So, Now What?

08- Why Private Practice is Kryptonite For Boundaries and Self Care

• angela tam

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You did it! You finally created an PLLC, opened a biz bank account, launched your website, and are waiting for your new clients. You might be accepting insurance under a group practice or are doing your own thing. 

Regardless, you get 7 consults. All at the same time. You are meeting your new potential clients. 

They are manageable and you are feeling good about each of them. But when you look at the calendar, dread sets in. 

"How can I sustain this?"

"How can I see 15 clients in one week indefinitely?"

"Am I going to make it through the week?"

You are wondering, how did I get from being thirsty for clients to very overwhelmed so quickly?

My guess is that you didn't evaluate client fit. You don't have a process in place to schedule clients on auto mode. You are troubleshooting schedule concerns after the fact. You are swimming in paperwork with insurance. 

When you signed up to be a MH clinician, you didn't think that you were not going to enjoy it. But now you feel defeated. 

Why?

It's because we make decisions in our PP from our therapist hat, not our CEO hat. 

Our therapist hat says, "how can I help as many people as I can?"

Our CEO self says "what is best for my clients and best for me?"

Our therapist self says "how can I squeeze in as many clients as possible without burning out?"

our CEO self says "what is my intention for my caseload? How do I want to thrive?"

This episode invites you to notice, who is in the driver's seat making these decisions. Tune in and find out





Come follow me on instagram @heyangelatam and subscribe to my newsletter here. Looking forward to adventuring with you!

Speaker 1:

Hey, how are you doing? This is another episode of so Now what this podcast is for all the folks out there who are the first to do anything in their family and their generational lineage line, and in this mini series I'm focusing on mental health clinicians. I'm specifically talking to BIPOC mental health clinicians, but this is applicable for anyone, and I wanted to talk about how being in private practice is a kryptonite for our self-care and boundaries. What do I mean by that when I say kryptonite for our self-care and boundaries? When we're outside of our private practice, we might be able to practice a lot of autonomy, a lot of boundaries, self-care but when we're in our private practice, something switches and we end up doing things that are not serving us in the long term but are definitely serving our clients in the short term. And for a lot of us who entered, private practice is always seen as something that we want to strive towards, thing that a lot of clinicians dream about. It's often marketed as something that allows you to have so much freedom and flexibility and autonomy and it's something that I know out of grad school for me I wanted to just go into versus staying in a community mental health clinic or a group practice. I know I just wanted to be doing my own thing and jumping into developing, building, nurturing my private practice. I did not realize the work it took to take care of myself. In that time I was focused on making my website look good and getting on all the directories, networking, really developing out my niche. I did not think of how to take care of myself in that time and I just at that time in my early years, just felt really compelled to just do what it took to get it started. I didn't think about the long-term effects or anything, but I just wanted to get it off the ground.

Speaker 1:

And in my early years that was right after I graduated and I was about to have a baby. So my focus was really on having this baby. And now my baby is 11 years old, she is her own person, she's doing great, and at that time I didn't realize that I was actually nurturing multiple things all at once. I was birthing my private practice, birthing my first child, who is now my oldest of my three children, and birthing a new version of myself, this clinician that was leading and managing my own private practice, my own small business. Leading and managing my own private practice, my own small business and I jumped in without knowing much and I want to share with you about what happened in that process and where I'm at right now. I'm at a different place right now than I was before.

Speaker 1:

I was not prioritizing my mental health, not prioritizing my self-care and not creating a sustainable practice for myself. I really, at that time, only thought that creating a sustainable practice meant setting a C that worked for me and that I wouldn't go broke and having some time left over to do my own thing afterwards, but not thinking about thriving outside of practice. I was really spent with birthing a new baby, having sleep deprivation and my baby was really suffering from a lot of eczema. So if you all know about eczema those who have skin issues or allergies y'all know that it is not something that is just easy to deal with. She had eczema when she was starting at four or five months of age and before that she had tongue tie issues, so it was a lot of breastfeeding issues and we went to so many doctors to see her skin and her tongue to deal with that stuff and I was not doing well, and nurturing and building my private practice is the last thing on my mind it was a bonus thing and for me, I wish I could have spent a little bit more time front-loading some of this work and letting it really run on its own eventually, but I didn't, understandably. So I had a lot of things I was juggling at that time. I didn't have things in place where I could front load the work and easily let it work for me versus me working so hard and being so burnt out in the process, and that's what I want to share with you. If I could go back in time, I would do things differently and I will share those things with you later, but for now I want to share with you why our private practices are kryptonite for our self-care and boundaries as clinicians.

Speaker 1:

And the first reason is because it's blurry the lines between a private practice clinician and an entrepreneur. We wear so many hats. We could become our own billing person, hr person, marketing person, admin person, front desk person, it person, cleaning crew, hipaa person, researcher person, crew, hipaa person, researcher person, student learning all these new modalities to work with our clients, and there's always a sense of having to be on because we're kind of a mini startup. Every private practice is its own small business and has its own processes that need to go in place. Business and has its own processes that need to go in place, and it can feel like an endless hustle culture, endless go, go, go kind of thing. The second reason is that we have set up our practices in order to heal and serve our clients, to be part of their healing journey, and it is a setup for those of us who came in with people-pleasing tendencies, like me.

Speaker 1:

I came in feeling guilty, saying no to clients asking for reschedules at a time where it wasn't convenient for me. I was afraid of losing income or being perceived as selfish if I didn't overextend myself and my boundaries got eroded over a long period of time when my inner rescuer, or my part of me that felt over-responsible or parentified, took the driver's seat and overrode my own needs, my own needs. Another big thing that comes up is my scarcity mindset. Private practice is directly linked to client hours and billable client hours. I feel like if I'm not working on my billable hours or towards my billable hours, I'm failing, I'm not doing well, I'm not going to get my income goals, I'm not going to be able to take time off or take vacations or take sick days or even a long weekend, and my time off translates in my mind as lost income and not necessarily a positive thing and my background as a child of immigrant really informs this, where I used to experience a lot of scarcity around my resources time, energy, money, especially the money thing and I used to get really panicky if I lost a client. Another thing is isolation and loneliness With private practice. Unless you're in a co-op or group practice and you can have your private practice on the side, most people operate in silos and so we are working on our own and we're not able to easily reach for community care unless we have a built-in community.

Speaker 1:

I am a high-level extrovert, meaning I get recharged when I'm with others. Being an extrovert helps in my position because I am not tired after seeing eight clients a day or however many clients. I could see a lot of clients and be really energized at the end of the day, but in some ways I am really tired because I'm not reaching out or talking to people. I'm not speaking to my clients about my own life. I'm not speaking to my clients on my terms. I'm really just allowing the session to be guided by their contract goals or whatever they want to talk about, which is exactly how our job is positioned For an extrovert like me. Seeing a lot of clients a day and being energized at the end of the day doesn't mean I'm depleted in other ways. And for me, I've really had to work hard to build community, recognizing that I actually need different types of conversation at the end of the day. So in my neighborhood I've developed a neighborhood walking group where I send out a group message and I have, depending on the day, a lot or little neighbors that come out and walk with me around my neighborhood just to shoot the shit, just to talk about nothing, just to catch up and just see how each other is doing. And that has been life-giving for me. And we've taken it to the next level. We do weekly dinners, we go on vacations together, we go on camping trips on a regular basis, we do fun excursions and outings and it's become a thing now. It's developed into pretty deep friendships and that's where a lot of my community comes from and I recognize that it's not only a luxury to have this, but it's a necessity to have this.

Speaker 1:

Another reason why we in private practice see our private practice as a kryptonite to our boundaries is this sense where our living situation is fused with our work situation. And if you are, like me, a telehealth therapist, I'm primarily telehealth and I do some intensives on the weekends or upon request. I'm always at home so I'm like in my PJs, working from my laptop. I might be wearing sometimes a nice shirt, but I'm still in my PJs on the bottom and working from home and I could hear my kids sometimes and I go upstairs to use the bathroom and I see my kids and I heat up my food in my kitchen and it doesn't feel like there's a lot of differentiation with my workspace and my private life, which contributes to a sense of burnout or a sense of blurriness without boundaries. Things have changed now.

Speaker 1:

I had the luxury of parking my RV in my front yard and I use my RV as my office, which is where I'm actually recording this podcast from. I do everything out of my little tiny RV. It's a great way that I can have less of a blur with my work and home life and I even bought like a little toilet so I could really essentially not leave my RV. I have a little fridge here, a little microwave, I have a little bed where I could take naps and I have a little sitting area where I read books and it's pretty nice. It's heated and it doesn't have AC, but for me right now it works because it does let me work from home full-time. But I'm not really at home. It doesn't feel like too blurry with my lines. I used to work out of a closet office on the first floor. Before that I used to work out of my garage. Before that I used to work out of my bedroom and that was hard. It was really hard to not take my work home with me because I work from home and there wasn't like a switch that I could make mentally and physically to tell my brain to turn off and that I'm leaving work.

Speaker 1:

Another thing that is a kryptonite for our folks in their private practice is perfectionism. There's this voice or this tendency that we have that we need to do the right thing in our private practice. We need to not re-traumatize our clients. We need to not cause any suffering for our clients or discomfort and we need to meet a lot of our clients' emotional needs and we need to have a great website. We need to have great Instagram presence. We need to have our sliding scale, be very generous. We need to take insurance, we need to be great clinicians with a lot of certifications, and that perfectionism will be part of how you run yourself into the ground with these should and these high expectations and this pressure that your parts put on you. The impact of that can be pretty detrimental.

Speaker 1:

The last thing that I want to talk about is our over-identification with our work. That could also be part of what contributes to being the Kirktonite to our self-care boundaries. This over-identification with work means that we feel like our identity comes from how well we do in our private practice not necessarily financially, but how helpful we are, and how helpful we are feels important for us, because our identities can still be fused with how we perform or how our outcomes are in for our clients or people who we serve in our practice. And so this over-identification or this identity fusion or rigidity in our identity can sometimes work against us. If we're failing in our private practice, if we're not getting enough clients, or if our clients come back with bad feedback to us, we feel like, oh my gosh, they really didn't do well and we're not only bad therapists, but I'm doing bad as a person and I'm failing as a person, and so that could be something that could be really hard and contribute to burnout and to this kryptonite in our private practice with our self-care and boundaries.

Speaker 1:

What is something that is the root of all of this? What is something that is beneath all of this that contributes to the kryptonite effect with blurring our boundaries and not practicing self-care? What causes this in our private practice? That is this phenomenon that we see in our lives that we don't see outside of our private practice necessarily, and maybe, if you do see it, that's something to also be curious about. Maybe sometimes you find yourself saying yes when your body says no and you're like completely exhausted, you're completely depleted. Maybe you prioritize your business survival over your mental health and well-being. Maybe you overextend empathy and under extend care for yourself. And I want to get beneath that. What is beneath that? That is something to be curious about, to work with, and this is my theory, and this could be different for everyone Because I operate from an internal family systems framework. I want to share with you a little bit about how my theory ties with internal family systems For us.

Speaker 1:

When we put on our clinician hat and we walk into our metaphorical office, or when we're signing on to our sessions. The persona that we walk in with is our empathetic, caring mental health clinician self. Right, caring mental health clinician self. Right. We've been trained in our grad school programs and over hundreds of clinical hours to really be empathetic, to really be deep listeners, to really be skilled tuners and to really read the room well, and especially us Asian folks. If you grew up Asian, you know that you were trained to read the room. You were trained to walk in a room and just to see what everyone else needs, see what other people's energies are. That is a persona that we walk into and we make decisions out of with our clients. Our clients are asking us hey, can we reschedule this? And then we put our mental health clinician hat on. What would my mental health clinician self say if my client wants to reschedule? What would my mental health clinician say if my client asked me about rates? What would my mental health clinician self say about any request that comes through Vacation time for myself, website and branding?

Speaker 1:

We are making decisions out of our mental health clinician part and that mental health clinician part is really only worried about short-term well-being for ourselves and our clients and maybe sometimes long-term well-being, but not for our own practice but they're looking out for the long-term well-being of our clients. They're really trained, this mental health clinician voice, to think through the lens of how it would be in our best interest to operate on behalf of the best interest of our clients. And that voice takes up a lot of space because we've been trained to allow it to take up a lot of space in our private practice. Ironically, it's trained to take up a lot of space for our private practice but take up very little space for our clients. What do I mean by that?

Speaker 1:

When I think of being trained in our grad school programs? We're trained to be a blank slate programs. We're trained to be a blank slate. We're trained to see our clients as people who we journey with and influence for the better, and how can we influence them for the better? We've learned all these modalities outside of our schooling. Probably. Maybe you've taken some CBT training or some EMDR training or, in my case, internal family systems and somatic and couples therapy training. And what do they teach us in those trainings?

Speaker 1:

And not share about ourselves and our personal lives in order to allow our clients to take up a lot of space and to share their feelings, and then we would go in with our interventions and work with their feelings right, that's obviously very oversimplified version and we're taught to not share a lot about who we are and our needs and to actually in some cases implicitly speaking to exile our needs and to, in order to prioritize the needs of our clients. That might not be the explicit training that you got, but that is definitely the implicit training because I've I can see in our cultural dynamics as therapists, a lot of us are really resistant to and really uncomfortable with sharing about our needs and really advocating for our needs in sessions and outside of sessions with legislative bodies and with policies and with mental health industrial complex at large. Right, like we have been trained to just keep quiet, to toe the line and to just do whatever causes the least amount of discomfort for others and then maybe as a bonus for ourselves, for others and then maybe as a bonus for ourselves. And when we are embodying this mental health clinician voice, this hat, sometimes we don't even know we're embodying this mental health clinician voice or hat. Sometimes it's just default and we are fused with it in a way that we can't even separate ourselves from that voice when this voice takes the lead in all of our business decisions. It will fail our business why? Because it is not really comprehensive in what it's taking into account. It's not comprehensive in talking to other voices. It's not talking to our inner marketer. It's not talking to our inner finance team. It's not talking to our inner accountant. It's not talking to our inner self-care guru. It's not talking to our timekeeper and time manager. It's not talking to our energy management systems and processes internally. It's not communicating with any of those voices except taking into account our client's best interests. And that is where the kryptonite effect takes place.

Speaker 1:

When we embody our mental health clinician persona, we forget about our needs and we, in fact we not only forget our needs, we suppress our needs, we exile our needs and we see our needs as something that is an inconvenience to handle and we reluctantly handle it when we need to handle it versus when we can proactively get ahead of it. And, as a result, I see a lot of other therapists in my practice as well as in my just personal life, have to change their policies, change their way of doing things. After getting a new health diagnosis, after having a baby and then noticing these things, maybe there's a family emergency and they're having to shift their entire lives and maybe they're having to give up their private practice because it simply wasn't sustainable to begin with. And my invitation to you is to get ahead of that before that happens. Not that we plan for that to happen, we don't plan for family emergencies to happen, we don't hope that they'll happen, but I would like to invite you all to plan to preemptively create a private practice that serves you in the long term, that is sustainable, that feels really good to walk into every day and that feels exciting to look forward to, to serve and that does not feel depleting. And so, if you do have a new health diagnosis, that it would be something that is so diagnosis, that it would be something that is so easy and maybe not easy is not the word Maybe it would be so much less stressful to think about your accommodations and to think about your if you have a new baby, to think about your family accommodations and your new schedule and your energy management behind with sleep deprivation and taking care of kids and child care. So my invitation to you is to invite you to notice who is taking the driver's seat with making decisions regarding your practice. Who is the main driver in leading the decisions, and conversations around the decisions with your clients, around time off, around sliding scale, around fees, around time and around fit. This all comes into play when we are in a bind and we have needs, and these conversations usually come up then. But I want to invite you to have these conversations now so that you can step into a practice that you feel at ease in and really looking forward to every day, every day.

Speaker 1:

If you want more information, I am going to dive into that, possibly in our next podcast. If you have any requests for any topics, let me know and I can address it in here and we can hopefully cover it and I really look forward to hearing more from you. You can DM me in the link that's in the show notes and I read all my DMs personally. Please suggest future topics and for our next time that we talk, I hope to expand on this piece of how we can work with unseating the mental health clinician that's taking up the space around driving our decisions and creating new space for different voices. I will look forward to talking to you really soon and I hope you enjoyed this podcast. Please like, subscribe and send me your feedback. I'll talk to you soon. Bye.