Today is a pretty incredible interview. I’ve been thinking about this interview with Tiffany McLain for several weeks now since we finished. So this is interesting.
Tiffany, just a little about her, is a licensed marriage and family therapist in San Francisco. She has a full fee practice. She only sees about 10 clients a week because she has set her fees at a point that that’s all she needs to see.
We’re talking today all about money mindset. What that is, how it shows up in our practices, how we set our fee, how we value ourselves, our emotional relationship to money, how you charge your fees, how you collect them, how that relates to sliding scale, giving back. We cover a lot of ground. I think it’s really important for a lot of folks to hear.
I will say as a disclaimer, this was an interesting interview for me because Tiffany actually [00:01:00] asked me a ton of questions to make this material come to life. I talk a lot about my relationship with money emotionally, logistically, how it comes up in the practice. At times it was uncomfortable. I certainly felt vulnerable to be talking about some of these things but my hope is that ultimately, it’s helpful for y’all. It’s certainly been helpful for me. Just to put that out there, this is a little different episode.
Before we totally jump into that, I have an exciting announcement. I mentioned last podcast that I took a few days off at the beginning of November to go to LA and recharge, do some visioning, get some clarity on my practice and coaching. A product of that is recognizing that I am excited to get back into the group coaching game.
I did a mastermind last spring for testing psychologists and it was awesome. So [00:02:00] this January 2019, I will be opening spots for a Beginner Practice Mastermind. This is for all of you who are just getting started in private practice. You really need those ins and outs of getting things set up: finances, schedules, EHR, batteries, all that kind of stuff. This is for you. If you’re interested in that, please go to thetestingpsychologist.com/consulting. If you scroll down a bit, you’ll see there is a spot to apply for the mastermind group. Fill out that application, it’s very brief, and I’ll be in touch with you to talk about whether you’re a good fit.
All right, let’s get onto the conversation with Tiffany.
[00:03:00] Hey everybody. Welcome to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Like you heard in the introduction, I am here today with a very special guest, Miss Tiffany McLain. Tiffany is in private practice in San Francisco. She is going to be talking all about money mindset; what that is and why that’s important and how we can wrap our minds around money in our practices.I’ve been stalking Tiffany digitally for a while. I’ve heard you in many other podcasts and I was like, that would be great to get Tiffany on. And then we finally connected about six months ago or something. This has been in the making for a long time. I’m glad to finally be here. Welcome to the podcast.
Tiffany: Thank you very much. I’m excited to talk. As you’ve said, it’s been a little while since I’ve done any podcasts and yours was like one of the last ones I’m going to do before I take a break. So I’m excited to do this one.
[00:04:00] Dr. Sharp: That’s awesome. I feel so fortunate to be able to have gotten some of your time. I know you’re super busy. I really appreciate that.Tiffany: Thank you.
Dr. Sharp: I want to give you some kudos before we get started, because you get the award for most, how would I phrase it? Most prepared or most interested podcast guest. I don’t know. When we had our pre-conversation six months ago, you asked so many questions and I got the sense that you’re really invested in this interview and want to understand what’s going on here. So thanks for that. That makes me more excited here.
Tiffany: Of course. It’s my pleasure. Also, you’re working with people around testing and assessment, and that’s a world that I don’t know a ton about. So it’s also exciting for me to think about this idea of money mindset, how we charge, how we set our fees with a little lens on a little bit of a different population than the one I normally work with. So this will be interesting.
Dr. Sharp: Totally. Well, thanks for jumping into it and doing something a little more unfamiliar [00:05:00] to you.
Tiffany: Sure.
Dr. Sharp: Cool. Maybe we could just start, if you could talk a little bit about yourself and your practice and how you got to where you are today. And then we’ll dive more into the money stuff. That sound good?
Tiffany: Absolutely. As you said, my name is Tiffany. I’m in San Francisco. I have a private practice here. I keep it small. I only see around maximum 10 or maybe 11 people that I work in an ongoing way. That’s my private practice. And then I also have online business, which is where I spend a lot of my business time, where I work with therapists around the idea of how to set fees, how to charge, how to actually create sustainable practices that serve you versus these practices we hear so much about where people are burnt out, overwhelmed, where basically the practice is running them versus the other way.
I work with therapists around money mindset, setting fees, earning enough not just make a living to be financially secure but actually have a great life where you’re able to do [00:06:00] all the things you wanted to do when you originally decided I’m going to go into this private practice in the first place.
Dr. Sharp: What got you interested in that and so fired up about it because this is your thing. How did you get there?
Tiffany: That’s a great question. Yeah, this is my thing. When I started in the therapy space, I’m psychoanalytically oriented so really into the unconscious process, long term work, but I was looking around seeing therapists do all of this great work but their marketing was terrible. So I was thinking, how do we get these kinds of therapists out into the world?
I did two marketing programs. Learned how to market myself but I realized wait a minute, even when therapists are marketing their business or learning how to do it well, they’re still terrified around this fee setting thing. So even as they start getting clients and start working with more folks, they’re still setting fees that are not in line with the reality of their financial needs.
I didn’t see anyone talking about money. Money is like sex or politics, [00:07:00] but even us therapists, we talk about sex way more than we talk openly with each other about money; how much we’re making, how much we’re charging, what it means to actually want to earn a great living. These were all taboo topics. I don’t know if I can swear. I almost swore. I’m like, darn it!
Dr. Sharp: You can swear.
Tiffany: I’m like, fuck! We got to go into this and understand what’s happening in the culture of our profession around this money stuff.
Dr. Sharp: I totally get it. The money comes up with everyone that I consult with. That is not an exaggeration. I haven’t found anyone yet where we’re not talking about that in some form or fashion, whether it’s the burnout and working too much or just fear around going off insurance or really anything. I think it’s super important.
It sounds like you’ve had a little bit of a journey maybe around that and getting there. I think that we focus on things for reasons. [00:08:00] Is there any personal piece that you’re willing to talk about as to why money is so important, and so important to help other therapists with?
Tiffany: Sure. You got me. I tried to give you the generic answer. I love that. I’ll dive in a little more.
I guess, maybe the first thing that got me really thinking about it, I was at an in internship, a post master’s program. It was a two-year program, psychoanalytically oriented, depth oriented. A really great training.
Theoretically, we were supposed to talk to our clients about fees every six months. I noticed that I was really anxious about doing that, terrified. I noticed none of my peers or the colleagues in the program were talking about it either. And so I made it a mission of mine to find out how to get comfortable doing this and the structure is perfectly set up. I knew I was going to be in private practice. I knew I was going to have to do it myself one day, so let me just really focus on it.
[00:09:00] That’s the clinical piece but if we zoom way back, I come from a family that had a lot of really mixed messages around money like a lot of therapists do. There’s a study done by this woman. I don’t know her first name. Her last name is Laskey. She studied the therapist community and found out that therapists more than most other or actually any other profession, are more likely to be upwardly mobile. So to come from blue collar or working class backgrounds and be the first in their family maybe to go to graduate school or to be working these kinds of professional jobs.And so we have a lot of stories. Personally, on one side of my family, my parents, my mom came from a really religious background. You hear all those things. Money is the root of all evil, blessed are the meek, all the messages saying if you have money, money is equated with evil. Poverty is created with wealth and goodness. On the other side, my dad, he comes from the projects of Chicago. I didn’t know what his [00:10:00] background was. He didn’t really talk about it until I was much older, violence and poverty.
I’ve definitely talked about this on other podcasts, but I was, I think around 18. We were watching 20/20. There was some kind of exposé about the worst projects in America and my dad said, that’s where I grew up. I was shocked because they didn’t raise us in a…
We grew up in a suburban town or in the suburbs, really protected. And so to hear, holy smokes, this is where my dad grew up? He grew up in this intense poverty, so his messages around money were… He’s African American, so like black people don’t get money. The things you have to do to get money are usually, where he grew up, related to criminality because there’s not a lot of access to wealth or business, a working life outside of this.
So, on both sides I have, one side, a desire for money to get out of poverty, to work one’s way up. On the other side, money is evil, blessed are the meek. And so just these conflicting money messages. So when I went to graduate school, I was like, I want to help [00:11:00] people but I also want to earn a great living and be my own boss. That’s going to be easy. But then the reality of all my internal stuff around what it actually means to earn money, what it means to make a great living, what it means to work with people I love but also earn, am I hurting people? Am I a bad person for wanting to, I didn’t have this thought but I hear this a lot, make money off of helping people?
All of these things I was wrestling with. And then I had them reinforced by the therapeutic community. I didn’t enter this work to make money or if you think you’re going to be rich, don’t become a therapist. Just these messages that were reinforcing the things that I was already wrestling with myself. I’m like, this has got to change. This needs to be really looked at. So that’s a little more of my personal journey into this.
Dr. Sharp: Oh, I hear that. I appreciate you jumping into that a little bit and sharing some of that. I think I heard you talk about the concept of being upwardly mobile on someone else’s podcast a while back, and that’s the part. I connect a lot with that part, and that’s what really got me thinking [00:12:00] we need to talk about this.
I don’t know if I’ve talked about this on my podcast, but I was born in West Virginia, Appalachia. I spent the first few years of my life in a trailer and have parents, one went to college but didn’t work after that. Anyway, my grandparents still live there. It’s like this really interesting thing to then go to graduate school and now be in a position to be somewhat successful, I guess, and fortunate. I don’t know. There’s some stuff to work through with that and how money is operating in that whole picture.
I think that hearing you describe that experience, a lot of folks are probably nodding out there listening and thinking, oh yeah, that’s me to some degree too. So, I’m glad we’re talking about it. There’s a psychological piece to it for sure.
Tiffany: Absolutely. That’s the juicy part of this. Money is just a concrete exchange. [00:13:00] It should be simple but it’s the stuff we bring to it that makes it so complicated.
Dr. Sharp: Totally. Well, let’s talk about it. We use this phrase money mindset. What’s that even mean?
Tiffany: Sure. We’re going to use a little illustration. That’s easier for me to be able to think about concepts if we put it to the streets on the ground. We’ll use your audience. We’ll use testing folks. Can you give for me an example of maybe a heart-wrenching scenario where somebody needs testing done and it’s very emotionally moving or it feels very important to do it with this person? Create a person for me.
Dr. Sharp: Yeah, for sure. Let’s just say, this person is a, I have many scenarios I can think of. So maybe a family who is doing well enough to have private insurance but they have this incredible deductible. They have a kid. [00:14:00] Maybe this kid is young, 3 years old, needs early identification of an autism spectrum disorder to open the door for other services. We’re the only ones in the area within an hour’s drive and a two-year wait list who can provide this kind of service, but it’s going to cost, let’s just say $1,000 to $1,500 and the family is clearly saying that that’s too much.
Tiffany: Great. You went right for the heart-wrenching. A 3-year-old, autism spectrum, waitlist for two years, limited access to services like this. So really, you’re talking about a lot of need. Why did you pick that? Tell me a little bit about the feelings when you imagined this kid and this family coming in.
Dr. Sharp: Oh, my gosh. Who else is going to help them? Somebody has to help them or else this kid is going to be a different kid in two years. And that’s two wasted years when they could be getting early intervention [00:15:00] that’s so crucial.
Tiffany: Wow, really interesting. So you’re talking about the real need for something like this. What happens if you don’t intervene at an earlier stage? You know and your audience knows the reality of that.
Dr. Sharp: Absolutely.
Tiffany: Would you, and folks can’t see you but I got to say, Jeremy’s face is like, ow.
Dr. Sharp: It’s surreal.
Tiffany: So let’s say you have a situation like this. You’re talking about having a waitlist too. Is it possible that you or even the people you work with would move a case like this up and maybe offer a sliding scale to make this more accessible to a family like this?
Dr. Sharp: Oh, gosh, yeah. Absolutely.
Tiffany: Oh, shock me. What do you mean? Say more.
Dr. Sharp: Well, let me see, with the waitlist thing, what I meant is any other place that might be able to do this evaluation has a two-year waitlist probably. It’s a local children’s hospital. This is a very real scenario that happens probably, I don’t know, at least once a week for us. [00:16:00] But our waitlist is still probably 5 or 6 months. There’s the chance that we would bump that up. There’s definitely the chance of doing a sliding scale. The insurance piece complicates things a little bit in terms of how much we can adjust the cost but we will definitely bump them up and try to provide access a little sooner.
Tiffany: I’m going to even twist the knife a little bit more in this situation and say they don’t have good insurance. So they would have to be paying out of pocket.
Dr. Sharp: Oh, well, in that case the likelihood that we would consider a sliding scale is like 95% probably.
Tiffany: So you would definitely do that. We’re going to come back to this money mindset. Don’t worry. We’re going to wrap back around. I’m thinking about what you shared about your upbringing, Appalachia, first few years of your life, your grandparents still there. I’m going to make a whole bunch of assumptions about Appalachia [00:17:00] but you know what it means to need, to maybe not have access to all the resources that you need to do well in the world and also to be surrounded by folks who you see struggling or maybe in poverty. Is that a little bit of what the situation is like there or was?
Dr. Sharp: Absolutely.
Tiffany: Okay. So you can both see it in this family, but it also resonates with something personally in you.
Dr. Sharp: Yes.
Tiffany: Okay. So you offer this family… Oh, go ahead. What are you going to say?
Dr. Sharp: Oh, I just said you nailed it.
Tiffany: That’s right. So you offer them a sliding scale. Give us an example. I know there’s probably intense calculations you figure out. Let’s say you slide the scale, what’s that look like?
Dr. Sharp: Our rule of thumb is 20%. If it’s $1,500, we knock off $300. If it’s $1,000, so forth.
Tiffany: So let’s say $900 to $1,200 now. Great, you feel good. How many hours does an assessment like this take?
Dr. Sharp: Oh gosh, let’s just say 10 to keep it a nice round number.
Tiffany: Excellent. Now you do the math for me. $1,200, 10 hours, what is that about?
Dr. Sharp: $120 an hour.
[00:18:00] Tiffany: Great.Dr. Sharp: Which is good.
Tiffany: Well, your voice went up when you said that good. What do you mean?
Dr. Sharp: It is pretty good actually, at least for our market, that’s okay. It’s on the lower end of acceptable.
Tiffany: Okay. So let’s say if you’re like most therapists, you feel good about it. You’re working pretty hard. You’re not making quite what you’d normally make but overall it’s like, all right, but this is why I created my own business so I could give back when I needed to. Things like this that may be in your minds.
Now let’s say after you do that, somehow something happens. You’re giving the parents the results of the assessment, giving them the suggestions for what to do next, and then the mother happens to let you know, by the way, her parents are actually multi-millionaires. They’re going on a fantastic trip soon. It’s not their income, it’s their parents’ but of course the parents are funding this trip. Help out with the rent sometimes.
Let me pause, for the folks who are listening to this podcast, Jeremy’s mouth fell open when I said this. And his eyes widened. What was your feeling when I said that?
[00:19:00] Dr. Sharp: I don’t know what was my feeling. Shocked that they didn’t tell us earlier, and confusion; what would I do in that moment? So an external representation of the explosion that probably happened in my chest.Tiffany: I have a sense of somethings come to my mind too or like something is a betrayal. We bent over backwards for you guys, some kind of resentment. I just did this work and it turns out you probably could have asked the parents, all kinds.
Dr. Sharp: Yeah, a little bit of that. Maybe a lot.
Tiffany: Yeah. This is an example. You and the audience gets to go through a visceral example of how we can think about or what it means when we talk about money mindset. So money mindset are all the thoughts, the feelings, the beliefs, the ideas we have about money that then inform our actions; the way we show up in our business, the way we show up professionally, and of course the way we show up personally. Also the ways we show up [00:20:00] clinically.
So if we have particular stories about what it means to have money, who deserves money, what it means to give back, all of these things inform how we show up in the world and how we show up in our practice clinically and all the assumptions we make about money show up. So when we’re talking about money mindset, we’re talking about all of these things.
The reason I brought it to this clinical example is because a lot of us have, we have the both conscious things we’re aware of. Oh, I want to help a family that’s in need. And then the unconscious beliefs that are behind that, that only show up when surprises happen in our clinical work, or we find out there’s more to the story than we originally thought. That’s when therapists often start having a conflict internally around where money mindset starts becoming an issue when we realized we’ve been making assumptions that maybe are not in line with reality. We’ve been setting up business practices on assumptions that maybe are in line with reality. So it’s really important that we start digging in and understanding both the conscious and unconscious [00:21:00] relationship we have and that our clients have to money.
Dr. Sharp: How do you do that? Is this like personal therapy? Are we saying, go to therapy and figure out your money stuff? I don’t know. What’s the process to start to get a handle on that?
Tiffany: Sure. Even just knowing, oh, that this is an issue. That’s number one. In our field, we learn about all kinds of things in our education but we’re not talking explicitly about money. That’s for sure. It usually doesn’t come up in any of our graduate programs. It doesn’t come up in terms of our relationship. So we don’t actually have access to it a lot. We’re not thinking about it and if it does, it’s usually related to something around shame. Our colleagues shame us and we feel bad or we feel like, did we do something wrong? Or guilt, oh, we’re charging too much. These kinds of emotions, but we only think about it then. And then mostly put it out of our minds otherwise.
So the first thing I would say is just start becoming aware of and thinking about, oh, the way I relate to money, the way my clients are relating to money, this [00:22:00] is actually an issue that’s impacting how I work. Number one, awareness is the first thing. I would… go ahead.
Dr. Sharp: Well, I was just going to ask, do you know, again, maybe trying to make it concrete. Do you know some ways that this shows up in our practices? How would we even start to become aware like, if you do this or if you’re saying this, I’m not sure, what are the signs that there might be something going on there that we could start to notice?
Tiffany: I’ll give you three clear examples of how it shows up that we can recognize in ourselves. The first is if a potential client calls up and asks if we have room, let’s say, we go through the intake process, we state our fee. My fee is $280. The person hesitates and we say oh, but I offer a sliding scale. What can you afford? Is there something that looks better? That’s a sign that there’s an issue that we need to start thinking about. Wait a minute. What’s actually happening in [00:23:00] terms of how I’m relating to money.
That’s one example that’s familiar. A second one might be similarly around sliding our fee scale. We’ll talk later, I know you’re wanting some concrete stuff around how do we actually figure out our fee, for example. If you’ve never actually sat down and looked at your fees, what you need to be paying off all your bills, being in financial integrity with your own life, paying off credit card debt, paying off student loans, things like that and yet you’re sliding your scale for someone who comes in to see you because you’re feeling bad or an urgency around feeling sorry for something that’s happening in their life, that’s a sign that there’s something you need to work out there.
It shows up a million ways, but just things that therapists can relate to, even something that’s not directly related to money exactly, is something around our cancellation policy. If we have a 24-hour, a 48-hour cancellation policy that we’re not enforcing or that we’re enforcing inconsistently, [00:24:00] there’s an indication there that something’s happening in our money mindset and the way we’re relating to our business practices that needs to be looked at and addressed.
Dr. Sharp: Got you. I like that. I know that I’ve done all of those at some point.
Tiffany: Enjoy the club.
Dr. Sharp: Sure. Okay. This is good. Maybe we notice that some of those things are happening and it’s like, okay, I’ve got some concerns with this, then where does it go? What do we do about it? And that can be from the psychological standpoint or just logistical.
Tiffany: I’ll start with the very concrete. The first step that I have folks do is actually get in touch with the reality of their financial situation, which means finding out what you actually need. I have a calculator. It’s free. It’s online.
Dr. Sharp: I’ll put [00:25:00] that in the show.
Tiffany: You can put it in the show notes, great. It actually has a place where you put your current expenses and your dream expenses. So also what you need for saving for retirement, vacations regularly, sick time, of a nice car; the things actually give you a fulfilling life. So both calculating the current reality and also the dream reality.
Then it also, this is something that a lot of people don’t consider. How many people do you need to see actually or can you see maximum to actually be able to show up fully in your clinical work? I know a lot of therapists who are seeing 30 people a week, 40 people a week. They’re overwhelmed. They’re stressed out. They’re burnt out. That’s not actually in line with a consistent practice where you’re doing your best work and giving back for most therapists. So this calculator also has you say, how many hours are you really working a week to really do your best and how many weeks are you working a year to really do your best?
So we’re taking the reality [00:26:00] of how much you need to live, how much you need to have the extras that lead to a good life and the time you’re committing. And then it spits out a number. Your fee has to be $215, let’s say. So that’s Step 1, getting real about what your fee needs to be in order to support your lifestyle.
Dr. Sharp: This is the, put the oxygen mask on yourself before you help other people, right?
Tiffany: Absolutely.
Dr. Sharp: So you’re saying you need to be locked in and know what your financial needs are to set your fee. It’s not setting your fee based on whatever else you might consider but just you personally, what do you need?
Tiffany: Yes, that’s exactly right. And the reason we do that is because it starts helping us get out of the feelings of money which leads us to do all kinds of wacky stuff into like, let me just see on paper, I almost said the cold hard number but I’ll even say the warm soft number. What does the reality need to be for us [00:27:00] to be showing up and doing our best work? That’s the first thing.
Like you’re talking about, and I’m sure we’ll get into it more later, if we’re not taken care of, we’re not able to take care of others. We’re not able to model appropriate behavior. We’re really not able to understand and work clinically with folks if we’re not actually doing the thing that we’re helping them theoretically do. If we can’t do it ourselves, how are we going to do it for someone else? This is the oxygen mask example.
Dr. Sharp: Sure. Got you. Okay. So getting some awareness of your personal finances and knowing what you need or want.
Tiffany: Absolutely.
Dr. Sharp: Okay, say we’ve got that. It’s out this number. You said $215.
Tiffany: Yeah, $215. Let’s say that’s the number. It could be who knows what. $215. Then you’re going to have feelings about that. The feelings might be holy smokes! How could I find anyone who’s going to pay me that? It could be shame. Am I really worth that? Do I deserve money like that? Who’s going to really pay me that? [00:28:00] Am I good enough to show up? That’s a feeling that can come up.
Guilt; oh no, am I greedy? It may be you put on your list you want to go on a vacation twice a year. Oh, am I greedy? Should I maybe start playing with that number to make it a little bit lower? Fear; that’s around who would actually pay me that. What if all my clients leave? Also, I’m already seeing clients. Do I have to raise their fee? So these feelings start coming up. It’s very hard to move forward if we’re not actually acknowledging, making room for the feelings and talking them through with people.
So this brings us to one, once you know the reality, it going to bring up feelings, make room for the feelings. That’s concrete Step 2. Journal about it, write about it, talk to your peer, a trusted peer, like, oh my gosh, I saw that $215 is what my fee needs to be in order to have a sustainable practice. Here’s how it feels to me. Talk it out.
Dr. Sharp: Cool. I’m going to maybe jump the gun a little bit and just say, what if that fee is [00:29:00] just not bearable in your market? Like the average fee is $110 and you’re like, I need to make $215. How do you reconcile that gap?
Tiffany: Say more a little bit about your question. Is it the emotionally reconciling it and/or practically businesswise reconciling it? Where does your mind go when you ask that question?
Dr. Sharp: I think practically businesswise and who knows, maybe I’m exposing some assumptions here, but if the market will bear $110 let’s say, I’m thinking that you’re in a community that can’t financially support a $215. Is there room for a practice that charges $215? Or in our case, maybe you’re going rate for an evaluation is $1,500 but your calculator says I need to be making $2,500 per evaluation. That’s a huge leap over the [00:30:00] market standard. What do I do with that?
Tiffany: This is a great question.
Dr. Sharp: There are emotional components. I don’t want to downplay that but it’s like, well, my peers think and how do I answer it when people are like, why are you charging more than everybody else? And so forth.
Tiffany: This is great. So the two, emotional piece, which we definitely can’t discount, and then also what feels like the concrete business reality of a number like this. The first thing I would say about the emotional piece; you chuckle because I said what feels like.
Dr. Sharp: Exactly.
Tiffany: We’ll address the emotional piece and we’ll get to the concrete business piece. I say it’s vital to find peers or colleagues who support what you’re doing, who will encourage you to have the growth that you need to get where you want to go. There are a lot of people who are going to challenge you, question you, try to tear you down, have envy for what you’re doing, and so they’ll try to take it away or minimize your desire [00:31:00] for success.
It’s important to find people who are supportive of you and already doing the thing you want to do. So if it feels like, how do I do this in a town? Can the market bear it? Look around for similar markets in the United States, 99% of them are going to be low fee, maybe where you are, but I bet you’ll find some exceptions of people who built extraordinary practices with premium fees no matter the market. I would look for examples of the people who have bucked the trend, gotten outside of the box and done the thing you want to do. Make sense?
Dr. Sharp: Yeah.
Tiffany: Okay. That’s the emotional piece. In terms of the concrete piece, we started to answer it with that last bit. If anyone has done it anywhere, that means it’s possible for you to do it too. So you start learning from the people who are actually able to do this thing. If someone’s in a private practice and they’re charging, let’s say something like $215, you don’t actually need to find 40 people on an ongoing way to pay that. You actually need 10, maybe 15 [00:32:00] in an ongoing way.
In most cities, not all but most, there’s a small class of people, and that means hundreds of thousands, who are in professions that can afford that fee. So you have to learn where are those people? How do I market to them? How do I provide value to those families? That could bring up, oh no, I’m only serving the richest but in truth, if you’re saying 10 people for $215, that definitely leaves you spots to see two other people, to serve a different population if you want to give back that way. That’s number one.
Let’s say you really truly are, let’s say a group practice, where you’re having to serve a higher volume of people. So you really do need to make sure that you’re getting enough people coming in the door. That again, we started thinking outside of the box. All right. If it’s true, and I always challenge this, that the market cannot bear this fee, this local market, that you start thinking, all right, how can I expand beyond the local market?
We have online services these days. We can actually start thinking, how can I take my services out of this local market if I want to stay [00:33:00] here and start serving a wider audience? So you can still actually, the most important thing is to see the reality of what you need to have a sustainable lasting business that provides for you, your family and beyond. Which means you might have to actually start doing something that’s a little bit outside of the box of what you’ve tended to do or imagine doing in the first place.
Dr. Sharp: That’s a good point. I’m even thinking like, well, how would we do online or extended testing somehow? What are the options for that? So just thinking outside the box a little bit.
It sounds like in a way, we’re largely data driven folks who are doing testing, gathering some data from maybe other locales to counteract this belief that we can’t charge what we need to.
Tiffany: That’s right. And really looking for the exceptions to the rule. You can always find data to support your fears. I encourage people to find data to support their hopes and dreams.
Dr. Sharp: That’s such a great point. [00:34:00] I’ll pause on that for a second because it’s important to sink in.
Tiffany: I’ll say about that point; this is why money mindset is so important. I know there are folks out there who just talk concretely about the fees. Here’s what you need to make your practice work. But our emotions shape our reality if we don’t know what our reality is. Like I said, you can always find evidence for why it’s impossible to charge $215 and your fear will drive that.
If you can actually step outside of the fear or recognize the fear that say, all right, I know that fear is there but I don’t want to make business decisions based on my fear. Let me try a different way to start looking. Let me look for different evidence. Let me look for different models. So you cannot separate the feelings, the emotions from the intellectual money mindset information.
Dr. Sharp: You’re so right. We talked in our background conversation a while back about the amplifying effect of the large [00:35:00] sums of money that we asked for in these evaluations. I wonder, is there anything to be said for that? To me, it feels easier to ask for, let’s just say $150 an hour for therapy or even $200, my fee is $200 an hour, than to say yes, that evaluation is going to be $3,000 or $4,000 or like two people I consult with, it’s $7,000 or $8,000. Even for me being exposed to the geographic differences, when I hear $7,000 or $8,000, I still I’m like, I don’t know how that makes any sense but it does. I don’t know.
So my question, that’s a long winded way to say, how do you wrap your mind around asking for these large sums of money that put a pretty big dent in a family’s finances, presumably?
Tiffany: Presumably. I’m so glad you added that [00:36:00] presumably because it is a presumption. Also one of the things therapists struggle with, and again, I’m thinking more about people who charge session by session but over time, that’s $12,000 a year, $40,000 a year. It depends on how much that person is coming in.
We often think about what we’re asking people to pay us based on our financial situation or what we can imagine affording ourselves. So we might have a hard time stomaching $8,000, but that doesn’t mean anything about our clients, necessarily. And also, I can imagine if anyone in the audience, I’m pregnant now, so I’m imagining having a child one day. If something is up with your kid, money becomes no longer an issue. You do what you need to do to take care of your family.
So I think because we’re askers and we’re like, are we really providing something of service? Are we really providing something of value? It’s harder to step outside and actually say, what is this person across from me needing? What’s that worth to them? [00:37:00] Chances are $8,000 is a drop in the bucket to prevent your kid from not being diagnosed with autism for two years and being set on a road that that sets you on.
Dr. Sharp: Sure. That’s a good point too. It’s just that lens that we’re looking through. Okay. I got you. Let’s see…
Tiffany: You’re trying to get to something which I’m excited about. Let’s dive in. Let’s dig in.
Dr. Sharp: What’s on your mind? No, what do you think? I’m spinning around all this.
Tiffany: Interesting, I’ll slow down. I also had coffee so I talk a lot.
One of the next things I’m curious about examining for therapists is talking about different lenses. I’m actually starting to explore. I’m going to read some biographies, look into the art world around value. Actually you can see for you, Jeremy, but people who are not watching, I have a painting behind me on the wall and I have a tattoo by the same artist that did that painting on the wall.
[00:38:00] It’s a tattoo on my arm. Very visible. I have no other visible tattoos. When I found these artists, I thought, “These are the people who I want to do a tattoo.” The process to get access to them, they live all around the world, you have to find them and they have to choose you through this elaborate process. And I thought, “Oh, I want this thing.”I actually, and this is crazy, didn’t think about the price. I thought something about what they’re doing, they were working in Syria in a refugee camp at the time. So they’re also into social justice to give me back, something about the kind of work they did and their message really spoke to me.
This painting behind me cost about $900 which I’d never spent on any kind of art. I don’t even know what I’ve spent that kind of money on. I eventually got chosen by them maybe two years later, flew to London. It was only my second time being out of the country and the first time by myself, flew to London, [00:39:00] got this tattoo. I cannot tell you how much it even costs.
I don’t know how much I paid for that tattoo. I paid him a first amount, and then when I showed up, they’re like, oh, and here’s the second half too. I just went and paid. I didn’t even think about it. So this is why I’m starting to think about a value. It’s all in our minds, value. I think it’s important for therapists to really start thinking about, what are we placing value on? What are we saying about the profession by how we set our fees?
I’m talking about a tattoo. What we do is literally save people’s lives as therapists. Take them from a place where they’re sleeping to a place where they’re awake, where they’re unconscious to where they can actually be making conscious decisions and having agency in their lives.
You guys who are doing assessment literally are solving a problem that some people have had for their whole lives. Something is off and I don’t know what it is. You guys are answering that question. I think we really need to get clear about we are fucking [00:40:00] doing amazing work. So when we started thinking about value, we got to start thinking outside of our lens of self and start thinking about what we’re providing for other people.
Dr. Sharp: So that’s like finding the value. How do we place value on these services that we have? It sounds like you’re saying the value is inherent if you’re doing good work. And then it’s like, how do you find the number that matches that? And how do you get comfortable owning that? How do you own that what you’re providing is very valuable to other people? That’s a hard question sometimes. It gets back for me to that question of like, would almost like what I pay for this myself and that’s a hard question. I don’t know if it’s like selling. How do we sell the value? How do we own the value? How do we communicate that value to people? Is there something to be said around that?
Tiffany: 100%. [00:41:00] You’re going to see, you and the folks who are listening, we’re going to raise a lot of questions that are going to stir up personal things in folks and the answers are individual because we all come from different backgrounds. We all have different money stories. There are certainly things that a lot of us have in common but then to start thinking about how do these things apply to me, that takes work and a particular kind of work. And it’s important so I would encourage people to continue examining it and looking into it.
This question of value. This is one of the reasons I created this calculator. It’s really hard to assign value to a thing. I just said we’re saving people’s lives, is that worth a $1,000,000? Is it worth $10? It’s complicated, which is why I really try to come with a concrete number. Just plug in the numbers. You don’t have to decide the value based on pulling something out of the air. You can look at this calculator and have a concrete number. That comes to really trying to ground [00:42:00] something that’s very effusive, very hard to get your fingers around.
Then you’re coming to the marketing piece, which is exciting. That’s the next layer of work. I have this five-week program that I take people to where we only touch the marketing in the last week. I basically touch on it to say, now you got to go learn how to do this stuff. We can do it here but you got to invest in learning how to do that.
So one of the things that you have said like, can I pay $8,000 for an assessment? That’s not a need of yours, I’m presuming. So you don’t need to spend $8,000 for an assessment. But the people who are coming to us, for them, it’s probably a life or death matter or an important matter. It’s not going to be for everyone but you got to find the people for whom it is.
That’s why niching is important, so you can get really clear about the language. Are we talking about serving families of 3-year-olds who may have autism? Or are we talking about working with a 60-year-old [00:43:00] professional men who are suddenly not able to perform at the level they were and they don’t know what’s going on. Or the thing that’s been driving them and helping them work really well is not working in their relationships with their wife and children and now things are starting to fall apart.
It’s important to find a very specific niche, one person you’re really serving because then you can learn how to speak to them in a way that they see the value of what you’re offering and that it’s something that will have an impact on their lives but you can’t do it if you’re making a general.
Dr. Sharp: Got you. I would guess that shows up in website copy, phone scripts, are there other places that you think, where do you speak to your client?
Tiffany: Just like you’re saying, where you put in your website, all those things. So this also comes to… you’re making me go deep on this, Jeremy. We’re thinking about what kind of space we want to take up in the market too, in the field.
So when I’m talking about looking at the realities of your [00:44:00] fees, in truth, some people go through my calculator and they’re like, my fee came out to $80. I always go back where those people email me and question, what are you really looking at in terms of your finances? What were your dreams, really? But people come up with different things. Some people come up with $175 and they’re like, that’s great, I can charge that, let me find out how. Somebody emailed me and they’ve come up with, I think, $377.
So first of all, it’s individual. We may not be someone who needs to be charging $377 per session. Let’s say that your fee comes out to a premium fee, that means you have big dreams, you’re really wanting to do something in the world. That means your marketing and learning about marketing and business, you’re going to have a different task than somebody who maybe takes insurance, and that’s their marketing for them.
If you’re someone who said, wow, this came out to $377, clearly I want a lifestyle that supports that. Oh, I want a fee that supports this lifestyle; who do I have to be in the market? How do I have to carve out a niche [00:45:00] for myself? I have to become an expert in a particular thing.
If we take Esther Perel, she’s someone who I think about often. I love her. I love what she’s done in the field. Or even Brené Brown. They’re LCSWs. They’re therapists who have realized, okay, I’m going to carve out a niche in the market. I bet the people who go to them for therapy have no problem paying $300, $400, $500, $600 to see them. They’ve found a way through their marketing to carve out a particular niche that supports the lifestyle that they came up with when they imagined what kind of fee they wanted to have.
Dr. Sharp: Yeah, that makes sense. I guess people out there listening are like, well, that’s great. I’m not Brené Brown. I’m not Esther Perel. Who am I to be able to charge? So what if I want to make $350 an hour, there’s no way. Why do I deserve that?
Tiffany: You asked earlier about the therapy. Do people go to therapy for this? Yes. If it’s a feeling of [00:46:00] how do I? I’m no good. I can never do it. This was something I struggled with too, for a long time. Carol Dweck is a woman, a researcher. Have you heard of her? Carol Dweck?
Dr. Sharp: Yeah. That sounds very familiar for some reason.
Tiffany: She talked about the fixed mindset versus growth mindset concept. This was transformative for me, paradigm shifting for me, and it’s actually what allowed me to go into creating my business, heytiffany.com and really go at it full force. She specifies the difference between people who are very successful and people who get limited or stuck.
The difference is fixed mindset are people who think you’re born with a set of skills. That reflects that idea; I’m not Brene Brown. I’m not Esther Perel. They’re somehow different than me. They have something I don’t have. That’s a mindset that gets you stuck or limited versus the people she was able to find in her research who were able to excel. They had an idea that they could learn. People who are successful simply learn a set of steps and if that person [00:47:00] can do it, I can do it too.
So if you think, all right, how did Esther Perel do this? If you have a mindset of she was born with something I don’t have, it’s going to be really hard to charge that $350 fee. But if you have a sense of like, oh, she’s a human. I’m a human. She learned a set of steps. I can too. That actually frees you up to start learning the steps to create a business like anyone. You’re not going to be Esther Perel but you could be Jeremy Sharp or you could be Tiffany McLain. You can be your version of whatever you need to be to create this business.
Dr. Sharp: Yeah. I like it. It sounds so easy when you say it.
Tiffany: It sounds easier but it’s difficult.
Dr. Sharp: I like that though. They’re human. You’re human. They did things just like you could do things and who’s to say what those are. That’s all awesome.
This might be shifting gears but you brought up insurance a few minutes ago and mentioned that, and that’s something that’s, I think, relevant for me. It’s very personal. Our practice takes a lot of insurance. [00:48:00] I’ve been pretty clear about that on the podcast. That that remains part of our ethos, I think is the word. How do we reconcile that? I want to take insurance. I want to provide some access to folks in that way and practice down the street which is maybe not doing as high quality work is charging out of pocket and maybe I want to do some out of pocket stuff too. One question is, how do you work this whole mindset into insurance which is a fixed cost system? Let’s start there.
Tiffany: Great. Give me a sense of why someone, let’s say an agency as opposed to an individual, what are the benefits and cost of being on insurance.
[00:49:00] Dr. Sharp: Okay, well, benefits, I think, let’s just do one on one. The emotional benefit is providing access to I think again, maybe an assumption, but more folks than would be having access with private pay only. So serving the community in that way. And then practically, it is generating referrals and bringing clients into the practice to fill the therapist or clinicians or psychologists who are doing testing.Tiffany: Great. And so what are the drawbacks?
Dr. Sharp: The costs, of course, I think for most of us are financial. Our insurance reimbursement ranges from 50% of the typical out of pocket rate to maybe like 75% of the out of pocket rate. So I think that’s a huge cost.
Time, for a lot of us doing testing, we spend a lot of time with paperwork and pre-authorizations and [00:50:00] “fighting insurance” for payment. Sometimes they don’t approve as many hours as we think are necessary for the evaluation. So we have to haggle around that or just not get paid.
Tiffany: Interesting. We could break these down bit by bit. One of the things you said when you talked about being a practice that takes insurance versus the guy down the street who maybe isn’t even doing as good work but is doing private pay, and there’s something you’re speaking to and you and a lot of therapists when I hear this question around desire. So there’s something that’s not satisfying about being the insurance pay practice and there’s something desirable about that guy down the street who has a private pay. Can you speak a little bit to that?
Dr. Sharp: Okay. You’re nailing it. I’m going to turn the video off because I think being able to see my face is like giving away some things to you and then you ask these questions. So [00:51:00] there is some of that. There is a part of me that is, in a weird way, almost the opposite of what we’ve been talking about which is, I think we do good enough work to charge private pay only. I think we do that. So what’s the hesitation to do that? Why is this other person able to do that and we are not?
There is some desire there to have the ease of private pay, to be able to maybe pay our employees a little more if we were taking more private pay, and retain employees or provide some insurance anyway against them leaving.
Tiffany: This is interesting. We can work with this. When I ran this most recent cohort of Lean In Make Bank, the program I do, one of the modules [00:52:00] we have them go through is around financial integrity. We have them look at places in their lives where they’re maybe not in integrity with their financial behaviors.
One of the clinicians noticed she takes a sliding scale, I don’t know if she was on insurance, maybe she was at too but sliding scale. She felt good about that and initially she was actually conflicted about it. But she noticed that when she goes to acupuncturist or other service health workers, she asks for a sliding scale from them. So she realized that she’s undervaluing the services of other people in the field who are doing this kind of work, often women, often minorities, often people like us who are upwardly mobile.
So we’re sliding our scale, but we’re also paying it forward in the negative in that we’re not actually paying other people for what they’re worth. And not only that, we’re taking spots from other people. That therapist has the capacity in her practice to be charging more and then therefore paying more, leaving those spots open for other people.
[00:53:00] So what made me think about that was, you’re saying, which I think is actually really important, giving access to folks that may not have private pay or may not have the means, but the cost of that is that you’re not paying your own employees enough for them to both have a satisfying life or be able to pay their own needs or take care of their own families. I’m sure you actually paying enough to do that but some part of you wants to pay even more to give even more back to your folks.So it brings up this question of who are we asking to pay for having this sliding scale? What does it really mean to give back? Who do we want to give back to? Could we create a system where we have private pay, we’re really able to take care of our own employees, and they can open up two spots, all of them to give back to people on a sliding scale or a different kind of format without sacrificing their well-being or their family or your well-being.
So we start having to shift, what are we really saying around giving back? Who are we giving back to? What is it all about? These kinds of questions start coming to my mind.
Dr. Sharp: Yeah, for sure. [00:54:00] I guess in my mind; I think automatically about the clients first. That’s who we are giving back to.
Tiffany: Yeah, it brings up a question of, so this Laski person who wrote this article about upwardly mobile folks. She also had this observation and the research she did, which really surprises me. A lot of therapists think we come from families where there was some kind of trauma, and that’s what leads people into the field of therapy.
She discovered it wasn’t actually that. She found that the therapists she looked at were in their families, the role of a caregiver, the parentified child. She actually found that the things that many therapists have in common is that they play the role of sacrificing their wellbeing for the good of the larger family and that they got their value and their worth in their family from playing that role.
So a lot of us, of course, [00:55:00] think of our clients first because that’s how we were valued. That’s how we got praise in the family. That’s how we define who we were. That’s how we identify. So even though it feels like that’s a good thing and it’s a logical decision, for a lot of us, it’s actually playing out a pattern that’s dysfunctional. It was dysfunctional on our family and likely it’s dysfunctional in your business as well.
Dr. Sharp: Sure. I’m just smiling because it’s like, that’s exactly what’s going on. Okay.
Tiffany: Deep. It’s important to start paying attention to. Our whole profession has been playing this stuff out without being able to think about it. I think it’s a rebellious act or revolution to start actually thinking about these things in our practice and changing the way we’re doing business.
Dr. Sharp: I’m going to tell just a little brief personal story. My friend, Kelly Higdon, do you know Kelly?
Tiffany: Yeah, I do.
Dr. Sharp: You know Kelly. Okay. I was talking to Kelly. This is, I don’t know, eight months ago or something. She has this [00:56:00] wonderful way of cutting through things. I was talking to her about some of this stuff. And just like 30 seconds in, she was like, so if you take private pay, you’re going to reject your family and abandon your parents or what? I was like, yes. Okay. I guess we’re done here. Thanks, Kelly. I’ll go work on that.
It’s kind of the thing you’re talking about. It really does go deep, I think, for a lot of us and ties back to family stuff. I just love that you’re putting it all out there. I hope that people are really starting to think through, okay, how might this be showing up and playing out for me?
Tiffany: Absolutely.
Dr. Sharp: Let’s just say we’re doing our work, get to a place where like, okay, we’re ready to be valuable and charge that, and that kind of thing. How do you reconcile that then you maybe are excluding certain people from services [00:57:00] by virtue of upping your fee or dropping some insurance or whatever it might be?
Tiffany: A really important question. One that I really encourage people to start behaving in line with their financial integrity first and then you’ll learn something more about how to answer this question of how to reconcile it. So a lot of therapists, especially psychoanalytic folks, they just think and think and think and are less action oriented. I like the idea of taking action, too. I think that’s really important.
So starting out by, all right, I’m going to… and I’ll say my fee is $280 now. I’ve been in my own private practice maybe three years. I’m not sure if I’m going on a little over three. But right out of the gate, I raised my fee to $180. I had one peer who was two years before me who was doing that but my supervisors, people who are psychiatrists and psychoanalysts who have been in the field for decades, 20, 30 years, they were still charging $150.
So for me, it was like, holy [00:58:00] smokes, I’m going right out of the gate, I’m going to charge $180. And then within a year or the next year I raised it to $280. I did not feel like a badass who was charging $280 and it was easy as pie. It was terrifying to charge that. But I thought, there is a lesson to learn in that terror. It’s uncomfortable. I’m afraid of it. Am I taking from people who can’t afford other fees? So all of those things were in my mind but part of coming to understand what’s on the other side was by moving through the fear anyway. Getting to the other side to answer those questions.
So that’s a broad answer to each individual, find out how to reconcile of that by virtue of taking action. But I’ll take this to a systemic in terms of that, how do I reconcile serving people who can afford to $280 an hour when I know there are people out there who are really struggling? I’m going to do my best to talk through this.
It’s a omnipotent belief. [00:59:00] A lot of therapists have an omnipotent belief. I’m a savior of all. I’m going to make a difference by having a practice that gives back to the people. The fact of the matter is you cannot have a private practice or even a group practice that’s sole function is giving back to the people.
We have a systemic problem where the people who are at the bottom keep getting the shaft and the people at the top keep getting tax breaks and all kinds of stuff. So it’s a way to, I’ll put a band aid on the problem. I’m going to fix it by offering a sliding scale, and I’m going to suffer and my clients are going to suffer, and we’re all going to suffer together but at least I don’t have to suffer the guilt of doing really well in America.
I say it’s actually much better to charge fees that are commensurate with what you need to have energy, to have power, to be able to make an impact and then use that to actually make political impact, to actually fix the system where the problem is versus participating and collaborating [01:00:00] with or colluding with a system that is continuing oppression. Does this make sense?
Dr. Sharp: It does make sense. It really does. I’m really glad that you’re diving into it. I was going to ask some of those questions. It’s hard to know how to sort through it all and how to ask those questions but yeah, I think it does make sense.
So to play devil’s advocate a little bit, let’s go that direction. Then it’s like, okay, so these people get stuck in community mental health and that maybe sucks. Or they go to a student clinic for testing where maybe it’s not as good and then they just continue to struggle or what?
Tiffany: I don’t know if I said it when we were talking on the podcast that I see maybe 11 people maximum in my private practice. Through hey tiffany now I have, [01:01:00] I don’t know, 3,800 people, let’s say on my email list. So that’s almost 4,000 people that I’m impacting around this stuff. And I talk about money, but I’m really talking as you’re finding out here about the clinical implications of what we’re doing, how it’s impacting our clinical work.
And then I have this program where I work with, I don’t know how, I think I’ve maybe about 50 people through this program right now. So we’re talking about, wait, if you’re taken care of in your practice, where you have the energy and resources, you could actually make a bigger impact in other areas.
Another example of this is I’ve worked on five death row cases where I’ve worked on a team that’s gotten men off of death row. That’s a life or death issue that I was able to do because I’m taken care of in my practice. I’m comfortable. I have enough money and I have a plenty of mental space that we had to do this other kind of work.
So I think it’s a zero-sum game mentality to think I have to take, let’s say insurance if that’s a problem for somebody, or I have to slide my scale to give back. I’m suffering. If you actually imagine an abundance, like what if I actually charge really great fees here and [01:02:00] then I have the capacity, time, money, a power and influence to really make an impact over here.
Create a system where people don’t have to go to the student center where they’re not really getting help or maybe an agency that doesn’t have the resources to really help them. What if you could start making a political impact to get more access or even raise insurance reimbursements; really getting in there and changing the system so that you’re actually solving the problem as opposed to band-aiding the problem.
Dr. Sharp: I love that. I feel like it just comes back to this idea of taking care of ourselves first, and that’s really hard. There’s a lot of messages around that, like being selfish or greedy or whatever it might be for not working hard enough. There’s any number of things you could throw into that pile but ultimately, it [01:03:00] totally makes sense when you lay it out like that. It’s, charge the fee you need, don’t work yourself to death, have some free time to spend it or you would prefer maybe in these kind of actionable just to see ways or give money in a certain way, who knows, rather than spreading yourself in and providing decent but semi-burned out services.
Tiffany: Absolutely. Mediocre. I know you already do good work. You’re already proud. And you’re even saying like, we could actually charge private pay. We do good enough work that we could probably build a practice that way. Can you imagine what an impact it will make? You’re already doing good work. If all of your folks were rested, taken care of, felt really financially secure, were able to take vacations when they want, and then they showed up and did these assessments. It would be beyond good. It would be fucking phenomenal beyond what probably most people get when they go into an assessment.
So you start thinking like, wow, what would it mean to go from good work or even great work to exceptional work? It takes resources to do that.
Dr. Sharp: Yes. [01:04:00] It does. I love it. I’m fired up. This is good.
Tiffany: I also want to put a caveat on this though. It’s really important, I think. We’re talking about getting off insurance or stopping sliding scale. I think that there are also people, let’s say, who are doing just fine on insurance or who are happy to slide their scale. Chances are, I’ll say, if they’re really fulfilled and really taken care of, they may come from a family that was able to provide for them. So maybe they don’t have $200,000 of student loans, for example, or maybe they have a partner who works a great corporate job, so they don’t actually need it. That’s it.
I think it’s important to also pay attention to where are the resources coming from? We have fantasies of like, oh, I see Betty over there. She’s only charging $110. But Betty might come from a family that has generations of wealth, for example, or even generations of stability, and she already has a retirement waiting for her.
What I’m saying is not universal, it really depends on people’s situation. [01:05:00] The most important thing is that people are being really honest with themselves about where they’re at, how fulfilled, how much capacity and how much energy they really have.
I have a lot of therapists who lie to themselves. Who come into me, I’m doing really great on insurance. I believed them at first, but then I started seeing the resentment, the frustration, the overwhelm. And I’m like, oh, that’s not the whole story. They’re not actually doing really well but they’re afraid of what it means to do something different. Again, that’s not everybody. People are different.
Dr. Sharp: Right. I was going to ask that question that you found, is there a way to do insurance and be fine. Can you still have positive healthy money mindset and take insurance?
Tiffany: I think absolutely. The insurance is not a be-all end-all. The thing for me is again, I have not yet, and probably because people come to me or not, these people met someone who’s on insurance really have a thriving, personal satisfaction life, can afford paying their own therapist a great fee. It’s mostly people [01:06:00] who are struggling who are on insurance.
When people start out, I hear a lot of folks, it feels like a great way to start your practice. It’s better to have someone for $70, it feels like than nobody especially when you need to pay your bills. For a lot of folks, it might make sense to do that initially. In terms of a long term work, people who are fulfilled, satisfied, really in touch and really in financial integrity, anything is possible. I just don’t meet those people too often. What do you think? How would you answer that question?
Dr. Sharp: That’s fair. I think that there are some areas of the country where insurance reimbursement is relatively close to out of pocket. There are some folks who do maybe limited insurance and are lucky enough to not have these real strict guidelines for preauthorization and hours and things like that and it might get close.
Tiffany: I think that, and I guess when you say that too, I’ve definitely heard of great reimbursement rates. [01:07:00] If the insurance is working well, I think it’s fantastic. I think it can be fantastic for both parties. It’s not common enough. I know there are people advocating to have higher reimbursement rates. Kudos to those people. If there was a way we could get a system that’s actually helping people with their mental health, I would love it.
Dr. Sharp: I’m with you. Well, that’s one thing that’s going to stick, I think is just that idea that when we are well taken care of both financially, emotionally, and personally, then that leaves time and space and money to put elsewhere and in ways that we really choose to and really want to and to do it in a quality way.
I don’t know, that might be a good place to wrap. I feel like we’ve done a lot. You’ve pushed me a little bit and we’ve heard a lot from you and your personal story. Like I said, I’m fired up and I would want to imagine listeners are too. I don’t know. Is there anything else before we part ways that feels important to throw out there for folks.
[01:08:00] Tiffany: I’ll say two things. The first one I would say it’s a journey for sure. It’s not an easy process. As people are listening, they might resonate with some things and feel shame or worried. Oh no, do I need to take action? I say, just chill out, take some time to think about it. Find supportive people. Again, this is a process that takes people time. Cut yourself some slack, be kind to yourself and started thinking, okay, down the road, let your envy be a guiding star for what you actually are wanting in the world. Or what is it saying about your desire and start paying attention to that and trust that.I’m out there. Jeremy, you’re out there. We’re willing to help people and think with you creating this podcast, which is actually an example of giving back. You’re reaching tons of people by virtue of the service you’re providing. So you’re doing the thing we’re talking about, by the way. So people can look to us and say like, oh, there are models of a different way that I could have access to some of the things I want. That’s number one.
I would ask you, you said this idea of having an expansive. [01:09:00] Oh, if I’m taken care of, that gives me the opportunity to do more. You’re really on fire. You said two times. You’re like, oh, what is it? How can you imagine this conversation might shift something in the way you do business or the way you’re practicing? Any thoughts?
Dr. Sharp: Oh, yeah. I’m just thinking right now about, I think for us, probably dropping in two insurance panels is the first thing that comes to mind. I have an idea of the ones that are paying lower and the ones that are harder to work with and all of that. Just going to run some numbers and figure out like when can we just get off those insurance panels?
Tiffany: Yay, I love this. I know we’ve been talking a lot about abstract and concrete but you actually through this conversation are thinking oh, there are some concrete steps I can take that are not all or nothing too. So you’re talking about oh, what if I can just loosen up a little bit, get off some of the lower paying ones, still take insurance, and maybe if I want to make some room for private pay and just dabble in what that would be like. That’s fantastic. I think the other listeners too can [01:10:00] start thinking, oh what are just small changes you could start to make to start playing with some of these ideas.
Dr. Sharp: Yeah. I love that. I would encourage other people to be thinking in those terms as well. If it’s not dropping insurance, maybe it’s revisiting your fee and make sure it’s market rate or above. With testing, I coach people to set your fee above market rate. It’s a specialty and it should reflect that. I love it.
Tiffany: I love it too. I’m working now on a series; it’s called The Money Sessions. I’m interviewing therapists who have overcome one of these hurdles. Maybe they raised their fee. Maybe they got up insurance. Maybe they just had one conversation with one client and it went terribly but they learned on the other side.
I think you have to be on my list because it’ll be, I don’t want therapists’ videos talking about this stuff to be out in the public. But for folks who sign up for my list, I’m just going to be releasing these so people can start seeing other people actually talking through, thinking through these ideas and [01:11:00] getting the conversation bigger. You can’t find it anywhere now, but by the time this comes out, hopefully that will be available for people who are on my list.
Dr. Sharp: Awesome. I was just going to ask, how do people find you and get in touch with you and maybe sign up for this stuff? You’ve got so many cool offerings I think, for folks who want to really dive into this.
Tiffany: Sure. For anyone who goes to www.heytiffany.com, sign up there. You’ll get my calculator that will calculate your fee for you. And then those folks, I’ll be sending this Money Session Series too. Once it’s recorded, edited and up.
Dr. Sharp: Nice. That sounds awesome. I really appreciate you. This is fantastic. Thank you for coming on.
Tiffany: Thank you. I was going to thank you for playing with me and being willing to dive in there and give us some scenarios and talk it through. It’s so fun.
Dr. Sharp: Yeah. Well, I appreciate you pushing me. It’s uncomfortable. I’m like, oh my gosh, I don’t think I’ve talked about this much personal stuff on the podcast, but yeah, it’s good. I think it brings it to life and it’s got me really thinking about things. So thank you so much [01:12:00] for being here.
Tiffany: My pleasure and keep us all posted on what you end up doing.
Dr. Sharp: Oh, of course. All right. Take care, Tiffany.
Tiffany: Thank you.
Dr. Sharp: There you have it folks. Quite an interview with Tiffany McLain. Like I said, I’ve thought about this one a lot since we wrapped up. I just so appreciate this perspective. I like how she balanced that ability to believe in yourself and charge what you are worth while also acknowledging how that may be hard from either a social justice perspective or your own personal perspective.
There’s a lot that goes into money and this was really valuable. So I’m taking some actionable steps to move our fee upward and start to charge what’s more in line with what we’re worth. I hope you will too.
Like I mentioned at the beginning of the podcast, a big announcement, the Beginner Practice Mastermind is going to kick off in January, 2019. [01:13:00] So if you are a psychologist with a testing practice that is just getting off the ground, this is for you. It’s a group coaching format, hot seat model. Should be no more than six psychologists in a group together. It’s awesome. We had a great experience back in the spring and I’m excited to get back to the mastermind coaching format. So if that’s interesting to you, go to thetestingpsychologist.com/consulting, scroll down a bit and apply for that Beginner Practice Mastermind.
All right. If you have not subscribed, please do so. I’ve got some cool interviews coming up. Next time will be Dr. Joel Nigg talking all about state of the art research on ADHD and where we’re at with that. You don’t want to miss that one. In the meantime, y’all take care, have a great December, and we’ll talk to you soon.