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Joe Sanok 00:00:00  It's time to bill insurance. Did your heart just sink? Practice solutions connects mental health providers with quality insurance Billers who manage your billing process, allowing you to spend more time working with your patients. Their Billers are all in the United States with specialized experience in billing for mental health. With practice solutions on your team, you can confidently accept insurance patients knowing that you've got an expert managing claim submission, follow up eligibility and benefit checks, payment posting and denials. Need help collecting from your patients? Practice solutions has you covered there too. Whether you are collecting insurance, copays and deductibles, or private pay. They have solutions for both. Practice solutions is offering practice of the practice podcast listeners, a free consultation and 15% off the first three months of billing. Head on over to practice. That's practice. To schedule a consultation to find out which service is right for you and leave your billing worries behind. This is the practice of the Practice podcast with Joe Sam. Session number 1194. I'm Joe and I'm your host.

Joe Sanok 00:01:25  And welcome to the practice of the Practice podcast. I am so excited to have you here today. We help you to build a thriving private practice you absolutely love. We cover business, we cover clinical, all sorts of things. We're covering a lot of different issues. We had our future of series and we just had so many interesting discussions. Then we covered the future of trust. Future of learning. So many just amazing researchers and people that are digging into just things that we need to know as clinicians. So I am so excited today to be digging into executive functioning. I'm with doctor Anna Levy Warren, who is the founder and chief executive officer of Organizational Tutors. With over 20 years of experience in the field of psychology, including a PhD in Clinical Psychology. Anna is a leader in the field addressing executive functioning challenges and students of all ages. As a licensed clinical psychologist, Anna has also operated a New York City based private practice since 2018, and through her work, Anna works with parents, couples and families, focusing on high conflict situations and family systems struggling with dysregulation, learning disabilities and ADHD.

Joe Sanok 00:02:36  Anna, welcome to the practice of the Practice podcast.

Dr. Anna Levy-Warren 00:02:39  Thank you so much. Thanks for having me.

Joe Sanok 00:02:41  Yeah, I'm really excited to have you here. so I feel like executive functioning gets thrown out a lot as, just like you don't have your crap together. You like, you know, I mean, in armchair psychology, it's, like, thrown around all over the time place. let's start with just some definitions. for you, when you look at executive functioning and how that affects families and kids, what working definition should we use as we jump into this conversation?

Dr. Anna Levy-Warren 00:03:12  Well, jump into some controversy because there are many different ways of defining executive functioning. But I really like the sort of CEO air traffic control of the brain. it's really an umbrella term for an interrelated set of cognitive processes. And I really like to focus on working memory, self-control and mental flexibility. So sort of the housing and retrieving, the self-regulation, self-monitoring and delayed gratification and then flexible thinking and transitions. I think that's actually the most sort of relevant and important from thinking at, at synaptic level all the way through how it manifests.

Joe Sanok 00:03:47  Yeah. Yeah. So, when you see people in, in your practice, how do like, I think let's maybe start with what are misconceptions, like what are areas that therapists or families or students that they just miss, that there's an executive functioning issue going on here?

Dr. Anna Levy-Warren 00:04:06  Well, I think one thing that's so tricky about executive functioning challenges is, first of all, you know, when somebody when you're sleep deprived, right? I don't know if you've ever been sleep deprived or you're sick or you're you're ego depleted or you're cognitively overloaded, you know, we're all going to struggle with our executive functions. So I think for some people there's an understanding of I've had a hard time a couple of times and then I, you know, come up with a system and suck it up, like, why don't you wear, you know, having so intermittently that makes sense. I have, you know, I would say I have pretty strong f and I have definitely lost my keys or misplaced my wallet when I'm in one of those spaces.

Dr. Anna Levy-Warren 00:04:43  especially, you know, when I have young children running around. But there's a different, you know, having ongoing consistency in executive functioning challenges means that it's not just about those times. It's about it's all the time. And we have different profiles for different people, so it can be trickier to pick up unless you're looking for it of sort of somebody who is chronically late. You know, you could interpret it or you could start to ask, you know, how are they time blind? Are they struggling with time management? You know, you can think they're struggling to hold on to what we talked about in the session before is that they have a you know, are they blocking it, avoiding it. Is it a defense? You know, depending what modality you're using in language. Or you could think, is there something going on in their working memory where I'm, you know, putting information out there and the way they're sending it back to me doesn't seem to really hold on to the core constructs that we want them to be holding on to.

Dr. Anna Levy-Warren 00:05:41  Right. You know, so just these are just examples of the way that stepping back and seeing over time, the way that somebody is showing up in your office, may give you indicators of a larger problem. And then that's what I would like to have a conversation about executive functioning overall.

Joe Sanok 00:06:00  Now you kind of started with that. A lot of people may not even be looking for that. if you were teaching grad school or if you were teaching, you know, a whole cohort of therapists to have better executive functioning radar. what what would you include in that in regards to what they're looking for or things that they really, could kind of have in their head? Like, okay, this is what I got to be looking for. If I'm thinking maybe executive functioning might be one of the issues here.

Dr. Anna Levy-Warren 00:06:29  It's such a good question. You know, I think it's this consistency across keeping like sort of what's important or what's unimportant. Right. So that's one of the things that I find really notable even in conversation.

Dr. Anna Levy-Warren 00:06:41  if the person in front of you is picking up on what's important versus what's leaving behind, what's unimportant, or if they can't differentiate. and sometimes that's like a little bit of a trick for me to think, What's going on? I also find that the time management piece is actually one that pops up pretty quickly. There's sort of a real challenges around changing the schedule or changing the time, which happens much more often these days, right? Like, can you change our time and trying to hold on to that information or you watch, you almost can watch the way that somebody enters their calendar space or doesn't, you know, is it overwhelming to them? Are they saying, I'm sending myself a text message and then three reminders, or do they have a system in place that in a way, to help them hold on to the information? I also find that there's a little bit of noticing around self-control, sort of can they really you know, a lot of that is actually misunderstood. Can you it's really not focusing on lots of things.

Dr. Anna Levy-Warren 00:07:40  So can they leave their phone behind during a session? Can they tuck it under and let it go? Can they not attend to other things and really focus on the things that they want to? Can they inhibit a response meaning like are they impulsively blurting out, or are you hearing about impulsive blurting out? No, these are just small examples. But I think there's a way that and I think as a clinician and I heard on another episode, someone referring to sort of like checking in with your own intuition or body like your own annoyance at something. You know, I think there's a way as a clinician, you can also or practitioner in any way, you start to feel a little bit frustrated actually, sometimes, like you start to notice that there's this way that something isn't working and you can feel it in your body even before necessarily all the little things pop up. But that's kind of what I look for, is like something isn't coming together the way that I would expect it to.

Joe Sanok 00:08:35  Yeah. And I know that you have a ton of tools.

Joe Sanok 00:08:38  what are some tools that you'd say are like your go to like what's your, your hammer and your like your wrench. Like what are the tools that like just apply to almost every person in executive function, maybe even every human. And then we don't. We? We don't have to. I'm sure you have plenty of ninja tools. You're throwing stars. But, But, like, what are your, like, go to tools? And maybe there aren't. Maybe it's it's, you know, depends on the person or the family, but like, are there go to tools that for you. Most people with executive functioning issues are going to get some kind of relief or, you know, some guidance from those tools.

Dr. Anna Levy-Warren 00:09:17  Yeah. I mean, it's a great question. What I would say is I often get asked, you know, like which is your favorite. And that's the one that I won't answer because it really is dependent on each individual. But there are some broad strokes. You know, I could give, hours and hours of talks even though no one wants to hear them on the calendar.

Dr. Anna Levy-Warren 00:09:34  I think that a relationship with your calendar is one of the most crucial tools that everyone should have at this point, and the reason I call it a relationship is that it is a way that, as in families, that we can work on this with, individuals we can work on this in our own relationships with our clients. We can work on this. What is the relationship you have with your calendar? Does it feel good to know the beginning, middle, and end of your day? We should all have anchors in our day. We should all have a way that we are seeing and reflecting on our days, our weeks, our months, and our years and having some way of integrating that into our practice and into our lives and into our clients lives. I think is the most important thing. And I really get, really get into it, which anyone will tell you. It's like, what? What color feels like appointments to you. You know, I use red because I will never miss my appointments if they're in red.

Dr. Anna Levy-Warren 00:10:31  What are my social interactions like? Are they yellow? Do they make me happy? You know what's the. I really want a relationship to be built with? The tool that's going to help you know, what you have to do and when you have to do it and to help. And there's so many little things in the calendar that I could get into, but I think that's the most important one. And then my second one would be a recognition that some people don't internalize time. And so using visual timers like time timers or egg clocks, you know, in the kitchen that those really help kids and adults who can't see time, can't feel time in their body because then they can visually see it counting down.

Joe Sanok 00:11:12  Yeah. Like for myself I know that I tend to get really absorbed in whatever I'm doing. so it could be unloading the dishwasher, it could be doing a podcast, it could be doing email. the I, I wouldn't say like easily drop into flow state, but I easily drop into forgetting about the rest of the world.

Joe Sanok 00:11:31  And so I probably in any given day, I bet I have 15 timers, like even I had half an hour between the last podcast and this one. my daughter's just got home, you know, they are having a snow day, and, I knew I wanted to go hang out with them for a little bit, but it's like I set a timer for five minutes before when you and I were supposed to start, because I know that I'm going to get sucked into it and then be like, oh crap, I got a podcast. And that's not the attitude. I want to come into a podcast with you. I want to feel relaxed. I want to feel grounded. So I've just realized that I have to live by timers if I'm going to allow myself to fully jump into things, because for me, the opposite is I'm constantly checking my phone for the next 25 minutes to make sure I'm not late to this podcast, and then I can't fully enter into that relationship with my daughters for the 25 minutes that I had with them.

Joe Sanok 00:12:18  whereas if I have that timer for myself, I just know I can jump right in.

Dr. Anna Levy-Warren 00:12:23  Yeah. I mean, I think you're naming that beautifully, and that's exactly right. And I think that there's the only thing that's hard about that is for some people, that requires a lot of labor of how would I know when to set my timers, right. So when do I know, when do I think about that? And there's some way that you've organized your your time and your day and some internal understanding of, I need I'm going to sink into these different spaces and I'm going to need to be reminded. And I would say that sometimes with executive functioning challenges that there's not a knowing. Of that. So that's where our jobs become. Let me help you know. Let's look at your day. What's so important? And to answer questions that feel intuitive to some people and really, really far from intuitive to others around. When do you need to leave? How much time do you need? You just said you needed five minutes before.

Dr. Anna Levy-Warren 00:13:10  You know, getting on with me. Great. Some people need 20. Some, you know. Do you need to shower? Do you need to, you know, get somewhere and commute? These questions are actually really complicated when you have executive functioning challenges. And so spending the time to organize around important things so that you don't have those misses. And no, to set the timer or the alert in your calendar become crucial. So sometimes, you know, we really miss you know, we this is what you know, as a psychologist, I'm really trained to look at sort of the underlying reason or the stress or strain or worry around some, you know, something that a person is missing and I want to think about that. And I also want to hold in mind that I'm giving them the tools that they need to prepare for something like an interview, including when do you need to set a timer to shower? When do you need to set a timer to leave? When do you need to set a timer to relax into what you're doing? You know, so these are the these are the things that we're thinking about all the time.

Joe Sanok 00:14:09  Yeah. Now what are some other tools that you found. tend to be go tos. I know you said you got kind of these two, but other, some other ones that you have as go to tools.

Dr. Anna Levy-Warren 00:14:20  I mean, some of these are very customized, but the there's also just a, some simplicity to making things really big. I know that sounds silly, but visual spatial challenges, you know, reading multi-step directions is really hard. And so if you think about school, how many times you have multi-step directions, also how many times do you give as a parent multi-step directions, right. And just, you know, telling parents that you work with, you can't yell, get ready for school because that has ten different instructions packed into it, and an implication that a child, for example, would know all of those. And so being able to break them down into socks, shoes, backpack, lunch, water bottle, and then to have a visual representation of those things so that it's not just verbally communicated.

Dr. Anna Levy-Warren 00:15:06  And then go even crazier sort of in time stamp it. I consider these to be all tools we use when we're coaching kids and and parents, and trying to help people support kids with executive functioning challenges is to break things down into their component parts, to ensure there aren't multiple steps to make large visual cues that allow people to help integrate those things and internalize them on their own.

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Joe Sanok 00:16:17  Com and receive a special two month trial. Absolutely free. Again, that's therapy notes. Com and use promo code Joe on the website. If you're coming from another EHR therapy notes will also import your demographic data quick and easy at no cost, so you can get started right away. Trust me, don't waste any more of your time and try therapy notes. Just use promo code Joe at checkout. So I have two girls, ten and 13, and I'm primarily a single dad. probably 80 to 90% custody, depending on the year. and so there's a lot to juggle. and there's also, you know, hormones of the teen and tween years. There's.

Dr. Anna Levy-Warren 00:17:04  I got that, too. Yeah.

Joe Sanok 00:17:06  Oh my gosh. Okay, so amongst the parents of both sets of these girls, there's this like, Dear God, where did the brain go? and then there's other times that they're, like, clicking along like crazy, like my daughter right now is like, I'm going to go clean my room because that makes me feel better.

Joe Sanok 00:17:22  And I'm like, oh, there she is. but it's like, so when you think about, like teens, you know, we want to teach them executive functioning. We want to make sure that, like, they have solid just ways that they operate in the world to make it easier on themselves now and in the future. And there's a lot going on in their brains right now. How do you think through teens and families and things that probably every family should do. And then when is it like you probably need some extra coaching here. You need some extra help, whether it's coaching or counseling. yeah. Like where's that break point when you're working with teens and tweens?

Dr. Anna Levy-Warren 00:17:56  I mean, with teens and tweens, right? You're right. There's so much going on developmentally and there's so much change happening. Right? So you really want to you want to start to see them becoming more independent. so I think when they start to fall behind their peers is one thing I really pay attention to. Another is, you know, sort of like when you're hearing from everybody the same thing versus your kid is having or the trouble getting to school, you know, most days is different than the one day a week that they overslept because they went out and or stayed up too late talking on the phone with their friends.

Dr. Anna Levy-Warren 00:18:27  And, you know, there's also a real for me, the dysregulation becomes really important. Are they eating and sleeping? And overall, you know, getting to school on time is a very different look than the most of the time. It's going the other direction. So I tend to look for that sort of that line where it crosses into what I would call more dysfunction. And that's across the board in terms of regulatory things and in terms of some of these routines and behaviors. I think also right, with phone use, this is one of the hugest things that comes up right now. And there's a real intersection with executive functioning here that it's there's a feeling like I can't put it down, I can't stop versus this is hard. And when I'm reminded I can do it. So if you're scaffolding and sort of helping in these ways, I've named and that really doesn't do anything, I start to worry and think that something more could come up. and then feedback, you know, in multiple environments.

Dr. Anna Levy-Warren 00:19:29  So there's trouble at school and at home in terms of organizing and staying focused makes a big difference to me. Can I throw in one extra tool that you just mentioned that popped up?

Joe Sanok 00:19:39  No you can't.

Dr. Anna Levy-Warren 00:19:40  Of course you can, right? Yes.

Dr. Anna Levy-Warren 00:19:42  So I think in this moment we're struggling. We're all with teens struggling so much with phone usage or screen usage. And one of my favorite things to recommend is getting a lock box with a timer. And instead of taking kids phones to ask them to put decide when they want to put phones away and to have family time where things are put away. So at our house, there are dinner times where we say everybody puts their phone in a lock box, and we set it for 30 minutes so that no one can access their phones. And it helps both in terms of, you know, and I think this could work for sessions with practitioners. And also advice to give that the idea is to help students especially figure out how to manage their screens, right, to to look together at their screen usage, to have them collaboratively make decisions about how to pull back screen time, and then when they go to sleep, to put it away.

Dr. Anna Levy-Warren 00:20:35  And that way we send them off into the world with their own toolbox versus just doing it for them.

Joe Sanok 00:20:40  Yeah. When my older daughter who does have a phone. first wanted one. I looked into all these different kind of agreements and talked to friends that had kids that were older. And, I decided to not have her help pay for it so that I fully owned the phone plan. Paid for the phone, all of that. then we have, like, a full contract, that kind of outlines all of it. And one of those things is, you know, at 8 p.m. that the phone gets plugged in downstairs, like her bedrooms upstairs. So it's not even, like, close to her so she doesn't have to worry about it. She can just tell her friends. My dad makes me turn it off at eight. and that we're not dealing with those sorts of things. And I think that finding those rituals, for me and for, for the family, just allows us all to just know, like, okay, like, now is the time that's totally fine for you to be on your phone.

Joe Sanok 00:21:28  You can text your friends, you can talk to your friends. You're not going to accidentally get in trouble. It just sets those expectations and like, okay, now we're we're eating or now it's bedtime. And we just don't do that in our family in the same way. Like we wear seatbelts, you know, it's just like, that's who we are. We wear seatbelts. I love hearing how other families kind of manage those things, too, because I do feel like, I mean, all of the social media and everything is just aimed to just get us addicted in and to distract us from real life things.

Dr. Anna Levy-Warren 00:21:56  Exactly. It's bottom up versus top down attention. They've done an excellent job, and I love hearing how you're managing it. That sounds great. What's you know, and what's really hard is when kids have executive functioning challenges. Some of these things don't go as well. And that's what you really need to lean in.

Joe Sanok 00:22:09  Well, I want to push into that a little bit more, into that kind of defiance or lack of seeing it like.

Joe Sanok 00:22:14  And it could be you have a child that doesn't see the problem. You have a partner that doesn't see the problem. it's probably harder and harder the further away someone gets. Like, I think about if an adult sibling or a co-parent like an ex, like, that's pretty hard to help change those people just in general, let alone just say, I think you have executive functioning. They're not going to necessarily listen to you. But those of you who do have some influence, how do you have those conversations? If they have a blind spot around just how much it's affecting the relationships and affecting maybe their ability to just feel grounded and like they have that blind spot?

Dr. Anna Levy-Warren 00:22:51  Yeah, I mean, I think it's so great to actually, you know, say from your own feelings perspective, right? You know, even as a practitioner, I've had times where I and I work with people with executive functioning challenges all day long, but sometimes they'll ask to change an appointment four times and they won't realize that they're doing that.

Dr. Anna Levy-Warren 00:23:06  And I will spend the time to say, hey, I really understand that you are struggling with fitting all of these things in, and I really want to help, and I want to be honest, that I'm feeling some frustration at the number of times we're changing our appointment, and I want to work together to figure out how we change this. So I do tend to start and lead with my own experience so that it's not saying you're doing something wrong. Maybe somebody else wouldn't care, but it really does impact me. And to kind of walk through then very slowly and carefully sort of what happens and then what we can collaboratively do to make a change there. And this is a place where even. Even when I'm working with couples, you know, we will work together to sort of open up calendars and think, how can we do this differently? How do we set this up for success and to actually have the experience of both people so that the intentions aren't misinterpreted or there isn't strain in it, that we also can really feel at a feelings level, the impact of some of these challenges.

Dr. Anna Levy-Warren 00:24:04  And that tends to shift from the blind spot, you know, like, well, I don't think I do that. It's like, well, I really understand. Let's go ahead and see over the next week. If we look at the number of text exchanges that we're having around this kind of change and really be intentional about it, and then we can reflect on it next week.

Joe Sanok 00:24:24  Yeah. Yeah. And I think that just that feedback loop. It reminds me of a lot of what we talk about kind of in just the business side of you know one tool is the lean manufacturing which like Toyota and Honda started off plan do check adjust that. It's like, yeah, if we're on different pages here, let's plan this out. Here's how I see it. Here's how you see it. We're going to do we're going to just like let this play out. We're going to check in and then we're going to adjust accordingly. to me, I think that that's just like a model that we could use with all of this.

Joe Sanok 00:24:53  one area is that you've you've grown both counseling and coaching, and I think sometimes, for therapists and psychologists and people that are licensed, there's this kind of like an arms length for using the word coaching. There's also sometimes, a fear of offering both clinical like licensed work and coaching out of fear that, like, your state board is going to come after you for something. talk to me about the the decision to to do some of the tutoring and how you did that, how you managed it, how you see them being different and how you see them overlapping. yeah. Let's just dig into that.

Dr. Anna Levy-Warren 00:25:35  Yeah, that's a great.

Dr. Anna Levy-Warren 00:25:36  it's definitely something.

Dr. Anna Levy-Warren 00:25:37  I spent the last ten minutes talking and thinking about. So.

Dr. Anna Levy-Warren 00:25:42  You know, I started doing this because I was doing complex like neuro psych assessments. And then it was like, who's going to implement the findings of these assessments? And sometimes, you know, that have complex learning needs. And, you know, building an academic self is something I like to think about.

Dr. Anna Levy-Warren 00:25:56  You know, your feelings about yourself as a student or as a professional. And then, you know, there's all. And one of the main ways I talk about the difference between coaching and therapy is like as a therapist, I'm often looking at the underlying reason or exploring or wanting to think about how are we going to directly change this behavior together. I'm not often looking to try to close down the experience someone is having in these spaces, so if they're struggling with the calendar, I'm not going to say, you know, well, then you should put this away and like, focus on this direct goal. I'm often trying to get underneath it. And with I think that that's that's why it's often so great to work with the therapist, I'll say. It sounds like you're having some, you know, avoidance about this or some anxiety about this. This is a great time to bring that to therapy as an executive functioning coach. And when I'm doing coaching, I'm saying very specifically, you know, we need to change this behavior and we need to contain the feelings that you're having around it.

Dr. Anna Levy-Warren 00:26:51  So it's very results oriented. I'm also very directive. You know, I'm saying this is what I think we should do. This is, you know, I'm constantly educating and trying to be very intentional about that. Do I think there are ways that practitioners can do both? Yes. But I think there's a loss on both sides because you're you're you are in the moments that I've had to do that, I'm sometimes saying let's explore the anxiety and then also saying, but now we have to stop and move on and do this other directed goal. I don't think the experience on the other side is as lovely, and I've gotten feedback that it's not. So I, you know, at this point, because clinical psychologists can coach, right? You know, in many practitioners who are licensed can coach, but coaches cannot do therapy if that's the only skill that that, you know, that's the only degree that they have or coaching the background that they have. So there's a lot of intentionality around being very clear about what we're doing and why we're doing it, and really making sure that there are clear goals for both sides.

Dr. Anna Levy-Warren 00:27:50  And depending on working with different, you know, clients what their needs are. And then it's really sort of spelling that out and making sure that you're sticking to those goals. Also after every single session with the coaching client. I write up the things that we did and send it to them, and I'm often in touch in a much more direct way, like, did you do this? You know, what? Can we how are we handling this situation? We're kind of live texting. Where in therapy there. The boundaries and the containment is very different. I don't love the term. You know, I've struggled to use coaching and tutoring. That's always been complicated for me as a licensed psychologist. So I'm just extremely clear and often work with clients to figure out language that feels good to them in terms of what we're doing.

Joe Sanok 00:28:34  Yeah. How does your marketing look different between your clinical practice and the tutoring?

Dr. Anna Levy-Warren 00:28:39  I wish I had any good marketing to share, but it's my least favorite thing. my, you know, the as a psychologist, I don't mark it at all, actually.

Dr. Anna Levy-Warren 00:28:48  But I have a clinical website and I'm on, you know, Psychology Today, and I get usually word of mouth referrals. and as a coaching practice, I will say all over organizational tutors and still advising, which is our adult version of the same coaching. You know, we are coaches. We are not doing licensed clinical practice. You can not submit to insurance. This is going to be we are picking an amount of time that we are doing this work in this way. And if we have, you know, concerns about your psychiatric well-being, wellness, that we are going to refer you to a practitioner. So and we have really out there super clear talk to the lawyers. They are super clear. Everything's in writing.

Joe Sanok 00:29:32  That's awesome. Well Anna, 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?

Dr. Anna Levy-Warren 00:29:39  I think I would really want them to, you know, go back to something I was saying earlier. I really want them to think about the relationship that their clients have with their scheduling devices.

Dr. Anna Levy-Warren 00:29:50  I know that sounds funny, but you know, our relationship that we have with our calendars, even with our phones, something that I think is really underexplored. And to think about the feelings that come up when we look at these things and the ways that we experience other people's calendar invites these days, or phone calls confirming activities. I think there's a lot of work to be done that we could all be really thinking more intentionally about in terms of those dynamics.

Joe Sanok 00:30:22  So if people want to connect with you, if they want to follow your work, if they want to make referrals, where should we send them?

Dr. Anna Levy-Warren 00:30:27  Thanks for asking organizational tutors or advising.

Joe Sanok 00:30:33  So awesome. Thank you so much for being on the show.

Dr. Anna Levy-Warren 00:30:35  Thank you for having me.

Joe Sanok 00:30:44  You know, there's one part that Anna said that I want to just kind of underline and highlight. She said she was doing neuropsychiatric evaluations and didn't have someone to refer to for the implementation. so often we think that we need to wait for someone else to create something that we think is good for the world.

Joe Sanok 00:31:05  you know, no matter what type of work you're doing, there's probably something that you could create that would go beyond just your clinical practice. We've we've often in our membership communities talk about the sandwich approach. If the middle of the sandwich is the therapy, your core product, like what's the bread on each side? Or if you're gluten free, you know, the gluten free crackers on each side? so what what is something that before someone comes to therapy that would help them? It could be an e-course, it could be a podcast, it could be a retreat. Maybe you help couples that are struggling and you've got something for folks earlier in their relationship. And then the other side, the other side of the bread is what are things that you could offer afterwards, you know, what's that ongoing support look like? It might be, you know, an ongoing group for people that have graduated from therapy. They don't need to have that that level of group. But you meet once a month or, you create some sort of retreat model or a course or other things, maybe some type of coaching.

Joe Sanok 00:32:04  We want to be thinking about creating the thing that we wish was in the world. Does that mean you have to create everything? Of course not. but there's lots of opportunities there. And you have a front row seat to see what your clients actually are asking for. we have something that we often talk about with audience Building Academy, and that's the three key process that, you know, when you have an audience to ask them first, like, what's that pain look like for them? So, you for Anna, that pain was they didn't know how to develop their executive functioning in their kids. and there wasn't anyone really to refer to. next is the product. what would be a product that would help address that pain? And then having conversations with our ideal clients as to what the price would be. and so going through that process, then your clients are the ones that are saying, you know, here's what I want. and so it may start with that. You're offering coaching, coaching or tutoring, and then it may turn into courses, or it may turn into live mastermind groups or other things, but then your actual audience is the one that's telling you where they want to go next.

Joe Sanok 00:33:06  So implement that. If you need any help. come join us in our membership communities. Over a practice of the practice, you'll see all the information about our memberships. right there in the dropdown under memberships. We have several different tracks for every single phase of practice. Whether you are just getting going, maybe you have a sustainable solo practice. You're starting a group, growing a group, or building an audience. We have a community for you within that membership. You know, we also couldn't do this show without amazing sponsors like Therapy notes. Therapy notes is the best electronic health records out there. They will help you switch over from your current EHR. they also give you two months for free or just money off if you use promo code Joe at checkout. they are phenomenal. They help with automated billing. it's going to make it easier to outsource your billing. So many reasons to switch to therapy. Now, let's just head on over to therapy notes. Com read about it and at checkout. Just use promo code.

Joe Sanok 00:34:00  Joe. 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, and this podcast is designed to 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.