[JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, session number 809. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast, where we cover everything around starting, growing, scaling, and even exiting your private practice. I hope you are doing awesome today. We’ve had some amazing interviews over the last month. I mean, when I look back, we just talked to Dr. Brian Dixon about mental health ecosystems last time, we talked to this guy Tom about how he started a carwash business and 80% of his employees are people with autism, so just a really cool model. We talked about the leaders playlist with Susan Drum, talked about having well-oiled operations, forecasting future scenarios, so if you missed any of those shows over the last couple weeks we’ve had an awesome group of people that we’ve interviewed. That’s just going to continue even more today where we have Betsy Byler with us, who is a mental health therapist, substance abuse counselor, and clinical supervisor. She’s also the host of the All Things Substance podcast. In addition to being a trauma therapist, she’s passionate about helping other therapists feel confident and competent in working with substance use. Betsy, welcome to the Practice of the Practice Podcast. [BETSY BYLER] Thanks so much for having me. [JOE] Yes, well you’ve had a private practice for a handful of years. I would love to first just start with why did you start a private practice and what was helpful in that process of starting your practice? [BETSY] Well, I’ve been in community mental health since 2003, and last thing I did, I was a director of an agency and did that for a number of years, and what’s hitting a lot of community mental health and a lot of agencies is productivity and increased expectations. I think it was when the CEO at the time suggested that we double book therapy appointments that that was sort of the moment for me of, okay, I don’t know about, I don’t know that I can do this. So it was a whole bunch of things that led up to it. It was earlier in my career than I thought I would go into private practice. I thought it was going to be, I don’t know, later, closer to retirement but honestly, it was the best choice I’ve ever made, probably. I found that it was easier than I expected and part of that is a couple things. One of them was do live in a smaller area and I’ve been in this area a while. So it was easier for me to transition because people know who I am. At the same time though, the business aspect was different because it’s just me. I think I double booked myself three times in the first week because I was so used to having someone do my schedule for me that I never truly appreciated I think how much my support staff did for me and learned really quickly. But one of the most important things was actually a checklist that you had. A friend of mine from Chicago had talked with me about your podcast. I hadn’t ever heard of it, and this was a couple years ago now. I listened to like a ton of episodes in a row, all the stuff about starting practice, and you had a checklist and it’s 28 or 29 items, and I followed it in order and the very first thing I think is to think of a name. I was like, that’s weird to start with, but I did a whole bunch of brainstorming and found the name and got the URL and the rest, as they say, is history. It’s been really, really great. [JOE] Yes, there is something about when you have the name and it feels more real. I think that’s why we start with that is that if you name it something, it just feels like, oh, okay, this is actually something I can visualize. I can visualize a logo or a website or that it’s beyond me so instead of just being an idea, it seems to once you name it and then give it the URL and all that, it’s a lot easier to start to create it. [BETSY] Right, it was [JOE] Now what was that first year like for you as you started your practice? [BETSY] So I actually started in November of 2019. The first year was interesting. It was fine and then all of a sudden Covid. It was getting used to, the hard part I think for me was all of the paperwork, all of, not so much like the documentation of my clients, that’s not difficult, but like the consents and all the things which you can buy packages. But I was trying to do this while preparing to leave my agency job and trying to bootstrap it in the beginning and hired out some things, hired out billing and that was always challenging the credentialing piece. So it was a lot of putting pieces in motion and trying to make sure I didn’t forget things and it took a while and waiting to get paid and all of that. It all worked out in the end so I don’t want to scare anyone off. It was just needing to have some patience that it could take six months for me to have it all ironed out. With Covid I had to really shift very quickly because I was really, I don’t know, against video therapy at that point. I’m an EMDR therapist primarily and I was very much like, we need to be in the same room. I’m super relational and I just didn’t think video therapy was great for me and all of a sudden here I am doing a hundred percent telehealth and I’m still doing a hundred percent telehealth and I love it. I found it to be really effective, which was shocking. You can do EMDR or video and it works. So that was a huge learning curve for me. [JOE] Now during that time was substance use and abuse, was that all part of your specialty or was that something that came later on? [BETSY] I’ve specialized in that pretty much my whole career. After I figured out early in the beginning that I didn’t know enough, I got out of grad school, figured that because I’m in recovery and had a class in grad school, I was like, oh, I know how to work with this. I found out very quickly that I didn’t, and that I didn’t have enough training. I really thought I was the only therapist who didn’t know and I was like frantically trying to catch up before anyone found out that I was a fraud and didn’t know what I was doing. Then I figured it out that, oh, most of us didn’t get adequately trained. As I settled into that, I made it my mission to get up to speed, so to speak, and to make that my specialty. I had always wanted to work with specifically angry teenagers that hate everybody and use drugs. I was one of those kids, so that was always a goal of mine. So I’ve been specializing in it pretty much since the beginning, but specifically, probably since 2008. [JOE] Then as you started a practice right before the pandemic how did that maybe speed things up for you? How did it slow things down for you? What was that like having a new practice in 2020? [BETSY] I brought a number of clients with me and so I had a pretty decently full caseload but over the pandemic, what I found was a lot of people reaching out, new people, people that probably wouldn’t have gone into the community mental health center where I was, a lot of people who probably hadn’t been in therapy even before. So it wasn’t a lot of people who had a lot of experience or knew what they were asking for really. That was really different and really cool actually. I have worked with the same population of folks since I moved up here 14 years ago and so it was really different and cool to have a different population and getting contacted by insurance companies and asking me about taking this client or that client and having to make choices about not taking EAP, which is just my personal preference. It was really an interesting thing, building it and the pandemic I think spurred people on to reach out because all of a sudden no one was going anywhere and people were starting to struggle harder than maybe they were before. [JOE] Now at what point did you sign up for Podcast Launch School and start your podcast? [BETSY] It was actually during the summer of 2020. I had always thought about someday I’m not going to want to do therapy full-time. I’m not burnt out. I love my job and I wanted to future-plan. You were doing a bundle with Marissa Lotton and I had already been working in one of her courses and saw the Podcast Launch School and knew that that was going to be the way that I brought my message to others. I don’t love to write so a blog was out and you’ve talked a lot about how podcasts are still popular and you had come out with this program to help get things launched and I had no experience, zero with recording or anything like that. So it was really helpful for me to have a step-by-step of how to do it because I knew what I wanted to say and I had done that put together what I wanted it to be. But getting started was really daunting. So it was, I think, I don’t know, I think that was in July or August of 2020 I want to say. [PILLARS OF PRACTICE] We brought together all of our checklists, videos, and other free things in one spot so you don’t have to opt in all over the place just to get another checklist. We’ve put it all together over at pillarsofpractice.com. Whether you’re just getting started or have an established group therapy practice, we have a free e-course for you as well. We have eight-minute experts, which are short eight-minute videos around specific topics completely free. If you want to take your practice to the next level, head on over to pillarsofpractice.com to get access to our free e-courses. Again, that’s pillarsofpractice.com to get all of those free e-courses. [JOE SANOK] So Betsy when did you start the podcast? [BETSY] Well, I did the Podcast Launch School in July or August, I believe, of 2020 and I went live in October, on October 27th, I believe, and did my first five podcasts like you recommended to make sure that people could binge-listen and it was challenging, but really cool to get it all set and going. [JOE] How did you think through your first episodes and what you wanted to cover? [BETSY] Well, the way that it was described in the Podcast Launch School, and I’m not just promoting your stuff, but it was how I did it and it was why we’re here, what the problem is. So I really set up the first five episodes to introduce that concept and do the, this is why I’m doing this, this is why it matters, this is why it should matter to you. Those are still pretty well listened to. I’m on episode 90, 95, I think, and by the time this comes out, it’ll be more than that and people still listen to those early episodes. [JOE] For you, what’s it done in regards to positioning yourself beyond just your private practice to have a podcast and start to level up? [BETSY] Well, I have listeners, it’s all over the world, which is interesting. I didn’t know that Australia liked podcasts as much as they do, and that was really surprising for me. I’ve had people reach out to see if I would see them internationally for therapy, and that sort of depends on the country but that was really interesting too. I’ve gotten to know some other podcast hosts and I’m still working on visibility for the podcast of course. But it’s been really interesting to me to get to know some people and then to be able to find people that are reaching out to me for different things that was really unexpected and I have people reaching out from all over the world and that was really for someone living in Wisconsin in the middle of America, that was a really unique experience. [JOE] Yes, yes. Now I know one of your specialties is now teaching therapists about substance use and maybe helping them understand what they can do, what they can’t do in the sessions. What are maybe some common misunderstandings that people have regarding what they can or can’t do in the sessions? [BETSY] I think that because we didn’t necessarily get trained, a lot of us maybe had a class or it was optional and it wasn’t on our licensing exams. I think the assumption is that therefore it’s not in our scope. Yet it’s still in the DSM along with all the other things that we do. When I’ve talked to a couple professors about why that might be that it’s not in our classes or on the licensing exam, they don’t really have an answer. They agree that we should talk about it. They agree that it probably should be part of our scope in terms of what we learn, but programs can only do so much. There’s so much to teach that they have to teach to the test pretty much and so I think that people think it’s not ethical or not in their scope. If you look at our different licenses, they include substance use as part of evaluating people’s life. Their medical health, we talk about that, but don’t have training there. It is something that is part of our scope. It’s literally in our manual. What I’ve heard from people is they worry about that, about practicing out of scope and then they worry that they’re going to mess people up, that if they step into this arena that they’re not going to know what to do, that they’re going to make something worse and they feel ill-equipped. I had a woman tell me that she feels like a fish out of water and that she doesn’t know what to do when it comes up. I think people think that there’s specific modalities that you need to learn and that there’s specific knowledge that’s about substance use or addiction. Really that doesn’t exist, like there aren’t specific modalities. There is no DBT for substance use. It’s actually all the skills we already use. I think people just need some more information and then they can apply all sorts of skills to substance use and that most clients don’t need to be referred out. The folks who are using really heavily typically aren’t going to show up in mental health therapy. They’re going to come in through another door, which is usually somehow mandated by the court. [JOE] What are some of the basic skills that you would say if someone’s not going to refer out that you would hope that people would have if they’re not referring out? [BETSY] So I think our basic assessment skills of symptoms are, is really helpful here. When did it start, how bad is it, how bad was it, what’s it like for you? What do you wish was different? What is it helping? What is it may be getting in the way of how are you using it? What goals do you have? I think we already know how to talk about it just like we would about depression or anxiety or PTSD. We just are looking for the flow over time and what’s most troublesome for people. That’s one skill. I think another really big skill is something that we work on all the time, which is distress tolerance because substance use is almost always related to distress tolerance. When people are using substances, whether it’s having a drink in the evening, having a number of drinks to try to relax from the day or deal with stress or they’re using marijuana in whatever ways, and it’s not recreational, it’s more to try to manage their anxiety or their stress. What we’re talking about is helping people figure out how to manage in a way that’s a little more adaptive that isn’t going to get in the way of other things. So we have to figure out ways to help people tolerate discomfort a little bit and use skills that don’t require something on the outside to be done, but that they can use internally. We do that work all the time. [JOE] Yes, yes. It sounds like a lot of those skills, I mean, anything that someone has in their life that’s getting in the way of living a better life that’s outside of them to teach them those internal skills. What are some of those skills that you find work especially well with people that are dealing with substance abuse issues? [BETSY] I find that a lot of the DBT work really helps, and I believe some of the DBT stuff that Marshall Lenahan created was taken from, well, she took it from a lots of places as she’ll say, but I recognize some of it from recovery literature, some from even 12 steps, although there’s lots of recovery choices. But sort of the idea of dealing with, let’s say a panic attack, so there’s DBT skills that one is called tip. It’s about temperature, intense exercise, paste breathing and paired muscle relaxation. So when someone’s having a really bad craving to use, and it’s not like what people would think of as like a junkie or whatever, we’re talking about a I feel like I’m going to crawl out of my skin I’m really stressed out and I feel like this will help immediately and everything in my body wants me to do this right now. Well, part of that is getting yourself regulated in terms of your temperature using cold to bring that temperature down, a burst of exercise or movement to get yourself focused on that. If you’re doing a fast walk, you’re not thinking about what’s happening in your head, eventually you’re paying attention to your breathing and then doing the paste breathing, the grounding breathing that we teach in all sorts of ways because our respiration is going to go up just naturally because we’re under stress and then doing some muscle relaxation. It’s very similar to a panic attack. A real intense craving, so to speak, or desire to use, whatever it is about 15 minutes to maybe 30 minutes at max and if someone can ride the wave there and get past it, then they have an experience of having success in managing it and that’s super helpful for the next time when they have those thoughts about I can’t deal with this. [JOE] Now you’ve put together, I know you’re working with Marissa on the side hustle support. Tell me a little bit about your e-course that you have coming out because love hearing people take their specialty and go beyond just their one-on-one sessions. [BETSY] When I was first working on the Podcast Launch School, one of the things you said was, what could I talk about without getting bored? I’m paraphrasing, but it was something along those lines. I realized that I am really passionate about substance use and I’m also really passionate about helping therapists feel competent that a lot of what I see from people, whether it’s in online groups, is this sense of feeling like they don’t know what to do. So putting those two things together, I am creating or have created a program called Charting the Course. You and I have sailing backgrounds, and so a lot of that is where I’m thinking about this course of moving through maybe some unchartered waters. I feel like for therapists, a lot of the substance use is uncharted. What I know to be true is that there are lots of courses people could take. You can go to PESSIE right now and Google probably, they probably have a hundred things labeled substance use. The trouble is not everybody needs all that information. That’s a lot of stuff and frankly, you don’t need to know that as a therapist. There’s some really specific information that you do need to know and I believe that I have figured out what you need to know. In doing supervision for my staff for interns over the last 10, 15 years, I have figured out, I believe what’s most important because the therapists that worked with me, they were mental health people and that was their training and that’s my training too. I’m primarily a mental health therapist and as I would work with them and their clients who had substance use, teaching them the same things over and over. That’s what I put together in the course. It’s a six week course. I teach it live, it’s two hours a week and then there’s six months of consultation calls after that that are optional if people want them. It’s a group monthly consultation call because I figure when we go to trainings and we leave the training, we’re excited about something, we want to use it, but things happen and you forget things or we don’t have all the stuff right in front of us and so these new skills go unused. I actually want people to be able to implement this because I really believe that lots of people are using probably alcohol or marijuana in a way that’s problematic. There are normal ways to use those things and there are lots of people that do, but there are a ton of folks I think who are struggling and self-managing it. I want us to be able to bring it into the room because I feel like we will be able to do better work and I firmly believe that if it’s not addressed, it’s going to get in the way of therapy. [JOE] Now Betsy the last question I always ask is if every private practitioner in the world were listening right now, what would you want them to know? [BETSY] I think that who we are as people, as therapists is unique and that while lots of people do therapy, only you can do it your way and with your unique personality, abilities and skillset. I think the most important thing that we can do is to learn to just be with people and to be ourselves and in your private practice. It can take a while I think, to have that word of mouth or niche, but I believe it does happen that people will say I saw so-and-so and I think you would be perfect for that. I think they would be perfect for that therapist. When you have a bunch of clients who really fit your style and you fit theirs, it’s really cool. Private practice is really different that way because while in the beginning you may see a lot of folks because you’re building a caseload, it does start to niche down and instead of it being a handful of clients in a couple weeks that really suit you, it starts to be almost everyone. That is easy and feels really great and feels like an extension of yourself so I would encourage you to have faith in the process and keep being who you are with your specialty and not trying to be all things to all people because I think there are people who just need you. Maybe they just haven’t found you yet. [JOE] So awesome Betsy. If people want to connect with you, if they want to read more about the course, where’s the best place to send them? [BETSY] They can go to my website at betsybyler.com and they can catch the podcast on everywhere there’s podcasts, Apple and Spotify and all of that. It’s called All Things Substance and comes out every Monday and they can definitely go check out the website and the different things that are there and they can reach out at my email, which is [email protected]. [JOE] Thank you so much for being on the show. [BETSY] Thanks so much for having me. [JOE] Well, go take some action. I just love hearing people’s stories of how they continue to grow beyond even their private practice and growing side hustles or e-courses or podcasts or different sorts of things. It’s pretty darn awesome to see. If you are looking for some extra help with your private practice, we have our free e-course called Pillars of Practice. There’s two different tracks, one for people just starting out and one for people that have an established practice. Within it we have these eight-minute experts where I set a timer for eight minutes, we just talk about websites, we talk about SEO, we talk about bookkeeping, all those different things. The checklist that Betsy referenced in the show is available in there as well, as well as tons of other checklists that you used to have to individually opt into, but instead they’re all in one place now. Head on over to pillarsofpractice.com. Also Podcast Launch School, you can go pick up that course over at podcastlaunchschool.com. Thank you so much for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for that intro music. This podcast is designed, provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.