Purpose Meets Profit: Building a Mental Health Practice That Sustains

Introduction

0:00welcome to organizational sherlocks the podcast where business meets psychology and your organizational puzzles meet their match join us for captivating stories and practical solutions to unravel your toughest challenges i'm dr elizabeth fleming your guide to a prescription for business success so let's dive in well hey listeners welcome back to organizational sherlocks

0:31i'm dr elizabeth fleming i'm standing in today as the only host um but that is okay because morgan covered me a couple weeks ago um and today we're talking about something that i think a lot of

Tension between purpose and profit

0:41people in the helping professions maybe feel but they don't really say it out loud and this is really that tension between purpose and profit so there's this kind of unspoken belief that in a lot of clinical and mental health spaces if you're truly committed to the work you should not be too focused on things like revenue or growth or building systems and that business side somehow competes with the mission and yet the reality is that organizations that cannot sustain themselves cannot serve anyone so the question is not really whether you think about both it is how you think about both so i'm

Guest introduction

1:15really excited to bring on a guest today um dr elil ivarajan um is a core faculty member in the society program uh in minnesota at saint mary's university of minnesota alongside me so thank you ilio i'm very excited to have you um but he's also the founder and ceo of stepping stone therapy uh which is a private practice that he's built into this growing organization uh so i'm really excited to have you here we'd love to hear a little bit more about you yeah thanks so much i appreciate

Dr Elil Ivarajan background

1:45you having me on the show um so yes uh my primary role is i'm core faculty at saint mary's in the sidee counseling program uh i teach uh cognitive assessment type of behavioral therapy multicultural counseling uh and do some practicum stuff within that as well uh and then as you'd mentioned part of my role is running the private uh of course me here in the practice in houston texas of river houston tech

2:18awesome so yeah um just to tell you a little bit about myself like uh originally i my master's in

Transition to psychology

2:27hr management from purdue primary school management and i worked in 10 years before i made the role in the cochlear collagen so i'm pretty big news uh ibm in your car ran and which is a great experience and then moved into the field to do for helping and being able to help people and i differ for uh so

2:59other site group and met my uh wife kristi there we stayed in the practice together to be a co-founder with me as well and we uh started in 2016 so it was in business for 10 years and uh right now i primarily do most of the direct leadership also stated with practice and yeah running the remote loads that is awesome i can't even imagine like i can imagine that brings

3:34different challenges um just being remote but at the same time i think we're also used to being remote now so maybe it's not so bad um i kind of prefer it at times but that's just me um well

Early career experiences

3:45thanks for sharing about yourself and i know you mentioned you started in kind of the hr realm and then transitioned over to becoming a psychologist and i'm just kind of curious um you know what drew you into that area into psychology and and also you know if you think about what a you know successful life looks like in this world what what did you think it was going to look like when you decided to make that transition yeah from the beginning of going into uh this id program um i think unlike a lot of people i knew i wanted to go to private practices uh the primary reason being i just worked for these

4:21really large billion dollar companies where i was some tiny cog in all of it i wanted to have roles uh over work that i did the awesome seas how we created employees decisions we made only because you know i'm a large company to me sometimes you use decisions up now that don't make sense for the people you operate but you still actively support them and communicate them on those things so uh so i knew i wanted and then um in terms of actual what it looks like for the most part

4:56i figured it would be me doing therapy that would be the extent of it i understand so the idea of bringing back into leadership managing people systems and processes i did not think that was going to be an ongoing my role in the church yeah yeah that's really interesting i can i can see i can see that i have this similar experience in that as well thinking oh i'll do therapy and then got into it and thought wow i love the systems and i love the process and all of those pieces um which i think is is

5:30really really cool um yeah so i think and i guess i'm curious like in your grad grad school experience

Grad school and training

5:38and training experiences and stuff this tension that i brought up at the beginning between kind of you know client care and profit or purpose and profit was that something that you ever had discussions about when you were early on into your psychology career um well i'll talk about it from a grad school perspective first which is mainly from a grad school perspective i think a lot of the messaging around going into private practice uh was you know you only go into private practice if

6:08you're like money hungry or if you don't really care about people when you really just want to uh make money more than anything than being a big therapist or good psychology right now um so then trying to define that on my own that was really an important piece to kind of think about okay here i am in the field of the technology what is the thing that i be wanted to do for and how do i need that from some point of how do i present myself and how do my view as to really wanting to

6:41people yeah which is i don't think we necessarily of the field don't necessarily think about as really or be like oh i want to make sure people know that i'm really sure to help them modern it for the money which i don't think uh i honestly like bummer that like oh do you really care about it so yeah he's different yeah that's totally fair i always um when i would talk with like supervisees and stuff i'd always you know talk to them about um like an electrician in some ways it's

7:12like the electrician probably i mean i know a few electricians and they love their job they love what they do they love creating things right all of that and yet it's not really a question of do i have to choose what i love to do and make money there's not really that question of choice because like when i was um you know in school and and even after the fact i just remember all of my cohort members saying well we don't get into this field to make money we don't get into this field to make money and my always i would say like i refuse i refuse to believe that i should be able to put food on my table and feed my kids and all of those things you know and so i didn't see it as a one or the

7:46other it was always kind of a both and um situation um and so yeah i just i think that you can be committed to a mission right and committed to your purpose and your business side of things like you put on your business hat can also be really um impactful both for you and for your clients and so i guess i'm i'm wondering gonna put that put that on your plate a little bit um what what do you

Conceptualizing the tension

8:14think about that tension that exists like how do you conceptualize that um and how would that be i guess helpful for our listeners who maybe are wondering the same thing yeah i think when we get into this field part of it is we have to get comfortable with the idea of making money dealing with money and thinking of money as part of the goal of what it is to work with you right in some way we almost have to take on the idea of i'm a business person that does psychology and not a

8:44psychologist who just happens to own a business right right um only because i'm like working for government or working for a hospital setting or something like that i have to think about sustainings and how much do you pay other people and what to charge in my clients even with the decisions am i so all of those things fall under like that question of okay like how much do you value yours but also how do you value yourself also part of your responsibility is to make it

9:16accessible to people and make sure that you're not somehow creating this situation where people can't afford you who need you right right that can be a quite a balance and too because you think about all the people in the world and i mean i think you and i could both argue that everyone deserves to have you know someone to to talk to or help i mean i think about just mental health overall and it's like it's not that you have it or you don't we all have mental health it's just you know to what to what extent do we need that support um and i think that's really important uh to think about too and and

9:51i talk a lot with clients that i work with about you know what is your niche area so like who is your population who do you want to serve right and part of that may be whether they can afford your services or if it's insurance based or self-pay or whatever it might be and those are all business decisions and yet i think we think about them as clinical decisions in some ways yeah and we even uh kind of mix that in with ethical decisions right if i'm providing a service and i'm charging i'm doing evaluations of an expert in a specific area and i'm charging five thousand dollars for an evaluation

10:26than in ten thousand dollars whatever that amount is that it feels like a lot different then i might into i'm charging too much which isn't responsible of me because because which was needed you come out i need to be sacrificed or give up something and to allow people to think we go for it right yeah which i don't think it's just one way the other like i think it is that you mentioned because it isn't just oh i'm gonna uh just lower my cost so then everyone's uh but it also has to be like wow

11:01look i'm providing a real that's valuable and how do i value myself and how am i okay the idea of making money off it uh maybe i'd do a nice call right one of my students is interesting i was uh teaching it in my cbt class and i was asking her like what is like i have a big questions about you know how we engage with therapies intake all those things and one of the students are you go okay i've always wanted to have a core man is it okay for me to drive to work or should i have a different car

11:32oh my gosh what a question yeah which speaks volumes about like okay like i don't want to show up in a beamer and have everyone judge me as like making money off this field in some way right um and i had a colleague who we were at a conference in the dominican republic right which great destination yeah she was like i don't want my employees to think i'm just off having fun and vacationing i want so i'm checking my email and responding because i want them to know i'm working and that's why i'm here

12:05yeah and it's just like okay this image i need to portray and i don't want people to ever think that i'm too successful uh that i'm taking advantage of people right or that i'm in it really for the money yeah that's so that's really interesting and i think it also like it brings up previous episodes like we've talked about burnout and all of that i mean if you're going to a conference or you're going on vacation i mean what if you're checking emails you're not setting those boundaries i also think about like what are you modeling for your employees as well you know what are they going to think is

12:39expected of them when in reality as leaders we probably would say you know what go on your vacation shut your email off it's okay you know yeah so yeah i think that connects back to many episodes that morgan and i have had um talking about burnout and you know balance and all that good stuff so yeah and i feel like that's a piece that leads to burnout for a lot of uh you know specifically private practice is i think that they uh want to put themselves in a place where they don't feel comfortable talking about measuring making money they often end up

13:11going upside down in some way and making less than if they just had been doing individual work and then they feel like like i'm doing all this work not getting paid for it isn't worth it all right that i'm providing to the communities but this should be enough yeah yeah i mean that's hard i and i get it and you know what it's it's what's hitting me right now and i'd be curious to get your perspective on this but it's like we're right now we are explicitly naming the tension right like we are

13:43saying it out loud and yet i think it's for a lot of people more of this like felt experience instead of it being something that they actually name and try to work through you know especially when you're starting out earlier in your career or you know whatever it might be and again i hear this a lot from my clients like i don't know what it is i just i can't figure it out it feels uncomfortable to ask for payment when people come you know um to to their session or to their assessment or whatever i'm just curious if you have experiences around that yourself or with people you work with

14:15your supervisees your employees whomever it's the water we swim in right we don't uh we don't often name the idea of money because we don't talk about money right so then we end up kind of keeping it within ourselves never really voicing it um you know even in the the the training i went to nick and republic you four people who have practically that made seven figures and 11 right it was so interesting but we were like talking about like okay let's talk about the size of his business areas

14:46struggling every single perk runner on the page and said uh i have this is the name and here's how many commissions i employ and here's my biggest right and until i kind of like bought it up and mentioned it right no one had mentioned how much revenue they were making or even would have much money as a cousin they were having which is interesting to me because i'm like i don't care if you have 700 people like what's merely considered with it is that okay to talk about right right so i

15:21think it will be and then we bring into it all and you know the parallel to television where we have our own stories around money that can share families and all this thing and for me you know family but that is an associate professor at north university in on near you and he taught it all four of us on that salary so i'm yet to scrimp and save for nice shared decor used by uh you know secondhand clothes things so i think it'd be silly of not practicing as if those things impact how i look

15:57at money money and the fact that practice isn't sure is for me i want to make for everyone because that is something that we wouldn't have or the pure tech and private payback right absolutely so and then i'm teaching you your practice class and elective in the fall and the first thing we're going to start with is your money store right right because with whatever goals you about your private practice well you want to help people with that it's meaningless about talking about that or

16:27acknowledging that person oh absolutely yeah i have a question for you i'm curious and um you're in more in more the business related side of uh the field right uh i'm curious if you have a feeling around that where there's somehow did that new are not seen as respect to become this you work the business you don't work with people who are offering them quote in the same way with

16:59i mean there's a significant amount of business there's struggle at and have parents and need support and all of them yeah hey you're turning the tables on me alio thank you i appreciate that i try not to interrogate people but it's tempting because i just want to know everything um yeah you know i think um i think just the field of psychology as a whole and i don't know if we've ever talked about this on the podcast but i think it's something i really want to get into um is that there's just a

17:29lot of misunderstanding right when we think about when like women people just in the world outside of the field hear therapists or they hear psychologists like they immediately tend to think therapy right um sometimes people think they you know mush psychiatrists in there as well um but what people don't realize is there's all of these other different avenues of psychology there's academic psychologists right people who really focus primarily their energy in education or higher education um there's people like me who are more applied right and so kind of if you think about that

18:04implied umbrella it's um you know your sports psychologists your industrial organizational psychologists like me um and and that kind of stuff and so yes the answer is it's it's interesting um to see what happens and because i'm not a clinical or counseling psychologist i can't take insurance right and so it is private pay which then makes the business side of things really really interesting and to your point about like anxiety and depression they're people are dealing with that all the time

18:36even when i'm sitting one-on-one with somebody coaching it's anxiety about that next conversation with their boss or asking for that promotion or you know what if i screw up this project and like that's anxiety in itself right now is it getting to there and i will be honest like there have been times where for me it's um hey i kind of just get to the point where i say this is bordering a little bit too close to clinical work um and in which case then i have people like you in my corner that i can say hey i think this would be a good path for you to choose um and i'll continue to work with you on

19:07the business side um and if you choose you can you know work with somebody else on kind of the more mental health side of the world um so i don't know if that answers your questions directly but i i do think there is a lot of confusion about that um and then when you bring that into some of those larger organizations you know your billion dollar organizations or fortune 500 they see io psychologist or they see a degree in psychology and they wonder well how is this going to apply right um and yet there's i think there's so much power in being able to apply these principles and these theories

19:40to places that employ people because ultimately that's what psychology is all about right it's people so yeah yeah i know does that answer your question yeah absolutely and that's where people spend their time right for the work that you do in supporting those things and helping those people is incredibly valuable and kind of beneficial in so many ways yeah when i think like people spend so much time at work like we think about how i mean i probably spend equally amount an equal amount of time between baseball and work and that's a kind of a joke but baseball is a lot man it's a lot

20:16but that's that's my current state as you can tell that's my current stressor um but like we spend so much time at work and so you think about like just well-being overall and it's like if i'm not well at work like how am i doing in the rest of my life you know um and i think from the business psychology perspective because again i'm not there working with you know people on that well-being side specifically but it's about creating systems and structures for me in the business psychology world that allow people to be well right and so i think it's still the application of psychology but being able

20:52to articulate that i think is confusing to people sometimes you know yeah yeah um again the image is working individually with people uh you know dealing with uh diagnosable ailments in some way um there's so many ways to make sense in so many ways to help and support people in a positive way that the accent yeah yeah i completely agree um okay so i want to i kind of want to jump to this place of

Shifting the mindset

21:21so we've talked about the tension we talked a little bit about the experience of it what is it going to take to shift it like what do you think is needed i know it's a big question and probably a lot of visionary thought there but what like what is it going to take for us to shift from this place it kind of almost to like a sustainability place as well you know if we can sustain a practice sustain ourselves then we can sustain our work for people so how do we make that shift and where does it start i guess yeah um i think that's a great question um and i think a part of that you know

21:54begins with the idea of you know early on within our um uh academic environments where we are you know learning these things to be able to have open conversations about money and you know because here we are sometimes we take significant loans to get better programs on week with all these things and be able to do about those things and to acknowledge those things i think is a really important piece right um i did also uh i haven't found that social justice and making money

22:30or somehow like completely at odds you get you there right giving an area i think makes a self-adjustice face but at the same time can i be an ecologist who makes money helps people and all the social justice initiatives and those things risk obviously i make money am i adequately i'll crush things the massive therefore you know i sure if i make money therefore what i say and what i do is worth it much yeah so i think part of it's changing that mindset to it and

23:05i think across the board you know it's part of us recognizing and being able to talk about those things in an open way uh yeah i mean we're willing to talk about relaying these and uh how the family struggles we've had things but once we start money people struggle uh and especially people who struggle are the ones who uh have money or from family backgrounds where they've made money

23:36here in paris right class and multicultural we'll talk about uh socioeconomics and the people who's probably the most to talk about it are the people who've had money and they well because in their minds well i are as much because i have money i'm not even talking to some level of social justice they're feeling like i'm supporting things so just because i make money you know i think happy folks bringing money into it is probably one of the most important pieces of what we do absolutely yeah gosh i think about that a lot because um you know and so in my work in the

24:11business psychology world when i'm working with private practices usually i'm working with startups right who are who are trying to get going maybe it's just them initially maybe with the goal of scaling in the future right and we i'll ask the question about like well what are your financial goals like how much money do you need to make each year in order to feel like you can live the life you want to live like that's a question i ask them and every single time it's like well i i don't i don't know like i i mean like i don't is it a hundred thousand like i don't know um and it's it's so hard

24:44because it's like those are important because that's it doesn't have to be the north star but it's part it's one spoke of the north star if you will if you want to think about it that way um and i just find it so fascinating because like truly you probably know how much you pay for a mortgage or rent you know how much your car payment is like if you know what your family structure is like what does that actually look like um now i'm gonna say this and i'm be transparent and vulnerable like somebody asked me that long ago and i panicked and didn't know what to do either um so it's taken

25:19time to get more comfortable with it but it is an important question because that answer may dictate business related choices like do i take insurance do i do self-pay you know do i do a mixture of that do i want to work with um like tricare or medicare or medicaid those are u.s based government programs for international listeners you probably maybe have something similar i'm not sure um but those are all big questions and they're all foundationally like business decisions and if we let i think if we let

25:53the personal side of that get into it we kind of do ourselves a disservice in some ways um because like i even think about like you said stepping stone is an insurance-based right insurance-based clinic like you can still negotiate with the insurance companies and people feel really uncomfortable about that you know um i just i think it's it's interesting so yeah well i agree and uh you know in terms of

Business decisions

26:19like beginning of the year when everyone's was reset and all of a sudden people are paying not just copay but the whole amount for whatever you've negotiated with i feel like a lot of therapists who work that piece down go into that struggle oh uh i know you can't afford let's talk about what you can afford and how we do that and one of the things that i'm doing it pretty really jumping into having their own uh amount that they to like help are they struggling like you know that they're struggling

26:54and it's like oh well but it's a lot of money and it's like okay like so clearly you don't feel like that money or maybe that you're allowing you know for that money and yeah right and that also is difficult for people to kind of understand and overcome but yeah the money is the life better without that money how do i pay my people but also do i need goals that i have and aren't those valuable aren't those important as well and isn't that media like you know if i were to have a client

27:30oh i'm sacrifice all these things my family can be happy one of the first things i mean you is like okay well what about you like where do you follow but we as therapists are blind to that like okay all my work for me are making good money and i'm having to take money out of my phone they make practice and i've known multiple therapists who do that right but they won't uh cut what they pay it they won't uh change any penny economies of the structure or any of the decisions instead they

28:06go and tell me until they're not able to do it anymore which i think is a shame you could be someone who helps people who isn't able to right right yeah i mean that's yeah that's sustainability piece i mean all of the like business side of things everything is interconnected in my mind and like i think too that there's there are times where you're clinical and i talk about it was hats but like your clinical your counseling hat and then your business and counseling hat they kind of mush together right and so like i i remember being on postdoc and my postdoc supervisor i had a client

28:38coming in and i had a very similar experience of like oh i just i don't think they can afford it or i i don't know um and so i never pushed and i didn't push for the co-pays or i didn't push for whatever it was um and a large balance there was a large balance on the account that ultimately impacted me it impacted the business there are a lot of kind of pieces and i remember my postdoc saying if this is happening in this setting where else is it happening in their life like this is not just a business issue this is also like something that they need to work through and it could

29:10potentially be an intervention now that was when i was working clinically um and there's a whole lot other other stuff there but but i thought was a really good lesson for me i think both from a client perspective but also just from a self perspective you know if i'm thinking this where else is this happening in my life you know um i just think that's so important the other thing that i i think just on the kind of the pay decision like as a business where you how you decide to go one thing that i notice and i'm curious if you hear this at all people a lot of people in the health care field

29:44feel like they can't discuss not just that they shouldn't discuss money but that they can't like they're prevented from it um and yes there are some federal laws in the united states that you know prevents it like you know antitrust laws or whatever to prevent price fixing and that's probably way beyond what we need to talk about today so there are some laws in existence and that doesn't mean you can't have conversations about it and so like what is true in minnesota from an hourly rate is different

30:16than chicago is different from new york city right may even be different from rural minnesota up north or north dakota to your point um so i think those conversations are really important and it doesn't mean you have to say hey dr leal how much do you charge per hour but you know hey where are we like what do you think the range is like you can keep it more qualitative um and i encourage people to do that have those conversations it's not against the law i absolutely agree and people should know like what is an average um therapist or what is an average therapy session cost right and most of those cash

30:49rates and things like that are on people's websites right or at least should be so people know how much you know their service costs but what's funny because by like insurance right i'm we're contracted under insurance and part of that is i'm not allowed for what i reimbursed it is without it exactly which is like indicating that i think the insurance between all those things that kind of tend to the fact that we're uncomfortable in money and just say like hey when you make it easy talk about it just don't talk about it yeah yeah so directly there could be another practice that's

31:20the exact same size as ours as the same mix of doctoral ministers level people it could be getting 20 dollars more per session of some kind than we do right yeah and again it's one of those things where you talk about it you would assist and it's it's hard for people to like have those conversations yeah no i would i agree you know when it's making me think about um it's making me think about when someone starts like a an individual like a solo practice right um maybe aren't they're not as

31:51comfortable with that business side of things right and then they decide oh my goodness i'm at capacity i need to hire someone right i think for a lot of people it's this like okay well i can't take any more clients so i must hire somebody but then they go well i don't know what i'm gonna pay them like what do i have in reserves like what what what strategic planning have i done that's a lot of times where i come in as a business psychologist like let's make a plan of what this actually looks like because again you go back to the pay structure if you don't have a pay structure that supports

32:22another person right you can't pay them right or you're underpaying them to try to make sure that you can cover your overhead and i think um in sometimes it's kind of like a reactionary thing like i i just i i need more people i need another person when in reality it should be a business decision

Hiring and pay structures

32:41not a clinical decision yeah i don't know if that makes sense as to that yeah absolutely and i think the other thing that they would do which which i think it's awesome but you had them actually think about her from a cost and revenue standpoint is okay i'm growing i have so much demand i need to hire another commission what would be fair to pay them right and they don't even look at what is the overhead cost what is the profitability how much does this pay towards my uh grand uh administrative

33:11thing like that and it's almost like they age it used to if they have money showing up in their bank account and then they're not with until you need more closely of that right right yeah which i agree with you and it's like okay when addict operate and null is something that impacts decision and this isn't about happy uh i belong to this uh online kind of group where people practice owners come carrier questions and ideas and a person came up where someone said well he had these two clinicians

33:44that i hired for x amount of per year it was like it'll be great they asked for representing these how do i you know talk to them about this mate how do i tell them that you know should i give it to them no one and you know a lot of people are thinking of like well what's airing your now making route other people i think a person brought something that will house back up what's about what would be if you do this it was always the other people you know the client

34:17excuse me the employee and whether fair to them no consideration what do i need what are my goals what's the risk i'm taking to putting this business together what is the risk i'm taking every month you pay rent and pay all these and all those kinds of things uh and we just don't talk about it about it yeah yeah i think about it kind of like reverse engineering it's like you have to again i mean it's similar to the whole what do i want to make conversation like you start with where

34:51are you at right how much that you know from for like a personal perspective how much do i need to make each year and then reverse engineering how i can get there um and my dad is also an engineer just like you're so um funny enough but yeah i mean you know it attracts it's just in our blood i think um but like then thinking about as a business owner that practice as well like how much do i need to make to be able to cover my rent my insurance my you know all of the different um you know expenses that you have and and all of that and there are so many great tools to be able to help you with that

35:24you know i mean i and i will be honest i look at my business i look at it at least monthly to make sure i'm on track for where i want to be at the end of the year which seems wild maybe to some people because i will how do you know what's going to happen i don't but i can try to plan for it and i know over years of doing this kind of what the seasonal kind of fluctuations are so it's forecasting right but there's so many people are really uncomfortable with it which i totally get i'm a data nerd people and all that but even outside of the data right to your point like oh how do i

35:56figure it out what are the pieces uh i imagine and from just the practice owners i interact with uh you know i think a lot of them don't know the levers to pull yeah you know like if i want to get to the amount how many sessions do i need to have per week in the business what is the overhead cost that comes out of that how is that going to change the result of hiring additional people how long to be taking up my people to you know get on or on that but you know like a lot of people don't know that so they'll know what the month is they'll know what they're doing right now

36:27and that's as far as it goes if they even head into that monthly cost right yeah i know that like the question i always get from students when because i teach a contemporary practice class and so it's a little bit more like where are we going in this field you know like what does psychology look like i actually asked them the question of like who owns psychology and what is it um weirdly a lot of people struggle with that question i think because it is more broad than just clinical work like it's more broad so there's a lot more to it um but one of the things that they they often ask is well

36:58what's a good split you know and it's like well it depends on so many factors right like there's not one answer um and and actually it's it's interesting because that's that that split idea of like i get 80 as the employee and the business gets 20 right for those who aren't familiar with what a split is um that's not so different from you know positions i've been in right they called it something different a lot of times it was called a draw um or whatever it might be and then bonus eligibility and that kind

37:30of stuff but um so in the it's there is they're asking a business question from a very kind of clinical sense i don't know how to describe it like it's it's like we need to change the question to to better understand the business components that support that 20 or support that 80 you know what i mean yeah absolutely and to understand like what does that actually mean for me and why is it set at that number right right and you're right it's often that people just come up with like well standard in this

38:02area right standard for doctor levels standard for a master's level this amount and it doesn't taste like okay like how do you have how much physical space right what are the tools and fees that you provide as a problem yeah are you gonna have to buy your own couch like i know that sounds stupid but and i it actually makes you think about it because i again i had this like awesome conversation with my postdoc supervisor um and she had said you know when she first started out you know 35 years ago with

38:32her practice she wanted to buy this new couch but she didn't have the capital or the money to buy it and so she figured out how many sessions she would have to have um taken into account what expenses she had she's a very business-minded psychologist clearly but she figured out how many sessions she would need to be able to buy that couch that she wanted right and that was her goal like that was the goal in that moment it was like i need x number of sessions i can buy that couch um and i i again i'm weirdly i pass it on to my kids too like how many things you have to do in order to get that

39:06the thing you want right um but i think it's a good lesson and that is a business lesson in a lot of ways yeah i think about how's the work i'm doing how much is the money i'm earning relating to the you know the thing that i'm trying to get to or how does that add to my uh this broader goal of retiring at this time or buying this house buying this you know whatever i remember when i was uh uh in like grad school basically i would always think in terms of the number of chipotle crudos they

39:40would buy me oh heck yeah or it's always my fruit in the point times that it's like all right if i work this many hours fruit crudos he's like kept me here's where it's funny because we can just kind of break it up a few of those numbers and i feel like we all have to though because money in a health was so abstract that i don't like it's weird absolutely okay so most important question of the entire podcast episode do you still like chipotle burritos absolutely oh yeah so absolutely i just don't necessarily go out and they're way more expensive than when i first started eating

40:11chipotle burritos first of all uh yeah absolutely no i still eat them at least once twice a week which is oh my goodness it has to go get chipotle i guess because i love chipotle too that honey chicken right now is really good yes yeah i like that they're trying new things as well you know the one other thing i do want to talk about just because i feel like um it gets to the other side of what you're uh kind of bringing up uh is uh there are definitely and businesses in general not even just

40:45i take advantage too i think one of the things that can make our businesses or our excuse me if you will put that in some way often it's the people who need or get light right uh and even come from they don't have as many options to book or find anything left around somewhere they're like they're down or need uh or people and manage it was um well right absolutely and i come

41:18uh some of the super news some of the postdocs people we've hired they've talked about like some struggles i've had other places or you know they you can get paid much and they really not a lot of break and they weren't really like employers you they like you have to name this you keep seeing the number of clients right no option control no any of those all right also i don't want to get

41:50in trouble just like giant hearted people that just you beware for free and not so psychology i think just as you've been there to find out the people who take advantage of this and take advantage of the people they bring on uh and these days whether that's because their immigration status it's because uh the need for leasing hours i think there's a that side of it too yeah i would i would agree with that and i think i mean you know obviously i think it's true in all

42:24fields i think like there there's people who are to your point really in it for the heart maybe people who aren't like i just i think there's a wide range and i i like i can't change those people you can't change those people right so what i think about is how can we prepare our future clinicians um these people who will be employed potentially by these companies or by these practices how can we prepare them to ask the right questions to see when those red flags are there you know like i think that that's where it's like i again maybe that's a bit reverse engineering as well like i can't change

42:57them but i can give you the tools i can help you develop the tools the business tools to advocate for yourself too you know and that is true even outside of health care right like that's true when you apply to a job at a tech company right um it's not unheard of to you know negotiate salary or ask for more days off or whatever it is so why would that be any different in our in this industry like i that's where i get caught up a little bit because and people don't know how to answer that question it

43:27shouldn't be different you know oh i agree and a part of that i think uh the other side of it i think is sometimes it's also important to recognize you know i'm going to totally sound like a boomer as i say but uh people don't owe you anything and that might not be a business that's going to give you materially or paid time off if you're sick or any of those kinds of things they don't owe it'd be great estate because it's a practice and there's for your employees and but no one owed you things and

44:04what if it is you have to figure out how you're going to ask for those things or learn her about those things and kind of deal with those as well absolutely yeah you know i kind of it's it's interesting because it does like we we talk a lot on this podcast about purpose and mission and vision and values and that kind of thing and i do think that um a lot of the clients that i work with who are who are private practices or small group practices um you know they talk a lot about

44:39kind of this um this gap between like what they value like what their personal values and morals are and then what the practice needs to do um and it just it kind of makes me because i was here like when i was listening to you i was just thinking like there's a lot of values here like what do i value like you know and there's a lot of um kind of individual or unique you know components there like we might we don't all value the same thing um what i will say is that with the people that i work with um in this field just in health care in general not just mental health but in health care is that

45:13most of the leaders that i work with genuinely mean what they say right like just because there is a gap between what they believe right or what their values are um and the systems that they use right it doesn't mean that they don't like believe that they want to do better a lot of times i think they just don't know how you know and then that's why they bring in someone like me who understands both the side of what you believe and what you value and how you do it like how do we make that a reality so i um i guess i just i'm not i'm just kind of curious i don't even know what my question is to be

45:49honest i just i find that to be really interesting i agree i think leadership sometimes we uh we treat our employees like they're from our field like their clients right where we try to do too much for them or you know the other we don't think of them as people and we kind of like to think of them as numbers right but you're right most people work with really good intentions and want to be helpful and to do positive things in the communities they value the times they don't know how to

46:20and they don't know how do i get these things to line up with things that i'm doing uh the way i'm being the way that i'm engaging all that out for me it's going to make that my value right and i think your your role is so amazing and you and i have a lot of conversations around this where that execution is such an important thing right and if i just kind of work in my own head and try to do stuff with my employees or try to do stuff with my clients but i don't have that extra perspective to kind of

46:54it's me am i am i'm with my values and we're doing the things that i need then sometimes we lose track of that and then we get into a place of burnout and confusion and we don't want what we're looking for but we're sort of doomed from the beginning you just didn't have the perspective to really understand what people need from us absolutely yeah you know and i think um i think we're it's like hearing people in the field and i do a lot of reading and stuff too around kind of just what like what is psychology where is it going and obviously there's a lot

47:26happening in the world when it comes to insurance companies and like online therapy companies i'm not going to name them but like ones where you find you know you go online and then they connect you to a therapist or the therapist works for that company um these big big organizations and there's a lot of concern in the field that private practices are going to go away um and i don't know like i okay i'm going to get my perspective but then i want yours like i i think that there is an

Future of the field

47:51opportunity for us right now in this moment to stand up and say like there is so much value in what we do and this is how and why then like like this the work that you do at stepping stone actually ends up helping those large insurance companies because they don't have to deal with as many hospitalizations or whatever like it ends up saving them money um now that feels weird again because we don't like talking about money but the truth of the matter is like it what what you do matters and it's helpful and it's valuable and and like i know i'm getting on a probably a

48:27didn't have a a rant here but i just like i think it's time for people to like come together and and show that value and my question to you then is kind of on that line which is like i mean you are you have a really cool position i think like you're training future clinicians you're training people who may have a private practice someday or want to have a private practice and you're working inside the system the mental health system right now so you're kind of like in this cool place to see where the

48:58field is right now but i'm curious about where you think the field is going like what do you think it's going to happen or should you know the first thing i'll say is our field tends to be uh we tend to run a little on the anxious systems of these things right um which i think makes it very first be really aware of people but when it comes to the higher and ever broader things that can be really wrong it's not knowing when each or and all of that um right that we do might are really valuable and i do think some level insurance companies recognize that's me

49:31reduce cost then people don't need to be hospitalized or taken to the internet right um or they mean we're in to like some fires all this because there's with right work and there's work that we're doing we may be able from you know get have your head right i think the difference is now is a position that the sum through we're in a place having to quantify it and there's a lot of good values

50:02give me the yeah value-based uh insurance companies it would be based on like you need to prove providing value to the client right and do so you need to be met what the improvement you need to keep track will be numbers to be able to prove that you know what's the lesson in the general population that has depression as it is to the population that is in clearly therapy and to be capture and pre-version prepare oh we'll set the people of practice

50:38have to know that you can or we're in a break to prove those right unfortunately we'll collect a lot of it up to you which again the role that you put is huge because how many people recognize the value of it that collected it in itself but i think we're moving in directions to be able to impact their thing at the same time always have to push back with insurance companies and say this doesn't mean you get to tell me how to do therapy or that i need to do my uh transfer of my news in order

51:16you to pay me uh reimburse me for something things like that you've had a couple of companies reach and say like oh if you use our um ai transfer it will be identified and we analyze that to be able to learn more about it doesn't and there's a number for me because i'm like okay you're trying to create a formula for works where provides value when you don't have the whole ways of measuring that and

51:47understanding what's actually adding value also there's this sort of intrudiveness like rubber list gas deciding what's right well i think it's on one hand we measure me and recognize that you have to figure out a way to apply some of the things we do on the other hand i think pushing back into main quantification i don't know yeah doesn't mean that we have to uh allow have everything and be involved in what we do in order to work right they're useful for who will

52:20be i don't regret getting into practice uh even in practice primarily like i think there's so much opportunity to continue doing good work i think it's just a matter of attempting to figure out how do we do good work with some of these constraints that are there for us and that's basically you need help on how do i still do and understand great yeah thank you i appreciate that yeah i mean i i think the field is going to i mean it will continue i think it will change i think with everything it evolves

52:54and that's just going to happen i mean you brought up ai like that's you know i don't know we'll see where that goes i mean all so many of like the systems like the software systems people use are now integrating ai into them so it's it'll be interesting that's another probably another topic well make i'll let me ask you a good question um and this may not be quick but do you worry from your role that your role will somehow be co-opted by or that you will no longer have a role to play because ai can do everything you do that's a good question i don't what i see what i believe will be the case is it will

53:32make me more efficient i'll be able to serve more people serve more organizations help more people because it will allow me to be more efficient again i'm not working in healthcare well i am but i'm not dealing with you know private health information right like so i'm not bound by hipaa in the same way that you are um with your role at stepping stone but um so ai is a little bit different like i'll give you an example i when i work with leaders um and do assessments sometimes we incorporate like a 360 degree evaluation right um there are options for those to be digital kind of

54:05survey like right um they tend to be relatively expensive and some of my my clients can't don't want to pay for that i don't know if they can't afford it they just don't want to pay for it and that's fine so there are alternative options which i would consider to be more of like a narrative 360 well previously if you think about probably five years ago 10 years ago for me that meant writing down everything everyone said so like all 10 to 12 people and then trying to figure out what those themes were now i can use ai that makes it so much more efficient so it's more about like again

54:37i say like group these into common themes you know um so no i don't think it will um i still think that i think that businesses are made up of people and people want to work with people right um how i do my work i don't know that my client i mean yeah i don't know how else to describe that like if i were not adding any kind of personalization or like i think that would be a problem but yeah i think you'll make it more efficient yeah but your clients will also be able to tell if all you're doing is

55:09putting something into either chat gpt clod and then copying and pasting directly into whatever exactly your interpretation your expertise and your ability to then determine whether that's helpful or not modifying it adapting it is a part of what you do and or part of what's important and you relate to it right ai can't communicate to people hold them accountable do those things right not in the same way i actually think you know you said discern like i think the idea of discernment might actually be i i always say like one of the things like when i'm hiring somebody

55:44one thing i always look for is resourcefulness like i think that is an important skill like resourcefulness having agency being willing to try to like research it before you come and ask me about it not because i won't help you but because i think that provides extra like knowledge and learning but i think that like at now that things are changing and ai is more incorporated into kind of just the world in general that discernment piece i think is is probably up there with my resourcefulness thing from a hiring perspective like i want to understand how you discern i mean everything like i want to understand

56:18kind of what's going on in your mind and again i'm you know ai can be somewhat human-like and whatever but it's not going to get to that nuance in the same way that we can you know um so i don't think so um but i guess we'll see i don't know i think i like to think that if my job does somehow go away that hopefully i'll have enough money in my in my bank um that i'll be able to just like go and sit on the beach you know like i don't know maybe not but yeah knowing you elizabeth there is no way

56:49you would ever for more than a day or two be comfortable sitting on the beach and doing nothing it just doesn't be you know you told me when i went to hawaii two years ago with my family over christmas i actually did not take my computer along that would be the first ever vacation i've taken when i didn't bring my computer along it was a lot it was really anxiety provoking but after like day two it was pretty good so and i was running around after two kids by the ocean so yeah fair enough distractions when it comes to the children side of things that exactly yeah totally well

57:22thank you so much i appreciate you being willing to come on and talk about i think this really important topic um is there anything else you want our listeners to to know to about you about stepping stone or just in general no you know they're out in the suburbs of houston so if anyone's ever seeking therapy or a guide you can look us up but really the big i hope people take it kind of well we all look at like words here you're talking about and how does that like i think funny maybe

58:05relationship maybe something else so that's one thing i'd add awesome thank you so much again we appreciate you um we will for our listeners um if you're in the houston area um you may want to check out stepping stone so we will tag that um on our socials so that you can find a direct link to their website um so check that out um and again thank you thank you um i appreciate you and thank you for the work that you do just for the communities that you serve so thank you i really enjoyed being on

58:36here and i really appreciate the work that you do too so there's a huge need for it well thanks very much um well listeners this concludes another intriguing episode of organizational sherlocks i'm elizabeth fleming reminding you that the journey to success is an ongoing investigation remember to stay curious stay strategic and keep utilizing insights to decode your business mysteries join us every friday for your next whodunit this is organizational sherlocks closing today's case

59:21you