I would overdo it, because I'm like, "Oh, my God, I feel good." And then, I would do something, and then I would pay for it for days.

And, you know, I just hosted a retreat in New Orleans last week, January 3, whenever that was, two weeks ago. And it was such a struggle. I co-hosted it, which was very helpful with my good friend, Jennifer Agee. And she's extroverted. And I kept telling her in the build-up, I was like, "What if I lose my voice? What if I don't? What if I can't show up the way I want to show up? What if like, I don't pull my weight here in terms of like how we do this."

And she just kept reassuring me, she's like, "I can talk for both of us, it's fine." And that was very comforting. But being in the retreat environment, trying to speak to 20 people who spent a lot of money to come, and participate, and be involved, and lose my voice halfway through or have to have other people speak for me when I would say, "Hey, can you tell the room to quiet down so I can speak." Or like, "Hey, can you get everyone's attention." And then I could speak. And my energy levels were so low, like, and so impacted, and I was just like, "Holy shit." I did not expect to be in this position three months afterwards. And you know, I'm still coming back from that, it's going to take time.

I just hosted a two-day course yesterday for therapists to start creating really authentic, captivating content, and being more authentic, and giving themselves permission to be themselves. And I was like sucking when trying to just talk and I'm like, "Oh, my God, this is hard."

k about, like, [INDISCERNIBLE:

HILLARY BOLTER: It's so much to adapt to. I had such an image while you're talking of like, the effort of swimming upstream, that being at that conference, and the voice, and it's just like, "Oh, can I lift my arm up for one more stroke?" Where you just need to, like, turn around and float for a bit. It's so taxing.

There's so many adaptations. And you and I were chatting about this a little earlier, because things are different, there's the way things were, and then there's the way things are now which how long will that last, and will have another voice surgery help or not? Or how much will it help and how? There's so much unknown.

How do you cope with the now and how do you plan for the future? I wonder what, you know, we were talking a bit about what adaptations, because we have to get creative, what adaptations do we have to do that might become the new normal?

PATRICK CASALE: Yeah, I think for me, I can no longer overdo it. I can't overload myself. I've scheduled two things a day now. If I'm going to do a coaching session and a podcast, two podcasts. Like, normally, I could do four, or five, six of these in a day, and I just cannot do that. So, that's had to change. I've had to really rely on admin support and just colleague support for things of saying, like, can you handle this? And outsourcing or just being okay with delegating more.

I've also just had to really make sure that I'm paying attention to my energy levels, and just really being creative in terms of how can I do the things I need to do without always having to be front and center.

And I think for anyone who is creating a business, and whether it's a therapy practice, or a coaching business, or consulting business, as an influencer you are front and center, you are your brand, you are your business. So, it really is interesting how you have to adapt, because I used to be able to like pump out content and make video after video, and for social media purposes. And now, I just tell my VA, I'm like, "Listen, I'll make a couple when I can. And like, I don't know, when the next time that will be." And I think there is an acceptance process of this is just going to have to be what this looks like for a while and trying to figure out ways to be okay with that, and doing a lot of my own therapy around that, that's for sure.


PATRICK CASALE: That is for sure.

HILLARY BOLTER: I'm with you there. Like, continuing to adjust expectations. And I mean, I've built into my schedule and after lunch nap. Like, it just has to be a part of my day. And when I don't build it then, I'm fried. I can't show up for my kids or my family at home. It's like, yeah, I'm toast.

And the tumbling, I actually was just saying out loud this morning, I was sitting in my kitchen and I was like, "Man, I'm doing it again, I'm scheduling over where I blocked rest time." It's so habitual, because I see spots in the calendar and I'm like, "Get it in there, make it happen." I don't have the capacity to churn stuff out in the way I used to.

that it will. [INDISCERNIBLE:

So, I was like, I can't do this job. I actually can't do this job yet. Maybe I will again someday be facilitating multi-day in-person trainings. I hope so, I love those. But I have to respect that limitation. What I can do right now is work the trainings in my online academy that are two and three hours long, once a week. That's what my energy can do. That's where I can show up and find my flow, and joy, and not overtax myself.

So, that's been an adaptation that I started like five years ago. I was like, these multi-day trainings are wearing me out, how else can I deliver or keep doing what I love in a different way?

PATRICK CASALE: Absolutely. And I think that's a great reframing point in terms of how we have to adapt and evolve when you're struggling with any sort of health condition and mental health conditions in a lot of ways of like, I have to reevaluate and be really honest with myself, because I can push myself. And I did that in New Orleans. It was too much. I had to be very honest with my co-host while we were there. I was like, "I'm struggling. Like, this is a lot harder than I expected it to be." Because my energy is so low, my distress tolerance is lower. I'm getting more frustrated in situations where people can't hear me or you know, whatever the case may be, or I'm multitasking and it's becoming too overwhelming.

And I am very thankful that, you know, she's very accepting of that, and very communicative around things, and we had some other support as well which helped. And you know, I told the coaches who are coming to my Ireland retreat in March, you know, we have three different coaches in addition to myself and I said, "Listen, if New Orleans is an example of how this is going to go, and Ireland is my show, like, I'm not co-hosting this, I am worried that I am not going to be able to put on the event that I want to have."

And all three of them in like unison were like, "That's why we're fucking coming. Like, you're paying us to be there, let us do the heavy lifting." And that is so hard, but also so humbling. And also, there's a lot of gratitude in that of like, there's a lot of gratitude in having that support to say like, okay, yeah, I'm probably going to have to take you up on this offer and recognize that the three of you may have to be more front and center than myself. And what I'm going to do in that event is just be very honest with people from the get-go when we do our like, check-ins, and introductions, and welcome party of like, this is where I'm at. And I may have to step away to take a break, I may go quiet or silent, or like, I may text and show you what I'm trying to say, because you can't hear me. And I'm just going to have to be really honest about that.

And I think there's some beauty in terms of like being like, this is the process, and I'm just kind of going along for that ride right now.

HILLARY BOLTER: Yeah, this is who I am and where I'm at, being really authentic and that being enough.

PATRICK CASALE: Yeah, absolutely. And just showing you can still show up. You know, that's the thing is like, you can still show up if you're really honest and transparent with your audience about your limitations. That was hard for me, because I don't think I can really be a therapist right now, given my capacity. And I only had a couple of clients left on my caseload prior to surgery anyway.

After surgery, I had to let them all know, I don't think I can do this right now and I don't know if I'm ever going to be able to do this, again, in this capacity. It was very hard to have that conversation. But it was the right thing to do for their care and for my own care.

And I think that's what a lot of this is about, as you all who are listening may be experiencing something similar, is just figuring out what your capacity is, and not overdoing it, not pushing yourself, because you do pay the price. I mean, there is a price to pay if you continue to push and push and try to do more, even though things have changed. And that doesn't make it any less hard to come to that reality and realization. Is it? I get frustrated very often, but it's getting easier. And I have more optimism than I have had. And I just realized, like, that's what your support systems are for.

HILLARY BOLTER: So much opportunity for humility and coming to terms with what is instead of what you wish were. And in modeling authenticity and reality. Like, when you say that to your clients, you're also giving them permission to be who they are, and where they're at, and speak it out loud. And that's beautiful.

PATRICK CASALE: Well, Hillary, I appreciate all of your vulnerability today and your willingness to share about your experience. And I hope for those of you listening, whether you're dealing with something chronic or something acute, you just give yourself some self-compassion and some grace and know that you're not alone in that. And it is hard. I don't want to sugarcoat that, I don't want to minimize that. But there's a lot of support out there too. And I just want to say thank you for sharing your story today and coming on and being vulnerable.

HILLARY BOLTER: Absolutely, and I think sharing the story is such a piece. I mean, I've been pretty public on social media about this cancer journey. And if I hadn't been, I wouldn't have received the support that I received. And people have said, "Oh, you're so vulnerable, you shared, you know, it was great to hear what's going on with you."

And I'm thinking, "I just don't know another way." If I had held this all there it would have been a million times harder. You know, I think it's such a shift of identity and such an opportunity to feel support. My personality is sort of like I got it, I can do it, I can do the martyr, I can push through. And like what an invitation to learn that I don't have to hold it all. And you don't have to hold it all. And you there's other coaches, DAP, and people, this can look different and it can be okay. So, I've been saying it can also be okay, it could even be great.

PATRICK CASALE: It could even be great. I don't disagree. And I think that, you know, this is just a lot of good advice. And I think being real about it, being authentic about it, sharing your story, sharing your journey, not only is cathartic for you, but it can be very helpful for people who are experiencing something similar, who may not be able to put it out into the world. So, I do just want to encourage that for those of you who are struggling.

And also, Hillary just tell the audience where they can find more of what you do have coming up, because I know you have some offerings as well.

HILLARY BOLTER: Absolutely. Yeah, I'm offering a free one-hour monthly webinar right now. It's like last Thursday of the month, so you're welcome to check out my website. It's micentreforchange.com. Our goal here is to provide engaging and high-quality training and motivational interviewing. We provide continuing education, we run these live virtual training series, and soon I'm going to be launching a certificate program in motivational interviewing. It's going to be really exciting for people who want to geek out in motivational interviewing with me.

PATRICK CASALE: Well, congrats on that, and all of that information will be in the show notes for those of you who are interested in learning more about what Hillary has to offer. I appreciate everyone listening today to another very real, authentic, vulnerable podcast episode. New episodes out every single Sunday morning on all major platforms. You can like, download, subscribe, and share. It's a great way for us to continue to grow the audience. Doubt yourself, do it anyway. We'll see you next week. Thanks.

About the Podcast

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All Things Private Practice Podcast
Real, authentic conversations about the mental health side of small business ownership and private practice startup.

About your host

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Patrick Casale

Hi, I'm Patrick. I’m a neurodivergent entrepreneur and therapist who truly believes in the power of disclosure, vulnerability, and authenticity. It’s become more and more clear to me that people are either attracted or repelled by what we put out into the world, and we can’t “be everything for everyone.” Through a lot of trial and tribulation, a gambling addiction, and an Autism/ADHD diagnosis, I’ve learned that being your TRUE self is what draws people in and creates connection. I have tattoos related to Lord Of The Rings, Travel, and Anthony Bourdain. And I travel constantly. Becoming an entrepreneur and working through my fears (they still exist) have allowed me to do more of the things I love. That’s my goal for you with this podcast — to use fear as a gas pedal, not a brake, and to learn how to reclaim and own your voice so that you can create your own entrepreneurial journey.