Andrew Burdette 00:00:00  The Grove Group Practice Podcast is part of the practice of the Practice Network, a network of podcasts to help you grow, manage and promote your business and yourself. To hear the other podcasts like The Practice of the Practice Podcast, go to practice at the Practice Network. You're listening to the grower Group Practice Podcast, a podcast focused on helping people start, grow, and scale a group practice. Each week, you'll hear topics that are relevant to group practice owners. I'm Andrew Burdette, a practice owner, and I love to hear from people. Their stories and real life experiences. Let's get started. Hello and welcome again to another episode of the Grove Group Practice Podcast. This episode I'm here with Justin Johansen. He's one of the founders of Broward Therapists, a group practice located in plantation, Florida. Welcome to the show.

Justin Johansen 00:00:59  Yeah. Thank you. Thanks, Andrew. Glad to be here.

Andrew Burdette 00:01:02  So I always like to ask people to give a little background about, how they ended up here and in their careers and doing what they're doing now.

Andrew Burdette 00:01:10  So what's your backstory?

Justin Johansen 00:01:13  Yeah. For sure. So I would imagine, like most, therapists, you know, you tend to go through something personal. And, for me, it was, you know, the family death and just some family chaos. And I moved out at a pretty early age. And what sparked it was wanting to help families navigate that chaos without having some big, dramatic, unnecessary cut off, if possible. so that's what sparked the whole interest in family and family therapy. back in the day, that's what got that moving. And then the practice itself, we've, we're a group practice. we've, like you mentioned, we're in Southeast Florida and we've got two locations. There's 22 therapists that we work with and I believe, and there's four, for a kind of management team, a full time, client care coordinator, and then three different, medical billing, you know, people that we work with, too. so we've definitely we've grown over the years. when we first started, my first partner, Hilda and I, we started going into people's homes.

Justin Johansen 00:02:30  before we took insurance and everything. We didn't want to take a loan out, so we were doing in-home therapy for about six months, and then that stopped, and little by little, just got bigger and bigger.

Andrew Burdette 00:02:41  Got it. So when you were starting out, in hindsight, because doing any of the business building is always a journey. And so there's always that and just life in general. I'm a developmentally oriented person, so there's always that. If I'd known this, then I would have maybe done something differently. So getting started. What were some good lessons that kind of helped you into that next growth phase or developmental phase in your business and practice?

Justin Johansen 00:03:07  Believe it or not, the first answer that come to mind is slowing down. there's a back in the day, there was this big sense of pride and doing 30 sessions this week, you know, a little bit of a selfish pride. Like being able to tell the loved ones and family. I did 30 sessions this week, and, you know, and on top of loving just the the clinical component, there was a few reasons, but doing between 27 and 32 sessions a week for, you know, X amount of years, it's like this.

Justin Johansen 00:03:43  It's, it's this illusion of some kind. It feels like that alone is I'm growing, I'm growing. It's good things are going well. And I'm not saying they're not. But in doing that 30 sessions a week, the amount of things that I was not getting to were off the charts. So, Obviously money is always an issue. So I was concerned about it. And, that was one of the also one of the many reasons for that many sessions. But looking back, I wish I would have capped myself at like some 22 at the most. Devote your time to something else. Even if the bank account isn't looking too hot. Slow down. That's what I wish I would have done. Probably a good 1824 months sooner than what I did.

Andrew Burdette 00:04:27  Yeah, there's it is that gung ho energy that kind of fizzles out and like the longer you do it. So we were talking a little ahead of the show about things like burnout and stuff like that. So I'm curious like, and there is that, hey, look at me.

Andrew Burdette 00:04:40  I can do all these things and, look at how awesome I can do, you know, 35 sessions. And it's like a badge of honor, I guess if you're working in, like, community mental health or like the VA or something like that, and those types of institutions where quantity really matters that level. But, I know a handful of people in private practice that probably see 25 plus people and it's sustainable for them, but they're a unique kind of individual type to be able to do that many sessions therapy wise. And, when you were kind of realizing, like, hey, 30 sessions a week isn't as I can technically do it, but it doesn't feel good because I'm not well-rounded, like I'm missing on my family time, fishing trips, vacations, whatever it is. How did it feel like or what did you kind of notice about? Like, hey, this really isn't working? Was it like, hey, 50, 60 hour weeks? Like, is it enjoyable? Is it for me? Like it's less about the number of hours that I see clients and more about the number of sessions in total number of clients.

Andrew Burdette 00:05:41  So six clients or six clients. If we did six half hour sessions, it's still six clients. And that's kind of how my energy relates to that type of work. So how what were some indicators that you needed to shift?

Justin Johansen 00:05:53  Some of the first indicators that I remember feeling was definitely stress, but not stress related to the clinical piece I've always loved, you know, very model heavy. I've always loved learning about different ifs or narrative, just anything. So the clinical piece that that never really started to get stressful. It was getting done those 25, 30 sessions in that particular week. And obviously physically you're feeling a certain level of tiredness, but the stress started to really stand out when it was text messages that I didn't get to. Client sent an email on a Monday. Sometimes if you're so busy, I would see the email and unfortunately not actively avoid it until, you know, I would convince myself I'll get to it on Wednesday. It didn't happen. So there were these. You know, you could.

Justin Johansen 00:06:53  One could say these customer service elements that started to not go so well. So I definitely felt a different level of stress that was more of like, there's a business developing here, whether I like it or not. There is, you know, whether I want to admit it, like it or not, there's a business that's developing and I just felt stressed with charging clients co-pays. 5 or 6 days after when I should have. so the admin stuff was piling and that was so stressful. And it's funny, these different waves in the early days, you have these waves. In the early days, I was convinced since I'm working till 8:00, three nights in a row, I'm going to make sure my next day doesn't start till two. And I did that for a little bit, right? Probably like a couple months. Thinking that was helping. In some sense it was. But that had to stop to So those were the indicators that stress was building of neglecting the admin work. And to answer the part, what I think you're asking about the, the burnout reference, at some point I had to do a hard stop weekend sessions.

Justin Johansen 00:08:10  They just stopped all together. And I used to work with a lot of kids, so I would load up on weekends, to see the kids and their families. Weekends came to a screeching halt. that was a big help. And then little by little, I. I made sure that Fridays around 430 was also kind of like a screeching halt. Now, if there's an emergency, if something payroll related is pending. Yeah, I gotta suck it up and we have to go work Saturday morning, but that's that's not too terribly common anymore. So I had to do these hard stops. I, I was never good with balance. You know, some folks that I know, they can work till 9:00 and it doesn't bother them. Start the next day at 11. I'm a bit more rigid, so I had to do those black and whites. no stop or hard stops on the weekends kind of thing. That pushed me towards having more energy and better balance.

Andrew Burdette 00:09:02  So a couple, there's only a couple ways you can kind of move things, reduce what you're doing, which is either to give them away or cut them out.

Andrew Burdette 00:09:10  And sometimes some of both is needed. And yeah, the burnout piece I was picking up on was like, I can see there's this email here and I'm going to actively avoid it. That that's a definite kind of where you go from stress to that, that we're in burnout turf at that point or whatever. I'm actively avoiding the thing I'm most stressed about. And, yeah, that that's kind of a danger zone. And, you know, on the one hand, it starts in mental health world often for people. And then sometimes it also just really translates into physical too, where your body is, just like, nope, I'm not going to wake up today and you're just screwed. And then you get more stressed because you're like, well, this is my whole day to catch up on this habit I've been avoiding for a week, and now I feel terrible and I can't even get that done. And you just snowballs.

Justin Johansen 00:09:54  And it's completely, completely, you know, what the hell with that was, Oh.

Justin Johansen 00:10:01  So, Hilda. my first, partner and I started Broward Therapist. her daughter, who was working on a bachelor's degree in psychology. She started helping us, and then she went to college, and then I, we hired one of our, not a W2, like an independent contractor. Olivia, Olivia came on board, and I think it was only 15 hours a week at the most in the beginning, and it was in office. So it was great when when we brought her on board. A quick clean of the office for any new clients coming in. She made sure that their welcome folder was ready. She made sure that there was this, you know, big welcome client's name on the whiteboard, there. And she would verify their benefits. So even that was I was nervous, but bringing Olivia on as the first one. Oh my gosh. that started the ball rolling with being able to walk into a session without worrying about the benefits verified. Worried about that? I have this paperwork ready game.

Justin Johansen 00:11:14  It sounds so simple right now, right? It sounds so simple, but that that was not so simple in the moment. At least it didn't feel so simple. And it was game changing. It sparked a whole new way of, looking at the practice and navigating the practice. That was big.

Andrew Burdette 00:11:30  I think the simplicity thing, you're touching on something really big there, which is it is simple. It's like, hey, just hire some help. That's the solution, right? And the process to get the help functional is all the work that goes into it. And I think that's I think people kind of know that that's a thing. I mean, I'm talking talking soon about W-2 and having W-2 employees versus contractors. And as somebody who started contract based and switched, like a lot of people, it's easier to start a contract from some end because it's less set up. And at the end of the day, you really want to be W-2. And I think the big barrier is people know that there's going to be a lot of tedious setup to get there.

Andrew Burdette 00:12:13  So then have the W-2 in motion. But once it's running, it runs just as smoothly as contract did. But yeah, the the process of offloading things and explaining to Olivia or whoever my current admin, Zachary, which he's awesome and but explaining, here's here's how I need you to address a client and bring it in and do this. And that handoff process is complicated. So in the midst of you being too busy, do you remember how that handoff went?

Justin Johansen 00:12:45  I do, I remember trying. So, Olivia was, at the time, this 25 year old woman ridiculously on point with, you know, Microsoft Word and software stuff. I had this skeletal outline of an operations manual. And within a day or two, she had it broken down into chapters and sections that you could click on. I don't know what, how she did it, but it was quick. but it did start again. That was one of the examples. I did have to suck it up and on a few Saturdays start to write like an outline.

Justin Johansen 00:13:25  And I remember keeping it very simple for her, the outline that I was trying to coach her on to answer the phone and how to navigate clients was just a very casual kind of look. These clients are in pain. they're they're going through a lot. Keep it super friendly. I remember actively trying to avoid that sterile, typical physician's office. No rapport, straight to the appointment. you know, that we were trying to avoid that like the plague, and we still do. so that was really the beginning of trying to to help her address the clients and get that conversation going in a way that is that I thought was the best way to go. I'm sure there's many other great ways to go, but, clients, they want someone relatable. and so that was the start of trying to coach her, and she did really well with it. So there was a coaching element. And again, I didn't see that, you know, graduating with my masters and everything. Coaching someone into that. It just came.

Justin Johansen 00:14:35  I had to. In a sense, I really did have to. Depending on how you look at it.

Andrew Burdette 00:14:41  Yeah. And one of the other things, too, when I talk to my clients that especially my anxiety spectrum clients about this clinical clients is there's also that unaccounted for time that you spend stressed in thinking about things when you're not actually working on them. And that's a really hard thing to quantify in terms of. So there's the practical here's ten hours a week. I'm not scheduling clients anymore and handling that, but there's probably at least that much time that you were worried about. Is this going to get done or not?

Justin Johansen 00:15:12  That yes. And I'm not sure of the exact, label we could chalk it up to, you know, ignorance, not knowing micromanager. You know what I mean? These are my own, words here. So, out of not knowing any better. that also was a really big shift, because now, to give an example, Anissa, who is our client care coordinator, takes all the incoming calls, sets up all the initial assessments.

Justin Johansen 00:15:48  We have an assessment team. They do the assessment. We get a brief description of symptomology, the client's background, a little bit of their personality. You know, like are they assertive, are they meek. And we do everything we can to link them up with the perfect fit of the therapist. That would be a good fit for them. Before I was doing all the assessments, so we had to build an assessment team, and then I was hands off of the assessments knowing that there were two for now, eight people doing assessments 18 months ago. That was brutal, not being the first person, because again, when it's your company. there's. You know, I wouldn't offend anyone, but there's a there's a different interest. There's a different accountability. So there was this very welcoming assessment. I felt like I was doing a very good job with getting clients to come back, you know, a little bit of clinical mixed in with an assessment, passing that assessment portion off, which is their first con.

Justin Johansen 00:16:49  Well, not first the second contact with the business. That was tough. And then if we ever crunch analytics we'll go back in time and look over 12 months. It's not a lot. But every now and then we'll see. Shoot over six months we did five assessments and no sessions happened happened after the assessment. You see that on a spreadsheet. And what comes up. Oh oh no no no no no this is not good. I have to get back in there. And then you have to recap. Hold on dude, calm down. So it's this. It was not easy. But again, for the sake of growth, we've always wanted to to grow. in terms of how many clients we could reach. Not like a clinical. Anyway, I don't want to get lost, but we wanted to grow from having a big clinical team and to touching a lot of clients lives. Being hands off with something like the assessment team just came with it, and that was so hard in the beginning.

Justin Johansen 00:17:44  That was so tough to do.

Andrew Burdette 00:17:47  I think you're touching on a really, really big kind of core thing that goes into whether you're doing solo or group practice, like it has to do with identity and identification with and, you know, in, in grad school, like I'm a counselor. So grad school counselor identity came up like every class, like over and over and over again. So there's this, like layer of, like, paranoid neuroticism about counselor identity that like they beat into you kind of thing. And then you get on the real world like, wait, I'm still a human first, like, and you kind of have to balance that out. So there's this kind of balancing out of this identification as a counselor, and then you get the like, hey, I'm in solo practice, what do I need to call my solo practice? And people can get really caught up in that branding about who they who their business is and kind of get lost in that identification. Because if it's my solo practice and it represents me as a therapist, it's also representing me as a person.

Andrew Burdette 00:18:45  And you really lean into that and really kind of death grip. Hold on to that. And as a group owner and part of the transition was just remembering some of the discomfort about who I'm bringing in is because I'm trusting them to represent my business the way I would, and trying to find people that can understand, even if they're going to represent it their own way, but are going to do it with the integrity that I would as a business owner. And so I think what you're touching on really is something that is a real struggle for many people transitioning from this is me as a therapist and this is me as a business owner and then as a business owner, I have to make decisions on behalf of my business. And sometimes it means that I can't be the one that always steps in. Like that fear of if it was me. What? I've rescued those other follow ups, right?

Justin Johansen 00:19:35  Like 100%. It's tough. You know, to your point. If anyone listening, if they ever venture into bringing therapists onto their onto their team, to your point, they've got their personality.

Justin Johansen 00:19:50  They've got their their models that they use. They have their approach. And you can't micromanage how they start their sessions. You can't you can't you can't micromanage who they bring into the sessions. It's it's you know, it's their clinical work. So it's it's really tough. And if you ever come across the day where there's negative feedback about another, you know, clinician or whatnot, It's it's it's tough. We try to keep it in perspective, which is that assessment team we learned a long time ago, not at least for us not to just blindly, arbitrarily refer. All right. Jane Doe just called. She wants a therapist. Oh, great. You know, George is available on the same time she is going to George. That approach, which we did for a couple of months in the beginning, and it just. Oh, my gosh, it just flopped. so we've learned over the years to do our best to hone in on our therapists, strongest, I guess, like, population.

Justin Johansen 00:21:03  You know, it could go either way. You know, you could focus on the therapist. Strongest diagnosis. What diagnosis do they just love working with? Or it could be phrases. Population. Do they love the, you know, the families who, just got divorced, and that's their specialty. Either way, no matter how you phrase it. We've learned to do our best to hone in on the therapist's expertise. that's helped a lot with navigating. I know that might be a little off topic slightly, but, that's helped us a lot.

Andrew Burdette 00:21:36  No, I think I think it relates. And I think the other part that I hear in that is there's technically like this therapist has eMDR training and IFS and these other things, there's that technical thing. But what you're really also speaking to is that rapport factor, that more intangible thing. That's it does show up in a measurable way, like how is this person's client retention rate and these things and you know, if you're sending to whoever has the most openings versus maybe is the best fit, right, you probably are going to have different retention numbers because it's going to show up differently.

Andrew Burdette 00:22:11  And it's also going to feel different in terms of the experience of those two people, too. So I do think it fits. And I do think, part of what gets challenging as we, as you scale is thinking about the kind of culture you want to create it.

Justin Johansen 00:22:26  Yes. So no, that's great that you just mentioned that. so we've I believe we've done a very good job with building up this, what we've called and for no particular reason, the name just kind of fit this clinical excellence and this relational excellence. those have been two kind of, topics that we've chosen to focus on as a, as a team. And this is all of us, myself included. The clinical excellence is referencing staying sharp on the clinical skills. I was so guilty of graduating, with my masters and getting licensed and all of that. And I was convinced for a solid two years. I'm good. You know, I learned my I learned my general stuff on CBT. I know the downward arrow. I know, you know, schematics in every schema.

Justin Johansen 00:23:29  You know I'm good. And for two years, not a lick of, like a quality continuing education. I mean, the broker where you just get them all done at the last minute. I don't mean that like a real solid training. And since then, as a team, we've done anywhere from 1 to 2 trainings a year. Six of us are in an attachment based family therapy training right now. I'm doing a, structural family therapy training based out of New York. so we've learned that as therapists, we try to push having an expertise in something. Great example is if a therapist tells us, No, no, I don't mind. I don't mind couples. I'll take couples. That is a pretty hard line that we're probably not going to send them a couple because we on our end, we've learned couples therapy is such a unique and challenging thing. If you are not competent in EFT or Gottman, hopefully both. If you don't know what you're doing in the couples therapy world, you could actually harm that marriage inadvertently.

Justin Johansen 00:24:42  You can actually do some pretty solid damage, and I'm not suggesting on purpose. Anyway, just to wrap that up, we've learned that we really gotta hone in on an expertise of some kind. that's been big for us.

Andrew Burdette 00:24:57  Well, no, but you're talking like on the clinical competence side of things, like I, you know, technically, my master's degree says I could counsel like, 12 year olds, but I don't have any experience or training doing it. So I'm. I'm not going to be near as good as my friends at run practices that have people that have months or years or decades of experience with that. And so some of it's just that and some of it's also just like I have people that come in and want to get trained in a certain kind of way. And can I support them as a group owner to like, bring that into things? Sure. So it does go back to that, holding on with integrity to make sure that the rest of the group is on the same page.

Justin Johansen 00:25:36  Yeah. And and that second piece of the I'll keep it short, but that relational excellence that I referenced, that's as simple as just without blurring lines, I need to I need to disclaimer without blurring lines. we've tried to harp on some form of when that client is coming into your office hallway waiting room. We really want them to feel like they're going to their favorite aunt and uncle's house, where there's a familiarity of comfort and ease. So you know it can go either way. It could be a younger therapist, older therapist, but it can go both ways. But sometimes you'll come across a therapist who is just very stoic. I don't know what model they might be following, but that, you know, the traditional legs crossed and just just unrelatable in any way, shape or form. And sure enough, when we compare analytics, those, those and at least for my experience, I can't stress that enough. In my experience, there's a better chance that kind of a therapist is the one who kind of struggles to, keep the the clients enough to see clinical change.

Justin Johansen 00:26:45  The clients might leave after session four, five, or six, which is a drop in the bucket if you're talking about trauma. So so yeah, that relational excellence is just being comfortable. That's essentially all it is. Yeah.

Andrew Burdette 00:27:00  There's also another piece of that too. And sorry, I'm pausing. I almost had to sneeze for a second. so the, the one of the other big things I remember from grad school was just the emphasis on the quality of the therapeutic relationship. Yeah. Sure. At least culturally, I try and instill that among my team of people, too, where it's like, look, I believe in transparency. If it's something I really can't have a conversation about, I will tell you and tell you why. But outside of a couple HR things, if we want to sit down and go over numbers, talk about how the business works, functionality, why we do things the way we do, or why we're making a choice to go in a direction. Let's talk through all that and also that at least as a boss and a leader.

Andrew Burdette 00:27:42  Like I can't change anything. As in keep doing good stuff or change bad things if I don't know about it. Right. So trying to emphasize that rapport and and you're right, there is that line between, maintaining professionalism but also being warm.

Justin Johansen 00:28:00  Sure.

Andrew Burdette 00:28:00  Sure. Like if a client asks me in session, like, how are you doing? I'm going to be like, hey, I'm kind of tired today. Got a headache. How are you doing? And so I can I can humanize this experience at the start of every session without making it about me in a disclosure sense.

Justin Johansen 00:28:16  100%. that part, I think it's a little too theoretical. at least it was in, in my experience, in a lot of the training with, like, the, you know, rapport and, and that kind of thing with clients. I think, if I remember correctly, a lot of our training was fairly don't share anything about yourself. And, I've learned quite the contrary. You know, obviously, I'm implying there's not an oversharing, but when it's clinically appropriate and, man, you know, a little bit of self-disclosure, it, it outweighs any model.

Justin Johansen 00:28:52  You're using. It. It has its own weight, man. so, yeah, we've definitely learned, not to be, sort of So distant in those sessions.

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Andrew Burdette 00:30:05  One thing you mentioned was retention numbers and retention. And retention is like balance. It's this ongoing discussion about where are we at in things. like a lot of things, especially in our field, because so many people are in private practice and don't report stuff. The data sets are not great. A lot of the data sets do say that a third of clients drop out after just the intake, and then 50% are going after three sessions. And that data was from a study published, I don't know, 15 or 20 years ago now, but I don't know that it's really that much different. And I don't know that platforms such as BetterHelp have really helped communicate to clients. Therapy is a process that takes an investment and you get out of it what you put into it, among other things. And I will kind of compare it to like going hiring a personal trainer and getting a gym membership. If you only go to the personal trainer sessions and do nothing else, you don't see results, right? And it's also not the kind of thing you're going to lose £25 in a month.

Andrew Burdette 00:31:07  So if you, you know, how are you navigating as a group owner with that size group your inputs, outputs, conversations around tracking those numbers and and also to like are you directly tracking them since we're talking kind of getting help and delegating. Like do you have a particular person in your staff that kind of heads up paying attention to that?

Justin Johansen 00:31:28  No, those are those are great points to bring up. So for us, the word retention. So in a while back when I didn't explain the why behind too many things with our, you know, with the therapist that we were working with retention got linked up with some kind of sales approach. Money hungry. You guys just want clients past their clinical. I'm like, you know, I'm starting to add stuff. But that was some of the themes, you know, in terms of the perception that it was not clinical. And that was, you know, my doing I didn't do a good job of explaining the why behind some of this stuff and what we've learned.

Justin Johansen 00:32:11  Retention is such a good indicator for us. To us, it represents the quality of the relationship. That's not the first thing, but it's one of them. We've learned that if the client if the clients enjoy coming to those sessions, if they're getting stuff out of those sessions, they keep showing up when they don't if they either, you know, unfortunately, if they don't feel a connection, if they don't like you, if they're not getting anything, they'll either go AWOL, they just won't stop. They'll stop showing up. I'm not I don't want to imply that someone's necessarily lying because I don't know. But we'll here lost my job, had to move, lost insurance. I'm sure a lot of those are true, but I don't know if some of them aren't. The point is, they just stop coming. The second thing. Well, actually tying to that is the clinical change. You know, the clinical growth when we do an assessment. And we'll see that going back to this Jane Doe woman or John Doe whoever.

Justin Johansen 00:33:11  So when we see in the assessment that parents divorced when they were ten. First hospitalization was at 11 afterwards and then a little bit of rehab with drug use. And then they got a divorce. We see all these potential big traumas, little traumas. Depends how, you know, someone might categorize them and then the client's not there past seven sessions. Those are some serious topics to work on that take way beyond seven sessions, let alone getting to know your body's reaction and what's happening inside internally, let alone could take three, four, eight sessions, I don't know. So the the clinical change, it takes some time. So when we see clients not staying after five, eight sessions, you know, we don't go calling them and hunt them down or anything. But it just brings up questions of like, okay, what's really happening in these sessions? Because this is some really solid clinical stuff to work on. The third thing, and I suppose I'll stop. Our referral sources, we have referral sources that we stay in contact with.

Justin Johansen 00:34:18  They actually some of them request that we send monthly updates on how they're doing because these referral sources, one of them, they ask for follow ups because they stay in touch with the client. And, you know, they all work together. They're part of the same organization. So it's an EAP service that works with the client. So if a client were to fall off or whatever you want to call it, if they were to stop coming in January and then we don't tell our referral source until March or April or if ever it's 3 or 4 months that they didn't know about it, where they can't follow up with the client because they know their clients lives or who their peers lives. They want to help, and we're not telling them we run the risk of burning the bridge with their referral source. So there's a lot, you know. So when you start going through all these reasons why, and it starts with retention, retention doesn't have the best association with it. I'm aware of that. But there's a lot of reasons behind why we're tracking who's staying for how long.

Justin Johansen 00:35:19  Okay, we noticed that I'll make up therapist names, but we noticed that Jason, for whatever reason, the 30 year olds, they don't stay with Jason, but Jason, the teenagers that were them for, you know, 15 months. He's clearly killing it. This is his popular. I'll stop at that. But there's a lot of reasons. Those are just some.

Andrew Burdette 00:35:40  Yeah. The for me the clinical length is is there I, there's as I'm bringing in new staff and stuff especially people needed private practice. There's this discussion around like here's here's realistic retention numbers. So stuff people are going to drop out early. It's not to you. It's not your fault. It's just sometimes people even committing to 5 to 8 sessions is difficult. I usually know about session four. Is this person going to like, you know, so someone comes in, hey, I'm stressed about this thing and I know there's some underlying stuff and you kind of get teased with a deeper stuff, but the willingness to kind of get, you know, underneath the surface to the bigger parts of the iceberg isn't always there.

Andrew Burdette 00:36:18  And so usually around session four, I can tell this person kind of came in, they're feeling better. They're they're probably going to like wrap things up once they feel like, you know, black tape's on my boat, I can finish my camping trip. We're good. And and so it's not retained if it's like eight or more if that's your metric, but it is retained. And I guess in some sense because you kind of have this like therapy arc and you can kind of make sense of it. It's like a short one season show, right? even though the desires may be to get into that deeper childhood trauma work. But a lot of people really don't want to go there, and even some of the clients that stick around for a long time, like because they're guarded with things like even it takes people sometimes a really long time to get there. But trying to explain that to clinicians and just say, hey, if you do internalize this, it's maybe going to be detrimental to your work with other people, but just talking to retention is challenging to it.

Justin Johansen 00:37:13  It is. And I've I still have a long way to go with how it's presented, because each time I present it, it it's it's never the smoothest conversation. And I'll try to stress that it's that we are really just trying to hone in on an expertise and who you seem to really just click with and who you love working with. And that's a tough conversation because unfortunately, most reasons when we try to find out, okay, so what's the you know, did they lose their insurance. Did that they move. We try to find out some of the whys. I can go back in my case load from 20 1918. I know there are clients who, when they didn't show up for a session or two, I could have totally followed up and I just didn't. There's several clients who I for myself, I would label. I dropped the ball on several clients. that I can recall pretty quickly. So it's hard to get that honest approach of like, no, I think I rushed it.

Justin Johansen 00:38:12  They they said this is their first time in therapy and in session two, I was trying to get down to their core wound. I went too fast. I went too fast. It's really hard to get a therapist to say those things. And that's, you know, we're just trying to explore what could have been done, different. but that's a really tough conversation to have. I need to polish how I have that conversation.

Andrew Burdette 00:38:37  So I'm curious since since we've talked about outsourcing and kind of scaling and delegating even parts of the clinical work about here's my assessors to kind of match people. So like intake coordinator type roles and then scheduling follow up and other things. How does it work in your practice for tracking? What are some of those process flows for key people? So for people that are maybe solo practice and haven't really scaled anything out at all, or are maybe like in that early stage of group practice where you have like 3 or 4 people total and you're not really centralizing everything yet. When you transition into centralizing things to grow up to 20 plus clinicians, how have you kind of broken up that flow into clients and then and then kind of tying back to retention? Who's tracking retention numbers and data so that you can then stay in tune with that health of the business.

Justin Johansen 00:39:31  So and please correct me if I, if I, if I'm not answering it directly. so with with a team member. We just did a 60 minute meeting and we're going to do it monthly, where we go through a really great leadership podcast. I don't know if you've ever heard of the name Craig. Rochelle. He's, he's a lead pastor of Life Church, but he does the Global Leadership Summit. He's for the last six years, like the initial speaker. He he does a lot with leadership. And we were listening to it this morning, and it involves breaking down the person's all of their roles and then categorizing them into the first one. Mission critical. So if we go back to this, you know, Olivia, that I referenced as our first office manager. If I was doing this with her, which I didn't, but if I was doing it back in the day, her mission critical tasks or things would have been And verifying benefits. Scheduling that initial assessment. Making sure the client has all of their consent forms done.

Justin Johansen 00:40:48  And for the sake of time, I'll stop there. But those three things would be the only thing she focuses on for the assessments coming in. And then when they're done, she would move into the kind of the what do they call it? They called it, not mission critical. There's a next level under that. It's, important and strategic. So then she'd have a couple things under there, and then there's external, low priority, meaningful but not vital. So I would have helped Olivia really break down the first thing to focus on. And you don't move on till it's done. and that concept really would apply to anyone as the team gets bigger. You know, Chris, who's our medical biller, His main role is submitting insurance claims and handling financial problems. If there's a credit card that gets declined, it's him who calls and that's all he does. There's no deviation from that. So it's a bit rigid, but I. We had another office manager, Harmony, and I definitely did not go about that.

Justin Johansen 00:41:56  You know we had a list of things to follow. And then sure enough, I just I dropped the ball big time. It turned into a harmony. Can you do this for me? Oh, can you can you check on this? You know, our therapist. You know, Alex said that he can't get into his Gmail. Can you do it? Sure enough, it went down a path where Harmony was doing anywhere from 5 to 10 things on top of the mission. Critical. Because of me. My fault. So really making sure there is a very, very clear list of priorities and really not deviating from the top list.

Andrew Burdette 00:42:30  I mean, what I hear you talking about, use the term rigid and I'm like, well, it's really structured and it's for clarity and without without that structure and saying the clarity about here, the person doesn't have a framework. And without a framework people do all kinds of things. I mean, it's it's been really interesting, like, noticing how much latitude people will take if you don't really clarify, this is this is priority one.

Andrew Burdette 00:42:56  This is all it is. And then secondary and third or whatever it is. Right. You have to be really clear. And it's not about it'd be micromanaging if you're still circling around and saying, hey, did you do this one thing the one way instead, versus here's an explicit set of instructions with decision making kind of built in about one, two, three work on this and then do you need more time or not to accomplish this? And if so, let me know and how much. And we can have these things in. Right. And sure.

Justin Johansen 00:43:24  Yeah. Have you ever stumbled upon that, that four hour workweek, book?

Andrew Burdette 00:43:29  Yeah. gosh, what's the, How I'm blanking on the guy's name. He's real famous now. but, yeah, he he's kind of in that the story. What was he started doing? What, supplements or something like that and then got everything done? Yeah, I think so, yeah. And, Yeah, it's a real interesting book. and just like this idea of, like, here's my, here's my goal, but I want to spend, you know, how do I.

Andrew Burdette 00:43:54  It's like the inverse graph. So, like, the more successful I want to be, I want to spend less time doing it. And how much can I actually give away. And a lot of it does come down to like without having a clear structure, you can't give it away. And, I'm currently in my own practice going through the process of, actually hired a friend of mine who's another clinician who's taking a break from being a solo practice business owner and therapist to just have a break because she needs a break. And, so I'm excited to have her come in to coordinate with my office manager type person to to to literally write the recipe book in a very clear, understandable way so that it's like, hey, how do we do this? Kind of in the same way you have an employee handbook. About terms of employment. We're going to have a big, thick like, you know, Good Housekeeping size like recipe book of how everything works. So if I need to delegate stuff out, well, here's your recipe for all the desserts.

Andrew Burdette 00:44:46  And that's now the dessert chef, right. And I make a lot of restaurant metaphors when it comes to running business. But they seem to kind of work. Right. Like front of house would be all the client facing stuff, back of houses, all the staff facing stuff. And you need the structure to like, make it all work. And then you need the description of how the process works so you know it. To me it kind of makes sense as a map. and most people nowadays have some food food service industry experience, but but yeah, to me I just that structure is really key. And it's also key to because when there is this issue about, hey, why is this not getting done? If it's not communicated, it's not going to happen. Or if there's not an understanding about how to prioritize outcomes, right? Like, you know, if your if your goal is to have a chocolate dessert and you're a brownie shop and you don't say, I need you, just say, hey, I need to talk with dessert and you end up with a cake.

Andrew Burdette 00:45:38  You can't really be mad you got a cake or ice cream because you didn't say I needed brownies, right?

Justin Johansen 00:45:43  So no, that's that's one of the honestly, that's one part of how the clinical, component has helped us a lot and meaning with focusing on self. I'm lucky enough to have come across a lot of these, you know, self-help, business leadership books and whatnot. And what's resonated the most is just it's you got to look at what you're you're doing. To your point, if something's not done, did I not communicated clearly? Did I not stress it enough? It's so easy, man, and I still do it. I have to actively fight it off to get into that. And this is clinical to the you, you know, especially in the family and marriage sessions that that you know, you know, you said, you said it's got to swing back to, you know, I probably should have done this. You know, I didn't, I could have that's the only way the change would come about.

Justin Johansen 00:46:40  So yeah, tying it into that clinical component makes sense in my head because if something doesn't go the way I thought. I'm still actively working on what. Did I explain it the right way? Did I map out the steps really, really clearly? Did I make it some overly lengthy process for them to try to follow? I gotta bring it back to to me, there's no other there's not many other options.

Andrew Burdette 00:47:06  Is it too little? Is it too much? Did I do it at all? Like, what's my role in this? Right. Like and, I think anybody that's come out of a long term relationship and healed from it and then entered a new one, part of that healing process is like, what was my role and how this relationship didn't work out right. And you're kind of speaking to that same thing.

Justin Johansen 00:47:25  Yeah. My role, my role. And yeah, this is this is actually going back a minute. And this is, you know, knowing that a lot of clinicians are going to hear this, a differentiator, which is not a unique one.

Justin Johansen 00:47:41  What I'm about to say, but it is a differentiator that we've seen great results with is having energy in the session. We have every office that we have. There are whiteboards. We are up on those whiteboards. Clients love to have things visually add up and make sense. So when you're drawing, you know, whatever a family mapping a gene and it's on the whiteboard and the client can see these behavioral emotional patterns stemming from whoever. These light bulbs go off. Addison, one of our relationship experts, she does this bond and build? Kind of like this relationship workshop at the end of it. The clients get this laminated five seven page booklet with all of their triggers and their dance. So for anyone who who might not do those things, because I believe me, if I'm tired or if I'm off, I will easily slip into. I'm just going to sit here and get curious with them. My body might not move at all. And that's my sessions for the whole week. And there's a I'm not saying I'm not trying to judge that.

Justin Johansen 00:48:58  I'm just suggesting that we've seen really good clinical results. When there's an energetic on your feet in the whiteboard element, it makes a big difference that we've seen. I don't know if you can relate to that, man. I don't know if you've seen something similar, but for us it's been it's a quite a difference.

Andrew Burdette 00:49:15  But it's true. I mean, it's that, you know, flat out is not interesting for most people. You know, same kind of thing. Yeah, I'll tell you with a grain of salt.

Justin Johansen 00:49:22  We'll be monotone. Don't get me. You know, that's what I'm saying. I hope people can read between the lines. You know, if someone's going through a traumatic memory and it's coming up. Yeah. I'm not suggesting get hyper and do jumping jet. So please try to, you know, read between the lines there. But, people love having the dots connected and the white board. Oh my gosh. clients love that whiteboard when it's used.

Andrew Burdette 00:49:45  I'm excited. I've got a big new space, and I'm going to get a big four by five foot by board.

Andrew Burdette 00:49:51  And so I'm super stoked to have one again. I've just been in office is way too small to do it, and it's exciting to have a space to put a big one up again. It's fun. so we've talked about a couple different things. We've talked about like the need to like, outsource and realize, like, you know, this is something I kind of need to hand off. We've talked about some really juicy things like, client session rapport and rapport building and that how that translates over to team building as well. delved into things like retention numbers and then just relational energy with clients and things. And so are there any key takeaways to listeners you want to make sure that they maybe, like, glean out of this or like if they were to go back and visit, like what was maybe a highlight out of this to talk through.

Justin Johansen 00:50:33  Yes. The the biggest I mean, not the biggest, but a big takeaway that stands out for me from our conversation is trying to work through that, that worry of finances.

Justin Johansen 00:50:48  And how can I possibly afford you know, that might be a big concern. It was for me for a very long time of an office manager, call it an assistant office manager at the title. I'm not sure the title even matters too much, but someone even it's it's rather easy, to find someone who is totally cool with remote ten hours a week. You can start slow ten hours 15. And it could even stop there if that's all you need it to, but somebody to come in and pick up the Moore, to pick up some of the, the administrative slack, that is game changing. And yeah, I go back to that, that that clinical we that clinical piece to, of trying to find your, your niche niche. I don't know, to pronounce it. We've seen a lot of therapists who might identify as kind of like the jack of all trades, where it's the, no, I love teams, but give me families. You know, I love couples. Let me take.

Justin Johansen 00:51:53  And that's if it's working, you know, leave it alone if that's working for you. Absolutely. But we've learned on our end, little by little, doing some soul searching and finding where your real clinical passion lies. It just it has a way of forming, you know, let's say you develop, you learn that your clinical passion is working with late adolescents whose parents just went through a divorce, specifically because of an affair. Right. For all you know, that's a unique, special population that you start honing in on it. You get a caseload of just those people, and now all of a sudden a caseload of 20 is met with such excitement. You know, you don't get that occasional couple people where it's like, oh, man, I don't really want to see them today. Do I really have to? I guess I should. When you get a caseload where it's like people you just love working with, it changes so much. And I attribute that to trying your best to find, your expertise, what you really want to hone on, hone in on.

Justin Johansen 00:52:55  There's more. Those are two big ones.

Andrew Burdette 00:52:57  Yeah. And I hear out of that theme, too. A couple things. Like one, the stuff that you're not that's falling by the wayside when you're extra busy is the stuff that you're really not passionate about. It's really it's the stuff that's really not in your niche, in a functional sense. And so that clinical piece translates over to like the business thing that you do or don't do. I mean, like, I like techie stuff. So I kind of enjoy the website stuff. I need more time to do it, but that's something I enjoy doing and probably won't outsource until it really becomes absolutely necessary. Whereas I hate the billing. So I gave that away initially. Right. So that same niche kind of thing matters. You can, I think in private practice, especially solo, we all start as generalists because we have to bootstrap to a degree, but then you have to hand things off. And the other thing about can I afford to do this? It's like, well, if it takes 20 hours of admin to make your business work and you need 25 hours of seeing people that are billable hours to make your business like to meet your financial numbers, can you afford the other? Can you afford 20 more hours of app and time to support those 25 hours? Like, that would be the question to ask yourself, and if so, how long can you do that before you're going to kind of run yourself like burned out because you're in-home singing home clients 30 hours a week, right?

Justin Johansen 00:54:15  Completely.

Justin Johansen 00:54:15  Look, depending on someone's unique goals. yeah. Let's let's make up this person who even their their kind of fantasy dream world as a clinician is to have just a consistent stream of just 27 clients a week. Let's say they can they can handle it. They're they deal with it. They love it. And that's that's their goal, that's their vision. And they get into that. Even with the 27 clients a week that they see. How many phone calls aren't being answered? Of the 27 sessions a week, how long do those 27 clients stay with you? So if seven drop off, for whatever reason, there's going to be a need for seven more. Who's answering those calls to keep the seven coming? Or you call a client, calls you back, calls you for the first time at 1:00 pm. You're in session. You call them at 9 p.m.. The the odds of a client becoming a client with calling them back versus the first phone call. Forget it. It's a world of difference.

Justin Johansen 00:55:21  And to keep running with this example, let's say you get so inundated and you're busy with your 27, you're loving it. That's your goal. What if you go two weeks without charging someone their $75 co-pay? We are so guilty of falling into this trap. Even with four people doing the billing and the management of the money, so to speak. We still lose clients because we'll we'll we'll screw up. We'll make the mistake of not charging their copay for three weeks. And then you don't charge someone. You charge someone $75 copay twice. Now they're hit up for 150. You do that to the wrong client. There's a bad Google review. I'm being really pessimistic right now, but all I'm getting at is that even with hitting that 25 dream session number. Client caseload. There's still things that a five ten hour person a week could still help you with. You can call them, you know, your right hand man, your right hand woman, whatever you want to call it. It's still a benefit to even bring them on for a few hours, even if you're at that ideal caseload.

Andrew Burdette 00:56:25  Yeah. And if you're like me, that I will space on certain things, like did the intake paperwork get done? So honestly, like, if I were still in solo practice, I'd probably hire somebody two hours a week just to make sure that was done. Because, again, same kind of thing. It's that clients have a certain expectation about professionalism from us. And when we forget to do paperwork things and build, people get really salty really quick sometimes and really quick.

Justin Johansen 00:56:49  We, absolutely. I would say I don't it's between about ten and 20 clients that have dropped off for us, because of delayed copay billing over the last, probably three, years or something. So it's not like it happens every month, but it happens, at least for us. So just one example of many. so that's a big takeaway. If someone's able to reframe that concern, they might have a much better time doing the clinical work.

Andrew Burdette 00:57:22  If you're aware of the cracks and things that fall through them, you probably need some help to fill those cracks in, I think.

Justin Johansen 00:57:29  Oh, sure.

Andrew Burdette 00:57:29  And this is a trick, to use a metaphor.

Justin Johansen 00:57:32  Yeah. For sure. And in that, you know, that bit of a long winded example that I just gave, that's for the person who is completely at ease and satisfied with the caseload of 25. If anyone's looking to grow it past that and have a couple clinicians working with you, there's a whole nother set of of reasons and rationales why to start bringing a office manager on board.

Andrew Burdette 00:57:56  Yeah. Well, if people want to reach out to you, how can they find you? And we'll like listeners like always, we will have it linked in the show notes.

Justin Johansen 00:58:04  Oh, absolutely. So. Yes. If anyone's interested. our website, Broward therapists dot net. there's our phone numbers, emails. the phone number will link right up to Anisa. the email will go right to me. so Broward therapists net is a really good place to find us. Our whole team's on there. The the workshops. quite a few things.

Andrew Burdette 00:58:31  Awesome. Well, thanks so much for being a guest. This is really interesting to talk. kind of the intersection between clinical and business structure. And then just also like the importance of kind of finding balance in your structure and making sure that balancing points are kind of really always, I guess, built in and considered at least.

Justin Johansen 00:58:50  Oh for sure. No, this was no, this was great. Thanks for the for the invite. This has been fun.

Andrew Burdette 00:58:55  Cool. Thanks so much.

Justin Johansen 00:58:57  Yeah, I appreciate it. Thanks, Andrew.

Andrew Burdette 00:59:04  Thank you so much for listening to this show today. We could not do this show without our amazing sponsor therapy notes therapy notes as the best electronic health records out there. You can go over to Therapy Notes. Com and use promo code Jo at checkout. That's going to help get you a couple months off for free. It also helps let them know that their podcast sponsorship is working. Thanks so much for hanging out with us today on the grow Group practice podcast, and we'll talk to you soon.

Andrew Burdette 00:59:29  If you love this podcast, please be sure to rate and review. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guest are rendering legal, accounting, clinical or any other professional information. If you want professional, you should find one.