The State of Therapy: Big Business, Burnout, and Reinventing Private Practice

Kelly Higdon: 00:00:00

Welcome to another episode of the podcast.

Kelly Higdon: 00:00:02

This one is super special.

Kelly Higdon: 00:00:05

Miranda and I have decided that once a month we're gonna be checking in

Kelly Higdon: 00:00:08

with all of you talking about what's happening in the field, our thoughts on

Kelly Higdon: 00:00:13

it, what it means for private practice.

Kelly Higdon: 00:00:15

I'm super excited.

Kelly Higdon: 00:00:16

We have not pre-talk about anything.

Kelly Higdon: 00:00:19

This is just us having conversations so you get some insight into our hearts

Kelly Higdon: 00:00:23

and our minds all about what's happening in mental healthcare around the world.

Kelly Higdon: 00:00:29

Let's do it.

Miranda Palmer: 00:00:31

Uh, this is Miranda Palmer's voice, um, over here and,

Miranda Palmer: 00:00:35

um, Kelly sent me some articles last night at like, after 11:00 PM Okay.

Miranda Palmer: 00:00:41

So when I woke up at five in the morning, I'm getting these

Miranda Palmer: 00:00:44

articles and I'm just like, in a little bit of alarm mode of like.

Miranda Palmer: 00:00:48

Oh my gosh.

Miranda Palmer: 00:00:49

Like what is happening right now?

Miranda Palmer: 00:00:52

And then I was so delighted that we, I realized that, oh, we're,

Miranda Palmer: 00:00:56

we're gonna be talking about this stuff on the podcast, um, today.

Miranda Palmer: 00:01:00

And I was like, I'm so ready to talk.

Miranda Palmer: 00:01:03

Um, it was a morning to say the least.

Kelly Higdon: 00:01:07

Well, last night I had choir till really late, and sometimes

Kelly Higdon: 00:01:10

it takes me a while to decompress.

Kelly Higdon: 00:01:11

So I was reading and I found some interesting stuff.

Kelly Higdon: 00:01:15

I sent you an article, for example, on how ULA is joining Amazon Health.

Kelly Higdon: 00:01:21

I don't know if you got an email about Amazon Health, but I did.

Kelly Higdon: 00:01:24

About how we can see a doctor now through Amazon.

Kelly Higdon: 00:01:27

You and I are both in an effort not using Amazon,

Miranda Palmer: 00:01:33

correct

Kelly Higdon: 00:01:33

our lives, taking Amazon out of our lives.

Kelly Higdon: 00:01:36

Uh, but I thought that was really interesting.

Kelly Higdon: 00:01:38

What did you think about it?

Miranda Palmer: 00:01:41

Actually, I got two articles from you and that

Miranda Palmer: 00:01:43

was not one of them, but I will tell you what I think about.

Kelly Higdon: 00:01:47

Um, I thought I also sent you that one.

Kelly Higdon: 00:01:49

Yes.

Kelly Higdon: 00:01:49

I sent you some others as well.

Kelly Higdon: 00:01:50

We can get to those.

Miranda Palmer: 00:01:52

Uh, you know, it's a really interesting space I've been

Miranda Palmer: 00:01:56

working on for our business schoolers.

Miranda Palmer: 00:01:59

A a, um.

Miranda Palmer: 00:02:02

Like an Excel spreadsheet that shows all these different online mental health tech

Miranda Palmer: 00:02:06

companies, um, and it helps them to look at if they're considering, well, usually,

Miranda Palmer: 00:02:12

well, let, let me go back a second.

Miranda Palmer: 00:02:14

Traditionally in our work, we've been working with therapists for 15 plus

Miranda Palmer: 00:02:19

years providing, uh, coaching and consulting around private practice.

Miranda Palmer: 00:02:24

And in the past, the question was always, do I do private pay?

Miranda Palmer: 00:02:28

Do I take an insurance contractor?

Miranda Palmer: 00:02:30

10, um, do I do a hybrid of the two?

Miranda Palmer: 00:02:34

What does that look like?

Miranda Palmer: 00:02:35

And now therapists are having to make this decision of.

Miranda Palmer: 00:02:39

Do I do a insurance contract credentialing on my own?

Miranda Palmer: 00:02:43

Do I just do private pay or do I navigate through one of these

Miranda Palmer: 00:02:47

online mental health tech companies?

Miranda Palmer: 00:02:49

Ula being one.

Miranda Palmer: 00:02:51

Um, better help being one of them.

Miranda Palmer: 00:02:54

Talk help.

Miranda Palmer: 00:02:55

I started Go Sonder Mind.

Miranda Palmer: 00:02:57

I started like putting the list and it was like.

Miranda Palmer: 00:02:59

14, 15, 16, 17. And I know that I don't have all of them yet.

Miranda Palmer: 00:03:04

Yeah.

Miranda Palmer: 00:03:05

So the noise that's out there for therapists to figure out where

Miranda Palmer: 00:03:10

they want to focus and put their heart and their soul and their

Miranda Palmer: 00:03:15

labor is getting like so complex.

Miranda Palmer: 00:03:18

And I could imagine, especially at this time, I know a lot

Miranda Palmer: 00:03:23

of therapists who've decided.

Miranda Palmer: 00:03:25

I don't wanna be a part of the Amazon universe.

Miranda Palmer: 00:03:29

Amazon, the amount of money they bring in that money does not

Miranda Palmer: 00:03:34

go back to, um, communities.

Miranda Palmer: 00:03:37

Like the money that I spend in my city, like what is it, like 2 cents or like a

Miranda Palmer: 00:03:43

very small amount of that profitability is actually coming back to my city

Miranda Palmer: 00:03:47

versus if I was go to go into a store.

Miranda Palmer: 00:03:49

And I think that that's really powerful and impactful.

Miranda Palmer: 00:03:53

So those same therapists that may have decided that they don't wanna be

Miranda Palmer: 00:03:57

associated with Amazon overnight, they've now become connected in with Amazon.

Miranda Palmer: 00:04:03

Now they're sort of an a contract employee because they've contracted

Miranda Palmer: 00:04:07

with ula, and ULA is paying them.

Miranda Palmer: 00:04:10

ULA gets to decide who and how they work for, and so suddenly they might

Miranda Palmer: 00:04:14

be supporting the Amazon universe.

Miranda Palmer: 00:04:16

And I, for one, would be sort of really disappointed, livid.

Miranda Palmer: 00:04:21

But also I think it's a call, I say a call to arms.

Miranda Palmer: 00:04:24

That sounds a little alarmist, but it's a reminder that when you are

Miranda Palmer: 00:04:30

going in to be a contractor and when you are signing these, uh, signing

Miranda Palmer: 00:04:37

these contracts and you're saying, Hey, I'm an informed business owner,

Miranda Palmer: 00:04:40

um, you don't necessarily know what they're going to do with your labor.

Miranda Palmer: 00:04:46

With your name, with your NPI provider number, with the contracts you are

Miranda Palmer: 00:04:51

putting trust in this organization that you're okay with the decisions

Miranda Palmer: 00:04:57

they're gonna make for you.

Kelly Higdon: 00:04:59

Well, and uh, rule has what about 15,000

Kelly Higdon: 00:05:02

therapists that work for them and.

Kelly Higdon: 00:05:05

They used to be, have a different name.

Kelly Higdon: 00:05:07

Their owner, uh, was convicted of some fraud and then, uh, they ended up

Kelly Higdon: 00:05:14

changing the business name and I think there's a new CEO and owner and such.

Kelly Higdon: 00:05:18

So there's a lot, lot that happens behind the scenes in these companies.

Kelly Higdon: 00:05:22

And what we are seeing is like the name of the game, right, is to

Kelly Higdon: 00:05:26

keep raising more money and then having more venture capital, um,

Kelly Higdon: 00:05:30

private equity firms involved.

Kelly Higdon: 00:05:33

And then things get.

Kelly Higdon: 00:05:34

Blended together, right?

Kelly Higdon: 00:05:36

So like combining forces till we're probably gonna have like some sort

Kelly Higdon: 00:05:40

of monopoly on the whole system.

Kelly Higdon: 00:05:42

But one of the articles I sent you on was Better help as well, and it

Kelly Higdon: 00:05:47

really speaks to, you know, what happens in some of these corporations.

Kelly Higdon: 00:05:54

Um, what is going on with when we give our labor, when we take away our labor,

Kelly Higdon: 00:06:00

the impact on these companies as well.

Kelly Higdon: 00:06:02

Um.

Kelly Higdon: 00:06:04

So looking at just Rua for example, I think there's going to be more

Kelly Higdon: 00:06:08

of, this is what I'm predicting more of collaboration with companies

Kelly Higdon: 00:06:14

that have no business in mental health care, let alone medical care.

Kelly Higdon: 00:06:19

But anyway, um, and then we have something like better help that is struggling now.

Kelly Higdon: 00:06:26

Um, personally I love seeing that, but, um.

Kelly Higdon: 00:06:32

I think there's gonna be a lot more volatility moving forward.

Miranda Palmer: 00:06:36

Yeah, there were, it was really interesting.

Miranda Palmer: 00:06:39

Yes.

Miranda Palmer: 00:06:39

Better help is struggling and according to their numbers now, their numbers

Miranda Palmer: 00:06:43

may not be accurate, but the way that they define the amount of therapists

Miranda Palmer: 00:06:47

that are working for better help, they're employing 17% of therapists

Miranda Palmer: 00:06:52

in the United States and what the CAO came out and did, um, as within like.

Miranda Palmer: 00:06:57

Two months of, of taking the helm at Better Help or Teladoc in particular.

Miranda Palmer: 00:07:03

Uh, Teladoc is the overarching organization that owns Better

Miranda Palmer: 00:07:07

Help, better help's an arm of that.

Miranda Palmer: 00:07:09

Um, they said, Hey, we've got, uh, we gotta figure this out.

Miranda Palmer: 00:07:13

This isn't working for us.

Miranda Palmer: 00:07:15

And so we need to figure out how to change what we're offering.

Miranda Palmer: 00:07:21

Mm-hmm.

Miranda Palmer: 00:07:21

Right.

Miranda Palmer: 00:07:22

Make more profitability, come up with different products.

Miranda Palmer: 00:07:27

So there's some different little places that they are navigating now.

Miranda Palmer: 00:07:30

Any therapist that has worked for better help will tell you that they're

Miranda Palmer: 00:07:34

not making any money or profitability.

Miranda Palmer: 00:07:38

Working with better help, despite the fact that Better Help will.

Miranda Palmer: 00:07:42

Um.

Miranda Palmer: 00:07:43

Send you, like, they've sent me things saying that I could make $120,000 a year

Miranda Palmer: 00:07:48

if I go to work, um, for better help.

Miranda Palmer: 00:07:49

Oh, isn't this fantastic?

Miranda Palmer: 00:07:51

I do this little slider bit.

Miranda Palmer: 00:07:52

It's, uh, looks great.

Miranda Palmer: 00:07:54

And what you find is that the base pay for most therapists

Miranda Palmer: 00:07:58

starts at about 30 or $35 an hour.

Miranda Palmer: 00:08:01

And I, or I'm sorry, 30 or $35 a session sessions are 45 minutes.

Miranda Palmer: 00:08:07

It does not account for documentation.

Miranda Palmer: 00:08:09

It does not account for.

Miranda Palmer: 00:08:11

Asynchronous communication that you're expected to do

Miranda Palmer: 00:08:13

with your particular clients.

Miranda Palmer: 00:08:15

Um, and then the rates only get up to their max, which is less than I

Miranda Palmer: 00:08:19

think, $80 a session in most states.

Miranda Palmer: 00:08:22

Once you're doing 35 plus client hours, and they'll switch around the languaging.

Miranda Palmer: 00:08:28

So they'll say, this is how much we're paying.

Miranda Palmer: 00:08:31

Per session, and then they'll talk about the client hours you're doing,

Miranda Palmer: 00:08:35

and you don't realize that they're using these, these words in different ways.

Miranda Palmer: 00:08:40

There's actually, I've heard, although I, I need to confirm this,

Miranda Palmer: 00:08:44

that there's a class action lawsuit from therapists coming together

Miranda Palmer: 00:08:49

saying, Hey, we were misled.

Miranda Palmer: 00:08:52

In the contracts, um, we were misled in the way that we were recruited on.

Miranda Palmer: 00:08:58

There is also sub companies because Better Help is sort of well known as

Miranda Palmer: 00:09:03

somebody that people are trying to avoid.

Miranda Palmer: 00:09:06

There are recruiting companies, one of them named Gotham.

Miranda Palmer: 00:09:10

Uh, yes, like Batman, g Gotham Industries, and Gotham is simply

Miranda Palmer: 00:09:16

recruiter for better help.

Miranda Palmer: 00:09:17

But because if they put that they recruiter for better

Miranda Palmer: 00:09:20

help, people wouldn't respond.

Miranda Palmer: 00:09:21

Because they kind of know the game based on Reddit and social media and a lot of

Miranda Palmer: 00:09:25

therapists showing their experiences, um, they're being sneakier and sneakier.

Kelly Higdon: 00:09:33

When you look at the model for how a lot of these work, I mean,

Kelly Higdon: 00:09:36

when Better Help First came on the scene, I remember us talking about, you know,

Kelly Higdon: 00:09:40

it's all run on venture capital funding.

Kelly Higdon: 00:09:43

It doesn't have profitability yet, and what they do is they

Kelly Higdon: 00:09:46

gather the labor, they gather the clients, and then they change.

Kelly Higdon: 00:09:51

How they're going to make the money in order to maybe show profitability for

Kelly Higdon: 00:09:56

sale or for merger or whatever it may be.

Miranda Palmer: 00:09:59

Yeah, that and Better Help has raised, you know,

Miranda Palmer: 00:10:03

from the last time that I looked at it a few weeks ago, $1.8 billion.

Miranda Palmer: 00:10:08

Um, and partially that is part of the Teladoc platform, so it's hard

Miranda Palmer: 00:10:12

sometimes to figure out what's better help versus what, what is Teladoc,

Miranda Palmer: 00:10:16

but $1.8 billion and they have been spending for a long time, a considerable

Miranda Palmer: 00:10:24

amount of money on marketing or.

Miranda Palmer: 00:10:27

Quote unquote client acquisition, right?

Miranda Palmer: 00:10:29

Yeah.

Miranda Palmer: 00:10:30

And their big complaint is that client acquisition is the issue.

Miranda Palmer: 00:10:35

It just costs so much money to get a client in a mental health

Miranda Palmer: 00:10:39

build 'cause they're paying.

Miranda Palmer: 00:10:41

I think the last time I looked it was like $10 million in podcast.

Miranda Palmer: 00:10:45

Um, uh, uh, podcast advertising like every quarter or every month.

Miranda Palmer: 00:10:52

It, like for years it's been really wild.

Miranda Palmer: 00:10:55

Um, and.

Miranda Palmer: 00:10:57

This is, I think, also really interesting what they attribute.

Miranda Palmer: 00:11:02

The reason that people leave better help is because of affordability.

Miranda Palmer: 00:11:07

So I wanna talk about this piece, right?

Miranda Palmer: 00:11:09

Better help is actually quite affordable, right?

Miranda Palmer: 00:11:13

In terms of like one of the cheapest ways to get therapy.

Miranda Palmer: 00:11:18

And better help is saying it costs us a lot of money to acquire

Miranda Palmer: 00:11:24

a client and the clients are leaving because of affordability.

Miranda Palmer: 00:11:28

Can we talk about is that the truth or is that a story they're telling

Miranda Palmer: 00:11:33

themselves and like, what is it really looking like for our clients that are

Miranda Palmer: 00:11:37

in private practice in terms of how much money do they spend to acquire a client?

Miranda Palmer: 00:11:43

And do most clients leave because of affordability?

Miranda Palmer: 00:11:47

Or what does that really look like?

Kelly Higdon: 00:11:50

I would say, you know, that was.

Kelly Higdon: 00:11:53

You could see it better help's model was to be everywhere, to pour into

Kelly Higdon: 00:11:56

marketing dollars to support every kind of freaking podcast you ever listen to.

Kelly Higdon: 00:12:01

Even if it had nothing to do with mental health.

Kelly Higdon: 00:12:03

They are everywhere, affiliates, all of that.

Kelly Higdon: 00:12:06

Um, that is an expensive mode of marketing, but they, but.

Kelly Higdon: 00:12:10

That's not the idea.

Kelly Higdon: 00:12:12

Like for them, it's not about, at in the beginning, it's not about profitability.

Kelly Higdon: 00:12:16

It's a numbers game.

Kelly Higdon: 00:12:17

It's about how many people, how many, um, you know, email addresses

Kelly Higdon: 00:12:22

you have, how many participants, how much labor you have.

Kelly Higdon: 00:12:26

And I think, you know, in private practice, a lot of what you and I

Kelly Higdon: 00:12:28

teach is how to do marketing with like little to no cost, very low cost.

Kelly Higdon: 00:12:35

It is more time investment.

Kelly Higdon: 00:12:38

Um, but it is less of this pouring dollars into ads and all of that.

Kelly Higdon: 00:12:43

And, and especially now when you have all of these companies, right?

Kelly Higdon: 00:12:46

They're all, they've got billions of dollars and

Kelly Higdon: 00:12:49

they're advertising everywhere.

Kelly Higdon: 00:12:51

Like, I don't, I don't even wanna be in, I don't even wanna, I don't even

Kelly Higdon: 00:12:54

wanna be in that space, you know?

Kelly Higdon: 00:12:56

So I, I do believe, like in, at least in the private practice sector

Kelly Higdon: 00:13:00

as a, as a small business owner.

Kelly Higdon: 00:13:03

You can do the marketing with a, a lower cost and not in the ocean

Kelly Higdon: 00:13:08

that everyone else is swimming in.

Kelly Higdon: 00:13:09

You know, we talk about Blue Ocean strategy if you've never read that book,

Kelly Higdon: 00:13:13

but like getting away from where everybody else is and kind of standing out in your

Kelly Higdon: 00:13:17

own unique way, usually in your community, you know, and being visible there.

Miranda Palmer: 00:13:23

I think that's the piece is that when you are advertising.

Miranda Palmer: 00:13:28

For a big organization, they wanna be national, they wanna be international,

Miranda Palmer: 00:13:33

and they want to basically reach out to every single person.

Miranda Palmer: 00:13:38

You can't really be customized based on who you are trying to target and

Miranda Palmer: 00:13:45

how you help, and when you have.

Miranda Palmer: 00:13:47

Tens of thousands or hundreds of thousands of, of very unique therapists

Miranda Palmer: 00:13:51

with very unique skill levels, they have made no effort that we can see.

Miranda Palmer: 00:13:55

Really very few of these companies have made any effort to specialize their

Miranda Palmer: 00:14:00

marketing, to ensure their therapists have particular types of training

Miranda Palmer: 00:14:05

to actually connect a, a, a client's specific needs with a therapist that can.

Miranda Palmer: 00:14:12

Actually help and support that particular issue.

Miranda Palmer: 00:14:16

And that has been a particular reframe that we've heard.

Miranda Palmer: 00:14:21

You see it all over Reddit, but definitely from from our clients.

Miranda Palmer: 00:14:24

That said, you know, I thought maybe I. Um, when I was transitioning from

Miranda Palmer: 00:14:29

the nonprofit to private pay or to, to opening my own private practice,

Miranda Palmer: 00:14:34

like this would be like a no brainer.

Miranda Palmer: 00:14:36

And then I realized that it was such a churn and burn experience

Miranda Palmer: 00:14:41

where I was being thrown clients that I had no business working with.

Miranda Palmer: 00:14:45

I was deemed if I said that I don't have this specialty or tried to

Miranda Palmer: 00:14:49

refer them to someone that did, um, or, uh, unfortunately in some cases.

Miranda Palmer: 00:14:56

Or in many places, well, I shouldn't say in many, but in some cases, in a, a

Miranda Palmer: 00:15:00

strong percentage, some of these companies did not require people to have valid

Miranda Palmer: 00:15:06

particular credit cards, have their real names on there or any of these places.

Miranda Palmer: 00:15:11

And so unfortunately, there were even, we say clients in, in parentheses

Miranda Palmer: 00:15:17

points, um, or, or in quotes.

Miranda Palmer: 00:15:21

That these clients were not clients, they were people who were actually trying

Miranda Palmer: 00:15:25

to target therapists or target, yeah.

Miranda Palmer: 00:15:29

Women who cause harm.

Kelly Higdon: 00:15:30

Mm-hmm.

Miranda Palmer: 00:15:31

Yeah.

Miranda Palmer: 00:15:32

In, in inappropriate ways.

Miranda Palmer: 00:15:33

And there was no way to tag those people to flag them.

Miranda Palmer: 00:15:38

Mm-hmm.

Miranda Palmer: 00:15:38

Um, there was no consultation.

Miranda Palmer: 00:15:40

I think any therapist that's been in private practice for any period of

Miranda Palmer: 00:15:43

time, we have all gotten those calls and it can be really distressing,

Miranda Palmer: 00:15:48

but at the very least we know.

Miranda Palmer: 00:15:50

You, you learn very quickly how to filter those individuals out and block them, but

Miranda Palmer: 00:15:56

there's no way to do that, um, in these.

Miranda Palmer: 00:16:00

Many of these organizations,

Kelly Higdon: 00:16:01

which I think brings up the case of are people leaving

Kelly Higdon: 00:16:04

because better help is so expensive.

Kelly Higdon: 00:16:06

Like, I can't, I don't wanna pay $30 for my session or whatever the number

Kelly Higdon: 00:16:09

is, but in reality, do I wanna pay $30 for therapy with a burnout therapist?

Kelly Higdon: 00:16:16

No, it's not.

Kelly Higdon: 00:16:17

I don't, I don't, it's not even 10 do, I don't wanna pay $10.

Kelly Higdon: 00:16:20

So it's a, it's like, so, you know, think of, you can't just say that it's, it's.

Kelly Higdon: 00:16:29

It's because of money.

Kelly Higdon: 00:16:30

We, there's a bigger, more insidious thing happening here where we are burning

Kelly Higdon: 00:16:34

out and traumatizing the workforce.

Kelly Higdon: 00:16:37

There's no support, there's no outcomes tracking or any of that.

Kelly Higdon: 00:16:42

And then the clients are just coming from wherever.

Kelly Higdon: 00:16:45

There's no and anywhere and they're just wanting to get some quick support.

Kelly Higdon: 00:16:51

Some people generally need a lot.

Kelly Higdon: 00:16:54

Of in-depth therapy, trauma work, and this is what is accessible to them.

Kelly Higdon: 00:16:59

But they're coming into a system that is already has the cracks breaking

Kelly Higdon: 00:17:04

and the foundation has cracks in it.

Kelly Higdon: 00:17:07

And then you ask, is this worth $30 and or 50, whatever.

Kelly Higdon: 00:17:12

No,

Miranda Palmer: 00:17:13

no.

Miranda Palmer: 00:17:13

That's always my thought is like $5 is too much to pay for bad therapy.

Miranda Palmer: 00:17:19

Like $0 free is too much to pay for bad therapy, and I don't think that

Miranda Palmer: 00:17:24

therapists are, are purposefully trying to be bad therapists.

Miranda Palmer: 00:17:30

But when you're on your 40th or 50th or 60th client of the week, when you started

Miranda Palmer: 00:17:37

this as a side gig to transition over to private practice and then quickly

Miranda Palmer: 00:17:44

realize that you couldn't do this.

Miranda Palmer: 00:17:47

Actually and and do this full-time.

Miranda Palmer: 00:17:49

And so you kept your full-time gig and now you're doing this other place.

Miranda Palmer: 00:17:53

You were burnout when you began, right?

Miranda Palmer: 00:17:56

Or again, you were in the space where there maybe you haven't really been

Miranda Palmer: 00:18:02

trained on how to be a therapist.

Miranda Palmer: 00:18:04

It's really unfortunate in our field.

Miranda Palmer: 00:18:07

What we find, um, in the, in the research from people who've gone

Miranda Palmer: 00:18:12

really in depth with, with the therapy work is that years of experience

Miranda Palmer: 00:18:17

or particular types of training, all these things do not correlate

Miranda Palmer: 00:18:21

with enhanced outcomes for clients.

Miranda Palmer: 00:18:24

Right.

Miranda Palmer: 00:18:25

And we are not doing a good job as a profession in terms of teaching

Miranda Palmer: 00:18:31

therapists not just how to do psychotherapy, but how to do it well.

Miranda Palmer: 00:18:37

I think a lot of people, like my play therapy training when I was working

Miranda Palmer: 00:18:42

with kids was we'll just play some games with them and do some Uno.

Miranda Palmer: 00:18:46

Um, you know, get out the, sorry or what have you, and I'm like, okay.

Miranda Palmer: 00:18:51

So then I'm playing sorry with them for weeks.

Miranda Palmer: 00:18:53

And I'm like, I don't understand what is supposed to be happening here.

Miranda Palmer: 00:18:58

I'm trying to read books, I'm trying to navigate it, but my, my ability to

Miranda Palmer: 00:19:03

actually provide child therapy, and this is while I'm in clinical supervision.

Miranda Palmer: 00:19:11

Didn't make any sense.

Miranda Palmer: 00:19:12

I was trained as a licensed marriage and family therapist in California.

Miranda Palmer: 00:19:17

Which unfortunately meant I had very little hours in terms of how

Miranda Palmer: 00:19:22

to actually provide couples therapy.

Miranda Palmer: 00:19:25

The only people, the only class that I took in school about couples

Miranda Palmer: 00:19:29

and family work was done by someone who was not a clinician, who was a

Miranda Palmer: 00:19:34

researcher who could tell us nothing about how to actually do the work like.

Miranda Palmer: 00:19:40

The whole situation was wild.

Miranda Palmer: 00:19:42

So I ha I made the choice to go and do additional training, um, in doing

Miranda Palmer: 00:19:48

couples work, but realistically, a lot of therapists don't have that

Miranda Palmer: 00:19:52

privilege or that time or that money.

Miranda Palmer: 00:19:55

And so they're sitting in a room, in an echo chamber doing the best that they

Miranda Palmer: 00:20:00

can doing, doing the work and saying, well, you know, it's just couples

Miranda Palmer: 00:20:05

therapy is really hard, you know?

Miranda Palmer: 00:20:07

Mm-hmm.

Miranda Palmer: 00:20:08

Yeah.

Miranda Palmer: 00:20:08

A lot of people just don't make it.

Miranda Palmer: 00:20:10

Without like taking responsibility that like Yeah, that's, that's true.

Miranda Palmer: 00:20:15

And we need to do better.

Kelly Higdon: 00:20:18

And I think you and I both had our practices during

Kelly Higdon: 00:20:21

a recession and we have been through a lot, we've watched a lot.

Kelly Higdon: 00:20:26

Economic ups and downs, the good times, the not so good times.

Kelly Higdon: 00:20:31

And this idea of like, people are leaving because they can't afford it.

Kelly Higdon: 00:20:37

I would say in some private practices, yes, you will have some people where

Kelly Higdon: 00:20:40

their circumstances change and they, they truly, they love their work

Kelly Higdon: 00:20:44

with you and it is not working for them, and you need to refer them out.

Kelly Higdon: 00:20:49

This is.

Kelly Higdon: 00:20:50

Particularly for private pay kind of practices.

Kelly Higdon: 00:20:54

We see it also in insurance where people are like, I can't even afford my copay.

Kelly Higdon: 00:20:58

You know?

Kelly Higdon: 00:20:59

So it does happen, but we have also seen the other side of where people are like,

Kelly Higdon: 00:21:04

this is a priority of my health and wellbeing, and this is something that I

Kelly Higdon: 00:21:09

prioritize over other things in my life.

Kelly Higdon: 00:21:11

That thing is, is that when you are in private practice, you are not meant

Kelly Higdon: 00:21:15

to be the better help of the world.

Kelly Higdon: 00:21:17

You are not meant to see 60 people a week.

Kelly Higdon: 00:21:19

You're not meant to see the people that can, that need something with

Kelly Higdon: 00:21:23

that level of financial assistance.

Kelly Higdon: 00:21:28

I don't know what we wanna call it, but financial difference, right?

Kelly Higdon: 00:21:32

You're looking for the 12, 15 people in your large community.

Kelly Higdon: 00:21:40

That really value the kind of work you do and that they can see the

Kelly Higdon: 00:21:44

transformation that you provide.

Kelly Higdon: 00:21:46

And so this is where we've been talking about, like in our business school.

Kelly Higdon: 00:21:50

One of the things I've been saying of if you want to make it through whatever is

Kelly Higdon: 00:21:55

happening in this world and our economy and all of that, we have to get really.

Kelly Higdon: 00:22:01

We can't just get by saying like, I hold space for you.

Kelly Higdon: 00:22:04

We have to really be creative and in our knowing of like the transformation

Kelly Higdon: 00:22:09

and the value that we bring.

Kelly Higdon: 00:22:11

And when we don't hold that value, no one else is gonna do it for us.

Kelly Higdon: 00:22:15

And so it's very important that we don't lob ourselves.

Kelly Higdon: 00:22:20

I'm making up weird words today.

Kelly Higdon: 00:22:22

I don't know why, but like into the category of the better helps of the world.

Kelly Higdon: 00:22:27

And we understand that like we're a different kind of business.

Kelly Higdon: 00:22:30

We do a different kind of service and we serve a different kind of client.

Miranda Palmer: 00:22:34

I think here's a, this is, there's so much like, I feel like

Miranda Palmer: 00:22:37

we could talk for hours, um, about this.

Miranda Palmer: 00:22:40

So first and foremost, I wanna talk to that idea of like, Hey, here's the 12

Miranda Palmer: 00:22:45

or 15 clients that we really need to see that value, the work that we can get great

Miranda Palmer: 00:22:50

outcomes with and what that looks like.

Miranda Palmer: 00:22:53

What I think sometimes it can, it can sound elitist on the surface.

Miranda Palmer: 00:22:58

It can sound elitist on the surface.

Miranda Palmer: 00:22:59

Like, this is it, this is how I can afford it, you know, whatever the dynamic is.

Miranda Palmer: 00:23:04

But what I have seen, um, like through doing this work for so long and talking

Miranda Palmer: 00:23:11

with thousands and thousands of therapists is that therapists really love this work.

Miranda Palmer: 00:23:17

They wanna give back.

Miranda Palmer: 00:23:18

Yeah.

Miranda Palmer: 00:23:18

And they have a huge impact on their community.

Miranda Palmer: 00:23:21

So when this person is full with these clients and they have a functioning

Miranda Palmer: 00:23:26

business, these individuals.

Miranda Palmer: 00:23:29

Go and volunteer.

Miranda Palmer: 00:23:31

They give back.

Miranda Palmer: 00:23:32

They are putting money.

Miranda Palmer: 00:23:34

Yes, they're doing donations.

Miranda Palmer: 00:23:35

They are doing all of these things.

Miranda Palmer: 00:23:36

Yes, they are making sure that they're preparing for their own retirement

Miranda Palmer: 00:23:39

so that they don't need outside assistance, so that they don't have

Miranda Palmer: 00:23:43

to be a drain on other nonprofits.

Miranda Palmer: 00:23:45

All these other things, like when they create this functioning.

Miranda Palmer: 00:23:50

Place.

Miranda Palmer: 00:23:50

It has a big impact on the world.

Miranda Palmer: 00:23:53

So that's like, mm-hmm.

Miranda Palmer: 00:23:54

The first part, I think the second part is a lot of times

Miranda Palmer: 00:23:57

we look at these scenarios and.

Miranda Palmer: 00:24:00

A lot of us came from nonprofit organizations where we're like, oh my

Miranda Palmer: 00:24:05

gosh, like this should be free, like the sliding scale model and all these other

Miranda Palmer: 00:24:10

pieces, and we really wanna take this nonprofit model into our private practice.

Miranda Palmer: 00:24:15

We wanna take the sliding scale, we wanna make things really low fee

Miranda Palmer: 00:24:19

for everybody who could possibly.

Miranda Palmer: 00:24:21

Come in for this resource and we forget, or maybe we didn't know that

Miranda Palmer: 00:24:26

that nonprofit actually functioned on multimillions of dollars and like hours of

Miranda Palmer: 00:24:34

grant writing and board meetings and all these other things to create these free.

Miranda Palmer: 00:24:41

Sliding scale resources.

Miranda Palmer: 00:24:43

So it's not like they were altruistically doing it for free either.

Miranda Palmer: 00:24:47

Like people were actually getting paid, maybe they weren't getting paid

Miranda Palmer: 00:24:50

well, but they weren't getting paid.

Miranda Palmer: 00:24:53

There was maybe some benefits involved.

Miranda Palmer: 00:24:56

There was vacation, sick time, all these other things.

Miranda Palmer: 00:24:59

So there's like a lot that was there.

Miranda Palmer: 00:25:02

Then finally going back to this idea of like, what does this

Miranda Palmer: 00:25:05

really look like in the real world?

Miranda Palmer: 00:25:07

So I'm talking with my friend the other day.

Miranda Palmer: 00:25:09

Um, they just actually moved to another, uh, another space.

Miranda Palmer: 00:25:14

We're having a Zoom check-in and we started talking about, uh, we were talking

Miranda Palmer: 00:25:19

about chat, GBT, and we were talking about therapy and they said, oh my gosh.

Miranda Palmer: 00:25:25

Um.

Miranda Palmer: 00:25:26

I think chat, GPT is a better therapist than my therapist.

Miranda Palmer: 00:25:30

I think they could do more of what I am looking for sometimes than

Miranda Palmer: 00:25:37

my therapist could look, could do.

Miranda Palmer: 00:25:39

And as we started digging in a little bit more, without going into too much

Miranda Palmer: 00:25:43

detail, they start describing their thera.

Miranda Palmer: 00:25:46

They met their therapist on one of these online tech company platforms.

Miranda Palmer: 00:25:50

Their therapist is consistently late to every single session.

Miranda Palmer: 00:25:56

Every single session, their therapist then starts randomly ending

Miranda Palmer: 00:26:00

early without telling them why.

Miranda Palmer: 00:26:04

Um, their therapist doesn't know how to set boundaries in terms of navigating, um,

Miranda Palmer: 00:26:10

in, in between session, the asynchronous communication email or text communication

Miranda Palmer: 00:26:15

that they adopted and brought over from the online, online tech company.

Miranda Palmer: 00:26:19

Mm-hmm.

Miranda Palmer: 00:26:19

Even when this person became like just paying, paying them directly.

Miranda Palmer: 00:26:25

So, and then they start describing more of like the actual intervention.

Miranda Palmer: 00:26:30

This person wasn't remembering what they were saying, wasn't able to track

Miranda Palmer: 00:26:35

the dynamics, and it literally just became like sitting with a friend.

Miranda Palmer: 00:26:41

But no real like diving into what is therapy?

Miranda Palmer: 00:26:45

What is therapy?

Miranda Palmer: 00:26:46

What is something that is therapy that goes beyond typing in or speaking

Miranda Palmer: 00:26:51

in what you're struggling with.

Miranda Palmer: 00:26:52

And someone goes, oh, that sounds really hard.

Miranda Palmer: 00:26:55

Well, you know, I hear this negative cognition pattern.

Miranda Palmer: 00:26:59

Here's what you could do differently.

Miranda Palmer: 00:27:01

Like, there's a lot of things that that chat GPT could do just

Miranda Palmer: 00:27:06

as well or better than we could.

Miranda Palmer: 00:27:09

But what can't chat GPT do?

Miranda Palmer: 00:27:12

They can't feel that shift.

Miranda Palmer: 00:27:14

They can't notice the way that you twitch.

Miranda Palmer: 00:27:19

And you talk about it, they can't notice the things that you continually avoid.

Miranda Palmer: 00:27:23

They can't see you like your, your throat shutting down.

Miranda Palmer: 00:27:28

Yeah.

Miranda Palmer: 00:27:28

They can't feel that.

Miranda Palmer: 00:27:29

Like your energy doesn't actually go beyond your shoulders and

Miranda Palmer: 00:27:33

you're not actually in your body.

Miranda Palmer: 00:27:35

Like there's so many things that we can do that chat GPT can't

Miranda Palmer: 00:27:38

do and we're not showing up.

Miranda Palmer: 00:27:40

I think sometimes as a profession 'cause we're tired and burnout.

Kelly Higdon: 00:27:44

Yeah.

Kelly Higdon: 00:27:46

I just wondering people listening that maybe work for these companies, how

Kelly Higdon: 00:27:49

they're feeling hearing us talk and we want you to know that we care about you.

Kelly Higdon: 00:27:56

Um, and that

Kelly Higdon: 00:28:00

I understand like some people feel like this is the only way for them,

Kelly Higdon: 00:28:07

um, to generate income, to take care of themselves, to make it through and.

Kelly Higdon: 00:28:15

Um, I just wanna challenge it just a little bit to say that there might

Kelly Higdon: 00:28:20

be some other better options for you.

Kelly Higdon: 00:28:23

Um, but trusting yourself and knowing and you doing what is right for you.

Kelly Higdon: 00:28:29

Like if.

Kelly Higdon: 00:28:31

If you work for one of these companies and you know that you show up on time

Kelly Higdon: 00:28:34

that you're providing great therapy, that this really works for you,

Kelly Higdon: 00:28:37

awesome, great if that, if that is you.

Kelly Higdon: 00:28:41

But if you're feeling like a little triggered or something by this

Kelly Higdon: 00:28:44

conversation, then maybe it's just like an invitation to say like, what do I need?

Kelly Higdon: 00:28:48

What do I need to shift?

Kelly Higdon: 00:28:50

So that I can feel good about how I'm showing up so I can feel good

Kelly Higdon: 00:28:54

about where I put my labor so I can feel good about like the decisions

Kelly Higdon: 00:28:58

I'm making as a clinician and just as a human being in the world.

Miranda Palmer: 00:29:02

Yeah, and it's not, I think that the thing that I, for me, with

Miranda Palmer: 00:29:07

online tech companies is that they're a, they're a bridge to trying to fix a

Miranda Palmer: 00:29:13

broken system that actually maybe in some cases breaks the system a little bit more.

Miranda Palmer: 00:29:19

I. Um, better help, obviously has traditionally been direct to.

Miranda Palmer: 00:29:24

Client consumer care, but now they're talking about pulling in and

Miranda Palmer: 00:29:28

starting to integrate in insurance.

Miranda Palmer: 00:29:31

But many of these other companies are saying, Hey therapists, we get it.

Miranda Palmer: 00:29:35

You've been struggling to get great reimbursement rates and to navigate

Miranda Palmer: 00:29:39

the administrative burden of insurance, we're gonna come into this inner,

Miranda Palmer: 00:29:44

into this in, in, in-between place, and we're gonna fix that for you.

Miranda Palmer: 00:29:48

And they're like, we're gonna negotiate, we're gonna get higher rates and we're

Miranda Palmer: 00:29:52

gonna take all the administrative burden.

Miranda Palmer: 00:29:54

We got you.

Miranda Palmer: 00:29:55

And then in reality, what is happening is that sometimes those

Miranda Palmer: 00:30:01

rates are not the highest rates.

Miranda Palmer: 00:30:02

In fact, sometimes those rates are much lower.

Miranda Palmer: 00:30:05

Sometimes those rates were higher, and then once people were established with

Miranda Palmer: 00:30:08

them, then the rates are getting dropped.

Miranda Palmer: 00:30:10

Some of these online tech companies are finding that like they're not getting paid

Miranda Palmer: 00:30:14

at all for some of the sessions because they're trying not to pass it along to.

Miranda Palmer: 00:30:19

Uh, to the providers.

Miranda Palmer: 00:30:22

Um, some of these online tech companies don't really understand the mental

Miranda Palmer: 00:30:25

health, and honestly, some of the private practice owners, when you are

Miranda Palmer: 00:30:30

contracted as a 10 99, you're contracted as a business, not as an employee.

Miranda Palmer: 00:30:35

And so when you are a 10 99 contractor, your contract is very clear of what

Miranda Palmer: 00:30:40

liability you are keeping in place.

Miranda Palmer: 00:30:43

And for a lot of therapists, they don't realize how much liability is coming in.

Miranda Palmer: 00:30:47

Maybe that company's gonna take care of clawbacks, but they're not gonna take

Miranda Palmer: 00:30:51

care of the fact that, um, their system wasn't HIPAA compliant and you didn't

Miranda Palmer: 00:30:57

do the, the right steps to put that in place, or that you started doing things

Miranda Palmer: 00:31:02

that weren't HIPAA compliant, thinking that it would work within their system.

Miranda Palmer: 00:31:05

But not realizing like, oh, I didn't use an encrypted email to email this

Miranda Palmer: 00:31:11

company that I'm contracted with, so now that's on me, and now I am at risk.

Miranda Palmer: 00:31:16

Like there's so much that's that's in there for us to let navigate through.

Miranda Palmer: 00:31:21

Right?

Miranda Palmer: 00:31:22

While in 2023 and in 2022, the top five health insurance companies in the United

Miranda Palmer: 00:31:28

States made over $40 billion in profit.

Miranda Palmer: 00:31:32

Like after paying everybody.

Miranda Palmer: 00:31:34

So when you have this space where most therapists would say, not, not in all

Miranda Palmer: 00:31:39

states, and not with all insurance con contracts, but a significant

Miranda Palmer: 00:31:43

amount of therapists would say, Hey, this system isn't really, work,

Miranda Palmer: 00:31:48

isn't really made for one-to-one provision, uh, across insurance.

Miranda Palmer: 00:31:53

Most companies.

Miranda Palmer: 00:31:54

That do insurance or medical offices, it's because they can say, you met with

Miranda Palmer: 00:31:59

the CNA and you met with this, and you met with this person, and everybody

Miranda Palmer: 00:32:03

spends two minutes with you, and all of that is put into place, and then there's

Miranda Palmer: 00:32:09

this big number that you're billed for.

Miranda Palmer: 00:32:11

We don't get to do that.

Miranda Palmer: 00:32:12

We're just one person.

Miranda Palmer: 00:32:13

We're just one CPT code.

Miranda Palmer: 00:32:15

Like here's, here's the piece.

Miranda Palmer: 00:32:17

So when the system is already broken and doesn't work, if you

Miranda Palmer: 00:32:20

put a middleman in the middle.

Miranda Palmer: 00:32:22

To take a percentage that has to make a profit because

Miranda Palmer: 00:32:25

they need to pay back, right?

Miranda Palmer: 00:32:27

Sonder might mean needs to pay back and provide profits on

Miranda Palmer: 00:32:31

$276 million in investments.

Miranda Palmer: 00:32:34

Grow needs to pay back and provide again profits on $178 million of investments.

Miranda Palmer: 00:32:42

Like where do we think all this money's going to come from?

Miranda Palmer: 00:32:46

It's our labor.

Miranda Palmer: 00:32:47

We are the product.

Miranda Palmer: 00:32:51

We are the product Spring Health Grow Sonder, mind ruler, better Health

Miranda Palmer: 00:32:56

would be nothing without us unless they use our knowledge to create

Miranda Palmer: 00:33:06

something that doesn't require us.

Miranda Palmer: 00:33:07

Mm-hmm.

Kelly Higdon: 00:33:10

Sorry.

Kelly Higdon: 00:33:11

I'm curious to see if we will have more unionization and things like

Kelly Higdon: 00:33:14

that coming on board, but even I. I'd say it was a year and a half ago when

Kelly Higdon: 00:33:21

things started to really pick up.

Kelly Higdon: 00:33:22

Maybe it was a couple years ago.

Kelly Higdon: 00:33:24

Oh, Siri talking to me.

Kelly Higdon: 00:33:26

Um, I.

Kelly Higdon: 00:33:28

I, I just, I have that, maybe it's intuition, maybe it's just

Kelly Higdon: 00:33:33

my own anxiety, I don't know.

Kelly Higdon: 00:33:34

But I have this feeling of like, in five years it's all gonna look different again.

Kelly Higdon: 00:33:39

That either there's gonna be some claw back that really obliterates

Kelly Higdon: 00:33:43

one of these companies, or they all kind of merge and eat themselves.

Kelly Higdon: 00:33:47

Um, be more labor disputes and things like that to come.

Kelly Higdon: 00:33:52

So I imagine.

Kelly Higdon: 00:33:55

This landscape is going to keep changing and it's why we're

Kelly Higdon: 00:33:58

gonna keep talking about it.

Miranda Palmer: 00:34:00

I think this is the part that's really hard though, too.

Miranda Palmer: 00:34:03

Like you mentioned the idea of unionizing, and I talk with a lot

Miranda Palmer: 00:34:06

of therapists that are like, union is the way, well, here's the piece.

Miranda Palmer: 00:34:09

There's a reason that they're hiring you as a 10 99 contractor.

Miranda Palmer: 00:34:13

Yeah.

Miranda Palmer: 00:34:13

And not as an employee because 10 99 contractors are businesses,

Miranda Palmer: 00:34:18

and businesses can't un unionize.

Miranda Palmer: 00:34:20

That's considered a monopoly.

Kelly Higdon: 00:34:23

But I think that what, what I'm, what I'm saying is that I'm

Kelly Higdon: 00:34:26

wondering if more and more that's gonna get more and more of an issue and these

Kelly Higdon: 00:34:30

companies are gonna get slammed with like better help, you know, has already

Kelly Higdon: 00:34:33

been taken to court for labor violations.

Kelly Higdon: 00:34:38

They really are like problematic.

Miranda Palmer: 00:34:41

It is, it's, well, and it's similar though, to, to,

Miranda Palmer: 00:34:45

it sounds like a weird suggestion.

Miranda Palmer: 00:34:47

So Uber eats Lyft.

Miranda Palmer: 00:34:49

Mm-hmm.

Miranda Palmer: 00:34:49

Uber, right.

Miranda Palmer: 00:34:51

These have all been 10 99 contractors.

Miranda Palmer: 00:34:54

Mm-hmm.

Miranda Palmer: 00:34:54

Who have been the major source of labor.

Miranda Palmer: 00:34:58

Right.

Miranda Palmer: 00:34:59

So we are more like Uber Eats and Lyft.

Miranda Palmer: 00:35:02

We are more of the token economy and we watch what they did to try

Miranda Palmer: 00:35:07

to convert over to employment.

Miranda Palmer: 00:35:10

Yeah.

Miranda Palmer: 00:35:10

And we saw how many millions of dollars were paid to keep these

Miranda Palmer: 00:35:14

individuals as contractors.

Miranda Palmer: 00:35:17

And it's.

Miranda Palmer: 00:35:18

It's a lot that the biggest thing that we could do, I think for therapists

Miranda Palmer: 00:35:24

if we wanted to come together before you can unionize, we have to either

Miranda Palmer: 00:35:29

change the dynamic that says 10 99 contractors or people that are

Miranda Palmer: 00:35:33

business owners can't unionize.

Miranda Palmer: 00:35:35

Or we need to make a, a strong argument to say actually we are

Miranda Palmer: 00:35:40

w we should be W2 employees.

Miranda Palmer: 00:35:42

Yeah.

Miranda Palmer: 00:35:43

Is an employment contract.

Miranda Palmer: 00:35:45

And realistically, every therapist that we've worked with who has tried to do

Miranda Palmer: 00:35:52

10 99 contractors in an ethical way, um, they have every time they get audited.

Miranda Palmer: 00:36:00

They end up having, like they find that they were actually employees.

Miranda Palmer: 00:36:05

Mm-hmm.

Miranda Palmer: 00:36:05

And then they get back payroll taxes and have to do back pay to these individuals.

Miranda Palmer: 00:36:10

But again, some of these individuals that, there's these managed services

Miranda Palmer: 00:36:13

organizations that some of these companies are, are doing these high level, really

Miranda Palmer: 00:36:19

complex contractor contracts where they say, no, that's not what we are.

Miranda Palmer: 00:36:24

We do not like they've gone through.

Miranda Palmer: 00:36:27

Lots of hoops to make sure that they're protected from what

Miranda Palmer: 00:36:30

happened with, with Uber and Lyft to say we, you are not employees.

Miranda Palmer: 00:36:35

And this is the other thing that I think is, you know, it comes down

Miranda Palmer: 00:36:38

to, is that all of the labor laws that we have that are protections,

Miranda Palmer: 00:36:45

those protections are for employees.

Miranda Palmer: 00:36:48

If you are a 10 99 contractor.

Miranda Palmer: 00:36:51

You don't, you're not protected.

Miranda Palmer: 00:36:52

You don't fall under those things.

Miranda Palmer: 00:36:53

Like they don't have to pay you at least minimum wage.

Miranda Palmer: 00:36:57

Yeah.

Miranda Palmer: 00:36:57

If you work more hours and they're not paying you at least minimum wage doesn't

Miranda Palmer: 00:37:02

matter because you are a business and you went into this contract knowingly.

Miranda Palmer: 00:37:07

Yeah.

Miranda Palmer: 00:37:09

I don't agree with it, but it's, it's the reality.

Kelly Higdon: 00:37:13

There are other articles I sent you, I don't know if

Kelly Higdon: 00:37:15

we wanna touch on those today, but

Miranda Palmer: 00:37:17

there is.

Kelly Higdon: 00:37:18

So

Miranda Palmer: 00:37:18

much that's here.

Miranda Palmer: 00:37:20

I know, I, I kind of do wanna talk a little, how long have we been chatting?

Miranda Palmer: 00:37:24

It's already been 40 minutes.

Miranda Palmer: 00:37:26

Maybe we should stop and then we'll chat about the other one, because I

Miranda Palmer: 00:37:29

think this is a lot to kind of take in.

Miranda Palmer: 00:37:31

So like

Kelly Higdon: 00:37:32

Yeah, I think like, can we just pause for a second and acknowledge

Kelly Higdon: 00:37:35

that you've listened to us, get all hyped.

Kelly Higdon: 00:37:39

This is what we do.

Kelly Higdon: 00:37:40

Actually behind the scenes.

Kelly Higdon: 00:37:42

We're like, can you believe that, you know, we talk back and forth.

Kelly Higdon: 00:37:45

Um.

Kelly Higdon: 00:37:46

And I just appreciate you hanging with us on this podcast, but let's just all just

Kelly Higdon: 00:37:51

take a breath for a second and just check in with like, what this is feeling like

Kelly Higdon: 00:37:56

for you and what, what does it mean for you if like, if, if it's anything, you

Kelly Higdon: 00:38:03

know, just coming back to yourself and your own knowing of what is right for you.

Kelly Higdon: 00:38:09

This is not about scaring you.

Kelly Higdon: 00:38:10

It's about really just kinda understanding how the whole system is

Kelly Higdon: 00:38:14

working now and how the landscape is shifting, and then we get to decide

Kelly Higdon: 00:38:19

how much we wanna participate in it.

Kelly Higdon: 00:38:21

Um, some of that is our privilege.

Kelly Higdon: 00:38:23

I will say that, you know, but, um, yeah, just taking a breath and

Kelly Higdon: 00:38:29

coming back to your own energy for a moment of listening to all of this.

Miranda Palmer: 00:38:35

I guess I would, I would love to leave you with a couple

Miranda Palmer: 00:38:39

of of questions for those of you who are listening, some things to like feel into.

Miranda Palmer: 00:38:44

Um, one is the contract are the contracts, and this is a across the board.

Miranda Palmer: 00:38:52

If you are in private practice in your contracting with one

Miranda Palmer: 00:38:55

of these companies, are these contracts really working for you?

Miranda Palmer: 00:39:01

And if they are not working for you and if you have the privilege to do

Miranda Palmer: 00:39:06

so, the more, the more therapists that say no to contracts that don't work.

Miranda Palmer: 00:39:12

This actually does put pressure on these online tech companies and on insurance

Miranda Palmer: 00:39:19

companies to raise the bar and do better.

Miranda Palmer: 00:39:23

If they want to stay in business, they need our labor.

Miranda Palmer: 00:39:29

If they find that our labor costs more, then they have to either pay more for our

Miranda Palmer: 00:39:36

labor or they need to leave the market.

Miranda Palmer: 00:39:42

And when they leave the market, it actually creates more space and

Miranda Palmer: 00:39:46

more ease for us, and it creates less noise for the consumer.

Miranda Palmer: 00:39:51

Right?

Miranda Palmer: 00:39:52

So first and foremost, can I get clear?

Miranda Palmer: 00:39:56

About what contracts do and don't work for me.

Miranda Palmer: 00:39:59

And let's say you find that there's some contracts that don't work for you and

Miranda Palmer: 00:40:04

you are looking at it and going, oh my gosh, like this really doesn't work, but

Miranda Palmer: 00:40:08

I don't have the privilege to do that.

Miranda Palmer: 00:40:10

Right?

Miranda Palmer: 00:40:11

Right.

Miranda Palmer: 00:40:11

Now, can we start to make plans?

Miranda Palmer: 00:40:15

Can we start to, um, to slowly divest.

Miranda Palmer: 00:40:21

Can we start to put some energy into finding our own place and our communities

Miranda Palmer: 00:40:27

to really stepping into that vision?

Miranda Palmer: 00:40:30

Because I think, here's something I, we were, uh, I was on a meeting with,

Miranda Palmer: 00:40:36

um, with some clients that we work with yesterday, and I keep hearing

Miranda Palmer: 00:40:42

this question of, is private pay?

Miranda Palmer: 00:40:45

Private practice like gone?

Miranda Palmer: 00:40:47

Like, can you really do it here today?

Miranda Palmer: 00:40:51

And I'm working with this client and their biggest issue is

Miranda Palmer: 00:40:55

that they're growing so fast.

Miranda Palmer: 00:40:58

Even now with all the noise in the market, there are private pay, um, practice.

Miranda Palmer: 00:41:05

They have a specialized kind of work that they do.

Miranda Palmer: 00:41:09

They had in the last three years, they had more people sign up in March.

Miranda Palmer: 00:41:15

Um, in March and April than ever before.

Miranda Palmer: 00:41:19

Like even like to date, like the amount of people that have come on and their,

Miranda Palmer: 00:41:24

their full fee private pay practice, um, that's made to do really well.

Miranda Palmer: 00:41:28

So they can pay their employees well and the employer well, um,

Miranda Palmer: 00:41:32

like they're, they're in the, in the expansion phase, right?

Miranda Palmer: 00:41:37

So.

Miranda Palmer: 00:41:38

Can we take a step back and maybe even just open up the space to go?

Miranda Palmer: 00:41:46

Maybe there's just a really great group practice owner I could work for.

Miranda Palmer: 00:41:49

Maybe there's somebody who's another therapist who really can protect

Miranda Palmer: 00:41:53

me, who can hire me as a W2, who can provide me benefits that will still

Miranda Palmer: 00:41:57

be flexible with this work that will help me develop myself as a therapist.

Miranda Palmer: 00:42:02

Maybe that person is out there.

Miranda Palmer: 00:42:05

If you are looking for that kind of position, like let us know.

Miranda Palmer: 00:42:08

Like we always have group practice owners who are fantastic, who are looking for

Miranda Palmer: 00:42:11

really great employees, but those people trying to find the clinicians because

Miranda Palmer: 00:42:18

there's millions of dollars being paid.

Miranda Palmer: 00:42:20

I just got something in my in in my text this morning, somebody trying

Miranda Palmer: 00:42:24

to hire me as a therapist or what have you from one of these companies.

Miranda Palmer: 00:42:28

Like it is exhausting and there's so much noise and.

Miranda Palmer: 00:42:32

A regular group private pay practice, they can't pay to get an

Miranda Palmer: 00:42:37

A list of therapists phone numbers to text all of them, you know?

Miranda Palmer: 00:42:42

Yeah.

Kelly Higdon: 00:42:44

All right.

Kelly Higdon: 00:42:45

Well, this is our first go at, like you and I doing this, just talking

Kelly Higdon: 00:42:50

about what's going on in the world.

Kelly Higdon: 00:42:52

I love chatting with you, of course.

Kelly Higdon: 00:42:54

And I love letting people see.

Kelly Higdon: 00:42:57

See this.

Kelly Higdon: 00:42:58

So we'll wrap this one up and we'll make another one and

Kelly Higdon: 00:43:02

we'll just see how this goes.

Miranda Palmer: 00:43:05

If you hate it, review us.

Miranda Palmer: 00:43:07

If you love it, review us from those reviews that you give us on podcasts

Miranda Palmer: 00:43:13

that will help us direct, um, whether these are things that we will continue

Miranda Palmer: 00:43:17

to do, um, but we would love to hear your reviews so we can decide if this

Miranda Palmer: 00:43:22

is how we want to continue to use this.

Miranda Palmer: 00:43:24

Again, we'll be still primarily starting a counseling practice, success stories.

Miranda Palmer: 00:43:29

We have so many great success stories.

Miranda Palmer: 00:43:32

Uh, that are booted up and ready to go.

Miranda Palmer: 00:43:34

So please know those will not go away.

Miranda Palmer: 00:43:37

Um, and of course, you'll always be able to skip these ones if you don't love them,

Kelly Higdon: 00:43:41

of course.

Kelly Higdon: 00:43:41

Um,

Miranda Palmer: 00:43:41

but there you go.

Miranda Palmer: 00:43:42

Until next time y'all, bye.