Abundance Party member Laura, a therapist navigating growth challenges and insurance acceptance in her practice, joins me to seek guidance on making strategic decisions for her business. We explore the complexities of insurance credentialing, marketing strategies, and ways to streamline paperwork and client outreach. Our conversation also includes a discussion about Laura’s pricing strategy, where we consider rate adjustments and reflect on the importance of self-care and maintaining professional clarity as she continues to grow her practice.
July 23, 2025 • 26 mins
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:08):
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) Hi, welcome to the Abundance Practice Podcast.
I'm Allison from Abundance Practice Building.
I have a nearly diagnosable obsession with helping
therapists build sustainable, joy-filled private practices, just
like I've done for tens of thousands of
therapists across the world.
I'm excited to help you too.
If you want to fill your practice with
ideal clients, we have loads of free resources
(00:29):
and paid support.
Go to abundancepracticebuilding.com slash links.
All right, on to the show.
So I've talked about therapy notes on here
for years.
I could talk about the features and the
benefits in my sleep, but there are a
couple of things I want you to know
about therapy notes that doesn't typically make it
into an ad script.
First is that they actually care if you
(00:50):
like their platform.
They don't only make themselves available on the
phone to troubleshoot so you don't pull your
hair out when you get stuck.
They also take member suggestions and implement those
that there's client demand for, like therapy search,
an included listing service that helps clients find
you, internal and external secure messaging, clinical outcome
measures to keep an eye on how your
clients are progressing, a super smooth super bill
(01:12):
process, real-time eligibility to check on your
client's insurance.
In my conversations with the employees there at
all levels, they all really believe in their
product and they want you to love it
too.
Second, they are proudly independently owned.
Why should you care about that?
Because as soon as venture capital becomes involved,
the focus shifts from making customers happy to
(01:33):
making investors happy.
Prices go way up, innovation plateaus, making more
money with as little output as possible becomes
the number one focus.
With over a hundred thousand therapists using their
platform, they've been able to stay incredibly successful
and they don't have to sacrifice your experience
to stay there.
You can try two months free at therapynotes
(01:53):
.com with the coupon code abundant.
Hey Laura, how you doing?
I'm good.
How are you?
I'm good.
I'm good.
What would be helpful today?
All right.
So I feel like if you don't mind,
I'm going to start talking about like a
little bit about my practice and how it
started and kind of where it is now
and like kind of the pathway that I'm
(02:14):
seeing for myself.
Yeah.
So I started this practice like maybe eight
years ago while I was working at an
agency.
And since then, I don't know if you
heard about like the pandemic happened, you know?
Oh yeah.
I heard about that.
Yeah.
Then I also had two kids and so
I kind of eased off the throttle a
little bit with all that.
And luckily my partner makes enough for us
(02:36):
to be comfortable.
Like we're fine.
We're content.
Like we're not like crazy, but like, you
know, we're comfortable.
We're fine.
So that kind of allowed me the flexibility
while the kids are young to be home
with them as much as possible.
Another good part about that is I hate
networking and marketing.
I would rather die.
Okay.
So it's kind of nice.
It's like, it's just like word of mouth
(02:56):
and you know, people who know me are
like, you know, that kind of referrals have
been coming in.
I'm just not good at it.
I don't like it.
But as a result of completely my own
doing, my practice is slow.
I don't take insurance.
I never have, but I've never really thought
about it until now.
I live in Maryland.
(03:18):
So right now things in this area feel
very unstable.
And with my partner's job, we don't really
know what's going to happen.
Right.
And so, whereas this is a very new
thing for us.
And so we've been talking about what's our
next plan.
If something were to happen, we need to
have a plan in place.
And that plan would be me taking insurance.
(03:40):
Okay.
And I just feel like a failure if
I take insurance.
It feels like I've, I didn't make it.
Like I just didn't cut it.
Right.
Like I wasn't enough on my own, but
really you have to like do the work
and I didn't do it because I don't
like it.
Right.
(04:00):
And another piece that's kind of important in
this is I have a really good relationship
with a psych nurse practitioner.
And she was like, Laura, if you take
insurance, I can fill your caseload tomorrow with
people that you want to see.
And then I've already vetted and they would
be a good fit for you.
Okay.
And so it seems like a good deal,
(04:20):
but I don't know that I I'm having
a hard time working past this idea that
insurance means failure.
Okay.
So here's what I want to introduce is
the idea of you're not failing.
You're making an active choice period.
The choices, do you want to network and
market, or do you want to take insurance?
(04:41):
And you sound so clear.
Yeah.
I don't want to do it.
So Laura, that's honoring what you want and
need in your life.
Okay.
Not taking insurance and networking and marketing when
you don't want to that's chasing somebody else's
goals and dreams and wants for themselves.
And you don't want to do that.
Yeah.
(05:02):
I'm just not good at like, if that's
my skillset, like I, that's just not me.
And I also feel like since my practice
has been slower, I don't know if this
is actually true.
I don't think it's actually true, but my
mind is saying, well, you haven't had any
like really tough cases.
Like maybe your skills aren't what they were.
So how can you go around and being
like, I can solve all your problems and
here's what I'm so good at.
Even though I know my skills, I know
(05:23):
I'm good at what I do, but like,
there's like blockage that's like, oh, you've been
taking it easy.
Well, I think there's also like, I was
having a conversation with a good friend not
long ago, who was like, I've been doing
it long enough.
Therapy's easy.
She's like, I'm, it's easy for me to
attend to my clients.
It doesn't take the same kind of work
it used to, to be present, to be
(05:45):
mindful, to conceptualize.
Like it's a muscle that I flex so
much that it feels easy.
And like, maybe you're there.
Yeah.
Maybe that's what it is.
I'm just not used to it being like,
oh yeah, I can do that.
Cause like, that's, that's a good point that
it doesn't feel the same as when I
started 10 years ago.
Cause it's not right.
And it may be that you have easier
(06:05):
clients now than you had back then.
It could be like a combo, but that
doesn't mean you need to start taking on
really hard clients.
Right.
Just because you take insurance doesn't mean you're
going to take on a bunch of hard
clients.
It's okay to stick with the ones that
feel like smooth and easy.
I think there's this like therapist martyrdom thing
that happens, right.
Where we feel like we're supposed to, because
(06:27):
we work with struggle, we feel like we
too have to struggle.
And I think that our clients are best
served when we're not struggling so hard in
our business or our lives.
Like it's inevitable that that will happen sometimes,
but we don't need to manufacture it, you
know, create these problems for myself.
Right.
(06:47):
It sounds like taking marketing and networking creates
that struggle for you.
Whereas having somebody already vetting the clients ready
to hand them to you, somebody that you
trust and like, and know, I mean, that's
a pretty sweet deal.
Right.
Am I okay.
I'm not like overly missing something.
I'm not, I mean, I think the only
(07:09):
thing that I'm speaking to that I would
probably need to know to say everything I'm
saying most accurately is like, if the insurance
company has a pain in the ass, or
they don't pay much and probably they pay
less than your full fee, but like, is
it a reasonable amount?
Is this something you can live comfortably on?
Yeah, that's.
And I think since I haven't ever taken
(07:29):
insurance and obviously when I was at an
agency forever ago, I never had to deal
with any of that.
I think I'm so afraid of breaking a
rule.
Like I met with a company called Alma.
Have you heard of them?
So I met with them and they gave
me their rates, but I'm a little leery
of signing on with a big company like
that.
Cause I use therapy notes and my own
(07:50):
therapist uses therapy notes and she takes insurance
and she was like, it's the easiest thing
in the world.
Yeah.
I just click a couple buttons.
Yeah.
And so I, I need to look into
if I can fill out that whole, like,
is it the CAQH thing?
See if I can find out what my
rates would be as a solo.
I don't know if that's allowed because they've
already been given rates through Alma and what
(08:12):
they could pay me.
So I need to look into if that's
okay that I can kind of contrast and
compare, but it seems like that would be
fine.
Well, a lot of the insurance companies won't
tell you what you're going to be paid
until you've already signed a contract to work
with them.
And therapists are not supposed to disclose to
one another what they get paid, but they
do all the time.
So I would find a therapist in your
(08:33):
zip code who has the same degree you
do the same license you do and just
who takes it and ask them, isn't that
like not okay that we're just expected to
just like sign on and be like, Oh,
a dollar an hour.
Cool.
Yeah.
It's ridiculous.
It's like, they'll say it in the contract,
but it's like an equation that doesn't like,
(08:54):
nobody knows how to do.
You can probably like enter it in a
chat GBT these days or something.
But I remember getting my contract the million
years ago when I was, I didn't really
know what I was doing.
And I was like, Oh yeah, sure.
I don't know what this is going to
equal when it's like whatever Medicaid pays times
this thing or plus this thing that, but
(09:16):
it was not just straight, a straight up
number, but a person in your zip code
with the same license as you will be
able to tell you.
Okay.
So yeah, that seems obnoxious.
And all there are things like that with
insurance that are obnoxious and that's another part
of what you're signing up for.
So in terms of breaking rules, I would
(09:37):
make sure that you keep your notes done,
like buttoned up medical necessities and everyone like
you're hitting the main points that insurance wants
to see if, and when they audit you.
So they don't pull callbacks and we talk
about callbacks a lot.
I hear about callbacks a fair amount.
But when you think about the, I mean,
(09:57):
I work with tens of thousands of therapists
and it's only like a few that I
hear from every year that got called back,
you know, like maybe 20.
So that's not awful percentage wise.
I think they are happening more often.
So I would just get really clear.
The insurance is going to be very opaque
(10:18):
when you're like, what do you need in
your notes?
They're not going to tell you, but medical
necessities in there.
And there are some like paperwork experts who
can kind of walk you through.
It's just, it feels all so overwhelming.
And that's why it's always just been easier
not to.
And to be honest, if my husband's job
wasn't the way that it is right now,
(10:38):
I probably wouldn't be having this conversation, right?
Like it just wouldn't, I would just keep
doing what I've been doing and everything has
been fine.
But I'm wondering now, as I'm talking to
you, if this really should be just a
plan B in case anything happens.
It can be a plan B, but it
might take about three months to get credentialed.
That would be fine.
(10:59):
We can, we can make that work.
Okay.
Not ideal, but it's, that would be okay.
Do you have strong thoughts about big companies
like Alma?
Because for some reason I'm very cautious about
signing out with them.
Yeah.
I feel like all those big companies do
not have our best interest at heart.
It's so interesting.
I just was talking literally the 30 minutes
(11:21):
slot before yours.
Um, we were talking about Alma hasn't sent
this person to anybody since January and she's
paying the $125 a month or whatever.
And it's like stressful.
Um, but I really don't believe any of
these companies have our best interest at heart
or our client's best interest at heart.
I mean, I don't think insurance does either,
but to have two companies that don't have
(11:41):
anybody's best interest at heart working against us
actively, there's all this interesting stuff about how
some of them are being bought or partially
bought by insurance companies.
And so what happens is these insurance companies
will be like, yeah, yeah, because we own
part of this company.
We will pay you more per session than
(12:01):
people that are credentialed with us in other
ways.
And it gives them this loophole because insurance
has to basically a certain amount of their
money that insurance companies make has to go
towards medical costs.
And so they can buy these companies, which
is going towards a medical cost and then
they can pay more.
(12:22):
So it's kind of like this weird, mean,
bad loophole instead of them just like fucking
taking care of people.
Cool.
Like, can you, can we just all be
cool?
I'll be normal.
Yeah.
Be insane.
Yeah.
So I don't like these middleman companies and
I know some of them have like reduced
rates on people kind of seemingly out of
(12:44):
nowhere.
And so it just feels, it just feels
less stable to me.
Yeah.
Something was just kind of holding you back
though.
I was like, I just don't know.
Like, and part of it honestly was just,
I had to switch.
I went from simple practice to therapy notes.
Now I have to use their stuff.
Like, Oh, well you don't have to, but
everything's on there.
And I'm like, then why am I paying
both therapy notes and Alma for any HR?
(13:05):
It doesn't make sense.
Yeah.
But then I was talking to that nurse
practitioner and she was like, I mean, good
luck.
Like taking insurance.
Like we've tried and it's been awful, but
also they're a huge practice and they were
doing like primary care, like not mental health
stuff, everything.
And she was like, Oh gosh, it was
just a nightmare.
That's way different than what I would be
(13:25):
doing on my own.
Yeah.
The insurance side, like in terms of filing
and all that with something like therapy notes,
it's super easy.
Really?
Like you just click buttons and I can
do that.
Yeah.
You can click buttons.
So that, that part's a lot less intimidating,
but what I might do is I might
suggest you get like all your CAQH stuff
(13:46):
in to see a QH and just let
it sit there.
Okay.
So that if you do need to like
go for it, you can just click the
button and it's not like, Oh no, I
need to gather this stuff.
And now instead of three months, it's taking
me like three and a half months because
I had to gather stuff for two weeks.
So just having that like plan B ready
to go.
I didn't realize I could do that.
(14:06):
And then not immediately sign on.
I believe so.
I think you can like save like your
info.
Perfect.
Yeah.
I got like halfway through it with Alma
and then I was so mad that I
just stopped.
So I was like, I, this is why
I didn't want to do this.
I hate doing it.
It's a lot of bureaucracy.
You could also consider hiring somebody to do
it.
There are people out there who will get
(14:27):
you credentialed.
Ultimately you're kind of doing the same thing
because you're still going to have to get
them a bunch of information to get it
all.
Yeah.
Yeah.
So it's kind of like hiring somebody to
do your billing when all you have to
do is push two buttons.
Okay.
See, I like the reframe of like, this
is just a choice that I'm making for
(14:49):
my own sanity.
Cause I genuinely don't like marketing.
And I know there's some like inner work
that I need to be doing and have
been doing in my own therapy of like,
why do you hate this?
It's cause you hate putting yourself out there
and saying like, Hey, I'm good at this
and you should hire me, which is apparently
a really uncomfortable thing to do.
And it's also hard when you do send
out emails and you don't hear anything back.
(15:10):
And it's like, do I just keep pestering
these people?
Do I just keep like doing the same
thing?
I can't go.
I just can't like go up to my
local high school and be like, Hey, I
want to meet with a counselor.
Like, I can't, I can't do that.
Yeah.
So, I mean, I think, yeah, working on
the fear of being seen in therapy and
the like owning that you're good at something
and all of that.
(15:31):
And not only are you good, it's easy
now.
No, that's great.
Working on that is great.
And I would work on that just for
the sake of working on it.
Not necessarily to get to a point where
you're like, yeah, I want to have my
own YouTube show.
You know, like if you decide to go
that route later, but I would keep that
maybe divorced from how you actually run your
(15:52):
practice.
If, if it's a heavy lift, you know,
like I want you to just be able
to work on being seen without your income,
depending on it.
Yeah.
I'm sure that would be very, and yeah,
I'm doing that within my own personal life.
And I, yeah, we can start kind of
transitioning into like all aspects of life.
I'm like, it's okay to know what you
want and know what you're good at.
And I remember um, one of my supervisors
(16:15):
in grad school was like, you need to
know what you're good at.
This is okay.
It's not bragging.
And I was like, oh, that's like, yeah.
How else are you going to do this
job?
It's like, I don't know.
I just thought I'd just show up and
do whatever job I did and hope it's
good.
Yeah.
Fingers crossed.
(16:35):
Okay.
Okay.
Yeah.
You're making an active, educated choice about what
works best for your life and your family.
And I also can't feel pressure to make
a decision because someone else has clients that
need to be served.
I think that's another piece of it too.
I feel bad.
Like there's people that want to be seen.
And if I don't take insurance and I
can't see them, but that's a choice I
(16:57):
need to make for myself and for my
family and how we're running right now.
Yeah.
Because there are lots of people with schizophrenia
that you could see right now, but I
don't think that's your niche.
You know, like there are lots of people
who, um, are not interested in being in
therapy, but need it.
And they're not your people either.
And so it's like, if we start to
(17:18):
put pressure on ourselves of like, we have
to take care of people, then when you
start expanding it to, you have to take
care of all people.
You start realizing how like ultimately ridiculous it
is.
Right.
You need to take care of the people
that it works for you to take care
of.
When I was thinking about my ideal client,
because I've worked through some of this stuff
in abundance and like trying to pinpoint it.
(17:41):
Is it normal to feel like, this is
going to sound so silly.
My ideal client is who I was five
to 10 years ago.
I feel like it would keep shifting.
And I like keep getting like, before I
loved working with teens and like more young
adults.
Now it's more like newer moms.
I'm like, I feel like it's just who
I was a little bit.
It almost always is.
I would say like probably like 90 something
(18:01):
percent of the time, our niches, like a
younger version of us.
And yeah, I used to love working with
college students and it was like, Oh, they're
just it, you know?
And then I got older and I was
like, Oh God, I'm tired.
I don't know what you're, I don't know
the words you're using.
Can you do the translation please?
Yeah.
And it's okay that that shifts, you know,
(18:24):
and now my whole entire niche, not just
the demographic, but my entire niche has shifted.
And that's great.
You know, I wasn't sure if it was
something that should be like set in stone
and like focused on.
And that's what other people did was like,
this is who I work with.
And like, that's that.
Yeah.
I mean, I think ultimately yes, for an
extended period of time, but not forever.
(18:45):
Okay.
And you will get people who are not
your ideal clients, but are very similar to
them in different ways, you know?
So like my eating disorder clients that I
love, I ended up getting a bunch of
people in my caseload who are business owner
perspective, perfectionist driven types.
There's a lot of overlap in like the
compulsion, but they didn't have any food and
(19:07):
body stuff.
They were just trying to make shit work
with their businesses.
And so whatever, even though my whole website
is like eating disorders, eating disorders, you know,
and that's just, they were attracted to the
other pieces of what I was saying.
Okay.
It's funny when like, you know, something like,
I know that to be true, but hearing
(19:28):
someone like reassure that it's very helpful.
Yeah.
Yeah.
Because I feel like when I do, and
I know this is true.
Like when I was working through it, I'm
like, it's okay if it's not like other
people will come, like they will still resonate
with what you're saying.
Yeah.
I just feel like this was the first
school, this past school year was the first
one where both of my kids were in
(19:49):
school.
Most of the time, not all day, the
most I've ever, the most freedom I've ever
had.
And so I was like, just like, take
a year and just like, see what you
want to do.
Like it's okay to just take some time
and like get yourself figured out.
And then now that the summer is coming,
I'm like, Oh, I should have gotten a
lot more figured out.
Yeah.
(20:10):
I mean, you probably needed the rest that
you got and you can't like, what I
am learning as I get older is you
can't force the knowing of anything.
You could have sat there and meditated every
day and like journaled every day and you
wouldn't be any closer to knowing what you
want than you do right now.
Like if you're leaving space for it, even
(20:33):
if it's not hours and hours, it'll show
up, you know, as long as you're questioning.
Yeah.
So now maybe next school year is where
things will shift.
Like I said, like, we just don't know
what's going to happen.
And so I think at least having a
game plan of like, it's okay to take
insurance, maybe not with a big company.
(20:53):
If there's something like there's something within me,
that's like, I don't think I want to
work with them.
Even if it means taking less money through
a direct insurance company, I don't think that
it's worth it enough.
But yeah, I'm not a failure.
If I take insurance, that'll be not at
all.
No, just like you don't think anybody else
is a failure if they take insurance, you
know?
(21:14):
Yeah.
These like crazy double standards that we put
on ourselves.
Like it's okay for you to take a
break.
No, you take a nap.
If I take a nap, I'm disgusting.
I'm the worst.
Like, right.
Yeah.
That's helpful.
Good.
I'm glad.
I'm glad.
Yeah.
Just these money messages can be confusing and
I'm glad people are starting to talk more
(21:35):
about money, but it's a very like viscerally
uncomfortable situation sometimes, right?
Especially when we're being told we can't talk
about it.
Right.
I know.
It's so, yeah, it's ridiculous.
It's ridiculous.
And I think just in general, the way
we talk about money as therapists with each
other, but also with our clients, like the
(21:57):
number of questions and things like that, I
would ask clients earlier on around like sex
that I'm so much more comfortable asking them
those questions.
Then like, how do you feel about your
financial situation?
You know, where do you feel shame around
money?
You know, like those kinds of things I
didn't bring up because I hadn't done any
of that work myself.
(22:19):
And so there's such opportunity for us therapists
to like do that work and to be
able to like take care of this whole
entire side of our client's lives that is
such an important part of their wellbeing.
We just like, don't touch with a 10
foot pole.
In eight years, I've successfully raised my rates
one time by $10.
(22:40):
I've raised them again recently.
I was like, this is a ridiculously low
rate.
Like you've got to stop.
But now anytime someone reaches out, I'm like,
oh, it's this, but I can also do
this if that's fine.
Whatever you want is fine.
I mean, Laura, I'd start there because it
could be, you could have a really small
practice at a premium rate and take care
of your family.
Even if you just took people on, like
(23:01):
only the new people were at a higher
rate.
I mean, in Maryland, you know, like if
you're anywhere near DC, then, you know, 250
is not unheard of.
I charged 125 and I just raise it
to 155, but no one is at that
155 because it's me.
Cause I'm like, oh, 125 is fine.
Don't worry about it.
(23:22):
It's fine.
It's fine.
Yeah.
And how, like what an interesting experience it
would be if every time somebody new called
and you change it on your website, but
every time somebody new called, you said like
sessions are $200 and you shut up.
There's the key piece.
I think I just go back to, but
(23:43):
I, I don't know that I could afford
$200.
So like, how dare I ask someone else
to do that?
Laura, you just told me that your husband
can float you guys financially.
You can afford $200.
It might not be your priority.
Yeah.
Yeah, we could.
Okay.
That's fair.
(24:04):
I mean, honestly, I've been doing this a
long time.
Yeah.
I also, there's concern about like raising new
people.
Cause it's like, do I want to remind
you that you pay me every week?
Like we talk about like me raising rates
and then you remember that.
Cause right now, like the card just gets
charged and we don't ever talk about it.
(24:25):
But what if we talk about it?
Yeah.
What if you do?
What if you do?
So scary.
Cause they know they're getting charged.
You know, they're not in fantasy land.
They probably don't even remember how much it
is unless they're people who are on top
of their bank accounts.
And they are like, you know, looking at
their budgeting, which most Americans don't do.
(24:45):
I tried.
And by the end of the week, I
was like, no, this is awful.
I can't, can't do it.
Yeah.
What if I just charge more?
Yeah, let me do that.
And if you start with new people that
you don't even know, it's easier for new
people than established people.
And if you make it 200.
(25:07):
And then I stopped talking and then you
stopped talking.
Yeah.
Yeah.
That would definitely make us more comfortable.
Cause I would say my income helps, but
like, it's not enough to really do anything.
Yeah.
And then I shut up.
I'm going to run right down 200 and
(25:29):
shut up.
Mm-hmm.
Might be able to do that.
Okay.
I'm going to have to practice in therapy.
Like we're going to practice phone calls.
I love it.
I love it.
And then you've got the backup plan of
insurance.
Yeah.
Like should you need it?
It's always there.
This was good.
Thank you so much.
I don't know why I didn't think of
(25:50):
like, just asking people to pay me more
because I can charge more.
Cause I've done this a long time and
I might be okay at it.
Yeah.
And can we just make that language a
little stronger, please?
I'll work on it.
No guarantee today.
I have therapy tomorrow, so we will work.
There we go.
Love it.
Love it.
So maybe this is a good like refresh
(26:11):
to like, look at the website again.
We can, we can do this.
Yeah, absolutely.
Awesome.
This was very helpful.
I'm so glad.
I'm so glad.
Awesome.
I'll talk to you later.
Thank you.
Bye.
Bye.
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) Hi, welcome to the Abundance Practice Podcast.
I'm Allison from Abundance Practice Building.
I have a nearly diagnosable obsession with helping
therapists build sustainable, joy-filled private practices, just
like I've done for tens of thousands of
therapists across the world.
I'm excited to help you too.
If you want to fill your practice with
ideal clients, we have loads of free resources
(00:29):
and paid support.
Go to abundancepracticebuilding.com slash links.
All right, on to the show.
So I've talked about therapy notes on here
for years.
I could talk about the features and the
benefits in my sleep, but there are a
couple of things I want you to know
about therapy notes that doesn't typically make it
into an ad script.
First is that they actually care if you
(00:50):
like their platform.
They don't only make themselves available on the
phone to troubleshoot so you don't pull your
hair out when you get stuck.
They also take member suggestions and implement those
that there's client demand for, like therapy search,
an included listing service that helps clients find
you, internal and external secure messaging, clinical outcome
measures to keep an eye on how your
clients are progressing, a super smooth super bill
(01:12):
process, real-time eligibility to check on your
client's insurance.
In my conversations with the employees there at
all levels, they all really believe in their
product and they want you to love it
too.
Second, they are proudly independently owned.
Why should you care about that?
Because as soon as venture capital becomes involved,
the focus shifts from making customers happy to
(01:33):
making investors happy.
Prices go way up, innovation plateaus, making more
money with as little output as possible becomes
the number one focus.
With over a hundred thousand therapists using their
platform, they've been able to stay incredibly successful
and they don't have to sacrifice your experience
to stay there.
You can try two months free at therapynotes
(01:53):
.com with the coupon code abundant.
Hey Laura, how you doing?
I'm good.
How are you?
I'm good.
I'm good.
What would be helpful today?
All right.
So I feel like if you don't mind,
I'm going to start talking about like a
little bit about my practice and how it
started and kind of where it is now
and like kind of the pathway that I'm
(02:14):
seeing for myself.
Yeah.
So I started this practice like maybe eight
years ago while I was working at an
agency.
And since then, I don't know if you
heard about like the pandemic happened, you know?
Oh yeah.
I heard about that.
Yeah.
Then I also had two kids and so
I kind of eased off the throttle a
little bit with all that.
And luckily my partner makes enough for us
(02:36):
to be comfortable.
Like we're fine.
We're content.
Like we're not like crazy, but like, you
know, we're comfortable.
We're fine.
So that kind of allowed me the flexibility
while the kids are young to be home
with them as much as possible.
Another good part about that is I hate
networking and marketing.
I would rather die.
Okay.
So it's kind of nice.
It's like, it's just like word of mouth
(02:56):
and you know, people who know me are
like, you know, that kind of referrals have
been coming in.
I'm just not good at it.
I don't like it.
But as a result of completely my own
doing, my practice is slow.
I don't take insurance.
I never have, but I've never really thought
about it until now.
I live in Maryland.
(03:18):
So right now things in this area feel
very unstable.
And with my partner's job, we don't really
know what's going to happen.
Right.
And so, whereas this is a very new
thing for us.
And so we've been talking about what's our
next plan.
If something were to happen, we need to
have a plan in place.
And that plan would be me taking insurance.
(03:40):
Okay.
And I just feel like a failure if
I take insurance.
It feels like I've, I didn't make it.
Like I just didn't cut it.
Right.
Like I wasn't enough on my own, but
really you have to like do the work
and I didn't do it because I don't
like it.
Right.
(04:00):
And another piece that's kind of important in
this is I have a really good relationship
with a psych nurse practitioner.
And she was like, Laura, if you take
insurance, I can fill your caseload tomorrow with
people that you want to see.
And then I've already vetted and they would
be a good fit for you.
Okay.
And so it seems like a good deal,
(04:20):
but I don't know that I I'm having
a hard time working past this idea that
insurance means failure.
Okay.
So here's what I want to introduce is
the idea of you're not failing.
You're making an active choice period.
The choices, do you want to network and
market, or do you want to take insurance?
(04:41):
And you sound so clear.
Yeah.
I don't want to do it.
So Laura, that's honoring what you want and
need in your life.
Okay.
Not taking insurance and networking and marketing when
you don't want to that's chasing somebody else's
goals and dreams and wants for themselves.
And you don't want to do that.
Yeah.
(05:02):
I'm just not good at like, if that's
my skillset, like I, that's just not me.
And I also feel like since my practice
has been slower, I don't know if this
is actually true.
I don't think it's actually true, but my
mind is saying, well, you haven't had any
like really tough cases.
Like maybe your skills aren't what they were.
So how can you go around and being
like, I can solve all your problems and
here's what I'm so good at.
Even though I know my skills, I know
(05:23):
I'm good at what I do, but like,
there's like blockage that's like, oh, you've been
taking it easy.
Well, I think there's also like, I was
having a conversation with a good friend not
long ago, who was like, I've been doing
it long enough.
Therapy's easy.
She's like, I'm, it's easy for me to
attend to my clients.
It doesn't take the same kind of work
it used to, to be present, to be
(05:45):
mindful, to conceptualize.
Like it's a muscle that I flex so
much that it feels easy.
And like, maybe you're there.
Yeah.
Maybe that's what it is.
I'm just not used to it being like,
oh yeah, I can do that.
Cause like, that's, that's a good point that
it doesn't feel the same as when I
started 10 years ago.
Cause it's not right.
And it may be that you have easier
(06:05):
clients now than you had back then.
It could be like a combo, but that
doesn't mean you need to start taking on
really hard clients.
Right.
Just because you take insurance doesn't mean you're
going to take on a bunch of hard
clients.
It's okay to stick with the ones that
feel like smooth and easy.
I think there's this like therapist martyrdom thing
that happens, right.
Where we feel like we're supposed to, because
(06:27):
we work with struggle, we feel like we
too have to struggle.
And I think that our clients are best
served when we're not struggling so hard in
our business or our lives.
Like it's inevitable that that will happen sometimes,
but we don't need to manufacture it, you
know, create these problems for myself.
Right.
(06:47):
It sounds like taking marketing and networking creates
that struggle for you.
Whereas having somebody already vetting the clients ready
to hand them to you, somebody that you
trust and like, and know, I mean, that's
a pretty sweet deal.
Right.
Am I okay.
I'm not like overly missing something.
I'm not, I mean, I think the only
(07:09):
thing that I'm speaking to that I would
probably need to know to say everything I'm
saying most accurately is like, if the insurance
company has a pain in the ass, or
they don't pay much and probably they pay
less than your full fee, but like, is
it a reasonable amount?
Is this something you can live comfortably on?
Yeah, that's.
And I think since I haven't ever taken
(07:29):
insurance and obviously when I was at an
agency forever ago, I never had to deal
with any of that.
I think I'm so afraid of breaking a
rule.
Like I met with a company called Alma.
Have you heard of them?
So I met with them and they gave
me their rates, but I'm a little leery
of signing on with a big company like
that.
Cause I use therapy notes and my own
(07:50):
therapist uses therapy notes and she takes insurance
and she was like, it's the easiest thing
in the world.
Yeah.
I just click a couple buttons.
Yeah.
And so I, I need to look into
if I can fill out that whole, like,
is it the CAQH thing?
See if I can find out what my
rates would be as a solo.
I don't know if that's allowed because they've
already been given rates through Alma and what
(08:12):
they could pay me.
So I need to look into if that's
okay that I can kind of contrast and
compare, but it seems like that would be
fine.
Well, a lot of the insurance companies won't
tell you what you're going to be paid
until you've already signed a contract to work
with them.
And therapists are not supposed to disclose to
one another what they get paid, but they
do all the time.
So I would find a therapist in your
(08:33):
zip code who has the same degree you
do the same license you do and just
who takes it and ask them, isn't that
like not okay that we're just expected to
just like sign on and be like, Oh,
a dollar an hour.
Cool.
Yeah.
It's ridiculous.
It's like, they'll say it in the contract,
but it's like an equation that doesn't like,
(08:54):
nobody knows how to do.
You can probably like enter it in a
chat GBT these days or something.
But I remember getting my contract the million
years ago when I was, I didn't really
know what I was doing.
And I was like, Oh yeah, sure.
I don't know what this is going to
equal when it's like whatever Medicaid pays times
this thing or plus this thing that, but
(09:16):
it was not just straight, a straight up
number, but a person in your zip code
with the same license as you will be
able to tell you.
Okay.
So yeah, that seems obnoxious.
And all there are things like that with
insurance that are obnoxious and that's another part
of what you're signing up for.
So in terms of breaking rules, I would
(09:37):
make sure that you keep your notes done,
like buttoned up medical necessities and everyone like
you're hitting the main points that insurance wants
to see if, and when they audit you.
So they don't pull callbacks and we talk
about callbacks a lot.
I hear about callbacks a fair amount.
But when you think about the, I mean,
(09:57):
I work with tens of thousands of therapists
and it's only like a few that I
hear from every year that got called back,
you know, like maybe 20.
So that's not awful percentage wise.
I think they are happening more often.
So I would just get really clear.
The insurance is going to be very opaque
(10:18):
when you're like, what do you need in
your notes?
They're not going to tell you, but medical
necessities in there.
And there are some like paperwork experts who
can kind of walk you through.
It's just, it feels all so overwhelming.
And that's why it's always just been easier
not to.
And to be honest, if my husband's job
wasn't the way that it is right now,
(10:38):
I probably wouldn't be having this conversation, right?
Like it just wouldn't, I would just keep
doing what I've been doing and everything has
been fine.
But I'm wondering now, as I'm talking to
you, if this really should be just a
plan B in case anything happens.
It can be a plan B, but it
might take about three months to get credentialed.
That would be fine.
(10:59):
We can, we can make that work.
Okay.
Not ideal, but it's, that would be okay.
Do you have strong thoughts about big companies
like Alma?
Because for some reason I'm very cautious about
signing out with them.
Yeah.
I feel like all those big companies do
not have our best interest at heart.
It's so interesting.
I just was talking literally the 30 minutes
(11:21):
slot before yours.
Um, we were talking about Alma hasn't sent
this person to anybody since January and she's
paying the $125 a month or whatever.
And it's like stressful.
Um, but I really don't believe any of
these companies have our best interest at heart
or our client's best interest at heart.
I mean, I don't think insurance does either,
but to have two companies that don't have
(11:41):
anybody's best interest at heart working against us
actively, there's all this interesting stuff about how
some of them are being bought or partially
bought by insurance companies.
And so what happens is these insurance companies
will be like, yeah, yeah, because we own
part of this company.
We will pay you more per session than
(12:01):
people that are credentialed with us in other
ways.
And it gives them this loophole because insurance
has to basically a certain amount of their
money that insurance companies make has to go
towards medical costs.
And so they can buy these companies, which
is going towards a medical cost and then
they can pay more.
(12:22):
So it's kind of like this weird, mean,
bad loophole instead of them just like fucking
taking care of people.
Cool.
Like, can you, can we just all be
cool?
I'll be normal.
Yeah.
Be insane.
Yeah.
So I don't like these middleman companies and
I know some of them have like reduced
rates on people kind of seemingly out of
(12:44):
nowhere.
And so it just feels, it just feels
less stable to me.
Yeah.
Something was just kind of holding you back
though.
I was like, I just don't know.
Like, and part of it honestly was just,
I had to switch.
I went from simple practice to therapy notes.
Now I have to use their stuff.
Like, Oh, well you don't have to, but
everything's on there.
And I'm like, then why am I paying
both therapy notes and Alma for any HR?
(13:05):
It doesn't make sense.
Yeah.
But then I was talking to that nurse
practitioner and she was like, I mean, good
luck.
Like taking insurance.
Like we've tried and it's been awful, but
also they're a huge practice and they were
doing like primary care, like not mental health
stuff, everything.
And she was like, Oh gosh, it was
just a nightmare.
That's way different than what I would be
(13:25):
doing on my own.
Yeah.
The insurance side, like in terms of filing
and all that with something like therapy notes,
it's super easy.
Really?
Like you just click buttons and I can
do that.
Yeah.
You can click buttons.
So that, that part's a lot less intimidating,
but what I might do is I might
suggest you get like all your CAQH stuff
(13:46):
in to see a QH and just let
it sit there.
Okay.
So that if you do need to like
go for it, you can just click the
button and it's not like, Oh no, I
need to gather this stuff.
And now instead of three months, it's taking
me like three and a half months because
I had to gather stuff for two weeks.
So just having that like plan B ready
to go.
I didn't realize I could do that.
(14:06):
And then not immediately sign on.
I believe so.
I think you can like save like your
info.
Perfect.
Yeah.
I got like halfway through it with Alma
and then I was so mad that I
just stopped.
So I was like, I, this is why
I didn't want to do this.
I hate doing it.
It's a lot of bureaucracy.
You could also consider hiring somebody to do
it.
There are people out there who will get
(14:27):
you credentialed.
Ultimately you're kind of doing the same thing
because you're still going to have to get
them a bunch of information to get it
all.
Yeah.
Yeah.
So it's kind of like hiring somebody to
do your billing when all you have to
do is push two buttons.
Okay.
See, I like the reframe of like, this
is just a choice that I'm making for
(14:49):
my own sanity.
Cause I genuinely don't like marketing.
And I know there's some like inner work
that I need to be doing and have
been doing in my own therapy of like,
why do you hate this?
It's cause you hate putting yourself out there
and saying like, Hey, I'm good at this
and you should hire me, which is apparently
a really uncomfortable thing to do.
And it's also hard when you do send
out emails and you don't hear anything back.
(15:10):
And it's like, do I just keep pestering
these people?
Do I just keep like doing the same
thing?
I can't go.
I just can't like go up to my
local high school and be like, Hey, I
want to meet with a counselor.
Like, I can't, I can't do that.
Yeah.
So, I mean, I think, yeah, working on
the fear of being seen in therapy and
the like owning that you're good at something
and all of that.
(15:31):
And not only are you good, it's easy
now.
No, that's great.
Working on that is great.
And I would work on that just for
the sake of working on it.
Not necessarily to get to a point where
you're like, yeah, I want to have my
own YouTube show.
You know, like if you decide to go
that route later, but I would keep that
maybe divorced from how you actually run your
(15:52):
practice.
If, if it's a heavy lift, you know,
like I want you to just be able
to work on being seen without your income,
depending on it.
Yeah.
I'm sure that would be very, and yeah,
I'm doing that within my own personal life.
And I, yeah, we can start kind of
transitioning into like all aspects of life.
I'm like, it's okay to know what you
want and know what you're good at.
And I remember um, one of my supervisors
(16:15):
in grad school was like, you need to
know what you're good at.
This is okay.
It's not bragging.
And I was like, oh, that's like, yeah.
How else are you going to do this
job?
It's like, I don't know.
I just thought I'd just show up and
do whatever job I did and hope it's
good.
Yeah.
Fingers crossed.
(16:35):
Okay.
Okay.
Yeah.
You're making an active, educated choice about what
works best for your life and your family.
And I also can't feel pressure to make
a decision because someone else has clients that
need to be served.
I think that's another piece of it too.
I feel bad.
Like there's people that want to be seen.
And if I don't take insurance and I
can't see them, but that's a choice I
(16:57):
need to make for myself and for my
family and how we're running right now.
Yeah.
Because there are lots of people with schizophrenia
that you could see right now, but I
don't think that's your niche.
You know, like there are lots of people
who, um, are not interested in being in
therapy, but need it.
And they're not your people either.
And so it's like, if we start to
(17:18):
put pressure on ourselves of like, we have
to take care of people, then when you
start expanding it to, you have to take
care of all people.
You start realizing how like ultimately ridiculous it
is.
Right.
You need to take care of the people
that it works for you to take care
of.
When I was thinking about my ideal client,
because I've worked through some of this stuff
in abundance and like trying to pinpoint it.
(17:41):
Is it normal to feel like, this is
going to sound so silly.
My ideal client is who I was five
to 10 years ago.
I feel like it would keep shifting.
And I like keep getting like, before I
loved working with teens and like more young
adults.
Now it's more like newer moms.
I'm like, I feel like it's just who
I was a little bit.
It almost always is.
I would say like probably like 90 something
(18:01):
percent of the time, our niches, like a
younger version of us.
And yeah, I used to love working with
college students and it was like, Oh, they're
just it, you know?
And then I got older and I was
like, Oh God, I'm tired.
I don't know what you're, I don't know
the words you're using.
Can you do the translation please?
Yeah.
And it's okay that that shifts, you know,
(18:24):
and now my whole entire niche, not just
the demographic, but my entire niche has shifted.
And that's great.
You know, I wasn't sure if it was
something that should be like set in stone
and like focused on.
And that's what other people did was like,
this is who I work with.
And like, that's that.
Yeah.
I mean, I think ultimately yes, for an
extended period of time, but not forever.
(18:45):
Okay.
And you will get people who are not
your ideal clients, but are very similar to
them in different ways, you know?
So like my eating disorder clients that I
love, I ended up getting a bunch of
people in my caseload who are business owner
perspective, perfectionist driven types.
There's a lot of overlap in like the
compulsion, but they didn't have any food and
(19:07):
body stuff.
They were just trying to make shit work
with their businesses.
And so whatever, even though my whole website
is like eating disorders, eating disorders, you know,
and that's just, they were attracted to the
other pieces of what I was saying.
Okay.
It's funny when like, you know, something like,
I know that to be true, but hearing
(19:28):
someone like reassure that it's very helpful.
Yeah.
Yeah.
Because I feel like when I do, and
I know this is true.
Like when I was working through it, I'm
like, it's okay if it's not like other
people will come, like they will still resonate
with what you're saying.
Yeah.
I just feel like this was the first
school, this past school year was the first
one where both of my kids were in
(19:49):
school.
Most of the time, not all day, the
most I've ever, the most freedom I've ever
had.
And so I was like, just like, take
a year and just like, see what you
want to do.
Like it's okay to just take some time
and like get yourself figured out.
And then now that the summer is coming,
I'm like, Oh, I should have gotten a
lot more figured out.
Yeah.
(20:10):
I mean, you probably needed the rest that
you got and you can't like, what I
am learning as I get older is you
can't force the knowing of anything.
You could have sat there and meditated every
day and like journaled every day and you
wouldn't be any closer to knowing what you
want than you do right now.
Like if you're leaving space for it, even
(20:33):
if it's not hours and hours, it'll show
up, you know, as long as you're questioning.
Yeah.
So now maybe next school year is where
things will shift.
Like I said, like, we just don't know
what's going to happen.
And so I think at least having a
game plan of like, it's okay to take
insurance, maybe not with a big company.
(20:53):
If there's something like there's something within me,
that's like, I don't think I want to
work with them.
Even if it means taking less money through
a direct insurance company, I don't think that
it's worth it enough.
But yeah, I'm not a failure.
If I take insurance, that'll be not at
all.
No, just like you don't think anybody else
is a failure if they take insurance, you
know?
(21:14):
Yeah.
These like crazy double standards that we put
on ourselves.
Like it's okay for you to take a
break.
No, you take a nap.
If I take a nap, I'm disgusting.
I'm the worst.
Like, right.
Yeah.
That's helpful.
Good.
I'm glad.
I'm glad.
Yeah.
Just these money messages can be confusing and
I'm glad people are starting to talk more
(21:35):
about money, but it's a very like viscerally
uncomfortable situation sometimes, right?
Especially when we're being told we can't talk
about it.
Right.
I know.
It's so, yeah, it's ridiculous.
It's ridiculous.
And I think just in general, the way
we talk about money as therapists with each
other, but also with our clients, like the
(21:57):
number of questions and things like that, I
would ask clients earlier on around like sex
that I'm so much more comfortable asking them
those questions.
Then like, how do you feel about your
financial situation?
You know, where do you feel shame around
money?
You know, like those kinds of things I
didn't bring up because I hadn't done any
of that work myself.
(22:19):
And so there's such opportunity for us therapists
to like do that work and to be
able to like take care of this whole
entire side of our client's lives that is
such an important part of their wellbeing.
We just like, don't touch with a 10
foot pole.
In eight years, I've successfully raised my rates
one time by $10.
(22:40):
I've raised them again recently.
I was like, this is a ridiculously low
rate.
Like you've got to stop.
But now anytime someone reaches out, I'm like,
oh, it's this, but I can also do
this if that's fine.
Whatever you want is fine.
I mean, Laura, I'd start there because it
could be, you could have a really small
practice at a premium rate and take care
of your family.
Even if you just took people on, like
(23:01):
only the new people were at a higher
rate.
I mean, in Maryland, you know, like if
you're anywhere near DC, then, you know, 250
is not unheard of.
I charged 125 and I just raise it
to 155, but no one is at that
155 because it's me.
Cause I'm like, oh, 125 is fine.
Don't worry about it.
(23:22):
It's fine.
It's fine.
Yeah.
And how, like what an interesting experience it
would be if every time somebody new called
and you change it on your website, but
every time somebody new called, you said like
sessions are $200 and you shut up.
There's the key piece.
I think I just go back to, but
(23:43):
I, I don't know that I could afford
$200.
So like, how dare I ask someone else
to do that?
Laura, you just told me that your husband
can float you guys financially.
You can afford $200.
It might not be your priority.
Yeah.
Yeah, we could.
Okay.
That's fair.
(24:04):
I mean, honestly, I've been doing this a
long time.
Yeah.
I also, there's concern about like raising new
people.
Cause it's like, do I want to remind
you that you pay me every week?
Like we talk about like me raising rates
and then you remember that.
Cause right now, like the card just gets
charged and we don't ever talk about it.
(24:25):
But what if we talk about it?
Yeah.
What if you do?
What if you do?
So scary.
Cause they know they're getting charged.
You know, they're not in fantasy land.
They probably don't even remember how much it
is unless they're people who are on top
of their bank accounts.
And they are like, you know, looking at
their budgeting, which most Americans don't do.
(24:45):
I tried.
And by the end of the week, I
was like, no, this is awful.
I can't, can't do it.
Yeah.
What if I just charge more?
Yeah, let me do that.
And if you start with new people that
you don't even know, it's easier for new
people than established people.
And if you make it 200.
(25:07):
And then I stopped talking and then you
stopped talking.
Yeah.
Yeah.
That would definitely make us more comfortable.
Cause I would say my income helps, but
like, it's not enough to really do anything.
Yeah.
And then I shut up.
I'm going to run right down 200 and
(25:29):
shut up.
Mm-hmm.
Might be able to do that.
Okay.
I'm going to have to practice in therapy.
Like we're going to practice phone calls.
I love it.
I love it.
And then you've got the backup plan of
insurance.
Yeah.
Like should you need it?
It's always there.
This was good.
Thank you so much.
I don't know why I didn't think of
(25:50):
like, just asking people to pay me more
because I can charge more.
Cause I've done this a long time and
I might be okay at it.
Yeah.
And can we just make that language a
little stronger, please?
I'll work on it.
No guarantee today.
I have therapy tomorrow, so we will work.
There we go.
Love it.
Love it.
So maybe this is a good like refresh
(26:11):
to like, look at the website again.
We can, we can do this.
Yeah, absolutely.
Awesome.
This was very helpful.
I'm so glad.
I'm so glad.
Awesome.
I'll talk to you later.
Thank you.
Bye.
Bye.
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