Episode 46: Building GROUP Practices — The Good, Bad, & Ugly [featuring Maureen Werrbach]

Show Notes

Ever considered running a group practice?

In this episode, I talk with Maureen Werrbach, group practice extraordinaire, owner of the Group Practice Exchange, and an LCPC in Illinois, about running group practices as a neurodivergent entrepreneur.

We discuss...

• the differences between running a solo vs. group practice
• motivations behind building group practices
• our own stories of the biggest mistakes (like me overpaying my clinicians by $75,000 one year) and how we handled them and learned from them
• the ethics and considerations that go into managing a group and being a leader
• AND MORE

Check out Maureen's Website: thegrouppracticeexchange.com

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A Thanks to Our Sponsor!

I would also like to thank Diversion Center for sponsoring this episode.

If you are looking to tap into a cool niche that can take your private practice to 6 figures or more, check out my guy Derek Collins at courtmandatedtraining.com. He helps licensed therapists expand their practice by working with court-mandated clients. So if you are burned out, and tired of writing notes and dealing with insurance companies, I highly recommend that you check out what Derek has to offer.

He can show you how to get paid cash every day through court-mandated evaluations and classes like anger management, domestic violence, substance abuse, shoplifting and theft prevention, and more.

This niche could be the breakthrough that you have been looking for. Go to courtmandatedtraining.com and watch the free webinar to get started.

Transcript

PATRICK CASALE: Hey everyone. If you are looking to tap into a cool new niche that you can take your private practice to six figures or more, check out my guide, Derek Collins at courtmandatedtraining.com. 

He helps licensed therapists expand their practices by working with court-mandated clients. So, if you are burnt out, tired of writing notes, dealing with insurance companies, I highly recommend that you check out what Derek has to offer. 

He can show you how to get paid cash every day through court-mandated evaluations and classes like anger management, domestic violence, substance use, shoplifting, theft prevention, and more. This niche can be a breakthrough that you have been looking for. Go to courtmandatedtraining.com and watch the free webinar to get started. Remember that is courtmandatedtraining.com

Hey, everyone, you are listening to another episode of the All Things Private Practice Podcast. I am joined today by Maureen Werrbach. She is the owner of The Group Practice Exchange and group practice extraordinaire LCPC in Illinois. I always have to remember these fucking acronyms, because they're all different throughout the country. And we are going to talk about group practice ownership, the good, and the bad, and the ugly, and also, being a neurodivergent entrepreneur. So, Maureen, I'm really happy to have you. I know you're busy. And I'm really just grateful for you to be here.

MAUREEN WERRBACH: I'm really excited to finally meet you, sort of, in person. I've seen you around a lot lately. And it's my fun first experience to actually be able to see you, sort of, in person.

PATRICK CASALE: Yeah, the in-person nowadays throughout this experience, right? Is like, can we have our first Zoom meeting and actually meet each other instead of like DMs and sharing each other's posts and pages? 

MAUREEN WERRBACH: Exactly. 

PATRICK CASALE: So, you own The Group Practice Exchange and the Facebook group. And it's been invaluable for me and my group practice journey, something I never first saw myself doing until COVID hit. 

And before we hit record, we were kind of talking about the reasoning behind getting into group practice. And in my coaching business people are reaching out all the time, "Hey, I want to start a group practice. I'm really overwhelmed with clients." I keep getting calls, I want to refer in instead of out. And my first question is always do you want to be a leader and a boss? Or do you just want to make more money. And I just want to get your take on that as, like, the why behind starting group practice, I think is really important as we're, like, scaling, and growing our businesses, and building our reputation and our brand?

MAUREEN WERRBACH: Yeah, I think you hit the nail on the head when it comes to looking at your motivations behind starting a group practice. I'll admit, 11 years ago when I started my solo practice, a year into it is when I hired my first person, and it very much came from this space of I would love to have someone else in the office to communicate with and to collaborate with. And I wasn't looking at it from a financial perspective, but I definitely wasn't looking at it from the perspective of do I have what it takes to be able to lead a team even if it's a small team? And I think that was a first big mistake that I made that turned out well, because I was willing to do the work, to learn how to actually be a good leader. And that was something that I had to do and I continue to do a lot of work on. 

And unfortunately, it's something that I'm sure you see too, a lot of practice owners don't put as much effort into, because it's not a quantifiable thing. You don't see working on yourself as a leader directly translate into money. And people focus more on that. That piece of it is hiring people, getting clients in. And oftentimes, it's not until it's too late and there's, you know, people coming and leaving, where they realize that business ownership and having a team of people is not only about income, and profit, and organizational structuring, but it's also about the human aspect of it. And you're all in leadership growth as a person.

PATRICK CASALE: Yeah, that's really well said. And I think that it's interesting to stumble on this journey and like figure out, you know, the what we don't know, we don't know, situation, and then learn and grow from that. And I guess you can either be proactive and do the work or you can kind of just dig yourself a hole and feel like you can't get out of it. And I think what you're saying too resonates a lot because you're talking about creating culture, right? 

Like, group practice is about the culture that you create, because so often we kind of recreate our agency environments for some reason, as therapists, I guess. It's probably because we don't have a lot of business training or understanding. And all of a sudden, we're seeing too many clients, we're feeling burnt out, we're feeling resentful, and maybe we're considering going back to bartending at Apple Bees like I've considered many times in my life. 

And I think that, you know, for me, I have an all telehealth group practice. We have whole therapists and psychiatrists. And at this point in time, it's been about a year of being open as a group practice. And the culture is so important for me, because I want people to feel supported, I want people to feel like they have teammates and camaraderie, even if they never meet each other in person. 

And for so many of us, I think we feel so isolated and alone in private practice ownership where you're like working, seeing clients, adding to the end of the day, you're like, "I haven't even talked to anybody like I can't even think straight anymore." 

And I think that very often, like, "Why would somebody join my group practice if they could start a private practice?" I'm sure you think that or talk to clinicians about that. And the answer that I so often hear is that they want teammates and camaraderie, and to feel like a part of something. And also, a lot of therapists just don't want to do the behind-the-scenes work to get their businesses up and running.

MAUREEN WERRBACH: Yeah, when people ask that question, which is a very common question to ask is, why would someone want to work at a group practice? My initial go-to response is that that's a very typical response that an entrepreneur would make, you know? Because we obviously don't want to work for other people, but that's not what kind of the average person is thinking. The average person doesn't want to own a business and wants to be a part of something bigger, and that's also then were having a practice that has mission, and values, and, like, goals for how it's going to engage in the community can be a real asset to employees finding a space that really aligns with who they are and the type of work they want to do. 

And so, I always say that's a really valid question to ask, because you're an entrepreneur, you don't want to work for someone else. But most people, even if it, in our industry, feels like everyone wants to be a solo practitioner, it's not true. It just feels that way, because that's what we're looking at. 

But there are plenty of people who want to work in a group practice, but they want to work in one that allows them the flexibility to practice in a way that aligns with who they are and they want to give back to something that's bigger than themselves.

PATRICK CASALE: Yeah, I couldn't have said that better myself. And I think you're right. You know, as entrepreneurs, we often can have that tunnel vision of like, everyone operates this way, everyone moves through life this way. And that's just simply not true. And I think about mine, and I'm like, well, of course, someone would want to leave an agency job or come out of grad school and work here if we create a culture that feels supportive and in alignment with values, like you said, and really working in the community to kind of support the causes that we support. 

And I also think we often lose sight of the fact that people want to be led a lot of the time. I've been in leadership roles all of my life, whether it be in community mental health, on my soccer teams, it doesn't really matter. But I realized more and more people want someone to kind of take charge and make some of the decisions that they really don't want to make. 

And a lot of my clinicians really just want to show up, and see clients, and like, they're very satisfied with having autonomy to work the hours they want to work and take vacation when they want to take it, because that's something that I really value, I travel a lot. And we can either create a culture based around like, money, money, money, money, and I'm not saying we don't make money as group practice owners, that's certainly has allowed me to step away and focus more on coaching, but like, my value system is more, so I want to pay people really well, especially, those that want to show up, and do the work and, you know, really invest in being a part of something that I feel, like you said, is greater than ourselves.

MAUREEN WERRBACH: Exactly, and so, for anyone who's in the process of looking to bring on their first clinician or even a very established group practice owner who might be listening and is struggling to find therapists for their practice, which is right now, I think harder than it usually is, just that reminder that we're in this interesting space where it can feel like there isn't anyone, but I foresee that shifting really soon. And I think it's also an opportunity for us to pause and look at how our practices are showing up, how they're being presented to the outside world. 

I know we've made in the past couple of years a lot of shifts to even like what our website looks like and not visually but in terms of how we're communicating who we are. And that's led to us receiving a lot of applicants who really align with it. It's almost similar to niching. You know, a lot of people talk about niching in private practice, and there's a whole group of people who are really afraid of niching, because they feel like they're leaving out a lot of people. 

And similarly, that same thought process can sometimes happen with group owners who, when they really make their values, and who they are very well known that they're afraid that it's not going to attract people who maybe aren't fully on board with those values. But in their heads, they're just thinking, "I just need to hire people, that almost doesn't even matter."

And in those instances, I say, let the people who don't align with your practice and your values, or your needs as a business owner, don't bring those people on, because those tend to be the people that are the first to leave, or cause issues, or cause resentment in you when you see that they are not what you're looking for. But it will definitely create opportunities for people who are looking for exactly that to gravitate to your business.

PATRICK CASALE: On this podcast, so often, I have so many great guests where I'm like listening, and I'm like, "Hey, I don't even know how to respond, because you just said everything so perfectly." But you're so right and I think that people are scared of niching. And whether it be in private practice, whether it be in group practice, because it's like, "Oh, I just want to take anyone and everyone, because I'm kind of desperate for either client referrals or staff to come and apply." 

And you're right, like if you're doing that you're probably not going to keep people very long if you don't really understand, like, who you're serving, and what your values are, and how you show up as a practice. 

So, I want to just speak to what you said about a lot of groups, like, struggling to find clinicians. I have never had that problem. And maybe I'm just lucky. But I get probably 10 applications a week at the point where I'm like, I look at them, and I just throw my hands up, I'm like, "Nope, not responding to this right now, I don't have the energy to hire someone else at the moment."

But we know who we are and we always have. And we've always been a very authentic, real, show your tattoo, show your like pink hair, curse in your content, you know, and that attracts clinicians who are like fucking, thankfully, like, a group exists where I can be me. And I don't have to, like, censor myself. And I can just show up and serve the clients that I really want to serve. 

And our clients are like, we are very inclusive, so it's a lot of the LGBTQIA population, it's a lot of the BIPOC population. We work from a harm reduction standpoint. Like, we want to be as ahead of the curve as we can be in terms of how we work and operate. And I can't tell you how valuable that is for me, because even in the stressful days where there are plenty of them, and I'd question every decision I've made as a business owner, I love my staff, because we've attracted the right culture. We haven't had turnover, which I know is unusual. And I'm sure it'll come eventually. But we have a group of like-minded professionals and my staff and my group is not for more conservative-minded human beings or therapists. Like, we curse in our content. 

My marketing person was like, "I don't think you should use the word fuck on your homepage, you're going to turn off, like, conservative clients and therapists." I was like, "Good, I don't fucking care. Like, those people are not for us anyway."

MAUREEN WERRBACH: Yeah, you know, one of our values has always been around anti-racism and anti-oppressive work. And over the past five or so years we've really worked at not only having that as a value, but looking at like, how are we making sure that our clinicians live that value, because having a practice have those values, but the clinicians not independently adding having those values means the practice doesn't have them. 

And so, we have a really sort of rigorous application process where we're screening for people who actually have done anti-racism work, not only just agree, which is something years ago we would say, you know, in our application, these are our values, these are our requirements, and then, we would say, like, are these values in line with yours? Is the value of anti-racism work and anti-oppression work in line with yours? And it was like this, yes or no. 

But we even found that that wasn't enough, because most people aren't going to say no to that, but it doesn't mean they've done any work. And so, you know, over the past maybe three years or so, we have where we're asking, like, what is your history around anti-racism, anti-oppression? And it's like open text, and this is just during the application, we haven't even seen them yet. 

And, you know, that has the potential, obviously, similar to your example to have a lot of people that not applied and maybe haven't started doing that work or aren't interested in investing extra time to do that self-work, but we're okay with that, because what it's also then done is it has brought in so many people that are doing that work who value the fact that this practice really, like, does what it says, like, lives it. 

And it's also created a space for marginalized communities to apply to who then feel safer coming in into a business that's owned by a white woman, because they know that that's something that is part of our everyday communication, so it's just a matter of not being so vague, you know, and just saying, "We're a group practice and we serve people, would you like to be here?" Because that does not feel inspiring, you know.

PATRICK CASALE: That doesn't make me want to apply. And you're absolutely right. And also, what that does, right? Is like you're also ensuring that those people who don't want to do the work, who don't agree to the work aren't going to apply, because ultimately, they're not going to fill out the short answer text to say, like, yes, I've done this, yes, I agree to this. They're going to say, like, "Oh, this isn't the practice for me." And that saves you time. And it saves them time. And it also ensures that the milieu or the culture stays very consistent and in alignment. And it's not as disruptive if someone's like, "Oh, I actually don't agree with this conversation that we're having." Not that I want an echo chamber, but I certainly want people who are on board with the mission. 

And what you're saying also translates to solo practice owners. So, if you're out there, and you have a solo practice, or you're thinking about starting one, understanding who you serve is really crucial. And it doesn't necessarily have to be I only work with population A, B, and C, but you have to understand what your clients are experiencing on a daily basis, and what is making them pick up the phone to call you. 

And if you don't stand out, especially, in an era where we're more online, telehealth-based, people are making decisions based on online marketing, and website design, and content that you've wrote, why the fuck would they call you? Unless they're just desperate, and they've called 20 practices, and they're just waiting for someone to call them back, I would not pick up the phone and call someone who doesn't know who they work with. And that is the same thing for a group practice who doesn't know who they want to hire or what kind of culture they want to have.

MAUREEN WERRBACH: Yeah, exactly. So, tell me, I'm flipping the script now on you. But you mentioned in the beginning, the good, the bad, the ugly, what are some of the bad and ugly so far for you? Since you're, you know, a year, a little over a year into it?

PATRICK CASALE: Yeah, I love talking about the bad stuff, because I think we don't talk about it enough. And we're almost, like, we feel ashamed to talk about the dark sides of being a human or being an entrepreneur, and a lot of my businesses, my coaching, my group practice, my retreats, my podcast was like flying by the seat of your pants, so to speak. 

Basically, what I did was download a lot of your stuff from your membership. And I can't say enough about Maureen's membership. If you want to group practice, buy the fucking membership, invest in the monthly cost, because it is so, so, so invaluable, and she is not asking me to plug this. 

However, I bought that. And I sat on it for months. And I had a friend in town who was like, "Hey, man, I want to come work for you." And I was like, "Why? Like, I do private practice coaching, help people build their businesses, I'll help you for free. Like, you're my buddy. Like, I don't care." "No, I want to have teammates, I want to come work for you." And I'm like, "You're about to get a PhD man. Like, I don't get it."

But anyway, he was my guinea pig. And we stumbled through a lot together. And I'm really grateful he pushed me. But we made a lot of mistakes together, too. Granted, he got full in a month, which then created my mindset of like, "Oh, I could probably do this again." 

But I've hired a lot of friends. And I know a lot of people would be like, "You shouldn't have done that." But I think that I've created a culture that it works. And my clinical director is one of my best friends. She tried starting a private practice on her own the same time I did in 2017 and she failed miserably because she couldn't do the marketing, and the networking, and sometimes the billing. Jen, if you're listening, I love you. But it's been wonderful, because she is such a good clinician and such a great supervisor, and I can't say enough about her. 

However, like there are growing pains. I hire two people, they get full. Okay, now you're onboarding again. And I always feel this, like, I feel this overprotectiveness of our clinicians and I feel like responsible for them to be successful. And I stress when calls aren't coming, or they're not converting, or whatever the case might be, I feel very invested. So, that's been something that can sometimes keep me up at night, working a few policies, procedures, admin staff. 

I've had so many bad admin staff, like one receptionist and office admin who wasn't answering phone calls. And I had throat surgery last April, and I was laying in the hospital bed watching calls come in, and come in, come in, and I text her I'm like, "I can't speak, because I just had throat surgery. But why are you not answering the calls. Like, I've seen like 20 today?" "Oh, I didn't see any of them." Had to fire her. 

Had another admin that replaced her who quit via text message, because she just didn't want to do the work anymore, and text me at 6 pm, "Hey, I'm done. I'm not working here anymore. Thanks for the opportunity." Which was a day before a wedding I was going to, which then put me I'm back in the admin seat of like answering calls and scheduling.

So, we've ironed a lot of that out. And, you know, thankfully that's been a blessing. Some people would probably say that I pay my clinicians too much. My bookkeeper and my insurance person are like, "Do you want to make money?" But I believe in paying them well, because I think that creates more investment in the business, more loyalty, and also, better work quality. So, I can make enough money to offset being a private practice clinician and focus more on the other things I want to do. 

Now, here's the biggest mistake I've made. And I've talked about it publicly, but I overpaid my clinicians by $75,000 last year. And the reason for that was, I had a lot of shame about this, but I'm okay, I've worked through it. And what happened is we use two different EMR systems. And we use SimplePractice for our clinical side, my biller and credentialing person uses My Clients Plus, because the reports are just more accurate in that. I was cross-referencing them. It's not a great system. So, I've improved that since this time, and then, just doing percentages off of that. 

And what I didn't realize is that her system doesn't just include insurance payments, but it includes copays and deductibles as well. I assumed it was just insurance payments, I never asked, because I was again, starting this without any real direction or understanding. I double-paid all copays and deductible collections that year. And I had the choice to either ask my clinicians for the money back over 12 months, which is what a lot of people told me to do. However, that is not in alignment with who I am. I had to reframe it to a mistake on my end that I could not ask for that money back because it was my shit to own. And I looked at it as bonuses for very hard work in a very hard year. 

And we talked about it at our team meeting. And I let them know, like, clearly paychecks are going to look differently this year, because some of you got paid like an extra $12,000. And I think that was another example of my own leadership within the business where they were really appreciative of the transparency. And they were really appreciative that I was not asking for that money back. And so many people told me that it was my money, I need to do that. That's a lot of money, blah, blah, blah. And I was like, "I already paid it. I wasn't even thinking that I had it." So like, I don't look at it that way. But that's one of the dark sides for sure. That was a rough one to swallow.

MAUREEN WERRBACH: I bet. But I agree with you, I would have done the same thing. And I think it also helps not only… I always find airing out mistakes you make within your business to your employees is really helpful, because it, one, lets them know that you're human, but it also allows them to make mistakes without being afraid, because we all do. And that's how we grow from them. I feel like the reason I am where I'm at in my business is because of the mistakes I made, not because of the luck I had. 

But I feel like it probably also, in you being transparent about the mistake and clear about the fact that you double paid and aren't taking it back probably increased their trust in you in decision making, especially, around finances, because you, you know, were able to be giving in that scenario and not ask for that money back. And so, like, they just probably have a sense of, "He's not trying to screw us." which I know happens a lot from employees in group practices, is there's this assumption that group practice owners are multimillionaires just sucking out all the money out of everyone. And this is like one of those scenarios where they are, like, "He made a mistake that benefited us. And he's not asking for it back."

There's some integrity in that and likely they feel like they can feel safe with you and trust you when it comes to the financial piece.

PATRICK CASALE: Yeah, for sure. And it felt like a fucking gut punch at first, you know? And I speak very openly about my history of having a gambling addiction. And I think if I wasn't so far along in my recovery, that would have sent me into some sort of spiral of like, I've got to get this money back somehow. 

Thankfully, I just was upset with myself, watched Game of Thrones all night, and then, the next day, I was like, "Yeah, whatever. It's fine."

MAUREEN WERRBACH: Game of Thrones?

PATRICK CASALE: I mean, I've been binge-watching it since the pandemic started so I've probably watched it now, I hate to admit, like 10 times, and anytime I turn it back on my wife is like, "Please, no, I don't want to hear that theme music anymore. Just stop." I'm like, "I can't stop." I always turn it off by season eight though.

MAUREEN WERRBACH: My two cats are named after Game of Thrones characters. 

PATRICK CASALE: Are they? What are their names? 

MAUREEN WERRBACH: Khaleesi and Tormund.

PATRICK CASALE: I love Tormund, I really do. And I love the Hounds character. I love all the character development until they ruin it all and like, but I do love that show. And you can see, like, my Hobbit picture behind me. I'm very into fantasy. I think it's always been good escapism, too. 

And that couldn't be a good segue into what we were talking about as being like neurodivergent business owners and entrepreneurs. Like, I think I realize sometimes on stuff like that to feel inspired and creative. And I think that's why travel for me is so important, because I get stuck. And then, as I'm in movement, and in like new environments with, like, new sensory overload and stimulation that kind of unlocks creativity for me and that's really powerful.

MAUREEN WERRBACH: I never thought about that for myself, because before we started recording, I was talking about how my creativity is sparked when I go on work vacations. I call them workations. And the biggest thing for my workations is that I have to be in, not only a new environment, but it has to be visually stimulating for me. And that actually helps me be focused. It's a very weird combination. But it's interesting that you said that, because I was like, but I never even tied that in with my ADHD.

PATRICK CASALE: I think it seems counterintuitive, right? Like, how people with any sort of neurodivergence go through life where it's like, oh, there's so much energy absorption, I struggle with certain sensory overload. But at the same time, when it's new sensory overload it's exciting, and it's stimulating, opposed to like, overwhelming. 

Now, if I was to go do that here, in a really loud group or environment with people I know, it would be very different. But for me to, like, be around strangers, or like one or two people that I really enjoy being around in a new environment, that's where I flourish. 

And my Ireland retreat was that way. Like, it was exhausting hosting it and it was depleting. But like, being in Ireland, being around, like, the scenery, and the backdrops, and the accents, and like, the music for me, that was, like, where I felt most alive and connected. And as someone who, you know, is autistic and ADHD, connection can be hard. 

But in those environments I feel most like myself, I think, and that, for me is really powerful. And it's always been a major component of my business and just my creativity, because if I'm sitting in my home office like I am right now, I have a very hard time, like, getting out of my way.

MAUREEN WERRBACH: Same, when I'm here, where you see me right now, well, it's my kitchen, dining room area, our living room area, but this is where I work. And I am the least productive here, because I get up, I walk, and then I'm like, "Oh, I have to pee." I'll go get up, go to the bathroom, then I sit back down, and I'm like, "Okay, now what am I doing?" And then, I go, "Oh, my coffee is full. Let me go warm up my coffee." I don't know how many times. 

I literally had my therapy session right before you, like, my own therapy. And I tell her that's probably because I lose my camera over so I can get up and go to my… I warmed my coffee up, I think two or three times in the one hour, just getting up, and moving my camera so she could see me. 

But when I'm in a different environment, where I can just visually, like, look up from my computer, and see something beautiful, and new, which is why I love Asheville for me, because I'm in Chicago, and it's flat and boring. When I go to Asheville, and I can see the mountains, I literally just need a room that has mountain view, and it's something as simple as that inspires me, it keeps me locked into my work, and like, all I need to rejuvenate myself is like look up from my computer screen for a few minutes, see the mountains, think about what I'm working on while I'm looking at the mountains and I can get right back into it. 

So, it's become probably for the past five years one of the ways that when I have real big work things to do, I just save it, and give myself like a four-day weekend to go somewhere else to get that thing done, because I know I'll be most productive there.

PATRICK CASALE: I love that and it's so spot on. And again, I think for people who are neurotypical that feels really strange to think about, like, how can you be more focused when there's different sensory overload, when you're always overloaded by sensory, you know, stuff in general, or like distracted, or scattered, because I can't tell you how many times in my house I, like, go downstairs with something in my mind, then I let the dogs out, then I pee, then I maybe get a drink out of the fridge, and then I'm like, "What was I doing?"

I don't even remember like the message I was supposed to send, the thing I was supposed to do, then I leave something on the counter, and I'm like, "Where did I just put that?" And that's like the behind-the-scenes stuff that a lot of people don't see when they're like, "Oh you guys are successful." But like so scattered in a lot of ways. And I think that's just a beauty of the brain type too, of like yeah, so scattered but then, can be so beautifully creative in situations and like, thinking outside the box, and really working on things in a different way. And like you said, like, seeing the mountains, and being able to ground, and settle because it's something beautiful, and it feels inspirational, and you can take it in, and then, you can get back to it. 

I'll go on those trips, and I will get major hyperfocus and tunnel vision. And then, in like three days I've created something, and I don't even know that it's been three days, and it almost feels hypomanic in some senses. I feel like creativity, inspiration, spark, right, right, right, right, right, create all these ideas, message my VA, my VA says, "Stop sending me more fucking ideas for now." And then, like, put them all together. And it's really wonderful to witness. 

And there's a depletion part of that too, because if you're going places, right? To feel that creativity and to get away, coming back to reality can be hard, because you're like, "Oh, this feels monotonous, this is boring." And I think for people who have any sort of neurodivergence, boring is painful, and we need stimulation all the time. And it gets so often confused with workaholism and grind culture. And that's not what it is. It's like, stimulation is life. And I think if we don't have it we feel like we aren't doing anything, because our brains are shutting down, or they just don't feel useful for us at that moment.

MAUREEN WERRBACH: Yeah, I want to say two things to that. One is my daughter's autistic and ADHD. And when she [INDISCERNIBLE 00:31:24] and she was first born, I remember, she stims a lot, even now. And I remember as a young kid, when she was young, like, six months old, it started to maybe a year and a half, when we really were trying to figure out, you know, how we can support her, and I remember thinking, like, it feels very stressful, the stims that she does, because she holds her breath, she shakes her head. She tenses her, like, fingers in front of her face, and like, holds her breath. 

And I remember thinking like that feels like it would be really stressful on the body, and now as she's gotten older… So backup, you know, we did a lot of work to help figure out, like, how we can support her, and learning like the stim. Well, she wasn't diagnosed with autism at first, because with girls they tend to not get the diagnosis till much later, so she was diagnosed with complex motor stereotypy, which is for neurotypical people who have stims, because obviously, stims is one of the criteria for autism. But later, she ended up being diagnosed with autism. 

But one of the things was let that go, don't even acknowledge that, like, allow her to do that, but she does it most when she's bored, because it's like a way to stimulate herself. And it's been really awesome as she's gotten older and been able to talk about what the stimming does for her and like, how cool her imagination gets when she's stimming. Like a whole other world opens up to her, so just on like another note around neurodivergence and like, the need for visual stimulation, and how, I mean, she's the most creative person I know, because when she's in that mode she creates the coolest things, the most awesome drawings and things like that. So, that's as a one-aside. 

But I think also, your point, the thing I'm most good at is the visionary side of my business, because that is where my creativity is allowed to be sparked, where I can get bogged down by the minutia stuff, which is why I have delegated so much. I can drop lots of balls when it comes to responding to emails, or like the things that are not sparking creativity and joy whereas like, my ex-husband is my best friend. So, I always use him as an example, because he's the opposite of me. He loves the small details, like, checking off lists, the responding to emails, or scheduling that doctor's appointment where those things all fall to the wayside, because there's like, not sparking these things in me. 

But when I get to do the visionary stuff that's where like my mind gets to go into all these creative modes and all these ideas come up. So, it's kind of similar to what you were bringing up in Ireland. And if I can just do that, I'm in kind of my zone of genius. 

PATRICK CASALE: And that's probably how you've created everything that you've created too, is being able to harness that as a superpower. And, you know, the things that we don't want to do, right? Like, we feel like we have to but that's why outsourcing is so damn important and having a good team around you, and that, you know, circling back to when you said, like, the hard parts of group practice ownership. 

I am someone who likes to be really responsive. But I hate responding to calls, and emails, and messages, but I do it anyway. Now I have a great, like, admin staff, and I can just trust that they've got it. And I don't have to worry about it. And it gives me more time to focus on the things that I love. 

And I think so many therapists don't understand that outsourcing is so crucial to business growth, because it allows you to spend more time in that zone of genius or in that creativities headspace and working on the things that are not only going to bring you more revenue, but ultimately, you're going to feel more fulfilling and more energizing. 

And I think therapists, as you know, traditionally are quite frugal, and don't truly understand the financial investment in business ownership. So, for me, that has really created so much immense growth, because I have a team of people who have been able to help take my ideas, write the visionary piece, and actually put them into action, because without that they're just ideas for me. And then I get lost in the, like, implementation phase of, like, okay, logistically, how do we make all this shit happen? So, it's just really neat how that happens.

For anyone listening, you know, I know some of you may be thinking, like, "Oh, I don't have enough money to travel." It doesn't have to be, you know, extravagant. It can just be take yourself out as a tourist in the town that you live in, get an Airbnb, get a hotel if you can for a night or two, and just get in a different environment, because I promise you, it will harness and kind of shift the energy that you have and act as a catalyst. That's why I travel so often. 

MAUREEN WERRBACH: I will even say, even if you don't have enough for an Airbnb, I have found finding a cool new coffee shop can do just as much for me too. Like, I really enjoy coffee, like not coffee, I don't drink coffee, but like Starbucks' smokers. And if I know I can't, because I have kids, and you know, sometimes I can't just get away, just looking up like a cool new to me coffee shop on another side of my town that I haven't been to that maybe in the summertime has a nice outdoor area is enough for me to spark my creativity. And that costs no more than a cup of coffee and a drive.

PATRICK CASALE: Yes, that is excellent advice. And I feel the same way. And again, I think it's like a smaller scale version of different environment, and different sensory overload, and stimulation, but in a good way. So, even being in a coffee shop around all these people who are working, or talking, and you're not talking to any of them, you're absorbing the energy, but it's also helping you focus, because that's how the neurodivergent brain works is like, sometimes I need to be distracted to focus, if that makes sense. 

And a lot of people probably don't get that. And that might sound just absolutely fucking bizarre, but like, I'm in a divergent mastermind group on Mondays, and I made it known early on, if I'm looking at my phone, if I'm on my email, it is not that I'm not listening to you, it actually means that I actually am paying attention, because that's the only way I can do that for an extended period of time. 

MAUREEN WERRBACH: My daughter, it's similar. When she is stimming it feels like there's no way you're paying attention, there's no way, she can't be. And it was an issue when she was younger in school, because the teachers would try to tell her to not do it, and we would say, like, don't point it out, because it causes shame, and we want her to not have to withhold the stimming until she gets home into a safe space, just like leave her alone. 

And we learned early on that she actually hears every fucking thing that we say. We've tested, we're like, "Lily, what did I just say? While she's [INDISCERNIBLE 00:38:34]. And we're like, "Great." We don't have to worry at all about the fact that you might be distracting yourself with something else. Similar to you, when I'm on my phone I can listen at the same time. It's like, I don't know how to explain it, and sometimes it feels like it could be rude, you know? Especially, if I'm with another person who's talking to me and I check my computer or I get on my phone at the same time. It's almost like either they're talking too slow, and I'm going too far ahead. So then, if I get on my phone I'm like at their pace, you know, and I don't interrupt them then.

But I remember as a kid, I listened to music while I did my homework, and my parents were like, "How are you able to pay attention?" It's like, "I'm not actually singing the songs or I just need to hear other things on the other end of the spectrum." There's certain noises that like will totally distract me in a horrible way like your-

PATRICK CASALE: Fire truck, stuff like that. 

MAUREEN WERRBACH: Yes, if it's like loud and unexpected or not consistent, or if it's like people chewing next to me, then I'll put my headphones in and put music on, but the visual part is always good for me. 

PATRICK CASALE: It's such a great way to frame that too. And for anyone listening that, you know, is considering maybe I have some neurodivergence, maybe I have ADHD, ADD ASD, whatever you want to call it, it doesn't matter. But at the end of the day, there are really cool coping strategies. And it's not going to look the way it looks for everybody else. They may say, like Maureen just said, "You're being rude, you're not paying attention." But in reality, you're actually doing what you need to do to slow the brain down so that you can focus on what's important, because our brains can be going a million miles a minute, a lot of the time, and we have our own ways of grounding, and just connecting, and it doesn't have to look the same for everybody, and it won't. 

So, just try hard not to shame yourselves if you feel like, you know, you have to act differently in social situations, or that's just the way that you calm yourself down. And I know embracing my neurodivergence has been life-changing. And it's also felt really powerful and empowering. So, it's been a cool journey so far, and definitely, excited to see where it goes.

This has been a really fun conversation. And I'm glad that, you know, another good representation of the podcast is just, I don't have structure, I don't have flow, I had no idea what we were going to talk about. And I felt like that was a really awesome segue and conversation, and I just appreciate you having it.

And I want you to just tell the audience where they can find more of you and what you have to offer. 

MAUREEN WERRBACH: Oh, yeah. So, for anything group practice related, I don't do any solo practice coaching. But for group practice stuff, you can go to thegrouppracticeexchange.com. And every year in July I host a conference usually in Chicago. I'm not as brave as you to hold things in different countries. In my hometown, it's overwhelming enough to host a conference. But in July, it's a business conference. It's not clinical-based. It's only business related, for group practice owners. It's the Group Practice Owners Summit. You can go to grouppracticebuilders.com to look at who's speaking at the summit. So, we'd love to see you there. 

PATRICK CASALE: I will, yeah, so I can see you there too. I'm really looking forward to that. And it's another good example of like, I didn't foresee my career going this way or being in that room, or connecting with you. It's just really cool when you start putting yourself out there and allowing yourself to be creative and knowing that you can make money in different settings and situations with the skills that we have that don't require 60-minute increments of your time and being in the office. 

So, for everyone listening, I hope you can embrace that and just check out Maureen's stuff. Like I said, it's invaluable and all of that information will be in the show notes. And I just really appreciate having you on today. 

MAUREEN WERRBACH: Thank you so much. 

PATRICK CASALE: For everyone else listening to the All Things Private Practice Podcast, you can listen, download, subscribe and share on all major platforms and continue to delve into the motto of doubt yourself and do it anyway.