[JOE SANOK]
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[WHITNEY OWENS]
This is the Practice of the Practice, podcast episode 557.

Welcome to the Practice of the Practice podcast. This is Whitney Owen’s private practice consultant taking over the podcast today. We’re doing a series of interviews with those in our membership community called Group Practice Boss, and doing some live consulting here on the podcast in this series on leveling up your practice. So today on the podcast, I have Cathy Sullivan-Windt. She is a licensed counseling psychologist with almost 20 years experience providing individual psychotherapy to adults in the Baltimore area. She started as a solo practice owner and then grew into a group practice called New Connections Counseling Center. She got her BA from Boston college, an M.A. and Ed.M. in Psychological Counseling from Columbia University Teachers College, and a Ph.D. in Counseling Psychology from the University of Maryland, College Park. In her free time, she enjoys spending time in nature, biking, traveling, reading, and spending time with family and friends.
[WHITNEY]
Well, Cathy, thanks for coming on the show today.
[CATHY SULLIVAN-WINDT]
Thanks for having me, Whitney.
[WHITNEY]
Yes, well, you’re a special interview for me because as I was getting all set up here, I was thinking about how we already did a little consulting session on the airplane back from Slow Down School.
[CATHY]
That’s right. Unofficially.
[WHITNEY]
That’s right. And so I love that you have grown so much since then, and that we got to have that time together at Slow Down School. So welcome to the show and I’m glad you’re here and that we get to do this today.
[CATHY]
Yes, thanks for having me.
[WHITNEY]
Yes. So why don’t you first share a little bit with the audience about your practice, kind of where is it at now, how many clinicians, what’s the setup of your group practice?
[CATHY]
So I started my group practice about a year and a half ago and now have four therapists, a grad student, and then an administrative person. I started growing after Slow Down School. That was kind of a game changer for me. And I was about to hire my second therapist when COVID hit. That slowed me down and I got distracted with other life priorities. Then last fall or winter, I started hiring again and today is when I’m about to offer my fourth therapist a job.
[WHITNEY]
Congratulations.
[CATHY]
So there’s about six of us. I have about six people on my team and we’re doing well, we’re growing a lot, but we’re all virtual right now. And so I’ve never met four of the people on my team, in person.
[WHITNEY]
The world we’re living in. It’s so crazy, isn’t it?
[CATHY]
Yes, it’s crazy.
[WHITNEY]
Yes. One of my therapists the other day, I hired her during this time and then I saw her in person and she was like, “Wow, this is the first time I’ve met you in person.” And I was like, “Oh really? I guess you’re right.” Like, it’s just, you feel like you know people so well, but at the same time you don’t know how tall they are.
[CATHY]
It’s amazing what we get used to, isn’t it?
[WHITNEY]
Sure it is. Well, Cathy you’ve really grown a ton. That’s awesome.
[CATHY]
Yes. I’m loving it.
[WHITNEY]
Yes. But there’s always this growing pains, right?
[CATHY]
Absolutely.
[WHITNEY]
So what is your question that you have for the consulting today?
[CATHY]
So my big question is around office space, especially as related to group cohesion. I had a single office when COVID hit and I gave that office up last summer. So I don’t actually have an office and I get the feeling we’re at the cusp of people wanting to come back on some level, clients and clinicians. And I want to stay ahead of that. So I’m starting to think about office space and how much to get. Prior to COVID, I had a dream of having a center where everyone’s there and popping into each other’s office and a real nice sense of community, but right now my therapists don’t know each other. I have been so distracted with getting everything up and running that I forgot to even really introduce people or communicate. And so I’ve got these wonderful individuals who know me and who know our administrative person, but don’t know each other. So I’m looking to get office space. I don’t know how much, especially since I think the field is changing, I don’t think we’re going to go back to virtual being a very small part of our practices. And so I’m kind of torn about how much space to get given that I think a lot of clients and clinicians may want to continue working from home at some level.
[WHITNEY]
Yes, this is such a good question, Cathy. And I hear this, even prior to COVID people always had questions about office space, but now it’s a particular challenge. So the couple of questions for you. And I also kind of heard within that questions about culture and community. So if we have some time after we talk about office space, maybe we talk about that a little bit. But first go ahead and share with me about the specialties of your practice and your therapists. Like what kinds of clients do you all work with? Because I think that plays an impact on the in-person versus virtual.
[CATHY]
Yes, that’s a good point. So we really see adults only. I just kind of naturally had a lot of women clients come to me, a lot of high achieving women, professional women, and that’s who continued to call the practice a lot and then roll over into the therapists that work with me now. So I do a lot of work with anxiety and sexual trauma relationship issues, perfectionism. Two of my therapists do EMDR. So there’s a lot of trauma work being done. And then I have one therapist that specializes in couples work particularly a Mago therapy. And then lastly, I have a therapist who specializes in problematic drinking and alcohol abuse.
[WHITNEY]
I think it’s important that we consider what types of clients we work with because we find that some clients in general do better with telehealth and some not, and then specific disorders and things like, from what I understand and you can correct me if I’m wrong, there’s not a ton of research out there about couples counseling being super effective virtually. In fact, I have heard that research, not conclusively, but it kind of indicates that in-person is more effective for couples. Is that, have you heard something?
[CATHY]
I haven’t. I know that you know, virtual therapy overall is fairly effective, but it makes sense to me that couples work might be less effective. There’s so many non-verbals that are important to be able to pick up on.
[WHITNEY]
Definitely. Definitely. And then some couples really just struggle to sit right beside each other in front of a video when they’re doing their therapy session. It’s a lot harder for the therapist to intervene when it’s on a video than when it’s in-person. And then we also found for children that, especially young children, can’t really effectively do play therapy the same way that you can in-person. And then with EMDR, there are definitely effective ways to do EMDR virtually, but some people find, as therapists, they feel like it’s more effective when they do it in-person. So those are things to consider when you’re thinking about your office space; is the type of clients that you work with. So it sounds like for you definitely having some office space would be helpful and not staying fully virtual, considering the types of clients who are working with. Would you say that’s accurate?
[CATHY]
It is. My therapist who does couples and one of the EMDR folks, they live about 40 minutes away. And when I pulled them, it seems like they are interested in doing at least half their work virtually.
[WHITNEY]
Okay. Great. And you know what, that’s so great for office space. I mean, you don’t have to get so much because they’re able to do some from home and then some in the office, so it really saves everybody money and energy. That kind of a thing. And so there’s, is it five therapists or four?
[CATHY]
Well there’s four therapists and then the grad student just sees a few and she’s going to be moving away this summer. So we’ll say me plus four therapists.
[WHITNEY]
Okay. So there’s five of you guys, because you’re wanting to see, you see clients too correct?
[CATHY]
I do.
[WHITNEY]
Okay. Great. So a good rule of thumb when we’re talking about rent is to not get rent that’s more than 10% of your revenue when you’re paying for it. So when you’re looking out there for rent, just make sure that you consider that model when you’re thinking about space. I think a lot of people assume they’re going to grow into space and then they end up getting space that’s too expensive for what their needs are ad then it takes too long to go into it and they struggle. Also, you can really maximize office space. I mean, we don’t want to put our therapists out in the sense of everyone’s stressed about office space and when they can see clients, but you can easily get two therapists in one office, sometimes three therapists, just depending on how many hours they’re wanting to work. For example, you might have somebody doing all mornings and then someone else doing all evenings or someone else doing weekends.
[CATHY]
Yep.
[WHITNEY]
So those are some things to think through. So if you’re having five therapists, if we were to put two in an office, you could probably do just two offices, right?
[CATHY]
Yep.
[WHITNEY]
What does that sound like though, when I say just do two offices?
[CATHY]
It sounds like I couldn’t imagine growing out of it pretty quickly.
[WHITNEY]
Yes. I agree. I think if I was in your situation, I would be looking at a three office space. That would give you enough room for six therapists easily in-person. Now you might be able to fit in a little bit more and you have some people virtual. So if somebody was doing two days in person, two days virtual, and those were your full-time people, you probably could fit eight people into three offices because you’re able to split those days up with the virtual. I’ve also heard some people say that they’ll take office space and make a really small room, or maybe there’s an office without windows and they make that kind of into the virtual office. That way, when you’re doing that virtual therapy, if you’re doing it between your in-person sessions, you can kind of bounce over to the other office and then someone else can use your office as needed.
[CATHY]
That’s a good point. They could do virtual from the office if they wanted.
[WHITNEY]
Yes. I mean, it’s really interesting to me how everybody in the nation is very different right now. You know, we’re recording this in March, at the very end of March of 2021 and I’m consulting people that, like here in Savannah, it is rare that someone wants virtual therapy actually anymore.
[CATHY]
Oh, well.
[WHITNEY]
Almost every person that calls wants in-person. In fact, when COVID started and we went back to in-person, we were back in-person in May, we had tons of protocols in place, but people were requesting in-person back then.

Wow. So here in Baltimore there, I don’t know any therapist that’s back in-person and not a single one of my clients or my clinicians’ clients have asked to come back in-person.
[WHITNEY]
Yes. And I do think being in a larger city people, I mean, COVID or not COVID in a larger city, people are more wanting to do virtual because the commutes are so difficult and you know, people have a lot more on their plate and what’s going on. I mean, Savannah kind of has that slow down feel to it. Let’s just sit and have a cup of tea or ice tea really is what I should say on our front porch. And so people do want to like have that in-person feel in this area and COVID, it’s just, unfortunately people don’t take it as seriously down here as they should.

So obviously what you’re talking about with the office space, I do think it would bring more comradery to your practice in a sense because people would get to meet in person. And we can talk a little bit more about other ways to bring more cohesion to your group, but what are you thinking about office space, kind of the suggestions I just made. Do you feel like that answers that for you or did you have some more questions about it?
[CATHY]
It does. I actually saw my first suite of offices a couple of days ago and I saw three office suite in a kind of bustling part of town for 1200 a month. And it was only a one-year lease, which I thought maybe could work because at the end of the year, I’ll have a lot better idea of how much people want to come in person, how much my clinicians want to come in person and how much we’re growing. So I’m leaning toward doing that. Although I suspect if I rent it now, nobody will use it for a few months.
[WHITNEY]
Sure. And yes, most people probably won’t and I don’t know about you, but I have found, as I’ve gotten back into my office, it’s helped me just mentally to separate work from home. And you know, when I’m doing my virtual sessions or my consults, my kids are coming in, banging on the door, sliding notes under the door. So I do think sometimes even if it’s all virtual, it can be a nice touch for your clinicians to say, “Hey, you know what, if you do need a space to be able to work, here’s one.”
[CATHY]
We have one. Yep.
[WHITNEY]
That sounds like a great situation for you. And I would definitely pursue that. And you know, other things to consider in space, these are probably things that you’ve thought through, but like parking and access to the building, is it easy location to get to? Is it like often interstate that’s a little more convenient bathrooms, kitchen access. I had one place that I saw clients where they had coffee, like one of those coffee machines and it had hot chocolate and teas and clients really liked that.
[CATHY]
This place does not have a parking lot, but it has metered parking outside that’s not too hard to find. Or a block away has street parking, which I think is reasonable.
[WHITNEY]
Oh yes. Especially in a city like Baltimore, for sure.
[CATHY]
Yes.
[WHITNEY]
Yes. And is there any kind of waiting room area for clients?
[CATHY]
Yep. It has a lovely waiting room.
[WHITNEY]
Oh, wonderful. Well, it sounds like that might be a good fit for you.
[CATHY]
Yes. It just feels weird to get office space and then nobody’s asking for it, but I imagine people are going to start and yes, I’m dying to get back into an office.
[WHITNEY]
Yes. And you know that putting an office together is no easy feat. So get the help in getting that put together. And it gives you time to not feel so rushed and getting furniture in there and those types of things.
[CATHY]
Yes. Actually this place wants to get rid of their furniture and it has lovely furniture. So I might be able to buy a lot of the furniture off them.
[WHITNEY]
Oh, nice. That would make life a lot easier.
[CATHY]
Yes, sure it would.
[WHITNEY]
So let’s talk about how can you help with your culture and kind of cohesiveness within your staff? First of all, is there anything you’ve already done or thought about doing that’s been helpful?
[CATHY]
Well, I sent out a survey to my clinicians a few weeks ago asking them several things, including when they might be available to come and sit in my backyard for a little gathering. Now that the weather’s getting nicer, I think even though we don’t have space, we could meet in my backyard and just kind of get to know each other. I’m not sure how to frame that first gathering. I don’t want it to be too business-y, but I also don’t want it to be cheesy get-to-know-you, like what dinosaur would you be if you could be a dinosaur kind of thing. Because no one has met each other. But that’s my thought, to find a way to get us all in the same space outside initially. I suppose even before that is sending an email saying, “Hey guys, I know you’re all up and running, but I neglected to introduce you,” and kind of do that a little bit.
[WHITNEY]
Yes. Well I love that idea, Cathy. I think having people in your backyard, I mean, you hosting shows, that kind of servant leadership and compassion for your staff and them getting together. I think you could definitely do some business things that don’t feel too, I guess, business like where, I mean, therapists want to talk about the work they do, like introduce yourself. What types of clients do you like to work with? How can we refer back and forth? What made you decide to work at this place? What do you love about new connections and what makes it special? So I think those are all some things they could talk about and maybe you could throw in some of those silly get to know you questions, but maybe some that brings some laughs because therapists really need to laugh sometimes.
[CATHY]
It’s true.
[WHITNEY]
Yes. And do you do any kind of staff meeting with your team?
[CATHY]
So that’s something I’m just starting. My clinicians were all independent contractors until a few weeks ago and I did not have a staff meeting. Before COVID it was just me and one other person. So we would just kind of talk sporadically and then the next therapist didn’t come on until December and she was an independent contractor also, and I just never really thought to get that going. But now that I’ve hired two W2 employees, we’ve started in every other week staff meeting, but we’ve only had one so far.
[WHITNEY]
Well, first of all, congrats on that transition. It’s not easy to do the 1099 and W2, but it can be so satisfying and rewarding in the end.
[CATHY]
Yes. I’m still in the midst of it, but it’s kind of awkward right now because I have a staff meeting where the W2 employees are told to come and they get paid for it and the independent contractors, I need to reach out to them and I suppose make it available to them, but it won’t be required.
[WHITNEY]
That’s right. That’s right. Yes, and then hopefully you can get everybody on the same page if you decide to go fully W2. I found it so helpful in my own practice. But I do think that that staff meeting can bring a lot together for sure. And the consistency of that and people seeing each other, even if they’re seeing each other on Zoom, that can be really helpful for cohesion. I do think you can do a lot of other things. You could celebrate birthdays or little victories on staff. Maybe if somebody has their first full week of clients or whatever it is, you send out emails to the team and say, “Hey, I just want to congratulate this person and what they did.” Or maybe you get a group text going, or some of these apps that you can use to put groups on like WhatsApp and everybody can be talking to each other or sending things to one another. I think those are really great.

Obviously when COVID is better, you can do some events. Like we do quarterly events, usually with our team and I have been trying to keep that up during COVID like back in Valentine’s Day time. I think Valentine’s Day was over the weekend. On that Monday, we did a bake off where people could drop off a baked thing and then people could stop by the office whenever it was convenient and taste them and then fill out a survey and send it in. And then the winner got a gift card. So it was something silly fun we could do, but it brought some cohesion to the team.
[CATHY]
Hmm. And do you think I should start that? Like I’ve introduced the idea of W2 employees to my two independent contractors and told them that that’s something I want to make happen by June 1st. And they’re both kind of, they have all the info and they’re chewing on it and you know, we haven’t really formalized anything at this point. But you would go ahead and do team building with them, even though they’re still independent contractors. Is that right?
[WHITNEY]
Yes. I think that you can. I think you kind of hit the nail on the head earlier when you said invite them, but you don’t force them to come. You can make anything, but you can say, “Hey we’re doing, I provided this thing,” or maybe you mail them a little something, you can treat them like your W2’s in the sense of if you want to do something like that, but you can’t force them to do anything.
[CATHY]
Hmm. But mailing them something and inviting them to come to the staff meeting does not violate any sort of independent contractor status, yes?
[WHITNEY]
No. There are actually other practices that have 1099s that do staff meetings, but the independent contractor does not have to attend the meeting if they choose not to, but a lot of times they want to attend the meetings because they want to know what’s going on in the practice. Like that’s advantageous to them because they can learn from the owner or from the other therapists, or they want to do peer consult, or they want to get more clients. And so by attending those meetings, they can let you know, “Hey, I have openings, or this is what I’m looking for.” That kind of a thing. But it does tend to have more positive results when you have W2’s because you are forcing them to come to the meeting. Sometimes contractors might have other things going on. And so they’re less likely, or maybe they’re working at multiple practices. So they’re less likely to be committed to your practice when you have that W2 model, you tend to find that those therapists are a little bit more committed and hungry, and then you can provide them all those other resources as well.
[CATHY]
Yes. Yes, bit more invested.
[WHITNEY]
Yes. Any other thoughts or questions surrounding the culture of your practice and bringing the team more together?
[CATHY]
You know, I guess my personality is like, I want to almost apologize to the team, to the clinicians about like, “Hey, I kind of neglected to do this. Hey, let me tell you about all the great people who are involved.” I’m just wondering if that’s kind of an appropriate leader thing to do.
[WHITNEY]
Yes. Well, that’s a good question. I think a lot of people would ask that. I honestly think we don’t want to be an extra burden on our staff, that’s for sure. But isn’t there something to be said for a leader that admits their weaknesses and mistakes and chooses to close on those? You know, there was a moment in my life as a business owner where something really difficult happened to me at the practice where I had to, a staff ended up kind of hurting me personally and ended up leaving the practice and it didn’t go very well. And I had to kind of address that with my team so that they understood what had happened in a way that was appropriate to the clinician and to me, but it was a very vulnerable time for me as a business owner, I felt super insecure about my abilities.

I didn’t say all those things to my staff, but I did kind of open up to them about the pain over this person leaving and what this person meant to me. And I was a little worried about that thinking, “Oh, I’m supposed to hold it together and look really strong that this is not a big deal.” And I was like, “You know what, I’m not going to fake that. I’m going to be honest with my staff.” And it really brought us together. Like they really comforted me and strengthened me and now when I look back on kind of the formation of this team, I feel like that was a real defining moment for us.
[CATHY]
Hmm. So your kind of authenticity, your vulnerability with boundaries worked for you.
[WHITNEY]
Yes. Yes. And you know, we do this clinically with our clients. I mean, we don’t tell our clients all of our personal problems, but sometimes we have to be a little honest with them and it actually brings them into closer relationship. I remember one time my mother texted me right before, or it might’ve been my brother, somebody texted me to let me know my mom was having an immediate procedure on her heart because she had had some chest pain earlier that day. And like all that had happened and I didn’t know she’d gone and seen a doctor and now she’s at the hospital and she’s about to have a procedure. That’s all I knew. And so of course my client comes in and how am I going to focus during a session after you hear something like that? I just said to my client, “Hey, I’m sorry, this is what I just found out. I just want you to know if I’m distracted or look at my phone, that’s what’s going on, but you are also important to me and I want to do this session.” And I think it meant a lot to her to know what was going on and that she could be trusted and it grew our relationship and she felt stronger. So it’s not that we put it on them, but that we use that to our advantage, to grow together in community. And so you can do that with your staff in the same way like you do it with your clients.
[CATHY]
Yes. Yes, just being very real. I think when I took on each clinician, I was very open that this is a new practice and we’re growing and we’re trying new things and then if we find things that don’t work, we’re changing them. So I think I could deliver it kind of in that spirit, like, “Hey, this is something I realized that got missed in the shuffle and it’s important.”
[WHITNEY]
Yes. And I think you’re showing them that it’s important because you’re going back and doing something about it instead of just moving forward.
[CATHY]
Yes.
[WHITNEY]
And I think with the cohesion idea, also letting your staff do things they want to do, like saying to them, “is there anything that, you have ideas for this practice. You know we are new. What do you want to see happen?” Not that we do everything that they tell us to do, but take them into consideration and make some changes. And if you listen to their needs and then you make a change to meet those needs, they will really be bond into your practice.
[CATHY]
Yes. That’s a big part of my kind of values; is I not only want to provide good care for my clients, but I really want to provide a working environment that works for my clinicians and for the staff. I’ve worked in enough places where I felt that is missing and that’s something that’s really important to me to provide.
[WHITNEY]
I love that. Well, I think you will. Well, Cathy, can you share a little bit about what Group Practice Boss is and kind of how that helps you do as a group practice owner?
[CATHY]
Group Practice boss has been excellent. I just joined at the beginning of February and it was like where I kind of gotten through the crisis part of COVID and was ready to start really investing and expanding again. And I joined a Group Practice Boss and it’s been like just a real fire under my butt. Whitney and Alison are just very kind of relatable, very savvy, they have a wealth of knowledge. And so once a week usually I try to get to the live webinar, I guess you would call it. Each month has a different theme. So last month was about hiring and I did in fact hire one admin and then two clinicians. and I switched from the independent contractor over to the W2 model. Like in one month I was able to make tremendous progress because I was going to these things, I could ask questions, I could hear and learn from the other practice owners.

And when they had little questions, I could throw it up on the Facebook group and pretty quickly get some immediate feedback from other practice owners, as well as Whitney and Alison. So it’s been really excellent and I imagine I’m going to be a part of it for a good number of months because it’s what I need. Otherwise it can be kind of isolating being at the top and not knowing a lot of other people who are doing this kind of work.
[WHITNEY]
Yes. Well thank you for sharing all that. We love having you in the group and it’s our delight. And honestly, I look forward to our Group Practice Boss meetings. It’s one of my favorite parts of the schedule that I get to do so glad to have you a part of it.
[CATHY]
Yes, me too.
[WHITNEY]
Yes. Well, Cathy, thank you so much for coming on the show. You asked some really good questions that I think lots of us will benefit from. So thanks for taking the time to be here.
[CATHY]
Yes. Thanks for having me, Whitney. It’s good to talk to you.
[WHITNEY]
One of the things I love most about Group Practice Boss is the community that we create among practice owners. I loved hanging out with Cathy today, doing some live consulting, but it goes beyond that and we get to meet every single week in weekly webinars, through the Facebook group, and through emailing and questions that she has. So a great part of Group Practice Boss is that sense of community, but you also have two consultants, myself and Alison Pidgeon that walk alongside you as you grow and scale your group practice. So if you’re looking for some consulting in a group setting, we would love to work with you. Head on over to practiceofthepractice.com\grouppracticeboss.
[JOE]
What an awesome show. Hey, if you have not yet tried Therapy Notes, you need some help around your notes, your billing, your scheduling, and now telehealth. Telehealth has never been more important than now, and it’s totally integrated within Therapy Notes. So make sure you go over to therapynotes.com, use promo code [Joe] and you’re going to get three months for free. They give you three months free, and if you’re in another EHR, they will take all of that data and bring it over securely. Why not try it out? If you’re frustrated with your EHR or you just want something better, you’ve got to check out therapynotes.com. Use promo code [Joe] at checkout.

Thanks so much for letting me into your ears and into your brain. Have an amazing week by special. Bye .

Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.