Episode Summary:
What happens when your grad school internship feels more like a security risk than clinical training? When “supervision” means 4am drug screens, and leadership thinks deli platters are a solution to burnout?
In this raw, unfiltered episode, therapist, TEDx speaker, and retreat leader Patrick Casale shares the chaos, dysfunction, and disillusionment that shaped his early years in mental health—and how he turned that burnout into a thriving, neurodivergent-affirming business.
From methadone clinics and crisis units to international retreats and coaching programs, Patrick’s story is a middle finger to the people who said, “You’ll be back in 30 days.”
3 Key Takeaways:
1. Burnout Isn’t Your Fault—It’s a System Problem
If you’re exhausted, unmotivated, or questioning your place in this field—you’re not the problem. Burnout is a predictable result of toxic, under-resourced systems.
2. You Don’t Have to Suffer to Be a “Real Therapist”
You can be ethical, effective, and successful without sacrificing your mental health. Staying stuck in harmful jobs isn’t a badge of honor.
3. There Is a Better Way to Do This Work
Whether it's building a values-led practice, leading with transparency, or putting your needs first—there’s no one right way to be a therapist.
About Patrick Casale:
Patrick Casale, MA, LCMHC, is an AuDHD therapist, business coach, TEDx speaker, and retreat planner. He’s the founder of All Things Private Practice LLC, co-host of the Divergent Conversations podcast, and host of the All Things Private Practice podcast.
He’s helped thousands of therapists build authentic businesses without abandoning their values. Patrick is known for his signature phrase: “Doubt Yourself. Do It Anyway™.”
He lives in Asheville, NC with his wife Ariel and their two dogs, Hudson and Hazel. He loves Lord of the Rings, Anthony Bourdain, Ted Lasso, cold brew, and craft beer.
Website: allthingspractice.com
Instagram: @patrick.casale | @allthingsprivatepractice
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📲 Tag us on IG: @therapy_with_kayla & @allthingsprivatepractice — Tell us what part hit hardest.
🎯 Keywords:
therapist burnout, toxic internships, community mental health, EMDR, private practice coach, neurodivergent therapist, supervision trauma, private practice startup, business coaching for therapists, values-led therapy, therapist podcast, group practice leadership, therapist retention, therapy culture change
This podcast includes personal opinions and experiences shared by guests and anonymous contributors. All identifying details may be changed to protect confidentiality. These stories are intended for educational and storytelling purposes and are not meant to defame, accuse, or harm any person or organization. Any resemblance to real persons or entities is purely coincidental.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kayla Schubert Wirth MSW, LC (00:00):
If you ever wanted to flip a table
during a staff meeting orscreen, this can't be what
therapy really is.
You're going to love.
Today's guest.
I'm Kayla, your host, lcswchaos maker, andrea proof
consultant, trainer and someonewho's fully over the
performative gatekeepingbullshit in this field.
Patrick is a therapist turnedTEDx speaker, business coach,
retreat leader and the guybehind all things private
(00:21):
practice.
He's neurodivergent, doneplaying nice with broken systems
and famous for the phrase doubtyourself and do it anyway.
He built his practice for theoutliers, the therapists and the
clients who never quite fit themold and after years of burnout
, shitty leadership and unpaidlabor, masses experience, he
said fuck it and created thecareer he actually wanted.
Now he runs retreats around theworld, coaches therapists to
(00:41):
ditch perfectionism and callsout the bullshit inner field
with honesty, edge and the kindof realness this profession
needs.
If you've ever been told you'llbe back in 30 days, this one is
for you Tune in and this one isfor the outliers.
Hi Patrick, thank you so muchfor joining me.
What got you into this field ofmental health?
Patrick Casale, MA, LCMHC (00:57):
Man, okay, right off the bat, let's
just jump on in.
So I think I've always beendrawn to helping people and
talking to people, especiallythose who feel like they're on
like the fringes of society.
My friends in college inupstate New York would make fun
of me because I would often talkto the unhoused people downtown
how they were doing and makeremember details about them and
bring them like drinks andsnacks and stuff Always a part
(01:19):
of my life and my mom was asocial worker growing up.
Kayla Schubert Wirth MSW, L (01:23):
But yeah.
Patrick Casale, MA, LCMHC (01:24):
I think it's always just been a
part of who I am and as anautistic ADHD-er, I think I've
always just really done a goodjob of connecting with people
who feel very misunderstood andout of place in society, a
little outcast.
Yep.
So I'm an LCMHC here in NorthCarolina, a licensed clinical
mental health counselor.
The fun thing that they did tous a couple of years ago we were
all LPCs and then likeovernight they changed our
(01:46):
license to L3MHD but they didn'ttell anyone.
They sent it out in like anewsletter and it was like who
reads this fucking newsletter?
Now we have to update all ofour stuff.
Kayla Schubert Wirth MSW, L (01:55):
How was like grad school,
internships, that kind of stufffor you, because I feel like
there's so many stories for somany of us in those.
Patrick Casale, MA, LCMHC (02:01):
It was a joke.
I mean I know you just hadCindy on, who's a good friend of
mine, and I was listening tosome of it and like it's just a
joke, it's just to like checkthe box and for the grad school
to make money.
You know what I mean.
Are we truly assessing who'sactually ready and prepared to
be a part of the helpingprofession or are we just like
moving people along becausethat's how we stay funded?
I think like we didn't learnmuch in terms of actual clinical
(02:22):
skill set in our grad schoolprogram.
We learned, like some of theoutside, like ancillary stuff
about being a counselor andmaybe some ethical stuff, but it
was not in depth and we didn'tdo a lot of like one-on-one
skill.
We had some courses where weworked on skills, but again,
nothing substantial.
My internship was at a methadoneclinic and yes, I will say this
(02:45):
, internships were hard tosecure in that time and it was
like the grad school did notexactly do a good job of helping
you secure.
But one of my classmates wasactually, in fact, the director
of said methadone clinic at thetime and he was like dude, we
are desperate for people like wewould love to have you come
here.
All it was was being up at 4 amto be at the methadone clinic,
which was awful Me half of thetime putting my chair against my
(03:08):
door of my office and fallingasleep so that nobody could come
in, because you're not supposedto be up at four in the morning
doing this work.
And then, like, because I wasone of the only two male staff
and observed drug screens weresuch a big part of compliance
with being a methadone clinic, Ispent most of my time like
watching dudes go to thebathroom and my grad school,
like internship advisor, wouldalways be like, hey, we need to
(03:28):
hear your recordings.
We, you know we're reallystruggling to get this content
from you to like process yoursessions.
The requirement to be incompliance in methadone is that
you have one to two 15 minutecheck-in sessions a month.
This is not therapy and Ididn't realize at the time that
the reason that our school wasso into sending people there was
because the director of theprogram was married to the
(03:50):
director of the counselingprogram.
So, of course, like we need tostaff this place up right, like
we need people and bodies.
It was not therapy, it was notcounseling.
It should never have beencounted as an internship.
Kayla Schubert Wirth MSW, LCS (04:00):
I think this happens so much in
internships in nonprofit worldwhere they're just like you can
do this.
But then what's happening?
Just with clients to therapists?
It's a clusterfuck.
It's like herding cats.
Patrick Casale, MA, LCMHC (04:15):
He would start every staff meeting
that way.
I was there for a year and ahalf.
I actually went from intern tocounselor to team lead to
assistant director within a sixmonth period all within my
internship.
By the way, part of it isbecause I think I just I didn't
suck at the job, but the otherpart is like I didn't quit and
he would start every staffmeeting with okay, we're almost
fully staffed, nobody quit thisweek, and that's kind of what
(04:36):
the vibe was.
I watched dudes stab each otherin the lobby.
I watched like shotgun fightsin the parking lot.
I would get so frustrated inour internship classes because
my professor just didn't get it.
I was like, listen, I don'tknow if I need to pull you aside
and tell you like this is myday to day, like this is not a
clinical world.
It was very frustrating.
Kayla Schubert Wirth MSW, LC (04:56):
So I'm curious in telling your
school about this, did they sayanything about like safety?
Patrick Casale, MA, LCMHC (05:01):
No, nothing was ever addressed.
It was kind of laughed off Likethat's what I'm laughing right
now, because I didn't.
That sounds like a wild day andI'm like yeah that was all by
Sam, like that was like we stillhad six hours left of this job.
you know a small glimpse intolike what some of these programs
and behind the scenes look like, and it's just when you're in
it you don't know any better.
(05:22):
You just are like I need thehours, I need to get through
this program right.
So it's really hard to advocatefor anything else when you're
new and you can't see the forestfor the tree, so to speak.
Kayla Schubert Wirth MSW (05:32):
Family dynamics and not recognizing
like the dysfunction in yourfamily to get that
differentiation, You're steppingback and be like whoa, that was
wild.
That's not normal.
Patrick Casale, MA, LCMHC (05:41):
Yep, A hundred percent.
I would go home every day andjust tell my wife I don't know
how I can keep going back here.
Not only is it killing my soul,but I'm so tired and also this
is not therapy and I feel unsafe.
We're in a situation where weare supposed to be the ones
de-escalating these situations,and this is not something that
(06:02):
we are equipped for.
Kayla Schubert Wirth MSW, L (06:05):
Did you guys get any training in
any kind A like, any kind oflike verbal, like crisis
management or like any likehands-on, like stuff for safety?
Patrick Casale, MA, LCMHC (06:12):
No, none.
We had like an armed securityguard and that was supposed to
be like the safety mechanism.
Kayla Schubert Wirth MSW, L (06:16):
Was he like 85 too?
Patrick Casale, MA, LCMHC (06:18):
Wow, he was like 28 and he spent most
of his time walking through thehallways on his phone texting,
and it was always like dude,there's a fight in the lobby.
Are you going to go out there?
Kayla Schubert Wirth MSW, LCS (06:27):
I was like nah matching with my
Tinder date.
That's Jesus Christ.
Looking back, I'm going to belike what the fuck were we doing
in these insane, unsafesituations?
Our shelves, but also ourclients, like these individuals
coming to the methadone clinicfor support, for help.
Patrick Casale, MA, LCMHC (06:41):
Yeah, all money-making for help.
Yeah, all money-makingfor-profit mechanisms.
None of this was reallydesigned in order to support
Like you can make the argumentharm reduction sure.
Kayla Schubert Wirth MSW, L (06:51):
How long were you at the methadone
clinic for and like Was that?
Did you stay in this kind ofworld or did you venture into
private practice, or whathappened?
Patrick Casale, MA, LCMHC (06:57):
So I ended up graduating with my
master's back in 2015 and alocal community mental health
organization here in Ashevilleopened up a 24-7 behavioral
health urgent care.
It was like one of the first ofits kind.
The whole goal was to reducerecidivism to the hospital down
the street and to really ensurethat people could walk in and
get mental health crisis careand substance use crisis care 24
(07:19):
hours a day.
And I was like, wow, thatsounds amazing, I'd love to
apply for that.
So I applied for that, I gothired and I quit the methadone
clinic and I got hired on as aclinician.
The goal was three 12 hourshifts a week and I was like
this is phenomenal.
We were like, yeah, this isgoing to be like the best thing
in the world.
But I'm one of those people whoquestions things out loud a lot
(07:39):
and points out things that mysupervisors have not appreciated
Very early on into our training.
I was like so we're a 24-hour,365 clinic.
We have peer support,specialists, qualified
professionals, licensedcounselors, nurses, a medical
doctor Love, it Sounds great.
How come we only have fournurses for seven days of 24-hour
(08:01):
shifts?
And people would be like, well,we have these two PRN nurses
who are going to cover like theoff shifts.
What are you using From like 7pm to 8.30, I can come in.
And it was like wait, this isnot going to work.
And the way they talked aboutthis to the community and
received funding from all thesestakeholders was like we're
(08:21):
going to be a place who supportsthe IDD community, we're going
to support children, we're goingto support adolescents, we're
going to support A, b and C andwe're going to be a place also
for, like, really violentoffenders who are psychotic.
And we have them all in thisobservation unit of eight little
beds with a nursing unit in themiddle.
It was not fun.
Kayla Schubert Wirth MS (08:41):
Because these are all high acute
populations with very specificspecialties.
Patrick Casale, MA, LCMHC (08:46):
We were not able to have any
restraints, no injectablemedications, nothing.
So once someone was deemedappropriate to come back to the
observation unit for 24 hours,things got pretty scary pretty
quickly and we were just not setup to succeed.
I found myself going fromclinician to program manager
within a year.
I tried to right the ship forabout a year but the burnout was
(09:08):
so bad that I ended up in thehospital.
Like you're talking 75-hourwork weeks, if a nurse calls out
at two in the morning, I'm theone who's supposed to for some
reason find the coverage.
Kayla Schubert Wirth MSW, LC (09:18):
Or go in.
Then I'm the one who's supposedto for some reason, find the
coverage or go in right.
Patrick Casale, MA, LCMHC (09:20):
So we were just again not set up to
succeed.
Kayla Schubert Wirth MSW, LCS (09:22):
I think I would last anywhere
from a year to a year and a halfat a job before I got
completely burned, because Iwould give it my soul.
Yeah, like everything, and thenI'd be like I can't do this
anymore.
Patrick Casale, MA, LCMHC (09:30):
So many of us do.
You know.
I think that's unfortunately apart of the helping profession.
Identity is like I'm supposedto give all of myself away.
My resume was quite short butultimately I mean it was just
not sustainable.
When I became the programmanager and was responsible for
outcomes and asking your staffto do more with less all of the
time, while going to thestakeholders and I was always
(09:53):
the one that was like we are notcapable of doing the things
that you have promised and again, people did not like that.
Or sitting in these meetingswhere I would openly say I'm
like no, we actually have shitto do, like I actually have to
go support my staff because wedon't have enough.
And you know that stuff leadsto so much resentment and
burnout and frustration and Ijust could not wait to get the
hell out of there.
Kayla Schubert Wirth MSW, (10:14):
What was your like?
I need to leave moment.
Patrick Casale, MA, LCMHC (10:16):
I had so many.
You know like I go throughmassive burnout as the program
director.
I asked to go back to being aclinician.
I'm like I can't do thisanymore.
I've done this for a year.
I feel like I've righted theship from the shit show of a
human that you hired first torun this program.
I think I've done my piece andI'd like to go back to a
clinician.
So they grant that, but theymake my life kind of hell.
(10:37):
So we open up a new programwithin that agency, another
grant funded program, and thiswas going to be more like case
management, still about reducingrecidivism within the hospital
system, and I was going to be ateam lead and I'm like good.
I'll apply, I'll get the hellout of crisis.
So I did get that job and Ihelped them get that off the
ground for about a year and itwas quite successful.
(11:03):
And then the agency that Iworked at was notorious for
bragging and celebrating thefact that they didn't give
raises to people.
We don't do that here.
So they finally make thiscompany-wide announcement that
they're finally going to offerraises based on productivity
within your funding stream.
So I get zero raise and Iquestion it with HR and they say
, well, it's because you're apart of a new grant and we just
don't have enough funding tooffer the raises.
I said, huh, that doesn't makea lot of sense, because all of
(11:25):
my staff that I'm supervisingare openly celebrating the
raises that they just receivedin the conference room and
they're like it's because youswitched roles from team lead to
team lead and because wehaven't had a year to do your
evaluation, we had to give youan average ranking, so you're
not eligible for a raise.
And I was like, okay, okay, I'mquitting.
(11:45):
So that was my final straw.
I wrote my 90 day notice thatday and they replaced me in two
days.
They did not.
I just sat in office for like60 days and I would just take
extended lunch breaks and go outand work on my private practice
and network First lunch breaksever too.
Majorly Everything else waseating on the fly, shoving a
(12:06):
sandwich in your face in thecorner like an animal.
So I ended up rescinding that90 day notice and I was just
like I think this has run itscourse, I'd like to get out of
here.
And then my manager actuallytook me out for like an exit
interview lunch and she wassomeone at the time who I
considered to be a friend andshe told me that I would be back
in 30 days because nobody makesit on their own, and she was
really happy that the personthey hired to replace me had
(12:29):
such a strong work ethic incomparison.
So, patrick, I think this isinteresting too is what, but I
always use it as fuel to thefire.
You know, like, similarly towhat you were saying about
starting this podcast, I'vealways kept that statement in my
mind.
And you know it was just likehurtful.
It sucked.
I know it was based in her ownresentment, jealousy, insecurity
, grief of like the loss of agood colleague, whatever.
Kayla Schubert Wirth MSW, L (12:52):
But should we like get the like
cojones to actually leave and doher own thing Right?
I see that a lot.
Patrick Casale, MA, LCMHC (12:58):
And there's just so much projection
within our industry and so muchinsecurity and so much unhealed
trauma and unhealed shit ingeneral.
So you know, and I've alwaysthink about how so many people
in this industry got into it toheal themselves through the work
that they do.
They never actually do the workfor themselves and that's where
you see a lot of codependencybe created within like clinical
interaction and relationship.
(13:18):
That's where you see a lot ofthese clinicians who are like my
clients need me, like I can'tgo on vacation because they need
me, and I'm like that is sofucking unhealthy.
Kayla Schubert Wirth MSW, L (13:28):
Did you then like open your own
private practice, or did youjoin a group, or what did you do
?
Patrick Casale, MA, LCMHC (13:33):
So back in 2017, I opened my own
private practice and I was doingit like part time as I was
leaving that agency job, but Iwas doing it at night and on
weekends when I had free timeand I always noticed how much
more energy I had, even going tomy own office space seeing my
own clients, even if it was 8 pmat night, and I was just like I
really need to make this areality.
(13:54):
Everything was really flying bythe seat of my pants Private
practice checklist circulatingthe internet at that time Not a
ton of private practice coachesor groups like there are now.
I just was like so full ofself-doubt and imposter syndrome
and it was a huge risk and Iknew that and everyone I told I
was going to start a businesswas like but nobody's going to
call you.
Kayla Schubert Wirth MSW (14:13):
You're not going to make it, you'll be
back on dirty days and no one'sgoing to call you.
Patrick Casale, MA, LCMHC (14:17):
Yeah, it's so demoralizing and I'm
one of those people when peopletell me I can't do things, I
think I get more entrenched inthis mentality like I need to
prove these motherfuckers wrong.
I did end up starting thatpractice back in 2017.
Fast forward to now.
I employ 25 therapists who workfor the practice.
I have not worked as a clinicalmental health counselor since
2022.
Had.
I have not worked as a clinicalmental health counselor since
2022.
(14:37):
Had several major throatsurgeries in the last couple of
years.
My vocal cord got paralyzedback in that second surgery, but
yeah, so I still maintain mylicense.
The group practice servesneurodivergent adults, autistic
ADHDers, people who are part ofthe LGBTQIA community, et cetera
, and all of our therapists areautistic or ADHD and I fucking
love it and it's been like areally awesome ride and I've
(14:59):
just tried to create a culturethat really feels supportive and
affirming and does everythingdifferently than the two
experiences that I had.
Kayla Schubert Wirth MSW, L (15:06):
And I feel like too, like this is
your practice of like I want theoutlier therapist and I want
the clients who feel likeoutliers, so you all can belong.
Patrick Casale, MA, LCMHC (15:14):
Yeah, exactly, that's perfectly said.
You know, and Cindy Miller, whoyou interviewed, is a therapist
of mine.
She's a good friend of mine,and I think it's about
supporting your staff, raisingthem up, modeling what can be
done differently in thisprofession, and not being judgy,
possessive or insecure whenthey tell you they also have
ambitions.
It would be so hypocritical ofme to have started all things
(15:36):
private practice back in 2020,teaching all these therapists
how to start and grow theirbusinesses.
We have a tremendous employeeretention rate and culture.
But also, when people leave, Iencourage them to do so and set
them up for success, because Ithink that's what it's all about
.
Instead of being like, no, wehave a non-compete, or you're
not going to make it, or youknow, all of these roadblocks
(15:57):
are in the way, I'm just likehere's my podcast, here's my
resources, like please go, dowhat you think is best for you,
and I think that makes a majordifference when we're talking
about a profession of people whooften do it very differently.
Kayla Schubert Wirth MSW, L (16:08):
And I think that's the thing is
that I had a group practice fora small amount of time, but I
also talked about ADHD andmoving fast right Open to
private practice in March of2022.
I was full by April and I waslike now what?
I hired four staff or W2employees by August of the same
(16:29):
year and I was like this is fine.
And I interviewed and I'mprobably around 50 to 60 people.
People are like how the fuckdid you do that?
I was like because I believe weall deserve to actually be paid
and like I'm not an assholeyeah, yeah, it goes a long way,
oh figure yeah, and all thestuff I brought online.
I'm still in contact with themall when I ended up closing the
(16:49):
practice last year, right, doyou want to open a private
practice one day?
Sure, let me show you what todo.
Don't make the mistakes I did.
Or, if you're're not happy,tell me, I can find you
somewhere else.
I have a couple of them still.
Text me, probably like once amonth, going Kayla, are you
going to open back up again?
I don't think so, and they'relike please, and I'm like no,
some of them are like.
You taught me that like I cansay no, you taught me how to
(17:12):
have my schedule supervisionaspect, because all of these
horrible supervisors, we justneed to do better.
Patrick Casale, MA, LCMHC (17:19):
We do , we do.
It is good to hear that thereare people out there trying to
actively do better.
I hear that from a lot of grouppractice centers that I come in
contact with and I'm like weget like 100 applications a
month.
We are not hurting forreferrals or for employees and I
think if you treat people likepeople and prioritize people
over profit, then we're weirdly,you can create employee
(17:42):
retention and culture thatactually works really well and
I've given a lot of trainingsand workshops on like that exact
process.
There are different ways to dothis stuff.
For me, I am fortunate because,like all things, private
practice does generate revenue,so I can make less money in my
group practice.
Not everyone has that luxury orprivilege.
But like it is also aboutrealizing how do we set people
(18:04):
up for success?
Because satisfied, happyemployees are going to last
longer and be a part of yourorganization for longer periods
of time, which ultimately costsless over time because you're
not constantly training andonboarding.
Kayla Schubert Wirth MSW, (18:18):
Then you have clients who are
getting better.
They are then noticing, andthen getting referrals from
clients is like one of thegreatest things to hear is like
oh, so-and-so sent me hereExactly In the long run.
It makes clients and therapistsbe able to sustain this long
term and not feel like they needto job hunt or have a resume
that's eight pages long.
(18:38):
What do you suggest?
New therapists, someoneinterviewing for grad school,
for internship in privatepractice I feel like these are
more and more common now tointerning in private practice or
someone who's in like communitymental health coming into
private practice.
What do you think are somethings like they should ask?
Patrick Casale, MA, LCMHC (18:54):
I think they should definitely ask
about the culture, the employeeretention, like I would want to
do a deep dive on the websiteto see what the values of the
practice are and really askabout the values of the practice
, because we often use certainwords as like, if we say we're
an anti-racist practice, whatare we doing to maintain and
ensure that we are ananti-racist practice?
If we want to specialize in theneurodivergent community, what
(19:15):
are we doing to ensure that weare doing so?
I would want to flip theinterview a little bit and you
should be asking a lot ofquestions as well, because so
often when we're in thosepositions, we feel unbelievably
grateful just to have anopportunity and we're almost
like we have to just say yesbecause I need to do an
internship, a job, right out ofschool.
So I think, having your ownquestions that you really want
(19:37):
answered, I would want to knowwhat you do to create and
maintain culture.
I would want to know how theleadership is structured and how
they communicate For us,because we want to be as
neuro-inclusive as possible, Ireally want our clinicians to
communicate in whichever waythey feel most comfortable, so I
have done one-on-one check-inswith people via text, video call
with the video off meeting themwhere they're at, and I think
(19:59):
that's super important.
I have interviewed people andhired people without ever
actually speaking to them beforeand just communicating via
email.
So, like I would really want toknow, can this practice create
accommodations that I need in mylife to be successful?
How are you going to help me?
Kayla Schubert Wirth MSW, (20:15):
grow and develop over time.
And that just goes back to whatwe said.
So many practices don't want tosee you grow and develop and
they want to teach you like keepyou up.
Yeah, exactly, and you know.
Patrick Casale, MA, LCMHC (20:23):
One thing I also ask is like where
do you see yourself in fiveyears?
I don't know how to answer thatquestion myself.
I myself have done a lot overthe last four or five years in
this profession, whether it bepodcasts or retreats and summits
or coaching programs.
I just did a TEDx and got a bookdeal, like there are so many
things that we can do and I wantto know if I can help you move
towards those goals.
(20:43):
So a lot of my clinicians willsay I really want to run
coaching programs, I really wantto do more speaking, et cetera.
I have definitely hired some ofmy therapists to come and do
some of those talks or giventhem spots in those events
because it aligns with theirgoals.
Your employers should really beinvested in your future and I
think far too often employersare afraid to do that because
(21:05):
the mindset is like if I do that, people are just going to leave
.
But in reality, so many of mystaff have been with us for over
three years and they're like Idon't want to leave and start my
own practice, I just want to dosome other things.
So having the safety net ofhere's, this practice that feels
consistent and reliable andsupportive, it allows me to grow
.
Outside of that, they'reprobably going to stay.
Kayla Schubert Wirth MS (21:26):
They're going to stay and they're going
to tell their friends on howamazing it is to work here.
And now you've got anothercouple of rounds of applications
coming through the door again.
Patrick Casale, MA, LCMHC (21:33):
Yeah, for sure.
Kayla Schubert Wirth MSW, (21:35):
It's amazing how that just that
cycle works.
Patrick Casale, MA, LCMHC (21:39):
We can sit here and have all of
these conversations right onthis podcast on so many
platforms of shitty jobs, shittyenvironments, shitty support,
shitty leadership.
But it doesn't have to be thatway and I just think that if we
are willing as leaders, toreally be accountable and
transparent and anchor into thevalues that we have, I think it
makes a world of difference.
(21:59):
Like I am not the type ofperson that says you need to go
iron your stripes and like pullyourself up by your boots and
then burn yourself out incommunity mental health before
you can start a practice likethat should not be what we are
encouraging people to do.
Kayla Schubert Wirth MSW, L (22:12):
And I know when I hired a couple
like fresh out of grad school inPennsylvania we call them like
licensed social workers orthey're not clinically licensed
yet and I was like, no, don't dowhat I did.
That made you want to likeleave the field and go work at
the man's store and sell fuckingshoes Like here's a different
way.
Patrick Casale, MA, LCMHC (22:30):
Yeah.
Kayla Schubert Wirth MSW, L (22:31):
And I think that's the thing.
There's so many different waysand I live in a really small
community in Pennsylvania andI'm like this isn't just this
area, this is fucking everywhere.
Patrick Casale, MA, LCMH (22:41):
People , yep, yeah, it is good for you
for wanting to offer a different, you know landing spot and
there is some validity to likeOK, community mental health does
offer a very diverse experience.
Right, you're going to workwith everyone and anyone and
that's fine.
However, people will alwaysdefault to like well, you need
to get really good supervisionbefore you can go out into
(23:02):
private practice.
The supervision I had incommunity mental health was
non-existent.
I went through almost threeyears in that job without ever
doing supervision.
So when I left I had to likemake up so many hours because we
didn't have hours to sign offon.
I sat in on some of thosesupervision.
It'd be like 35 people in aroom just venting and
complaining for an hour,including the supervisor.
(23:24):
So then seeking externalsupervision with someone else
who was doing groups of two,groups of three individual.
Oh, this is what supervision is, when you actually get to have
support and can staff cases in ahealthy way.
Kayla Schubert Wirth MSW, L (23:38):
And I hear I see a couple of
therapists who are, who are incommunity mental health and
sometimes in therapy.
They're just just like I have asupervision question, kayla,
and I'm like is this helpful foryou right now?
Like I just they're like I needhelp, I don't know where to go,
and I'll be like okay, and I'llsay to them and they'll just be
like I'm like what's that?
Whoa, because that's not whatI'm told.
I'm told this or I'm told thatand I'm like, right, let's step
(24:01):
back, like myles's' hierarchy ofneeds.
How do we look at this from atrauma-informed lens?
I'm like you guys don't talkabout this.
I'm like we're told like why isour no-show rate at 45%?
I'm like because you're incommunity mental health, in a
fucking ring for three months,no one's coming Right, and I
think it's just it's soinfuriating.
I know some people.
I've seen people charge like$30, $50, $60.
(24:27):
And I've seen people chargelike $300 for clinical
supervision to get licensed.
I'm like that is just, that'sinsane.
Patrick Casale, MA, LCMHC (24:36):
Like how can?
Someone making $30,000, $40,000a year afford $300 a week 100%
and you know oftentimes you haveto do that supervision for
several years to get those hours, so that can definitely be a
barrier to licensure andaccessibility.
I have this goal, you know.
I've talked about it publiclyon my podcast and elsewhere
before.
But I'm a big Anthony Bourdainfan, as people can probably see
(24:58):
from behind me, and all over myoffice.
Really I want to write a booksimilar to his kitchen
confidential, called liketherapy confidential, and it
would be about the dark side ofbeing in the mental health
profession and industry.
And yeah, I just have a fear itwould ostracize me from the
profession, but I also don'treally give a fuck about that
anymore.
Kayla Schubert Wirth MSW, LCS (25:17):
I feel like it would be amazing
and he does like a stand up nowand he literally has like huge
things sold out of him doinglike these skits and comedy, is
it?
Patrick Casale, MA, (25:25):
potentially Sam Silverman.
He was on my other podcast andhe's a stand-up comedian.
He's a psychiatrist who has OCDand tells all these ridiculous
stories and it's justoutrageously hilarious.
Kayla Schubert Wirth MS (25:36):
Imagine doing like a show where
therapists come up and tellthese stories and they are.
Some of them are literallyhilarious.
Patrick Casale, MA, LCMHC (25:41):
Yeah.
Kayla Schubert Wirth MSW, (25:42):
Like and stepping back and be like.
Patrick Casale, MA, LCMHC (25:46):
I just did that.
I can still remember back inthe day.
This was not a therapy job, itwas just a case management job
Used to work with the unhousedpopulation here in Western North
Carolina.
Our goal was to, like endhomelessness in Appalachia and
we would move people intopermanent supportive housing.
So much of public housing hadbedbugs all the time and my
coworker and I would getpainter's suits from Home Depot
(26:07):
and have to go into people'sapartments and throw out all of
the furniture and then we wouldrun back to our car, take these
painter's suits off, put themall in a trash bag, put our
clothes back on and go home andimmediately wash your clothes.
So you did not also get bedbugsand that was like four years of
my life.
Kayla Schubert Wirth MSW, LCS (26:24):
I used to do in-home family
therapy so not like family-based, like I was by myself in homes
and the animals you know lovedme, right.
I would have these pit bullssitting on my lap during in-home
family therapy.
Or the massive cat which I'mdefinitely allergic to being
like can you please take the catoff my lap, and they would just
come down like so yeah, fuckingwild.
I mean.
I also remember, like I said, Iwas trying to leave the field,
(26:45):
like I was burnout.
I literally applied to like thevan store.
I would tell people like oh, Ithink I maybe just want to go
into the business world, like Idon't think you're made out for
it.
If I can assess for activesuicide, not cry and do this,
this and this, I think I canwork in any industry.
Patrick Casale, MA, LCMHC (27:07):
And they would just like look to
realize and recognize that thisis not a one size fits all
career path and our skills areapplicable in so many different
ways and arenas.
I mean, when I graduated mymaster's in 2015, I didn't think
some of the stuff I've createdor accomplished over the last
four or five years was even apossibility.
There's lots of hope out there.
Kayla Schubert Wirth MS (27:28):
Awesome .
Thank you so much, Patrick, forbeing on.
I appreciate you talking.
Patrick Casale, MA, LCMHC (27:32):
Yeah, you're welcome.
Thank you so much for having me.
Kayla Schubert Wirth MSW, LC (27:34):
If you ever thought maybe I'm the
problem, let this be yourreminder You're probably not.
Patrick's story is proof thatyou don't have to shrink
yourself to fit the brokensystems.
You can burn it down, rebuildfrom scratch and still do work
that's powerful, ethical anddeeply needed.
This field wasn't built for theoutliers, but we're not waiting
for permission anymore.
We're building something better.
(27:55):
Thanks for listening to Burnoutand Bullshit.
If this hit home, send it to atherapist friend, who's one more
unethical supervision away fromflipping a desk.
And if you're ready to build apractice that actually fits,
If you ever wanted to flip a table
during a staff meeting orscreen, this can't be what
therapy really is.
You're going to love.
Today's guest.
I'm Kayla, your host, lcswchaos maker, andrea proof
consultant, trainer and someonewho's fully over the
performative gatekeepingbullshit in this field.
Patrick is a therapist turnedTEDx speaker, business coach,
retreat leader and the guybehind all things private
(00:21):
practice.
He's neurodivergent, doneplaying nice with broken systems
and famous for the phrase doubtyourself and do it anyway.
He built his practice for theoutliers, the therapists and the
clients who never quite fit themold and after years of burnout
, shitty leadership and unpaidlabor, masses experience, he
said fuck it and created thecareer he actually wanted.
Now he runs retreats around theworld, coaches therapists to
(00:41):
ditch perfectionism and callsout the bullshit inner field
with honesty, edge and the kindof realness this profession
needs.
If you've ever been told you'llbe back in 30 days, this one is
for you Tune in and this one isfor the outliers.
Hi Patrick, thank you so muchfor joining me.
What got you into this field ofmental health?
Patrick Casale, MA, LCMHC (00:57):
Man, okay, right off the bat, let's
just jump on in.
So I think I've always beendrawn to helping people and
talking to people, especiallythose who feel like they're on
like the fringes of society.
My friends in college inupstate New York would make fun
of me because I would often talkto the unhoused people downtown
how they were doing and makeremember details about them and
bring them like drinks andsnacks and stuff Always a part
(01:19):
of my life and my mom was asocial worker growing up.
Kayla Schubert Wirth MSW, L (01:23):
But yeah.
Patrick Casale, MA, LCMHC (01:24):
I think it's always just been a
part of who I am and as anautistic ADHD-er, I think I've
always just really done a goodjob of connecting with people
who feel very misunderstood andout of place in society, a
little outcast.
Yep.
So I'm an LCMHC here in NorthCarolina, a licensed clinical
mental health counselor.
The fun thing that they did tous a couple of years ago we were
all LPCs and then likeovernight they changed our
(01:46):
license to L3MHD but they didn'ttell anyone.
They sent it out in like anewsletter and it was like who
reads this fucking newsletter?
Now we have to update all ofour stuff.
Kayla Schubert Wirth MSW, L (01:55):
How was like grad school,
internships, that kind of stufffor you, because I feel like
there's so many stories for somany of us in those.
Patrick Casale, MA, LCMHC (02:01):
It was a joke.
I mean I know you just hadCindy on, who's a good friend of
mine, and I was listening tosome of it and like it's just a
joke, it's just to like checkthe box and for the grad school
to make money.
You know what I mean.
Are we truly assessing who'sactually ready and prepared to
be a part of the helpingprofession or are we just like
moving people along becausethat's how we stay funded?
I think like we didn't learnmuch in terms of actual clinical
(02:22):
skill set in our grad schoolprogram.
We learned, like some of theoutside, like ancillary stuff
about being a counselor andmaybe some ethical stuff, but it
was not in depth and we didn'tdo a lot of like one-on-one
skill.
We had some courses where weworked on skills, but again,
nothing substantial.
My internship was at a methadoneclinic and yes, I will say this
(02:45):
, internships were hard tosecure in that time and it was
like the grad school did notexactly do a good job of helping
you secure.
But one of my classmates wasactually, in fact, the director
of said methadone clinic at thetime and he was like dude, we
are desperate for people like wewould love to have you come
here.
All it was was being up at 4 amto be at the methadone clinic,
which was awful Me half of thetime putting my chair against my
(03:08):
door of my office and fallingasleep so that nobody could come
in, because you're not supposedto be up at four in the morning
doing this work.
And then, like, because I wasone of the only two male staff
and observed drug screens weresuch a big part of compliance
with being a methadone clinic, Ispent most of my time like
watching dudes go to thebathroom and my grad school,
like internship advisor, wouldalways be like, hey, we need to
(03:28):
hear your recordings.
We, you know we're reallystruggling to get this content
from you to like process yoursessions.
The requirement to be incompliance in methadone is that
you have one to two 15 minutecheck-in sessions a month.
This is not therapy and Ididn't realize at the time that
the reason that our school wasso into sending people there was
because the director of theprogram was married to the
(03:50):
director of the counselingprogram.
So, of course, like we need tostaff this place up right, like
we need people and bodies.
It was not therapy, it was notcounseling.
It should never have beencounted as an internship.
Kayla Schubert Wirth MSW, LCS (04:00):
I think this happens so much in
internships in nonprofit worldwhere they're just like you can
do this.
But then what's happening?
Just with clients to therapists?
It's a clusterfuck.
It's like herding cats.
Patrick Casale, MA, LCMHC (04:15):
He would start every staff meeting
that way.
I was there for a year and ahalf.
I actually went from intern tocounselor to team lead to
assistant director within a sixmonth period all within my
internship.
By the way, part of it isbecause I think I just I didn't
suck at the job, but the otherpart is like I didn't quit and
he would start every staffmeeting with okay, we're almost
fully staffed, nobody quit thisweek, and that's kind of what
(04:36):
the vibe was.
I watched dudes stab each otherin the lobby.
I watched like shotgun fightsin the parking lot.
I would get so frustrated inour internship classes because
my professor just didn't get it.
I was like, listen, I don'tknow if I need to pull you aside
and tell you like this is myday to day, like this is not a
clinical world.
It was very frustrating.
Kayla Schubert Wirth MSW, LC (04:56):
So I'm curious in telling your
school about this, did they sayanything about like safety?
Patrick Casale, MA, LCMHC (05:01):
No, nothing was ever addressed.
It was kind of laughed off Likethat's what I'm laughing right
now, because I didn't.
That sounds like a wild day andI'm like yeah that was all by
Sam, like that was like we stillhad six hours left of this job.
you know a small glimpse intolike what some of these programs
and behind the scenes look like, and it's just when you're in
it you don't know any better.
(05:22):
You just are like I need thehours, I need to get through
this program right.
So it's really hard to advocatefor anything else when you're
new and you can't see the forestfor the tree, so to speak.
Kayla Schubert Wirth MSW (05:32):
Family dynamics and not recognizing
like the dysfunction in yourfamily to get that
differentiation, You're steppingback and be like whoa, that was
wild.
That's not normal.
Patrick Casale, MA, LCMHC (05:41):
Yep, A hundred percent.
I would go home every day andjust tell my wife I don't know
how I can keep going back here.
Not only is it killing my soul,but I'm so tired and also this
is not therapy and I feel unsafe.
We're in a situation where weare supposed to be the ones
de-escalating these situations,and this is not something that
(06:02):
we are equipped for.
Kayla Schubert Wirth MSW, L (06:05):
Did you guys get any training in
any kind A like, any kind oflike verbal, like crisis
management or like any likehands-on, like stuff for safety?
Patrick Casale, MA, LCMHC (06:12):
No, none.
We had like an armed securityguard and that was supposed to
be like the safety mechanism.
Kayla Schubert Wirth MSW, L (06:16):
Was he like 85 too?
Patrick Casale, MA, LCMHC (06:18):
Wow, he was like 28 and he spent most
of his time walking through thehallways on his phone texting,
and it was always like dude,there's a fight in the lobby.
Are you going to go out there?
Kayla Schubert Wirth MSW, LCS (06:27):
I was like nah matching with my
Tinder date.
That's Jesus Christ.
Looking back, I'm going to belike what the fuck were we doing
in these insane, unsafesituations?
Our shelves, but also ourclients, like these individuals
coming to the methadone clinicfor support, for help.
Patrick Casale, MA, LCMHC (06:41):
Yeah, all money-making for help.
Yeah, all money-makingfor-profit mechanisms.
None of this was reallydesigned in order to support
Like you can make the argumentharm reduction sure.
Kayla Schubert Wirth MSW, L (06:51):
How long were you at the methadone
clinic for and like Was that?
Did you stay in this kind ofworld or did you venture into
private practice, or whathappened?
Patrick Casale, MA, LCMHC (06:57):
So I ended up graduating with my
master's back in 2015 and alocal community mental health
organization here in Ashevilleopened up a 24-7 behavioral
health urgent care.
It was like one of the first ofits kind.
The whole goal was to reducerecidivism to the hospital down
the street and to really ensurethat people could walk in and
get mental health crisis careand substance use crisis care 24
(07:19):
hours a day.
And I was like, wow, thatsounds amazing, I'd love to
apply for that.
So I applied for that, I gothired and I quit the methadone
clinic and I got hired on as aclinician.
The goal was three 12 hourshifts a week and I was like
this is phenomenal.
We were like, yeah, this isgoing to be like the best thing
in the world.
But I'm one of those people whoquestions things out loud a lot
(07:39):
and points out things that mysupervisors have not appreciated
Very early on into our training.
I was like so we're a 24-hour,365 clinic.
We have peer support,specialists, qualified
professionals, licensedcounselors, nurses, a medical
doctor Love, it Sounds great.
How come we only have fournurses for seven days of 24-hour
(08:01):
shifts?
And people would be like, well,we have these two PRN nurses
who are going to cover like theoff shifts.
What are you using From like 7pm to 8.30, I can come in.
And it was like wait, this isnot going to work.
And the way they talked aboutthis to the community and
received funding from all thesestakeholders was like we're
(08:21):
going to be a place who supportsthe IDD community, we're going
to support children, we're goingto support adolescents, we're
going to support A, b and C andwe're going to be a place also
for, like, really violentoffenders who are psychotic.
And we have them all in thisobservation unit of eight little
beds with a nursing unit in themiddle.
It was not fun.
Kayla Schubert Wirth MS (08:41):
Because these are all high acute
populations with very specificspecialties.
Patrick Casale, MA, LCMHC (08:46):
We were not able to have any
restraints, no injectablemedications, nothing.
So once someone was deemedappropriate to come back to the
observation unit for 24 hours,things got pretty scary pretty
quickly and we were just not setup to succeed.
I found myself going fromclinician to program manager
within a year.
I tried to right the ship forabout a year but the burnout was
(09:08):
so bad that I ended up in thehospital.
Like you're talking 75-hourwork weeks, if a nurse calls out
at two in the morning, I'm theone who's supposed to for some
reason find the coverage.
Kayla Schubert Wirth MSW, LC (09:18):
Or go in.
Then I'm the one who's supposedto for some reason, find the
coverage or go in right.
Patrick Casale, MA, LCMHC (09:20):
So we were just again not set up to
succeed.
Kayla Schubert Wirth MSW, LCS (09:22):
I think I would last anywhere
from a year to a year and a halfat a job before I got
completely burned, because Iwould give it my soul.
Yeah, like everything, and thenI'd be like I can't do this
anymore.
Patrick Casale, MA, LCMHC (09:30):
So many of us do.
You know.
I think that's unfortunately apart of the helping profession.
Identity is like I'm supposedto give all of myself away.
My resume was quite short butultimately I mean it was just
not sustainable.
When I became the programmanager and was responsible for
outcomes and asking your staffto do more with less all of the
time, while going to thestakeholders and I was always
(09:53):
the one that was like we are notcapable of doing the things
that you have promised and again, people did not like that.
Or sitting in these meetingswhere I would openly say I'm
like no, we actually have shitto do, like I actually have to
go support my staff because wedon't have enough.
And you know that stuff leadsto so much resentment and
burnout and frustration and Ijust could not wait to get the
hell out of there.
Kayla Schubert Wirth MSW, (10:14):
What was your like?
I need to leave moment.
Patrick Casale, MA, LCMHC (10:16):
I had so many.
You know like I go throughmassive burnout as the program
director.
I asked to go back to being aclinician.
I'm like I can't do thisanymore.
I've done this for a year.
I feel like I've righted theship from the shit show of a
human that you hired first torun this program.
I think I've done my piece andI'd like to go back to a
clinician.
So they grant that, but theymake my life kind of hell.
(10:37):
So we open up a new programwithin that agency, another
grant funded program, and thiswas going to be more like case
management, still about reducingrecidivism within the hospital
system, and I was going to be ateam lead and I'm like good.
I'll apply, I'll get the hellout of crisis.
So I did get that job and Ihelped them get that off the
ground for about a year and itwas quite successful.
(11:03):
And then the agency that Iworked at was notorious for
bragging and celebrating thefact that they didn't give
raises to people.
We don't do that here.
So they finally make thiscompany-wide announcement that
they're finally going to offerraises based on productivity
within your funding stream.
So I get zero raise and Iquestion it with HR and they say
, well, it's because you're apart of a new grant and we just
don't have enough funding tooffer the raises.
I said, huh, that doesn't makea lot of sense, because all of
(11:25):
my staff that I'm supervisingare openly celebrating the
raises that they just receivedin the conference room and
they're like it's because youswitched roles from team lead to
team lead and because wehaven't had a year to do your
evaluation, we had to give youan average ranking, so you're
not eligible for a raise.
And I was like, okay, okay, I'mquitting.
(11:45):
So that was my final straw.
I wrote my 90 day notice thatday and they replaced me in two
days.
They did not.
I just sat in office for like60 days and I would just take
extended lunch breaks and go outand work on my private practice
and network First lunch breaksever too.
Majorly Everything else waseating on the fly, shoving a
(12:06):
sandwich in your face in thecorner like an animal.
So I ended up rescinding that90 day notice and I was just
like I think this has run itscourse, I'd like to get out of
here.
And then my manager actuallytook me out for like an exit
interview lunch and she wassomeone at the time who I
considered to be a friend andshe told me that I would be back
in 30 days because nobody makesit on their own, and she was
really happy that the personthey hired to replace me had
(12:29):
such a strong work ethic incomparison.
So, patrick, I think this isinteresting too is what, but I
always use it as fuel to thefire.
You know, like, similarly towhat you were saying about
starting this podcast, I'vealways kept that statement in my
mind.
And you know it was just likehurtful.
It sucked.
I know it was based in her ownresentment, jealousy, insecurity
, grief of like the loss of agood colleague, whatever.
Kayla Schubert Wirth MSW, L (12:52):
But should we like get the like
cojones to actually leave and doher own thing Right?
I see that a lot.
Patrick Casale, MA, LCMHC (12:58):
And there's just so much projection
within our industry and so muchinsecurity and so much unhealed
trauma and unhealed shit ingeneral.
So you know, and I've alwaysthink about how so many people
in this industry got into it toheal themselves through the work
that they do.
They never actually do the workfor themselves and that's where
you see a lot of codependencybe created within like clinical
interaction and relationship.
(13:18):
That's where you see a lot ofthese clinicians who are like my
clients need me, like I can'tgo on vacation because they need
me, and I'm like that is sofucking unhealthy.
Kayla Schubert Wirth MSW, L (13:28):
Did you then like open your own
private practice, or did youjoin a group, or what did you do
?
Patrick Casale, MA, LCMHC (13:33):
So back in 2017, I opened my own
private practice and I was doingit like part time as I was
leaving that agency job, but Iwas doing it at night and on
weekends when I had free timeand I always noticed how much
more energy I had, even going tomy own office space seeing my
own clients, even if it was 8 pmat night, and I was just like I
really need to make this areality.
(13:54):
Everything was really flying bythe seat of my pants Private
practice checklist circulatingthe internet at that time Not a
ton of private practice coachesor groups like there are now.
I just was like so full ofself-doubt and imposter syndrome
and it was a huge risk and Iknew that and everyone I told I
was going to start a businesswas like but nobody's going to
call you.
Kayla Schubert Wirth MSW (14:13):
You're not going to make it, you'll be
back on dirty days and no one'sgoing to call you.
Patrick Casale, MA, LCMHC (14:17):
Yeah, it's so demoralizing and I'm
one of those people when peopletell me I can't do things, I
think I get more entrenched inthis mentality like I need to
prove these motherfuckers wrong.
I did end up starting thatpractice back in 2017.
Fast forward to now.
I employ 25 therapists who workfor the practice.
I have not worked as a clinicalmental health counselor since
2022.
Had.
I have not worked as a clinicalmental health counselor since
2022.
(14:37):
Had several major throatsurgeries in the last couple of
years.
My vocal cord got paralyzedback in that second surgery, but
yeah, so I still maintain mylicense.
The group practice servesneurodivergent adults, autistic
ADHDers, people who are part ofthe LGBTQIA community, et cetera
, and all of our therapists areautistic or ADHD and I fucking
love it and it's been like areally awesome ride and I've
(14:59):
just tried to create a culturethat really feels supportive and
affirming and does everythingdifferently than the two
experiences that I had.
Kayla Schubert Wirth MSW, L (15:06):
And I feel like too, like this is
your practice of like I want theoutlier therapist and I want
the clients who feel likeoutliers, so you all can belong.
Patrick Casale, MA, LCMHC (15:14):
Yeah, exactly, that's perfectly said.
You know, and Cindy Miller, whoyou interviewed, is a therapist
of mine.
She's a good friend of mine,and I think it's about
supporting your staff, raisingthem up, modeling what can be
done differently in thisprofession, and not being judgy,
possessive or insecure whenthey tell you they also have
ambitions.
It would be so hypocritical ofme to have started all things
(15:36):
private practice back in 2020,teaching all these therapists
how to start and grow theirbusinesses.
We have a tremendous employeeretention rate and culture.
But also, when people leave, Iencourage them to do so and set
them up for success, because Ithink that's what it's all about
.
Instead of being like, no, wehave a non-compete, or you're
not going to make it, or youknow, all of these roadblocks
(15:57):
are in the way, I'm just likehere's my podcast, here's my
resources, like please go, dowhat you think is best for you,
and I think that makes a majordifference when we're talking
about a profession of people whooften do it very differently.
Kayla Schubert Wirth MSW, L (16:08):
And I think that's the thing is
that I had a group practice fora small amount of time, but I
also talked about ADHD andmoving fast right Open to
private practice in March of2022.
I was full by April and I waslike now what?
I hired four staff or W2employees by August of the same
(16:29):
year and I was like this is fine.
And I interviewed and I'mprobably around 50 to 60 people.
People are like how the fuckdid you do that?
I was like because I believe weall deserve to actually be paid
and like I'm not an assholeyeah, yeah, it goes a long way,
oh figure yeah, and all thestuff I brought online.
I'm still in contact with themall when I ended up closing the
(16:49):
practice last year, right, doyou want to open a private
practice one day?
Sure, let me show you what todo.
Don't make the mistakes I did.
Or, if you're're not happy,tell me, I can find you
somewhere else.
I have a couple of them still.
Text me, probably like once amonth, going Kayla, are you
going to open back up again?
I don't think so, and they'relike please, and I'm like no,
some of them are like.
You taught me that like I cansay no, you taught me how to
(17:12):
have my schedule supervisionaspect, because all of these
horrible supervisors, we justneed to do better.
Patrick Casale, MA, LCMHC (17:19):
We do , we do.
It is good to hear that thereare people out there trying to
actively do better.
I hear that from a lot of grouppractice centers that I come in
contact with and I'm like weget like 100 applications a
month.
We are not hurting forreferrals or for employees and I
think if you treat people likepeople and prioritize people
over profit, then we're weirdly,you can create employee
(17:42):
retention and culture thatactually works really well and
I've given a lot of trainingsand workshops on like that exact
process.
There are different ways to dothis stuff.
For me, I am fortunate because,like all things, private
practice does generate revenue,so I can make less money in my
group practice.
Not everyone has that luxury orprivilege.
But like it is also aboutrealizing how do we set people
(18:04):
up for success?
Because satisfied, happyemployees are going to last
longer and be a part of yourorganization for longer periods
of time, which ultimately costsless over time because you're
not constantly training andonboarding.
Kayla Schubert Wirth MSW, (18:18):
Then you have clients who are
getting better.
They are then noticing, andthen getting referrals from
clients is like one of thegreatest things to hear is like
oh, so-and-so sent me hereExactly In the long run.
It makes clients and therapistsbe able to sustain this long
term and not feel like they needto job hunt or have a resume
that's eight pages long.
(18:38):
What do you suggest?
New therapists, someoneinterviewing for grad school,
for internship in privatepractice I feel like these are
more and more common now tointerning in private practice or
someone who's in like communitymental health coming into
private practice.
What do you think are somethings like they should ask?
Patrick Casale, MA, LCMHC (18:54):
I think they should definitely ask
about the culture, the employeeretention, like I would want to
do a deep dive on the websiteto see what the values of the
practice are and really askabout the values of the practice
, because we often use certainwords as like, if we say we're
an anti-racist practice, whatare we doing to maintain and
ensure that we are ananti-racist practice?
If we want to specialize in theneurodivergent community, what
(19:15):
are we doing to ensure that weare doing so?
I would want to flip theinterview a little bit and you
should be asking a lot ofquestions as well, because so
often when we're in thosepositions, we feel unbelievably
grateful just to have anopportunity and we're almost
like we have to just say yesbecause I need to do an
internship, a job, right out ofschool.
So I think, having your ownquestions that you really want
(19:37):
answered, I would want to knowwhat you do to create and
maintain culture.
I would want to know how theleadership is structured and how
they communicate For us,because we want to be as
neuro-inclusive as possible, Ireally want our clinicians to
communicate in whichever waythey feel most comfortable, so I
have done one-on-one check-inswith people via text, video call
with the video off meeting themwhere they're at, and I think
(19:59):
that's super important.
I have interviewed people andhired people without ever
actually speaking to them beforeand just communicating via
email.
So, like I would really want toknow, can this practice create
accommodations that I need in mylife to be successful?
How are you going to help me?
Kayla Schubert Wirth MSW, (20:15):
grow and develop over time.
And that just goes back to whatwe said.
So many practices don't want tosee you grow and develop and
they want to teach you like keepyou up.
Yeah, exactly, and you know.
Patrick Casale, MA, LCMHC (20:23):
One thing I also ask is like where
do you see yourself in fiveyears?
I don't know how to answer thatquestion myself.
I myself have done a lot overthe last four or five years in
this profession, whether it bepodcasts or retreats and summits
or coaching programs.
I just did a TEDx and got a bookdeal, like there are so many
things that we can do and I wantto know if I can help you move
towards those goals.
(20:43):
So a lot of my clinicians willsay I really want to run
coaching programs, I really wantto do more speaking, et cetera.
I have definitely hired some ofmy therapists to come and do
some of those talks or giventhem spots in those events
because it aligns with theirgoals.
Your employers should really beinvested in your future and I
think far too often employersare afraid to do that because
(21:05):
the mindset is like if I do that, people are just going to leave
.
But in reality, so many of mystaff have been with us for over
three years and they're like Idon't want to leave and start my
own practice, I just want to dosome other things.
So having the safety net ofhere's, this practice that feels
consistent and reliable andsupportive, it allows me to grow
.
Outside of that, they'reprobably going to stay.
Kayla Schubert Wirth MS (21:26):
They're going to stay and they're going
to tell their friends on howamazing it is to work here.
And now you've got anothercouple of rounds of applications
coming through the door again.
Patrick Casale, MA, LCMHC (21:33):
Yeah, for sure.
Kayla Schubert Wirth MSW, (21:35):
It's amazing how that just that
cycle works.
Patrick Casale, MA, LCMHC (21:39):
We can sit here and have all of
these conversations right onthis podcast on so many
platforms of shitty jobs, shittyenvironments, shitty support,
shitty leadership.
But it doesn't have to be thatway and I just think that if we
are willing as leaders, toreally be accountable and
transparent and anchor into thevalues that we have, I think it
makes a world of difference.
(21:59):
Like I am not the type ofperson that says you need to go
iron your stripes and like pullyourself up by your boots and
then burn yourself out incommunity mental health before
you can start a practice likethat should not be what we are
encouraging people to do.
Kayla Schubert Wirth MSW, L (22:12):
And I know when I hired a couple
like fresh out of grad school inPennsylvania we call them like
licensed social workers orthey're not clinically licensed
yet and I was like, no, don't dowhat I did.
That made you want to likeleave the field and go work at
the man's store and sell fuckingshoes Like here's a different
way.
Patrick Casale, MA, LCMHC (22:30):
Yeah.
Kayla Schubert Wirth MSW, L (22:31):
And I think that's the thing.
There's so many different waysand I live in a really small
community in Pennsylvania andI'm like this isn't just this
area, this is fucking everywhere.
Patrick Casale, MA, LCMH (22:41):
People , yep, yeah, it is good for you
for wanting to offer a different, you know landing spot and
there is some validity to likeOK, community mental health does
offer a very diverse experience.
Right, you're going to workwith everyone and anyone and
that's fine.
However, people will alwaysdefault to like well, you need
to get really good supervisionbefore you can go out into
(23:02):
private practice.
The supervision I had incommunity mental health was
non-existent.
I went through almost threeyears in that job without ever
doing supervision.
So when I left I had to likemake up so many hours because we
didn't have hours to sign offon.
I sat in on some of thosesupervision.
It'd be like 35 people in aroom just venting and
complaining for an hour,including the supervisor.
(23:24):
So then seeking externalsupervision with someone else
who was doing groups of two,groups of three individual.
Oh, this is what supervision is, when you actually get to have
support and can staff cases in ahealthy way.
Kayla Schubert Wirth MSW, L (23:38):
And I hear I see a couple of
therapists who are, who are incommunity mental health and
sometimes in therapy.
They're just just like I have asupervision question, kayla,
and I'm like is this helpful foryou right now?
Like I just they're like I needhelp, I don't know where to go,
and I'll be like okay, and I'llsay to them and they'll just be
like I'm like what's that?
Whoa, because that's not whatI'm told.
I'm told this or I'm told thatand I'm like, right, let's step
(24:01):
back, like myles's' hierarchy ofneeds.
How do we look at this from atrauma-informed lens?
I'm like you guys don't talkabout this.
I'm like we're told like why isour no-show rate at 45%?
I'm like because you're incommunity mental health, in a
fucking ring for three months,no one's coming Right, and I
think it's just it's soinfuriating.
I know some people.
I've seen people charge like$30, $50, $60.
(24:27):
And I've seen people chargelike $300 for clinical
supervision to get licensed.
I'm like that is just, that'sinsane.
Patrick Casale, MA, LCMHC (24:36):
Like how can?
Someone making $30,000, $40,000a year afford $300 a week 100%
and you know oftentimes you haveto do that supervision for
several years to get those hours, so that can definitely be a
barrier to licensure andaccessibility.
I have this goal, you know.
I've talked about it publiclyon my podcast and elsewhere
before.
But I'm a big Anthony Bourdainfan, as people can probably see
(24:58):
from behind me, and all over myoffice.
Really I want to write a booksimilar to his kitchen
confidential, called liketherapy confidential, and it
would be about the dark side ofbeing in the mental health
profession and industry.
And yeah, I just have a fear itwould ostracize me from the
profession, but I also don'treally give a fuck about that
anymore.
Kayla Schubert Wirth MSW, LCS (25:17):
I feel like it would be amazing
and he does like a stand up nowand he literally has like huge
things sold out of him doinglike these skits and comedy, is
it?
Patrick Casale, MA, (25:25):
potentially Sam Silverman.
He was on my other podcast andhe's a stand-up comedian.
He's a psychiatrist who has OCDand tells all these ridiculous
stories and it's justoutrageously hilarious.
Kayla Schubert Wirth MS (25:36):
Imagine doing like a show where
therapists come up and tellthese stories and they are.
Some of them are literallyhilarious.
Patrick Casale, MA, LCMHC (25:41):
Yeah.
Kayla Schubert Wirth MSW, (25:42):
Like and stepping back and be like.
Patrick Casale, MA, LCMHC (25:46):
I just did that.
I can still remember back inthe day.
This was not a therapy job, itwas just a case management job
Used to work with the unhousedpopulation here in Western North
Carolina.
Our goal was to, like endhomelessness in Appalachia and
we would move people intopermanent supportive housing.
So much of public housing hadbedbugs all the time and my
coworker and I would getpainter's suits from Home Depot
(26:07):
and have to go into people'sapartments and throw out all of
the furniture and then we wouldrun back to our car, take these
painter's suits off, put themall in a trash bag, put our
clothes back on and go home andimmediately wash your clothes.
So you did not also get bedbugsand that was like four years of
my life.
Kayla Schubert Wirth MSW, LCS (26:24):
I used to do in-home family
therapy so not like family-based, like I was by myself in homes
and the animals you know lovedme, right.
I would have these pit bullssitting on my lap during in-home
family therapy.
Or the massive cat which I'mdefinitely allergic to being
like can you please take the catoff my lap, and they would just
come down like so yeah, fuckingwild.
I mean.
I also remember, like I said, Iwas trying to leave the field,
(26:45):
like I was burnout.
I literally applied to like thevan store.
I would tell people like oh, Ithink I maybe just want to go
into the business world, like Idon't think you're made out for
it.
If I can assess for activesuicide, not cry and do this,
this and this, I think I canwork in any industry.
Patrick Casale, MA, LCMHC (27:07):
And they would just like look to
realize and recognize that thisis not a one size fits all
career path and our skills areapplicable in so many different
ways and arenas.
I mean, when I graduated mymaster's in 2015, I didn't think
some of the stuff I've createdor accomplished over the last
four or five years was even apossibility.
There's lots of hope out there.
Kayla Schubert Wirth MS (27:28):
Awesome .
Thank you so much, Patrick, forbeing on.
I appreciate you talking.
Patrick Casale, MA, LCMHC (27:32):
Yeah, you're welcome.
Thank you so much for having me.
Kayla Schubert Wirth MSW, LC (27:34):
If you ever thought maybe I'm the
problem, let this be yourreminder You're probably not.
Patrick's story is proof thatyou don't have to shrink
yourself to fit the brokensystems.
You can burn it down, rebuildfrom scratch and still do work
that's powerful, ethical anddeeply needed.
This field wasn't built for theoutliers, but we're not waiting
for permission anymore.
We're building something better.
(27:55):
Thanks for listening to Burnoutand Bullshit.
If this hit home, send it to atherapist friend, who's one more
unethical supervision away fromflipping a desk.
And if you're ready to build apractice that actually fits,
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