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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

PAR offers the RIAS-2 and RIST™-2 Remote to remotely assess or screen clients for intelligence, and in-person e-Stimulus Books for these two tests for in-person administration. Learn more at parinc.com.

Welcome back, everybody. It is so good to have you here. I hope you are all doing well. Let’s see. What are we talking about today?

So today I am doing a summary of the article from the IOPC, the Inter Organizational Practice Committee, all about guidelines for assessment during the pandemic.

So this is the most [00:01:00] recent article that came out from the IOPC, co-authored by Karen Postal, Bob Bilder, let’s see who else was on that co-author list? It was a real rockstar co-author list. So, check that out. It’ll be linked in the show notes, but I’m going to summarize the article for any of you who may be running low on time to read articles. I know that is often the case for me.

Just to provide a brief summary. I think this is a great piece of work to pull together the existing research. I don’t know that there’s a ton of new information in the article compared to what I’ve seen over the last several months, but I also acknowledge I’ve been paying pretty close attention to this because I’ve been doing a number of presentations on remote assessment for different entities. So I’ve kind of stayed tuned into it. For those of you who may not have been [00:02:00] reading everything that’s out there, this is a nice, like I said, summary, and it really, really pulls together the state of the literature right now. It’s small literature granted, but it pulls it together quite nicely.

Before I get to the actual episode, I want to invite any of you beginner practice owners to check out the beginner practice mastermind group. This is a group coaching experience just for testing psychologists who are launching a practice in 2021. So I think we have one or two spots left at this point.

The group starts on March 11th. So. Let’s see, two weeks before that gets going. And yeah, if you are thinking about launching a practice or maybe just launched and trying to get some traction and need some support and guidance, this could be for you. You can go to thetestingpsychologist.com/beginner and get more information. You can also apply for a pre-group… sorry, [00:03:00] I always say that. You’re not applying for a pre-group call, you are scheduling a pre-group call and then we’ll figure out if the group is a good fit for you. You’re not really applying for anything, so don’t get scared. But you can get more information and schedule that call at thetestingpsychologist.com/beginner.

All right. Let’s jump to the summary of the latest IOPC guidance on assessment during the pandemic.

Okay. Let’s dig into this latest article from the IOPC. So the article starts with an outline of why neuro-psych assessment is important. It cites a little bit of literature explaining the utility of neuro-psych testing and how [00:04:00] it does add something to treatment and conceptualization above and beyond what can typically be found through more traditional means like interviewing therapy, and other modes of client contact. So that may be interesting for some of you. I know that this is a side note, but I have run into one particular insurance panel that will not approve any hours for neuro-psych assessment because they have claimed that the literature says that it does not provide any benefit above and beyond therapy as usual. So that might be valuable if any of you have run into a similar situation.

After, they spend just a bit of time discussing why a neuropsych assessment is important. Then it goes into a section where it talks about the dangers of delaying a neuro-psych assessment during the pandemic. And they cite a number of examples of how [00:05:00] this might be the case. As you might guess, one of the examples is medical conditions getting worse. For example, someone with epilepsy, uh, waiting for a neuropsych eval before getting surgery, and then they have to endure further seizures while they’re waiting.

They talk about increased risk of accidents, for example, in older adults or individuals who are experiencing cognitive decline. So any amount of time that they go without a neuro-psych assessment to guide them and guide their families on treatment could result in increased risk of accidents and them hurting themselves or someone else.

They also give an example of academic performance declining in kids if we put off the assessment of learning disorders. And they also cite an example, just a random example of psychiatric concerns getting worse, and of course, [00:06:00] suicide is one of the things that we think of right off the bat with a situation like that. So, so they talk through again, a number of risks or dangers of delaying neuro-psych assessment during the pandemic. So, kind of building the case that we do need to find a way to do this or continue to do this.

Now on the flip side, the article then talks about the risks of performing an assessment during the pandemic.

The first thing that they talk about is contracting COVID-19, of course. So this would apply to the clinician or the client. Related to that, they discussed the risk of transmission to the community. So, even if you or the client presented as asymptomatic, the transmission to the community could be quite problematic. They discussed the idea that the validity of the assessment could be undermined by [00:07:00] anxiety, either anxiety about the illness or anxiety about a divergent process, modifying the test administration format, and so forth or PPE, so assessment being undermined by poor validity, secondary to anxiety.

And then they also talked through, what I thought was a helpful section. This is information I’ve seen before, but it’s nice to see it recapped where they talk about legal risks as well which would fall into a couple of camps. The idea that practitioners might be questioned on the validity of results from an evaluation conducted via alternative means or an unstandardized format. And they also talk about the idea of your liability insurance, maybe not covering the transmission of illness within your office. So if those are things that are [00:08:00] concerning for you, you could certainly check that out to make sure that your liability insurance would cover you. And if not, that may inform your decision.

So after that, the authors of the article transition into the typical models for doing assessment during the pandemic. And throughout the article, they have a couple of nice tables or infographics, I suppose, where they talk about sort of the balance of validity of the assessment with safety and how those really are two sides, polar opposite, you know, like when one goes up, the other goes down. There’s an inverse relationship. That’s what I was looking for. So there’s an inverse relationship between validity of the assessment and safety of the assessment. And we have to balance those things.

But the models map onto that idea I[00:09:00] think pretty clearly where at one end of the spectrum, we have in-person assessment like we did pre-COVID. This is what they call it, the gold standard. After that though, things get more interesting. So many of you have maybe heard some of these methods being discussed on listservs or podcasts and whatnot, but one of those is an in-person assessment with PPE.

This is the model that we have been using in our practice, which is an outpatient mental health practice over the last, I’d say six months, since probably June or July. Now we have had relatively low case rates for most of that time compared to many parts of the country. So that’s certainly a factor to keep in mind and something that I’ll circle back to when we talk about decision-making for which model you might pick. But in-person with PPE is one model to choose from. It’s sort of one step removed from totally in-person, no PPE.

[00:10:00] Now they make sure to point out that we still don’t have great research or really any good research on the impact of using PPE during the administration. We don’t know how that affects the validity or the performance that we might get from someone. And that really runs the gamut. So you could be masked, could be face shields, could be the plastic barriers. We just don’t have good research on the impact of using PPE, at least as far as they specified.

So the next step up with a little bit more protection or distance or buffer with regard to COVID is in-clinic tele-neuropsychology.

Let’s take a quick break to hear from our featured partner.

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All right, let’s get back to the podcast.

I have been calling this the hybrid model. It looks like that terminology is not exactly right. But this is the model where both the client and the practitioner or clinician are in the same office suite but they are in different individual [00:12:00] offices and the assessment is taking place really over telehealth entirely.

Now, it may be proctored, it may not be proctored, but that’s the setup here. The interesting thing about this setup is that this is where most of the research has been conducted as far as tele-neuropsychology. It is a nice setup, but the authors point out that it is not ideal because many people still say that when you have to modify the administration of a measure that is doing it over telehealth and introducing a proctor and whatnot, that it is changing the test that you’re in effect giving a different test at that point. And so we can’t even really call it then the same thing.

Okay. So the next model that they speak about is in the home tele-neuropsychology or direct to [00:13:00] home. They’re not super supportive of this. I don’t think many people are. It is maybe a better than nothing approach, but when you are testing into someone’s home, you really are introducing a range of risks just due to the lack of control of the environment. So you don’t know if people are in a private space, are they able to access fast internet, are they going to be protected from interruptions? And it also introduces a barrier in terms of keeping track of the individual and their health and their performance. And it’s just one more step removed.

They also point out rightfully so that lack of access can become a really big issue, particularly, lower SES clients and certain racial or ethnic groups that [00:14:00] certain folks don’t have internet access at the same rate or at the same speed and are less technologically literate than others. So if that’s something that… these are just variables that come into play when you test directly to home.

And then lastly, they mentioned the idea of a hybrid. Now, a true hybrid, or at least the way that they define is actually the mode that we are using, which is doing feedbacks and intakes over telehealth but doing the testing in person with PPE. And there are any number of combinations that you could use to do a hybrid model.

Now, perhaps, more importantly, the authors then walk through a rubric for how to make the decision on what to do and which of these models to choose. So there are a number of factors to consider.

The first is urgency. So we touched on that at the beginning of the podcast, but [00:15:00] urgency of the case and whether it is going to be more or less risky to conduct the assessment now. And there are so many factors that could go into that, but that’s the first component that you want to consider. What is the urgency here?

The second one that they talk about is symptom acuity. So, it can go both ways. Is the symptom so acute that it’s going to, going to color the assessment in the wrong direction? But on the other side, are these acute symptoms that actually need to be assessed as quickly as possible in order to help the patient as quickly as possible? So symptom acuity is something to take into account.

The next point to consider is incremental validity. So this is really getting at the question of, will testing add much to the referral question or is it necessary to test right now such that it would [00:16:00] add useful clinical information above and beyond what is already known? And they give the example of course, of a kid who has a previous diagnosis of dyslexia and wants an updated assessment, well, you probably don’t need to go through and give a full neuropsych battery at that time, you can just do the reading specific measures and other pointed narrow-band measures to get at the referral question rather than a more comprehensive battery, at least right now.

Another factor that they discuss is the health risks for the client and the clinician. So thinking for yourself, are you in a high-risk population? And there are a number of qualities or characteristics that might place you in a high-risk category. You can find those on the internet, at CDC, et cetera. [00:17:00]But also for the client, is the client in a high-risk population? And is it going to behoove them to go through this assessment?

Another factor, the last one that they talk about are the community factors. So being aware of the broader context of COVID-19 in your community, the number of cases, the transmission rate, the positive test rate, all of those factors. These are sort of the epidemiological factors, I suppose, that help drive decisions about what to do around the community and whether people are able to open their businesses or kids go to school and whatnot. So just being mindful of your community factors and how that might impact your community if there was some spread within your office.

Now the one thing I was really kind of hoping for a more definition [00:18:00] or a concrete discussion of how to weigh these factors, of course, I think that’s really, really hard. But they basically just say, here are the things you need to consider and then choose for yourself what makes the most sense when you weigh out all these options?

The article then goes into a section on preparing to reopen your practice. I think this stuff has been pretty well discussed in previous articles and other resources that are out there.

I’m not going to go into great detail about preparing to reopen, but it is nice. They actually go through and they kind of compile all the information that I’ve seen out there over the past year on what to do throughout the testing process. So things that you need to do before the patient arrives, things to do upon arrival- that’s like temp checks and things like that, what to do during the appointment, minimizing [00:19:00] contact, et cetera, and then afterward and wrapping up. So that was a nice section of the article. Even though it’s not brand new information, it is nice to have all in one place where you can just see the bulleted list.

They do emphasize moving to electronic forms if you haven’t already. So using something like IntakeQ for example. There’s a link to that in the show notes, but some means of sending electronic form so you’re not having to pass paper back and forth.

And then, to start to wrap up, the article talks about informed consent and how to account for non-standard administration in your report.

So they give a few examples of places where we need additional informed consent where we might not have otherwise had them. So there are examples of providing informed consent [00:20:00] for in-office assessment when someone is coming in and running the risk of contracting the virus. There is an informed consent for tele-neuropsychology and there is a separate informed consent for the hybrid model.

So the moral of the story here is that your patients just need to know what they’re getting into and it’s up to you to provide these informed consents to make sure that they know what to expect.

And then the last part, like I said, is they give a nice sample paragraph for how to explain the non-standard administration in your report text. And that was really cool too. I’ve um, gotten a lot of questions over the past year or so about how do you explain how the administration changed and account for that in the report? And so this is a nice paragraph. We use it in our practice and have been [00:21:00] for several months.

All of these tips and tricks and everything from the article will be linked in the show notes. So I do have the article linked and you should be able to access it relatively easily.

Like I said, it’s not a lot of brand new information. I think I was maybe hoping for more of that, more conclusions around what we should “be doing.” But it’s a nice compilation of all the information that’s out there and a nice summary of the research as far as we know so far on tele-neuropsychology over the last year or so.

So I highly recommend that you check it out. It’s a quick read. I went through it in I don’t know, maybe 15 or 20 minutes, maybe less than that. And it’s relatively short. So definitely worth checking out to see if there’s anything there that you have not been putting in place or might need to brush up on.

[00:22:00] So thank you as always for checking this out. A little bit of a shorter clinical episode today. We’ve got some great interviews coming up over the next month or so. We have another masterclass coming up. We have, let’s see, interview with a two psychologists around validity and performance factors in ADHD assessment. I’m going to be interviewing the co-developers of the Spectra personality measure.

Let’s see. What else? There are a two other great ones. They’re just slipping my mind right now.

So yeah, stay tuned. If you’re not subscribed to the podcast, now is a great time to do that. If you have any friends who you think might want to listen and they aren’t aware of the podcast, spread the word, that’s always great. And it’s been a pleasure to continue to do the podcast and bring some of this info to you. So I will [00:23:00] be back on Thursday with a more businessy episode and I hope to see you there. All right. Take care.

The information contained in this podcast and on The Testing Psychologists website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. [00:24:00] If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to the Testing Podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. The BRIEF-2 ADHD form uses BRIEF-2 scores to predict the likelihood of ADHD. It’s available on PARiConnect- PAR’s an online assessment platform. Learn more at parinc.com.

[00:00:35] Hey everybody. Welcome back.

Today’s episode is a continuation of our Practice of the Practice takeover for the month of February for the business episodes.

Today, I’m talking with Whitney Owens about private pay practices. Whitney is a licensed professional counselor and private practice consultant. She lives in Savannah, Georgia where she owns a group practice called Water’s Edge Counseling. [00:01:00] In addition to running her practice, she offers individual and group consulting through Practice of the Practice with a special emphasis on helping clinicians start and grow faith-based practices.

Whitney hosts a podcast to help faith-based practice owners called The Faith in Practice Podcast. She has spoken at the Licensed Professional Counselors Association of Georgia’s annual convention as well as Maryland. She has spoken the past two years at
Practice of the Practice’s Killin’ It Camp Conference hosted right here in the Rocky Mountains.

She’s also been interviewed about mental health issues on several media outlets including WSAV in Savannah and the Atlanta Journal-Constitution. She’s a wife and a mother of two beautiful girls. I had a great time talking with Whitney about private-pay practices.

Now, you’ll notice right off the bat, Whitney is not a testing psychologist but she brings a lot of things, experience launching and growing private pay [00:02:00] practices. And I think that the information that we talk about in this episode is helpful for any of us. The principles that she describes and the strategies that we go into are going to be useful for anybody trying to build a private pay practice.

Whitney also has the interesting experience of having pursued an evaluation for one of her kids. She talks about that experience and what it’s like from the other side, in terms of seeing the marketing and customer service of different psychologists that she contacted.

So we talk about a number of things. We talk about really what not to do as a testing psychologist if you’re trying to get referrals and land customers or clients, we talk about the flip side of that which is great customer service, and how that shows up in her practice, we talk about phone scripts and how to sell private pay services to clients on the phone. [00:03:00] And a number of other things that I think will help you really just get into a customer service mindset more than anything else.

A cool thing about Whitney is that she launched her practice in Savannah in what she would call a saturated insurance-heavy area. So if any of you resonate with that situation, you’ll definitely want to check this out.

Before we get to the interview. I want to invite any beginner practice testing psychologists to check out the beginner practice mastermind group. So this group is launching on March 11th. It’s a group coaching experience just for beginner practice testing psychologists who are trying to launch their practices here in 2021. You’ll get accountability and support and guidance as you tackle all of those important components of starting a testing practice. If that sounds interesting, you can get more information at thetestingpsychologists.com/beginner.

[00:04:00] All right. Let’s jump to my conversation with Whitney Owens.

[00:04:22] Dr. Sharp: Whitney, hey, welcome to the podcast!

Whitney: Hey, I’m glad to be here with you.

Dr. Sharp: Yeah. Thank you so much. I’m so excited to be talking to someone who also has a Southern accent. So thank you for bringing that to our show today.

Whitney: Yes, I usually bring it on pretty fixed.

Dr. Sharp: I love it. Well, we were talking before the episode about how you’re in Savannah, right?

Whitney: That’s right.

Dr. Sharp: Yeah. So that’s just a few hours from where I grew up in South Carolina. So it’s a lot of that familiarity. There are here’s not too many of us southerners here, outside the South.

Whitney: No, [00:05:00] there’s not. I actually was born in Charleston, so I like having that kind of claim to fame there.

Dr. Sharp: Yeah, for sure. Of all the places in South Carolina, I feel like there maybe two or three you would want to go to, and Charleston’s one of them.

Whitney: Definitely. There’s kind of a competition between Savannah and Charleston actually.

Dr. Sharp: Yeah, I could see that. They do have similar vibes. Yeah. So what do you think? I mean, you’ve been to both. Which one wins?

Whitney:  Well, I have to say Savannah. I live here. But one of the other fantastic parks is the St Patrick’s Day Parade which we just found out was canceled. But there’s a lot of other great things to Savannah, but that is one of my favorite parks that you can’t get in Charleston or very many places. We have in the top… I think it’s in the top three in the nation for St. Patrick’s Day Parade.

Dr. Sharp: All of that’s incredible.

Whitney:  With Chicago and Boston. I know it’s crazy.

Dr. Sharp: Wow. Wow. Who knew? Well, so maybe that’s a good place to start actually. I mean, you have your practice in Savannah. [00:06:00] It’s a private pay practice. That’s what we’re going to be talking about today.  What is the private practice community like there? Can you describe it?

Whitney: Wow, that’s a good question. The way to go at. This is the first time someone’s asked me that on a podcast. Yeah, so I actually came here from Colorado. I am in a different experience. So I do compare just to be real about it.

Dr. Sharp: Sure.

Whitney:  I found it a little close to here in a lot of ways. I would say I’m definitely unique in the experience of a cash pay practice. In fact, I don’t know any other group practices in Savannah maybe someone will hear this and correct me, but I don’t know any that are cash pay. There’s a lot of people here doing practices. So I do feel like there is somewhat of a competition feel, which is really kind of sad to say, but it is saturated. So people are looking for clients. We definitely do have some membership communities. I shouldn’t say membership like Facebook communities where we talk to one another and help [00:07:00] one another and finding referrals.

But it’s very insurance-based in that. So I don’t get on those very often because they’re focusing on getting clients for certain insurances. So I don’t usually get those types of clients. It’s a different clientele.

Dr. Sharp: Sure. Yeah. So that makes me think of… so you moved from Colorado, how did you even decide to set up a private pay practice in this area? Did you scout it beforehand? Did you do market research? I mean, how did you even know that that was viable?

Whitney: I actually didn’t really do all that much to tell you the truth. The state decided for me because, in the state of Georgia, you cannot take insurance without being licensed.

Now, when I was in Colorado, I’d been licensed for several years, but Georgia has some different laws. And I could go into details if you were super interested, but basically, they would not let my license transfer, and had to go back and do more supervision even though I had already overqualified for the number of hours in the state. I  actually had a psychologist do my supervision [00:08:00] here in Georgia.

She did a fabulous job. I really loved that connection. And so I had to start out cash pay. And so I actually worked under a church because that was the only connection I could make when I got here and you have to have a director to be able to see clients. I tried to get jobs at other places in town, but no one knew me, and Savannah’s one of those you got to know somebody to get something. And so I met one guy fortunately through someone from grad school and then him and I came under this church. So they were the director, but we kind of did our own thing to tell you the truth.

And so I thought to myself, “Okay, I’ve got to do one year of supervision. Let’s try to build a cash pay practice. And if I can do it in one year, well, I go back” and so it worked. And I was full within a year and I was honestly about full at six months. So when the one year came, I just kept going.

Dr. Sharp:  That’s amazing. Were you pleasantly surprised? Did you think of what’s going to work or are you one of those…?

Whitney: Yeah, I was surprised. Well, when I was in Colorado, I [00:09:00] had joined a great group of ladies and they really mentored and helped me along the way. And we did cash pay. We had been at an insurance-based place. It’s another great story. We’ve been in a where the lady fired us all in one day. She called it bloody Monday. And it was bad.

And so we pulled all of our charts out as fast as we could before she locked us out. We contacted all of our clients and said, sorry, she just fired all of us. We’re going to set up shop elsewhere. We were in a new space within a week, but we couldn’t get on panels that fast. And I couldn’t get on panels at all because I wasn’t licensed yet in Colorado at that time. So we took cash and it worked. And so I had seen it work and so I thought I can do this again and I did.

Dr. Sharp: That gave you some confidence. Yeah. I love that. So let’s see. How long ago was this?

Whitney: How long have I been in Savannah?

Dr. Sharp: Yeah.

Whitney:  I started my practice in 2015.

Dr. Sharp: Okay. That’s fantastic. So you’ve passed the [00:10:00] five-year Mark, right? Isn’t that the thing that dreaded businesses fail in five years thing?

Whitney:  That’s what they say.

Dr. Sharp: Yeah. Well, congratulations! That’s awesome. These conversations about private-pay or cash-pay are always interesting to me because we have a pretty insurance heavy practice and I’m always curious how people are doing this out there, especially in areas where it’s super insurance heavy. So I’m excited to dig in.

Whitney:  Yeah. Again, I think so much of it has to do with the way you want to do therapy and how do you want to Market it? How much time do you want to put into your marketing?

If you’re an insurance-based practice, you can meet the needs of a lot of people, a lot faster. You don’t have to put so much into all that. You can still market and obviously be great practice and meet a lot of needs. But the way that you talk about your practice and the way you talk about counseling, I think is a little different for an insurance-based practice than a cash pay practice. So it really does dictate a lot of the way that you run your [00:11:00] business.

Dr. Sharp: Yeah, absolutely. And I know that you’re primarily doing therapy of course, but I think a lot of these things will probably translate to testing just some way that you present your services and talk about your practice and so forth.

So we’ll just sort of make that translation here at the beginning and let that apply here as we talk. Maybe that’s a good place just to dig into it. From the, I guess you’d say marketing perspective, how do you talk about your practice differently and present it to others in the community?

Whitney: Yeah. And so a big part of that is educating people on how insurance works. A lot of people think, especially in mental health, like mental health is a different ball game when we talk about healthcare and when we talk about insurance. So some of it is helping them understand some of the taboos around mental health and getting rid of some of those.

And then they don’t know what kind of [00:12:00] information is sent to the insurance company. All they think is, Hey, I give you my copay and that’s it. They don’t think about how you’re interacting with them. And you’re giving them information, especially if their insurance is through their work in such a way that’s very intertwined. Like you’ve worked for the city and so the city holds your insurance information, and that you have to be given a diagnostic code to be able to send that off. And then based on your diagnostic code will determine if they think you need services.

And I explained to clients in the same way that if you need heart surgery, your primary care doctor would have to send you to a cardiologist.

And that cardiologist would have to have a legitimate code for giving you heart surgery. Insurance is just going to pay for it. Like you have to have a legitimate reason for needing therapy for major depressive disorder and that code has to be sent to your insurance company and they will approve it just like with any treatment.

And people don’t think about that part. And unfortunately, we’d like to think the world is very confidential, but not always. The more people who have your information, the more concerning it can be. I think it was [00:13:00] in, you can maybe correct me, I think it was in 2014, there was a breach with Blue Cross and Blue Shield and tons of records got out. And yeah, we hope stuff like that doesn’t happen, but it does.

And so insurance does create a record for people. For example, if you were to become… if a child wanted to become a pilot or military, sometimes that information is found and so we want to protect you as much as possible. I do tell people, use their insurance if they need to. Don’t let that determine you not getting help because the most important thing is that you get help.

But if you can avoid it, then avoid it. I mean, I have a child, she got tested, we can talk about that a little bit about her experience. But yeah, we used insurance because I’m going to have to use insurance the rest of her life to get her care. And so that code is going to be there and I’m okay with that.

Dr. Sharp: Sure. Do you find that that’s a compelling reason for people to go cash pay? Like when you have that conversation with them, are they like, “Oh, I didn’t know that. I’m going to [00:14:00] avoid that then and go cash pay.”

Whitney:  Some. I mean, for some of them, if they’re coming in for something that’s not severe, I guess I should say, maybe they just have a situation they want to talk about or they just want to have a better life quality, and they don’t really have a legitimate diagnostic code. It could be a V code or something like that. Insurance is going to be a lot less likely to cover that. And it all depends on what their benefits are, right? So those situations I’ll say, or maybe it’s a couple that wants to come in, like, you know, your insurance, isn’t going to cover this kind of couples therapy that you’re asking for?

And so yeah, you could try to go somewhere else. It’s probably going to get denied eventually. So you might as well do this. So it’s helping them understand how that billing process works.

Dr. Sharp: Sure. Are you having these conversations? When people call to schedule appointments or is it on your website? I’m just trying to think through the workflow here as far as client acquisition because I would think if they [00:15:00] knew you didn’t take insurance, they might be less willing to call in the first place.

Whitney: You would think, wouldn’t you? You’d be amazed how many people call and they have not looked at the website or have… even the psychology today, it’s clear that we don’t take insurance and they call and they’re disappointed. But I’d rather them call and then we can give them a list of providers that we know take their insurance and get them to the right place than not calling.

But yes, it’s on our website. We have a very clear description about insurance. We do accept other networks for the licensed professionals so they can come and we will give them the superbill and then they can send it to their insurance company for reimbursement and that does work some of the time.

Dr. Sharp: Sure.

Whitney: So, yeah, but we talk about it on the website. And then if they call, we have a discussion with them again about it. If they ask about it. It’s not all that often that we have to explain all that. Some people call, and when you give them the rate, they’re totally fine with it. Or that’s kind of becoming a little bit more of a norm than it was 20 years ago to cash pay for counseling. So it doesn’t surprise people as much as it used to.

Dr. Sharp: Got you. What about other [00:16:00] professionals? So these are the client conversations. Actually, before I move to the professionals, I’m curious how those conversations typically go with clients? Do they have objections? Do they have concerns? And if so, how do you talk through that with them?

Whitney: Yeah, a lot of people we’re really glad we explained that to them regardless, if they choose to use their insurance or not, they’re glad to understand the process and that their information gets sent somewhere else. That’s just good for them to know what’s happening.

I can even think about clients that I’ve had in my practice that did superbills. And I say to them, Hey, I want you to know your diagnostic code because someone else is going to see this or your work. Normally work doesn’t get involved, but what if they did, because they manage your insurance. And I want you to know what’s going on with this piece of paper because it’s your information. Sometimes that makes people not want to bill their insurance because they don’t want anyone to know like marijuana abuse or something like that.

Dr. Sharp: Sure.

Whitney: Yeah. No, I just went on a train there. I don’t [00:17:00] remember what else I was thinking about that situation with that client. He was so pissed at me. Yeah. I was like, well, you’ve been abusing marijuana. We’ve been talking about it every time he’d come in. I can’t put that on your diagnostic code. You’re doing it every single day for several hours and it’s impacting your job.

Dr. Sharp:  Yes. It seems like a no-brainer. Well, I did have another question that I was going to ask you, like, just very detailed. When is this conversation happening on the phone when the client calls? Is this right at the beginning or what? How do you work this in?

Whitney: Yes, this is such an important question. So I train people on this as well as part of having a cash pay practice. This part is really important when people call, the first thing I have them say, the assistant will ask is “Give me your name and your phone number..” She says it a lot nicer than that “…because if we get disconnected, I want to be able to call you back.” Right. And you’d be amazed. If you start getting into that call, people just hang up. They don’t give you a number. You can’t follow especially if you end up getting into a dangerous [00:18:00] situation, you want to be able to get back in touch with them for whatever reason.

And then the next question is, how did you hear about us? Because referrals are super important with the cash pay practice and following up with every single one, you always want to know where you’re putting your money in your marketing and what’s working and what’s not. So that’s the next question we ask.

Dr. Sharp: Sorry to interrupt. Is your assistant… I know we track intake phone calls through a Google form. We’re filling it out. Do you all do something like that?

Whitney: We do the same thing. It’s so helpful. And it gives that cool paragraph. I’m like, I could see my numbers really fast.

Dr. Sharp: I love it.

Whitney: I love it. Yeah.

Dr. Sharp: Nice.

Whitney: So after we find out where they got our name and number, then we ask them, “Well, what’s bringing you into counseling?”

We find then maybe the listeners are thinking this, when you call a place and the first thing they say is, “What’s your insurance?” You can tell me this, Jeremy, what does that feel like to you when you call a place in the first question they ask is what’s your insurance?

Dr. Sharp: Well, [00:19:00] there’s the assumption that I’m going to use it at first of all, which for me is not always true. We’ve opted not to. But it also kind of puts the financial piece right front and center. Like that’s the only thing they care about.

Whitney: Yes, exactly. And so when we speak to the clinical issue first, it shows that we care about the client and we care about the reason they’re coming in and it’s not necessarily about the money.

Now the money’s important. We’re going to talk about it, but we’re going to talk about their safety and their clinical concern first. So we build that rapport right there on the phone call and that’s going to help encourage them to come in because we know that so many practices don’t pick up the phone. They don’t call people back or they pick it up and they’re not friendly, or they don’t explain the process. Well, I can’t tell you how many times somebody would call and they’d say, wow, someone answered the phone. That’s the first thing they say and we’re like, yeah, we always, we almost always answered the phone. That’s so important.

And I especially think it’s important with the cash-pay practice because you’re going to lose [00:20:00] that client if you don’t answer. And when people finally call, we know that they’ve waited too long. Anyway. Right. And a lot of times they’ve thought about it. I mean, I can tell you that when I’m going to make a phone call, sometimes I wait for weeks before I call the doctor. You just don’t want to deal with it. And then you’re finally like, “Okay, I have to deal with this, let me call.”

Dr. Sharp:  Absolutely.  I’m going to interrupt you a lot because I have a lot of questions here. So tell me how, how many clinicians are in your practice, again?

Whitney: There are seven of us. We’re adding an intern next week, so there’ll be eight next week. So I’m excited about that. Yeah.

Dr. Sharp: Nice. Well, so the reason I ask is, I think a lot of us with group practices as they get larger especially kind of struggle with that live answer problem because of the phone calls, they’re just too many phone calls and we can’t seem to, and it sounds like y’all are spending a lot of time on the phone with people when they call. It’s at least I’m guessing 10 minutes maybe.

Whitney: If they schedule, it takes about [00:21:00] 20 minutes to get all the information. Yeah.

Dr. Sharp: Sure. So if you just do the math, that’s not a ton of phone calls in the day if you want to have time for something else, right? So I’m curious how you’ve handled that problem from a staffing standpoint and how you approach that because it is important to answer the phone, especially in a cash pay practice to acquire those clients.

Whitney: Yeah. So I’ll kind of share with you a little of my story of this because I think this will help listeners depending on their face of the practice. So when I first started, I was getting about three to five calls a week. So now we’re maybe three to five calls a week, one to two new clients a week. So not very much, but it was enough where I was tired. I couldn’t get back to people. And then I started growing a group practice and that became a couple more calls, not that many. And I hired my first assistant. Very part-time.

And then when I got to four clinicians, we were getting more like 15 [00:22:00] calls a week and she couldn’t keep up anymore. She was a work-from-home mom and so then I brought on a counselor who was a part-time therapist, part-time phones. Not a lot of people do that. I was really nervous about it. It actually turned out really great. So if someone’s needing someone in a bond and the more people you have trained on phones, the better. Someone goes on vacation, you’ve got somebody or someone’s sick.

Dr. Sharp: Right.

Whitney: And then her caseload filled up and then we were like scrounging around for someone else to answer the phones.

And so then I hired someone else and then the girl that had originally answered phones became the office manager. So what’s really great about that is that basically got two people to answer the phones now. I have the assistant or the intake specialist is what we call the office manager. And we have a phone tree. So if the intake specialist is on the phone or doesn’t answer after two to three rings, it flips over to the office manager, and then she can get it. So that’s helped us answer more live calls to have two people available.

Dr. Sharp: Great. Yeah, it seems like that’s an [00:23:00] ongoing problem for me and for a lot of other people, just so many calls. So we were talking about the phone call which you’re answering lives, like you said, as much as you can. So you’re talking about the client’s concern. You’re building rapport, you’re spending 20 minutes on the phone with them to go through the whole process. That’s a lengthy phone call.

Whitney: Yeah, usually we can get through the clinical part within the first five minutes. By the time we hear about how they know about us and everything. And then we hear about that and then we recommend a therapist or we might ask them a few specifying questions like, do you have a substance abuse problem or any disorder or whatever, and make sure we get them with the right person.

And then after that, say to them, “Okay, well, what are your hours? When are you available?” Because we want to make counseling as accessible as possible. We don’t want times or distance or whatever to make it more difficult for somebody. So, Hey, do you need Telehealth, or do you want to come in, and when are you [00:24:00] available? Like, can you do Saturdays or whatever?

And then we recommend a therapist that has those hours, but also that we think really meets that need and even above that, explain why we recommend that person. So we might say like, “Amanda’s our child and adolescent person. Amanda has been working with kids for years.

She likes to do some play therapy. She’s really great at communicating with the school counselors. These are the reasons why Amanda is a good fit for your child, instead of just saying, Hey, I’m going to schedule you with Amanda.: That really buys them into that relationship with that therapist from the beginning.

Dr. Sharp: Sure. Yeah, I think that’s important, especially…. you can tell me if this is right or wrong, I think of cash pay practices as a higher level of service that there’s that expectation from us or from the client that it is more high touch, more personalized,  almost like a concierge thing where you’re doing a little bit more to match and take care of the [00:25:00] client than an insurance-based practice. Is that accurate?

Whitney: Definitely. And I tell everyone when to hire them and bring them on the counselors, I say we’re giving them an excellent client experience. So when they come to our building, actually it’s a really old home built in the thirties. And if you can imagine Savannah, the Oak trees, and the moss hanging down, like when we found this building, I thought this is the place I thought I’d be 20, 30 years down the road in my life owning a practice.

But like, it’s beautiful. It’s two stories. I have five offices and wood floors. I feel very fortunate to be there, but it has that cozy feel. You’re not going into a white sterile office like all other offices in the area. And when you come in and we have coffee brewing when it wasn’t COVID, but we’d have coffee brewing and water and soda and chocolate, and you’re really trying to give them extra when they come in. So that they’ll want to make that step coming back because yeah, they’re paying a lot of money to be able to come in for therapy. So that plus the experience [00:26:00] really helps.

Dr. Sharp: Sure. Are there any other experiences, items, things you can think of to kind of increase the value add for clients coming in?

Whitney: Yeah. I do know that some practices do a lot more as far as like a Christmas gift for clients. And I’m talking about something small like I knew a practice… Wow. You’re asking me. I recently knew a practice owner who gave journals to clients like $3, $5 journals with stickers of their practice on them. We don’t do that stuff, but I do know that cash pay practices do do that. That seems like a lot of work.

Dr. Sharp: Well, I just think as you grow, especially in a group practice, not from a financial standpoint, more just logistically like, hundreds of journals or whatever the item is that you’re trying to coordinate, but yeah, maybe there’s the infrastructure to do that at some point.

Whitney: Yeah. We [00:27:00] do go above and be with our referrals in our referral network. So you’re giving them a really good experience. We do give them gifts on a regular basis, not big gifts, not manipulative gifts, but like, some cookies from a local place in town, at Christmas with a sticker on it that says joy and wellness or something simple like that.

Every time we get a referral, we call that provider. And speak to them about the referral. I think a lot of places are just too busy to do those things. That’s especially big far schools that were calling the school counselors. Hey, what’s going on at the school with this child? Here’s what’s going on in therapy. Here’s how we can work together. And we try to really make an effort to do anything that’s asked of us. So if a school calls and says, “Hey, will you come do a training with our staff on X, Y, and Z?” We really try to go out of our way to do those kinds of things because that’s how you’re going to get those referrals.

It’s the relationship that they can call you and talk to you about things. They’re going to refer to you if there’s someone else that they can’t get on the phone, or they don’t know what’s going on in someone’s treatment, they’re going to be a lot less likely to follow up with that person.

[00:28:00] Dr. Sharp: Yeah, right. I think that’s such a good point. Now, from a business standpoint, do you pay your clinicians for the time involved to do that?

Whitney:  No. So I include that as part of the treatment. So they have an hour that they get paid for. The sessions are 45 to 50 minutes. So that gives them 10 to 15 minutes of more pay to make whatever call they need to make, or if they need to write a treatment note, something like that. That’s kind of included in that. Now, if we get asked to actually go into a presentation or a networking event, they get paid for those types of things. Yes.

Dr. Sharp: Sure, okay. Got you. So those incidental contacts or collapsed contacts are included in the session, right? Yep. That makes sense.

So let me rewind way back. I don’t know if we closed the loop on when during that phone conversation, you’re talking with people about insurance because this is sort of like the closing the “sale” moment, right? So how do you work that in?

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Whitney:  Yeah. So then after we set them up with the right therapist, we’ll say, okay, well, here’s the time that’s available. Does that work for you? And they’ll say yes. And then we’ll [00:30:00] say, and want to make sure that and I’ll say, Amanda, because we’ve been talking about her, I’ll say Amanda’s rate is $110 an hour. Are you comfortable with that rate? And they’ll either say yes or no.

Now, sometimes people are still confused and they actually come in and think we take their insurance, which still amazes me, but we try to make it super clear on that phone call. Hey, this is what the rate is, we’re cash-pay practice.

And then we do follow up with an email. Again, this is Amanda’s rate, we’re a cash pay practice. We put it in the paperwork, we send it to them in advance. So they have three different ways of hearing that we don’t take insurance. And this is what the rate is just to make sure.

Now when you get to that point, a lot of times people will say, Well, I have this insurance and then we have to explain to them, Oh, we’re not networked. And then we do offer, and then we do this extra step talking about clinical care. I mean the extra experience for the client, we will say, we are happy to call your insurance and check your benefits for you. At least that way, you know what you’re getting yourself into with mental health.

So one of the great things about that [00:31:00] is it puts us back in control of the situation. So we know what’s happening for that client, as opposed to saying to them, well, you go check your benefits. And plus they don’t want to make that phone call. It’s confusing. They don’t know how to get through to somebody.

And then the person tells them and they don’t know what all those numbers mean. So for us to call and get those benefits, and then we call them back and say, Hey, you know what? You have really great in-network benefits. You only have a $30 co-pay. We would love to work with you. But if you want to use this, we understand. And here’s some places that we would refer you to. Or if they have out-of-network benefits, we could say, Amanda’s not able to take your insurance out of network, but here’s another therapist at the practice that can, here’s how that works. Or sometimes their deductibles are so high or their code pays are so high. Like if your code pays already $`80, don’t go through the trouble of billing your insurance that may say, you know, three months down the road, we don’t want to cover anymore. Like, go ahead and just pay cash and not have to deal with that. Do you really want this other person dictating your treatment that doesn’t even know you?

Dr. Sharp: Right. That’s such a good [00:32:00] point. So that’s again, just another piece where you were helping remove hurdles. It sounds like it for them. And I totally agree with that. Bringing that back under your control makes such a difference because clients, I mean, nobody wants to make that phone call. And like you said they don’t really understand a lot of the time either what insurance numbers mean.

I’m interested to know how this comes across in the conversation. I would love to hear one of these phone calls. I know that’s impossible, but just the salesy part of like, ” Well, hey, listen…” You present it very straightforward, right? Like you have an $80 code pay. You might as well just come and pay $110 and not even mess with insurance. So just laying it out clearly seems important.

Whitney: Yes, definitely. And a lot of people do ask me this, so I’ll throw this [00:33:00] out there. And when we’re running our numbers each month, I’m always looking a how many clients converted on those calls? How many of them did not? How many said that they wanted to use their insurance? Almost every single month, 20 to 25% we lose because of insurance.

Dr. Sharp: Okay.

Whitney:  But that’s not that many in my mind. We usually convert somewhere between 50 to 55% actually schedule an appointment. And then a lot of the other ones, it’s just random stuff. Well, you didn’t have a time that worked for me, or by the time we called them back, they’d already scheduled elsewhere. All those types of things.

Dr. Sharp:  Right. I love tracking numbers. I’m glad that you brought that up. So tracking that conversion rate is super important. I would be curious, I’m sure there’s research out there about conversion of private pay versus insurance.

Whitney: Actually, I know what that is.

Dr. Sharp: Do you really?

Whitney: Yeah, I love numbers too. I track my numbers every week on my practice, all that stuff like retention, and how are the therapists? Are they seeing their clients? How many [00:34:00] sessions they do, and then going into Google analytics. It’s like, that’s so much fun, right? So cash-pay practices tend to convert at least 30% when you get into 50%, you’re doing pretty good as a cash pay practice. Insurance-based practices, it’s more around 70 to 80% convert.

Dr. Sharp:  Yeah.  I think this is a nice segue then into referral sources and how you get those folks in the door. It sounds like you have a pretty high conversion rate for a cash pay practice which is fantastic. But it is a numbers game than that you have to maybe get more people in the door. So that 50% conversion is at par with 70 or 80 at a different rate on insurance-based practice. So where are your referrals coming from?

Whitney:  Yes. So over 50% of them are through Google. It’s probably 50% to 60% in a given month. And I do a lot of stuff with marketing and the website. In fact, I had someone who [00:35:00] was a contractor who was helping me, but then I hired her part-time in July. She’s the marketing director and so she does SEO and she does all the social media stuff. Oh, it was so great when I hired her. I was so happy to get that off my plate and not have to even think about, “Hey,  what theme are we working on this week? What videos are we putting out?” Someone else does all that now and I can just be hands-off with it.

So once I invested in SEO on my website, though, I would say the practice tripled in the number of calls within a few months. That was a few years ago that I really started working on that.

Dr. Sharp:  Got you. So most of those  Google searches, is that like just organic search traffic or are you paying for ads as well?

Whitney:  No, actually I’ve never paid for ads before.

Dr. Sharp:  Oh, that’s somewhat surprising.

Whitney:  I know. I feel very fortunate about that. I think Google ads are really great and other ads in general, are really great if you have something you want to target really specific in your practice, like if you bring on a new clinician who does eating disorders like a target that, [00:36:00] but SEO, I say it’s the gift that keeps on giving. Like once you put your money into working an SEO, you will have it forever. The ads are just a small amount of time and then they’re over.

Dr. Sharp: True. That’s a good point. So how did you know how to do that in the beginning? Did you just get lucky and write good copy right off the bat or did you hire someone when you were setting up your website or what?

Whitney:  No, the contractor does it for me. I did create my own website at the very beginning, super basic. When people called and said, I like your website, I’d laugh. I’d be seriously, it’s terrible. I didn’t say that far but said it’s terrible.

And then every relationship, this is just a motto of mine, every relationship could lead to something, right? So many people at my practice have been people I’ve just known through other ways. So the person that created my website was my nanny’s husband years ago. And he was getting his master’s in [00:37:00] graphic design at SCAD, which is the Savannah College of Art art and Design. And he’s such a great guy and he still does the updates on my website and helps with that.

And then Molly is my marketing director. Her daughter and my daughter were like first friends when we got to Savannah. Like 18 months old, they were in the baby room together And we met. And we’re out at the pool one day, and I’m like, “What do you do for work?” She’s like, “Oh, I help physicians on their websites and social media.” I was like, ” Really, I can go for that.” So she just started really part-time. She did real basic SEO on my website and made huge differences.

In fact, right now she’s going through Jessica Tappana’s course.

She has a 12 part course that you can go through. And so, my marketing director is going through it and updating the website as she goes. She’s been doing it all for me. And then as far as the copyright, I did do the writing for a while, but now I have my clinicians do it because they know their area better than I do for service pages and stuff like that. And I just pay them an administrative right to do that and then Molly goes in and updates [00:38:00] it and puts all the fancy stuff on it and we put it out.

Dr. Sharp: That’s amazing. Let me ask you. What led you to hire that person in-house versus outsource it like a lot of us do?

Whitney:  Probably because I like control.

Dr. Sharp: Well, that’s fair if I can get…

Whitney: Yes, I’m very controlling with my practice. And honestly, the other part that… that sounded so bad that I said that. The other part is I actually just really like her. And I was really concerned about our friendship because she’s the only person I’ve brought on that I was friends with before I hired them.

But we really talked about that a lot in advance and have really worked together to figure out that relationship. And she was looking for a job. She was doing contract work, but she just wanted something more stable and she was wanting something more relational. And we have a very family feel to our practice. Like we get together like right now we get together and sit by fires outside. But yeah that’s why I brought her on and it’s actually been a really great fit for the [00:39:00] practice.

Dr. Sharp: That’s amazing. I know you’ve listed a few things, but just to pull it all together, what does she do in her role as a marketing person?

Whitney: So anything on the website that needs an update or is fixed, she does that. And then if she can’t do it, she sends it to the website designer. And he’s a contractor that I contract out to make changes. She’s also in charge of whatever social media we’re doing that week. We try to make themes based on what’s going on. So she’ll decide what the blog is going to be about. Sometimes she writes it and she’s a fantastic writer. I’ve been really impressed. But then sometimes my office manager also likes writing blogs. They fight over who gets to write the blogs actually, which is just so funny, right?

But they’re both really good at it and I hate writing them. So I let them do it. And then Molly will be, the director on, Hey, here are some videos we want to put out or I want a therapist to talk about this idea. So she’ll reach out to that therapist and they’ll make a five-minute video and she’ll do the SEO and get it put [00:40:00] up.

She also does all the referral stuff. So every time we get a referral, we put it on that Google form.  We get that call it’s on the Google form regardless of the person scheduled or not because sometimes they’re not going to schedule because we don’t take their insurance, but we want to follow up with that referral source and say, Hey, you know what, thanks for that referral.

So she will write a card, a handwritten note that says, thanks for the referral. Three to five sentences we enjoy working with you. It’s always really thoughtful that you think of us, no client information, just a general note. And then when we give out gifts, she was in charge of all that, putting the cookies together, creating the stickers, and then delivering all of them. We keep her busy.

Dr. Sharp: It sounds like it. So how many hours a week is she?

Whitney: She does about 20 hours.

Dr. Sharp: Yeah. Got you. That’s really cool. You can choose to answer this or not, but just from a compensation standpoint, how does this position compare to like an office manager or a [00:41:00] receptionist? You don’t have to give exact numbers, but just like relatively what are we talking about if we wanted to do this?

Whitney: Yeah. I can say she’s the highest paid of all the admin staff. And she also has a college degree and a lot of experience. And she’s been in the workforce for longer. So she has lots of reasons to pay her more. She has been very kind to let me pay her a low rate and that’s because she really wanted a consistent salary.

She was tired of not knowing what was happening and she also really wanted just one job instead of having all these different places she worked for. It just made her life more simple. And a lot of people work at my practice because of the culture I create. So it is not about the money, but it’s really about the people, right? We know that about all of our jobs. You could pay us so much, but if we don’t like the people we work with or the work we do, no one wants to work at that job.

Dr. Sharp: Right.

Whitney: So there’s a lot of flexibility. We all have young children. In fact, every single one of us except for one [00:42:00] has children. And so we make it flexible. It’s not like she has to work from this hour to this hour. As long as she gets the job done. So she might be at the beach or sitting by a pool or whatever she wants to do. And that makes it easy for her.

She says to me, my kid is sick or like, I think her kid had to quarantine. And so someone else went and delivered the bags and so we’re very team-oriented. So I think that’s a part of why someone’s willing to work for us without making an optical amount of money.

Dr. Sharp: That’s fair. Yeah, culture can make up for a lot. I mean, it counts for a lot. So tell me, since we’re talking about the money component, those being private pay, running a group practice, does that affect the compensation of your clinicians?

Is it higher, lower than an insurance-based practice? Not monetarily. I’m assuming it’s higher just because it’s more money per session. But if you want to think of it like percentage-wise, are group practice owners who are cash [00:43:00] pay to pay their clinicians a higher percentage or not so much.

Whitney: Yeah. I’m not quite sure how everybody does it. I still run my numbers about the same as an insurance-based as far as compensation. So if you have a W2 practice, all employees giving them around 40% to 45% is a pretty good ballpark for the revenue that’s coming in because you’ve got to pay for so many other things.

So that even includes if you have benefits that would be included as part of that. Now we don’t have benefits, so I can pay them a little bit extra because that’s not included. There’s a lot of reasons for that, but that’s about what they make 40% to 45% of whatever the client is paying for that session. And then they get paid. I also do a tiered system. So the more clients they see, they actually get paid more per hour. So it gives them the incentive to see more clients in a two-week period that helps as well.

Dr. Sharp: Yeah, that makes sense. That’s interesting. 40% to 45%, I guess, is on the lower side of what I’ve heard the other [00:44:00] W2 practices. So I don’t know if I have a question in there, but maybe just a reflection.

Whitney: You’re definitely making a point. And when I do consulting, I actually was just talking to someone before this call. People pay a lot. People pay their people a lot because they’re worried they’re going to leave

Dr. Sharp: True.

Whitney: And so many practice owners, which if next time someone says that you should ask them if they pay themselves enough because a lot of practice owners do not pay themselves enough. If you’re a medium-based practice, if you’re making over $400,000 a year, Which I consider kind of medium size there to the like $500,000- $600,000, then you should be paying yourself at least 20%. Most people are not. Is that true or not? 

Dr. Sharp:  Yeah, that’s a good point. There are so many questions within that. But I can get past that. We could go down. People do ask about that a fair bit. This is maybe getting away from cash pay specifically, but just profit margins and what we could expect from a [00:45:00] group practice. And yeah 20% when you’re on the lower end, smaller to medium-sized practice, I think it’s pretty reasonable.

Whitney: Well, the smaller you are, the more revenue you take in. So if you’re a smaller group practice, just a couple of people, you should be taking about 50% of what’s coming into the practice.

Dr. Sharp:  Right.

Whitney: And no one does that.

Dr. Sharp: Yeah. Well, and I think that a misconception of people doing group practice is like, the bigger it gets, the more money I’m going to make. And I mean, that is literally true. Like you will make more money, but it’s a lower percentage certainly of the revenue most of the time as practices get bigger.

Whitney: That’s right. It’s all a numbers game. And you got to run your numbers right or you’re going to mess yourself up in the end or resent your job. I remember when I was first starting, I paid my people too much. I’d started with contractors, and I would write that cheque and I would be like, why is she making more than me? I run this thing. And [00:46:00] so then I changed everything and I did the W2 model. I was losing contractors because they would go start their own practice. It was so much easier. And then I really worked on my culture and the way I was doing things and things turned around. So, no problem.

Dr. Sharp: So one of the questions in there with compensating at 40% to 45%, I’m sure that is something you figured out just based on your overhead and revenue and all that stuff and what is feasible. And I’m guessing there are practices in your area that pay more than that. So that leads me to the question of what are you doing to keep these clinicians on board when they might be getting paid a lower rate or percentage than they could make elsewhere?

Whitney: Sure. Well, a couple of things here. First, with the cash-pay practice, we tend to take in more money per session, right? So our lowest rate is $100 all the way up to $200, depending on the licensed person and the experience and all that kind of [00:47:00] stuff. So, if you’re billing insurance, if the insurance is paying out $120 and you’re charging for cash $150, you’re actually making more to your cash pay practice. So your percentages change so is the amount. So that’s one thing to think about. So they technically could still be making more with me even if they went somewhere else that took insurance.

Dr. Sharp: Yes.

Whitney:  And the other thing is you have to make it desirable that they want to stay. Like, I don’t put too much work on them. They get to come in and easily do the work that they want to do. Or I provide them a bonus every year, or I do provide a PTO, which a lot of places don’t do or they get continuing education every year which is covered by us. We try to do one fun event a quarter where it’s usually some kind of nice meal and enjoying our time together. So that helps.

We do like group text messages. Lately., we’ve been sending each other funny videos where we do parodies, [00:48:00] get them and we’re laughing and we have all these inside jokes. So I think that makes people want to stay. Why would I want to leave something so great unless I wasn’t happy about something going on.

Dr. Sharp: Yeah, sure. That’s like a culture component for sure. And just to spell that out for people to double back to the rate and percentage and all of that. So many making 40% of $200, that’s going to be $80, right? So if you compare that to somebody making 50% of a $100, that’s a lot more money. The 40% is a lot more money. So just the fact that you’re charging more per session, even though it’s a lower percentage, it’s going to be more money overall for the clinician.

Whitney: Yeah, and it tends to be less work too, right? They’re not having to bill insurance or if the insurance doesn’t want to pay them, they’re going to get on the phone with someone to discuss that they don’t have to do any of that stuff. They don’t have to fill out any forms. So it’s less hassle for them and the client, which is really nice. And then I don’t have such high overhead with [00:49:00] my admin staff in that sense. I’m not having to pay someone to follow up with insurance and do all that billing. The clinician just hits the card in the EHR and that’s it.

Dr. Sharp: Right. Yeah, I think we underestimate the amount of time that it takes with insurance or that insurance takes up especially with testing. It’s complicated. Checking benefits can be hard. Following up on denials is hard. Here are a lot of hurdles that come upon you to take insurance for testing.

Well, let me see. What else? We talked about referrals. You said a lot of it comes from Google. Are you doing anything else referral-wise to connect with people in the community or diversify your referral streams?

Whitney: Yeah. Some other things that we do are we create good relationships with [00:50:00] churches. My husband is a pastor. And so that’s a big part of how I got going was use those networks that you have and that was the first one I had. We used those. And so a lot of times the church might say, ” Hey, we’re going to cover the first session for this client.” And then after that, we call and we say we did the first session. We think this client’s going to need eight sessions. This is what the rate is. And the church will either pay this portion or we won’t pay it all. Or the client will say, I can cover this. So that helps, especially as a cash pay practice to have someone else help pay for the treatment for somebody when they refer them.

Another really great thing we have is a relationship with an organization called Cure and it’s to help with childhood cancer here in the state of Georgia. Yeah. And it was amazing. My assistant knew the girl that was in charge of the marketing and the client relations at Cure. And so we had lunch with her and she said, we need a place to send people for counseling because we know that counseling helps with cancer patients and [00:51:00] helping their mental health, but also less likely to get sick when they’re in treatments. That’s really great.

And so we have a partnership with them and they pay for the first 10 sessions for our client. We do a reduced rate for that. So that’s a really great relationship that we have with them. So I think having those relationships and whatever, you can create an offer to make it beneficial for the person referring, make it easier for them if that’s a discount or they have access to you more quickly or whatever that is. That helps.

Dr. Sharp: Yeah, absolutely. This has been so valuable. I feel like we packed a lot into.

Whitney: I’ve enjoyed our conversation. I looked at the time. I was like, ” Damn, this went fast.”

Dr. Sharp:  I know. It’s going fast. Are there other considerations on anything that I didn’t ask or we could have talked more about in terms of just things you’ve learned for sustaining and growing a private pay practice?

Whitney: Yeah, we’ve [00:52:00] discussed it, but the referral relationship is a big one. I think a lot of people reach out to someone to form a referral relationship. If it’s a school or maybe a doctor’s office or whatever, and then if they don’t hear from them, they don’t reach back out. And just because you don’t hear from them doesn’t mean that they don’t think you’re a great therapist. They don’t like you. It just means no one’s come in that needs your services at that moment. And so consistency is really important. So in the first few years of my practice and also… I wasn’t getting tons of referrals. I was getting them very slowly. And then I was consistent about my relationships with people.

So every three to six months we track how often we hear from people. So if we don’t hear somebody six months down the road, we reach out to them and in reaching out, it doesn’t have to be a big deal. It could be a quick text message that says, Hey, how are you doing? Or especially when COVID started and the relationship I had with churches, it was, “Hey, this is tough on people. I bet you’ve got people in your [00:53:00] church calling you up needing help. We’re here for you” or whatever the case may be.

Same for schools. A lot of students were really struggling. They still are, but really struggling at the beginning of the pandemic reaching out to us. So being really intentional about your referral sources in doing it over and over again even if they don’t reach out to you, just being consistent about that relationship really over time to make a huge difference.

Dr. Sharp: Yeah. I get that. That’s like compound interest in a way. It just keeps on building.

Whitney: That’s a good one.

Dr. Sharp: Yeah. How are you tracking that? How do you track how often you get to them?

Whitney: So I used to do that myself and now my marketing director does it. But I wish I could tell you, we have this perfect system, but we don’t. We still are trying to figure that out. So if someone’s listening to this podcast, like reach out and tell me your perfect system. Right now, we use a Google sheet. We have them all really organized at the bottom with tabs psychiatrists, schools, whatever. And then we have all their contact information. And at the back, it says, around the end, it will be like how many contacts this year? And when’s the last [00:54:00] time we heard from this person.

Dr. Sharp: Got you. I love the technology piece and systems. And is there some software that can pull all this together? I know everybody’s always looking for a CRM software that will integrate with our EHR and work for mental health practice. So maybe that’s what we’re digging into here, but I don’t think there’s a perfect answer that I’ve found yet.

Whitney: Well, I need you to create that for us.

Dr. Sharp: I will work on that when we’re done here and we’ll be back with you in a week. I’m just kidding. Yeah. So let me see, what else you up to? I know that you’ve… we didn’t really talk about this at all, but you are a coach as well or a consultant? I don’t know which.

Whitney: That’s right. So I work with Joe Sanok at Practice of the Practice. A couple of different niches I have: one is helping cash-pay practices. Some people will call and they want help on getting off of insurance panels and [00:55:00] growing that revenue stream with cash pay. So I help those group practice owners.

I also help people go from a solo to a group practice. And then I help people that have faith-based practices. So like, how do you integrate faith appropriately without overwhelming clients with religion. But how do you make that apart, especially in the South, as you know, we get a lot of calls from people who want Christian-based counseling? And so how do you offer that ethically and appropriately sets another part of the consulting that I do. So I really enjoy that part.

So I probably am in the practice and then I see about 30% of my time with clients, about 20% to 30% of my time with admin responsibilities, and the rest of it I spend consulting.

Dr. Sharp: Yeah. That’s awesome.  And you said you are launching a membership program, is that right?

Whitney: Yeah. So Alison Pigeon another one, a consultant at Practice of The Practice. We together have two membership communities actually. One of them we launched back in October, and then we just launched our second cohort which is called Group Practice Boss.

And those are for people who have established group practices of at least three people or [00:56:00] more. And until we really focus on the systems and the hiring and things that further group practice owners are really working on. So we have lab events every week and when we deep dive into topics related to group practice.

 Right now we’re working on systems for the month of January. And then in February, we’re going to be talking about hiring and clinician retention and being able to keep those clinicians on and the cultural things we’ve been talking about today, actually. And then we’re going to launch another membership community starting in March called Group Practice Launch. And that is for people who want to start a group practice.

Sometimes when you’re in those starting phases, I think it’s great if you can get individual consulting, but not everyone can afford that or they’re not ready for that. So this will be a membership community to get you from a solo practice to one to two clinicians within six months. So we’re really excited about that. So that’s a group practice launch.

Dr. Sharp: Very cool. Well, you clearly have your hands on a lot of different things. And from talking to you today, it’s [00:57:00] clear you have a lot of experience and success in building this practice. So I’m glad that you’re sharing that with other folks.

Whitney: Thank you. Well, it takes a team, right? If I didn’t have my team, my practice would not be functioning anymore. And even with Practice The Practice, I get to work with some really great consultants and people that reach out to me for the consulting, they teach me to. I feel very fortunate with the people that have come around me.

Dr. Sharp: Sure. That’s well said. I think I mentioned it on the podcast before, but yeah, that was my initial jump into consulting was working with Joe way back when… so I have a soft spot for Practice of The Practice and everything y’all are doing over there. It’s cool to see the team is growing.

 Thanks so much for the time. This was awesome.

Whitney: Yeah. Loved it.

Dr. Sharp: Thanks for tuning in to my interview with Whitney. I really enjoy [00:58:00] this interview for a number of reasons.

One it’s just nice to talk to somebody else with a solid Southern accent. But Whitney was so kind and clearly deliberate about what she has been doing and building her practice and how she continues to build her practice. So I hope you took away some gems from this one.

Like I said, in the beginning, if you are trying to launch a testing practice here in 2021, I would love to help you with that. The Beginner Practice Mastermind is going to start on March 11th. Right now we have three spots available as of the time of recording, three spots out of six. So if you’re interested in a group coaching experience where you’ll get accountability, support, guidance, homework, and just the collegiality that comes from connecting with other folks, this could be for you. So you can get more info and apply for a pre-group call at [00:59:00] thetestingpsychologist.com/beginner.

Okay, everybody, have a great weekend. Catch you on Monday.

The information contained in this podcast and on The Testing Psychologist’s website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. [01:00:00] If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR.

The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConnect, PAR’s an online assessment platform. Learn more at parinc.com/faw.

Hey, welcome back everybody. Hey, guess what? We have a brand new podcast format for you to check out today. I am super excited about this. This is genuinely one of the most enjoyable podcast discussions that I’ve had, and I hope that you all enjoy it as well.

Here’s the deal. [00:01:00] I’m calling this, The Testing Psychologist Happy Hour. What we’re doing is I’ve invited four of my amazing colleagues to come on the show and just have a free-flowing discussion about all things testing, business, life, whatever we might stumble into.

And for a first go-round, I think it turned out really well. To be honest, even if this flops as a podcast format, it was a blast. It was amazing to connect with these folks. So that’s what we’re doing today.

Let me tell you a little bit about our guests. If you’re longtime listeners or Facebook group members, I think you’ll recognize some of these names. So I have Dr. Andres Chou, Dr. Laura Sanders, Dr. Stephanie Nelson, and Dr. Chris Barnes here for the happy hour discussion today.

[00:02:00] I’m not going to do separate bios for each of them because I think that would take forever. So suffice it to say, you can find each of them in the show notes, you can look them up and you can converse with any of them in the Facebook group if you would like, but they are all incredible psychologists, wonderful professionals, and even more incredible people.

So honored to have them all here to have this discussion which touches on all kinds of topics. We talk about the state of affairs here in month 10 of the pandemic in terms of our practices, we talk about self-care and how we’re doing that, we dive into a discussion on neurodiversity and inclusivity in our field, we talk about what measures we like and don’t like, we talk [00:03:00] about a lot of stuff.

This is a really great discussion. I hope that, like I said, you enjoy it as much as I did. As always with any of these new formats, I encourage you to shoot me a message. Let me know, did you like it? Did you not like it? And we’ll see where this goes. So without too much more delay, I want to bring you this wide-ranging conversation with four amazing testing psychologists.

Hey, welcome to all of you to the podcast. How are you? Chris, how are you?

Dr. Chris: Good. It’s great to be here. I’m coming to you from Kalamazoo, Southwest Michigan, where it’s 17 degrees right now. It’s not very fun at [00:04:00] all, but I’m in my guestroom, so that makes it a little bit better.

Here in Kalamazoo, I have two practices, testing forward. Lots of cool experiences. Lots of learning happening over the last few years. I am a self-identified OG of The Testing Psychologist community and have been around for a while. I’m super happy to be here.

Dr. Sharp: Awesome. Y’all are giving us a run for our money with the temperature. I think you’re lower than we are this morning, but that’s what we do here in the wintertime as Laura knows. Laura moved here from Texas but Stephanie’s next. Stephanie, welcome.

Dr. Stephanie: Hi, I’m Stephanie Nelson. I have a pediatric neuropsychology practice here in Seattle where it’s temperate all the time. It’s 41 degrees. I’m super excited to be here on a Friday morning.

Dr. Sharp: Glad to have you as always. I think we have all OGs of The Testing Psychologist [00:05:00] community on Facebook.

Dr. Stephanie: Did you just call us all old?

Dr. Chris: Original, not old.

Dr. Stephanie: All right.

Dr. Sharp: Original. Laura, how are you?

Dr. Laura: I’m okay. I’m not enjoying the weather. Having moved from Texas, this has been a little bit of a shock, but I still have a practice in Texas through Tele-health and then also seeing people here in Colorado. So running two practices, paying for two office spaces, using none of them.

Dr. Sharp: Amazing. Fun fact, Laura and I have offices 3 miles from one another, and we haven’t seen each other in person since she moved to Fort Collins because of COVID.

Dr. Laura: It was before that, it was crazy. How is this life?

Dr. Sharp: That’s nuts. I’m looking forward to the day when I can sit across from you again.

Dr. Laura: Me too.

Dr. Sharp: But we’ve got this in the meantime. [00:06:00] Thanks for being here. Andres, welcome.

Dr. Andres: Hello. Good to be here. I’m Andres Chou. I have been running a private practice since we last spoke. I’ve gone full-time into private practice in Pasadena, California, near LA.

Dr. Sharp: That’s amazing.

Dr. Andres: It’s been great. I wish I started earlier as everyone in private practice says. I’m a little bit different from most people; I do mostly therapy and a little testing on the side, but my testing is mainly with adults in personality-based things.

The weather here is, like you guys, freezing. I’m going to be that person from California and say it’s a cold 50 degrees. So it’s terrible.

Dr. Sharp: I have a lot of friends in LA and I do this weird thing, I don’t know, maybe y’all do this too, but on my weather app, I have the weather locations of where my friends and family [00:07:00] live. For some reason, it’s important to me to know what the weather is where they are, and LA is one of those places. So every morning, I look at the LA weather in the winter, shake my head, and close my eyes for a second.

Dr. Andres: We totally take it for granted here. When I lived in Chicago, this would be t-shirt weather. I’m freezing right now.

Dr. Chris: It’s 50 there and you’re wearing a sweatshirt and it’s 17 here and I’m wearing a t-shirt. This is great.

Dr. Andres: I have a heater and a space heater on right now. It’s ridiculous.

Dr. Stephanie: And then Chris has a ceiling fan on.

Dr. Chris: I got to keep the air moving.

Dr. Sharp: Right. I love it. I interviewed Joe Sanok yesterday for my podcast, he’s a Michigan guy, but they’re traveling. They did that thing though, where they bought an RV and are driving their family around the country like people are doing right now.

And so he’s in California right now. He’s recording [00:08:00] outside and was wearing a puffy coat, a down coat. I’m like, Joe, what is it there? He’s like, I don’t know, maybe like 60 in the shade. Come on, man. This is awesome. I’m so glad to have all y’all here.

As we floated this idea, it seemed like a dream to have all of you in the same place just to talk about business, testing and life but here we are. We made it work with the schedules and I’m excited. I’m curious, I just want to know what do y’all’s lives look like right now between COVID, home and practice? How’s everybody doing at this moment in time?

Dr. Laura: My kids finally went back to school, so I’m not homeschooling and seeing people at the same time. So that’s been really interesting and nice. [00:09:00] I am all telehealth, all sitting right here in this beautiful small room that I’ve converted into my office. Every day I’m seeing usually one, maybe two people. That’s what I do. I don’t leave here.

Dr. Sharp: Are you doing testing over telehealth?

Dr. Laura: Limited testing depending on the case.

Dr. Sharp: True.

Dr. Laura: Lots of rating scales.

Dr. Sharp: A lot of rating scales. That’s for sure. It was a blessing we’re in the same school district obviously or maybe not obviously, but we are. My kids went back too and it’s been amazing.

Dr. Laura: How much freedom?

Dr. Sharp: I know. My wife was the one who has been hanging with them during the day. She’s also a therapist and so she moved all our clients to the evening and does three, four, five, six, or whatever most nights.

[00:10:00] Anyway, when they went back to school, she all of a sudden gained 25 hours a week. She’s the happiest person ever right now, which makes the rest of us happy too. What about the rest of you? What’s life look like? Stephanie, how’s it going in Seattle?

Dr. Stephanie: I’m an introvert, so I haven’t really noticed. Has anything changed in the last year?

Dr. Chris: I see your dream come true.

Dr. Stephanie: Pretty much. Still, I’m doing testing. I’m doing a lot of the intakes and feedback. All of those are over telehealth of course. A lot of my business now is consulting work. And so that’s all over telehealth. So mostly I just sit in this chair but I do go in one day a week to do testing where I have the child seated 10 feet away from me, basically, with all the precautions in place. I have been doing testing like that since maybe about June.

And then on the weekends, my [00:11:00] husband and I still take our RV out and that dream you are talking about, that’s Joe Sanok’s doing, that’s what I would love to be able to do, Some mobile testing situation. I haven’t quite got there yet.

Dr. Sharp: Oh, that’s amazing. I see all the pics that you post. You do a lot of wildlife photography.

Dr. Stephanie: It’s a bit of a hobby, lo-fi wildlife photography. Like if you want a blurry picture of a deer, I am definitely your girl.

Dr. Sharp: There is a market for them.

Dr. Chris: Who’s downplaying that? I saw some of her photos and I said, what camera are you using? She’s like, I don’t know. It’s just some point in shoot. I’m like, where are you getting those shots?

Dr. Laura: Agreed, Stephanie knows all the things.

Dr. Sharp: This is true.

Dr. Stephanie: Andres, you’ve started a practice in the middle of COVID, what has that been like launching during this?

Dr. Andres: Somewhat say that is a bad idea and what are you doing? But it’s been amazing. [00:12:00] We had a tough decision to make. I was working a full-time job and teaching psychological assessment and then things shifted my position there and it was becoming impossible.

I can’t imagine you guys with multiple kids in grade school. My kid’s 18 months. And so I was watching him, seeing clients in the evenings or on the days my wife doesn’t work, and then trying to hold meetings during his naps. It was just too much. So we just talked about it and private practice was the way to go for the time being, but it’s been amazing.

On the therapy end, there’s just a huge need and also some of the best work I’ve ever done in therapy. I don’t know what it is. I don’t know how many of you guys do therapy, but it has been phenomenal. I think we all can collectively understand each [00:13:00] other, like what’s going on in all of us and just the intimacy of telehealth it’s, I thought it would be weird and it was at first, but then it became rather intimate. That’s how most therapists would describe it, that you’re really up close to someone.

Dr. Sharp: And in their home too. That’s what we found, seeing into people’s homes has added a whole layer of complexity and intimacy that we didn’t really anticipate.

Dr. Andres: Or in their cars or walking on the street sometimes and you have to explain to them but you go with it.

Dr. Stephanie: My husband is a group therapist and he runs men’s groups. He was worried about what it was going to be like having men’s groups over telehealth, but he said the same thing, like that little bit of extra distance has actually made the groups more intimate. People are more willing to share and the men are bonding more. It’s really amazing.

Dr. Chris: There’s no doubt things are absolutely changing.

[00:14:00] Dr. Sharp: Practice-wise, I’m curious to see where we end up after this. We all talk about going back to normal, but I don’t know. At least in our practice, I could see telehealth always being an option; giving people the option to do telehealth intakes and feedback if they want instead of defaulting to being in person. What are you thinking when you …?

Dr. Andres: Can I jump on that? Because where I am in LA, when we would do assessments, a lot of times we talked before I do these clergy assessments, and a lot of these denominations are pretty scattered. And so I would feel so bad about making clients drive like two hours to do a feedback.

At the time, we didn’t know the telehealth rules that well yet, and some of our team was researching it but now maybe they could drive out still for the testing part. I still rather do that in person as much as I [00:15:00] can but the feedback, it makes so much sense. Absolutely, I think it’s completely transformed everything.

California’s pretty large, say you specialize in something and you can have them just come in for testing for one day and then say they’re in Northern California, do the feedback that way too. There so many things you do, especially with the psychology stuff. I don’t know any of that stuff, because we’re not a psychology expertise but I’m really excited about what could happen with this.

Dr. Stephanie: Chris, what has it been like for you?

Dr. Chris: It’s been complicated. I was probably 75% assessment-heavy heavy and when COVID started to leash itself onto our environment, I stopped just about everything. It was interesting timing because therapy clients were really reaching out and I was 100% therapy for, [00:16:00] other than December, I haven’t seen a testing client since last March. And I was seeing 30 clients a week with therapy, which is completely masochistic, but there was a need and I had the time and energy to do it. And it was good.

I think that I’ve done some of my best therapeutic work over the last year. And maybe that’s just me wrapping some narrative around it, but I felt very effective over the last year just doing great therapeutic work. I’m just now starting to get back into the teleassessment side of things, which has just been an interesting.

It’s been this like, do I do it this way? What happens if I don’t do these things I’m so used to and what implications does that mean? Oh my God, I’m waking up at two o’clock in the morning with panic attacks. I didn’t give an IQ test. What does that mean? It doesn’t even mean anything. So it’s been really complicated for me but it’s been a tremendous learning experience.

Dr. Andres: Can I ask about that? Two comments or questions that come up as you say that [00:17:00] Chris is that one, I’m starting up my practice and I’m trying to decide how much testing should I do? should I make it half and half? Most people tell me that’s pretty hard to do. It sounds like you were doing 75, 25. The first question is, was that by design or that just happened?

And then the second part is, I’m hearing a lot of psychologists go like, I haven’t done testing for years and now we have this pandemic. I don’t feel comfortable with in-person or even telehealth. I don’t know if I could go back to it, but you seem to be able to do that. Maybe you could speak to what your thoughts are on going back to doing more therapy because I think most of us were trained on some levels.

Dr. Chris: Absolutely. Therapy has always been what’s driven me to the field. I’m not sure why necessarily, that’s where I cut my teeth [00:18:00] and then I fell into the assessment world. And that’s where I was like, oh wait, this is pretty cool. Like datum, what’s that? Let’s jump on this board.

I got enthusiastically involved with the testing side of things, but I’ve always wanted to keep both hands in the game because I’m risk-averse, and so I want to make sure I’ve always got options. I enjoy the therapeutic side and the testing sides, but I always made sure I was maintaining a caseload on each side.

As I started to grow my practice here, it became very testing-heavy. And so COVID came around and I was like, what happens? But at that point, there was not necessarily the need for the testing that I do for a lot of assessment. There was a tremendous need for therapy. So it very organically transitioned into a therapy heavy caseload right now.

Dr. Sharp: How long [00:19:00] before that had it been since you were really doing therapy, since you were immersed in that world?

Dr. Chris: I’d estimate 3 or 4 years.

Dr. Sharp: What was it like coming back?

Dr. Chris: It was refreshing. There was something exciting about it. It was like, wow, I forgot I had this skill and not that it’s even good necessarily, but it was just very fulfilling and people were responding well to it.

Dr. Sharp: I think if I were in your position, I don’t know, there’s something to be said for taking a long break and then coming back with fresh eyes and a different stage of life. I could see that being really nice to dive back into it and get reacquainted and start to get better at it again.

Dr. Stephanie: Jeremy, what is your mix right now? What’s happening with your practice?

Dr. Sharp: My schedule is ridiculous. I probably spend [00:20:00] 50% of the time doing practice admin, direction and business development, probably 40% doing podcasting consulting stuff. I do one assessment a month, maybe two, if it’s a friend or something like VIP thing. So then maybe that’s 8% and then I have one therapy client who I have seen for 12 years, maybe 10 since way back since I graduated, who comes back intermittently, but he’s back now. So I have one therapy client.

Dr. Andres: You’re barely a psychologist then, that’s what you’re saying.

Dr. Sharp: Barely. Exactly. I’m getting further and further. My employees are always asking, they’re like, when are you going to stop doing clinical work? Thus far, the answer is never. I love testing and still learning new things and it [00:21:00] seems hard to get better.

Dr. Laura: It’s got to be nice to have a boss who knows that side of things too. I wouldn’t want you to stop, if you were my boss.

Dr. Sharp: Thank you.

Dr. Stephanie: Laura, did you say you have two businesses that you’re doing?

Dr. Laura: It’s the same business in two locations, essentially.

Dr. Chris: You’ll find that this is Laura’s style to downplay everything.

Dr. Laura: I build up my business in Dallas-Fort Worth area because we lived there and then we moved last May. And moving during a pandemic, I do not recommend because I still don’t know anyone. I still don’t know what the inside of my kid’s school looks like.

It’s been really challenging, but it’s been interesting because of all the telehealth stuff, I’ve been able to keep up my business in Texas and still see people there maintain those [00:22:00] relationships. I’ve cut back on who I’m seeing, so I’m only seeing little bitty people, 18 months to 5-ish for autism assessments and then also seeing 18 and up. So I’ve cut out that whole chunk in the middle because I’m not doing achievement, IQ, heavy stuff.

I’m really looking forward to getting back to that because as a school psychologist, having that background like that, those are my people, that’s where I’m comfortable, but the pandemic has made me become more comfortable with other things.

Dr. Sharp: Were you selling your practice in Texas at some point, or were you trying to?

Dr. Laura: I am still in the process. I have a person in mind who as soon as she passes the licensing exam, it’s all hers.

Dr. Sharp: No pressure person, whoever you are.

Dr. Chris: I’ll buy it right now to [00:23:00] him.

Dr. Laura: Ultimately, I’d like to get rid of that practice. I’d like to sell that and then be able to focus more on Colorado.

Dr. Sharp: Are you at liberty to talk at all about that process of selling your practice? What’s that been like? If anybody wanted to do, how do you even do that?

Dr. Laura: It’s been a huge pain. I have a business broker I’ve been working with since well before the pandemic. And so the valuation, he helped establish that. He’s been advertising and fielding all the calls. I have had a lot of interest in the business, but it hasn’t been anyone who is qualified to do what I do because there’s not another psychologist who has my experience.

So it’ll a therapist who wants to buy the practice, but then they don’t know my piece of it, so [00:24:00] they would have to outsource it. There just been a lot of weirdness around exactly who can buy the business but it’s been interesting. Just speaking, honestly, the valuation, I was at my top. I had psychometricians, we were doing 4 or 5 evaluations a day sometimes. We were moving and then COVID.

Dr. Sharp: Was the evaluation based on the top or the not top?

Dr. Laura: It was based on the top. And so then we’ve had to adjust that because all the interests were pre-COVID and now as things have not gone as well, things are fine, it’s just not as profitable. So it’s been interesting.

Dr. Sharp: I hear that. Chris, did you sell up any of your practices? I feel like you’ve done a lot with your practices [00:25:00] over the past two years.

Dr. Chris: There’s been lots of movement in lots of different directions. It’s incredibly complicated. This is probably not the best forum to have that conversation, but there’s been a lot of learning along the way. There’s no doubt about it.

I can certainly appreciate what Laura is saying that it’s such an emotional roller coaster. And then you think you have a plan and then you get kicked in the knees, and then you have a better plan and someone wants it, and then you’re like, wait a minute, I wasn’t thinking clearly, I need to renegotiate. It’s pretty messy.

Dr. Andres: As you guys are talking about this, I don’t know if this is a total tangent, but the thing that has been on my mind, especially because I just recently left my job at a graduate program is the idea of talking about business in our training programs. Even in the Facebook group, that comes up all the time.

A few weeks ago, someone said they’re $500,000 in debt. [00:26:00] I was like, oh my gosh, I can’t even imagine that. I’m curious what y’all guys’ thoughts are and your experience of the teaching of the business side of any practice or anything in your own programs?

Dr. Laura: There was nothing.

Dr. Andres: Nothing.

Dr. Laura: Zero

Dr. Andres: I’m curious what are your thoughts on how we can change that, if that’s even possible? Our programs are pretty intense to begin with. So just thinking about this the other day.

Dr. Sharp: I was disappointed. Our program had, I think it was called professional development seminar. It was an eight-hour thing on a Saturday later in our program. Maybe it would have been a good experience at a different point in my life, but the professor who taught it was like, see as many clients as possible, work 40 to 50 hours a week billing 40 to 50 hours a week, invest in real [00:27:00] estate and then sail off into the sunset.

That was our professional development, because that was the path that he had taken, which worked really well, but different era. And then after that, they had me teach the professional seminar once and then it got canceled. I guess I did a terrible job. And that was 8 years ago or something. So it hasn’t been back.

Dr. Andres: You gave away too many secrets and you destroy the economy there.

Dr. Sharp: Thank you.

Dr. Andres: I think you’re speaking to something there too because I remember as a graduate student, we would have some of those classes and first of all the people who taught them, they’re doing it because sometimes they’re passionate about it, sometimes they just need a little extra income.

The people who are making tons of money doing this stuff, they’re not going to have time to go [00:28:00] teach some graduate class eight o’clock at night or something like that. And then as a graduate student, you’re not thinking about that stuff just yet.

Dr. Chris: You’re also taught that you’re never going to make money as a psychologist. I remember my graduate program is like, all that private practice stuff, that’s for nights and weekends, but you got to go work at the university or you got to do this or whatever.

It was spoken, but it was still unspoken truths that were communicated. So it was really interesting to think about, well, there are so many different possibilities out there and we don’t have to believe it necessary.

Dr. Andres: Our program, maybe because it was a faith-based program and there’s all that stuff about helping people that we’re supposed to do, we got a different message. We had some professors that would say, I drive a BMW, but then the way we received that was like, oh, we don’t want to be like him. We want to help people.

And then now that we’re out, we’re like, oh men, I feel the [00:29:00] BMW will be nice and not having that will be nice and all that kind of stuff. It’s tricky. So in our program, there were some messages of that, but we couldn’t receive it.

Dr. Sharp: I hate that they opposed, that they get presented as mutually exclusive.

Dr. Stephanie: I don’t even think it was on the radar of my graduate program. I think the model was just write 30-page reports that you get paid $150 an hour to write, and somehow it will all work out.

Jeremy, when you started your podcast, were you more interested in filling that hole on the business side, or did you want to help people find other experts in the field? What drove you to start that?

Dr. Sharp: Originally, it came from the business motivation because I taught that professional development seminar and I love that stuff. I’d done informal lectures on that stuff and [00:30:00] guest lectures over the years. So that’s where it came from initially, but then I figured out like people really like hearing from experts too.

Dr. Stephanie: That is why now you alternate?

Dr. Sharp: Exactly.

Dr. Andres: That’s a good thing that they stopped offering that course, or you’d be teaching some night courses and we wouldn’t have this right now.

Dr. Sharp: Again, a great reframe. This is a great group to talk about this though, because there are so many different… I think we’ve all done different models of figuring out how to be in private practice and make money doing different things. Like you said earlier, Stephanie, in passing, that you’re doing a lot of consulting these days, what I took from that is that it’s been enough to replace some of your clinical work. Is that right?

Dr. Stephanie: It has. [00:31:00] I’ve cut my clinical work in half now. And so I do have clinical, half consulting and it’s been amazing. One of the things I’m sure we’ll touch on today as we’re discussing is the idea of burnout and replacing doing the work with something that puts me in a different lens has just refreshed everything. It’s just so fun.

I talk with people who are just starting. I talk with experts and I learned so much from them and yet I still somehow earn money. It’s incredible. It’s been really neat.

Dr. Sharp: That is so awesome.

Dr. Andres: We met after the pandemic and after you did the first episode on the podcast fan here. Were you doing your consulting work before the podcast [00:32:00] episode or that’s when you started?

Dr. Stephanie: Having that deadline was a great incentive to get the website set up and things started. So it actually happened literally at that moment, that’s when it started.

Dr. Andres: Both of you guys are saying that you guys were offering amazing resources for free to the public and it actually resulted in more business. There’s really something about that. I forget what the term is in marketing. It’s like a lead or whatever like that but there’s something to be said about that. Maybe the rest of you, Laura and Chris, maybe you could speak if there’s any experience of that on your end with the practice.

Dr. Chris: I think along with similar grounds the idea of burnout and then utilizing your skills and other avenues is so incredibly important because it’s new and it’s exciting. I recently started consulting on a marketing team for a startup with a wine app. [00:33:00] I’m a wine person but it’s so interesting to take the information that I’ve gotten along the way in marketing my own business and all of these things, and then utilizing it in a different environment.

I’m not a marketing genius, not even close, but to utilize the skills and could riff on ideas with people in different industries and still get paid for it, there’s just something really fulfilling about that. The money is not the important piece, it’s like, let’s try this idea.

I can take my psychological experience and my understanding in my training, and so how do we work this? How do we work through these problems? How do we market to different populations? et cetera. And so it’s intellectually stimulating in a very different way, but you’re using the same skill.

And so COVID has burnt me out way bad. I had to do something. So [00:34:00] this fell into my lap and there you go. And so it’s speaking to exactly what Stephanie was talking about. It’s the same skillset, it’s just utilized in a different way.

Dr. Stephanie: And that’s another thing we don’t talk about in our training programs a lot is how applicable our skillset is to other areas of life and other things we could be doing. Most of us just think we’re going to be doing testing or therapy, whatever our mix is forever. And then you find out we have all these skills that apply to other areas of life. It is exciting and energizing.

Dr. Chris: Especially when you can meld two hobbies together. It’s doubly rewarding. That’s really cool.

Dr. Stephanie: Neuropsychology is my hobby, so I am. What are the rest of you guys doing to avoid burnout?

Dr. Andres: There’s a premise that everyone’s avoiding burnout in that statement, which may or may not be accurate.

[00:35:00] Dr. Sharp: I am literally burned out right now.

Dr. Laura: I’m trying to be more intentional in my scheduling and only doing one person or two people a day, and trying to turn around reports super-fast so that I’m not dwelling on it. It’s not lingering. Other than that, I can’t wait till I can get back into a choir. I cannot wait till I can meet some people. I cannot wait to just leave my house. So I’m just waiting and burning.

Dr. Stephanie: While waiting, can you explain to me the part about getting reports out super-fast. I was wondering if maybe just look for a friend?

Dr. Chris: That’s a thing? That actually exists?

Dr. Laura: Yeah. The way that I’ve been doing it is at night while I’m watching a show, I’ve prepped the report with all of the backgrounds and as many rating scales as I’ve got back. And so that template is there and it’s already [00:36:00] partially completed. So while I’m talking to the person, I’m filling it in, and then I’m getting it done, hopefully within the rest of that day, and then proofing the next day and I am cycling through.

Dr. Stephanie: Amazing.

Dr. Sharp: Remarkable.

Dr. Laura: It doesn’t always work.

Dr. Sharp: Side question that’s equally important, what show are you watching right now?

Dr. Laura: I just finished watching the Search Party on HBO Max, two thumbs up.

Dr. Sharp: Sweet. I’ll put that in the show notes. Awesome. What about the rest of you? What are you doing to stay sane? Again, there’s an assumption there.

Dr. Andres: There’s a lot of things I want to actively do more like some more exercise. It doesn’t help that my practice is [00:37:00] even closer to my house now. I could walk to it but I don’t, I drive. It’s ridiculous, like a 1-minute commute but just some really simple practical things.

I’m on Facebook a lot, but it’s just to be enough The Testing Psychologist group, but just trying to limit my social media intake. My gosh, that’s huge. I tell my clients this all the time. It’s so hard. It’s so addicting. That’s stuff messes with you. It keeps you locked in. The more emotion it brings out in you, the more you’re going to react to stuff. All those algorithms are doing stuff to us.

The research is still emerging in this but just noticing that the weeks that I’m focused on my practice, the things that I’m excited about, spending time with my family and not [00:38:00] spending time with strangers somewhere off, arguing about who the secretary of education is for some strange reason. That’s been one way that I’ve been trying to help with the burnout and things like that.

And this is a tricky thing in private practice too, that I’m learning but I actually find it easier with my full-time job. This is my full-time job now. My other job was just reducing my work to my time in the office. I have the luxury of being able to come into my office here, but that’s been tremendous. It’s like, okay, if I’m in the office, I’m doing work. Home is for home. Just those simple things that we tell people all the time, but it goes such a long way.

Dr. Stephanie: You brought up such a good point that we’re all figuring out how to balance our practices over [00:39:00] Zoom, but that human connection with our colleagues is hard. We have the Facebook group, but staying on Facebook for too long really does corrode your soul. So how are people staying connected with colleagues during this time?

Dr. Chris: It’s hard because, at least my experience is everyone’s still trying to maintain clinical levels and to really produce good work. And for many of the people that I’ve had conversations with, doing therapy is almost therapeutic in of itself, because it’s pulling us out of our own stuff and being available and opening space for other people as well. So Slack is my friend right now. It’s asynchronous necessarily because we’re not really communicating in the moment, but Slack has been really good.

Dr. Stephanie: Explain it for those of us who don’t know what that is?

Dr. Chris: Slack is like multiple text threads in chapters.

[00:40:00] Dr. Sharp: What a way to explain it. It’s like a chat app.

Dr. Stephanie: Thank you, Jeremy.

Dr. Sharp: For work.

Dr. Stephanie: So can we have one?

Dr. Sharp: Sure. I’ll start one right now. I’ll Slack you in just a second.

Dr. Stephanie: Perfect.

Dr. Andres: Chris, you’re speaking to something there, this is hard for the people who don’t do mainly assessment and testing but I enjoy my time with my clients. It’s the limited amount of human interaction that, I’m an extrovert, so that’s part of it.

The moments when I don’t have sessions, the times that I have for my administrative stuff, it’s when I have to sit with men. We’re really isolated right now in this pandemic. I was just talking to my wife about that yesterday, about that’s when it settles in a little bit. [00:41:00] I think it’s easy as testing psychologists to just try to ignore that but that’s telling us something about what we need at the moment.

That’s why consultation groups are huge for me. I have regular groups that we meet right now on Zoom and we sit around and talk about nothing, it’s just so good. It’s exhausting too being on Zoom all the time, but just that little bit goes a long way.

I’m curious for those that do mainly testing though, what is that like for you? Because a lot of the time when you’re doing an assessment, you’re mainly just writing reports and interpreting data. How does that work?

Dr. Sharp: For us, like Chris said, our chat rooms in our [00:42:00] practice have exploded over the past few months because people are just going nuts in there. The consultation stuff, there’s been a lot more messaging back and forth about cases and what we’re thinking about and how we conceptualize things.

Dr. Andres: Is the amount of work that you’re doing right now, Jeremy, I’m curious because your practice is crazy. I’m wondering if the intensity of it is still the same, more or less since COVID has kicked off.

Dr. Sharp: It’s just been insane because right at the beginning of COVID was when we decided to expand into a local pediatric practice as well. So I’ve hired 5 people during the pandemic into another location. We had to figure out the remote testing [00:43:00] piece or not. I have decided to double down on the podcast in June, which was great in June when I wasn’t doing anything. And then come November, it turned out to maybe a less good decision, but it’s all been fun.

I’ve almost conceptualized this pandemic as a really long silent meditation retreat in the sense that I see my moods and my behaviors; there’s a lot of waves. There are moments and weeks of being isolated, and then there are moments where I’m like, I like this and it’s great to be home. It’s like watching how I react to all this. I don’t know if any of y’all have experienced that, but with such a duration…

Dr. Laura: That’s a really good point. I hadn’t thought about it in that way, but I have spent a lot of time with myself lately because there’s no one [00:44:00] else.

Dr. Sharp: And even see all that like reacting to the kids or my partner or work or whatever, it’s just like, this is interesting.

Dr. Andres: I heard this by Andrew Schulz, he’s a comedian. He has a Netflix thing now. It’s pretty crude so not suitable for work people. He said the statement and really stopped me that COVID has exposed all our pre-existing conditions. So if you were overworked before COVID, you definitely feel it now. If you’re doing work that you didn’t enjoy before COVID, you had to really re-examine it.

Going back to the question of what’s it like to start a practice, it got me to really think what kind of work do I want to do because it’s so much harder when we’re doing it during a pandemic and you’re not enjoying it.

[00:45:00] Dr. Sharp: Absolutely.

Dr. Stephanie: A colleague who survived postdoc with me, we used to joke that postdoc turns you into a caricature of yourself, like whatever your leading trait is, postdoc concentrated that and that’s what it made you into. There’s been some ways that COVID, I can feel, does that to me, but I’m also hearing people say that they’re finding some bright sides inside this terribleness. Has anybody else seen anything good coming out of COVID or feel like lessons learned that we’re getting from this?

Dr. Chris: I’ve gone through this weird roller coaster where COVID initially was like, oh God, what do we do? How do we protect the business? How do we still provide services? I got super excited about that. I was just so drawn into we got to figure this out. Here we go. These are the systems. This is what we’re going to [00:46:00] do.

And then June came around and I got burnt out, like depressed. And then it was that moment where I was like, dude, I can’t do this anymore. You’re working from home and you get to go upstairs at lunch and see your kids.

And we did this weird thing here at the Barnes house where we implemented nodes, no seed left behind, wherever you seed out of a vegetable at the dinner table that was not eaten, was planted. So we had a jungle growing in our basement and it was so interesting and so ridiculous and so exciting simultaneously that the kids would come downstairs and they’d take the spray bottle and they’d spray the pepper seeds and they’d spray the cucumber seeds.

It was at that moment where I was like, all right man, there’s more to life than work. There’s more to life than this. Sure, you still love it. You still love the clinical side and the business side, but I’m looking out of my basement window right now at my backyard and my golden retrievers running around the outside, I’ve never been able to experience this when I was at the office.

And so the process has been really [00:47:00] interesting. And as you were describing earlier, your primary defense mechanisms come to the service, absolutely, but here we are so let’s pay attention to them.

It’s been super insightful for me. I’ve gone through such a tremendous transformation as a human in the last year, maybe 10 months, but it’s been so cool. COVID can go, it needs to do somewhere else. If I had a gene, I’d take it away in a second, but here it is. There are probably some things to be learned from it.

Dr. Andres: What is it clinically that’s shifted for you and everyone else to that COVID has brought to the surface in terms of what you want to do more of. I know some of you already spoke to this already, but maybe Chris, it seems like, for you, some other clinical work changed.

Dr. Chris: It did on interesting levels. I’m a statistician at my core. I love numbers. I love data. I love looking at graphic. It’s the beautiful mind down here in my basement. Sometimes I’ve got all these graphs all over the place and markers [00:48:00] everywhere but there’s a lack of human interaction in there.

I think that what drew me to the field was that human interaction. I fell into the testing side of things and built a business out of it. And as a result, I neglected what was really driving me to it. There’s something about that human interaction.

As humans, we’re social beings and it’s important for us to make sure we’re figuring out why we’re doing what we’re doing and going almost all therapy from March to November/December was a really good insight for me into what I need to put my energy into.

Dr. Andres: That’s great. Stephanie, what about you? You asked the question, but I’m curious

Dr. Stephanie: I think that what Andres and Chris were both speaking to is that intentionality where you start looking at, what is it that you want to do? Where do you want to focus your energy? How much of it do you want to be your business versus your relationships versus your hobbies?

So right before the pandemic hit, my husband and I changed our schedules so that I [00:49:00] now work Wednesday through Saturday, which is odd, but we go off in our RV, and this way we can book reservations at places that would otherwise be full. And it also switched me to a four-day schedule so that I have these beautiful three days off.

And thinking about choices like that, sometimes you’re like, I’m not sure pandemic is the best time to try it, but there’s something about it that highlights, well, this is what I need to be a thriving human being. And if there’s ever a time that I need to be a thriving human being, it’s during the middle of a pandemic. So it’s been helpful for figuring that out; what do I need in ways that we do all the time for our patients, our families and our friends, but that we don’t always stop and do for ourselves?

Dr. Sharp: I totally agree. It’s been a nice marker or a slap in the face.

Dr. Chris: It all absolutely sucks, but here we [00:50:00] are.

Dr. Sharp: Right. I will say this, Stephanie, I’m an introvert as well, a complete introvert who can fake it when I need to, but it’s been awesome. I’ve never had a ton of close in-person friends as an adult, but I have gotten super close with like my college friends, this group of guys. Our text chains have just been insane in my graduate school group of guy friends.

We’ve gotten super close over the past 10 months and that’s been nice LESSON. It’s like an outlet for my introverted personality, but also at the same time recognizing I do not miss the plans on the weekends and running our kids here and there and what are we going to bring to this potluck [00:51:00] or whatever.

Dr. Chris: Always meatballs.

Dr. Sharp: For the win.

Dr. Andres: Maybe because I’m in LA and we live in a tiny condo, but men, I long for let’s go to the zoo because my kid is going nuts in our little place.

Dr. Sharp: That’s my wife.

Dr. Laura: It’s a hard balance.

Dr. Stephanie: Laura, I could tell that you are an introvert because I follow you on Goodreads and you read 72 books last year.

Dr. Laura: I sure did. I beat my goals.

Dr. Stephanie: It’s amazing. Was your goal like one a week?

Dr. Laura: Yeah, I think it was like 50.

Dr. Sharp: So I have to ask, what are we reading? What are you reading, Laura? What’s everybody reading?

Dr. Laura: Okay, here’s the thing. I don’t retain any of it. I read whatever is popular, whatever’s good. Right now, I finished last night, the Vanishing Twin [00:52:00] which is popular right now. It was pretty good. I’ve read some real duds recently, too. You’ll have that.

Dr. Sharp: You’ll finish a book even if it is a dud?

Dr. Laura: I do.

Dr. Sharp: You are a completest.

Dr. Laura: It started at graduate school.

Dr. Chris: I did not have a similar experience in graduate school, I can tell you that.

Dr. Laura: I know.

Dr. Stephanie: I think it took me until graduate school when I realized that you don’t have to read everything. Nothing bad happens. I’m still not totally convinced, but I’ve heard.

Dr. Sharp: We had a professor our first year who pulled us aside in a way, and if there’s a way to whisper behind your hand as a professor in class, she was like, you don’t have to read all this stuff. It was pretty amazing. You could tell people were falling apart inside in that moment from all these high achieving students, but it was pretty awesome.

Dr. Stephanie: I had a professor once that told me that if you’re not getting B’s, you’re not busy enough. If you’re [00:53:00] getting A’s, you’re working too hard on your academics and not enough on your research. I nearly died of shock. I was like, what grade are you talking about? Nope. So it was traumatic.

Dr. Laura: So if you guys weren’t in psychology, what would you be doing? Well, I know what Chris would be doing.

Dr. Chris: Oh, that’s interesting. I can’t wait to hear that.

Dr. Sharp: What would you guess what Chris would be doing?

Dr. Laura: I think Chris would own a really fancy restaurant with very good quality products, alcohol and exotic food.

Dr. Chris: We’re going to have to talk about that perspective after this, but you’re 50% right. I’ve always wanted to own a restaurant, but I know it’s not a good idea to do that.

Dr. Andres: With your psychology stuff that you could get a meal, get some psychotherapy.

Dr. Chris: What will we call it? If I want a coffee shop, it’ll be [00:54:00] called Bruin Blab Whine N Dine.

Dr. Andres: There we go.

Dr. Chris: It’s deep. Isn’t it?

Dr. Andres: Have you guys read the book, it’s called, Maybe You Should Talk to Someone? It’s a book about a therapist and her experience, but she would have this client that would bring lunch for her every week and they would have their session over lunch. Maybe you could do something like that. That’d be pretty cool. You have what? 15 sessions a week and that’s it, just during meals.

Dr. Chris: If I were to pick a profession other than psychology right now, I’ve actually thought a lot about this, I would be a non-hazardous waste semi-truck driver. Me and my dog would get in the car. We’d take a weekend or not the car, of course, a semi because you got to pull something heavy, but we’d be out and we’d see the world and we’d come, [00:55:00] next weekend it’s the daughter and the next week it’s the son.

It would be mindless effectively. Now, certainly, it’s not mindless, but I think that our work is so hefty that I have such a desire to be out of that space, which is why I grew pepper plants and covered whatever plants. It doesn’t take any effort necessarily, but there’s still effort involved.

Dr. Andres: How about you, Laura? You asked the question?

Dr. Laura: I’ve got two siblings who are air traffic controllers, and that is the life. If I could go back and redo this, I would probably be an air traffic controller.

Dr. Sharp: Can you elaborate on that is the life?

Dr. Andres: You can’t just throw that out there.

Dr. Laura: They get great benefits. They’ve scheduled slacks for the first few years as they get established, they do two hours on, two hours off. So you’re not even working the whole time. [00:56:00] My brother has been furloughed for like the entire pandemic. That’s maybe not the right word, he’s still getting paid. And so that’s what I would like to be doing.

Dr. Sharp: Wow. I perceive that to be a very high-stress job, but maybe I’m wrong.

Dr. Laura: It’s interesting. They’re much more laid back than I am. Like I’m the type A, they’re more the type B people. And they both love it. They’ve had two issues in the center where there’ve been near misses or whatever, but in general, it’s a good job.

Dr. Sharp: Our eyes just got really big, for those listening. Wow. That’s amazing.

Dr. Stephanie: Jeremy, I’m totally curious what you would do if you didn’t do this podcast world?

Dr. Sharp: I would open a running shoe store. Here’s why, because I love running. I run [00:57:00] a lot but I love the idea of helping people. People come in and they’re like, oh, what kind of shoe do I need? And I can totally geek out on different types of shoes and what’s good about them or not good about them, when you want to wear them and what kind of runner you are, and do a little bit of the coaching like you might want to try this and organize little meetups through the running store and stuff.

Dr. Stephanie: So you’d be like a shoe psychologist?

Dr. Sharp: Yes, exactly.

Dr. Stephanie: Chris, I think we met at AACN and for some reason, what I remember about you is your shoes and your socks. Are you also a shoe person?

Dr. Chris: I’m more of a sock person than a shoe person, but I don’t choose socks based on shoes, I choose shoes based on socks.

Dr. Andres: And that’s a motto to live by something.

[00:58:00] Dr. Stephanie: We’re all like thinking you got it. Everybody’s head is mmmh.

Dr. Andres: Leave it to Chris to overcomplicate things, trust me.

Dr. Sharp: That’s amazing. Let’s round it out. Andres, what would you do?

Dr. Andres: Oh gosh. When that comes to mind, I used to be a graphic designer and I used to do videography media stuff and I really enjoy it, but not when I’m being paid for it. I don’t know. Maybe there’s too much pressure to turn over a good product, but the thing is, I’m such an extrovert. I love interacting with people.

Since starting the practice, I’ve loved helping other people start practices and stuff like that. So I have no idea what that would be, some business consultant or something like that, but if I was being paid for it, I think that would change everything.

Like what Chris was [00:59:00] saying, the days I just want to just zone out and not think about things too much, I think I would enjoy just computer programming or woodworking, something I could just be in the zone and there’s a clear product that’s done and “correct”. You don’t have to interpret anything. It’s just, you measure it and if it fits, you did a good job.

Dr. Sharp: I also feel pulled to woodworking for some reason. That’s come up many times when I have this conversation with myself.

Dr. Stephanie: A lot of times the product that we create, whether it’s a change in therapy or our reports, we don’t get the dopamine rush of seeing a finished product. And so if things never really get that sense of completion, and then if you have a hobby where you make something and actually get to see it, I think we all probably long for that sometimes of I built this with my hands, and there it [01:00:00] is. We don’t get to see a lot of that in psychology.

Dr. Sharp: It’s so true. So is that why I like things like vacuuming and mowing the lawn where there’s clear documentation of my progress and I know when it’s finished? Is that the dopamine rush?

Dr. Stephanie: No, that’s more just your pathology. No, I’m just kidding.

Dr. Chris: Paging Dr. Freud.

Dr. Stephanie: I have heard a theory that people really like activities that involve tidying up where they could see the tidying and that a lot of our games, not video games really, but are a lot of our other games that we play like pool or bowling or solitaire, you’re making a mess and then seeing it tidy up, you’re seeing the balls dropped down into the pockets or you’re seeing the cards get neatly stacked up. And that there’s something about that, that we evolved to enjoy. So maybe it’s something like [01:01:00] that.

Dr. Sharp: Ooh, I like this.

Dr. Chris: We should put that to the test. We could make a game that you have to just make a mess everywhere, and that’s how you win.

Dr. Sharp: Maybe I’m pushing this too far, but there’s a lot of parallels with testing. We start with this “crazy” mess. We get all this data and then somehow we clean it up and pull it together and create a nice tidy thing maybe.

Dr. Andres: This is The Testing Psychologist podcast, maybe we should go back to that topic.

Dr. Chris: It’s like Block Design, you know you have all this mess and you got to create something neat out of it.

Dr. Sharp: Okay, there we go.

Dr. Chris: Thank you.

Dr. Andres: Jumping off that, this gets really nerdy now, I think this is one of the questions we were thinking about, what kind of measures do you think are lacking that you would want someone to create, content [01:02:00] PAR and contains Pearson?

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All right, let’s get back to the podcast.

Dr. Chris: I don’t see the other p-word. [01:03:00] Well, never mind, we’ll talk about that later also. The one thing that I’d love to see and its prompts exist, I’m just not that savvy to really realize it does, is performance and performance validation all at the same time. How can you do a CPT and some sort of PVT simultaneously? How do you bleed those two together?

That’s if I could have my witches brew, that’d be what I do because I feel like it does exist. There’s just not a tremendous amount of data necessarily to support it. Because when I give a CPT3, I can tell by watching someone if they’re tanking it, but the data’s still is crazy.

Dr. Stephanie: I think Bob Bilder who does some talks on neuropsychology 3.0, talks a lot about the data that we’re throwing away, the information that we could be getting from our tests that were not the [01:04:00] timescale type things, the patterns of responding that really could be incredibly valuable that not just making new tools, but making our current ones work better.

I think also they’re thinking about this for the D-KEFS 3.0 as well. I’m fascinated by those topics but we’ve reached the limit of my knowledge about them.

Dr. Sharp: There are two good NavNeuro podcasts on that whole domain. I was thinking along the same lines. I remember them talking about that with D-KEFS 2.0, is they’re trying because it’s all digital. Everything’s happening electronically. So I think they’re trying to build that stuff in where they’re looking at all those little latencies and behaviors that we just can’t track just by the naked eye or whatever. I think we’re moving in that direction.

Dr. Chris: It raises an interesting point between clinical intuition and [01:05:00] data. As a clinician, we can sit and observe things and we can see things, and there are certainly patterns there, but those patterns are so idiosyncratic. So it’s just interesting to think about how do we blend clinical intuition with performance, with data. That’s where my brain just goes a little bit crazy, and I’m not smart enough to develop any of those things.

Dr. Sharp: Let me ask you all a question. This is related and then we can steer back if it takes us in a crazy direction. I’ve been contacted by someone who’s trying to develop a report writing software. So the question is, do you think we will ever truly have report writing software that can synthesize our interpretation summary, the observations, the nuances, anything that can ever actually do that part? Do you think it’s possible?

Dr. Chris: I think anything’s possible if the probability of it, depending on what you want and the nuance you [01:06:00] want to really demonstrate that that’s one thing.

Dr. Stephanie: I don’t need software because I’m just going to give all my reports to Laura now because I heard she can get them done while watching a TV show. There’s a lot of report writing software out there that people try to develop themselves and it ends up being expensive and hard because we actually do a lot when we’re interpreting the data.

I think all of us who write reports have had a dream of coming up with some sort of software that can get it from our heads onto the paper, and then it turns out like, wow, there’s a lot in our heads. And so I’m waiting for the chip that they put in my eyeball. I think that’s when things are really going to change.

Dr. Sharp: Are you vaccinated yet, then you should have gotten over with that. Oh, sorry.

Dr. Stephanie: Maybe with the second shot.

Dr. Sharp: Was that too much. Sorry.

Dr. Laura: I will say I have tried [01:07:00] probably four or five different report writing types of software out there and spent a ton of money on these things, and lots of time trying to make it fit my style and how I want things and to customize, and nothing has ever stuck. It’s very sad.

Dr. Sharp: I’m in the same boat.

Dr. Andres: Just to jump on that, this goes back to the graduate school thing because this is closer to me because of my recent past, but the idea that there’s a right way to write a report, we’ve all been taught the research paper style and I think you did a few podcasts on this, Jeremy, that’s what all this software is about. There’s a right way to do this. You can put it in some software to reproduce it, but that’s not the way we look at data at all.

[01:08:00] I would even argue that we’re doing wrong if that comes to that point because we have to rethink like, okay, what is the client hiring us for then? It’s not necessarily the report but the interpretation of it. Our understanding; making it make sense for them.

And that’s always a struggle for me. That’s always going to linger there for me, like, this doesn’t feel like what I was taught in graduate school. I’m with Chris here, like maybe there’s one day there’s going to be software so smart, it can figure that out for us. Like okay, this is your voice. I just can’t imagine it right now or that it would be useful.

Dr. Chris: My response is that we can create it individually, but we can’t create it in mass. I use technology to write my stuff really quickly, but it’s not going to sound like Laura’s report or Jeremy’s report or anyone else’s report.

I think that what we can do, and I [01:09:00] love technology. I spend way too much time just researching it and it’s probably counterproductive, to be honest, but identifying ways to do what you need to do and the way that you need to do it, and then just tweaking it along the way instead of saying, this is going to be the way that it is and therefore this is the way that it needs to be.

Dr. Sharp: That makes sense.

Dr. Andres: What kind of software are you using?

Dr. Chris: I just leverage Google. I use Google Form Builder. There was someone in the group that had a thing for a while and I totally pilfered most of it from her.

Dr. Sharp: I think that was Rebecca.

Dr. Chris: Thanks, Rebecca. I hope she cashed my cheque. It was mind-blowing to me. It was the best money I ever spent, but then you go in there and you tweak it along the way. And so I can go in there now. I want to say elevations here, elevations there and I think it means this. And then I put my cursor somewhere and dictate the rest of it. And that’s been the biggest game-changer for me going from very technical reporting to more [01:10:00] narrative style reporting.

Dr. Stephanie: I think the right use of technology is to do the psychometrist part, writing the background part that you don’t necessarily need to interpret, getting better data from our patients, maybe using machine learning, that kind of thing but then I think we’ll always, as humans, will be necessary for the part where we’re giving the family a new story or helping them understand their child or adult in a different way, or helping a person process something about themselves that they’re not comfortable with. I think we’ll always be necessary for that part. Luckily we can’t be replaced by robots for that part I hope.

Dr. Sharp: I was listening to, I forgot which podcast it was and it was like, is your job going to be replaced by AI? I was like, no way. And they said, come in after the break. [01:11:00] The A.I. Therapist. The VR is developing this where the sensors will read your emotions and go, hey, I sense that you’re feeling anxiety right now. Let’s talk about that.

And then once in the VA, because you have these people in the military where there’s a lot of stigmas, and so it’s so much easier to talk to a machine about it than to another human. A lot of thoughts about that, but it’s awesome

Dr. Sharp: I got really scared. Maybe two years ago, I saw some research around how people actually prefer a robot physician that talks like a normal person to a real physician in the majority of cases or something crazy. I don’t know. Stephanie, you’re nodding. I don’t know if you’ve seen that.

Dr. Stephanie: That’s true that people actually do like talking to a robot about these things or [01:12:00] chatbots. Ever since that first chatbot, ELIZA, people have been really excited about it. There’s 99% invisible about it. You can put it in the show notes. You should definitely listen to it. It’s fantastic.

People like talking without that human connection about scary, difficult things, but I think they also need to talk to a human about those scary, difficult things. And so you can get some benefit from that and you might even need to talk to yourself or an animal or a robot first, and then do the harder work of actually connecting with another person. I’m hopeful that that won’t necessarily all be replaced by robots.

Dr. Chris: Well, maybe the robot is the exposure therapy to the true experience. It’s like they’re one of those steps into it. It’s like let’s break the ice here. It’s not as scary as you think it is or maybe it is, but you at least get some data at that point, and there you go.

[01:13:00] Dr. Sharp: Yeah, related but a little bit different. I’m super excited. I’m going to be talking with a two guys who are doing research into VR assessment. I’m not sure exactly what that even looks like, but that’s cool. So that’s out there too. I just love technology and seeing how it’s going to help and aid us in what we do.

Dr. Andres: It makes a lot of sense for ADHD assessment because we talk about ecological validity with our CPTs and you would really want to simulate a classroom environment. The VR stuff is where you might want to go.

Dr. Sharp: Sure. I think about older adults as well. There’s so much.

Dr. Stephanie: Like watching people actually grocery shop or people say hell is watching someone else pack for a vacation because they’re doing it the opposite way that you would do it. I think that would be such a great test. Bring someone in a VR environment, watch them pack for a vacation. And [01:14:00] then I would know everything I need to know.

Dr. Laura: That’s loops back to what you were asking about what measures we would love to see and that’s something that I find lacking in basic ADHD screeners. Everything is so obvious. Like, do you have problems doing this? Yes, of course, I do. I have problems with all of these things. And so finding some way to measure how it actually impacts life, what that looks like, that would be really cool.

Dr. Sharp: I totally agree. I would love a good writing assessment. I don’t know that we have a great one. I haven’t used the FAW though, but I hear, I don’t know, it’s supposed to be better.

What else do we need? Oh, I have a random question. I know some of y’all, at least two of you use Trails-X, right? Why do you like Trails-X? How is it different than the other [01:15:00] stuff that’s already out there?

Dr. Andres: Because of this X in the title, it sounds cool.

Dr. Stephanie: I was literally thinking the same thing. That’s it?

Dr. Chris: It’s the X factor, Jeremy.

Dr. Stephanie: Are you familiar with the test?

Dr. Sharp: Yeah. Laura showed it to me back at AACN.

Dr. Laura: What did I say then? Because that’s what I meant. I can’t remember because I haven’t used it in so long.

Dr. Stephanie: It allows people to start wherever they want to start. And then there’s a goal to meet where they have to try and connect as many circles as they can following some rules. And so they start and have to come up with a plan and you’re assessing their accuracy and their speed, and getting a sense of that speed-accuracy trade-off, how well they can maintain set, how well they can come up with a plan. In my mind, the closest analog to it is the tower.

Dr. Sharp: I think that’s what I asked Laura back [01:16:00] then. I was like, this is a tower, but on paper with circles.

Dr. Stephanie: Exactly. Kids really like doing it, which is amazing. It’s pretty fast. Sometimes if you don’t want to give Tower of London in that day or are already doing some other trail tasks or want two different measures of that, I find it really helpful to see that.

Like all of our tests, it’s not incredibly sensitive in the sense that kids are developing this skill. So they usually score in the average range on it, but when they do, it’s pretty spectacular. It’s like when you’re doing the Tower of London and a kid does not score well on it, and you’re like, oh, I could see exactly what the problem is. So I find Trails-X the same way when kids don’t do well on it. It’s pretty notable.

Dr. Andres: As you’re saying that I’m thinking about, this comes up all the time in the Facebook group about how the [01:17:00] sensitivity of tests and things like that, I don’t know what the question is here, but then I’m just thinking about how a lot of times we use these tests because we either our supervisor introduced us to it, or we were always… You said, we’re not even sure they’re good measures of what we’re wanting to do.

Dr. Sharp: The question that comes up for me, somebody asked me this question. I forget who it was. It was a few months ago; about how do we make sense of this idea? This is something we don’t talk about a whole lot, but we give all these tests and then we extrapolate to the real world. How does that even happen? Why would we feel justified to do that? What is happening in that black box between testing, recommendations and the real [01:18:00] world that we can do that? Do y’all have thoughts on that?

Dr. Chris: I think the scary part is many of us don’t necessarily know, and there’s just this art piece of it. This is being a little bit vulnerable here, but just think about coming out of graduate school. Well, I’m using these tests because, and this score means blah, and I’m going to make this story around this.

And then we have some degree behind us that says, well, this is the truth. And then people believe us. And sometimes it is and sometimes it isn’t, but yet there’s this weird thing that exists in that black box that it certainly warrants examination on a clinician’s piece.

That’s an examination I’ve been through myself, which I mentioned earlier. I wake up with panic attacks every once in a while. That’s when that stuff gets activated. It’s like, oh my God, I didn’t do this or I should’ve done this, but there’s this weird spot that exists, that creates so much tension, anxiety, all these things as a clinician that we just have to work ourselves through.

[01:19:00] Dr. Andres: As you’re saying that, Chris, I love controversial topics now that we’re over an hour in, but it reminds me of that whole discussion about scattered doesn’t matter. It comes up every now and then in the Facebook group. I don’t know if we want to go there, but then just the tension of how do we interpret scores and all that stuff.

I’m curious what comes up for you guys as I mention that because I got that a lot working with graduate students, wait, so is this significant? Is it not? This professor saying yes, this one’s saying no. Usually, my answer is maybe, sometimes, depends. What do you think?

Dr. Stephanie: I think that’s so hard because I think most of us who get into this profession were good students who wanted to do the right thing. We were probably even attracted to the idea of assessment because then you’d have [01:20:00] numbers that told you, oh, you’re getting the right answer.

And then we start using these tests and start realizing, oh, these tests are a bunch of hammers when I really was hoping it was like a jeweler’s toolkit. It’s hard and messy. We’re also dealing with messy people and a messy diagnostic system. And then it turns out that most of us, 5, 10 years in start realizing, wow, there are no clear answers to any of these things.

A lot of it really is art. A lot of the data that we’re getting is not the data on the test. The test says it’s measuring writing, but what part of the brain is that? Is it measuring writing? We start grappling with those issues and then it’s hard to even discuss them.

All we can really do is yell at each other in the Facebook group and occasionally have productive conversations, but it’s tricky [01:21:00] because we all come to this realization and often feel alone in it, and then don’t know what to do because other people seem so confident in their opinions. It’s tricky. There is a lot of art to it.

Dr. Sharp: Laura, could you speak to that a little bit because you do a lot of autism? I don’t put you on the spot, but you do a lot of autism evaluations. I won’t even begin to understand any of that stuff but that’s where it’s tricky. There’s a lot of controversy with the measures and how you even do an autism evaluation. What’s your experience been?

Dr. Laura: It’s the same like we were talking about with ADHD measures. You give someone an autism measure and they have all the things or no, they have none of the things. And so there’s so much digging to find the nuance. And on so many different levels, you’re looking for data that isn’t in the rating scale, that isn’t in the [01:22:00] Tele ASAP. And then trying to put that into words as to, yes, this is why your child needs support, or this is why you don’t quite meet the criteria.

You’ve got some hints of autism or some neuro-diversity, but it’s not quite meeting the threshold. I’ve had people who are so interested and invested and having that diagnosis and people who are so on the other side that you question yourself a lot and you question the data and new question, what you saw or what you thought you saw or how you interpreted what you saw? Stephanie, your whole response made me real anxious.

Dr. Stephanie: Because we want there to be right answers. But given that there isn’t, like if you had to give advice to younger clinicians and help them fast track this process of [01:23:00] realizing that this is a blend of art and science, what would you…

Dr. Chris: I have an immediate reaction to that. I’m shooting from the hip here that validity scales are everything, always pay attention to validity scales, the clinical scales are an important issue. It’s not the data you get; it’s how you get the data.

Dr. Stephanie: Say more about that.

Dr. Chris: There’s something driving performance. If someone bombs some scale on an IQ test. Well, it’s either because they suck at it or because they weren’t paying attention, or because they didn’t sleep that night before.

So numbers are only numbers through the eyes of the interpretation. And that was something that was not taught to me as a graduate student. It was like numbers or numbers. Well, there was a tornado in the middle of the Digit Span and they bombed it. Obviously, they have that deficit. That’s not the case.

And so whenever I’ve worked with interns or students, it’s like, all right, let’s look at the validity scales. Let’s see what this says. We’re not looking at clinical scales ever [01:24:00] until we look at validity scales and behavioral observations are super important.

I think that’s something that’s probably underscored or not necessarily emphasized enough rather in training. It’d be interesting to see what Andres says about that now that he teaches psychological assessment.

Dr. Andres: Well, I’m just thinking about the other extreme. It’s so hard to teach assessment, because everyone, like you guys said, the students want a right answer. Wait, what do you mean there’s this maybe, but I’m thinking about the other extreme where we throw away the data because, when I say we, I do that because I’m perfect, but there’s a tendency for sometimes clinicians go, no, no my gut is telling me this is this diagnosis.

And so there’s confirmation bias. Okay, I’m going to look for all this evidence of borderline personality [01:25:00] even though the MCMI is not elevated. We’re just going to give that diagnosis anyway because that seems to fit. And so that’s my reaction to that. Well, what about when we relied so heavily on the behavioral observations? So I don’t know.

Dr. Chris: I think also where the interview is so important too. The data should support your hypothesis after the interview. And so your interview drives those hypotheses and there should be some recognition of that there’s complete bias as you’re absolutely bringing to the attention involved in all of those hypotheses.

Dr. Stephanie: Chris and Andres, I think you guys are bringing up, the Erickson used to have this concept, or did have this concept of disciplined subjectivity, that this is a subjective thing that we’re doing, but that there could be more disciplined ways that we’re doing it. We could be looking for repetition, [01:26:00] singularity, and representativeness of the subjective data that we’re getting.

So when you get a behavioral observation or someone does something unusual, we could be teaching our students to look for repetition of that theme or to look for the singularity of that particular behavior. Like if it’s that they’re talking to something internal, you probably only need to see at once to know what that means.

And that we could be helping people understand that we get a lot of data and it’s not all numbers, but that doesn’t mean that it isn’t data that could be in a disciplined way, looked at and considered. I think we’ve missed out on some of that in our drive to keep adding more and more tests.

Dr. Sharp: That’s a good point. I think one of the things that helped me along the way was realizing that the answer can be maybe [01:27:00] fried. That you don’t have to arrive at two DSM-5 ICD-10 diagnostic codes with a clear recommendation. You can say, I don’t know, this is complex, let’s check it out in a year. So I’m getting back to the advice piece but to give someone the advice it’s okay to not know. And so maybe we’ll reassess.

Dr. Laura: And that it’s okay for somebody to be mad at you too.

Dr. Chris: It’s so interesting that you bring that up, Jeremy. I got records request yesterday and I dig through my clinical notes. I pulled up my own personal notes and diagnostically, it was like, don’t know yet. End of feedback, don’t know yet. I was like, wait, you said what? But we didn’t know, there were more questions raised than answers provided and that’s okay.

Dr. Sharp: Sure.

Dr. Stephanie: And sometimes that drive for questions actually comes from us. The parents probably don’t necessarily care [01:28:00] exactly what DSM diagnosis or ICD-10 diagnosis we’re providing. We pretend the referral question is diagnosis so that we can say, oh, it’s ADHD, and here’s your cut-and-paste list of ADHD recommendations, but that’s not usually why families or individuals come to see us. They actually have different questions like, how do I get my kid out of the house in the morning?

You don’t necessarily need to know the right answer for what diagnosis it is to be able to actually provide really useful, helpful information based on the data you get that could help with that question.

Dr. Andres: I’m going to dive into more controversy. Maybe it’s not controversial. Controversy for us.

Dr. Chris: For those of you not watching, everyone just took a very deep breath, myself included.

Dr. Andres: I’m thinking about how this is so complex because I’m seeing more and more of a [01:29:00] movement of people seeking out diagnoses to explain why they’re struggling, especially in the independent. So I get calls to like, look, I could tell in these calls that they’re looking for some specific diagnosis. The ones that come to mind the most are ADHD and autism.

And so there’s a balance because sometimes it’s really affirming while assuring like there’s an answer to why you’ve been struggling and this label, if you will, will help with that but then there’s also the balance of like, well, you’re going through a lot of things but it’s not necessarily ADHD or autism. Then there is a balance of, I don’t know if you’ve encountered this, but how do you manage that where you want to advocate for what the client experience is, at the same [01:30:00] time do right with them and not give them a false diagnosis.

Dr. Laura: I get a lot of people who are self-referred for autism. These are adults who say, I know I have autism. I already identify this way. I just need the official paperwork, kind of thing. I’ve found whether or not I do diagnose autism, there’s always some sort of neurodiversity there. I’m recommending a lot of the same things like check out these websites, read these books. I think this is going to help you frame your life within the parameters of neurodiversity in general.

Vulnerability here, then I feel like a fraud. If I’m giving you the same recommendations that I’m giving someone who I did diagnose with autism, why am [01:31:00] I not calling this autism? You know what I’m saying? I don’t know.

Dr. Stephanie: I think that in some ways we’ve also started to train our patients, our clients, to ask the wrong question. You guys might know I’m obsessed with this idea of the secret question that people bring in. I don’t think their secret question is necessary, do I have autism? It’s more like, is it my fault that life is so hard? Is there something wrong with me? Am I too much or not enough for other people?

We are replacing those hard questions with this seemingly easier question of, do I have autism? We could probably speak to those bigger questions in ways that are actually more helpful, especially if the answer is no, you don’t have this diagnosis that you thought you did, or yes, you do have a diagnosis, but it’s not the one you thought it was.

Those have the potential to be really activating for the person because it’s not what they wanted to [01:32:00] hear, but if we could get underneath and speak to it’s not your fault, life really is hard. You do have some things that make it more challenging, and there are ways that you can help while still accepting yourself. If we could speak to those questions instead of replacing them with the easier question of, do I have diagnosis X check box, yes/no?

Dr. Chris: That’s the classic example of responding to process over content. That’s drilled in first year of graduate school; process over content. It’s not what they say, it’s what they’re really saying. I think we have to ask ourselves what our role really is in this situation.

From a business perspective, what are you selling? You’re selling answers, you’re selling illumination, you’re selling something, but there’s a way to do this very ethically and clinically, and we can use our various specialized skills to accomplish that.

Dr. Stephanie: Where did you go to school that you got the emphasis of process over content? That’s amazing.

[01:33:00] Dr. Chris: I went to Illinois School of Professional Psychology. They are no longer in existence, by the way. Lots of drama last year over that school. It was AP accredited all the time. We’ll fall back on that.

Dr. Stephanie: I feel like my program was just content, content, content.

Dr. Chris: You went to Vermont. Is that true?

Dr. Stephanie: I did. The University of Vermont.

Dr. Chris: I went through this weird process where I went to Western Michigan undergraduate which is behavioral. You are basically Skinner’s kid when you come out of that place. And then I went to Illinois School, which is super. You can do clients there, you can do psychoanalytic, you can do cognitive-behavioral, which was still like not behavioral. It was very cognitive.

It was a transition. It was so interesting. Very good, nonetheless. You come out of Western as a mini genius in behaviorism at then know nothing about anything else. So it was a good experience.

Dr. Andres: So rewinding a little bit. I hope it’s [01:34:00] okay.

Dr. Sharp: It is. You’re safe here, safe place.

Dr. Andres: The topic of neurodiversity or just because you brought it up, that fascinates. It fascinates me because, I appreciate the discussions you’ve had on the podcast about it, Jeremy, and because that was a new thing to me. I don’t really have a question here. This is just me talking.

I have a colleague who described it as being able to advocate for neurodiverse people as a social justice issue.

I thought that was interesting. I stopped to reflect on it and see for my own understanding of it and things like that. I’m curious about this movement if you will, and what’s you guys’ thoughts on it. [01:35:00] Even as I’m saying that because there’s a social justice tie to it.

I’m already catching myself like, well, can we say? I’m always interested in the things we “can’t” talk about in our society. As a therapist, I’m like, let’s talk about the things you can’t talk about, but yet there’s a lot of that now. We can’t talk about these things but I think that’s where we grow. So I’m curious what comes up for you guys in terms of that controversy if you will, and if it leading to other questions of diversity and things like that.

Dr. Sharp: I just want to acknowledge since people are being vulnerable here, that whenever this stuff comes up, I get anxious.

Dr. Stephanie: I was seriously thinking, who invited Andres?

Dr. Chris: Zoom in.

Dr. Sharp: Stop what, internet? Can you help me [01:36:00] out?

Dr. Stephanie: I’m breaking out. I’m going through a tunnel.

Dr. Andres: It’s fine. Things that’s so tricky about these Facebook groups. Social media is that sure. In-person, the debates I see about any of these topics, we would never talk that to someone face to face.

I’ll disclose, politically I’m more left-leaning, liberal but my clients who are conservative, I have some of the best conversations with them because we treat each other like people, and then there’s a deeper understanding, but yet if we were interacting on social media, it would be like, no, you’re a racist, you’re Marxist, stuff like that. And then it goes nowhere.

So I’m always fascinated about these long-form discussions about these things that really need a lot more time and attention. I think it’s a shame that we feel anxious about it.

Dr. Chris: I think we get anxious about it because we’re not used to opening up [01:37:00] space to alternative hypotheses. We walk through our lives with our own narrative and our own CBT stuff, but we’re not willing to entertain necessarily contradictory evidence. And so we’re unwilling to open up space globally for contradictory evidence.

In a situation like this, here we are on our Zoom and we’re going to be podcasted to the entire world here soon being incredibly vulnerable, but there’s still this place where there’s this conservatism in terms of what we’re willing to experience, what we’re willing to entertain as hypotheses, what we’re willing to even share with the world.

But there’s something about that, that’s interesting. And that thing that’s interesting is why do we do this? Because it’s playing out in our clinical world, it’s playing out in our social world, is playing out in our relationships. It’s playing out everywhere. And so why do we offer opportunities like this to be safe whereas other opportunities are [01:38:00] not. I think it’s because of the space that we keep for that. Are we willing to entertain it and entertain ourselves?

Dr. Stephanie: I think a lot of us really struggle with imposter syndrome. I don’t think I’m speaking out of turn with saying that a lot of us have really heavy, we’re making really heavy decisions for families or for individuals. The idea of being wrong is really scary.

And so when you bring up a new area or a new way of thinking, and we have to think about, well, maybe I’ve been thinking about this wrong the whole time, maybe I’m still thinking about it wrong, maybe these other people who are my colleagues are wrong, that brings up a lot.

It’s hard for all of us to realize that we’re making mistakes a lot and that’s okay. That’s not really something that I learned in my training, that I could make mistakes. I can find all the mistakes [01:39:00] in my colleague’s works pretty easily, but the idea that I’m constantly talking about things wrong or thinking about things wrong or getting it wrong is hard.

And when you bring up something like neurodiversity, which is a different way of thinking, well, then somebody is wrong here. And it might be me and that’s a pretty uncomfortable place that I don’t always want to spend all my time.

Dr. Sharp: It’s a great point. I want to just be explicit and say that I feel we have to talk about it. It is very hard, but we owe it to ourselves and really to everybody else to talk through these things. Neurodiversity, social justice, inclusion, whatever heading you want to put on that conversation, because those conversations have been either ignored or censored or whatever for so long.

We [01:40:00] have to find a way to do it. I don’t know how to do that. I do it wrong and I get nervous when I think about doing it but I think we have to somehow.

Dr. Chris: That’s an interesting point, Jeremy. I was involved in a group this summer and we were all clinicians, and there was one clinician in there that was very diversity-focused. That was her thing and she’s incredible at it.

And my reflection on that moment was, that made me nervous. Why was I so anxious for 90 minutes about this thing, leading up to it, experiencing it, and afterward. And here I am, a white dude, and so I have all this extra stuff that’s involved in all of this, and it was just so interesting to me.

After some reflection, it’s like, man, how do I play this out clinically? How do I play this out neurodiversity? How do I play this out in all these ways? These are all great questions as long as we’re not judging ourselves, that we just continue to ask.

Dr. Andres: I’ll just be [01:41:00] clear, I do judge myself. I’m like, I need to know this stuff, seriously. Just being straightforward, I feel a lot of responsibility and Laura, you share some of this as a moderator of our group to either take a stand somehow or know how to talk about it or police the way other people talk about it. I’m like, I don’t have those skills. I think we need to be talking about it, but as far as shaping how others do it, that’s really challenging because I’m still figuring it out myself.

Dr. Laura: And language changes so fast and keeping up, one of the questions that was posed here was how are you keeping up and staying connected with the field and how do you keep up with the research? And that is so challenging. Unless you have the personal experience, you’re living as others or [01:42:00] you’re completely invested in it, and that’s the only thing that you’re doing with your time is speaking to those populations or working with those populations, that’s so hard and you don’t want to be judged.

Somebody in the Facebook group had posted something where they said, what am I supposed to do retroactively about like the language I’ve used in the past? How am I not going to get judged for what I’ve already said? And that’s so hard.

Dr. Sharp: Sure. Just speaking for myself and I am obviously a white guy who’s has a lot of privilege in this world. I have come to the place where it’s like, I just know that I always have to keep it front and center somehow. So there’s always like a book in my rotation, or that podcast, I’m listening to, or that audiobook on the way to work or whatever is something to do daily.

It just has to be like a daily thing because otherwise, I will forget and that’s really shitty, [01:43:00] but that is the way that my brain works because of how I’ve grown up and what I was born into and all that nonsense. So that’s, for me, the thing that has to happen is just always be thinking about it somehow and slowly working through it and having these conversations and willing to make mistakes.

Dr. Stephanie: The privileged behind privileges is not having to think about it. And so if you keep going and not thinking about it, you’re slipping back into the very problem.

Dr. Sharp: It’s a small step, but for me, it’s like the privilege is to not have to think about it. So I’m going to make sure I’m thinking about it in this very deliberate way. I don’t know if it’s the right way or not, but it’s a way.

Dr. Andres: As you guys said that 2020 was such a big year to bring these conversations front and center. I’m curious how it’s shifted maybe the way you’ve [01:44:00] practiced if it has.

Dr. Stephanie: What I’ve been trying to focus on is relevance of our work, trying to make it more practical, understandable, useful and real in the lives of whoever I’m working with the idea that I might get the language or the diagnosis wrong.

I hope when I look back on my reports from five years ago or 10 years from now, when I look back on my reports that I’m embarrassed by some of the things in them, because that will mean I’ve grown, but I hope that the meaning of it, the usefulness of it, the understandability of it, the relevance of it will make up for the fact that I’m getting some of that other stuff wrong despite my best intentions.

Dr. Sharp: I like that. You’ve always been an advocate for readability even on a simple level, like writing where people can read it and being [01:45:00] useful. That’s a big step. Not writing to people of our education level and assume that everybody is there.

Dr. Stephanie: Right. Our education level, our level of privilege, our level of all of the gifts that we have so that we’re not just writing to each other. And that happened because I looked back on my old reports and was like, whoa, I can’t read this.

Dr. Sharp: Totally.

Dr. Andres: As you say that, one of the things that come up for me a lot of times when these conversations come up is, A lot of time it’s not social media. Just thinking about how it’s so easy one person declaring that there’s a right answer for these things.

If I could change anything about our graduate programs is [01:46:00] how we talk about diversity. Typically, it’s like some white male professor telling us how to be diverse. I always thought that was interesting. And telling us the right way to do it.

I’m remembering one of our guest speakers in class, it was a discussion about diversity. And then talking about who are your people? And then the guy looks right at me and goes, who would you say are your people, Andres?

Everyone knows exactly what he’s talking about, but he didn’t say it. So I was like, I’m going to mess with him a little bit. I’m a religious person. So my people are people who go to my church. Clearly, it wasn’t the answer he wanted.

So then he was like, what about you? Turning to another student. [01:47:00] I love how you guys are talking about this. We don’t have answers for this. There’s no textbook on how to do this. And you go to 10 years from now, the way we’re talking about these things that are going to be wrong, they’re going to sound wrong and that’s okay but that’s frustrating for us. We also don’t want to offend anyone.

Dr. Stephanie: That’s the dialectic that we live in. We’re all trying to get it right but sticking by the status quo historically has never been the right answer. Here we go.

Dr. Sharp: Yes. That’s such a good point. I feel we have had an amazing discussion. It’s hard to cut this off, honestly, but I know we’re getting close time wise here. I wonder if we might close with just some thoughts on what are you working toward? How are you hoping to get [01:48:00] better? What’s keeping you going over the next few months or years or whatever it is, what’s exciting for you right now?

Dr. Laura: I am about to do the therapeutic assessment training. And so I’m very excited about that. I’m hoping it’ll bring a new lens, some new ideas and I can be more like Stephanie someday.

Dr. Stephanie: That’s sweet. That’s so exciting. Are you doing that with Raja?

Dr. Laura: Yes.

Dr. Sharp: One of my psychologists is going to be there. If you see her online, her name is Jocelyn.

Dr. Laura: Awesome.

Dr. Sharp: That’s exciting.

Dr. Andres: Being new to this thing, I’m working on my practice, building it, that’s exciting to me, connecting with people who are starting off too. I’m like [01:49:00] Chris where I love systems and trying to spend 30 hours trying to be efficient. We’re just funny. That’s for me, but then just rethinking how we do all our work. COVID has really challenged me. The traditional way of doing things has completely shifted, and to rethink that.

Dr. Sharp: Super cool. Chris, you got anything on your radar?

Dr. Chris: What I’m going to do nothing for a while. I’m taking the first two weeks of March off. This year has been incredibly difficult on so many levels. And so I’m trying to work from the abundance mindset where I can take two weeks off and it’s going to be okay. It’s time to regroup and fill the batteries back up. And so I don’t know what’s going to happen in the next 12 months, but I know what’s going to happen in the first two weeks of March, and that is nothing.

Dr. Laura: Do you have vegetables to eat from your garden?

[01:50:00] Dr. Chris: I will buy them and also plant them because that experiment did not go as planned, by the way. They were fun to talk to and sing to every once in a while. How about you, Stephanie?

Dr. Stephanie: My passion project right now is I’m going to be presenting on report writing at ABPN in April. It’s going to be three hours, which is both ways too long for anyone’s attention span, but also way too short to cover such a big topic. So it’s like consuming all of my thoughts right now. So if anybody listening has questions that they would love to hear about or things they didn’t learn about or pain points that they have, please send them my way so that I can make sure that the talk is really relevant to the people who might actually attend.

Dr. Sharp: That’s cool. I saw that on the program. I was like, whoa. I cheered out loud.

Dr. Stephanie: Thank you. I heard it all the way.

[01:51:00] Dr. Sharp: I love that. It’s been cool. I’ve made a recommitment to being deliberate in what I’m doing. So I did a ton of research on daily journals that keep you accountable, accountability sort of things, and settled on one. And it’s been awesome. I write out my ideas and goals for the day and plan by the week and by the quarter and all that stuff. So I made a recommitment to do that.

Dr. Stephanie: You’re going to do a podcast about that, I hope. That’ll be the next business one. That sounds really neat.

Dr. Sharp: This has been amazing. Thank you all for sitting down for two hours and talking through all of this. I hope that it’s been helpful for folks. If nothing else, it has been a lovely way [01:52:00] to spend the morning and a good way to connect with colleagues and friends. So, thank you all so much.

Okay, everyone. Thank you as always for tuning into this episode. Like I said, this is the first time that I’ve tried this format. So please shoot me a message. Let me know how you liked the happy hour format. If there are any topics that you’d like to see discussed and anything else that comes to mind, any reactions to this new format. I really had a good time. I can’t say that enough. So big thanks to all of my guests who came on today. I hope that we can do it again.

If you’re a beginner practice owner or someone who is looking to launch their practice in 2021, I would invite you to check out the beginner practice mastermind group, which is a group coaching experience just for [01:53:00] folks who are launching their practices. It’s going to start in March 11th.

And this is a cohort-based experience where you’ll go through this together with five or six other psychologists who are in the same stage of practice. It’s a group where we will hold you accountable and give you support as you launch your practice and set some goals for yourself and hopefully reach those goals. If you are interested, you can schedule a pre-group phone call to check out the fit by going to thetestingpsychologist.com/beginner.

As always, thank you so much for listening. Hope you’re all doing well. Take care of yourselves. I’ll talk to you on Thursday.

[01:54:00] The information contained in this podcast and on The Testing Psychologist’s website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment.

Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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