Speaker A: This is the therapist Burnout podcast, episode 40. Hello, therapist. It’s just me today. It’s been a while since I’ve had a solo episode on this month, I have had Emily Irvin. I think I’m saying that right, and Kate Donovan, which were great interview episodes. So if you haven’t checked those out, go back and check out those episodes. Yeah. So I only had one solo this month, which is different, but good. So if you haven’t checked out the interviews with Kate Donovan and Emily Irwin. I think I’m saying that right. Emily Irwin, not Irvin. Okay, I digress. Maybe I’ll keep some of that in there. I just said it, like, three different times the wrong way, which is great. All right, so today I am talking with you a little bit about the recap of this month and some reflections that I had. And so part of the discussion I want to have today is, what would I do if I could do it all over again? And that means, like, my career as a psychologist, my therapy practice, all the things when I get into it. So that was kind of prompted from the last episode that I have with. With Emily Irwin when we were discussing private practice. And I don’t know if I really talked about it in this way before, so I wanted to jump on and just talk about that a little bit. Before I do that, though, I want to talk a little bit about what’s coming up next month. So next month, I am diving into a little bit about why therapist burnout is different. And so my ideas have really evolved over the past year. It’s been a year that I’ve been podcasting on therapist burnout. Before, the podcast was called Joy after burnout, and then I changed it to the therapist Burnout podcast, which it is now. And I think my understanding of burnout has kind of changed from the therapist’s perspective. I think I was coming at burnout more from a literature perspective and what we know. I wrote my dissertation on compassion fatigue almost 20 years ago, and so things have changed quite a bit. And also, I feel like talking with therapist for this past year or so, I’ve just got a different. A different sense of what we’re dealing with, what we’re going through on a day to day basis, and the different flavor. Like, I talked with Kate Donovan, who is the host of Fried the Burnout, a burnout podcast, what her opinions of therapist burnout was. And she talked a little bit about aces, which are adverse childhood experiences, that we have more of those than the typical population, which is true, but I think that’s part of the answer. I think there’s a lot more to that answer. So I kind of wanted to get into some of that. So next week, I’m going to talk about why therapists burnout is different. What does it all encompass? And so some of that, I’m going to talk about some research y stuff, but also I put a post on LinkedIn about therapist burnout, and I just asked the LinkedIn community, why do you think therapist burnout is different? And I got some really interesting answers, so I’m really excited to share just the reflections on that. And some of that is related to moral injury and burnout. Some of that’s related to just compassion fatigue. Some of that is the system, dealing with insurance, dealing with agencies, dealing with all the things. What else am I going to talk about in that episode? Also starting the profession. So some of the people that listen to this podcast are just starting out as counseling students or psychology students. And I think I’ve definitely seen this theme. And talking with therapists, it’s not just one incident of burnout. It is the. It’s the cumulative burnout episodes that we’ve had throughout our career. And that makes so much sense because if you think about it, when we feel stressed out, like, this week especially was difficult for me, again, because I’m not doing therapy, but I still use my therapy skills in what I do as a psychological interviewer or as a psychologist doing evaluation. And I, you know, sometimes difficult things come up. I won’t talk about the details of any of the difficult things that came up. But number one, I was struck about how I was able to get much more in touch with my emotions. Like, it affected me emotionally differently than it had when I was counseling for a long time. So I feel like when clients would bring up difficult situations to me in session, I was desensitized. I mean, that’s just what happens, right? We become desensitized to our clients stories. We become desensitized to trauma. And having nearly a year and a half away from being a therapist, I could feel like, I feel emotion again. And part of that was scary, right? Part of that was like, can I control this emotion like I used to as a therapist and be able to be present through this emotion? And I was, and I wasn’t like, I’m like, is my, like, am I showing too much emotion on my face right now? And I just don’t think that I’ve had a meta experience that like that in a while. And so it just kind of took me back to those beginning days in the field, the beginning days of me being a caseworker, beginning days of me just starting as a psychologist. So I’m going to talk a little bit about moral injury. And so I’m doing a couple episodes on that and also going to talk about kind of moral injury and election cycles. Oh, my goodness. Because I know that you guys are dealing with this. I’m seeing all the post about the election cycles and how people are showing up in their sessions after debates and after hearing about different things. So I want to lend a little attention to that on the podcast in the month of October as we’re ramping up to the pinnacle of electricity election season. And you guys are probably dealing with the fever pitch of what that is in your sessions every week. So I think we’ll dive into that. That will be the focus for next month. I also hope I also will have a therapist client of mine come on and talk about their journey through burnout and through closing their practice. And so I’m excited to have them on and talk a little bit, a little bit to you about all of the things. It’s going to be a great episode. So I’m excited for that coming out. So lots of great things coming in October. So, you know, download those episodes when they come out. Okay, so let’s jump into today’s topic. So today’s topic, we’re talking about what I would do differently if I could do it all over again. Oh, my goodness. So I got into this with Emily Irwin, and they were talking about how they would just approach their business differently as a private practice owner. And also, so Emily Irwin was a school psychologist before going into private practice. And it’s like we did the reverse. So I was working in private practice and closed that practice, and now I’m working in schools contract, not full time. That is key. I don’t know if I want to ever do that. We’ll see. Never say never, right? For now, I contract and I do this podcast and I do coaching with clients. So that’s. That’s my roles right now. And our, what our discussion, what that brought out was talking about really all the things that kind of make us fall into poor boundaries, that make us feel like we have to be everything to everyone that we have so much fear about, like losing our license or saying the wrong thing even today. You know, I think that comes up for me sometimes. Certainly there’s other times where I’m like, just burn my license. I’ll find other ways to work if I have to. I think I definitely got to that point at the end of my practice where I just felt like, you know, I will do real estate or it doesn’t really matter. Like, it is okay. Like, I will be okay. And I think I just had to get there because I kind of had to let it go, right? So if I had to do it all over again. So let’s. Let’s go on the wayback machine. So if I had the wayback machine and I could talk to 25 year old Jen, like, nearly 20 years ago, what would I tell her? So I was at a crossroads in my career. I had in my educational career as well. So at this point, I had gotten a master’s degree in experimental psychology. So I had thought about teaching honestly in academia because I have a research masters. I really should have a PhD because, like, I got a research master’s and then a Psyd. So I digress. But, you know, just feel like I should have that anyways. So I had this research masters, and at that point in time, where was I working? I was. I was doing casework at that time. Maybe I was almost doing parent training, maybe. So I worked in therapeutic foster care as I was finishing up my master’s degree, or maybe I was done with it. I can’t remember so long ago. And I got to this point where I was like, I don’t see myself working in the foster care agency anymore. However, that was, like, one of the best places I worked, by the way. It was just a really healthy system. The leadership was wonderful. So even if the work is really difficult, sometimes you just have a unicorn of a boss that creates a beautiful system and it kind of works. And so it is possible to work in an agency and like your job, even if the work is hard, because I was happy there for several years and felt like when I left, it wasn’t out of. This is horrible. I want to leave this. Yeah, I’m going to get a doctoral degree, and that’s taking me other places, so. But anyway, I needed to leave casework. That was just kind of tough on me, seeing the pain of children. And I made a sidestep into doing parent training, which was, again, one of my favorite jobs. I love training. I love just empowering helpers. That’s what that is, the through line through my career. So that was kind of my, the first time that I worked with parents, right. And so I did parent training. I supported them and their work as foster parents, and that was one of my favorite, favorite roles. And I think that’s why I love working with therapists now, because I get to support their work and their journey in helping other people or taking a break from helping people, right. And doing something else, which is a really hard process to go through. And I know I’m preaching in the choir, so I will move on. I was at this crossroads where either I was going to get an MBA and just change fields like done with psychology. I just wanted something that made more money that wasn’t as emotionally taxing. And you know, I was seriously considering that. However, I applied to a doctoral program. Just the one, by the way. Oh, I’m so funny in my, in my decision making process, I’m like, let’s just, just see what happens. This is the type of person I am. We’ll just put it out there, see what happens. And I was waitlisted, actually, now that I remember, I was waitlisted and I did get into the program. So of course I’m going to go, right. They wanted me, so I went. And then I was just talking to my husband about this. He was a psychologist as well. We met in grad school. He was like, you mean you didn’t really know that? It was like five years to the time of five years to get through the program and then six years to licensure. Because psychologists, we have to do well in my state, I have to do a postdoc year. So that’s 6000 hours of experience in the four years of school. And I already had a masters on top of that. And I was like, yeah, I just didn’t really think all the way through that one. So one thing I would do is know like how long, number one, how long am I going to be underpaid? So I joined that program in 2006, right? So I joined in 2006 and I was there for four years and I, I didn’t match my first internship. So psychologists, I’ve talked about this before. We have to do a predoctoral internship. We go through a national match process and I didn’t match. There was a match imbalance of like 25% the year that I was going into the match, which was like 20. No, it was zero, nine, something like that. Anyway, something like that. And so I had to wait. My husband also had the same thing. Like he had a, he had to wait a, a year. So then I have a year where I’m just working. I worked as a caseworker supervisor in New York City. Wow, foster care in New York is something, let me tell you. So I did that for a year. Again, maybe I made like 40,000 in New York City, which I was like woo hoo. After the four years in school and working half time. So again, I was working half time at my job. Who knows what I was making, like 25,000. I don’t know what I was making at that time. I didn’t really think about money. And I’ll state my privilege certainly that I did have support, like my family did support me in school. So I know that there are folks that do not have that support and I definitely appreciate that privilege. And know part of me not looking at money was my privilege and for better and for worse. So I think it had me not think about what I really needed and that my work needed to be like all passion, right? So first thing I would say would definitely think about the time you’re going to be underpaid in the work. And so that first year internship, when I finally got to it, that was a minimum wage position. I’ve had people say to me like, oh, you actually got paid. There was also the two years previous where I worked for free for 2000 practica hours. So that was previous to internship. And then we got like the minimum wage internship and then postdoc, which was around probably, I think I was like making thirty k at that point with a doctoral degree. And so that was essentially six to seven years of not getting market pay for my career, right? So I’m not receiving like a top level salary that I could expect for like a college educated person. If we’re just thinking of what does a person with a bachelor’s degree receive for payment for a job, like a cubicle job, I don’t know, but people just cubicle job, who knows? We’ll call it that. And also thinking about like all the times where maybe I was underemployed, that certainly came into play there as well. After my postdoc, I had a baby and so I didn’t work a lot. I didn’t go back to my job. I’ve talked about this a number of times because my son had heart surgery and my agency job would not take me back less than full time. So I decided I’m not going to do that and I’m going to open a private practice. Yay. Yay. Me trying. So I started a private practice, launched it, and really out of scarcity. So I just was like, I don’t know what I can do. I can’t go back to this agency job. So I guess I have to open my own practice. That’s what people do, right? They open a practice. And I was pretty stressed out. I’m proud of that self that I was then. So that was ten years ago? Yeah, ten years ago march that I was building a private practice when I had, like, a four month old. And I worked really hard. I made a website. I met with people to try to figure out, like, how was I going to do billing, how was I going to get clients, all of that? And I opened insurance based, because, I mean, at that point, like, ten years ago, I don’t know if there was really many people that were doing private pay. At least I didn’t know them. And then really, my perceptions about private pay was that, like, people don’t do that. I don’t know who does that? That seems crazy. It doesn’t seem viable. Like, who is going to do that? So I didn’t choose to do that, although I would. I’ve always had, like, a smattering of private pay clients just due to, like, people being underinsured or things of that nature. And I started out just accepting clients. I even took many clients without payment because I was just getting started and I didn’t know how to bill. And so I gave thousands and thousands and thousands of dollars away in free therapy. And I know I’m not the only one that does this when they start. I know, I know, I know I’m not. And I say that because, again, that’s another, like two or three years where I probably didn’t make a lot in private practice, maybe didn’t really turn much of a profit at all that first year. Uh, which is, you know, typical first of all business is that a lot of people do not turn a profit in their first year. Uh, but again, you know, if we were thinking about from the time that I started grad school in zero six until I opened that private practice, 20 1420. Yeah, yeah. So that’s nearly ten years of not being paid a decent salary. And it’s kind of just looking at that now, it’s almost like, crazy making to me that people in this field are, you know, like, oh, how can therapists charge so much? Like, I can’t. I don’t even know how they think they can do this when probably for many, many, many years you’ve gone without the payment that you needed. You need more money. Like, life is just life, and it is very expensive now. And so, you know, I know that there’s some people out there marketing, like therapists, should make $100,000 a year. I can teach you how to have like a self paid practice for $100,000. I think that $100,000 is kind of like that baseline for where therapists need to be right now. I know it’s not reality for most therapists right now, but I’m just thinking about for our level of education, our training, the demands to have continued education credits, for example. All of those things cost a lot of money, and we have to think about all the time that we spent being underpaid. So I am ranting today. So, first I would think about, like, all that time that you spend being underpaid in the field and then thinking about, you need to kind of make up for lost time. So now that. I mean that, of course, I hit 40. Like, 2020 is when I hit 40, right? And so I’m 40. Peak of the pandemic. And I’m just like, oh, we don’t have money to do basic renovations on our house. And it’s not super basic. You know, our house is just aging. It is what it is. It’s life. But it was because my practice was only bringing in about $50,000. And granted, at that time, I did have kids in preschool and stuff like that, and they’re in school full time. And likely now, maybe I could have inched that up to, like, I would think, 60 to 70k. Take home the way that I was doing it then in my ability to see the number of clients that I did. Because as time went on in my practice, I felt like due to compassion fatigue, vicarious trauma, and moral injury, which I think were the trinity that affected me, which I want to talk more about in this podcast of the trinity of those things occurring, because I hear themes of this happening to therapists, that all those things are coming up. So if you’re seeing clients who’ve been traumatized at some of that pieces of the vicarious trauma, it’s just a compassion fatigue from listening. Right. All of that is happening, and also the moral injury. I am going to talk about this. I just have not felt ready to talk about what it was like marketing myself as a christian psychologist and then feeling like there was a huge values mismatch between my clients who identified with certain particular values and beliefs that were not congruent with my values and beliefs, but they believed that those were beliefs and values that were wrapped up into their faith belief, and that I should believe them, too. Whole nother episode, but certainly part of what was happening for me, and I think I’m not the only one there, too. Right? Maybe it’s not about your faith. But maybe it’s about the way you see the world. Maybe it’s about kind of your spiritual knowing and understanding about people, about humans that got really disrupted by the work. So I will talk about that. I just have not felt completely ready to do that. I think I would just advise people to, again, really look at that time. They’re going to be underpaid and make a solid plan to make that money. Right. Either it’s a job at a school or it’s your private practice and putting together a solid business plan. If that’s what you’re going to do, if it’s not what you’re going to do, then think about another career, perhaps, where you could make money. Otherwise, I think that’s just what I would do. If you’re already in it, you’re in it, right? And so if you. If I were to start private practice again, I think some of the things that I would do is really think about the people that I wanted to see. So here we’re talking a little bit about some clinical issues. So if I. Okay, like, I took a number of clients because I was starting out, I didn’t have many clients, and I thought I needed to take whoever came in first to get money in the door. That was not the best choice for me. And so if you are, like, leaving agency and going to start another private practice, I would really. Have you considered doing that over a slow transition, so slowly bringing in clients? Maybe you start with like four or five, let’s say. Right? And those clients that you really feel like, I could do these, I could do this therapy in my sleep. Like, I know this clinical issue. I really feel, like, strong in my body doing this type of work. I feel competent and secure, and it’s not stressful at all for me to do this work. Those are the clients I want you to see because you’re already kind of stressed with whatever you’re doing in your other clinical work. Okay. And then slowly over time, adding those new clients in, whether or not you’re taking insurance or you’re doing private pay, think about that. Think about slowly adding those in. And then once you get to kind of like a critical mass of clients where you can kind of see like, okay, I have some referrals coming in. Maybe when I’m getting closer to, like, that ten client mark where you’re like, you know, I really need to make that plan to switch, then start switching over to private practice and then perhaps like, having some other kind of stream of income. I think that it’s pretty tough for most therapists that I talk to, to only do therapy. So whether it be, maybe you do, maybe you keep some intakes, for example, at another job, intakes, I feel like are, you know, they’re. They can be heavy, but they’re also like, you have someone, you see them, and then you don’t see them anymore after that session, and it’s still a helpful service. Of course, it’s not like holding a therapy client long term. It’s very different. I would consider that slow transition. Also consider what is your average clinical hour fee that you are taking in. So if you are taking insurance, which, you know, I think it’s not a bad idea to take some insurance. Right. I think now with some of these, I don’t know how folks feel about Alma. I almost went back and did it again, but I did. I stopped myself. Oh, I was going to start taking therapy clients, just therapists only. And I just wasn’t ready. I just didn’t feel ready. And I don’t know when that will happen. I might not ever be able to. I don’t know, sometimes it calls me back, and sometimes I’m like, no, this is further from anything that I think I could do. But for you wonderful people, I thought I could. And perhaps that might be more in like, a group setting or a retreat setting where I can incorporate some therapy kind of techniques, but not therapy. Therapy stuff is what I’m thinking at the present moment. So I would think about a slow transition. If you’re doing it, really think about the types of clients you can see. Think about mixing up your caseload. So a lot of times we’re like, I’m a trauma therapist, and I only see, like, childhood trauma. Please don’t have that. Be your niche, unless you are like a superhuman, because that’s a hard niche because most of your clients are going to probably be pretty acute. So I would really have you think about a mix of clients. For me, I would always have, like a couple or two, like a pair of people, partners who were like two people coming in. So I usually would have couples or I’d have a couple families. I did brain injury work, so sometimes that would look like family work. I might have some EMDR cases where I might work with first responders or veterans. Again, those are more challenging for me. First responders, I loved seeing first responders, so that was some of my favorite work. They just moved through their target so quickly. But other clients that I also enjoyed were just kind of relational issues, issues related around someone who had a partner, and they either were using or doing other addictive behavior. So supporting, you know, typically female identifying clients who either had a partner that was using or abusing something in some way. Those were some of my favorite clients as well. And also have you think about dropping difficult insurance panels. So if you are taking insurance, dropping some of those difficult insurance panels, really talking to other therapists in your area about which panels are good ones to work for if you’re going to do it, I think it doesn’t have to be all black and white because just starting a practice from zero can, can be challenging to get clients in the door. And it is a little bit easier if you have some insurance space if you want to do that. Some people are like, I don’t think I could ever go back personally. So that’s just me, because I think some of that moral injury piece hit me, you know, what they were asking me to do. And also, you know, yeah, I could talk about insurance for a long time and why I never want to work with insurance again. But that’s not what I’m talking about today. Possibly. That is maybe another point, though. Do you even want to work with insurance at all? Because of how difficult it can be. And that’s why I think, you know, some of the services, like these third party places, like an alma or headway, which I’ve heard, you know, decent things about, maybe some people have had bad experiences, but supposedly they’re supposed to pay out every two weeks regardless of if you see the client or not. And then, like, reimbursement stuff is not on you, for example. So that’s what I think about. I think about also having help. So a lot of times therapists think they have to do it all their own. Like, okay, I have to do my admin. I have to do my billing. I have to do everything involved with my clients. And that’s really stressing you out, the admin side of stuff. And I only added, I had an admin assistant before I closed, so probably I added them a year before I closed, year and a half. And I, if I’d added them sooner, I think I would have been a lot better off they or someone I trained. So someone I knew in my community that did billing work. And so they, you know, had a little profile in my thera nest. That’s what I used at that time. And they would follow up on billing stuff. All I did was, you know, did my note, and then I put it into the little billing queue. They would bill it out, make sure that my invoices were balanced. They also helped me with intake stuff. So if it wasn’t a client inquiry, they would call them back and kind of do a little screening for me before I got on the phone. It was so worth it. So, so worth it. And I was able to see more clients. So just thinking about, if I see two more clients a week and then I don’t have to do that admin work, then I’m also able to make more money overall, which we don’t think about. We think about, you know, what’s right in front of us. Like, oh, if I pay somebody, that’s money out the door, but not, you know, what money am I losing by doing this stuff myself? Or what money could I be making if I’m not doing this because I’m not stressed out? So definitely getting help. So if you’re going to do solo practice, especially get some help on the admin side of things. And for the clinical side of things, also consider consistent supervision and consultation. That was one huge thing that came out of my discussion with Emily Irwin is that we just. We don’t see what we can’t see, so you can’t read the label of the jar that you’re in. And that happens clinically for us. I’m like, closing my eyes and I could say this stuff in my sleep now because I wish I could have told myself this at the time, that, of course I can’t see how poorly I’m doing because I’m still in it. And it really takes that objective person that you can be honest with. And my mix of people was, I had a therapist, an EMDR. An EMDR therapist. I had my EMDR consultant, and I also had a coach who was helping me towards the end, kind of help me get out of burnout and figure out my next kind of steps out of everything. Also had pts and other people that I would. That I worked with nutritionists at one point, all the people, and I needed them, so needed them. So just to recap, number one, really think about the money that you are going to lose out on in your career due to being underpaid, having to go through training, and what requirements you’re going to need at licensure. If you’re going to solo practice, that would include things like a business plan, knowing what your average session fee is. So out of ten clients, I am charging $100 a session, and that means I make a week. You can. That’s basic math. You can change that as you see fit, but your average session fee then is $100. Right. And so if you have a different mix, if you’re using insurance, whatever it is, then, you know, these are how many clients I need to see. This is for what I want to make. Right. So that’s .1.2 was really. It’s like kind of double pronged, but also .2 is really to get assistance in the day to day aspects of a practice. If you’re going to do a practice, that’s what I would do most certainly earlier on in the process. If you can get support with billing, with admin, with anything like that, that is great. And think about if you are going to leave an agency or leave your private practice, think about doing that slowly. Part of me feeling like I needed to take every client in my private practice was that I was making zero income because I quit my job at the agency, because my son was, because my son had heart surgery at day five. So if at all possible, that is not always life. You know, try to make that transition more slowly or try to put less pressure on yourself. I think about that time when I was a new mother. If I’d gotten a biller and gotten some help with some admin stuff, or even chose to join a practice part time in a group practice just to kind of get myself over the hump, I think I could have actually made more. But in my mind, I thought about what is that dollar amount that I could charge per hour versus what is the take home pay that I’m getting from like a w two job or 1099 job? But I think I could have earned more if I was in a group practice that probably had some pretty decent fee splitting, and that wasn’t like one of these big conglomerate practices. But there’s still a number of them that are really doing good work, and I’d love to have one on the program that talks about how they support clinicians in these smaller practices because we are social beings. And that goes to .3.3 is willing to get the consultation and supervision that you need throughout your career for clinical reasons, but also for you. So we need other people, other clinicians in our lives to do this work. So if I were staying in the career, that’s something I would have to do, and I had to do it on my transition out. So on my transition out, I think I had everybody on board. I had a therapist, I had a coach, I had a consultant, I had medical people that I was working with because my health was not doing very well. And so it have you think about all those people, if you’re transitioning out of a therapy career that you’re doing that, and if you’re going to stay in it, to really think about those like your team, what team that you need, and what continuing support you’re going to need to stay in that work. Okay? That’s what I have for you guys today. If you need support in any of this, please know I’m here. So if you want to check me out on LinkedIn, I’m on LinkedIn at Doctor Jen Blanchett. And if you think you really want one to one support with either leaving agency or closing down your private practice. I’ve helped a number of people close down their practice and it is super lonely and fraught with all kinds of stuff that comes up, lots of terminations. And I hate for you to go at it alone. It is really tough. So I’d love to just talk with you on a free consultation. It’s no obligation just to see what supports you might need. And if that’s me, that’s great. If it’s not, then I hope I can direct you to some resources that could be helpful. One of those is this podcast. So it’s things I talk about on here all the time that I would like to share with you. So also, my last little bit to connect is my therapist pen pal list. So I like to keep up with you guys. And I do write back. That’s my tagline. I write back. It’s simple, but it works because I’m still small and I have time to do that for right now. So if you write me a line and just let me know how you’re doing, I will write you back. Let me know how you like this episode. All right, have a good one.
