Episode 192 | Dealing with Therapist Burnout with Kelly + Miranda from Zynnyme

Hey, everyone. Welcome to another episode of the group practice exchange podcast. This week, I have Kelly and Miranda from Zynnyme on, and we’re going to be chatting about therapists, burnout, and bows for the employer, us and our employees. It’s a very timely and relevant topic right now. How you guys, how are you?

Good. Thanks for having us. We’re really excited to be here and very excited to be talking about burnout. It’s always been a part of our profession. But you add on the stressors and that are happening right now in a global pandemic and just more demand than we’ve seen in our lifetime for mental health care.

And it just really exacerbates what we’re already issues. Yeah. I’m seeing so much of it being discussed in my circle of group practice owners, not only from the perspective of the group practice owners, but even more so with wanting to know how they can better support their employees. Who are facing a high amount of burnout because of, like you said, this such a higher need and just not.

Therapists out there to support the need and therapists really going through a lot of the things that the clients that they’re working with are going through. And so it’s this constant dialogue with group practice owners around, what other new thing can I do to support or help reduce burnout?

And I feel like it’s an issue. Group practice owners haven’t yet seem to be able to figure out how to snap away. Yeah. Cause I think it’s not like a new, magical thing. It’s not an app to download. It’s not a mantra. It’s not a team building exercise. I think it goes back to the core of what really should have been a part of the initial interview, where you talk with someone and you said, Hey.

What does like life and working in my practice sound like what would really work for you? What is your hourly schedule look like? And really getting clarity of are we aligned? And then as they started onboarding, usually with people that are burned out, you see somehow if you were to think back to when you first met them, you look and you go, oh, This person said they wanted to work this many hours, they’re working 30 or 50 or a hundred percent more than that.

This person said they didn’t want to work before this time or after this time. And now there’s schedules all over the place. This person said that these were the type of clients that they really want to work with. That really inspired them. But that doesn’t seem to be the bulk of their caseload and or that doesn’t seem to be inspiring them anymore.

And so I think like at the very least that the very minimal place to reconnect with your employee. And I think this also applies to the employer as well, but to reconnect and say, Hey, a lot of things have changed the last three years. What would an ideal day look like? What would an ideal job look like to you?

Like what would the ideal caseload look like to you? Let’s get back to, let’s put all this other BS aside and let’s reconnect and maybe it’s exactly what they said when they came in for their initial interview. And maybe it’s different, with kids at home or all these things have changed, but let’s figure that out and just start aligning with some of the day-to-day.

You make it really good. Something that practice owners aren’t looking at, or at least the group practices they’re coming up with. I’ll give them one mental health day. It’s oh, that’s not going to succeed. I will like host an outing and it’s like an outings. That’s not going to help either. Or one literal thing.

And as if that will wash away the burnout, no, one’s acknowledging that our capacity has changed the capacity of the owner, the capacity of the employee. And then I have heard. It come up of like the demand’s so high. I need to take it while I can. And okay. Maybe for the first month or two of the pandemic, but because of the long haul of what’s going on in our world, that’s not sustainable.

As group practice owners, it’s important that you set the framework and the culture for how people approach their work and what is acceptable, what is a norm? And if we come at it from a I don’t want to say cash grab, but hey, we’ve got to do it, or I’m motivated by guilt because no one else will see these people.

So I have to, that is not good for clinical outcomes. Yes. It may lie in your pocket bank in the short term, but it’s going to come at the expense of people’s health and wellbeing and that’s not worth it. So does that mean caseload sizes need to go down? Schedules need to be shifted. Fees need to go up to accommodate all of those shifts.

So you don’t feel it so much. Then that’s what you’ve got to look at that people think like stuffing the sausage, the case can only hold so much. Like I don’t need another yoga class to attend. Think about ourselves. I’m more easily overstimulated in public places because I’m not used to being in the miss much traveling though, while I do it, it used to be energizing.

It’s now more depleting because of all the stuff like everything takes more so asking for more is not the answer. But instead recalibrating, I think that’s such a good point. And one of the dilemmas that some group practice owners are facing, and it’s something I myself had been thinking about too, especially for those who have salaried employees, is how to balance reduction of caseload when salaries are based on.

That expectation, maybe pre pandemic and the likelihood of those employees not wanting a reduction in salary to accommodate maybe this new need to see less clients. And I think that’s something that a lot of practice owners who are in that, because it’s much easier to do that if you are paying someone hourly or whatnot than it is for salary.

And I think that’s where the point, I think. You brought up of even offering flexibility in how they do their work, their timeframes, working from home, being maybe less rigid about, when and how they’re doing their work and where they’re doing their work and who they’re doing their work with.

Can all be great ways to. Help reduce that burnout. And then also maybe letting go of some of these non client facing things that, like staff meetings and things like that are keeping people on zoom for one to two hours every single week. I think you bring up a really important point, which is, and Kelly touched on it is what is the financial piece and picture.

And so when we have the salaried employees, and again, it could be for your employees that it’s more. Maybe they’re working even more than what their productivity requires, even just saying, no, it’s not okay for you to do more than your productivity because when you have a salaried employee oh, this is great.

They’re so productive. Let me praise it. When I worked for a nonprofit, I remember one of my supervisors saying we will absolutely respect. Your boundaries and your need for self care and life balance, but we will reward your lack there enough as a group practice owner, are you rewarding behaviors that actually impact burnout and.

That person leaves. They decide they’re going to go off on practice or their own. They’re going to go to some other place they’re going to leave. And then you’re going to be in this place of oh, this is so frustrating. Everybody leaves. I don’t understand. They were my top performer. And in some cases there’s some other icky stuff with group practice owners of oh my God, like I filled up their practice and they just took everything away.

And, but again, it comes back to that person going oh my gosh, this isn’t sustainable. How do I make an adjustment? And then they do their own math and pull away. But going back to the math of, for the group practice owner, sometimes we have to say no to insurance contracts that they’re, we’re seeing some of them dropping rates right now during the pandemic, as they’re profiting way in 2021.

It’s not like they’re struggling financially. So maybe we need to do that. Maybe we have a higher percentage of private pay clients. And again, maybe we do have private pay. Maybe we do up the overall fee just to make sure that people are really well taken care of. I think sometimes if it was the issue of your rents went up, if the rent just went up and your space, and that was the only way you would adjust your business plan for that rent, if the cost of. Taking good care of your employees in the midst of a gold pandemic, whether that’s benefits or lowering their hours. And it may not be as much as drastic as you think. If that’s what it costs them.

We have to do the math and we need to create something that’s sustainable. Yeah. That goes to the point of. As a group practice diversifying how you have income coming in your group practice. And one of the things that I personally look at, so we recently implemented unlimited time off policy for all of our salaried folks, as a way to encourage.

Because there’s salary they’ll get paid no matter how much time off they take. And it’s been really nice to see people not feel stressed. If you’re hourly or commission, you obviously need to save that money yourself so that when you take off, you can have. Enough money to pay your bills. During that time off and making that shift to salary for me was a way to help my employees be able to safely be able to take off and not have to worry that income isn’t going to come in for them.

And then implementing this unlimited time off and really being like, you want to take four months off out of the year, you can do it, without, and it totally encouraged them to take more time off because. Before, when they were commissioned in Illinois, in California, that’s not allowed, but in Illinois it was, I saw people taking two weeks off out of the year because they either didn’t have the strategies to be able to save throughout the year, or weren’t able to, for whatever reason, simple things like that, shifting to salary model, which I get is much higher risk for a group practice owner.

But it’s been really nice. Yeah. Has given staff the ability to take as much time off as they need while still having some yearly metric to ensure that they’re actually bringing in at least enough income to cover that. Yeah. Beautiful. I love it. Yeah. Yeah. Shifting over to the practice owners, because I think there’s a little bit of a different sort of burnout because a lot of practice owners aren’t seeing clients anymore.

We were practice owners. A lot of them aren’t, it’s like a different sort of burnout because it’s not the. I am working with the type of clients who are going through similar types of things as me, but there’s just the burnout of businesses needing to pivot different types of decisions that are needing to be made amount of demand versus the amount of.

Hires that are available to meet that demand and all of that fun stuff. I feel like there’s, it’s a different sort of pressure that business owners are facing to keep up and feel like they’re able to recruit the right type of therapists, especially in this market. And there’s a lot of burnout and people pleasing.

And it’s an interesting thing, right? When we talk about. When is it enough? Yes. Something I think we all have to talk about as business owners. I always tell my group practice owners, you’re always hiring. You really are in that always that mindset of hiring, but in terms of growth and projections and wanting to repeat last year’s revenue and all of that, that all comes from you.

So you get to decide what you’re going to recalibrate internally within yourself. Is it okay if it was just to hold and have a repeat of a year, do you have to grow it assessed? Are there things that are now what you could do easily before would be better to be outsourced and that you need more support on your team?

Because I do see some of more group practice owners bringing in more clinical supervisors because there is still that clinical piece that can come up that the group practice owner gets involved with. That now they’re seeing, Hey, if I had something with a caseload that was providing the clinical supervision, I could alleviate myself of that.

But I think there is this interesting question that people don’t spend enough time thinking about of what is my enough point. And we can always do more in our expenses will always expand to the amount that we make. Like I’ve lived that I’ve lived on very small salary in my past, and my expenses fit into that. And as things grow, so what is really important to you, of the growth at what cost to yourself and how do you mitigate that cost with support outsourcing those kinds of things. But do we have to grow as fast as we’re putting pressure on ourselves to do? Yeah, I think that’s a good point.

And I think that’s the million dollar question for group practice owner. Especially now for a variety of reasons, one being the supply issue or the demand is. And secondly, with all of these Facebook groups and ways to connect with other people that are doing similar things, as you, what is there’s always people doing more or faster, faster, but then.

The behind the scenes. Yes. Crumbling. I think it really is this interesting, like you’re saying that million dollar question of yeah. What is the meaning of it all to you and the girls and what kind of value do you put on it, defining you or whatever? I think. There’s some ego work of detaching, some more there too, that needs to be done for micro-practice owners.

The first thing is oh my gosh, if I could make this kind of profit without a caseload. And that would be amazing. Okay. If I could have this many hours, but at a certain point, it starts to get that ego driven. Oh, what are we going to seven figures? Or what if it was then fill in the blank, whatever this is, but I think always coming back to, and it’s okay to dream big.

It’s okay. Sometimes we need those stretch goals just to get out of our own way, because we are definitely taught to think very small as clinicians. And I think that’s a beautiful. But also what do I want my life to look like? Not just, I want a seven figure business, but I want a seven figure business where I, as the business owner could take unlimited time off that I could take four months off per year and it would be okay.

I want to create a business that’s sustainable. That at some point I could sell it to another amazing person who would want to run the day to day more, that I can have things so outsource that I could take care of my mother with cancer, and I wouldn’t have to go into the office and yeah, maybe my profits would go down, but I would still have a sustainable income, like to create something that really.

Live past us that if we, at any age drop dead tomorrow that we had a sustainable business that could still provide income for our family and for our legacy. Like I have a child, I would like there to be a business that still did something after that. In addition to being prepared. So I think there’s some other pieces it’s.

What does that stretch goal? What does that vision? But we just cannot forget that quality of life piece. And I think this is the part that has really been stood up for a lot of people in the pandemic is that when we are in times of stress, it brings up our old coping strategies. It brings up our old trauma profiles.

It brings up how our families deal with traumas, all of these things. So I went from, oh my gosh, I’m a super bad. Outdoing after yoga doing yoga a couple of days during my lunch break, everything’s in flow kind of person to working 65 hours a week. Overnight when the pandemic started and I didn’t notice it.

I didn’t even notice it, like when I sat back and was like, oh, wait, I got on the computer at this. And I’ve been there from this time to this time for this many days, I’m working on the Saturday and the Sunday oh my gosh, but that is the old Miranda. And I think for a lot of group practice owners, they haven’t stopped and paused and said, wait, is this me?

And my grounded say. Whole healed place or have I been in a space that is part of old staff? I it’s another layer for me to work on. I also find that in many ways, when we slow down or step back, our businesses seem to thrive more in a lot of us, stop messing with it. Like I wonder how many of us are breaking our backs over the business right now, when.

Taking that break could actually allow it to flourish in a way that we weren’t expecting. And even if not, even if it just stayed steady. You still are able to have that time to really go back inward and not be all in the business and everyone who’s done it. Everyone who’s delegated a thing where they, that faulty thinking if I’m doing it, then I’m not paying someone else.

Even though your time is worth money sort of thing. Like every time someone has said, I finally hired a person to answer the phones, or I finally hired a billing company, so I don’t have to do it anymore. They’ve all said, it’s. I can’t even think of a time. I’m sure it’s happened, but it’s so rare that group practice owners say within a month or two, they’re like, I it’s already paying for itself.

Yeah. And so similarly with the self care and really being able to potentially take a chunk of time off, or really cut your hours down so that you’re not bending over backwards constantly and using all of your hours to do business stuff, it’s very likely that. Things are not going to dramatically change.

We have a lot of group practice owners that are now taking sabbatical. Long, intentional time off. We’re not talking about just vacation. We’re talking about growth oriented time away, and the business has to run without them. And it’s a really great Testament to the groundwork they’ve put in. And I think sometimes we don’t ever give our business a chance to breathe and release.

That foundation is there. I had a question for you about this whole supply issue. Cause I’m hearing it too, there’s no good candidates, all this kind of stuff, but you know what I have a prediction and I’m curious what you think that a lot of people have jumped into the private practice game, but they’ve never really wanted to be private practice owners and that they’re ours and that things are trying to shift this year.

I’ve already started seeing it. It’s not just an automatic, the phone will ring that. Now, if you haven’t had marketing and in place, it’s starting to show a little bit densely. Some of those people are going to come back to, I just want to work in a practice. I think there’s an evolution in a cycle having been consulting for this long that yeah, there is a supply issue and then a demand and then it comes back around.

I completely agree. I think one thing. Has done is made it easier for people to just start their own thing remotely without having really any expenses at all. And I think it was a great thing because it allowed people to get out of harmful workplaces and really be able to. Stay at home with our kids, if they needed to not go back into an office, if that office was going into soon.

But I agree with you that there are a portion of those people that are meant to have their own business and it just like jumps started at, but there’s also a portion of people who were able to go solo remotely without much effort. And we’ll realize that before. Struggles of growing a business as the clients potentially want to start going back and office, and they’ll have to decide if they wanna, market a remote or a tele-health business or get a brick and mortar and the cost related to that.

And. And I do think that there’s going to be a portion of people that maybe it was either a temporary thing that they were going to do until it just didn’t work for them or a group of people who thought it was much easier than it really is to have your own business. And it would shift back in. I think that’s part of the whole burnout aspect is you have to play a long time.

Yep. And so holding that in mind that there’s economics at play here and that it’s not yes, there’s a supply issue right now that is going to shift again and it will, and it’s having that business foundation. Hey, it’s not always about doubling your growth every year. Sometimes it’s about sustaining and sometimes, it’s going to shift again.

It will change again. And so the longer you’ve been in business, the more you get adapt to just the wave of it all, instead of being freaked out at another waves coming, I think that just comes with time. And that burnout, I think, is rooted in some of that capitalistic kind of hustle culture of oh grow.

And so seeing the bigger picture of Hey, this is going to shift again. And that might have the foundation for that adaptability. Sorry, Miranda. No, it’s okay. I was thinking this client in particular and they had done all their numbers. They knew where that was, what they could pay people, what they needed to charge all the different pieces.

And then they literally had people that were doing contract positions, some numbers that didn’t quite match up that were calling. And like grabbing people, like kind of head hunting, calling officers. And they ended up for various reasons. People laugh. They’re people that were crying in the office saying, oh my gosh, it’s an amazing place to work with.

I’m just like ready for this next thing. And they were sitting there thinking. Oh, my gosh, I have no employees like overnight. I don’t know what to do. And what about this place? They’re paying this much as a contractor. I know that this person doesn’t understand what’s going to be happening with tax time, but I can’t compete with that.

And we just kept saying, look, you have to know your value. You have to know your numbers and sit with it and really market this practice and know that the right people are going to get. Three people out of nowhere in six weeks, they’re all, I think there’s two slots left, last week, able to hire, attract the people at the right pay who wanted the work that they’re doing understood the benefits of a W2 employment opportunity that understood what they were going to be getting.

But when they were looking out to all these other things, Like it was so easy to convince yourself to shift something. Even when the math doesn’t make sense, even when you know that it’s not workable. I think there are a lot of group practice owners that are out there who are making decisions based on comparison without running.

And I think a lot of things are gonna happen right now. As people are looking at their profitability, just based on their taxes and they’re going to go, wait, I grew my stuff by 30%, my profits went down by 10%. What happened? I doubled the amount of work that I did, and I’m less profitable in 2021 than I wasn’t 2020.

And you could blame that on the economy, but it’s not it’s that you need poor decisions and you didn’t do your financial model. And do the math, you made it emotionally based decision. Yep. I want to end with what is a thing that you guys are each doing to help with burnout just personally, because you guys are business owners and people very famous in the world of therapy and for people

infamous, what do you guys do that helps with. I’ll say my thing is delegating. I think really I don’t do much in my group practice anymore for various reasons, because I have a few other businesses. My amount of time that I can commit to any of my businesses is just not as high. And yeah, my group practice is a very well-oiled leadership high there’s.

I think we have eight or nine people in leadership who we all from our anti-racism values, no one person makes a decision, including myself in the. Alone. And it’s a collaborative decision-making and it’s also helped me be able to step back and not be the most important thing. I think for me, it’s really been reconnecting with who I know myself to be prepared.

Dimmick getting back into weekly dinner nights at my house and getting outside every afternoon and getting out into the being. There was so much about it. Lockdowns and all of that kind of threw me into a lot of trauma state. And so really reconnecting at just a very base level of what are these non-negotiable things that I need in my life that bring me joy and connection.

And when I take care of those things, then a lot of other things fall into. I got my Reiki master level training this past year. And so a lot of embodiment work and Miranda naive and we’ll meditate before we make decisions. We go on a lot of walks now, a lot more we’ve been training for like trail runs and things like that.

And Reiki is really helped me. I have good intuition. I have a good internal compass and I lost sense of that over the past two years. So getting back into that has helped me immensely. That’s awesome. Yeah I really appreciate having you two on the podcast, I believe way later than I should have ever had you on.

And I apologize for that, but it was so nice having you on and thank you for taking time out a year. I know very busy schedule. I appreciate it. I know my audience will appreciate. Where can people find you if they don’t know who you are? I can’t imagine anyone listening is going to be like,

so I guess out at a me.com Z Y N Y M as in Mary e.com. We’re steam ever. And if you just click on free, we’ve got great lines. Free training. Some of the CES, we’ve got trainings on demand. We’re going to be doing a training soon. That’s all about group practice, finances, and how to run those numbers. What are the numbers you should know?

Yeah. That we see people getting really stuck with. So we got some support for you guys. Thank you. And a good rest of your day. Thanks for listening to the group practice exchange podcast. Like what. Give us five stars on whatever platform you’re listening from. Need extra support. Join the exchange, a membership community just for group practice owners with monthly office hours, live webinars and a library of trainings.

Ready for you to dive into visit www. members.the grouppracticeexchange.com forward slash exchange. See you next week.