Episode 154: The Power of Group Therapy in Private Practice [featuring Brittany Bate]

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Transcript

PATRICK CASALE: Hey everyone. You're listening to another episode of the All Things Private Practice podcast. I'm your host, Patrick Casale. I'm joined today by a friend and colleague, Dr. Brittany Bate. She is the owner of Be Bold Psychology and Consulting, a licensed psychologist, entrepreneur, private practice strategy coach, trial consultant, and speaker. And she's here in North Carolina.

Be Bold offers LGBTQIA+ celebratory, neuro-affirming individual, family relationship, couples, and lots of group therapy services, which is what we are going to talk about today. We've actually never talked about running groups on this podcast, which is bizarre. So, I am excited to have you on here today to talk about this.

BRITTANY BATE: Yes, I'm excited to be here. I love talking about all things groups, so…

PATRICK CASALE: Well, you certainly excel at them. And I watch your marketing and it's very consistent. Always good graphics, lots of posting. And I want to get into, like, the before, the process, like the struggle areas because I think you know this as well as I do, that you constantly are seeing therapists who are asking in Facebook groups because I tag you in a lot of these posts, "I want to start groups. How do you do this? I want to do a private pay. I don't want to do so much one-on-one therapy."

So, did I miss anything in your bio that you want to share? And why have groups become such a big portion of what you're doing?

BRITTANY BATE: Yes, I think you covered all the high points in my bio. So, thank you for that.

I guess, sort of related to your second question that sort of goes into my background, a lot of my practice before private practice was in secure facilities. And in those places, group therapy is sort of the primary modality of treatment.

So, I came kind of out of grad school and after my internship and into private practice with a lot of group therapy experience. And I just had an opportunity to see how powerful it can really be, and across kind of different places and with different folks. So, I always knew I wanted to bring groups into my private practice experience and I have. And it just has been so powerful. It is so cool to see the way that people can really get into things in groups that we haven't been able to touch in one-to-one therapy, including my own clients that have been in one-to-one with me and then have been in groups with me as well. And I think that has just, sort of, been motivating for me to continue to offer them, along with a lot of the other benefits of groups, you know? Lower cost is a great thing. So, more accessibility is great.

And then on the clinician side, diversifying what you're doing is always really fun, I think. And being able to see more people in that hour time, I think, is also really cool, and powerful, and fun, too.

PATRICK CASALE: Yeah, I think you hit the nail on the head there with, like, the fact that it's great for clients. It helps them feel connected and like, there's some community building going on. They can probably drop into places that they might not in 50 minutes of one-on-one therapy.

And for the people who are listening, probably, the most important part is breaking up the monotony of, like, doing the same thing over and over and over again. I know for a lot of our listeners, they're probably neurodivergent entrepreneurs like you and I are. And that means thinking about doing the same thing every day for the next year of my life. Sounds like pure hell. So, being able to diversify.

And I think, you know, you're a group practice owner, you have clinicians who work for you, psychologists, for the most part, it allows you to pay them differently too, right? So, can you talk to the benefit of like, how that impacts your business structure in terms of how you hire, how you kind of think about that process?

BRITTANY BATE: Yeah, definitely. So, a really big value of ours is work-life balance. So, I really do not like any of our clinicians to be seeing more than 25 clients a week. And frankly, I don't know that any of our clinicians do see 25 individual clients a week.

So, it lets them be able to, you know, make a little bit more in that hour, if they're doing a group, and also, just, yeah, have a little bit more fun, do something a little bit different, and help more people. And when our clinicians get closed, I still have the opportunity to say, "But they're leading this group or they will be leading this group. So, if you really want to work with them, here's one way that you could that might be a really good fit for what you're looking for and what you're asking." And so, I really enjoy that too.

And I think that kind of goes into a little bit of, like, group structure, and like, what it takes to start a group. So, I always ask that there are at least four people per group before we start it. If we don't get four people, then we just extend and continue marketing for a little bit longer to see if we can get that minimum of four. And so, it allows me to pay the clinician at a minimum what they would make if they were seeing an individual client during that hour, usually, a little more with that four. And then, anything after that is a bonus in a lot of different ways. But that is sort of where that number comes from.

The other piece is, if someone can't show up for a week, if a client can't show up for a week, we still have three people, and that still feels kind of like a group. Whereas if we have three people committed to the group, and we start with three, and then one can't show up, then we have two people. That doesn't feel like a group.

So, I really like to be looking out both for the clinician's time and for their own goals in terms of their own work-life balance, as well as for the client's group experience, too. I really want it to be a group experience if they're giving their time, and obviously, investing in the group emotionally and financially.

PATRICK CASALE: Yeah, that makes a lot of sense and I love that. So, four is the minimum. What's the sweet spot for something like that when you're running something like this?

BRITTANY BATE: I think six to eight is the sweet spot. And it really depends on the topic, and it depends on the clinician, too. I've had groups up to 10, and that has worked for me. But that has been my adult queer plus group, which has been a little more fluid. This was when it was closed. I've also made that an open group after the closed group, but it was a lot less topic-specific and a lot more process-based. And so, I think having 10 people was okay in that regard because some days some people wanted to talk more and share more, and some days they didn't.

I think for groups that might be a little more skills-heavy, I think six might be a little bit more of the sweet spot. That way you have some time to talk about and teach the skills, and then, kind of go through with each person and talk about their experience of implementing that skill.

PATRICK CASALE: Yeah, that makes a lot of sense. So, experience versus implementation and skill set groups.

Marketing groups can be a place where people fall flat. And I have watched a lot of people, whether it's in my own Facebook groups or other groups that I'm a part of market, but their marketing kind of looks like this "Hey, everyone. I specialize in whatever. I'm running a group on A, B, and C." Sounds like a great group. That's the first and only post you ever see from them. And then, nobody signs up.

And like, anything that we're doing when we're trying to get it off the ground, you have to be consistent, right? Like, I see you posting, and maybe it's you, maybe it's a admin, but it's constant, and it's in a lot of the groups in North Carolina. So, it's not just like, "I'm going to put this out there into the North Carolina group and it's going to fill today." It's like, no, this is going to take some time.

So, can you talk about the process of, like, consistency, how much marketing plays a role, and, like, some of the pitfalls that you see in terms of people who are not being successful when they're trying to launch these things?

BRITTANY BATE: Yes, absolutely. Well, I want to take a step back just to kind of the topic of the group because I think you're right. A lot of people have what looks like such a great idea. I look at it, I'm like, "That's such a great idea. It'll go great." And I think everyone believes that and thinks that. And I think a lot of times it is a great idea. But I think it's more than having a great idea. I think you need to have an idea that is really needed right now in your community, too. And so, I talk a little bit about finding that warm audience that kind of leads the development of the group that you're looking for.

So, maybe it is sort of paying attention to what your colleagues are saying in Facebook groups and on listservs. And then, going from there, and developing something, and really striking while the iron's hot, just kind of doing it scared and just make it happen. And so, finding those posts and being like, "We're going to do that, have them email me." And then, you start to build your list of interested potential clients as you're kind of structuring out what the group is going to look like. So, I think that is one piece.

The other piece could be within your own practice. That's how I started groups. I first started groups in private practice when I was seeing a large caseload of gender diverse teens, and they shared that they didn't really have anywhere else to go. They didn't really know how to find other gender diverse teens to talk about their experiences with. And I probably had four or five of my own caseload all sharing that same sentiment.

So, I was like, "Well, I can create a space like that and just see if they want to join." And that was my very, very first group. It filled quite easily because I had four or five automatically that I knew would join. And then, I was able to get about three more folks just kind of in the broader community that were interested.

So, I think looking at your own caseload, or your practice, if you have a group practice, or you're in a group practice where the needs are being shared and in case consultation. And then, yeah, what do you see in your community? So, I think that is where to start, so that it makes it a little easier.

Then from there, it is about consistency. The biggest hurdle I had to get over was this, like, bully brain thing in my mind saying, like, "You're so annoying." That is what I kept, like, feeling having said, like, "You're so annoying. Why do you post so much? People are going to get annoyed." And there are some people, I think, that have been annoyed. I can count on one hand the amount of times that people have been like, "Hey, maybe post less." And it's mostly been on listservs that have rules that I didn't know existed. And I'm like, "Okay, you know what? You run a listserv, it's your rules. I will do what you ask."

But I think the vast majority of people don't see it and that is why I do have to post so often. Facebook has some weird algorithms. And I cannot tell you the amount of times I will have posted about a group on a weekly basis for eight weeks, and I will still see in a group I know I posted in, "Hey, who's running a grief group?" And I'm like, "Me, I am. I'm running a grief group. I've been posting about it for eight weeks."

PATRICK CASALE: [INDISCERNIBLE 00:11:30] actually because we're in so many of the same groups, and I'm just like, watching this stuff unfold, I'm like, "Yeah."

BRITTANY BATE: Yes, yes. And I think those are little moments though, that do make me feel like, okay, I do need to post a lot. And if people don't like it or don't need it, they can keep scrolling.

And I think, too, it's been a little bit of a mind shift for me that I'm not selling, I'm helping. We have this thing that I do really believe in, and I do think could be really helpful. And I hear that there's a need for and I want to make sure people know that there's a need for it. And I don't know a better way than just posting often and hoping that someone sees it at the right time. So, that has been, again, a shift for me.

I do all the posting myself. I have other people that help me with some developing of the marketing materials. We have a director of groups, is Brianna. She is incredibly creative and wonderful, and she helps develop the actual flyers. But I do the posting. And to manage my own anxiety around being annoying or posting too much or double posting, I created a little matrix, and it just sort of outlines I'm going to post this group, this therapy group, in these Facebook groups on this day. And then, this group, and these Facebook groups on this day. And I just go through the process, and I kind of just check it off as I go, and then, it restarts over the next week and the next week. And I typically do that for about eight weeks lead time before the group because I've learned that you got to see things seven times before it sticks. And so, I try to get people to see it seven times before it starts.

PATRICK CASALE: There's a lot to unpack there because you just gave a lot of good answers. Number one, I think, is a lot of people relate to what you're saying about, "I don't want to be annoying. I don't want to post too much." And I've had that same mentality, honestly, for my stuff where I'm like, "Do I really want to post this again?" But it's like, no people need to see it. And because social media algorithms change all the time based on what you like, based on what you click, based on what you're talking about in your house when your device is [INDISCERNIBLE 00:15:56] on it. Like, there are lots of ways for you to miss opportunities. And then, that is when that question of, like, "Who's running a grief group?" And you're like, "Oh my God, I've posted 200 times about this." So, that's totally real.

I like that you mentioned the eight-week lead time because that gives perspective for people who are listening, who are like, "I posted twice and nobody signed up." And it's like, well, again, like you mentioned, people need to see things over and over and over again before either they absorb it, or they take action on it, or both. So, you really do need to do those things consistently. I love the fact that you have like a matrix for yourself to be like, "This is what I do. This is when I do it." Like, you should sell that.

BRITTANY BATE: I do. I do sell it.

PATRICK CASALE: But I think that makes so much sense. And going back to what you said about, like, it's almost low-hanging fruit, right? If you're like, what are my clients constantly talking about? What are the common themes? What are the common threads that people want connection over? Pay attention to that. Pay attention to what people are asking in the Facebook groups that you participate in because people ask the same questions a lot of the time. So, it makes sense why, you know, you can start to do some marketing research that way.

Now, another question that comes up a lot is like, I take insurance, but I want to run private pay groups. Can you share? I know you're all private pay so you don't have to deal with that issue.

BRITTANY BATE: Yeah, so I always do tell people, because I still do offer people some coaching around this question, and I don't take insurance. But I say, check your contracts, obviously, see if group therapy is covered, and then, figure out, sort of, from there what to do.

I know, I point people to Kim Tolson's groups a lot about insurance and how to navigate that because I think there's some good answers in there. But I think if you are going to be doing a group, and it's going to be private pay, if you're not handled with the insurance, then you can offer super bills. But the important thing about that is you have to make sure that you are doing group therapy, otherwise, you can't offer that super bill for that CPT code.

And by doing group therapy, I mean, there needs to be a process component to it. You can't be doing some sort of educational seminar because then it's not really group therapy.

So, I think if you are going to offer super bills for people, you also have to make sure they have, obviously, a diagnosis that qualifies and makes sense, which, if we're doing a grief group or something around anxiety, you know, we probably will.

But I think you just have to be really clear. You have to be really clear about what you're offering, what your price point is, if you do or do not accept insurance, and then, just checking your contracts to make sure that you're doing what you need to be doing, in that regard.

I think a lot of people do still find it, depending on what your price point is, to be a worthy investment, and it just depends. And you know, kind of, thinking about both the area and what you need to make in that hour to make it sustainable for you, too. But I've seen groups kind of ranging between 30 and $65. And for some people, that's equivalent to a copay, depending on what their own benefits are. And so, that's also something to think about.

Another thing that we do is we offer at least one sliding scale spot per group, and it's essentially a pay what you can spot. So, they just kind of share what they can reasonably afford without causing undue burden for them. And then, we go with that. We do one for the first four, and then, after that, we just kind of add on whatever the clinician feels able to. But it's usually an additional two for two or something like that.

PATRICK CASALE: Yeah. So, there's lots of ways you can create accessibility for people, too. And I like that you use the reframe of, like, this is what a lot of people's copay is, and the power that group processing and group experience can offer, like you mentioned before. Like, I think the community connection piece is huge, and one that, especially, if we work with any group of marginalized human beings, especially, with any sort of intersectionality, there's always a need for connection. And feeling like I want to be around people who get it. I want to feel safe. I want to feel heard. I want to feel affirmed.

So, this is just another way to offer increased mental health safety, increased mental health support because you're going to also be offering connections that are being made that you really can't offer in one-on-one therapy. Because I know so many times, like, when I used to specifically work with addiction, I would think like, "Oh man, client A would be really good friends with client B if I could, like, just connect them in some way that wasn't breaching HIPAA." So, because they would be asking for these things in therapy. Like, "I really need a group of people who get A, B, and C. And I really need a group of people who I want to spend time with that isn't a 12-step meeting or whatever." So, I think that's really important, too.

Things that you think are important in terms of, like, how many groups are we offering per quarter? Does it just depend on how many therapists and the capacity? Does it depend on the need of the community? How are you evaluating that?

BRITTANY BATE: Yeah, I think all of those things. I always start with, you know, who at my practice wants to do a group this quarter? And kind of going from there. We've offered up to eight and filled up to eight in a quarter. We've done as few as one or two. And it just sort of depends on, first and foremost, what the clinicians want to do. But then, also, what we do see as being a need in the community.

And then, I think a little bit too like, what do I have the capacity to market? Or what does my team have the capacity to market? Because when I get my matrix going, I have to post for five different groups across these different matrixes. It is five times more times than if it's one group. And it can get really overwhelming sometimes. So, I think I also have to think about, kind of, the season of life that I'm in and if I am feeling able to be able to market that much too.

And some groups will just naturally fill a little bit faster because there is more need. Or maybe we have a waitlist already from the last group cycle that it wasn't a good fit, but we've kept them on. We've asked if we can keep them on, and we notify them next time. So, we already have, again, a warm audience for this group to launch. So, that's a little easier. But sometimes some are a little harder, and so, that's going to take a little bit more time and energy to market and to get out there. So, it really is a balance of all the things that you mentioned. And we just kind of see.

I'm always willing to give it a try as well. And if it doesn't fill I always look at it as a learning opportunity, never a failure. And we still have some folks, you know, that are interested. We've gotten the word out there, and we can then just ask if it's okay to move them to the next time we're going to be offering it if we want to then delay it to the next season.

PATRICK CASALE: Yeah, that makes a lot of sense. And I imagine there's a lot of trial and error, and then, just figuring out what works. And if something's working really well, doing it again and again and again, and just filling that need. So, that's really cool. I mean, this gives me a lot of stuff to think about because I'm like, "Man, I would love to have you come do some training for our clinicians on how to do this."

Because, I think, again, breaking up the monotony, breaking up the like, "Oh my God, I have to see six clients a day, four days a week." I don't think that feels like too much. That's where we cap our full-time clinicians. But I also would get very bored of it very quickly. And I did. That's why we're sitting here because I just didn't want to be a therapist anymore.

But, yeah, so good advice, really helpful. I know you have coaching and training on this. And I want you to highlight that because I've kind of been trying to push you into highlighting your stuff for a long time. And I'm so happy that it's here.

You're also going to be speaking at our Greece retreat in a couple weeks on how to do this, which I'm really, really excited about. And it just seems like a topic that people really need more information and support around. So, you've definitely created something really cool for yourself, and for your clinicians, and for the community. And big congratulations on that.

BRITTANY BATE: Thank you. And yeah, thanks for all the gentle shoves into the coaching and consulting world. I do really, really enjoy it. It definitely brings a different dynamic into my day-to-day that I really love.

I did a soft launch of Bold Practice Builders, that is my coaching and consulting practice. The website will hopefully be live in June. I'm just putting the finishing touches on it. I offer one-to-one coaching services. And also, a lot of products for purchase. All these products have been, I guess, born out of both a deep, deep love for organization, and spreadsheets, a deep hate for wasted time. I hate wasted time as well as a way to manage my own anxiety. So, my anxiety about posting too much, or posting on the wrong days, or being annoying, I've created, like, some spreadsheets for Facebook groups about these are the days you can post on, these are the threads you can post on. And I use that so that I don't piss anybody off, basically.

I have group informed consent templates that might be really helpful for folks. It kind of goes over all the things in the ways I do structure my groups, especially, in terms of, like, payment, and like, once you register, you're registered. That's a big thing with groups, too.

I have note templates. I have email templates. I've got a bunch of templates. I love templates. So, you can reach out to me, first and foremost, probably just @drbate, at beboldpsychnc.com, until my website becomes live. And if anyone reaches out to me, I'm happy to shoot you an email when my website is live for you to be able to take a look at what I'm offering and purchase directly, so…

PATRICK CASALE: Perfect. And can you send me that information if you haven't already so I can include it in the show notes for everyone?

BRITTANY BATE: Yes, absolutely.

PATRICK CASALE: Perfect. Well, thank you so much for coming on and taking the time. I've been trying to get you on here for a while, so I'm glad this worked out. And honestly, really excited to see where this next chapter of your career and your journey goes because I think it's super valuable.

I've met Brittany in person many times at different events. And if you are listening and you're like, "This is something I'm interested in." I highly recommend you connect with her so that she can support you or your journey in terms of running groups and moving into that private pay model as well.

BRITTANY BATE: Well, thank you. Thanks so much for having me. And I look forward to seeing you in Greece.

PATRICK CASALE: Yeah, me too. To everyone listening to the All Things Private Practice podcast, new episodes are out on every single Saturday on all major platforms and YouTube. Like, download, subscribe, and share. Doubt yourself, do it anyway. We'll see you next week.