Andrew Burdette 00:00:00 The growing 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.com backslash network. You’re listening to the grow a 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 back to another episode of the Grow a Group practice podcast. I’m back again with Doctor Brittany Bates, who is a group practice owner of a telehealth practice in North Carolina and also a private practice strategy coach for therapists and entrepreneurs. So welcome back. Thanks for coming back on. Dr. Brittany Bate 00:01:01 Yeah, thanks for having me. I’m glad to be here again. Andrew Burdette 00:01:04 Yeah. So for listeners that didn’t catch your intro the last time, do you want to give a quick intro of kind of how you got to be at this place in your career? Yeah. Dr. Brittany Bate 00:01:12 So my background in training was actually in forensic psychology, and as part of that we did a lot of group therapy. So a lot of group therapy in, secure, forensic psychiatric hospitals as well as state and federal prisons. So I know I’ll be talking a little bit about group therapy today. So I wanted to give that background that I had sort of a unique opportunity, I think, with my training program, to just be able to do a lot of group therapy, and I really saw how valuable and beneficial it could be. So fast forward to my private practice journey. as soon as I jumped into private practice, I wanted to start groups, I wanted to do groups, and I wanted to have a lot of groups. And I love them for so many reasons that I will talk about today, but they can be challenging to get off the ground. So, that is part of it at our practice at at be bold, we have probably anywhere from 3 to 6 therapy groups. Any given quarter. Dr. Brittany Bate 00:02:04 in the last three years, we’ve done about 25 different groups, and every group has usually anywhere between 4 to 8 clients. So, being able to help and access a lot of people in that way. So. Andrew Burdette 00:02:17 I did inpatient therapy for my internship and stuff at a rehab center, and it was great. did a lot of groups there, did very limited, like one on one just because of it was a 4 to 6 week, like, substance abuse treatment thing. one of my clinicians actually is now working in the prison system. So up here because that’s her passion demographic and stuff. And so she works very limited for me outside of that. But, you know, it’s groups and institutional settings are just such magic, I think. And it’s what I love the most is when you have a group that gets past, gets into that norming phase, and you kind of just get to kind of pull back as a clinician and just watch the magic happen, and they kind of do therapy on their own, and you’re just kind of there watching the things happen and facilitate. Andrew Burdette 00:02:59 It’s really, really cool. So, since I’ve been in private practice, I haven’t been doing groups because they’re set up and there’s space is kind of a big thing. And I’m excited. I just added a new space. It has a group room, and our office is big enough to do a small group, kind of like you were talking. And everyone on my team is like is wanting to do group stuff. So this is kind of a cool, appropriate subject to talk about. so in institutions or community mental health agencies, like they handle all the logistics. So the first thing I guess for listeners out there, then we’re mostly going to be in private practice listening to this. What does one need to do functionally to be able to make a group happen from scratch, just the logistics without the subject? Dr. Brittany Bate 00:03:41 Yeah. so I think we need to first think about a group that you’re excited to run. You need to think about a group that you may be able to get enough folks to actually have a group for. Dr. Brittany Bate 00:03:53 You have to think about what you want your intake to look like, what you want your paperwork to look like for groups, thinking about, you know, private pay versus insurance when it comes to groups and in what is covered. and then what platform do you want to use if you’re doing virtual or what space do you want to acquire if you’re doing in-person? And then how do you get the word out there? How do you get people to know that your group exists so that you can have enough clients to have an actual group? And with that, too, what do you want your minimum group size to be before you’re, ready to start? And then what happens if you have almost enough people, but not quite as many, then what do you do? So those are some of the nuances and challenges that, we work with and we think about when it comes to group therapy. Andrew Burdette 00:04:33 So how about we start with a very foundational thing, which to me is usually the paperwork end of things. So my practice doesn’t do couples doesn’t do adolescents. Andrew Burdette 00:04:43 So adults individual really really really basic simple, just one size fits all paperwork kind of thing. So group wise, how does that change? If I wanted to do a therapeutic group? Yeah. Dr. Brittany Bate 00:04:54 So we have a separate group consent form in addition to our primary informed consent. And that discusses, you know, all our practice policies and everything. But the group one kind of talks a little bit more about the nuances of fees, of registration, of commitment and expectations for attendance and group. we also let people either pay weekly or do a pay and full for the group plan, which offers a slight discount on group sessions. So that is kind of the main parts of what is discussed, along with just another additional layer about confidentiality in group. And that, you know, obviously I’m going to do my part in maintaining confidentiality, but it also lies within the group members. So it talks a little bit about expectations to keep what is said in the group, staying within the group. And should there be, an indication that that has not happened, you know, kind of the process for remediating that which would be talking with me about or talking with the group leader about it and figuring out where to go from there. Dr. Brittany Bate 00:05:48 But the piece that I really do want to make sure people have in their informed consent, or think about if they want to have in their informed consent, is about group participation and registration. So for us, we do have our informed consent that once you register and once you commit to the group that you are committed to being there, or at the very minimum, paying, which will usually motivate people to be there for the entire group. And you don’t have to say anything because you can get a ton out of group by by listening. You never know what someone is going to say that’s going to resonate with you. so even if you’re not really feeling like talking that day, you know, I encourage people to show up and see how that feels. But it’s really important as a commitment to the other group members, too. So if we have four people that are starting a group and then two people are kind of like, oh, it doesn’t really work for me after the third session. Now we still have five more sessions left and we only have two people. Dr. Brittany Bate 00:06:41 That’s not really a group and that’s not really fair. And that’s the reason why for us, we feel like that policy needs to be put in place. I have also had it happen where people you know are nervous or we’re talking about some some really heavy stuff, and I think it motivates them to work through that anxiety avoidance cycle and to be able to be in a space that can be held safely for them, and for them to have the permission and consent to show up however they want, just so long as they show up and it ends up end up being really, really valuable. I’ve had so many clients say I wasn’t going to say anything today. I wasn’t going to talk. But, you know, this person said this and I just really needed to respond to them about it. And I think that is just really an important policy to have to make sure that everybody is getting the experience that they’re signing up for. Otherwise it can get a little a little tricky on the on the middle end or the back end. Andrew Burdette 00:07:31 I like what you’re emphasizing there. And we always talked about it as like group expectations and kind of setting those and reminding people of what they are at the start, because again, everyone’s going to participate differently. Like if I’m if I’m any group setting as a peer or participant versus a leader. I’m usually the wallflower that’s kind of quiet through the group and listens more than I participate. I mean, I will jump in, but if anything, it’s maybe a response to being the leader person that talks all the time to try and not go into therapist mode or group leader mode as a group member, right? so people show up differently in groups and for different reasons and stuff. but just those expectations and then the confidentiality thing too is another thing too, where it’s just like as a reminder, what’s said here should stay here. But I can’t ensure that Jo over there and chair A is not going to share stuff that Jen and Chair B said outside of the. It just gets complicated. And anyone that’s done any kind of couples or family work, it’s the same kind of complicated relational dynamics to where you go from like one relationship to three to like exponentially growing rapidly kind of thing. Andrew Burdette 00:08:37 Yeah. All right. So logistics there. I liked how you were talking about the expectation, too, about, you know, you’re committing to participate because if you were a group member and assumed for other people were going to be here and two of them drop out. You know, if you’re one of those dropout people, you may not may not seem as impacted by it. But for the rest of the people here, if you weren’t one of those people dropping out of three people drop out, how would you feel about this whole experience kind of thing? Exactly. Dr. Brittany Bate 00:09:03 Yeah. And, you know, I try to add a little levity to it. And, you know, I kind of talk about like the gym membership kind of thing. You know, a lot of times people invest in a gym membership to make sure that they go to to the gym, and it’s going to be hard. one of the primary groups that I’ve led over time is a grief group, a grief and loss group, and it is really normal and natural for people to not want to come or to dread coming or to say, I don’t really want to come. Dr. Brittany Bate 00:09:27 but every single time they have came because of their commitment to group, because of the conversation that we had on the front end and at intake about the importance of showing up. even if you’re just going to observe and listen, it has been positive for them to do that. So yeah, I just think that that is one way to kind of protect the, the group space and to make sure that it stays consistent and creates the safest space and the opportunities for cohesion, for the group to be able to have that together. Andrew Burdette 00:10:00 I think in a general sense, and I like your analogy to like the gym membership thing, because I’m realizing one of the broader trends just as a whole like that seems to be a thing in the past year and a half, two years coming out of Covid and with big tech companies moving to outer space with some disruption, good and bad, shifting the bad being, shifting our service into a product which I’m not really a fan of, but in that transition, trying to communicate to people that just because you’re showing up to therapy is not the same as participating in therapy. Andrew Burdette 00:10:28 And sure, you can sign up at the gym, hire a personal trainer if you’re only ever participation there is you attend when you have a personal trainer meeting and your goal is to look like Arnold Schwarzenegger, You’re never going to get there without your own work. Right? And so trying to I like the highlight and emphasis there as a group of, as a group leader to just say you need to you need to participate. You can’t just not participate, right? Yeah. Dr. Brittany Bate 00:10:53 Absolutely. And I think part of that is to about, you know, doing an intake screening. So that’s a question I get a lot like do you do an intake. You do a full intake. What does that look like. At our practice we do an abbreviated intake. We meet with the client or if it’s a group with minors, we spend half the time about like 20 minutes with the parents and guardians and the 20 minutes with the, the minor adolescent. and we just focus on the group, we focus on their goals for group. Dr. Brittany Bate 00:11:18 We get relevant background history that is maybe more specific to the group. You know, usually we ask about mental health. Usually we ask about peer support. we ask about if it’s, you know, a grief group. We ask about, you know, just to share a little bit about what grief, what they have experienced or what they’re hoping to get support around. And then we talk about expectations and we ask how they feel about those expectations and if they think that they can commit to that, and then we ask to just yeah, what are your goals and how can you know? What are you hoping to get out of the group so that we have that on the back end? But there have been times where I’ve done an intake and after the intake for the group, we’ve realized that it’s probably not the best fit for this person at that time. And that is totally okay. But that is part of why I think an intake is really important so that you can meet with this person one on one, so that you can get a really good understanding of what they’re hoping to get and to see if it’s going to be a good fit so that you’re setting them and the whole group up for success. Andrew Burdette 00:12:11 there’s a couple of things in there that I want to, like, ask about. First. I’m going to ask about it. Sounds like the groups you’re doing are closed. And so when I’m saying closed group, it means like we start. It’s an eight week program. We wrap up at eight weeks and then the whole generally resets. And then there’s open groups to where there’s kind of people kind of come and go as they kind of go through a cycle. when I was in DDP groups, they were really open groups because people would start at different points. And so you kind of have this revolving 12 curriculum, and people would kind of start somewhere in that sequence. And because of the nature of the group, it kind of didn’t matter if you were it was mostly co-ed. So week six wasn’t going to. You didn’t need weeks one through five to make sense of week six, right? so it sounds like most of what you’re doing is closed group kind of things. do you ever do you have experience setting up, like, an open group? So if people wanted to have that, you know, experience of, like, so, like, for example, one of the areas that seems to be a need locally, and this is one of the things I think my practice is going to step up and do is probably our first group is, which I’m excited about early. Andrew Burdette 00:13:14 is a group focusing on adults caregiving their aging parents, not just caregivers in general, but specifically that niche. And they just there doesn’t seem to be a group for it. So to me, like, it makes sense to have more of an open group type format for that. So people can kind of come and go as they need versus a closed group and it may start with a closed group format. I think is probably where we’ll start because it’s easier to conceptualize. But do you have experience working with close versus open groups, and of doing an open group as a thing? How does that translate? Dr. Brittany Bate 00:13:44 Yes, I love this question. So historically I’d always started with closed groups. Yeah. Where, you know, it’s eight weeks. That’s what it is. You start together, you finish together. I will say within that I did allow new people to join within the first two weeks. just because I still felt that group cohesion was developing and it’s and it’s been fine to kind of let new people join, but then it’s like a hard stop at group three through eight. Dr. Brittany Bate 00:14:06 No new people. come. But I had so I led an adult queer plus group that was amazing and had ten, participants. And as we are nearing the end of it, there are probably about 6 or 7 people that were like real bummed that it was ending. And so we talked about what it would look like to continue, and we did. So I that was actually my first kind of transition into an open and ongoing group. So seven of those folks continued on, and I marketed for additional space for anyone else who wanted to join. And so we actually do have several open groups at our practice as well now. and the way that we do them, and it was been a little bit of a trial and error, but the way that we do them as people can join at any time, as long as there’s openings in the group. But when you’re joining, you’re committing to at least six sessions, and that is so that we’re not having kind of that in and out of people that might impact group cohesion and safety. Dr. Brittany Bate 00:15:03 So they can join minimum of six, and then after that they continue on until they don’t want to continue on anymore. But if you’re a member of the group, you’re a member of the group and you’re paying for each session regardless if you show up or not. And again, this is to kind of get, get, to make sure we don’t have a situation where two people show up for the group and then they’re investing in that. And that’s part of the challenge of just having a very like fully open group is I worry for the clinician that is, reserving that time on their calendar that if we don’t know exactly how many people are going to be showing up, that could be that could be problematic for them. And then for the clients too, that are making, the commitment to come, you know, if it’s just one person or if it’s just two people that might not feel like a group. So, we always have a minimum of four. If it drops below four, we see if people are comfortable with their being three. Dr. Brittany Bate 00:15:54 And then we continue to, you know, market and get the word out there to see if we can get new folks to join those open and ongoing groups. But they are, they’re open and ongoing with some structure around them, if that makes sense. Andrew Burdette 00:16:04 It does. And that kind of clarifies things to you about, having people start in like the formal set, closed group and then kind of transitioning out and then also just kind of finding a way to balance that out with some, some pros, I guess, or some experienced people that have done the curriculum side of things to kind of balance out the people that are just kind of the walk ins, as it were. Yeah. So, one other question I had too was do you have people that are seeing a therapist individually that then participate in groups, and are there some specific logistics around that to consider? Dr. Brittany Bate 00:16:38 Yeah, we oftentimes do. If it is an individual therapist who is outside of our practice, if they want me to connect with and consult with their individual therapist for any reason, I’m more than happy to do so. Dr. Brittany Bate 00:16:52 I’m sure that there might be some situations where it probably would be more clinically relevant and necessary than others, or where I might ask a little more formally for a release of information to be able to do so, but I’m happy to. It’s not a requirement necessarily. but I’ve also have had situations in this question comes up a lot too, and this is just my training and my perspective. I have individual clients that are also clients in my own groups, and I feel okay with that. I actually think it can be incredibly powerful. It’s just making sure that the client, we’re very clear with the client about what they’re comfortable with the group knowing in terms of our relationship outside of group and most clients, I let the client take lead on it. And most of my clients have said, like, yeah, when I was talking with doctor B in our individual session. And so they they let people know and that’s, that’s our choice to do that. But I don’t until they do or unless they give me permission to I don’t bring up anything in that regard. Dr. Brittany Bate 00:17:47 But I think it can be really powerful. I’ve had group clients, you know, use our individual session to really talk through more about something that was discussed in group. And I’ve also had my individual clients bring a topic to the group for feedback on. And they’ve it’s just been incredibly helpful and powerful in both situations in ways that has made both individual and group therapy. I just think I don’t have a better word for it, but more powerful. Andrew Burdette 00:18:14 So as your as you’re sitting here talking about this, I’m just I was sitting here thinking I’m like, so when I worked in agency settings and inpatient and stuff like the idea that that was a weird thing wasn’t even a thing. And so it just what I don’t know what it is about private practice, like, kind of breaks the way we think about things in a way. Because, yeah, I just it’s I was just observing that just like it’s not any different over there. It was it was very natural and normal over there to see people three times a day in groups and then see them one on one, like, you know, in the inpatient setting. Andrew Burdette 00:18:45 I don’t know why my brain’s making it seem like it’s weirder or harder in private practice. I guess it’s not. But yeah, I guess it’s a mindset thing, right? Dr. Brittany Bate 00:18:52 Yeah, yeah. And I don’t know, maybe it is. Yeah. Same thing with my background. Like group was the primary modality used in those treatment settings. But some folks that you know needed additional support came to one on one with me. And we talked about group. We talked about one on one. and so it never even crossed my mind that there could be something different or weird about it in a private practice setting. But I know some people do have perspectives and thoughts about that and the ways that it could be different or some challenges that might come up. but for me, I found way more benefit, to people participating in groups if they’re also my individual clients, if that feels good for them and right for them. Andrew Burdette 00:19:34 I think it’s the because there’s this whole awareness of logistics and that as the practice owner, we have to figure the logistics out ourselves, like versus someone else did it for us. Andrew Burdette 00:19:43 I think that’s probably where, at least in my head, that disconnect comes in where like, oh, that’s for me to figure out. I can offer that task, right. yeah, I can’t, so I’m an insurance based practice if I remember at your private pay only practice. So I’m not able to speak to how insurance works with offering groups because I haven’t done that yet for my own practice. I know oftentimes insurance does cover some degree of group therapy and and group settings. I’m not at all familiar with billing codes and stuff. This is part of the logistics. The next month, in my own practice, figuring out how we’re going to make this work. And I do know for listeners out there that are taking insurance, because it comes up a lot with couples, that and this was something that Barbara Griswold again, the navigating the insurance may is highly recommend her expertise on this whole area. But her perspective and I, I align with this from a value standpoint that if you take insurance and it is a service that’s covered, you can’t only take insurance because of individual, even though like couples or, or family therapy pays at a lower rate, you can’t not take insurance for this stuff that pays lower. Andrew Burdette 00:20:55 So if it’s covered by the plan and you’re an insurance based practice, you’re in-network for that service too, even if it’s not what you really want. And so that seems like a reasonable segue to to talk about another logistical thing of you’d mentioned a minimum of four people in the group from a clinical standpoint. There’s also a financial piece to things like how do you how do you wrap, how do you go about like, say, it’s going to be an hour and a half group and we’re going to charge X amount for it. How do you start setting up pricing and things like that? Dr. Brittany Bate 00:21:23 Yeah. So I really want it to make sense as, as an hour on my clinician’s or my schedule. I really want it to make sense. And that’s also part of where that for kind of makes sense for, for that reason. both for group reasons, for membership reasons and for pricing reasons. So just for easy math, let’s say that a clinician has a fee of $200 per hour for an individual therapy session. Dr. Brittany Bate 00:21:47 I would at that point then use with the math. I would have the group session be 5050, and then that way if we have four people, that is going to be the $200 that they would be getting if they were using that time for an individual therapy session. and then if you have more than four, then you’d be making a little bit more, which is is great, but also it’s just nice to have some differences in your schedule and doing different things, which I think can help with, fighting off burnout and things like that. So that is sort of the way that I think about pricing. If you are private pay, thinking about what that hour looks like on your calendar and then doing pricing that can accommodate that. I do in our groups, we do have one sliding scale spot for every four people that we have, and then after that we add it. We keep adding on a 1 to 1 basis. So if we have four full pay group clients, then we can have up to two more sliding scale clients and then one more full pay, one more sliding scale and sliding scale is just kind of pay what you can. Dr. Brittany Bate 00:22:47 Essentially whatever works for that client to be able to participate in the group. The other piece where I say four is an important number is because if for some reason, although I have a policy that you have to attend for the entirety of group, if they’re sick, if something comes up, if they can’t make it, if one person can’t make it, we still have three, which still feels like it can be group work. If I had a minimum of three and one doesn’t show up, then we only have two. it does happen sometimes when we’ve had four people in a group and two people can’t show up, we do the best with that. We make it work. But I try to navigate around that by having that four person minimum to have a group start, both to make it make financial sense for our, our collections and myself, and also to make it make clinical sense in case someone can’t make it at any given week. Andrew Burdette 00:23:33 So one question I’ve got, because again, I’m conceptualizing how to start my first group. Andrew Burdette 00:23:38 And one thing I’m really thankful for for my group practice owner support group of people is realizing, like it takes about six months when you start something new, to kind of get things dialed in to where it works for your practice. And so if it didn’t work right, right out of the gate, that just means you’re learning. And that’s fine and know that it’s going to settle out. And I’m just that’s been huge this year for my sanity. And I’m kind of taking a similar attitude about setting up groups to go around. And it’s thankful. I’m grateful to have all the people like you that can kind of bounce things off and kind of have a blueprint, at least to kind of then make your own. but for me. So my my practice is insurance based and it’s kind of a percentage model. So people get a percentage based on the payer rate thing. I may eventually move to flat rate just because the math is it’s easier math versus percentage stuff. But spreadsheets make it easy too. So, but the thought is like, kind of like couples is more work because you have more people. Andrew Burdette 00:24:30 I would want to I in thinking about rates and things, my goal is to maybe have like a higher flat rate for, say, for people in a group because there’s for people there’s going to be a documentation hour that gets paid for that so they can get notes written up and stuff. Because it’s for notes and a group notes, it’s more not just one. So do you have clinicians that work in your team that feel that getting the same rate for four people versus one is how are their feelings around that? And if you had to talk through them with people and and how does that conversation go. Dr. Brittany Bate 00:25:04 Yeah, yeah, that is a great question. So I think there’s a few ways that I think about this. So I think the first part is, you know, people only do groups if they really want to do groups, that’s by no means a requirement. so I think that is kind of the first part is that the people who do it really enjoy it. More often than not, we are having more than four people in the group and that they are ultimately making more per clinical hour. Dr. Brittany Bate 00:25:27 And so that feels good. And they have the opportunity, depending on how many signups we get for the group to make significantly more, even double for that clinical hour. So, they never they’re never making less than a minimum. They’re making as much. And they have a lot of opportunity to make more. So I think that’s helpful. We also talk a lot about documenting group sessions. and I, I use simple practices, my EHR and I have a template for a group therapy note, and as many EHRs do, I’m sure, you know, you can copy forward from the last note. And we really just talk about the way that we write the group. Note that it’s a lot of copy forward and copy and paste for every single client with a little bit of change and nuance to speak to the individual client’s participation in the group. So documentation really doesn’t take very long. Even if we have four people, it it takes some time, but it doesn’t take remarkably longer than documenting an individual therapy session. Dr. Brittany Bate 00:26:24 I’m a really big fan of documenting the as general and the need to know information. I know it’s a little different with insurance in terms of what has to be in there, but still taking that perspective of general need to know only, and especially for something like group. so it’s a lot of like having the different tabs open, copy and pasting in the different sections and then adding in the stuff that is specific to that client that we want to make sure we have for, for adequate documentation for insurance. Andrew Burdette 00:26:52 And my, my biller, who’s been doing it for over a decade, has looked at this. She’s she’s like your note. Most of my note is checkbox. So there is a narrative thing. My newer my two new people are new to the field. So they’re like copious documentaries and I’m like, you’re going to get tired of writing an essay. I’m just going to let you know. Like, it doesn’t mean you’re a bad clinician for not wanting to write an essay every session. But, you know, I’m only going to pay you 12 minutes per session to write a note. Andrew Burdette 00:27:18 So that’s your cap. You don’t get more because you there’s no extra credit, right? but yeah, like 3 to 5, you know, things and it can be really general. And my training on documentation in school is to always make sure it’s not going to harm a client if somebody else is reading it first and foremost. And then also, like, you don’t want to have identifying information to people that aren’t your clients. And so a lot of those things kind of when you really follow those guidelines, like 3 to 5 senses is plenty. And then a lot of the rest of my note kind of like I’m an intake cue or practice cue, depending on how you’re seeing the website. But same system. a lot of it carries through in a similar way to simple practice. you can actually select parts of the note to carry through and not the whole note, which is kind of cool. Simple practice was like the whole replicate thing, when I used it, but, yeah, I guess to me, when I was doing groups and I’m thinking my more recent one with like an IAP where, you know, there’d be 12 people in there and you do like a two sentence thing for the group note. Andrew Burdette 00:28:17 And a lot of that was the same because it was a set curriculum for the 15 sessions or whatever it was. And, I don’t remember how many. It was like a long time ago now, but, you know, so here’s like my $0.02 is about what we covered in group, and then each individual person got like 1 to 2 lines of like they participated, they didn’t whatever it was. And it’s just the volume of things is where things the per note thing was shorter, but the number of notes made it a longer process because it was more notes. Dr. Brittany Bate 00:28:42 Absolutely. Yeah. I think I haven’t had anyone, any clinician you know, share that the note like that the time it takes, it’s more I think like psychologically the overwhelm of knowing I have six notes to do right now. but I think that I also talk with all my clinicians about their schedule and setting up their schedule in a way that helps them succeed. And so it would also be about choosing a group time that ideally, they’ll be able to do the note right after group so that they don’t get behind or be able to do it the next morning. Dr. Brittany Bate 00:29:14 There’s no, like hard and fast rule. They just have to complete their notes. Timely and ethically is kind of what we talk about. But I think usually if people can like sit down right after the group and they have their we also have curriculum templates essentially. So for a lot of the groups, we do have our notes pre-written with our with our curriculum, and obviously we edit or change it if the group kind of changes or goes in a different direction. But it really is sort of like a open the different tabs copy paste across. in this again general non pathologizing non super identifying way. And most people, they say it takes them about ten minutes to do five group notes. So I think then it you know takes them usually five minutes to do one individual note. Andrew Burdette 00:29:57 So my But two previous companies I did groups with, the Iope company and the DIY company. Both of those were notes for my future self, which is now of things not to do because they were really inefficient. So I’m thankful for those lessons though, like I’m never doing it this way. Andrew Burdette 00:30:14 This is awful. I just, you know, you’re working in a bad system. so again, efficiencies and building those in because again, if it’s you can streamline so many things nowadays and it just makes everything easier. Yeah. Joe Sanok 00:30:33 You’re someone with a vision for your practice, for your side hustle and for your personal journey. But when it comes to establishing your path and how to get to where you want to be with your practice, things get a little messy. You’re also someone who would prefer to go in person instead of groups and listening to everyone else’s story. To me, it sounds like you could benefit from one on one consulting with our experienced practice of the practice Consultants from 595 a month and up. You can work with a consultant that will give you more direction and practical, tried and tested tips match to you and your goals. For more information, visit practice of the practice. Com forward slash apply. Again, that’s practice of the practice. Com forward slash apply. Andrew Burdette 00:31:23 See about in clinical our time. Andrew Burdette 00:31:25 How long have you found in your experimentation with groups in private practice. Is there like an ideal length of a group. I’ve run groups to me like an hour. Feels short. But that’s just me personally. So, like, I’m probably going to do a 90 minute group versus a single hour. But when I was doing like IOPs with 12 people, like three hours felt short because of the number of people in the group. Dr. Brittany Bate 00:31:49 Yeah. So we’ve always done in private practice, I’ve always done 60 minute groups. and I after every group, I also send out an anonymous feedback form to to the participants that I asked them that question as well, like how did you feel about the length of time that the group was? And almost every person has said that 60 minutes felt perfect and that 90 would have felt too long to them, and that the 45 would have felt too short. So we’ve we’ve stayed with that. I think it also goes back to the time on your calendar, on your clinician’s calendar and the pay for that time as well. Dr. Brittany Bate 00:32:21 I think at keeping it at 60, I’m able to keep the group prices on the lower side, whereas if it was 90, I would feel that I would have to charge a bit more to be able to appropriately compensate them for that 90 minutes. and that depends on group size too, though, you know, I think our average group size across all of our groups is about six. And I think six people for a 60 minute group tends to work pretty well. that’s what’s worked. I know a lot of clinicians do have 90 minute groups and market 90 minute groups, and I think that that’s wonderful to I just think, you know, we want to make sure that everyone’s feeling like again, they’re being compensated fairly on their calendar for that time and that they have the energy to do that, especially if it’s like an evening group and we’re hungry and dinner and all those things. Andrew Burdette 00:33:02 So yeah, and some of it too. It was one thing with Dwe class because people are mandated. Same thing with IOP. Andrew Burdette 00:33:08 Most of my clients were mandated to be there in some way. So their their commitment to showing up had legal consequences or like fines or some other thing that we’re going to be there. And, it’s different if I’m thinking about. So here’s somebody that works a full time job who’s, you know, in their 50s, like May or may not still have kids at home, and they’re caregiving. They’re like adult parents, like as an example, like 60 minutes is probably going to be about as much as they can really commit to on a regular basis versus like a deep dive into trauma stuff. Dr. Brittany Bate 00:33:39 Absolutely. Andrew Burdette 00:33:40 Yep. you talked pricing wise, as an example. what do you find as a like it’s $50 for like an hour for a group thing, like agreeable. Like, I haven’t really done too much market research, and I’m still kind of looking into it, but, and up here in Asheville, it’s a particularly interesting economic area to kind of price things out to like very saturated, like just very interesting. Andrew Burdette 00:34:05 And so is do you find people that scoff again? We talked value and how people value services, like in the other episode we interviewed or talked through and stuff. but how do you do you ever get a bunch of pushback about, hey, if it was $30, it’d be great versus 50? Like, I know you’ve got some sliding scale range stuff to, but like, you know, how do you how did you settle on a price, I guess. Is it? Yeah. Dr. Brittany Bate 00:34:30 Well, part of it was, before I opened my practice, even my solo practice. I worked at a group practice for two years, and so I was sort of I saw what, what fees they were setting, and it seemed to work for them. So I think I had, maybe a naivete, but also a optimism. About what? About what that number is or could be. But I did do some market research as well. And I think that from what I can see, when people are advertising groups, I think that groups range anywhere from about 35 to 45 a session, up to even upwards of 85 a session. Dr. Brittany Bate 00:35:03 And I see that more for the specific groups. It seems like they’re 85 per session or a fixed fee for, for the module for one module. so I always start my groups at 50. The first time I’m introducing a new group, I started at 50 per session and then have the sliding scale options as well. And then after we run the group once or twice, then I put it up to about 65 per group. So most of our groups now, because they all have been facilitated at least three times, some of them 4 or 5, six and seven, they’re 65 per group. I don’t usually have folks balk at the price, and if they do, we offer them the sliding scale. Or and we say on our flyers that their sliding scale spots available so they know to ask for it if they need it, and then if for whatever reason, we can’t offer it because they’re already full, we put them on the waitlist for that sliding scale spot and let them know if we’re if we’re able to. Dr. Brittany Bate 00:35:56 Typically, if the group is going to run, we’ll give them the sliding scale spot and let them in because that’s most that’s again values driven. And that’s more important to us. we just can’t have for that our sliding scale to get the group to run because that wouldn’t, be fair to the clinician necessarily. So. Andrew Burdette 00:36:11 So how does one there’s this balance of like I want to run a group to talk about X versus identifying a need in the community. So the group I’m mentioning that is getting started, but I think we’re going to take on and start is because there’s a need. And I have clients that were looking for a group and I can’t find one to send them to. So I’m like, I guess I’ll just create one. And that seems like a great way to kind of one reduce the lead time needed to market it, because there’s already people interested in that service and even in the community, people looking for that too. But like, what kind of lead time does one need in terms of conceptualizing a group and then actually advertising to get people in the seats? Yes. Dr. Brittany Bate 00:36:52 This is one of my favorite questions to talk about because I think there’s like such important information here. So I think you’re really wise on what you’re doing. My favorite way to come up with a group idea is when someone tells me there’s a need, and that there is not a filling place for it. So the best groups that I have been able to run and fill the easiest are ones where I either see commonalities among my own caseload and then kind of put out the idea to my own caseload, and then from there market it to the broader community as well as my caseload or my practice, or I’m seeing the community keeps saying they need this thing, they need this thing, they need this thing. And then I created I fill the need for them. So I think that is absolutely the best way to go. I have found that that tends to get the groups full faster than a group that, although really cool, that you’re just maybe very excited about and want to do. Those are the ones that have been more challenging to fill, I find. Dr. Brittany Bate 00:37:48 So filling a need is definitely important in terms of lead time. I believe that a minimum of eight weeks is needed and you need to be marketing consistently. So the number one mistake I see clinicians make is they’ll drop a flyer in a Facebook group, and then I never hear from them again. And the algorithm a million reasons it’s not going to be seen. And I always hear people and I had to work through this myself about not wanting to be annoying, not wanting to spam. And I hear you. I don’t want to be annoying, I really don’t, I don’t want to spam. And also I’m I’m offering a valuable service and I want to make sure people see it because not everybody’s on Facebook on every single day or every day of the week. the algorithm is weird. Some people don’t see it, and I truly can’t tell you the amount of times I use the grief group again, as an example, that I had marketed my grief group every week in every Facebook group for six weeks. Dr. Brittany Bate 00:38:44 And on week seven, I have someone, hey, is anyone leading a group grief group in this? In this Facebook group that I know that I’ve marketed in and they just haven’t seen it. They have not seen it. And so that gives me the motivation to continue to market and put the information out there. But you have to be consistent and you have to get it out there because they’re not going to see it. And then from there, you also have to make sure that it’s to clinicians and to places and spaces that are going to be passing it along to to the clients that need to get the information. So be consistent. And if anyone’s annoyed, I’ve had like I kind of one hand and it it hurt, it sucked. I had to work through it. The amount of people who have been like, hey, like maybe don’t post so much or hey, the rules for this listserv is you can only post once per month and got it. Love it. Got your rule. I have a I love spreadsheets, I have a spreadsheet for all the like listservs in the rules. Dr. Brittany Bate 00:39:39 I have a very big spreadsheet, both local to North Carolina and local to like, or just United States based that has all the Facebook groups that I’m in and the rules for posting, the rules for marketing. And that has helped to alleviate my own anxiety about being annoying and has also helped to keep me really organized in making sure that I’m showing up consistently to get this information out there, because I really want to lead this group and I want people to know about it. Andrew Burdette 00:40:02 So I found in the Facebook groups a couple different things. One, people that are commenting about your annoying and posting too much, that’s their own stuff. It’s not your stuff. And like again, once a week. I mean, I knew people that promote groups like up here locally in our group, like they’ll do it daily, kind of ramping up to that kind of cut off point for the group to try and get out of attendance and stuff or even mention like, hey, I need two more people in this to really make it viable. Andrew Burdette 00:40:26 And I really want to do it because the couple people that are signed up really want to do it too. And, that’s just being real. And there’s, in North Carolina’s two extremely similarly named Facebook groups, and one is very open about self-promotion and other things. The other one’s hateful on it, and I’m like, I got them confused trying to promote this podcast, actually, like, in the in the group, I kept getting shut down, like, can you tell me what’s up? And then turns out I message the admin of the other group is like, oh, we don’t care. You’re talking about this other group. I was like, oh, now I gotcha. So the Facebook thing is weird, the algorithm to things that make me crazy. So you’ll be scrolling through, you’ll see something and then it’ll like refresh, and then you can’t find what you just went for and you can’t search for it. It just it’s maddening. It’s really designed to keep you trapped on their platform, trying to find what you just thought you saw. Andrew Burdette 00:41:17 Yeah. Dr. Brittany Bate 00:41:18 exactly, exactly. And so that’s what I say. And, yeah, people are mad about it. or if you’re breaking a rule, then, you know, that’s what the spreadsheets for, to keep you from breaking rules. If you’re a people pleaser a little bit, or if you just don’t want to break rules, I get it. Me too. But yeah, if people are annoyed, it’s their own stuff. Like you could just probably keep scrolling and it would be fine. Andrew Burdette 00:41:37 Do you run the same group, meaning the same curriculum or format type group at different times in multiple sections, as it were? Dr. Brittany Bate 00:41:47 We don’t currently. It’s something we’ve thought about. What we do do is we have an interest list. So we have a I just created this to have it organized a little bit better. We have a Google Forms embedded on our group therapy page on our website, and we have a list in that Google forms of all the groups that we’ve ever run and the groups that we’re probably going to run in the future, as well as like a catch all other category. Dr. Brittany Bate 00:42:09 And we ask people to check the ones they’re interested in, and then that and then we also ask them about best days and best times, generally speaking. So we have that data and that helps us to pick the best day and time for the most people that might be interested in that group. If we were at a place where we did have, like, let’s say, six people interested in our Mindful Awareness for ADHD and anxiety group at noon on Tuesday, and six people who are interested in that same group at 5:00 on a Thursday. We would probably run it twice or run it at the same time or different time, same section. But we just haven’t had that happen. We’ve only had it happen where we have enough people to make a good group at one specific time, and if people need another time, we just keep that in mind for our next, running of it. Andrew Burdette 00:42:57 I am super excited for my CRM, because it’s going to make tracking all that so much easier, and it has a mailing list feature and all that stuff. Andrew Burdette 00:43:05 So part of moving into that now is just making sure that I don’t have to do all the, like, manual, because Google’s been great for that. We’ve used Google Forms for that. There’s a great like, waitlist tracker and colleague of mine built that uses Google Forms. It’s awesome. It’s available on Etsy. If anybody’s interested, you can message me and I could put you to it. But the part of the CRM thing is to track all that. And people can sign up interest lists. it’s it’s going to be a game changer for all of this stuff and it’s like the last big system I’m excited for. But yeah, the interesting in the marketing and stuff is going to be really big. It’ll do all the social stuff to you. But yeah, the I think it’s, I think for us, I’m expecting there to be enough interest in this group around, you know, adults parenting or adults having to parent their parents in a way kind of thing. And the stress that’s unique to that. Andrew Burdette 00:43:53 And, there’s probably going to be more than one section, I guess. Is it? So I was curious about that to just see if people do it because there’s an Am and a PM. These are things that were normal in my agencies, like, you know, you’d have a morning and afternoon on an evening IOP section usually like those kind of things. so just kind of interesting. are there any, any hot topics or big things on this that I haven’t thought to ask you about with regard to setting up and running groups? Dr. Brittany Bate 00:44:20 I think the only other thing that I, I get a lot is, you know, we do all virtual groups at my practice and I get a lot of like, how do you do that? How do you set it up? as I said, I use simple practice as my primary EHR. I know a lot of them run very similarly. So what I do is so simple practice did just do an update to be able to do group clients. I haven’t looked into it. Dr. Brittany Bate 00:44:43 I don’t love change necessarily, and I like the way that I have things running right now. I will look into it, but before I look into it, let me say what I do is I schedule all my clients in that same time block as individual clients, so they still get their reminders, they can do their billing, and we can write their individual notes in their individual client profiles. And then I have the HIPAA compliant zoom, and we set up a zoom link that we set the location and simple practice to zoom. So they’re reminded that it is zoom and it doesn’t do our simple practice a telehealth link. And we send out an email. We schedule a zoom to send it out 30 minutes before two with the with the link before every session. And that is how we do it. So it’s not the only way. It’s not maybe the best way, but that’s the way we do it and it’s worked for us. So that works. And then I think the only other thing is like, truly, like, you really do have to have a marketing plan, even if even if there are people saying, we want this, we need this. Dr. Brittany Bate 00:45:39 I have had a lot of groups. Right now, right now we’re trying to run. It was based out of a need that we were hearing in the community from higher levels of care, saying that we love your groups, but they’re close. Most of them are closed. And when we have people discharging and stepping down who love groups that have done groups here, we really need someone that they can jump into right away. And we’re like, groovy. We are going to do an open an ongoing adult mental health group. So for anyone who just wants additional mental health support and a process space, it’ll be open and ongoing. You can join. You can jump in any time. We’ve been marketing that since May and we have one very interested, very excited person. we’ve been reaching out to IOPs and PHP and higher levels of care, and they’ve been passing it along and for whatever reason, we just don’t have enough interest yet to do the formal registration process and begin. So all that to say, you’ll want to make sure you’re doing a lot of marketing and really focusing on marketing. Dr. Brittany Bate 00:46:33 blogging is really helpful. Blogging on the topic so that that is also helping with some SEO. Having an interest list is going to be really helpful. Telling people that, you know, having a mailing list, telling people that you’re doing it, getting people ready and having that lead time, just make sure you have that lead time is going to be really, really important and that you have a plan essentially. Andrew Burdette 00:46:52 So some of the things you’re talking about in here about just, you know, interest list and lead time and these kind of things and managing these kind of wait list type things are there is no EHR that does CRM kind of stuff, and CRM is a customer relations management I think is what it stands for software. But they don’t do waitlists. Well, they don’t do any of this well. And so if you are group practice out there and you’re scaling, I can’t emphasize enough about trying to find some kind of CRM type solution to automate some of this marketing tracking kind of stuff and sign up. Andrew Burdette 00:47:22 I mean, the setup Sox we’ve been doing all summer, but we’re close. And like once it’s online, my ovens can kind of monitor things and no one’s got to manually do all this stuff, which is then going to make scaling either individual or group stuff so much easier. Yeah. yeah. It is really interesting how, you know, you’ll get a lot of noise about we need this and then. Well, here it is and no one’s there. And you’re like, what? Everyone said they wanted a pet rock. I’ve got a whole bag full of pet rocks. No one’s buying, you know, any kind of thing or whatever it is, right? It is really. Marketing is weird like that, honestly. Like I think so. It seems to be like, this should work, but it doesn’t. And then other times, like, I don’t know, we are really supply side economic kind of Reagan era is still mindset for I think a lot of people and but usually that works and it doesn’t seem like it works as well in our field about well, the supply is I have the supply of room for therapy clients and offer something and people are like, but I don’t know that now that it’s offered, I don’t really want it. Dr. Brittany Bate 00:48:22 Yeah. Dr. Brittany Bate 00:48:22 I think you know what I’ve noticed in talking to some of my colleagues, I think were the where the disconnect and where the challenge is, is I have folks like, I’m marketing like crazy. I’m getting the information out there, but then the clinician has to then have the time energy and remember to then pass it along to the client. That’s going to be a good fit. And I think all of those can be tripping points. You know, maybe they don’t have the time to forward the email on. Maybe they don’t remember to forward the email on, or maybe they’re not sure how to bring it up to their client. I have clinicians at my own practice that have clients that are going to be really good fits for certain groups, and they have challenges with how to bring it up in session and suggest it to the client. And I think all of those are really fair and valid, challenges. And I don’t necessarily know how to get past all of them in my own practice. You know, it’s just kind of 1 to 1 talking with the clinicians and consulting about how to best present it. Dr. Brittany Bate 00:49:18 And then with colleagues, I try to send an email that they can truly just forward, like I write it, so that the client can read it, and then they can just forward it to anyone that might be helped be helped by this group. But I think that’s the challenge. It’s getting the flyer in front of the client that’s going to most benefit, and most of it is incumbent upon our colleagues having that the time and the energy and the ability and just whatever to be able to pass it along. And then the client buying in to that’s always a big piece is I love groups, but not every client loves groups. Not every client is comfortable with groups. There’s I have met very few. I can count on one hand the number of clients that weren’t some level of anxious to begin the group. so I think that’s part of the challenge too, is figuring out how do we get this in front of the clients more successfully, and how do we get the clients, to feel safer to consider this idea? Andrew Burdette 00:50:08 I think there’s. Dr. Brittany Bate 00:50:09 A kind of more. Andrew Burdette 00:50:11 Fundamental thing that’s common among most therapists about, again, it’s the self-promotion thing, you know, or remembering to like, oh, by the way, I’m also offering this even even doing this world over here for things like podcasts and stuff. I’m supposed to kind of I need to. It’s reminding me I should double check and see if there’s some other little bumper plugs I should do, because I forget to bring them up. Like, you know, it’s like I ask you at the end of it, like anything you want to plug. And there’s I know when Joe and other people are hosting to you, they’ll kind of plug some things to. And I think it’s normal for us therapists to forget those kind of things, because it’s not normally what we do where they’re to do mental health processing. We’re not there to like plug the next event. Right. Like and it kind of fits in that. So I think there’s a, a built in kind of disconnect there about inviting that with our clients in a way. Dr. Brittany Bate 00:51:02 Yeah, absolutely. Absolutely. Dr. Brittany Bate 00:51:04 I could probably do a whole other session on or a whole other interview here on how to best present groups to clients. and maybe I will maybe we can, touch base on that for around too. Yeah. Andrew Burdette 00:51:14 Sounds good. Well, are there any other any things that I haven’t covered that you want to make sure people have? Or as a summary, you want to make sure people kind of take away from this episode on groups. Dr. Brittany Bate 00:51:24 I, I just think, you know, look for what is needed within your own caseload, within your own practice or within your community, and go there. And you said something earlier that I think is really important as a summary to if if you try to get a group going and it doesn’t work out the first time, it is not a failure. It’s a learning process. And you have learned you’ve gotten data about what you know is needed, what’s not needed. Or maybe it’s the day and the time, or maybe it is the price or whatever it is. Dr. Brittany Bate 00:51:52 it’s not a failure. It’s data. And I love data. So keeping that in mind and you just don’t know unless you try and and just try, just try and see what happens. And then I think just recognizing that it does usually take some time and energy in community and marketing. And so have a plan, have a plan for that. and then give it a go because it really is so worth it. it increases accessibility. Group therapy is an entirely different modality in and of itself that can lead to incredible connection and growth. And it also just adds diversity to your own work week, which can be really exciting too. Andrew Burdette 00:52:27 So I think to and you kind of touched on this indirectly, like for practice owners out there looking to diversify their lines of business, streams of income and those kind of things within their practice because groups are at scale one, they are more affordable to the people in it. But if you have a ten person group paying $50 a session, that’s $500 for the hour, right? So the clinician benefits immensely from that versus what they would normally get, say like 1 to 150 and for for a one on one session. Andrew Burdette 00:52:55 And the practice also benefits because they’re getting that same equal split however that lays out in your practice. I don’t know what your numbers are, but assuming it was a 5050 thing, it’d be 250 each way versus 100 100, right? So that’s a big deal. Right. Dr. Brittany Bate 00:53:08 And yeah, and. Dr. Brittany Bate 00:53:10 That’s and that is also for eight weeks in a row, or 12 weeks in a row, or 15 weeks in a row, depending on how long the group is too. So it’s not just one session that’s going to be $500 for that hour. It’s going to be eight, it’s going to be six, it’s going to be 15. And I think that’s you know, also. Yeah helpful. Dr. Brittany Bate 00:53:24 For sure. Andrew Burdette 00:53:25 Yeah. And if you’re having people kind of sign up for the whole package at once, then that’s kind of secured income which you don’t like. You it’s easier for private pay practices like you all to kind of bill ahead of time. I can’t bill ahead of time because I’m insurance based. Andrew Burdette 00:53:38 And that would be unfair to my private pay people to do so. But you know, there’s different logistics there and rules and for understandable reasons. But yeah, trying to trying to have that package deal in there sounds like you can kind of just guarantee it a bit more. Dr. Brittany Bate 00:53:52 Yeah. Andrew Burdette 00:53:53 Yeah. Well cool. Well thanks so much again for coming on and talking about things. And if you decide you want to come back and Hot Topic, some other thing about groups or some other thing that we missed and be happy to have you on again. if people want to work with you, how do they find you and what are your goals? Dr. Brittany Bate 00:54:08 Yeah. you can check me out on bold practice builders. Com. I still have some edits to make to my website, but good enough is perfect so it is there for now. I have some products too that help to streamline, simplify and succeed. The things that I tend to offer to people who are looking to start group therapy programs. I have kind of a whole a whole package for for that. Dr. Brittany Bate 00:54:30 I sell my informed consents done for you customizable that you can have. I sell my marketing manual, which has probably about ten pages specific to group therapy marketing and people say has been very helpful. It has this like whole matrix about how to market, where to market. and then just recently I mentioned it earlier, those, those spreadsheets that I’ve created that have the different days that you could market or the different ways that you can market in the rules for rule followers like me, I have those for purchase as well, and I’m constantly updating them. And I’m happy to send out updates for those who purchased them. So those would be the kind of the main things that I think people might find most helpful and then 1 to 1 coaching with me. I love talking with practice owners and people looking to scale, simplify, streamline, and succeed so you can reach out to me through my website, Brittany at Bold Practice builders.com and I would love to talk to you. Andrew Burdette 00:55:24 Awesome. Well, thanks again for coming on. Andrew Burdette 00:55:26 This is really great and look forward to catching up with you sometime soon in the future. Dr. Brittany Bate 00:55:30 All right. Dr. Brittany Bate 00:55:30 Take care. Andrew Burdette 00:55:37 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.