[JOE SANOK]
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This is the Practice of the Practice podcast with Joe Sanok, session number 688.

I’m Joe Sanok, your host and welcome to the Practice of the Practice podcast. I am so glad that you’re hanging out with us today. We help with all sorts of things that have to do with private practice. We talk about marketing, we talk about billing, insurance or going private pay. We talk about your websites. We talk with lots of people outside of the field of counseling as well to just learn from the world because people are doing really interesting things outside of the world of private practice inside the world. There are disruptors everywhere.

I’m so excited today to have this conversation with Marc and Christine from Resilience Lab, because they’re really at the forefront of thinking through how do we do private practice in a different way? How do we think through negotiating with insurance companies differently? How do we expand, grow and help more people and to do that in a way that can be replicated, in a way that can really go beyond maybe the scope of what a typical solo entrepreneur could do on their own before and in a lot of ways, it’s in a positive way disruptive. So I’m so excited to have a conversation with Marc and Christine from Resilience Lab. Welcome to the Practice of the Practice podcast. I’m so glad that the two of you are joining me today.
[CHRISTINE CARVILLE]
Hi Joe. Thank you so much for having us.
[JOE]
Yes, Christine really glad you’re here.
[MARC GOLDBERG]
Joe, great to be here.
[JOE]
Marc, I’m so glad you’re here too. Well let’s start with resilience and we’ll get into what it is. I always love hearing the origin story of new ideas, new businesses, and Marc, before we got going you’re giving me some bullet points of your story and some of it starts with Burning Man. Tell me about that.
[MARC]
So here is the true story. Seven years ago, some friend of us invited me to Burning Man. I arrived in my RV with my friend. I got out of my RV and lo and behold, I met Christine who was parked next to our car. That was seven years ago and he was the beginning of a friendship and the beginning of a long ongoing discussion on what we could do together. It morphed and gave births to the idea of trying to change private practice in the US.
[JOE]
I’ve never been to Burning Man, but I’ve always been intrigued. What would you say to someone that is considering, is in the pre contemplation stage of Burning Man?
[CHRISTINE]
It’s all about the camp. You have to find your people.
[JOE]
That’s what I’ve heard. How do you find your camp and find your people?
[CHRISTINE]
Wow. That’s oh, it’s not just about that week. They’re out doing things in the world trying to make it a better place and so they tend to gravitate towards each other, different interest groups, different change makers. In New York City, for instance, there’s just lots of meetups and ways to meet different camps and different people.
[JOE]
Wow, so interesting. What types of camps are there? I know there’s probably a bazillion, but what are some of them that you have been connected to?
[CHRISTINE]
Well, ours particularly is a camp around looking to solve greater societal issues, so people who are working on different science fields and ways to make the future just a better place for all of us. So that was our camp. Then there’s art focus camps, or dance focus camps, different philosophies, all different types of people.
[JOE]
Wow. Well, so after the two of you met at Burning Man, how did things flow from there? What did you grow? What did you do after that?
[CHRISTINE]
Well, I had been working in behavioral health. I’d been running a program for the city of New York for people with schizophrenia and bipolar disorder. So I was bringing some of the issues that I was wrestling with and grappling with about just not integrating technology into the space, not utilizing and going for the innovations that could be brought into treatment and helping improve people’s lives. I brought those discussions to the people at the camp and Marc was one of those people. We were talking about, and he’s from France, I don’t know if you can hear it, but he just was incredulous about how broken our healthcare system is and how fragmented and particularly behavioral health just sort of relegated to the side of healthcare and not even integrated fully and just couldn’t wrap his head around why that would be the case, especially from his background as a technologist and software builder. So we started talking about how to fix this and how to do something about it.
[JOE]
Marc, when you’re having that conversation and the months afterwards from the tech brains point of view, where was your brain going? What were you thinking about, oh, we could do this or this. Especially, I love that outsider perspective. That’s something that in Thursday is the New Friday is such a superpower when people have that. As someone coming from France and having a different way of viewing healthcare and systems, maybe how did all of that combine with what Christine was saying?
[MARC]
So I embark in this discussion with the usual naiveté of the entrepreneur, which is, of course there must be a better way to do this. Of course, everything is a software problem. If only we could streamline the flow of information from the questions, I need some help, I’m looking for a clinician, how do I find that person to, how do I afford that? How do I understand my insurance? I thought, well, it’s pretty easy. That has been done in many other industries. So let’s build a system that’s going to streamline and make, that’s going to remove the friction so that you can find the right clinician, the clinician can be paid a decent amount, we can create a partnership between the clinician and the insurance company, and it’s not us versus them. And let’s test that in New York and let’s start building it.

It’s not that we had a magical idea on how to make things better or north store was, we’re going to be value driven. We’re going to be clinical centric and we going to build a fairly large innovation environment until we understand what we’re doing. Two years after we do understand what we’re doing is we’re creating an environment where a community of clinicians can collaborate to produce better outcome and to improve access. It seems very obvious. It seems very simple. It’s actually horribly complicated. In the last two years, I shift from the perspective of it’s great to come from the outside, because then you see things to the perspective of the reason you have to be in the inside is that this is very complicated for a whole host of reason, legal among one of them. So we build this team, but the perspective from the outside was let’s change private practice in the US. How do we make private practice a team sport so that it’s not a lonely activity where not only you have to find your client, but they have to take care of them and then you have to manage to get paid? Let’s enable collaboration.
[CHRISTINE]
From my history too, at that point I had had alongside my agency program director role, a very successful private practice for 10 years. I attribute that because I have also had a business background. So this was a change of career for me. It was a no brainer to be able to set up a successful private practice in addition to managing another program. But that’s not the case for most people. You don’t come into the field being a therapist with a lot of the business skills. A lot of times you have to hire consultants or just really learn so much from the ground up.

So that’s another barrier that I was finding for so many of my colleagues. We thought that doesn’t have to be, and I could do workshops or I could consult, or I could teach people, or I do teach people as well. But that’s a classroom of people or it’s one on one. So how can we create a system where people are getting this training on the job in the role, providing the care, getting paid and learning these skills that really needed to be learned?
[JOE]
So when you first had this vision, maybe the first six months to a year what were the things that you were sorting through? How did you figure out where to put your time, energy, financial resources to build out these things because it’s one thing to see a problem and to say, I want to help address that. It’s a whole nother thing to build out a business that could potentially really in a positive way, disrupt the market and create systems, create technologies, create all these workflows. What did the first six to 12 months look like for the two of you? Why don’t we start with Marc?
[MARC]
So I think it all started from Christine intuition that the people that were graduating from her class at Columbia could be trusted to provide great care to clients once they were licensed, not fully licensed, but could be supervised in that we could create a supervisory environment that would support them if we trusted them. So the first experimentation was we built what’s called a pod, which is a group of five supervisee that Christine was supervising.

We started to build a company around this. This was pod number one that was in Soho and it started to work. The client came and once pod number one was up and running, we found a second supervisor and we build pod number two and then pod number three. We have 22 pods as we’re speaking. So we iterate it around the basic intuition that if you trust people and if you create a great environment for them to work, good things happen for their client.
[JOE]
So 22 pods, five in each. So we’re talking over a hundred clinicians?
[MARC]
Yep, 120.
[JOE]
Wow. So I’m interested, even just in a human management side, I mean, I was a foster care supervisor, have done mid-level management. I absolutely hated it. Like, that just wasn’t for me. How do you keep track of all those clinicians? How do you train those supervisors? Does it feel like it’s pretty automated or does it feel like hurting cats, sometimes?
[CHRISTINE]
That’s a great question. I mean, it’s about building a community and we’re going to keep the organic metaphors going. These pods are proliferating and they’re sort of self-guided and self-contained, and then we create a larger organism around that and a larger community around that. So we are community-driven, community sustained and organized. And that’s the advantage of being professionals, all professionals. So there is a code of ethics that everybody needs to follow, but given their professions, we also have licensed mental health counselors in addition to social workers and clinical psychologists. So everybody’s practicing independently. Then we have our community guidelines and our community values that we use to speak to each other and to manage our own decision making. So we sort of leave it in that realm.
[MARC]
But Joe you’re right, it’s horribly complicated. It is hurting cats. There is this very subtle balance between norms, value, community, which is people running around and doing what they want. Infrastructure, so we can manage scale. We are iterating day after day. I think the reason nobody’s doing that is that it’s very complicated. There’s a lot of people building the Uber for therapy. One, it does not provide the right care. Two, it doesn’t pay people the right way. Three, it’s really not interesting. Here we are building a community at scale. We have 120 people and the question we’re wrestling with is how do we organically evolve and iterate to a thousand people because in other professions like law or management consulting or investment banking or other that has been done very successfully. How do you create a platform where the best in your industry are interested to join? How do you train them? How do you develop them? How do you accelerate their growths?
[JOE]
So now that you’re at 120 clinicians, I know you’re expanding into other states, that seems like another level of complexity, whether it’s licensure or negotiating with insurances. How did you decide to, I mean, because I think when businesses are successful or growing like this, there’s always that push and pull between, wow, this is amazing what we’ve created. We could just sustain this. It’s fulfilling our time and economic freedoms we want. We could just call it good and not expand or we can see what we really could do. It may be a ton more work. It may fail. It may be that we’ve scaled too much. How did the two of you decide, okay, we’re not going to just stay at 120. We might hit a thousand or 2000 or 5,000. We want to really disrupt the whole industry. How did that conversation go regarding no, let’s keep going?
[CHRISTINE]
Well, I’ll start with this because for me it’s always been about just creating an alternative delivery system for care and accessibility, both jobs for a field that I’m passionate about and I want to make more attractive so that more people come into the field to become therapists and then also accessibility for the clients. So I had a really comfy lifestyle and a really great private practice. This vision is what sort of drove the development to scale. So I use access and impact as my north star. Marc describes it as scale. But really it’s what gets us up in the morning, is to know that we’ve made a difference on a significant level.
[MARC]
And Joe, the question that you’re asking is a question that we are asking ourself and struggling with on an ongoing basis, I would say less and less as we’re growing. A practice of one is perfectly, okay. A practice of 10 is wonderful, a practice of 20 is complicated and how much growth at what speed and what are you trying to do? I’m coming at it from the software industry and the investment community, which are my two past lives. So in those industries, one, there is an addiction to size and there is the belief that with size comes the ability to create infrastructure.

So what if we could create a world where the environment that you work in could tell you who in your team or the best in that diagnostics, the best in that modality, where you have outcome-based care tools so you can understand in what circumstances what work? What if we could assist you the clinician with the collective intelligence? That’s very exciting because that changes the rule of the game and changes the industry. That’s one of the vision that we have, and that’s why we get up in the morning. So we are trying to solve a gigantic national problem. We’re very, very, very small but the pain of growing is worth taking because of the problem we’re trying to solve.
[JOE]
I feel like it’s a new category of private practice that is going to take some extra education for people because you’ve got individual solo practices, you’ve got group practices, maybe there’s franchises of practices that people buy into and then there’s clinics. But this feels like it’s a category, like all its own. Take us through for Resilience Lab, how would you describe this new category of private practice?
[CHRISTINE]
Marc, this is yours.
[MARC]
So what is new, we want to have the best of both world. We want the clinician to have autonomy. They decide who they work with, they decide which client they take, they decide how they want to focus. They take clinical decision. They are fully accountable of their clinical care. We want to automate and enable anything which is nonclinical and anything, which is nonclinical should come from this clinical dial tone, this technology infrastructure that we’re building, which the clinician can turn on. So it’s a community, it’s a network, a decentralized network of practitioner. They can be a sole practitioner. They can be group of 10 or 20, but they’re all working on the same infrastructure and what the infrastructure does is deliver collective intelligence and collaboration. We are not, it’s not interesting to build a backend for a world where you have hundred couches of one.

Because the clinician in the couch of one metaphor is still lonely, is still struggling to learn and is still alone in front of their client. We want to enable team collaboration at scale so you have peer review, so you have focus group, so you know that if you want to start deploying EMDR with one of your client, you can access the top EMDR practitioner in the country. So we are creating this decentralized organization where people have full clinical accountability and we take care of all the rest.

All the rest involved learning. So for example, we went live last week with the Resilient Institute, which is our online teaching institution. We are going to deliver CE. That’s where we onboard and train our people. So they all speak the same language. We have the Resilience Lab Methodology, which has been evolved and crafted in the last two year and a half that creates this common language so they can collaborate. Collaboration is the north star here.
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[JOE]
Christine, I feel like Marc did a really good job of macro big picture what Resilience Lab is. I would love for you to maybe walk me through what’s the individual experience for a clinician. So someone that is coming out of grad school, someone that is licensed, someone that is in New York, what’s their experience of, they join Resilience Lab, then what happens? Walk us through maybe that first six months or a year,
[CHRISTINE]
So that has been until last month the one experience. So somebody coming in, pre-licensed maybe right after graduating or within those first three years, and then last month we introduced a whole partner clinician option, but for this first clinician, so the interview process is fairly extensive. We’re not looking for experience of interventions or the bells and whistles of providing therapy. What we’re looking for is curiosity, and somebody who usually tells us what I love about this profession is lifelong learning. So we then have an onboarding process that lasts about 12 weeks, where you have a cohort, a peer cohort from week to week that you work with, and you’re taught how to build the right profile. You’re taught speaking about yourself online, making sure that you are, when the client Googles you, what they find and how you’re speaking to your ideal client.

We give you the basics of the first few sessions and transitioning from week 12 onward, selecting your treatment, planning, the rest of your team, who might need to be added to your treatment team, how to work with your supervisor, how to choose your supervisor. So that’s another aspect of the onboarding process that people usually find really refreshing; is we take matchmaking of clinician to supervisor, as importantly as we do matchmaking between client and therapists. So we have a number of different lenses and modalities and professions that you can work with as a supervisor.

Then there’s the foundations of the Institute that you get over the course of that first year, which is outcome measurement, personalizing your treatment, doing a really thorough assessment and evaluation, measuring and connecting with the therapeutic alliance, how to know that you’re the right match for this client. Just all of these sort of business questions that often don’t get brought in a private practice setting where you don’t have to work with every client that comes your way, that there’s, it’s not about keeping and retaining a client because you don’t know how to find the next one. It’s about making sure that you’re establishing that relationship and understanding who you work best with right at the very beginning.

Because there will always be another client to come in and work with and there’s a whole team of other people that client might work better in. So you’re sort of getting this education and comfortability with your own voice as a therapist. We’re realizing that it’s going to take some time that it usually takes between three and four months for people to access that comfortability in that voice. There’s somebody there, there are, a whole team of mentors and peers that you’ll bounce your ideas about imposter syndrome off of and get recommendations.

And we have a whole community and spaces for you to connect with within the community, whether that’s clinicians of color processing group, or it’s just the peer across pod supervision. There’s group supervision on a biweekly basis within your pod. There’s individual supervision on a biweekly basis with your supervisor. So there’s lots of touch points to process your doubts and fears and also to share your knowledge, because we also realize that everybody’s coming in with so many life experiences and other trainings and things that they’ve participated in. So we very much all learn from each other, whether you’re a supervisor that’s been working in the industry for 20, 30 years, or you’re two months out of school. So that’s pretty much the environment that we try to foster.
[JOE]
Who would you say joining Resilience Lab is for and who maybe they’re past it or wouldn’t get something out of joining Resilience Lab. I mean, would it be people mostly that are fresh out of school or that are a supervisor that want to expand? Who’s the ideal person to talk with you or be able to explore potentially joining this growing movement?
[CHRISTINE]
So yes, until last month it was for the person either right out of school, or maybe you’ve been in a nonprofit or a clinic role for a year and you’re saying, okay, I definitely want to deepen my long term therapy skills and work with that sort of environment where I’m going to be deepening my therapeutic skills. Or there was the opportunity for the supervisor or the clinical director, which is somebody who’d been in private practice for many years and seeing 20, 30 patients clients a week and saying, huh, I’ve gleaned so much from my work, but now how do I give back? I can’t just hire and be paid as a supervisor. The states usually don’t allow for that structure. So how can I be that mentor?

We provide that environment that is legal for you to be a supervisor and five, six hours a week you are meeting individually and providing group supervision for your pod. Then last month we introduced the partner clinician option, which is for a fully licensed clinician therapist who had been thinking, do I want to start my own therapy practice, or do I want to join a group practice? What we are hoping is that, you know what Marc was talking about that tension between the independence and the autonomy is very attractive, but then you also have the group support.

You have your own pod of peers that you join and get that consultation accessibility. You have the option to also be a supervisor at that point, too. So you can be a partner clinician and a supervisor. There’s all sorts of tracks, but we definitely have now the community and the draw for anybody who’s independently practicing to come in and start your practice through us and be able to maintain that clinical autonomy while gaining the access to the community as well.
[JOE]
It’s so amazing. I think there’s a whole category of people that this will serve. I think about a lot of the people that were 1099 contractors or W2 is that they didn’t necessarily want to do all the infrastructure building or getting all the contracts with insurance or all those different things that they would’ve loved to do something like this. Then there’s probably some people that are highly motivated entrepreneurs that are already doing their own thing. Maybe this maybe being a supervisor might be a fit, but not being one of the partner clinicians. So I think it’s great that you’re offering this whole new category for people that maybe in the past just were stuck in potential employee positions or things like that.

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? Christine, why don’t we start with you?
[CHRISTINE]
Well, hands down. I’ve had several careers before this one and a hands down, this is the best field in the world. I never want to retire and anybody who’s listening, if you’ve chosen to become a therapist, it is absolutely a fantastic career.
[JOE]
Marc, what about you? If every practitioner were listening in the world, what would you want them to know?
[MARC]
That this industry hasn’t changed a lot in the last 200 years. It’s been fundamentally two human meeting in a room and one trying to support the other within their process. We are trying, we are building a movement to change this industry. So change is possible in this industry to reinvent what private practice and what therapy is all about. It doesn’t have to be your parent therapy. It can be different.
[JOE]
So great. So I know that you’re specifically looking for clinicians in New York, Connecticut, and New Jersey right now. If people are interested in talking to you more about that, potentially becoming a supervisor, exploring whether or not doing this with Resilience Lab is something they want to do, what’s the best place for them to go for more information?
[MARC]
If you go to resiliencelab.us, you will have everything that you can find about us. Resilience Lab/career/the name of your state, New York, NG, CT. You will have the information about everything that’s happening in that state. If you have any question, you can always email me, Marc with a C @resiliencelab.us.
[JOE]
Perfect. So again, those URLs are resiliencelab.us/careers/NY or slash CT or slash NJ. So resiliencelab.us/careers/those three state shortcuts. Thank you so much both of you for being on the Practice of the Practice podcast today.
[MARC]
Joe, thank you. It’s been a pleasure.
[CHRISTINE]
Thanks.
[JOE]
I don’t know about you, but I love hearing how people think through problems and don’t just buy into the way it’s always been done. To say, this is what I see, this is what, are some problems I see to just be having a conversation at Burning Man and then to say we’re going to do something about this. We’re going to try it. We’re going to give it a whirl for six months or a year and then they start adding pods and pods after pods, and now expanding to three states.

It’s so inspiring to just personally think about what are the problems I see in the world and what can I do about it but also to know there’s these new categories that are popping up that serve more clinicians and they then in turn serve more people. We do not have enough mental health access in the United States, and this is one of those ways that it’s addressing that problem. I’m just so excited what Resilience Lab is doing. Hopefully you go check them out, read a bottom, and hopefully you’ve been inspired by what they’re working on.

Also, we love Noble. Our friends over at Noble have some really exciting news to share. Their goal is to help mental health professionals serve more people in less time, support a worthy cause and earn passive income. They’re on a mission to add 50,000 mental health professionals to their platform over the next few months. If you join Noble right now, you’ll be able to continue using Noble accounts for free forever. Recently I just set up my own Noble account. I’m no longer practicing clinically, but to see the roadmaps and different things that they have within Noble, so many amazing supports for your clients and for you. You can sign up for free over at www.noble.health/joe. Again, that’s www.noble.health/joe.

Thank you so much for letting me into your ears and into your brain. Tomorrow’s episode is with number one, wall Street Journal bestselling author, Dave Jennings. He’s sharing how he saved Intel 12 million in one conversation. Actually it’s pretty amazing because he talks about a lot of the skills that we have as clinicians that are super applicable to gigantic big consulting contracts. He walks through exactly how you get those contracts, how you think through things. I mean, it just was a mind blowing conversation. So make sure you tune into that, that is going to be tomorrow.

Then we have a bonus episode where Alison Pidgeon is going to be talking all about how do you design an office that really matches what clients want and matches your own style? So we’ve got some really great episodes coming up here. Thanks 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 your intro music. We really like it. 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.