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Episode 1: Taking The Leap — From CMH into Private Practice
Episode 115th November 2021 • All Things Private Practice Podcast • Patrick Casale
00:00:00 00:18:18

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Taking the leap from community mental health and into private practice is Fuc*ing Scary!! As a therapist, group practice owner, and private practice coach and strategist, I was full of self-doubt, insecurity, and overwhelming anxiety.

Who the hell was I to be successful, and why would someone hire me? We hold ourselves back for so long and prevent our own journeys into small business ownership with a laundry list of excuses, but we don't know what we don't know.

This podcast will take you on a journey with a discussion about Failures, Fears, Impostor Syndrome, and Self Doubts. Normalizing failure and celebrating triumph is the goal.

I'll be interviewing experts in the industry to talk about how normal it is to struggle in small business ownership and the process of becoming an entrepreneur. We'll also talk about how stepping into and embracing fear leads to overwhelming success, however the hell you want to define that.

Subscribe wherever you listen to podcasts, and share this with anyone who's dreaming big but thinking "why me?"

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PATRICK CASALE: This is Patrick with the All Things Private Practice Podcast, where we talk about, you guessed it, all things private practice. That includes startup, struggle, failure, success, and everything in between. Today, we're going to talk about my journey and why I left community mental health, and I hope that this resonates for you. If you're listening at home and thinking about taking the leap, I know it's scary. I worked at a community mental health agency for almost five years, always in leadership or middle management, which is a shitty place to be. Can't ever take care of your staff enough, they never have enough resources and the supervisees don't ever get enough supervision, and then, the administrators are always adding things to the list, more productivity requirements, more expectation, less money, right? No raises. I was there for a long time. I always knew that it was not going to be the last stop for me, but I didn't know what else was next in that journey. I had no vision and I had no conception of how to get there.

I started to think, “Hey, this job is truly burning me out.” I'm sure you all can resonate with that, because we are right now in an era of psychotherapy, where we are feeling a lot of burnout, we're experiencing a lot of stress with COVID, and with a lot of other things happening in the world. It's exhausting as professionals and helping professionals, in general, to be thinking about, “What do I do? Did I make a bad career choice? Do I leave the profession?” Which creates a lot of shame and a lot of feelings of abandonment? “Why did I go to grad school? Is this something that I can do for the rest of my life? Do I go back to bartending or anything that isn't this?” And I know that community mental health agencies serve a role and a purpose. They help some of the most vulnerable populations, the uninsured, the Medicaid population, the homeless populations. I get it. They need to exist for a reason. I understand that budget cuts, state funding, and national funding isn't there.

But for the people who are doing the work, it doesn't really matter that the funding isn't there, because you're doing the work, and you're not getting paid appropriately or accordingly. You're working a lot of hours, maybe 50, 60 hours a week and making peanuts, while the agencies are actually making quite a bit of money from state grants, from Medicaid reimbursement. I know a lot of states where Medicaid pays about 130 to $140 an hour, yet you’re making, I don't know, 17 to $20 while doing all the stressful stuff, right? And never feeling appreciated, and always feeling taken for granted. The way that you're shown appreciation is like, “Hey, guys, we're having a communitywide luncheon on Friday. We're going to provide it.” It's like some shitty restaurant in town that caters sandwiches, and it's like, “This will appease them and keep them quiet for a couple of weeks.” No raises, impossible to get PTO approved, et cetera. The list goes on and on.

I get it. I've been there. You start to question and you start to think about private practice, but it feels like a pipe dream. You don't know how to do it, you don't know what steps to take, you start to really wonder, “Is this a possibility for me?” As that curiosity grows, the interest in leaving your job also increases and you start to pick out things at your 9:00 to 5:00 that don't feel good for you. They don't match your lifestyle or your needs anymore. That's a problem because then you start to check out and that's not fair to your clients. But it's also not fair to you.

I know when I was thinking about private practice, I kept thinking like, “I don't think I can be successful at this. I don't think that I can do this in a way where it's going to meet my needs, people aren't going to pay me, I don't have enough experience, letters behind my name, I don't do EMDR.” Whatever, it doesn't matter. All of those thoughts started creeping into my head. Mainly, at the end of the day it's like you're not good enough, you're not worthy, essentially, of doing this for yourself. I get to the point of burnout, our agency announces companywide raises for the first time ever. They're really proud of this ridiculous bump in pay. I don't receive one, because I left one grant that we got off the ground for a program that was meant to keep people out of the hospital to another new grant and was the program manager of that.

What happened is they told me that because I started a new program, I wasn't eligible for evaluation yet, so not eligible for a raise even though I was there with the company for four years. That was it. That was my breaking point. There were a lot of other moments leading up to that. But that was the final straw where I was like, “I've got to get out of here and go out on my own. I cannot take this anymore.”

In supervision, I remember naming that, and just being like, “I've got to go. I cannot be a part of this organization anymore.” I decided to put my notice. I put my notice in the next day. I gave a 90-day-notice because they weren't going to function without me. My staff was going to need me, and my clients blah blah blah blah blah, all the excuses that we tell ourselves to prevent ourselves from leaving. They replaced me in two days, someone who had been on staff for four years and helped to create two programs get off the ground, two days. Basically dead man walking for almost three months. I cut the notice short after two months, because I was like, “There's no point of being here, I am not feeling useful, you are certainly not getting anything out of me at this point in time, and I need to go.” They refused to pay my PTO out. It became a really messy situation. At the end of the day, I just cut ties, and I was like, “All right, that's fine.”

I had lunch with my program manager to do an exit interview on my last day. She told me straight up, point blank, “You'll be back here in 30 days. Nobody ever makes it on their own. The people who try fail and they go back to agency work. Nothing is special about you.” And I was like, “Oh, my God. This person and I have had a relationship, even a friendship.” That hurt so bad to hear that. I know later down the road it was out of like resentment, jealousy, and frustration that I was leaving, and whatever else was going on for her. Wasn't my shit, you know? Anyway, I've always used that as motivation to continue to push forward.

I take the leap. I immediately go to Scotland to take my dad for his 60th birthday. I realized very quickly, I don't have paid time off anymore. I'm coming back to a small business that I've created that has a couple of clients and I'm not getting paid for the two weeks that I've been gone. That was really fucking scary. I realized very quickly, there's got to be a way to have some systems in place, you have to truly understand how to get this up and running and off the ground. But more importantly, it needs to run smoothly, and you need to obviously plan for time off, and sick time, and all those other things. I was like, “Oof, did I just make a big mistake?”

In the first month of practice ownership I did not get a single call, even though I thought I was doing all the right things: networking, blogging, putting out social media content, and nothing was working. It was one of those moments that really tested me. I'm looking at my schedule, I see all the blank space that I really wanted, and I start to freak out. How do I fill this space? How do I get clients in the door? Do I take them for $20, $30, 40, whatever? Sometimes I did, I'm not going to discourage you from doing that. Because I know we need to survive. How am I going to get more calls? What am I doing wrong? Did I make a mistake, right? Was she right? Am I going to go back to this agency job in the next 30 days? That really fucking sucked. I was like, “She's right. I can't make it on my own.” I think there's a resiliency to small business ownership and entrepreneurs where you face obstacles, and challenges, and struggles, but you push through them. You're open to them, you embrace them, you feel the feels, right? It's scary, it's intimidating, it's emotional, it's exhausting, it's sad, even.

But then there's this light at the end of the tunnel that's like, “If I can make this work, it's mine.” I think that creates empowerment, motivation, and even creativity to say, “I'm going to start working in my business and getting this off the ground, and trying to get as creative as possible to make sure that this works.” I remember going to a networking lunch during that time and voicing, “Hey, if this doesn't work, I can always go back to agency work.” And this person's response will stick with me forever. She was like, “Absolutely not. You need to remove that from your thought process. You never go back. You do anything else. You work at the gap. You go back to bartending. You figure it out, but it's not that. Don't let them feel like you have to go back to this world of working 50 or 60 hours a week, not getting paid, and just burning yourself out beyond belief.”

She was right. I started to get really creative about my networking. I used to only work with men struggling with addiction. I realized I should probably start connecting with halfway houses in the area, treatment facilities, and SAIOPs, or substance abuse intensive outpatients. I shot my shot. I sent a bunch of messages to a bunch of halfway houses, “Hey, I want to store your programs, because I'm going to need to refer to you at times, which is absolutely true.” It wasn't a lie, it wasn't false at all. I think only four or five out of 30 responded, which was great, and they’re, “Yeah, come to our programs. We’ll tell you about what we do. We'll talk about cost.” All that stuff. I went, and I toured them, and I was uncomfortable. I felt out of my element, like what do I really have to offer these people? I made some good relationships.

The next month after I quit my job, it was like a dam burst. One of these halfway house owners called me and said, “Hey, Patrick, I've got 15 clients who need therapy. Can you support them?” I was like, “Oh my God, yes, absolutely. Send them all.” I was worried about conflicts of interest, and stuff like that. I had to set very firm boundaries, but that networking paid off, and I never thought it would. I just was like, “I'm going to try something, I'm going to be vulnerable, I'm going to put myself out there and we're going to see if it sticks.” And thankfully, it did. All of networking I did with other therapists in the community that also really paid off. I’ve met so many therapists and it wasn't one-sided. It wasn't just like, “Hey, I'm in practice, this is who I am, send me clients.” It was more like, “I'm in practice, I want to support you. I want to build my networking list, and my referral list, and my community.” Because I can't work with everybody that comes in my door, and I don't want to, so it's a really great way to refer back and forth and to support each other.

That was so scary. The first year or two was horrifying. I get the question a lot, “When should I quit my job? I have to worry about time off, and health insurance, and how to pay the bills.” Those are all valid concerns. I'm not going to say that they're not. But if you don't try, if you don't put yourself out there, if you don't feel those feelings of distress, and discomfort, and you don't know what it's like, that's going to feel really regrettable towards the end of your career if you never take a chance. If this was a sure thing, and I would love to tell you that it is, but I've seen a lot of people try and fail, but I give them credit for trying. If this was a sure thing, everybody would be doing it, right? We wouldn't have a need for community mental health workers, because nobody would do that job.

I think that we have to recognize that we need to surround ourselves with good supportive people, and mentors, and coaches, and colleagues, and people who build you up, not people who when you tell them you're going to start your own business tell you that's not going to work, right? Don't surround yourself with my former supervisor, for example. Surround yourself with people who know that this can work, because this business is replicable. You are allowed to continuously develop, and evolve, and really change the way you practice over time. You don't have to know it all at first, and you never will. It doesn't have to be perfect, and that will never happen either. You'll never have a perfect website, you'll never have a perfect landing page, or directory page. But you can constantly improve it. You can constantly work through that and make sure that it feels like it's your version and your vision.

I think that's what's mostly important about private practice and small business ownership, is we have a dream, we have an idea. We're really creative. Entrepreneurs really have a lot of cool ideas going on all the time, and we take chances. Sometimes they don't work out, but that's not a reflection on you as a human being or your ability. It's just the reality that sometimes it doesn't work, but then we try again. We pick ourselves up, and we continue the process, and we continue to work through this stuff, because honestly, I don't regret any of it. I don't regret the community mental health experience. I got some good experience there. I know what I don't want to do now, I know what I do. I know how I want to practice, I know who I don't want to be as a practice owner and group practice owner. I know what kind of boss I want to be, and don't want to be. I know how I want to work with clients, I know how many hours I want to work, and what days I want to work. The beautiful thing is, I get to make all of those decisions. I get to decide when I want to take time off or put my PTO request in, because it always gets approved.

I get to decide when I want to do trainings, and CEUs, and which ones I want to do. If I only want to work one day next week, I will. Sometimes we don't always have the ability or the privilege to do that. I've worked really hard to get to where I'm at. At first, it wasn't like this. It was like scraping by, taking clients in the door who weren't good fits for rates that I would not take today, and doing hours that I didn't want to do like Saturdays and evenings, but I thought that's all I could do to get my business up and running. I will say small business ownership can be a grind. A lot of people aren't built for it. That's why they join group practices or they don't leave their agency jobs, because there is a grind to networking and putting yourself out there, and clients ebb and flow, right? Some clients will work through their shit and move on. Some will go to every other week or monthly. Some will just disappear off the face of the earth, and sometimes it's just not a good fit. This is all common.

But if we don't understand abundance mentality, and we're always in the scarcity mentality mindset, we truly believe that when that happens we're bad business owners, we're poor clinicians, we're never going to be successful. In reality, it's the opposite of, hey, it just wasn't a good fit. Or we worked on some cool stuff, our client got to where they needed to go, and that's it, and another client will come in the door. You'll get more phone calls, every time. It's like a revolving door. People come and go, ebb and flow, right? So does money. Money comes in, money goes out, and that's a part of small business ownership. Getting really comfortable with these things, and not beating yourself up when something doesn't go your way.

Again, to answer the question that I get pretty often of when should I quit my job? I don't know the answer to that. I think if you're already asking that, then you're already putting the wheels in motion. It's important to obviously have some security, but I believe agency jobs can almost be like emotionally abusive relationships. Like, I know it's consistent, I know when I get paid, I know what to expect, but it's damaging, it's painful, it's traumatizing, it's making me feel underappreciated. We get to decide how we want to play life, and if we want to play it safe and never take a risk, then yeah, absolutely stay at your agency job, or join a group practice even. There's nothing wrong with joining a group practice. I own one, but at the end of the day, tap into who you are, and be authentic and be real. Have your values guide you with where you want to go. I don't think you'll regret that. If you take a chance, and it doesn't work out, I don't think you'll regret that either, because at least you tried instead of just holding yourself back in fear.

I held myself back for so long. I can't be successful at private practice ownership, then group practice ownership, private practice building and coaching. Nobody's going to hire you, why would they? What do you have to offer that's different? We all have our own voices, we all have our own ways of working with people. We attract what we put out, and we repel what we put out. I just want you to think about that, and really tap into who you want to be and how you want to work. I really think that that's important. I think that surrounding yourself, again, with the positive people and support systems in your life.

I hope this is helpful, and we'll continue to have these conversations on here. We'll be having different professionals from all throughout small business ownership, but most importantly, private practice owners on the podcast as guests, which will be a really fun conversation. We're going to talk about real shit. We're not going to sugarcoat things, we're not going to stay above the surface. I believe you can only go as deep as you're willing to go yourself. This is going to be about authenticity. This is not going to just be about practice building and ownership, because there's a lot more that comes up emotionally, psychologically. These things are important to discuss. I want to normalize failures, missed attempts, struggles, things that we've had to work through to get to where we're at, because when I started my private practice, I never envisioned having a podcast, a private practice building Facebook group, a coaching business, a group practice. None of those things even seemed conceivable to me, because I didn't even know what I wanted my private practice to look like. I just knew I didn't want to be at my agency job anymore. That's all I knew.

But the more that we work in this field, and the more that we can tap into becoming entrepreneurs, and accepting that we're entrepreneurs and business owners, the more opportunities open up, and that's what this last year for me has been, is saying yes to opportunities, speaking at conferences, going on podcasts, Zoom webinars, offering coaching courses and mentorship. Say yes to opportunities. I promise that it will work out. It might be scary along the way, and that's normal, and that's okay.

I want to let you know where you can find more of me and my information. I own All Things Private Practice. I have a Facebook group, All Things Private Practice. Please feel free to join it. Please feel free to download this podcast and share it wherever you listen. I also have coaching courses, individual coaching for practice building. I also have a group practice here in Asheville, North Carolina, and individual practice as well. None of this would have been possible had I not said yes to leaving my agency job and taking the leap of faith on myself. I hope that you can do the same, and we'll continue to support each other, build each other up and hold each other accountable. Thank you so much.

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