009: Intensives and Retreats: A New Paradigm for Therapists to prevent burnout and boredom

November 8, 2023
009: Intensives and Retreats: A New Paradigm for Therapists to prevent burnout and boredom with Susannah Horwitz

In this episode, therapist Susannah Horwitz shares her personal journey of burnout and the pivotal moments that led her to find joy again. She discusses the challenges she faced upon moving to a new location and the pressure she felt to maintain stability for her family.

Susannah reflects on her beliefs around money and how she overcame scarcity mindset to increase her fees and create a more sustainable practice. She also explores the role of rest and play in finding abundance and shares her experience of shifting to offering intensives as a therapeutic approach. Susanna emphasizes the importance of collaboration and connection with other therapists and the need for a collective shift in the field of therapy.

 She shares her passion for supporting young parents in STEM who are dealing with chronic illness or health anxiety. Susanna also introduces her coaching program for introverted therapists who struggle with  networking and offers insights into somatic regulation as a tool for building relationships and referral bases.

More from Susannah: https://www.susannahhorwitz.com/

More from Jen: https://linktr.ee/drjenblanchette

Speaker A: This is the finding Joy after Burnout podcast, a podcast for therapists and mental health professionals. Together, we unravel burnout and find our road back to Joy. Here’s your host, Dr. Jen Blanchette. Hello, Susannah. Welcome to the Joy after Burnout podcast. It’s so great to have you.

Speaker B: How are you doing?

Speaker A: Thank you.

Speaker B: Thank you, Jen. I’m doing great, and I’m so glad that we got to do this, because not only do we get to hang out, but I get to be on your podcast. Thank you for having me.

Speaker A: My pleasure. So I’m going to kick it off to you and to share your burnout story.

Speaker B: Okay, well, my burnout story, I’m like, I think that there are probably several of them, but the one that we really pinpointed, I think, when we were.

Speaker A: Talking earlier, was one of them. I think many therapists say, okay, which burnout story do you want to hear?

Speaker B: Which one do you want?

Speaker A: Which one you want to share? Is always the answer.

Speaker B: Most recently was sort of like, as I was telling you before we started recording, there was a point where I was just like, something has to change. And I think that was really towards the end of 2020. I think that probably happened for a lot of people. But basically, I had gotten onto a second Medicaid panel here in Colorado. I had moved from working in Massachusetts in private practice for a while, and then I was on all insurances, big insurances, like Blue Cross Blue Shield, and then moved here and didn’t get on insurance because they were closed to clinicians, even if I had experience. And that was probably a blessing in disguise, because for many years, I just sort of worked and sort of hustled to get full fee. And I actually started to charge 150 when everybody here that I noticed was paying, they were charging at the most maybe 120 a session, and I increased it just because there were multifactors. That made me go, okay, let’s try 150. And I was kind of scared about it, but I just sort of did it.

Speaker A: What were some of those?

Speaker B: Well, what were some of the reasons.

Speaker A: Why you chose to increase your fee?

Speaker B: Well, my fee in Massachusetts was 100, and this was back in 2010 to 2014, and I kept it at 100. Nobody ever talked about, increase your fees yearly. Nobody said that they were just like, get on insurance. I had, like, maybe two or three people that were paying me $100 per session. Blue Cross Blue Shield was paying whatever they were paying at the time, which is even less than probably what they’re paying now. And I was just excited because I was like, I’d left a nonprofit world, and I’m like, wow, I’m making money. But when I moved here and didn’t get insurance, part of it was that I was the primary earner. I was making money for the whole family. It’s me, my husband, and my son. And at the time, our sons old. We moved out here because a family was out here, and we wanted to make a change. And we love Colorado, so we just sort of moved out here, didn’t have a place to live initially, finally found a place to live, and I was like, okay, well, based on what we had all saved, I had about two or three months that I was like, until we’re just out of money. And so I decided to start sort of doing a lot of networking because I didn’t have any professional connections here. And eventually I just happened to, it was somebody that I had actually just met in Massachusetts. Before I left, she referred me a client of hers who was moving from Massachusetts to Colorado. And the way that she set it out was, and by the way, because I wasn’t thinking of increasing my fee until this, she said, by the way, this client meets with me 2 hours a week. The parent pays. I think it was 125. She said, but you have a lot more experience, and you’ve been licensed longer than I have. That was the reason back then, right? Yeah. Maybe you can charge more. And so I was like, you can’t.

Speaker A: Charge more than someone who’s been longer than the field, right? There’s these rules that we have in.

Speaker B: Our brains, which I now think is just a whole bunch of stupidity after all the work that I’ve done with money mindset. But at the time, I was like, okay, well, maybe 150. So I was making. At first with this one client, I was getting $300 a week, which was unheard of. I was like, I had never experienced anything like this before. I thought I was the luckiest person in the world, one client. And also I was making money before I had expected to start making money, and then it was really slow going. I would say it took like a year and a half to two years to really build up my clientele. And I also didn’t have a website. I had a psychology of today page. I was doing a lot of networking, but I was able to make it work, where eventually, after a year and a half, I was full. And I had a great. And full for me was like 15 clients a week or something like that. At that time, maybe less ten to 15.

Speaker A: I know I’m always amazed by what people are like, therapist, what is full for you? And we’re just kind of like gauging, right? Like, what can I do to my nervous system?

Speaker B: That’s what I’m telling you. Exactly. Well, and I didn’t realize that until the longer I was in private practice that I was like, I’d start to whittle it away more. And now it’s like right now. And you’ll see, like when I’m doing intensive, it’s a little different, but I probably have a max of five or six people a week now. But going back to it, the reasons were that just because it was sort of legitimized, I was like, okay. But the thing that wasn’t legitimized was that all the people in my area here, even in Colorado, even when I checked in places like Boulder, where I expected it to be higher, I wasn’t finding people. And that’s a whole other thing. There probably were people charging more, I just wasn’t finding them because I wasn’t looking in the right places. But it seemed like nobody was charging more than like 120. Some people, even in Colorado where it’s hard to get on insurance, were taking insurance. So I raised it to 150. And then I just started charging people. That I also did at the time, though, people. My money mindset was all over the place. When people would come in, I’d be like, well, I need clients. So I was sliding a scale all over the place. I started with like, my sliding scale fee is 90 because that’s sort of what insurances might have been paying around the time I found out. You’re not supposed to share that information.

Speaker A: Which is, no, someone’s going to get us.

Speaker B: And so I had people paying $90 a session. I had connected to some programs in the area that were providing free, twelve free sessions, and then they would pay me $70 per session. It was all over the place. And then eventually I started to listen to these podcasts that were starting to be out there. I was looking at free programs and being like, oh, maybe I need to increase my fee. But really, for about six years, I never changed my full fee from 150. I never increased it by any kind of increment because I didn’t see anybody else doing it. I didn’t know that that was a thing, and I don’t know that a lot of people thought that that was a, so was the burnout piece more.

Speaker A: Around getting to Colorado and kind of scrambling, not knowing where clients would come from, not knowing how you were going to make your business.

Speaker B: It’S maybe because one thing that pops up for me a lot lately, Jen, is the scarcity issue. The idea of scarcity that creates a burnout and scarcity, kind of that feeling of like, oh, I’ve got to do something. But also, scarcity holds us in a place of, like, I have to make money, and I am in charge of making money for my whole family. So I can’t just change things all of a sudden, because the mindset goes to, if I increase my fees, then all of a sudden I’m going to lose all my clients. I’m not going to have any money. And really, in my experience, it’s not entirely the case. I think what happens is we forget that things are temporary, and we forget that we can do things temporarily, and we can get creative temporarily to make sure that we’re still getting food on the table and we’re still paying our bills. And we can also look at, like, what do I need? I don’t have to increase my fee to 250 or 300 right away. If certain circumstances in my family are that I need to pay for certain things, I can do it incrementally. Right? But I wasn’t even doing it incrementally. The burnout was just, I think a lot of what burnout? Why it happens is people are trying. They’re thinking they’re staying safe. And then over time, what’s happening is you’re not safe. Your nervous system is dysregulated, and then all of a sudden, you get sick, and all of these other things start to happen. And so you can’t work. So we don’t think of. It’s interesting because we think like, oh, I’ve got to stay safe, and I can’t make a big change or what feels like a big change. And so we sort of stay stuck, and that just sort of tends to feed the burnout. So I think, going back to the story of it, I think what I’d mentioned to you before we recorded, too, is I feel like I’ve always sort of just been on the edge of burnout, and then something will like, and it’ll just motivate me to be like, oh, no, I’ve got to get going. I can’t fall apart. For me, burnout would start to. I sense burnout starting to happen. When I’m starting to get really exhausted or irritable or sick or something’s happening, that’s like, I’m off. And usually what I noticed that I’ve done has been like, I got to do something about this more so probably in the last ten years, I’ve figured that out. And part of it also, Jen, is because if I didn’t do something about it, then I knew that I wouldn’t be able to work and I wouldn’t be able to take care of my family. But when I moved to Colorado, I don’t know that there was necessarily a burnout that I felt happening. It just was maybe like me trying to figure out how to get stability and how know, take care of things. But what ended up happening is for me, and it’s interesting, we didn’t talk about this part before I started to become work addicted. So it was like, I have to work, I have to work. And this is related to scarcity, too, I think. But I have to work, and I have to keep working in order to maintain stability in order to take care of my family, right? But then I would become so obsessed with everything about work to make sure, and I’d be looking at my numbers all the time. So I was doing a lot of thinking instead of taking action, right? So I was kind of like, what would happen if I did this? What if I did this? And what happens is I get stuck in this analysis paralysis. And that’s what leads to burnout for me.

Speaker A: Yeah.

Speaker B: But taking action, which sometimes can feel scary, is actually what then moves the needle towards solving your, I think, solving the burnout issue. I have realized more and more that I don’t have to, actually, I’ve heard this from so many places, especially in these sort of, like, more woo woo manifestation circles, that you don’t have to work as hard. We have been taught that we have to work and work and work and grind and grind and grind till we’re just so sick in order to be successful in order to make money. And my ideal. Right.

Speaker A: And I think from the industrial mindset. Exactly. It’s not even a woo woo. I think there was industrialism. People used to work in toil in almost their entire lives, right?

Speaker B: And so what I’m saying is, in more of those woo woo circles, which I think are wonderful, and actually, we need to listen to it and not call it woo woo all the time, because it’s probably truth, is that this has become my mantra. It happened on a retreat that I was on last year where I came up with this, where I was like, wow. I have always seen everybody around me, my own lineage. It’s like, work, work, work, and that’s how you be successful. And so I just sort of decided, let me change it up. Rest and play will bring me a steady flow of abundance. And I was like, what? How do you.

Speaker A: Because for most people, they’re like, I’m Bernay Browning. You.

Speaker B: There’s two of them. It actually started out with something that I feel a little shame about, but I’m going to tell you it anyway. My first one was rest and play. Bring me a steady flow of big money. And for me, the big money is also. It’s like money I’ve started to learn as a vehicle, if you don’t have to feel shame about money, because money is something that we need in order to provide and help the world and invest in things that we really care about, like social or environmental justice issues. For me, anyway. And so in order for me to really. The things that have been shifting, especially for me in the last year, are recognizing the times that when I am rested and I am in a state of play, which is sort of the state of flow, right.

Speaker A: Yes.

Speaker B: That is actually when I am moving the needle to becoming more successful, not when I am sitting there in this ideal sort of, like you said, industrial work work until I’m exhausted and I can’t do anything. But just like, yeah, that bro hustle.

Speaker A: Culture that’s out there in the marketing world. So I think for therapists that feel like they need to adopt that mindset. So if I want to change my practice or I want to make more money, that’s the way I do it. I have to hustle for more clients, see more clients, or do more. And that’s the antithesis of therapeutic work and soul work that we do as therapists.

Speaker B: And so, yes, the big epiphany for me. And now I’m thinking about, I’m like, yeah, the burnout was happening, sort of like underneath the surface for a very long time because of that work, work mentality. And it tends to slip in every once in a while. I was telling you before that, even yesterday, I was like, wow, I’m so exhausted. Oh, wow. Even in the place that I’m in right now, we can have these experiences where it’s like. And for me, it happens within a few hours or a day where I’m like, whoa, okay, drop everything. You’re going to sleep tonight. Don’t do anything. It’s going to be fine. But I think that in the past, it was like, no, I have to work. I have to work so that I can get the thing that I want. And what I’m realizing more and more is that rest and play are what bring you exactly what it is that you want. And I’m now starting to figure out, like, I’m not just infusing that into my personal life, but fusing that into my work life. And that’s why maybe this is a good segue into intensives. That’s why I decided to shift even the whole paradigm of how I’m offering therapy. Because when I look at the way that we offer therapy in the world, that’s a typical, traditional way of doing it. Took me actually changing and trying out a different way to be like, oh, my goodness, this could be like this. And I’ve done that with several things. So my master’s degree is in expressive arts therapy. So already I’m doing things a little bit differently because I’m, like, playing with people in my work. Right. And then when I moved to Colorado, I started to get back to these things that I really love to do and started to realize, like, I’m a person who had been a rule follower. Like, I think a lot of us therapists are where I was like, I want to take my clients outside, but how can I do that without getting arrested? How can I do that without my life falling apart and get my license taken away?

Speaker A: And then it legitimately had this fear of taking a client outside because they had someone listening. Someone literally listened to them in the bushes, and I had to tell them, if someone is hiding in the bushes, that is on them.

Speaker B: Yes. No, right.

Speaker A: Not your fault. You did not reach confidentiality.

Speaker B: And I figured out ways to be able to sort of merge just by reaching out to people who are already doing it. I think that’s the other thing. That’s great. And this is why I love that you’re doing a podcast, because if we can reach out and connect to these people that are doing the things that we are, like, wow, that’s so amazing. How are you doing that? Instead of like, oh, I could never do that. Talk to them. Because me, when I moved out here, I was scared out of my mind to do it. Then I started talking to people, and I figured out how I can get a liability form that has all these things that they can sign off on when we’re going outside, how to talk to people about, like, what if we do bump into people? What if you run into somebody you know, or I run into somebody I know? There’s a whole protocol around that.

Speaker A: And I think COVID changed a lot of that, Right?

Speaker B: Yes.

Speaker A: With therapists taking their work outside because of. Because they had to. They had to. Some clients needed to be seen in person.

Speaker B: Similar with telehealth, too, where people are like, oh, we can do it this way. And I think that what’s interesting is that there were things that would happen when I started to change things up and do things in a different way. I started to realize that not only is this helping my clients, because getting out into nature, whether I’m doing actual nature based activities or not, just being out there creates a shift for people in their nervous system. And there’s lots of research out there to prove that we’re so disconnected from nature. And here we do therapy where we’re coming in. And nothing against being an office. I do it sometimes, but we come into a little box and we’re expected to sort of help people grow and expand when it’s like, wow, there’s actually things out there that we can connect with out there. And there are ways to do it even if you feel scared. So even though I worked in outdoor education for many years and have some experience being outside with people, I still was scared about, how do I do this and still have it follow the rules of therapy. But like I said, I figured out ways. I’m still figuring out ways along the way to do it. I started also, I trained in EMDR, and I had been taking people outside, but I was like, how do I do EMDR outside? People will see us. They might see us with the tappers and we’re holding the thing. And what if we’re doing this thing and people are like, you know what? After a while, it’s like, just do it. And then it turned out it wasn’t a big a deal.

Speaker A: We found places. I never did it. I’m EMDR trained as well. I never did it outside. So I was always like, it is so magical.

Speaker B: And I’ve done walking EMDR. I’ve done it with people. Where?

Speaker A: Bilateral. Right, exactly. Okay, let’s notice that. And we walk.

Speaker B: Exactly.

Speaker A: I always thought about doing that, but I never did.

Speaker B: And that’s the thing. There are these things that you’re like, oh, I wonder if. And then it’s like, oh, no, the licensing board’s going to get me. And it’s like, well, actually, what if your client gets better?

Speaker A: Well, actually, that’s how Francine Shapiro discovered the model. So she was working through her own grief and she walked.

Speaker B: Exactly.

Speaker A: And she was like, there’s something to this walking. And then she kind of started exploring. And it was play. I think it was partly like, I’m going to kind of see what happens here. So I’m going to walk. This is, something’s shifting in my body when I walk and I’m experiencing this.

Speaker B: And then she was like, oh, and my eyes are moving back and forth. I’m like, yeah, but also you’re moving your body. There’s something else happening to your brain. So that was part of it. And then shifting into, I basically shifted by getting help even more. I joined coaching programs. There was a coaching program that you and I were part of where it was like learning to do things and being in groups of people where they’re like, I need to shift the way I’m doing things. I think a lot of people who come into these programs have all these creative ideas, but they’re afraid of the system of therapy, and they’re like, how do I do this and still be okay? And how do I do this and still have clients?

Speaker A: Right?

Speaker B: And one of the first ones was a money mindset program where I increased my fee significantly. So I went from 150 to 200 within a matter of like and shifted it. And it was not a big deal to my clients, even though I was scared out of my mind to tell them. And then it turned out that a few months later, I was, hmm, I think I need to leave Medicaid. I think I need to not be in insurance because I’m getting really irritated by being beholden to all of this right now. And I realized that if I had more time and space and I had more money, I could probably affect change. Like, I thought that I was giving back, right? So I was like, I can affect social justice and environmental justice issues and be part of it more if I have more time and I have more money, which wasn’t happening when I was working with, like, say, five Medicaid clients a week. And I love the clients I was working with. But what would happen with insurance, especially Medicaid, because at least here in Colorado, they weren’t paying anything, is that people would stay for a real long time, and it would be hard to sort of terminate because they’re just like, okay, I’m just coming every single time. It’s like, this is great. And some people really needed it, and it was really helpful. But some people I would have conversations with, like, hey, maybe let’s just. Yeah, it was finding that referral for.

Speaker A: That person to find another.

Speaker B: Exactly.

Speaker A: Medicaid provider. And I think, oh, my gosh. I mean, for me, the layers of burnout were a lot in the insurance system. So, as many of the listeners will know, when this podcast launches, you’ll be part of that launch. So you’re hearing it now, podcast listeners. However, I’m not in practice anymore. I closed my practice this year in 2023. But a big piece of my burnout was the insurance based system. I had one insurance carrier. We can theorize which one it is. Did not pay me for three or four months.

Speaker B: Yeah, there’s too many stories of that.

Speaker A: Yeah, exactly. Distinctly, like, being on a phone call and being in a phone loop and just like, yes.

Speaker B: The same thing with, like, here’s the thing. When I got onto this second Medicaid panel, first one was really have. There’s different ones for different regions in Colorado. But the second, and, you know, I’m nice and empathetic, I realize that one of the reasons that it sucks is because they don’t have enough people working for them and they don’t pay them enough. I would call to try, like, it took me nine months. I always say it was sort of like the baby that was Medicaid. It took me nine months to get onto this Medicaid panel, and because they lost my stuff and because there was somebody who their message. Every time I’d call, they’d say, we’re on maternity leave. They were on maternity leave, for know, I don’t know, eight months. They didn’t change the message. There was no way to get a hold. You didn’t know who was moving to what position. So it was, like, hard to figure out how to. And finally, when I got on Medicaid, it was when COVID started and all the lockdown happened. I was like, at the time, I was like, yay. Well, at least I’ll have a steady way of getting clients. I don’t know what was going on. Like, in my brain, I was like, people aren’t going to be able to pay for therapy anymore. Turns out a lot of people I knew increased their fees significantly during COVID and it was no problem. So then in 2021, when it was still sort of more COVID lockdown times, I increased my fee to 200. Then halfway through, I decided, I’m going to leave Medicaid. And I also decided I’m going to increase my fee for new clients coming into $250. And I was scared. And then I did it, and then it worked. And there were a lot of changes happening at this time. I was like, I think it’s because I was like, oh, if this can happen, then maybe I can make this happen. Well, first of all, leaving Medicaid was a lot more complicated than I thought because I wasn’t reading the fine print when I signed up because I was so tired from the process of getting on that one of the Medicaid panels, it was four months notice you had to give them, right? And this other one that gave me a headache and getting on for nine months, they required six months notice. They wrote it as like 180 days, I think, to kind of make you feel like it’s not that big deal.

Speaker A: I went through all that process, too, with panels, and they’re all different, which is great. Each one has its own rules. You have to, oh, my gosh, that was a lot.

Speaker B: And that’s a mess for therapists, too. And again, we get locked into the system thinking this is the way it is and this is the way it’s supposed to be, until we start to sort of break out of that, and then we start to find other people who are like, oh, we don’t have to do it this way. Even I get a little irritated by things like betterhelp. I see those commercials that come on all the time because I get really irritated because you watch them, and anybody who’s not a therapist is like, that’s so wonderful. And the celebrities are promoting it, and this is extending options for mental health for people. Turns out most of the stories you hear are that the therapists who are working for better help are burnout because they’re not getting paid.

Speaker A: Are they brand new?

Speaker B: They’re brand new. They’re not getting paid anything. They’re not able to for the most part. I’m sure that there are some good situations, but it made me go, like they would reach out to us as therapists, almost like it felt, like hungry.

Speaker A: Yeah, I got one. Can I give you a $25 gift card for getting on a call with me? So even incentivizing and kind of bribing us and trying to bring us over.

Speaker B: To the dark side, and I think for something like that, if somebody is starting out, if they know, like, I’m going to limit myself or if somebody’s like, I’m increasing my fees, so I’m going to go on something like betterhelp, but I’m going to limit it for like a month.

Speaker A: I think a therapist could work for them, certainly, but it can lead to.

Speaker B: Burnout because there are other options now, though.

Speaker A: There’s other options other than the lower paying ones of these telehealth companies that are more caring for therapists and will honor a higher fee.

Speaker B: And when a client is getting a burnout therapist, they’re probably not getting the best therapy, to be honest. That’s the thing that I started to realize is as I increased my feet and created more space for myself, I was actually showing up clearer. I was showing up more focused. I was showing up with more knowledge because I had more time to kind of do more reading and learning and other things like that, and just to kind of keep up on things. I’m still excited again. I got off of Medicaid. Finally, at the end of 2021, I had set an income goal that was like higher than anything I’d ever had before. I was like, I’m going to make 100K by the end of 2021. Did not reach that goal, but did okay. And then.

Speaker A: It hey, therApist, I wanted to let you know about a free resource that I’ve developed for you. Introducing the before you quit guide. This is a free resource I wish I had when I was in the throes of burnout. So it’s going to include focused journal props on areas of struggle and burnout in clinical practice, identification of depleting experiences in your practice and in your life. And then we’ll hopefully identify some actionable items for change. If you’re feeling depleted in your role, please give yourself the gift of slowing down and assessing what’s really going on with your career turmoil. As a therapist, I know it can be confusing, isolating and totally overwhelming. So grab your freebie. The link for that is in the show notes. Thanks.

Speaker B: Got off of Medicaid, and then in 2022, finally reached that goal in 2022, right? Because I’d gotten off of Medicaid, I had increased, and then I increased everybody that I was working with to 250. And then I started to shift this whole thing because in the end of 2021, I started trying to do intensives, and I was scared to do that, too. I was like, how am I going to do this for 3 hours? How do you. And then somebody was like, just try it. See what happens. Offer it up. So I did it. And the first time I did it, I was like, I love this. I never want to do anything else. And here’s why I was. And a lot of therapists have this happen, too. I was very often going overtime. Like, I was doing full 60 minutes sessions for the whole time from 2010 until 2021. Full 60.

Speaker A: If you’re doing EMDR work, EMDR using.

Speaker B: Art therapy, using being outside, there are aspects of it that’s like, you sort of need a little. And I was like, well, maybe I can go to 60 minutes. People will pay for that. And then I started offering, like, hour and a half sessions. I was like, well, that’s nice because what was happening with our sessions, and it’s really hard for me to do, is I would be like, oh, gosh, we just got into the meat of everything. We’re just getting into the flow and now we have to close up. And it was really hard for me because I felt like I was doing my clients a disservice. I would run over time a lot. I wouldn’t charge them for the time that we were running over. And that was contributing to some burnout probably, too. And so eventually, when I started doing these longer sessions, I was like, oh, I can have somebody pay for up front for a three hour session, and we can take little mini breaks in between and we can slow things down and not feel so rushed, and we can really open it up and close it up nicely. And I can use. There were so many times where as an expressive arts therapist, I was like, an hour. I don’t have time to do any art with people. There’s just no time because I had to do like, mini art therapy activities that I was like, this is not digging in in the way that I learned, because you need time to get into both a creative flow, into the flow of like, wow. If we’re in the depths of something difficult, to be able to be in that and be in that in a safe way and to be able to titrate and sort of like pendulate in and out of it, it needs time. So when I started to do these intensives, I was like, whoa, this is all I ever want to do. So this is what I was saying before. It helped my clients, but it also helped me because I tend to be a person who just needs, I need slower time and space and connecting with nature and connecting with art. I always felt like they’re my co therapists, right. But now I’m starting to realize that extended time also helps me because it allows me to feel more grounded as a therapist. So even when I called them intensives, I’m shifting into calling them sort of more intensive retreats. The intensive word is sort of like a buzword out there. So it’s like good for SEO, I guess.

Speaker A: Yeah.

Speaker B: But I’m using it as intensive retreats because it feels more like retreat style. I’m taking people outside. We’re including art and movement and music.

Speaker A: My body’s moving, as you’re saying, right? Yeah.

Speaker B: And we’re including times where I can send a client out on a little wander to go and have a dialogue with a tree, and then they can come back and we can process it. So it’s giving both of us space and time. And what I find is that I leave things that are called intensives and sound intense, and there are some intense material that might come up, but I’m leaving them feeling so much more satisfied, so much more grounded, so much more excited about what I’m doing. Because something is like, we get into the flow and then we can move through it because it doesn’t get cut off with like, oh, wow, our time is up. We have to make sure that you’re feeling safe, and we need ample time to be able to do that. I find very often that when I’m doing an intensive, people get to the end of it and they’re like, no, I don’t need any extra grounding. I think I’m feeling good because we’ve.

Speaker A: Been doing it because they’re grounded essentially, by the time they leave, they’re in nature. They’re doing all those Activities you mentioned that are so regulating to the nervous system. So you get to the end of all that and it’s like, yeah, I’m great. I’m in a really great place right.

Speaker B: Now, so see you later.

Speaker A: I was going to say about intensives. I found I offered them towards the end of my practice, and for me I think 3 hours was way too long. But I was doing them in office. So I think there’s a parallel that I can’t quite meet between the way you’re doing it. But for me, my Max was beyond 2 hours in an office. Forget about it. Especially doing EMDR work and couples work. That was my Max. So I think for each therapist, I just want to give the caveat that you’re doing them in a different way.

Speaker B: Exactly.

Speaker A: And that’s different. Well, to use it as like, this is your PlayGround, you can do different things Just because One therapist offers One whole day intensive, and that’s the way they’re doing it.

Speaker B: And I know therapists who do all day intensives, like in their office or multi day. And the thing is, I think what I realized was, and you can do this Whether you’re inside or outside, is that you’re really being mindful outside. It’s a little easier because there’s just sort of things happening that allow you to take breaks where you’re just like, oh, a dog. Or like, oh, the wind is blowing, oh, the weather. Maybe we need to move over here. There’s just a lot more of this kind of reminders from nature of these sort of ebbs and flows. But when you’re in an office, you could schedule it so that you’re like, okay, we’re making sure to take breaks. One of my supervisors for EMDR was like, if you’re doing EMDR intensives, you never want to do more than I think even maybe Cambria Evans has said this, you don’t want to do more than an hour and a half at a time of deep reprocessing. Right? I would be pausing in between those times anyway. But if we get to 90 minutes and I’m like, we’ve really been doing this, we would take a break, be like, it’s snack time. It’s time to go to the bathroom. It’s time to get up and move.

Speaker A: And I did that before. I’ve had like a client book a 90 minutes, 290 minutes sessions in a day. And you could call that an intensive, but I had time to have my own lunch. I kind of had them leave for a couple of hours.

Speaker B: And I told them all of what we’re talking about because you’re getting creative about how can you make this work so that you’re regulated and your clients Regulated and you can still do the work and even as you’re doing. I did a full day with somebody. I have only done one full day with somebody. And what I realized is this is somebody who needed. This was an EMDR intensive and full day, meaning like 3 hours in the morning and then a break for lunch and then 3 hours in the afternoon. And I realized that pretty quickly, some people are going to need a lot more Resourcing and Grounding, and some people are going to be a little bit more ready to go through the full protocol. And the person that I did a full day with needed a lot of resourcing and Grounding. And it was a little more exhausting for me because of how much they actually needed. And I realized then that I was like, if I’m going to do that with somebody, then I need to shorten the window for me in my nervous system. Then I actually need to shorten the windows of time that I’m working with that person each day so that I can sort of reground myself without being.

Speaker A: The person in the room. Some clients do take up more of you than that co regulation. So that’s what we do in therapy. We co regulate.

Speaker B: Oh, and you’re reminding me of something.

Speaker A: Some clients need so much more of your own regulation. So you’re like breathing all the time through the EMDR work. You’re helping them.

Speaker B: We’re doing it with. Yes, with them. You’re reminding me of why I’m getting excited about another phase of something. Look, I like to learn everything, so.

Speaker A: I actually am the same way. All the trainings, all the knowledge.

Speaker B: I don’t know if I told you this, but I am training in psychedelic assisted therapy. I’ve started a year long training that officially starts at the end of July, and it’s an online training. The cool thing about this for me is that I’m like, I’m actually just really interested in learning about it. I’m not like rushing to be like, oh my gosh, I have to get certified immediately so I can figure this out. But one of the reasons that that is not, I’m realizing that this is sort of the psychedelic assisted therapy world is set up to do therapy in a different way already. Because a lot of the ways that that therapy is done a lot of the time, depending on what type of medicine they’re using, is that there’s two therapists working together with somebody. If you’re working in a certain situation where you are doing an intensive session and you’re using that kind of medicine and it’s over like a full day, it’s almost like this teamwork kind of thing that needs to happen and that takes a lot of work in and of itself. Right. But I was thinking about that just in terms of doing work in the world. And I have a person who, there’s an opportunity for me to connect with somebody right now who’s doing retreats, like at a hot springs. But they do EMDR and they always team up with another person and they also pull in other Modalities. Like they have a trauma informed massage therapist that can come in. It’s sort of like what’s going to work for this person to help regulate them. But then it also gives the therapist time to take a break during the day and go and sit in the hot springs and then come back. Right. So that’s the kind of thing that I’m looking at just in general as like maybe this is a shift and it’s going to take a while, but for us to be able to look at ways that we can continue to sustain ourselves in this profession and maybe the profession needs to change. And maybe it’s that, like you were saying, therapists, trained as therapists become coaches and have a little bit more say right now in what they’re doing than feeling like the big brother of the insurance companies and everything is looking over you, I’m still holding on to, I have two licenses in Massachusetts and Colorado. I’m still holding on to them for now because there’s part of me that’s to, I want to figure out how much I can do this before maybe it’s just, like, not possible anymore with the licensure. But I would love to see things shift and change as a whole. And a lot of that has to do with therapists being able to believe that we can increase our fees so that we can take care of ourselves, so that we can sustain ourselves and be more focused as therapists and do this for the long term without burning out. And then also, just how do we create our policies around what we’re doing and around our time and around taking breaks and vacations and, I don’t know, just maybe not working on certain days, those kinds of things. How do we reach out for help so that we’re not feeling like we’re so isolated in this profession? Because the way that I find it works, like I was saying, is collaborative stuff, whether it’s like you’re, I mean, I’ve worked just solo. I’m not in a group practice, but I feel like I have way more coworkers than I did when I worked in a nonprofit, because I have all this people that I’ve networked with where I can reach out to anybody at Any given time and be like, okay, I’m not alone. So I think that that contributes to the thing that has contributed to healing my own burnout is collaboration and connection with other therapists, especially therapists who are not locked into that. I have to do it this way. They’re the ones who are sort of like, we can do something different. Right? Like you, Jen.

Speaker A: Yeah.

Speaker B: And then the other thing is, when you’re in those communities, you’re believing that, oh, wow, I can do this. I can increase my fees. Oh, I can charge for cancellations. Oh, I can create even a no cancellation policy. Oh, I can do whatever. There’s rules. But there’s also, how do you sustain yourself and take care of yourself so that we can be, I don’t know, just really be doing the best service that we can for other people?

Speaker A: Yes, I love all of that. I love all of that. I just think therapists are the best people. We are, I think for therapists. Listening to this, I was someone in the pandemic. I started listening to podcasts probably maybe close to that time like you did, where I just felt like I was in this therapy box and that this is the way I had to do it, and that’s the way I had to make money. I won’t get into too much of my story because I’ll probably talk about a lot of it on other podcasts. But I think I grew a lot from just listening to these stories that, oh, well, they’re doing it differently, and that person’s doing this and this person’s doing that. It almost gave me some permission that I needed to hear that it could be done differently. There’s not one way to do it. And that judgment we’re seeking or not we’re seeking the judgment that we might feel will come from others in our field usually is one person that we have in our mind, and if we take care of that one person in our mind.

Speaker B: Yeah, there’s the parts work.

Speaker A: The parts work. Where’s that judgmental part coming from? Where was it based and who was that person? And that has been interesting work. When I did some of this, when I increased my fees and all of that.

Speaker B: Oh, and when I increased my fees, Jen, I started paying out of pocket for the first time in my life, consistently for a very premium fee therapist who’s a somatic experiencing and co regulating. Touch more about this.

Speaker A: Yes.

Speaker B: Oh, my goodness. She is wonderful. She is so good. I have had some really great therapy. And the thing is that my therapist before this, and I worked with her for six years when I moved out here. We’ve talked about this extensively. She’s actually even increased her fees since I’ve talked to her about this.

Speaker A: I’m on my therapist, too. I’m like, she’s insurance based, but I’m.

Speaker B: Like, she was insurance based. But what happened was, when I first started working with her, I wasn’t paying anything because of whatever insurance I was on. And then my insurance changed once I started making more money. And then it turned out I was like, there’s times when my husband and I are like, why are we paying this much for insurance? I mean, obviously, we’re healthy people so that we don’t have to put a lot of extra money into it. I mean, he had an issue with his eyes for a long time that we had to keep putting money, but we were like, why are we paying for insurance when we actually have to pay all this other extra money? Because when I was seeing her, I was still paying, like, I think it was like $130 out of pocket on top of what Cigna was apparently trying to pay. It was like pennies on top because I think her fee wasn’t that much. Oh, no, I was paying 110 and her fee was 130. So Cigna was paying, like, a little. Here’s $20.

Speaker A: Yeah, don’t Bill Cigna. Just bill me.

Speaker B: Because I was one of those people that was like, I have to make sure that this therapist takes my insurance. And when I started to increase my fees, I was like, if I’m going to ask people to pay this much money, then I need to sort of. This was just for me. I need to figure out what it feels like to actually invest that kind of money in myself and see what happens. And I think the act of doing that also informed how I showed up to my therapy. And this is the thing, the Therapist before that was wonderful and still is, and we did great work. She actually was what inspired me to train in EMDR, because I did EMDR with her. But towards the end, I felt like, kind of like these other Medicaid clients. I was like. I felt like I was sort of staying, even though I was kind of curious about trying other types of modalities and doing other things. And I talked to her about a little bit, but I was scared to leave her until she actually gave me impression. She was like, Susanna, I’m going to be all right. You don’t have to take care of me. And I was like, oh, this is sort of very, like, I had to take care of my own therapist by.

Speaker A: Not processing the room.

Speaker B: And then I started looking for other therapists, and I found this person who I’ve now been working with for probably a little over two years, maybe three at this point. Yeah, let me think. 2020? No, about two years. And it was just a very different kind of experience for me because it was doing a lot of my own somatic work consistently. She does co regulating touch, which is a branch off of somatic experiencing, which is really boundaried and really wonderful.

Speaker A: I bet that’s awesome.

Speaker B: And I have healed in ways that I did not know I could. And it was really helpful for me to do this in the process of really sort of shifting and changing my identity as a therapist and as sort of, like, just a person in the world, to be able to allow myself to take the risks, to ask people to pay me more money instead of being in that same box, right, that a lot of therapists are in, where it’s like, I would just do this for free. Well, you would do this for free for a few months until you start burning out. And so it gave me all day.

Speaker A: That must be easy, people.

Speaker B: That’s easy money and time allow.

Speaker A: My favorite thing is, like, how about you listen to your pain of humanity for, like, 7 hours.

Speaker B: Yeah, right. Have you actually talked and been with somebody in their trauma for that many hours? Really opened up without being like, okay, that’s enough. So, yeah, I think that Having more money and more time has allowed me to do that, has allowed me to also take vacation. I wasn’t taking vacations before this. I was just like, if I can, and to actually schedule out vacation time, all of these things. And also, the thing I want to be real about my life is not all roses all the time. Like, it ebbs and flows. Like I was saying yesterday, I was exhausted and realized, oh, it’s because I didn’t get good sleep the night before because I was trying too hard to be like, oh, I have to listen to this podcast at night. And I left my earphones on. People were talking at me. It was funny because my husband said that to me. He’s like, yeah, if you’re, like, listening to people all day and then you have a pod. Because I was like, how do you listen to podcasts at night? And he was like, I don’t talk to people all day. And I was like, oh, yeah. Because I left this on and I forgot to shut it off. And there was just voices. I mean, I had a dream that my husband was on the podcast. It was bad. And I woke up being like, I did not get good sleep. I was not fresh all day yesterday. I was just like, very, like, I had one client, which was fine. Luckily, it was a client that we’ve been doing work for a long time, but I don’t believe that I was the most focused therapist. And what happened is, instead of that being like, well, this is my life. I have to do this every day. Like this, where I might have been doing that before, I immediately was like, whoa. I recognized what was happening in my body, and I was like, okay, you’ll do this for one day. But, Suzanne, it’s like, going to, you’re going to get good food, you’re going to chill out and take a shower early, and you are going to tell everybody. You are going to.

Speaker A: Mean, I’ve been doing a lot of that similar kind of work, I think, as I’ve started a new career this year in school psychology. So that’s what I’m doing now. I’m working for a school. I’m not doing therapy. I’m doing testing and collaboration.

Speaker B: So that’s cool.

Speaker A: But there’s times where my body, I work myself into a frenzy. It’s just naturally what I tend to do. It’s my modus operandi I relate. And so I allow myself to shut down now. Whereas before I would push through that where I’d say, like, okay, today is like a HDTV and chill day and maybe do some gentle movement because before I might have done really intense movements.

Speaker B: That was all, yeah, you’re like, I got to go for a run class.

Speaker A: And hit tennis balls across the room.

Speaker B: Like, I’m going hard.

Speaker A: That’s my personality, but no gentle movement. Jen, HGTV, pet the dog. Like that’s on the agenda, making those.

Speaker B: Plans for yourself, because that’s the mantra, rest in play. Because it’s like our mind immediately wants to go to, I have to fix this. I have to work really hard, and I have to figure out how to do this. So we do more instead of flipping it and being like, wow, what if I just relax? This is the other thing that I brought into it, and this is a whole other conversation that we could have. And I know we don’t have much time for this.

Speaker A: No, but you can come back. You’re coming back. I already feel it.

Speaker B: Well, this thing is that the rest and play reminds me of just generally, like, the idea of liberation and the idea of wanting to make sure that everybody can feel this rest and play. And what I started to realize was, and probably a lot of other people have realized this a long time ago, is one of the reasons that not just the industrial revolution, but I think that intergenerationally, for many of us, but especially for those people who have been marginalized or because of the roots of things like slavery, we have been taught intergenerationally that if we are not working hard, that we’re going to die. That’s basically it. Not working. Being lazy equals death. You’re out of here, right?

Speaker A: I even think for my depression era grandparents, they had things, we had privilege, and I’ll acknowledge that privilege. At the same time, with that privilege, my grandfather felt like he had to.

Speaker B: Work constantly because they’re getting messages from all around you in the environment and in the world, like, whether it’s slavery or it’s the Holocaust or it’s the depression, these are all different levels of this, and they get passed down without us really addressing it collectively at all and going, no, you got to keep working or else you’re not going to be successful. Well, basically, it’s like people are just running around trying to avoid void death. That’s what I’m thinking about. And I’m like, wait a minute.

Speaker A: Even from a biological perspective, Hunter Gatherer, we were working constantly towards survival and so it’s in our DNA, and in.

Speaker B: This day and age, we’re like, wait a minute. Is that actually true? If we flip it, there’s this whole movement towards, like, I don’t know if you know about the NAP ministry, but this is something. Yes, I do this whole movement towards.

Speaker A: Like, I love the NAP ministry.

Speaker B: Rest and liberation. Right. Because it talks about what you’re talking about with the regulating the nervous system. I do this all the time with my clients where I’m like, if we are ramped up, our nervous system is ramped up, and our logical processing, our problem solving doesn’t work at all. If we regulate and we slow down and breathe, all of a sudden, we start thinking of options, and we start being able to get creative and we start being able to process things more, and we start to be able to problem solve better. Yeah. There’s this process of helping my clients interrupt the agitation and the activation by being like, wow, did you know? So, now, my client yesterday, there were several times where she was saying it. I was like, oh, you’re doing it. She was like, oh, I just noticed that my voice got. Just started being more rapid. And I was like, okay, pause. Right? So that kind of a thing. And I think we all need to do it. Those of us who are working with clients, we’re telling clients all the time, but I always try to bring it back to myself, being like, how can I even right now? I was like, oh. Even when I get excited, it’s like, after this, I’m going to get in my car after podcast.

Speaker A: I have to be like, okay. That was all energy I expended in certain way. And how do I think about what my body might need after that energy expenditure?

Speaker B: And if we don’t have the space and time, then you’re not going to be able to do that. So let’s create space and time in between these things so that we can.

Speaker A: So, Susanna, I could talk to you all day, but you have so many things to do today.

Speaker B: I know it’s the last day of school, but I’m going to be taking many breaks in between and not taking everything too seriously. That’s another thing.

Speaker A: Good. So, where can some therapists reach out to you if they want to talk to you some more?

Speaker B: Oh, boy. Oh, my goodness. So, I have two different websites. One of them is a therapist. I’ll put out my therapy website, because that’s what I’m focusing on the most. But I guess I could tell you about the coaching website, too, because that’s where we met was creating that program. I have Susannahorwitz.com. That’s Susannahorwitz.com. I should name it something else.

Speaker A: Link will be in the show notes.

Speaker B: Yeah. And that’s my therapy website where you can find. I actually love working with therapists too, like in therapy. So if a therapist is like, I want to do an intensive. I want to experience this whole nature based, arts based intensive type of thing.

Speaker A: Great.

Speaker B: The thing that I started to figure out is I finally found a niche of, I really am going to be niching in sort of like young parents in STEM. This is going to be very specific. Are you ready for this? Young parents in STEM who are like working parents who also have difficulties with chronic illness or fear recurrence from an early diagnosis of something like cancer. I get so excited about this kind of stuff. I love working with people who are dealing with that because there’s such an overlap between the doing and people pleasing and everything like that. And also the illness that starts to sort of like the worry about the illness. Right? Even health anxiety. And I’d say that because I experienced it myself, too. So I have done my own work now I want to be able to be like, hey, I’m providing these retreat style intensives for people who really feel like they can’t take a break and they need to take a break, and they’re having a lot of fears about their health and fears about dying and leaving their kids too early and all this kind of stuff. So that’s my little focus right now. I’m still working on the wording of it, as you can tell. But the other thing is wellconnectedtherapist.com, where you can go if you are an introverted therapist who has trouble with networking and really wants to figure out how to do this in a way that really helps build up, because I build up my whole business through networking and I’m introverted. And so really, it goes back to the somatic regulation piece. I built that whole program on somatic regulation, nervous system regulation, and how that can help us to be able to connect and collaborate with other people so that we can build up a referral base, basically. Especially if you want to be a premium fee therapist that doesn’t use insurance.

Speaker A: Right.

Speaker B: That’s where you can find me.

Speaker A: Great. Well, I’m sure people will reach out. Thank you so much for being on the podcast today. Thank you for inviting me, Jen. It was kind of fun.

Speaker B: Yes. All right, bye.

Speaker A: Thank you for listening to the Joy after Burnout podcast. Be the first to hear new episodes by following the podcast and your podcast player. This is an informational podcast only. Any information expressed by the host or guest is not substitute for legal, medical or financial advice.


Sign up with your email address to receive the latest on the podcast and my offerings