Episode 156: Money, Burnout, and Career Transition for Mental Health Workers [featuring Angela Koivula]

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Transcript

PATRICK CASALE: Hey, everyone. Welcome back to the All Things Private Practice podcast. I'm here joined today with Dr. Angela Koivula. Did I say that correctly? I'm so sorry if that's…

ANGELA KOIVULA: Koivula, that's all right.

PATRICK CASALE: PhD, she/they, is a licensed psychologist with over 15 year's experience in the field of mental health, serving individuals, couples, and groups, as well as active and retired military personnel and wellness industries.

She has also served as an adjunct instructor at the University of Florida. Personally, she is a black and queer individual on the journey to be her most authentic self in everything she does. Her roots originate in Kansas City, Missouri, and is a lifelong die-hard Kansas City Chiefs fan.

Welcome to the show. I am excited to have you. I find it interesting, you don't have to read the Kansas City part if you don't want to, if it clings you.

ANGELA KOIVULA: All of a sudden we've become the team that people hate. You know, that's what happens when you start to do well, and you do well consistently. I don't know what that is.

PATRICK CASALE: Being from New York and like, not a baseball fan, but like, obviously, Yankee's success, I can understand it for sure. And hating Tom Brady and the Patriots so much can also understand it. But anyway, I digress.

ANGELA KOIVULA: Right. We hated Tom Brady for years. And now, all of a sudden, we're putting Mahomes in the category of Tom Brady. So, we'll deal with it.

PATRICK CASALE: You take what we can get.

ANGELA KOIVULA: Yeah.

PATRICK CASALE: So, today's topic is going to be an interesting one, for everyone listening. Angela and I met at a conference in Alaska, and we were kind of talking about, like, "What are we going to talk about on the podcast?"

And I know that you are shifting some things in your career right now, and we can talk about that a little bit, but you mentioned something that felt really interesting to me, which was, like, really focusing on the money piece of becoming a helper, and how nuanced and complex the topic of money is, and how it can really impact how we move through this career, and impact our decisions on how we proceed in our career path.

So, tell me a little bit about why this topic feels really important for you, and some of the thoughts that you have around that.

ANGELA KOIVULA: Yeah, I appreciate the kind of fluidness because I think for the last couple years money has been really at the center of everything that I do. So, why don't I just talk about that? Because when I talk to other counselors about money it brings up so many feelings.

And I think for me, when you talk about, like, even I'm in the process of kind of shifting not so much career focus, but sort of fine-tuning and money is a central factor. I built my private practice really intentionally. I've been in private practice for about five years, six, with some bumps, and I was really aware when I started. I used, oh, the practice, they helped me kind of get my practice set up. I kind of followed. I'm really good at following directions. And you know how they tell you to set things up. It worked. Kept my overhead really, really low. I think my overhead in my first year in practice was like $300 a month. I had a cheap rental space. I kept everything really, really low, and I focused on profit. I used profit first. So, money was a big part of how do you make money when you work in the field that there's not money heavy, you know, we're here to help people.

But over the last few years in private practice, I just heard people talk about, so we're working toward, you know, the six-figure income. And we're working toward all this money. And I started to slow down around, what is it that we're doing?

And when I think about how I was trained way back in graduate school, I remember doing a research study on money with clients, and we did this presentation in APA around greed and envy with money. And I'm aware that money in this field of mental health and therapy is really this taboo topic. We're not supposed to charge for what we make. It's supposed to be all about the clients, the patients. We're in service to other people. But yet, as a instructor, I'm hearing more and more from my students crushing debts. Not a lot of people talking to them about money, trying to figure out where to get student loan forgiveness. So, I'm just like, what are we doing with money? Because I feel like we're losing sight of helping people, focused on how do I get out of debt to do this thing that I want to do? And then, how do I make money without, you know, being, you know, kind of a slimy person who's asking to be paid for services, which feels weird. Doctors don't question that.

And that's really been at, kind of, the undercurrent of me thinking about, "Well, if I just get my finances in order then I can just do what I want." So, it's really thinking about the end, and where do I want to be? What will my life look like, thinking about retirement, thinking about what do I need to live? And then, I work backwards. And that's actually been the most powerful thing within beyond private practice, just my life. So, it's really, yeah, it'd be cool to just kind of talk more about that.

PATRICK CASALE: Yeah, I think it's a huge topic because you can go in so many directions with it. And there's so many feelings when we talk about money, especially, in this profession. Like you said, doctors don't question the money piece, dentists don't question the money piece, lawyers don't question the money piece, accountants don't like… I think we are one of the only professions who really struggles to even talk about money for a lot of different reasons that we can get into.

And you're right, like, when you use the word crushing debt, I felt a reaction because I have like $150,000 in student loan debt from a private graduate school in North Carolina. And the interest alone feels insurmountable. So, it's one of those things where you're like, "Yeah, of course, I want to help people." And simultaneously, like... "How do I help all of these people if I am struggling myself to keep my head afloat or above water, so to speak, financially?"

And I think a lot of mental health professionals find themselves in that boat. And then, are like, really living day-to-day, week-to-week, without any plan in place, like, without any ability to think about long-term future, like you said, security, retirement, doing what we want to be doing opposed to what we think we should be doing. I think that's a big distinction in this, is like what do I want to do versus what do I feel like I have to do? And that's a big topic, for sure.

ANGELA KOIVULA: Yeah. Well, yeah. And even as you say that, what do I want to do versus, you know, what do I have to do? I love working with my students [INDISCERNIBLE 00:07:56] taught adjunct as a profession, I didn't teach adjunct for so many reasons. But listening to them, they're so hopeful. They have so much energy, so much excitement for the work. But yet, what they'll say is, "I don't think I could take a job where I make less than $60,000 a year." And so, it's like all of a sudden, right away, what they want to do, who they want to work with, goes out the window, and they're focused on, where do I make X, Y, and Z money?

And it's really sad because I know we didn't start going into the field that way, but yet that's where we end. And then, I end up thinking that when you mentioned, you know, I appreciate that you sharing just the amount of debt that you're in. For me, I was really aware of not wanting to incur debt when I was in graduate school. And I have a great deal of, it's so funny being a black queer person also having a great deal of privilege. My undergrad was paid for by my parents, and I had no idea what I want to go to graduate school for. I just knew I didn't want to keep working the job that I was in. But I knew I was not going to go into debt for it. I didn't know why. I didn't know why I didn't want to, but there was just a part of me that was just like, "I'm not going to go into debt for this."

And for me, it became the hustle of, okay, what can I do to make money, to not go into debt? And I learned about graduate assistantships, and I became an expert in everything because I was not going to go into debt. I think I ended up taking an assistantship in graduate school, doing something that I had no idea how to do at the start of the summer, but I figured out how to do by the end of the summer when I started graduate school. And I don't have any student loan debts, which even you and I talking about money, I don't think a lot of mental health professionals talk about money, which is part of the problem because it continues to brush under the rug. And I get really concerned that mental health professionals are going to end up in the category of massage therapists, hair stylists, and feeling like they have to work until they die.

And we're not going to do this job well if our focus is money. We're going to sell out even though we said we didn't want to. We're going to be doing things that we don't want to do. And we're going to be working beyond when we need to. And I think, I fear sometimes some of the people that are getting on board with traveling therapy or saying I'm never going to be able to retire, let me figure out how to be on vacation while I work because I don't know how to take time off. So, I think we're creating another problem not paying attention to the money piece of our field.

PATRICK CASALE: Yeah, I think it's huge. And I think it's, like, interwoven within the culture of the profession, too. And I mean, I think a lot of people can relate to going through grad school pretty stressed, whether it be financially or just stressed, in general, about the experience. And then, being told by graduate school professors, like, you don't get into this field to make money. And that is kind of reinforced over and over and over again.

And then, if you leave graduate school and go into community mental health, which so many of us have done, and you make, I don't know, let's estimate 18 to $30 an hour with a master's degree working, you know, 50, 60, 70 hours in crisis environments. And you're like, "Holy hell, I could go back to bartending." I know I had that thought so many times where I was like, "I made more money and had a more comfortable life working three days a week bartending."

And I think that's the rub, right? Is like the desire to help, the desire to show up for our most vulnerable populations, acknowledging that we live in a capitalist society and the fact that our financial needs do matter and do impact our mental health and the decisions that we make. And then, ultimately, we see such a high, high, high rate of burnout in this profession where people are leaving it in droves to go do other things, it's concerning.

ANGELA KOIVULA: Yeah, I'm pretty concerned. And I think for me my biggest shift… so during the pandemic, it's so funny the pandemic coincided with, sort of, the very public, you know, upheaval of, you know, the public killings of black people and, you know, race relations and everything sort of imploded at the same time. And I'm very aware of my nervous system. When I get into sort of a fear response, I retreat. And in private practice, it's really hard to retreat. It's really hard to take time off, use a sick day. It's almost like asking myself, Angela, can take a sick day? I don't know. Can we afford to? I don't know. Can we?

So, you know, it's like I'm responsible for myself, I'm in charge, I'm the boss. But trying to figure out the money piece was really, really difficult because I knew I needed to take a big step back.

And it was fascinating what happened because… So, I'm a PhD, I'm a psychologist, and I don't think my professors in graduate school armed me really well with what that meant, meaning what it was that I could do.

Similar to you, I was taught by some of the most humanistic wonderful professors that I can name, some really big names in the field. I think they're almost all retired at this point. And they were trained in a very different time when inflation wasn't what it was. You didn't need as much money for things. So, I think there's an out-of-touchness about sort of what's happening now.

So, I wasn't focused on money. I wasn't focused on money. I was going to go into college of mental health. I remember my first job in college of mental health, I think, I was making $50,000 a year, which was so much more than what I was making on internship, which is so much more than I was making in graduate school. So, it's like, "Okay, cool."

But I remember during the pandemic, I started looking around for other jobs because, again, it's just like, "I don't think I can maintain my private practice right now." But there's not a quick avenue to get into. And I became aware of contract work within the military system. And always been intrigued by the military, I was interested. I was 20 years old now, not back in the early 2019s. It would have been a really appealing option for me, everything from Don't Ask, Don't Tell, to people of color. There's no way I would have joined the military 20 years ago. But it's a system that I enjoy.

So, I started looking at these contract jobs start popping up, and it's like, oh, you can work in primary care settings, doing not for mental health focus, but behavioral interventions for people who are struggling with sleep, eating, all these things that we know perpetuate mental health problems. I was like, "Oh, that sounds pretty cool." And the money is ridiculous. It is ridiculous. Our tax dollars are being spent by the government on the military in a really big way.

And as a psychologist, I was like, "Well, that's an opportunity that I can take advantage of." So, it was instantaneous six figures and a job that I really enjoyed. And it just turned everything on its head that why are all these jobs out here where you can make a great deal of money, one, there's so much gatekeeping, only a certain degree is allowed access to them. And why on graduate schools promoting that you can make money when you graduate by having this skill set and doing X, Y, and Z. So, it was all these things. And at the same time, hit six figures, paid off a bunch of debt, put a bunch of money into my bank account. Then I was like, "Well, so now what do I do?

Again, with capitalism, hustle, working, we're taught to make money, but we're not told what to do with our life. So, for me, it really opened up this really cool thing to be like, let me learn about this. I spent the last four years teaching myself a lot about money, about financial independence, retirement is not an age, it's just a number. What do I want my life to look like knowing that I'm almost 42 and I've got, like, this 15 year bump where, ideally, my health is at its peak, and it's only going to go downhill from there. So, I don't want to wait until I'm 65 when maybe my body's breaking down to be able to do things. So, how do I take hold of my life at this point and be prepared for what's coming? Kind of forgive myself for any, you know, financial mistakes that I made, where I might not be in a position where I want to be, and really take charge right now.

And that's been a game changer because I no longer am focused on what I do, what my job is. I just run the numbers everywhere to be like, am I on track for this? Can I afford this? Cool. I can go do this. I can take that speaking engagement. I don't want to spend money or time on that. I can't do that, this matters. It changes everything.

PATRICK CASALE: Yeah, it sounds like, you know, very thorough and intentional processing around this to really plan and to really figure out a way to pursue the life that you want to have in a way that you want to live it.

And I think so many people in this field, especially, are just like you said, they don't have a retirement plan. They're thinking about like, I'm going to have to work until I can't work anymore. That feels like my reality. For a lot of people in private practice, they are grinding away constantly. Like, clients fall off, I've got to market. I have sick days, do I take them? I feel bad canceling on my clients because I'm sick and I need to take care of myself, but then that's money that I can't make. So, now, what do I do?

And there are all these internal dilemmas about these moment-by-moment experiences of being a small business owner that a lot of people don't talk about because, you know, when we see any sort of marketing or promotion of anything, it's always the glamorous side of what life looks like, but in reality, it's quite challenging. And, you know, it can really impact your value system too, to say like, these are the things I value, these are the things I have to do to create the life I want to live. And those don't always feel like they're synchronistic.

And I like that you mentioned that a lot of grad school programs don't talk about other opportunities that you could potentially make more of a salary at because I think if more new grads went into programs or places of employment where they were paid reasonable living wages instead of being paid $20 an hour, whatever the case may be, there would not be that mindset shift of everyone needs to just become a private practice owner. I think there would be a lot more people going into places of employment where there might be additional security in terms of retirement, and healthcare, and etc., opposed to like, "I'm going to feel like a freaking Uber driver for the next 10 years while I piecemeal all of these nuggets."

ANGELA KOIVULA: Well, yeah, that's funny you mentioned Uber driver. And I think about all the, you know, private practice folks who also have side hustles, even though private practice often starts at side hustle. Like, we continue the hustle culture, and when does it pay off? And, yeah, that idea of just being, like, almost stuck without a direction, but yet starting out with one, but it's like, "Now, what do I do?

And even what you said, I think some people are making the best of it and almost saying, "Well, yeah, it's my choice. I want to go do this other thing." But I think a lot of people want to stay in this field. I think a lot of people really enjoy the work. When you mentioned $20 an hour, it's just, yeah, and I've got teenage kids at home, and they make close to that in grocery store and restaurant work. And those of us that go to school, advanced degrees with that it doesn't really compute. It doesn't make sense.

PATRICK CASALE: [CROSSTALK 00:22:56] in that situation. And I think that's the complication here is like, how does this field progress in a way that ensures that people who are moving into this space are going to also be able to take care of themselves? Because I think it's a field, and I don't want to say in generalization terms, but where we often don't practice what we preach in terms of like taking care of our own needs and our own self-care, own mental health, etc. And that's a lot of helping professions, not just mental health professionals, either. And there's got to be a way for that to shift away from the current structure because if the current structure is go through grad school, accrue debt, go into a job that pays $20 an hour when costs of living is constantly going up, and that doesn't feel sustainable. So, then you have to get a second job doing something else in the evenings or on the weekends, etc. That's not a sustainable long-term plan for most people, especially, with the heaviness of the work that we do.

And I don't know what the answer is. I mean, I know that for-profit college institutions are not the answer because those create complications in terms of accruing massive amounts of debt. And systemically, I think there's a lot that we're talking about that would really need to shift for this to be something that feels way more sustainable, all-encompassing, all around.

ANGELA KOIVULA: Well, yeah. When you mentioned about the, you know, private practice not being the answer, I think one of the biggest sadness that I feel from hearing more and more students that aren't pursuing agency work because there is a burnout model. When I think about myself and oh, just training, I was not done after graduate school. And you know, my graduate program was six years. I had to do a masters and PhD together, and then, I had a full year of internship. I had five practicums before internship, and all my classes, and I still didn't feel ready to be independent. So, the transition into a year and a half in college and mental health, continued to work under supervision, being able to live on less, and knowing how to manage money helped me do that, not leaving with a great deal of debt.

And I think I worry with so many students who are seeing, "Oh, I can make so much money prior to practice." They're skipping over developmentally what could be really useful, what's needed, getting the supports, not feeling like they're completely on their own because private practice is a fairly lonely field. And it's a big jump to go from being kind of told what to do to having zero direction. And I feel sad for the almost necessity that some students are making the jump to private practice even before licensure. So, I really think we're creating a really big problem, but yet there's continued demand for more services.

PATRICK CASALE: Yeah, I don't think the demand will ever stop, right? So, like, that's another piece of it. So, I think as our world continues to crumble in front of our eyes, and life becomes increasingly more complicated and more stressful, the need for mental health care is never going to go away, but you're going to start seeing, like, some of these marketing firms and tech firms show up and take up more virtual real estate and start promoting even more than they already are in terms of how accessible mental health care can be from the click of a button. And a lot of the times hiring people who, like, really haven't gone through any process of continuing ed supervision, training, etc., and it's just one of those, like, rinse and repeat cycles.

So, it kind of creates this narrative to the general public, like, see, this is why mental health care isn't that valuable if we're just, like, paying a subscription fee every month, and like, messaging with our therapist who I've never actually even seen their face before. Super complicated.

I think this conversation could go for hours honestly, and it's interesting because when we talked about, you were like, "I don't really know what we're going to talk about." But this is a really fascinating topic, and I'm glad, you know, to have your perspective about it because I think it shifts a lot of former perspectives of guests on here when we're talking about private practice and entrepreneurialship, predominantly. But I think it's important to highlight both sides of the coin.

So, I don't know if you're up for this at all within the last couple minutes, but I know you are moving away from your private practice to take a job somewhere else. Do you want to talk about that at all? And[CROSSTALK 00:27:54]-

ANGELA KOIVULA: Well, it's funny that you mentioned that because it's [INDISCERNIBLE 00:27:59] both. And I'm in the process of, you know, looking at an opportunity with a VA. And so, for me, when I think about jobs, I can do anything that I want. And, for me, even though I've had so much experience in the field, I like to keep learning and growing, and to have the ability to do that working within a primary care setting with the VA will help me do that, and helps me pivot in a way that I want to.

And for me, I know retirement security, you know being a queer person married to a woman, you know, queer relationship, all those things matter to me. And so, the shift is I want to like continue to see the clients that I want without the pressure to have to only do that. And I want the freedom to live my life and leaving private practice, I have multiple streams of income. I have maybe six streams of income. I'm exhausted by it, and I'd rather make the same amount of money doing one thing than doing six things.

And, you know, people talk about passive income, and there's no such thing as passive income. It doesn't exist.

PATRICK CASALE: [CROSSTALK 00:29:18] on that, for sure.

ANGELA KOIVULA: There's no such thing as passive income. You have to build it. You have to keep doing it. If you care about it, you can't just say, "Oh, it's done." It's like-

PATRICK CASALE: [CROSSTALK 00:29:26] situation.

ANGELA KOIVULA: No, it's like saying, I'm just going to rent out my house when I move and you're a landlord. So, to me, the shift is really thinking about how do I do less with work and more with my life?

PATRICK CASALE: Love that.

ANGELA KOIVULA: And that's for me the shift. Like, I would encourage every mental health professional, whatever you're doing, get out of debt. If you do nothing else, get out of debt. Cut your spending in half, and get out of debt because a six-figure income, a double six-figure income, none of that is going to impact your life if you are working for your debt.

PATRICK CASALE: Yep, agreed.

ANGELA KOIVULA: Well, that is really where freedom is. And for me, I feel the freedom to choose where do I want to live, what I want to do. And that to me, like tomorrow I know a lot of people are taking the day off, tomorrow is Juneteenth. I'm working tomorrow and I'm taking all next week off.

So, figuring out how life works for you instead of waiting for whatever system is going to tell you, you can do what you want to do, to me it might be my shift to say I want to do this, and I found a setup that they're actually providing all the things that I want. Again, it's every agency, you know, system, job is not created equal. I think middle professionals, we actually have a lot more ability to ask for what we want right now. So, do that, advocate. And, yeah, for me, this shift is about, I'm thinking about my life and not just my job.

PATRICK CASALE: Love that. I really do. I feel like that's like a perfect transition to end this episode together because that really does encapsulate exactly what you're trying to put out into the world, and I really commend you for that. And really wise advice for those of you listening to try to figure out ways to pivot, and adapt, and really reevaluate what's important to you going forward, and how you can take some control over your career's trajectory because life is really freaking short.

ANGELA KOIVULA: It really, really is.

PATRICK CASALE: Yeah, it really, really is. So, well, Angela, thank you so much for coming on and making the time. This was a really cool conversation. And I'm excited for your next chapter. And you're going to be a couple hours from here, so, hopefully, we get to run into each other more than once a year in Alaska.

ANGELA KOIVULA: That would be pretty cool.

PATRICK CASALE: Anything you want to share with the audience about your practice or anything in general? The [CROSSTALK 00:32:03]-

ANGELA KOIVULA: Oh, goodness, everyone always asks me that. So, it's like, so I have the most Google-able name. Like my name is my SEO because there's not another one that exists on the planet. So, you can just Google my name, Angela Koivula. You'll find my practice, you'll find my consulting group. It's easy to figure out what I'm doing. I don't do social media all that much, so it's hard to find me there. You can message me. It might take me a while to see it. I check it maybe a few times a week. But yeah, if you're curious what I'm doing, you can Google my name. And, yeah, that's about it.

PATRICK CASALE: Okay, easy enough. For everyone interested in pursuing that information that will also be in the show notes for you, so you can check out what Angela is doing. And thanks again for coming on and making the time, really appreciate it.

ANGELA KOIVULA: Thanks for having me on, this is great.

PATRICK CASALE: And to everyone listening to All Things Private Practice, new episodes are out every single Saturday on all major podcast platforms and YouTube. Like, download, subscribe, and share. Doubt yourself, do it anyway. I'm going to see you next week.