Don’t Let TikTok Fool You – Being a Therapist is Hard Work: An interview with Sandra Kushnir, LMFT and Anita Avedian, LMFT
Curt and Katie interview Sandra Kushner and Anita Avedian about how the therapy business works now. We talk about how the profession and those who are entering it has changed over the years. We look at what new therapists can expect when they join a group practice, pushing back against some of the broadly held misconceptions of what it is like to be a therapist today.
Click here to scroll to the podcast transcript.Transcript
An Interview with Sandra Kushnir, LMFT and Anita Avedian, LMFT
Sandra Kushnir, LMFT, brings over 12 years of rich experience in various capacities within the mental health sector. Her journey has been marked by a dedication to continuous learning and service, which has taken her from launching a successful podcast to teaching in a graduate school program. She has honed her expertise across a broad spectrum of settings, including treatment programs, the Department of Mental Health, and private practice. Her entrepreneurial spirit led her to establish her own company Meridian Counseling, which has grown to a team of over 105 dedicated professionals in both California and Utah and is a recognized CARF-accredited program and CAMFT-approved CE training program. Meridian Counseling has been able to help thousands of clients connect with quality providers and also had the privilege of training and employing hundreds of associates and licensed therapists since it was founded.
Anita Avedian, LMFT an accomplished entrepreneur who owns and manages several mental health-related businesses including Avedian Counseling Center (a boutique therapy group practice in the Greater Los Angeles area), Anger Management 818 (a national program for court-ordered, probation-ordered, and volunteer consumers), and Anger Management Essentials, a national training program to certify counselors in the field of anger management. She has appeared on multiple reality television shows including Vanderpump Rules, and Bad Girl’s Club. Anita has authored a 52-week anger management program which has been translated into Spanish, Hebrew, and Armenian, and a teen’s workbook which has also been translated into Spanish. She is also the Co-Founder of the California Association of Anger Management Providers (CAAMP). As a headline speaker, Anita has shared her insights at both international and national events, further establishing her thought leadership in our field. Additionally, she founded a Toastmasters club tailored specifically for mental health professionals, fostering a community of skilled communicators and leaders in our industry.
In this podcast episode, we talk about what new therapists can expect when entering the field
We invited Anita Avedian and Sandra Kushnir to come talk about their latest endeavor: a course called Degree to Practice.
What are the misconceptions new therapists have about what it looks like to work as a therapist?
“A lot of [Grad] schools are dropping the ball…they’re not really preparing people for this next stage in their career properly.” – Sandra Kushnir, LMFT
- There is a difference between desired caseload and the capacity to earn money and hours toward licensure
- Expectations don’t seem to be realistic and seem to be impacted by conversations about burnout
- These expectations are being set by grad school, social media, coaching programs
- There doesn’t seem to be an understanding about what it takes to build a practice and what group practice owners are doing to create these workplaces
- Therapists will need to learn how to work with clients that they are not comfortable with
- Developing expertise is essential for attracting clients – be the best at what you do
- Part of developing expertise is learning how to address higher risk with all clients
What can therapists expect when they join a group private practice?
“[New therapists] know what they’re comfortable with, what they’re not comfortable with…They’re being assertive. They’re setting boundaries…[But] it doesn’t always work… if we’re helping clinicians be the best they can be. This is the time to do it (during the associateship) of trying things out, and, you know, being scared, but still pushing through and learning through the process. Because that’s who we are training and teaching to go out there in the world to be licensed clinicians, who can handle a different area of issues that come through their door.” – Anita Avedian, LMFT
- The best group practice owners will have transparency and clarity around expectations
- Often there will be a minimum caseload (Sandra and Anita both require a minimum of 20 clients per week)
- There is an overhead for each therapist, so therapists will not earn the full amount they are charging
- Insurance or sliding fee practices will need to pay therapists less than private pay practices due to the income available
- In many private practices, it will take some time to build a caseload, which means that it will take time to gain consistent income
- Some group practices will teach you how to run your own practice, some will just provide a space for doing clinical work
- Looking at practical limits as “task conflict” rather than “relational conflict” – for example, pay is a factor of the business’ needs and capacity, not a personal evaluation of someone’s worth
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Sandra’s website: meridian-counseling.com
Anita’s websites: anitaavedian.com, avediancounselingcenter.com
Relevant Episodes of MTSG Podcast:
Open to Opportunity: An Interview with Anita Avedian, LMFT
Is Your Therapist Website ADA Compliant? – An Interview with Anita Avedian, LMFT
Addressing the Burnout Machine
Getting a J-O-B as a Therapist
I Just Graduated, Now What? – Career Advice for New Mental Health Clinicians
Interview Strategies for Therapists
Does Your Social Media Make You Look Like a Bad Therapist?
Why Therapists Shouldn’t Be Taught Business in Grad School
Topic: Pre-Licensed
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Openening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapists, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that are going on in our world, the things that happen in our profession, and kind of encompassing a lot of the conversations that we have. This is an episode that we’re kind of talking about the ways that the therapy field is changing. There’s a lot that we get talked in graduate schools about things that were relevant, 50, 60, 70, years ago, that at least theory wise, some of that stuff still holds very much true. But as time is wont to do things around that kind of change, including the ways that the profession runs as a business, the ways that employees come in, and sometimes the very wildly differing expectations of what people come to expect when they apply for grad school versus the job market that they run into once they graduate. And to help us along on this conversation today, we are joined by Sandra Kushnir and one of our good friends, returning guest, Anita Avidian, so thank you so much for joining us today.
Anita Avedian 1:26
Thank you so much for having us. We’re really excited to be here and have this conversation and hopefully help some new therapists that are entering our field set their expectations.
Katie Vernoy 1:36
We are so excited to have you. I know, Anita, you’ve been on here before, but Sandra, why don’t you tell us who you are and what you’re putting out into the world?
Sandra Kushnir 1:45
Yes, my name is Sandra Kushnir. I’m the owner and founder of Meridian Counseling. We are a counseling center based in California and Utah. We do in person and telehealth services as well as med management and IOP. And we have about 120 therapists now on our platform, so we’ve grown a lot. And what I’m putting out there is I’m passionate about mental health and bringing mental health to the masses, getting more people help and allowing them to use their insurance if they can’t afford it financially.
Katie Vernoy 2:17
And Anita, you should introduce yourself too, for folks who haven’t listened to your past episodes.
Anita Avedian 2:22
I am the Executive Director of Avedian Counseling Center and Anger Management 818, where we do offer therapy services and anger management groups. We have about 15 anger management groups a week in the LA and throughout California, offering online and in person therapy sessions. And you guys know I also offer the anger management certification training to therapists on a monthly basis, which is a nationally approved training.
Curt Widhalm 2:49
On this call, we have, I don’t know, 60 to 70 years of license experience between us, which makes us sound way older than any of us actually are, but I know Anita and Sandra, you’ve both worked a lot with people very early in their career, whether it’s being faculty at local universities, whether it’s supervising people fresh out of grad school on their way to licensure, it’s a big part of my practice and my professional experience as well. So, we usually start with a question around like, what does therapists get wrong? And the natural question in this episode is, what did new therapists get wrong about being a therapists? That’s a really broad question in this.
Katie Vernoy 3:31
Good luck!
Curt Widhalm 3:32
I’m going to maybe even narrow this down a little bit more of what are some of the misconceptions that therapists have when they’re entering into this field that you find yourself correcting or educating about, kind of over and over.
Sandra Kushnir 3:49
Yeah, so I’m going to backtrack a little bit and tell you about the work Anita and I are doing together. We actually launched a course for new therapists called the Degree to Practice, which helps new therapists set their expectations for what it means to enter our field and be an associate, even what they expect post graduation in regards to work environment, what they need in a supervisor. And to answer your question, I think what a lot of therapists, in my experience, are getting wrong right now is they don’t really know what it means to be an employee postgraduate school at a counseling center or at a private practice, and the amount of hours and work that it takes in order to get the income that they’re expecting. So we’re seeing a lot of people kind of with expectation hangovers post graduate school, entering the work force and feeling just unfulfilled and job hopping a lot. And Anita can speak a little bit more about like her experience with that. But an analogy that I like to use is if you hop on a plane and you think you’re going. to Paris, France and you end up landing in Anchorage, Alaska, you feel disappointed, you didn’t pack right, right? It’s not where you thought you were going. And what I think a lot of schools are dropping the ball on is they’re not really preparing people for this next stage in their career properly. For instance, a lot of my friends are doctors, and they know what residency looks like, right? They know they’re going to be working 60 to 80 hour weeks for $65,000 to $80,000 a year. They know they’re going to have 24 hour shifts. And so they go into that stage of their career with the mindset that that’s what their life is going to look like. And I do feel like a lot of therapists entering our field just are not prepared, mindset wise, for what it means to work.
Anita Avedian 5:47
And I think to piggyback off of what Sandra is saying is, you know, oftentimes in during an interview, and I’m sure you guys may have experienced something similar, when I ask an interviewee, what does your ideal caseload look like. And the response is around 15 clients a week. And I’m thinking, how are they going to build their hours in the time frame they may need it? And how is it that 15 clients a week is the like the limit at in terms of what they can handle right now? So there’s almost this tolerance of they don’t want to work as much, necessarily, not that they don’t want to, but it feels too overwhelming to see more clients a week, and there’s this expectation of the pay to be decent enough to make a living. So I think there’s this difference in how realistic is it to work 15 hours a week and get this pay that you want. So that’s kind of that difference that I’m seeing, is when you go into a work field, oftentimes it’s really going to look potentially closer to 30 hours a week or 20 in terms of clients, it’s going to be closer to 25 to 30 clients a week. So so that’s kind of this transition that I have seen, and as what Sandra was saying is there’s this expectation that feels very different and not realistic.
Katie Vernoy 7:07
Where do you think these expectations are coming from?
Sandra Kushnir 7:10
I think they’re coming a lot from school talking about burnout and self care, which is very real and very, very important. But in my opinion, it’s almost like an overcorrection in a lot of ways. Obviously, we have a very high burnout career, where we need to be aware of that and how it’s impacting us, but also when somebody needs to make a living wage and survive, right, especially in an expensive city like Los Angeles, it’s unrealistic to work 15-20, hours a week and make enough money to support yourself. And so I’m I’m thinking it’s coming a lot from the schools, and there have been more conversations, right, about burnout, not just in our fields, but in a lot of fields in general, especially if they as things have moved to being more online, and people are experiencing like physical issues from looking at a computer screen all day. So these are very valid conversations, but I think the problem is they’re not setting expectations with what that means in regards to income and earning potential as well.
Anita Avedian 8:14
And I want to add to that, I think also what I’ve seen, and I don’t know if you guys have noticed this as well in the last probably 6-7-8, years, there’s been a lot more out there; with coaching, we can help you make six figures with just a few hours. So I think there’s these workshops and maybe TikTok videos or Instagram videos: Here’s how to make more money and work less. So there, I’ve kind of seen this in the younger generation, because I’m so old with this, make more work less, you know, mindset. So that I think that’s coupled with that as well. It’s not just the schools, but what folks are learning out there as well, which is that great idea, by the way. I’m not against it, don’t get me wrong, but it doesn’t work out when you enter, you just get hired somewhere with that mindset, thinking that’s what’s going to happen, and it’s not the case. And this, I think, is why we’re seeing so much job hopping going around. You know, whereas in the past, you’d see associates working at one center all the way through their completion of their hours, now it’s every three-four months, they’re just jaw popping because they’re not satisfied with where they’re at, whether it doesn’t meet their expectations or they want something more.
Curt Widhalm 9:29
How are you as group practice owners, trying to find this balance? Or what are you hearing in interviews that you are looking for like, Okay, this makes you more likely to succeed in my practice that you’re kind of sensing, Oh, I hear other candidates saying these things. I don’t necessarily I’m seeing the they might not be red flags, but they’re definitely orange flags coming down the pike.
Sandra Kushnir 9:58
Well, I can speak for myself, one of the big things that we look for in therapists that we hire at Meridian counseling is the ability to have difficult conversations and receive feedback. And so when somebody comes in and they have an expectation to see 10 to 15 clients and make six figures a year in their interview, right, we have those conversations, right? We we break things down for them very directly and very honestly, and we explain, you know, yes, there are some people that have private practices in Beverly Hills that charge $200-$300 an hour, and they see very few clients, and they make very good money, but there’s a lot of work that went on in the back end, right, in order to get those clients, in order to build their brand, that those types of clients are willing to work with them. It doesn’t happen overnight, and there’s a lot of time and energy and effort spent behind the scenes to build your career up to that. And we we walk them through, right? Like, what is a realistic salary based on how many clients you’re expecting to see. And for us, our minimum is 20 for associates. So we expect 20 clients, two hours of group supervision, one hour of individual supervision, and then if they want to make more money, they can go above 20. But we very clearly like that is our minimum. And some associates are like, that’s too many. I can’t do that. I’m gonna burn out. But then, you know, so usually what we see is they either come back a few months later when they try at other jobs where they’re not giving enough clients, or they’re not making enough money, and they ask to rejoin the practice. And sometimes we’ll take them on, and sometimes that position has been filled.
Anita Avedian 11:40
And yeah, with our center, what we end up doing, I think, the same thing Sandra as you guys do, is we have this expectation of carrying a caseload of 20 or more. But Curt, what I’ve also realized is, for some folks, that’s just not going to happen there in terms of where they’re at and what work then life balance. So as a supervisor and or the director, I will help adjust what we’re doing, what we’re offering them, and how much they can give back. We just kind of reevaluate to see what is going to work for them, so long as it still works for the company. So there is a lot of that, but what I think, what I’m seeing is there’s more requests around that, because the associates coming through, some people are either at 25-28 clients a week. Others are wanting only 10 clients a week, because that’s what they can handle realizing they’re getting overwhelmed too much with too many clients in their caseload. So we work with them.
… 12:37
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Katie Vernoy 12:39
It seems like a hard balance, because I know that there are a lot of practical reasons why someone might need a lower caseload. I’ve certainly seen all the conversations about, you know, see like two clients and make $500,000, you know. So I know that there, there are these expectation issues, but it also feels like we’re in a time in the world where we have a shift to my work isn’t my life. Like I work to live, I don’t live to work. And and so there’s the cultural shift, but I think there’s also we’re in a time when a lot of therapists are just burnt out on life. We just, I guess we’re still kind of in it, but we’re mostly out of a pandemic, where we were going through things at the same time as our clients, Sandra and I were talking before we got on. You know, there’s definitely some perks to doing virtual but you can get a lot more physical issues when that happens. And so to me, it seems like there’s, there’s a balance that needs to be struck. And I think that, you know, I think I’m the only one on this call that’s not a group practice owner. I mean, I would love to hear how you guys balance that, because some of it is actually like legitimate accommodation needs. Some of it is, this is what I’m willing to do, and some of it’s just kind of misplaced expectations that have been swirled around, whether it’s social media or school. So how do you balance that? Because to me, I don’t want to go too far to like, Oh, these youngsters, they expect too much, and they need to, you know, earn their stripes, you know. And then I also don’t want to go to the other way of like, okay, well, you we’re just going to pay you a bazillion dollars, and you don’t have to do that much, because that’s what’s fair, right?
Anita Avedian 14:15
Totally.
Katie Vernoy 14:16
So how do you do that?
Anita Avedian 14:21
I think it’s a great question that that finding that right balance is really important. And here I could set up my expectations and say, Okay, you’re you’re going to start working for my company. This is what I expect from you. This is what you should expect from me, and and that’s discussed and agreed upon. And so but there’s life, and then there may be health issues and there may be adjusting or moving, you know, so different factors arise that we also have to be flexible with, as a group practice owner, and how to work with that, how to balance that. So it definitely is a two way street. We’re open. We want them to be open. But I think there’s sometimes, for me as a group practice owner, there may be this: How was it possible I was seeing 60 clients a week, and 15 clients feels overwhelming, like, you know, I can’t help but do that little comparison at times, and I’m like, Okay, I was on one extreme. Now it’s on the other. How do we get that, get it to meet somewhere in the middle? But that’s just my…
Sandra Kushnir 15:22
Yeah. I mean, my thoughts on this are, that’s why we created this course is, I believe, early expectation setting and early intervention and helping associates, you know, while they’re still in school, before they graduate, get a little bit of career coaching and understand, right, what they are getting into where they should work, based on their personality and their income goals, what the differences are between working, let’s say, at a DMH agency, or a treatment center or a private practice, right? A lot of schools don’t go super in depth in preparing people what of understanding what the options are, and so for me like to change this is really like, Let’s educate people right. Knowledge is power, and helping people understand what their options are and also make informed decisions. Right to sit down and be like, Okay, how much money do I actually need in order to feel safe and comfortable. Do I need $500,000 or do I actually need $80,000 or $60,000 right? What’s more important to me being with my kids and being with my family, or work? Right? Everyone’s driven by different values and different priorities and different things, which is fine, but I do think that those things should inform the decisions that you make as you enter the field, right? Some people need health insurance because their husband or their partner they’re alone or they don’t have it elsewhere, right? So that’s important to them. So maybe for them, it’s better to work at a DMH agency. For other people, they might want to be with their kids more, or they might want to prioritize their hobbies or a different side hustle that they’re doing, maybe doing a part time private practice is what they’re needing. But they need to be, you know, prepared to understand, okay, in a DMH agency, you’re going to have a lower salary, but better benefits and more stability and income. In private practice, yes, you can make more, but you’re going to be spending a lot of time working for free, marketing yourself. So all those things, I think, empower people to make decisions that are more aligned with what is right for them.
Katie Vernoy 17:33
I want to ask one quick question, Sandra, because you said in a DMH agency, you’ll make less, but have more financial stability. And in a private practice, you have the potential to make more money, but there’s other unpaid work. My experience, and obviously this is a bazillion years ago, was that, and what I’ve heard from people more recently is that it takes a while in private practice before you can even make as much as you normally make in DMH or public mental health organization. And so do you have a sense of the timeline for folks? Because I think that’s the other thing. They’re like, Oh, I’m going into private practice. I’m going to make more money. And it’s like, no, no, you make a lot less for at least probably six months, is my understanding of it. And so is that reasonable? Like, what is the actual reasonable expectation of income? Because some public mental health agencies, you actually make pretty decent money. You make that $70,000-$80,000 a year from the beginning, without any marketing, without any of that stuff, and private practices, you’re not getting that until at least the first year.
Sandra Kushnir 18:29
So, Meridian takes insurance. So we’re a little bit different. We operate like a private practice, but we are a network with all the insurance payers. So when somebody joins our practice, they do build their caseload pretty quickly, just because there’s such a high demand for clients that want to use their insurance, and we take all of the plans. So I can answer from that sense, if you’re joining an insurance based private practice, you’re going to build your caseload a lot faster, just because there’s more clients out there that are willing to pay their low copay. Some people have no copay, but if you’re joining a private paid practice right where the the fee is $200 or more, it’s going to take a lot longer, because not very many people can or want to pay that much money for therapy. And now that there’s more options to use insurance, a lot more clients are hesitant to pay privately, because they can go to these new platforms that have popped up, right? So it takes a little bit longer, and Anita can speak more to that, because I know you mostly do private pay…
Anita Avedian 19:32
Yeah.
Sandra Kushnir 19:33
…but yeah, I got there’s a lot of differences in what type of private practice you work at too, right? If you work in an insurance versus private pay practice.
Katie Vernoy 19:42
So before we switch to Anita’s experience, Sandra, what is an earning potential for someone coming into an insurance based private practice? Like, what’s the what’s a possible salary range?
Sandra Kushnir 19:52
Yeah, so our associates, depending on their caseload, anywhere from 20, and we have some people that work 40 hour weeks, like they see 40 clients, their better salary ranges. Everyone at our practice starts out hourly, but we have had associates that have made $100,000 a year. However, they are working 38 to 40 hours a week, in regards to how many clients they’re seeing.
Katie Vernoy 20:17
Got it.
Sandra Kushnir 20:17
So, yeah, it really varies on caseload. Our requirement is, once they reach their 20 to 25 caseload, they can switch over to being salaried with us, and then they have to maintain that caseload in order to get their salary. If they want to, they can stay hourly if they don’t want to worry about, like having to maintain a certain caseload. So it’s so different for each person, but, yeah, there’s earning potential to make six figures, but you are working a typical 40 hour week, and that situation.
Katie Vernoy 20:49
38 to 40 clients is actually more of a 45 to 50 hour week, right? With all the documentation?
Sandra Kushnir 20:55
Yeah, we do our documentation within the last hour. So we created a super easy, note template. So we’re very like tech forward, and we use, like, AI and stuff like that, so our notes aren’t as heavy as as other practices. Maybe.
Anita Avedian 21:12
Yeah, I think to answer the question for our center, it’s interesting because we, in the last year, started accepting Aetna and Cigna and so before that point, it was probably a slower build. And then now I’m realizing, for example, the associate we hired a few months ago, within a month, she was already at a case load of 18 a week within one month. So it’s a it’s a faster build, whereas back in the day, it was probably about six months before you saw someone have about 18 clients a week. So it’s definitely a faster build, right now. Ours is more cash pay and some insurance versus I know what Sandra it’s, it’s all mostly insurance. But it’s nice, like, it’s nice to have that hybrid, a little bit of a mix. And it’s, it’s been pretty decent. So right now, we’ve been trying to hire a new associate every two or three months until we build our caseload.
Curt Widhalm 22:07
I used to teach a course on careers and advocacy when I was teaching, and part of what I found in trying to do what you’re doing is in addressing some of the grad school deficits around this is that developmentally, do you think that grad students are in a place where they can conceptualize what it really looks like to be in private practice. Like I hear, you know, some of the gaps that you’re trying to fill here, And maybe it was just my style of teaching, or maybe it was the couple of groups of students that I taught that I’ve had them reach out to me four or five years later and be like I just was not in the mindset to be able to receive the information of what it truly means to work in private practice when it comes to this kind of stuff. So I’m wondering if there’s also just kind of a developmental factor, not just blaming the problems from the grad schools on this.
Anita Avedian 23:07
Yeah, from the private practice setting, I know back it in the past, because I’ve even switched how I’m doing things, of course, but earlier on, I would have our associates and Curt, I know you know this. I would have our associates teach them how to do the business aspect. I would require them to network. I’d have them I’d require them to attend association meetings, join the board, get involved with our community. I wanted them to learn what it takes on the back end to do the things that are needed. And so the transition has been, I’m as a center, covering all of those grounds, and they’re really doing more of just the clinical work at this point, but that’s just the that’s my transition as as that individual, and I’m trying to still learn what is the better approach, because they’re not learning to be more involved the way I’m doing it right now. So, and I kind of liked that. That was my passion in teaching that So, but, but now it’s a little bit more okay, here’s the business, here’s what we’re expecting. But to answer your question, I don’t know, I don’t know the right answer. I just know that I’m trying to navigate through that as well, to see what is the need right now. How can I best service the associates who are coming through today, and how can I best guide them? And am I missing out on this opportunity of teaching them the leadership and getting involved and the business aspect of it?
Sandra Kushnir 24:34
Yeah, and my my thoughts on that are, I think it’s something that’s very teachable. However, I do think that there’s other factors at play right. A lot of people see the success of Meridian now, right? So they see like the results, not the back end work behind the scenes, right? A lot of these career coaches that are coming out and saying, you know, you can make a million dollars in your private practice. Because, well, a lot of them don’t have clinics. I’m like, How are are you making a million dollars in your private practice? Right? Like, who are you to speak about this, right? So I think a lot of it is kind of what’s happening with social media, right? People see their friends on vacations in Italy with designer handbags, and they think that that person like, you know, has everything, and their life is super easy, but people only see the highlights. And I think with this, it’s kind of similar, right? You see the private practice Beverly Hills therapists, or you see me as a young girl with a big practice, right? But behind that you don’t see like the tears, the sweat, the hours, the money, the time, all of that that’s been lost. And so I do think that by giving them the information and the opportunity to learn, some people will really grasp what it means, and other people, you know, maybe won’t. But I do think that for those that will grasp, it sets them up to be more successful in the in the long run, right? And my thoughts are, when we surveyed the people that were coming through our course and asked them what they want to do in their career, about 90% of them said that they want to be in private practice. And then after they did our course, they realized, a few of them were like, maybe this isn’t what I want, right? But I think it’s kind of a glorified thing in a lot of ways. Like, just like, again, I’m using an Instagram analogy, where it seems like being an influencer and traveling around Italy with your designer handbag is is great. It might seem like that when you are seeing someone in a private practice that’s successful, but it’s not what you see in the forward facing sense always.
Anita Avedian 26:46
And I wanted to add something, too. Like, even when we’re hiring associates right now, because I give them the option of becoming full time, which may mean more admin hours, I give them a series of options of, would you rather be out networking? Would you want to work on our Instagram platform, writing blogs? So they’re trying out different things, and pretty quickly they’re going to come back and say, this was not for me. That’s not for me. And they’re realizing whatever’s involved in that back end, probably half of what we do they’re not really interested in doing. So they’re kind of testing to see what parts of this work do they like? And I also wanted to add, I have also seen people coming through they get out of grad school, they start doing therapy, and they realize this is not for them. They literally transition out of the field completely. So that has been surprising. I’ve seen a few of the associates fully exit the field after grad school. So, and maybe that was during the pandemic. They, you know, have the experience of in person. I’m not sure whatever happened. But so there is some of that too, where they come in, they do the clinical work, and they realize this is they can’t handle it.
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Curt Widhalm 27:57
Can we talk about the influence of the pandemic on, I mean, because I think that all of us, you know, we did all of our grad school. We got licensed well before that. We were established by the pandemic. But we’re really seeing the first wave of people who entered into graduate school during the pandemic, or because of the pandemic is that kind of cohort showing up differently than even the people who were graduating right before.
Sandra Kushnir 28:31
100% not just in their expectations for employment, but I do see less of a drive to even do, we offer a lot of internal trainings on different types of clients and different issues and theories and modalities to work with. People just don’t attend. When I was an associate, I was like, every training I could go to, I would go to, and I would absorb that. They do not attend. They only they want, will only go if they get paid to go. There’s like, not as much of a drive to learn. I see a lot of and Anita and I have talked about this, a lot of associates who encounter like a really difficult client that maybe they haven’t had exposure to, and then they’re like, I don’t want to work with this person. I want to transfer them out of my caseload, and we have to talk to them and be like, hey, you need to work with this person, because this is your opportunity to learn, and we will supervise you through it, but you’re in your training, and you need to learn how to deal with these types of clients, so that when you’re licensed, you know what to do. But a lot of resistance for that, where they’re like, I don’t want to I’m this isn’t what I want to specialize in, and we have to explain like, it doesn’t matter what you want to specialize in. You need to know what to do in these situations if you ever encounter them when you’re not under supervision, right? So we’ve seen a lot of that just which has been really shocking to me. Because that in my head, I’m like, if you want to make a lot of money and you want to be successful in this field, like capitalism, is still at play here, right? You need to be the best at what you need to be the best at what you do, right? In order for you to be successful, you need to be really good at what you do, and leaning into trainings and supervision and prioritizing that, with or without being paid for, it is how you get there. So that’s been my experience.
Anita Avedian 30:24
If anything you just touched on something. There, there’s a there’s more. I think what I will say, the what I’m finding, is there’s a lot more boundary setting. They know what they’re comfortable with, what they’re not comfortable with. The threshold of the discomfort is different. And I guess that’s what I’m noticing, and I’m not used to. But, you know, you’re speaking up, or teach people to be assertive. They’re being assertive. They’re setting boundaries. You know, great. It doesn’t always work so well in terms of from a company perspective, but more so if we’re helping clinicians be the best they can be, this is the time to do it, during the associateship of trying things out, and, you know, being scared, but still pushing through and learning through the process. Because that’s, that’s who we are training and teaching to go out there in the world to be licensed clinicians who can handle a different area of issues that come through their door. Right? That’s what we’re hoping for.
Katie Vernoy 31:21
The question I have on this, because I hear you and I was, you know, hiring, you know, I feel like 1000s of clinicians when I was working in public mental health as a director and saw some of this. But certainly it was a very different picture, you know, different cohort of folks coming into community mental health, and also a very different generation. This was, you know, 10-15, years ago, and so to me, I think about what Curt and I talked about a lot on this podcast, which is the industry, the profession, is in some ways broken, and we need to advocate. We need to encourage change, and we need to make sure that we’re not allowing all of us to get so burned out and be so underpaid that that this continues forward. And clearly that message has been heard right, like we’ve got, you know, brand new folks coming in and really setting boundaries around it. And so I guess this goes back to that kind of, kind of, how do you sort through, is this a realistic boundary? Is this a realistic complaint? Or is this something that is a wrong expectation based on what what you know, whether it’s the coaches or the grad schools that are saying that this, this other type of being a therapists is possible, or the TikTok therapists that act like they’re a therapists but aren’t. Like, how do we sort through how we move forward in the field, what people, quote, unquote, should push back against, and what is too much of a pendulum swing over into therapists that don’t actually do therapy for anything that’s difficult, and for for for any money less than what they actually want to earn. I mean, like to me, it feels like there’s not a good answer here, because of practical things. And so how do we sort through that?
Anita Avedian 33:13
It’s great question. I think you know, part of it is with supervisors trying to really encourage and help challenge folks who have fears. Like I am always asking, tell me what’s happening, what do, you know that I’m noticing this resistance? Or what is the real concern here? Because it’s, it’s almost this fear based that’s not, I’m not going to do well, or I’m uncomfortable with that. You guys know I teach anger management, so this they’ll get trained on anger management, but then there’s angers bringing up a lot, like, of their trauma from the past, or they get scared in the room. So like, anger is going to exist, not even doing anger management. It’s gonna be couples therapy, individual therapy. Like you, if you can’t, if you can’t help being around anger, how are you being a therapists? So we have to, like, it’s my job as a supervisor to help them see through that and hopefully create a place where they can start working through their fears and pushing through a little bit. Because, you know, for me, that’s a lot of therapy is.
Sandra Kushnir 34:20
Yeah, and I think it’s for us as leaders, like people in the field, who have been in the field that are open minded and, you know, want to impact change and understand that the field is changing. To be able to guide them in what this is and how to navigate it all is really important. And I think what’s important is to as people who have been in the field for a long time to stay open to like cultural changes when it comes to employment, when it comes to graduate school, when it comes to technology, and be forward thinking in that way. I remember when I first started grad school, there were some professors that were just, like, very set in their ways, right? Like it was like, This is what it is, and this is how therapy is going to be, and anything different is bad. But like, the world is always changing, and like our field is going to change as it changes, right? And we need to be aware of that, while also creating, like, an opportunity to balance out, like the integrity of the clinical work and protecting our clients and making sure we’re staying in scope of quality care right, while leaning into a changing world and a changing demographic of people entering the field as well. So yeah, I wanted to also mention, really quickly, I was listening to this podcast, The Hidden Brain, and they talked about different ways of dealing with conflict, and how engineers and lawyers and doctors are able to separate task conflict from relational conflict, and people who go into more caretaking professions, like psychologists and teachers and you know, all of us nurturing people that we have a hard time separating task conflict from relational conflict, right? So what I think is really important is that therapists are taught how to have healthier conflict in schools and how to receive feedback in a way that doesn’t make them feel emotional or defensive, but rather looking at it as like, I’m just trying to help you objectively, right? Because what I see is like, when you tell someone, hey, I don’t think you can make that much money sitting 15 clients a week. A lot of times, they’ll take it as like, you don’t think I’m good enough, right? They’ll take it as a personal attack on on who they are, versus what the research has shown is like, if you were having that same conversation with someone who has, like, more of a personality that would go into engineering, they would be like, Oh, tell me why. Like, let me problem solve this. They wouldn’t take it as a personal attack. And so I do think that that’s important is to help associates early on, learn to receive feedback and have these types of conversations in a way that isn’t as emotional or triggering, but a little bit more just like objective, and view it as an opportunity to help them grow and learn, versus something that has anything to do with their like, competency or earning potential, or anything personal.
Katie Vernoy 37:23
Yeah, that really pushes back against the charger worth, right? That’s BS, like, charge your worth, like that. That doesn’t mean anything, right. But it certainly makes how much money you can make a personal valuation of your worth. And so I really like that, Sandra. I think that that, that’s, that’s a big takeaway for me, is kind of the the task conflict versus relational conflict. I love that. Thank you.
Sandra Kushnir 37:47
Of course.
Curt Widhalm 37:48
Where can people find out more about your course?
Sandra Kushnir 37:50
Our website is degreetopractice.com, and we are offering the course right now for students post graduate school or about to graduate that are entering their associate training portion of their career. However, we do plan to launch some courses in the future that will be for people looking to get into graduate school, so for people in undergrad thinking about becoming a therapist or doing clinical work, and then all the way down to what it means to start a business. So we’re going to have a few different modules and options for people, but yeah, you can find us on degree to practice. Or for me, you can find me at MeridianCounseling.com
Anita Avedian 38:33
And for me, it would be AvedianCounselingCenter.com
Curt Widhalm 38:37
And we will include links to all of those in our show notes over at mtsgpodcast.com. Follow us on our social media. Join us in our Facebook group, the Modern Therapist Group, to continue on with the conversation. And until next time, I’m Curt Widhalm with Katie Vernoy, Sandra Kushnir and Anita Avedian.
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